Primary human papillomavirus (HPV)-based cervical screening will be introduced in The Netherlands in 2016. We assessed the five-year cervical (pre)cancer risk of women with different combinations of HPV- and cytology test results. Special attention was paid to risks for cervical intraepithelial neoplasia grade 3 and 2 or more (CIN3+/2+) of HPV-positive women with a negative triage-test, since this determines the safety of a five year screenings interval for HPV-positive, triage test negative women. In addition, age-related effects were studied. 25,553 women were screened by HPV-testing and cytology in a screening-setting. Women were managed on presence of HPV and/or abnormal cytology. Five-year cumulative incidences for CIN3+/2+ were calculated. Five-year CIN3+(2+) risk was 10.0%(17.7%) among HPV-positive women. When stratified by cytology, the CIN3+(CIN2+) risk was 7.9%(12.9%) for women with normal cytology and 22.2%(45.3%) for women with equivocal or mildly abnormal (i.e. BMD) cytology. For HPV-negative women the five-year CIN3+(2+) risk was 0.09%(0.21%). Additional triage of HPV-positive women with normal cytology by repeat-cytology at 12 months showed a five-year CIN3+(2+) risk of 4.1%(7.0%). HPV-non16/18-positive women with normal cytology at baseline had comparable risks of 3.5%(7.9%). HPV-non 16/18-positive women with normal baseline cytology and normal repeat-cytology had a five-year CIN3+ risk of 0.42%. No age-related effects were detected. In conclusion, HPV-positive women with normal cytology and a negative triage test, either repeat-cytology after 12 months or baseline HPV 16/18 genotyping, develop a non-negligible CIN3+ risk over five years. Therefore, extension of the screening interval over five years only seems possible for HPV-screen negative women.
- Received November 12, 2014.
- Revision received February 4, 2015.
- Accepted February 12, 2015.
- Copyright © 2015, American Association for Cancer Research.