Work

Impact of repeatedly screening negative on cervical cancer risk

Year: 2025

Type: article

Abstract: BACKGROUND: We demonstrated that cervical cancer risk following any screening result is lower if there is a known prior negative screening history vs an unknown screening history. We extended these findings to look at how screening performs following repeatedly negative screening results. METHODS: Approximately 1.7 million women aged 30-64 years underwent triennial human papillomavirus (HPV) and cytology co-testing from 2003 to 2021. We modeled 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) and invasive cervical cancer for the initial co-test, and then successive rounds following negative co-testing. A logistic-Weibull prevalence-incidence model was used to model risks. RESULTS: HPV test positivity was greater than cytology positivity for only the first co-test, and both positivity rates decreased with each screening round. Diagnostic yields of CIN3+ and cancer declined with each round of screening so the first screen yielded 8-fold more CIN3+ and invasive cancer than the fifth screen following 4 consecutive negative co-tests. Five-year risks of CIN3+ for positive and negative HPV and cytology results, individually or combined, decreased considerably after the first screen, with smaller decreases in each subsequent round. For cancer, we noticed a considerable decrease with the first screen only. Five-year CIN3+ risks were greater for positive HPV or cytology results, with a longer antecedent screening interval and younger age at screening (Ptrend < .001). CONCLUSIONS: Triennial screening that includes HPV testing becomes inefficient after a single and more so after multiple negative screens. These data support the use of longer screening intervals, especially following negative screen(s).

Source: JNCI Journal of the National Cancer Institute

DOI: 10.1093/jnci/djaf317