Long-Term Worries after Colposcopy: Which Women Are at Increased Risk?

Sharp, Linda; Cotton, Seonaidh; Cruickshank, Margaret; Gray, Nicola M.; Rothnie, Kieran J; Thornton, Alison J.; Walker, Leslie G.; Little, Julian

doi:10.1016/j.whi.2015.04.002

Cited by 12 publications

(14 citation statements)

References 40 publications

(48 reference statements)

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“…A drawback of HPV testing, however, is that most HPV infections are transient, 1 and therefore HPV‐based screening has lower specificity 2 and may increase colposcopy referrals compared with cytology‐based screening 7,8 . Unnecessary colposcopies should be avoided because they can be associated with psychosocial and physical discomfort 9,10 and may ultimately lead to overtreatment of regressive cervical intraepithelial neoplasia (CIN) 11 …”

Section: Introductionmentioning

confidence: 99%

Benefits and potential harms of human papillomavirus (HPV)‐based cervical cancer screening: A real‐world comparison of HPV testing versus cytology

Thomsen

Kjær

Munk

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Human papillomavirus (HPV) testing as the primary cervical cancer screening method is implemented in several countries. We report data from the first round of a large Danish pilot implementation of HPV‐based screening. Our aim was to compare colposcopy referrals, detection of high‐grade cervical intraepithelial neoplasia (CIN) and cervical cancer, and positive predictive value (PPV) of colposcopy referral in HPV vs cytology‐based screening. Material and methods From May 2017 to October 2018, women aged 30‐59 years attending cervical cancer screening in the uptake area of the Department of Pathology, Vejle Hospital, Region of Southern Denmark were screened by primary HPV testing (n = 16 067) or primary cytology (n = 23 981) depending on municipality of residence. In the HPV group, women with HPV16/18, or other high‐risk HPV types and abnormal cytology, were referred to immediate colposcopy. Women with other high‐risk HPV types and normal cytology were invited for repeat screening with HPV test and cytology after 12 months. From a nationwide pathology register, we obtained information on screening results and subsequent histological diagnoses during up to 2.9 years after the first screen. PPVs included diagnoses within 1 year after referral. Results In the HPV group, 3.7% were referred to immediate colposcopy and 2.8% were referred at the 12‐month repeat screening. The total referral to colposcopy was higher in the HPV (6.6%) than cytology group (2.1%) (age‐adjusted relative referral = 3.05, 95% confidence interval [CI] 2.75‐3.38). The detection of CIN3+ was higher in the HPV (1.5%) than the cytology group (0.8%) (age‐adjusted relative detection = 1.88, 95% CI 1.56‐2.28). The probability of CIN3+ among women referred to colposcopy (= PPV) was lower in the HPV (21.1%; 95% CI 18.7%‐23.7%) than the cytology group (34.6%; 95% CI 30.7%‐38.9%). In the HPV group, the PPV was lower among women referred at repeat screening (12.1%) than among women referred immediately (27.8%). Conclusions Compared with cytology‐based screening, HPV‐based screening provided a 90% increased CIN3+ detection at the cost of a threefold increase in colposcopy referrals, when considering complete data from the prevalence round. Our findings support implementation of HPV‐based screening in Denmark, but modifications of screening algorithms may be warranted to decrease unnecessary colposcopy referrals.

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Section: Introductionmentioning

confidence: 99%

Benefits and potential harms of human papillomavirus (HPV)‐based cervical cancer screening: A real‐world comparison of HPV testing versus cytology

Thomsen

Kjær

Munk

et al. 2021

Acta Obstet Gynecol Scand

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“…For women, both undergoing either a colposcopy or repeated testing is distressing. 27 , 28 , 29 Previous cytology‐based studies have found that when given the choice between a direct colposcopy and surveillance, a majority of women prefer the former, even in case of mild abnormalities. 30 This was confirmed in a study of older Danish women undergoing HPV testing, where women seemed tolerant toward direct treatment instead of surveillance, even if that means over‐treatment.…”

Section: Discussionmentioning

confidence: 99%

Adherence to follow‐up after the exit cervical cancer screening test at age 60–64: A nationwide register‐based study

et al. 2021

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Background: In Denmark, human papillomavirus (HPV) testing has replaced cytology in primary cervical cancer screening for women aged 60-64; at this age, women are invited for the last (exit) screening test within the national organized program. Aim:We investigated the adherence of these women to the recommended follow-up after a non-negative (positive or inadequate) HPV test and the overall resource use during that follow-up. Materials & Methods:We included all 2926 women aged 60-64 years with nonnegative HPV screening tests between March 2012 and December 2016. All relevant follow-up tests and procedures were retrieved until the end of 2020 from the highly complete Danish administrative health registers, and the data were linked at the individual level. We determined the extent to which the adherence patterns followed the national recommendations for follow-up and estimated the total numbers of tests and diagnostic procedures utilized during the entire process. Results:In total, only 26% of women had follow-up in accordance with the recommendations; 4% had no follow-up, 46% had insufficient follow-up, and 24% had more follow-up than recommended. We estimated that 17% of women remained in follow-up for longer than 4 years. The average numbers of diagnostic tests and procedures used after positive HPV screening were higher than expected, even among women who had insufficient follow-up, that is, those who received less invasive procedures than recommended, or experienced delays in receiving those procedures. Conclusion:To conclude, we found that the patterns of follow-up of women with nonnegative primary HPV screening tests at 60-64 often diverged from the recommendations. Addressing these inconsistencies in follow-up by providing evidence for optimal clinical management should help improve the quality of

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“…It is important to note that colposcopy is not a cervical cancer screening tool, but it is an essential test for clarifying abnormal Pap test results (16) .…”

Section: Discussionmentioning

confidence: 99%

Tracking of cellular atypes of the cut of uterus of women in Primary Care

2020

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Objectives: to analyze the screening for cervical cell atypias in women assisted in Primary Care. Methods: quantitative, retrospective and cross-sectional study, with analysis of 190 medical records of women who had atypical results from the cervical cytopathological exam collection from 2012 to 2014. Results: the most frequent atypias found were possibly Non-neoplastic squamous (ASC-US, 57.4%) and Low-grade intraepithelial lesion (LSIL, 23.2%). The time elapsed between the exam and the result was 24 days. The professional’s conduct after the result of the last cervical cytopathology was adequate for 51.1% of women. Conclusions: there is a need to improve the cervical cancer screening program and correctly target the atypia identified, aiming at the access of the target population for the diagnostic investigation and treatment of precursor lesions of cervical cancer.

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Long-Term Worries after Colposcopy: Which Women Are at Increased Risk?

Cited by 12 publications

References 40 publications

Benefits and potential harms of human papillomavirus (HPV)‐based cervical cancer screening: A real‐world comparison of HPV testing versus cytology

Benefits and potential harms of human papillomavirus (HPV)‐based cervical cancer screening: A real‐world comparison of HPV testing versus cytology

Adherence to follow‐up after the exit cervical cancer screening test at age 60–64: A nationwide register‐based study

Tracking of cellular atypes of the cut of uterus of women in Primary Care

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