Organization of cervical cancer screening with DNA–HPV testing impact on early–stage cancer detection: a population–based demonstration study in a Brazilian city

Abstract

Summary: Background: Cervical cancer is a preventable disease, and the Brazilian screening is opportunistic and has low impact. The current study evaluated an initiative to organize screening using DNA–HPV testing as a replacement for cytology. Methods: This demonstration study examined information from 16 384 DNA–HPV tests for screening in women aged 25–64 years from Indaiatuba city between October 2017–March 2020. The comparison was 20 284 women screened using cytology between October 2014–March 2017. The flowchart indicates the repetition of a negative test in five years. HPV16- and/or HPV18-positive tests and the 12 pooled high–risk HPV-positive tests with abnormal liquid–based cytology were referred for colposcopy. If cytology was negative, the HPV test was repeated in 12 months. The analyses evaluated coverage, age–group compliance, and cancer detected. Findings: After 30 months, the coverage projection was greater than 80%. The age compliance for the HPV test was 99.25%, compared to 78.0% in the cytology program. The HPV test program showed 86.8% negative tests and 6.3% colposcopy referrals, with 78% colposcopies performed. The HPV testing program detected 21 women with cervical cancer with a mean age of 39.6 years, and 67% of cancers were early–stage compared to 12 cervical cancer cases detected by cytological screening (p=0.0284) with a mean age of 49.3 years (p=0.0158), and one case of early–stage (p=0.0014). Interpretation: Organizing cervical cancer screening using DNA–HPV testing demonstrated high coverage and age compliance in a real–life scenario, and it had an immediate impact on cervical cancer detection at an early–stage. Funding: University of Campinas, Indaiatuba City, and Roche Diagnostics.

Keywords

• cervical cancer
• Papillomavirus infections
• public health
• cancer screening
• Pap smear, DNA-HPV test