Divergent Effects of Switching from Cytology to HPV-based Screening in the Nordic Countries

Overview

Journal Eur J Public Health

Publisher Oxford University Press

Specialty Public Health

Date 2024 Jan 23

PMID 38261374

Authors

Veli-Matti Partanen

Joakim Dillner

Ameli Trope

Agust Ingi Agustsson

Stefan Lonnberg

Sirpa Heinavaara

Ahti Anttila

Affiliations

Soon will be listed here.

Abstract

Background: Cervical cytology has been the primary method of cervical cancer screening for decades. Tests that detect viral HPV are shown in several randomized trials to provide better protection against cancer compared with cytology. HPV-based screening has been implemented alongside cytology in the Nordic countries for several years. The aim of this study was to compare cytology and HPV-based screening in the colposcopy referrals and detection rates of cervical lesions.

Methods: Individual-level screening data from Finland, Iceland, Norway and Sweden were harmonized and aggregated locally. We utilized data for tests taken during years 2015-17 and biopsies taken during years 2015-19 to allow 24 months of follow-up. Age-standardized estimates and age-adjusted risk ratios for six different outcomes of screening management were calculated.

Results: The age-standardized colposcopy rates were higher in HPV-based testing compared with cytology in Finland (3.5% vs. 0.9%) and Norway (6.0% vs. 4.1%) but lower in Sweden (3.7% vs. 4.9%). The relative detection rate of cervical intraepithelial neoplasia grade 2 and above in HPV-based testing compared with cytology was highest in Finland (RR 2.37, 95% CI 2.13-2.63) and Norway (RR 1.66, 95% CI 1.57-1.72) while in Sweden the difference was not statistically significant (RR 0.98, 95% CI 0.95-1.00).

Conclusions: The effects of implementing HPV screening varied by country as different screening algorithms were implemented. HPV-based screening increases colposcopy rates mainly through referrals from increased repeat testing and detection rate is therefore significantly higher compared with cytology. Monitoring of these indicators in subsequent rounds of HPV-based screening remains essential.

Citing Articles

Impact of HPV Catch-Up Vaccination on High-Grade Cervical Lesions (CIN2+) Among Women Aged 26-30 in Northern Norway.

Jorgensen A, Simonsen G, Sorbye S Vaccines (Basel). 2025; 13(1).

PMID: 39852875 PMC: 11768673. DOI: 10.3390/vaccines13010096.

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