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. 2021 Feb 11;16(2):e0246902.
doi: 10.1371/journal.pone.0246902. eCollection 2021.

Histological outcomes in HPV-screened elderly women in Denmark

Gry St-Martin  1 , Petra Hall Viborg  2 , Ane Birgitte Telén Andersen  2 , Berit Andersen  3   4 , Jette Christensen  5 , Dorthe Ejersbo  6 , Hanne Nørgaard Heje  7 , Kirsten Marie Jochumsen  8 , Tonje Johansen  9 , Lise Grupe Larsen  10 , Elsebeth Lynge  1   11 , Reza Rafiolsadat Serizawa  12 , Marianne Waldstrøm  6   13
Affiliations

Histological outcomes in HPV-screened elderly women in Denmark

Gry St-Martin et al. PLoS One. .

Abstract

Introduction: Danish women exit cervical cancer screening at age 65 years, but 23% of cervical cancer cases occur beyond this age. In addition, due to gradual implementation of cervical cancer screening, older women are underscreened by today´s standards. A one-time screening with HPV test was therefore offered to Danish women born before 1948.

Methods: Register based study reporting histology diagnoses and conizations in women found HPV positive in the one-time screening. Number and proportion of women with severe or non-severe histology results were calculated for screened and HPV-positive women by age group or region of residence. Number of women with biopsy and/or conization per case of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) or CIN3+ were also calculated by age groups and region.

Results: 4,479 (4.1% of screened women) had positive HPV test. 94% of these had one or more additional tests. 2,785 (62%) of HPV-positive women had histology results, and conization was performed in 1,076 (24% of HPV-positive and 1% of all screened women). HPV positivity and CIN3+ detection varied little between regions, but the proportions of HPV positive women undergoing histology varied between regions from 40% to 86% and the proportion with conization from 13% to 36%. Correspondingly, the number of histologies and conizations per CIN3+ detected varied from 5.9 to 11.2 and 1.8 to 4.7, respectively. In total, 514 CIN2+ (0.47% of screened women, 11% of HPV-positive) and 337 CIN3+ (0.31% of screened women, 7.5% of HPV-positive) were diagnosed, including 37 cervical cancer cases.

Discussion: HPV screening of insufficiently screened birth cohorts can potentially prevent morbidity and mortality from cervical cancer but longer follow-up is needed to see if cancer incidence declines in the screened women in the coming years. Management strategies differed among regions which influenced the proportions undergoing biopsy/conization.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: Dr. Andersen reports non-financial support from Roche and Axlab, outside the submitted work Dr. Lynge reports non-financial support from Roche for other studies, during the conduct of this study. The remaining authors have no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Proportions of women who were HPV positive, had histology performed, had CIN3+, or underwent conization, by birth year, compared to national average.
Fig 2
Fig 2. Regional proportions of women who were HPV positive, had histology performed, had CIN3+, or underwent conization, compared to national average.
See this image and copyright information in PMC

References

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