Transition from opportunistic cytological to organized screening program with DNA-HPV testing detected prevalent cervical cancers 10 years in advance

Abstract

Cervical cancer screening in Brazil is opportunistic, based on cytology and offered for women aged 25-64 years, with low coverage (30%) and 70% of cancer diagnoses done in advanced stages, without impact on mortality. The current study reports 5-year first-round results of a population-based DNA-HPV testing screening program in a Brazilian city, which intended to be a model for transition to a more efficient program. Program flowchart is simple and current, indicating repetition of a negative test after five years. The first-round (October 2017-September 2022) screened 20,551 women by DNA-HPV testing with 58.7% coverage and 99.4% compliance with the program's targeted age range. Coverage increases to 77.8% when excluding the 'pandemic period'. The DNA-HPV testing was 87.2% negative with 6.2% colposcopy referrals and 84.8% colposcopies performed. A total of 258 high-grade precursor lesions and 29 cervical cancers (mean age = 41.4 years, 83% Stage I) were detected. As a reference, 41,387 cytology tests from the previous program (2012-2016) detected 36 cervical cancers (mean age = 52.0 years, p = 0.0005), with 67% in advanced stages (p < 0.0001). Organizing cervical cancer screening using DNA-HPV testing demonstrated good coverage, high age and colposcopy compliance, and detection of more precancerous lesions and cervical cancers 10 years in advance.

Fig. 1

Cumulative number of HPV screening tests performed in the first round (60 months) of the program (bars; total tests = 20,551), including the COVID-19 pandemic period. Population considered: 35,000 women using the public health system aged 25–64 years from the official 2020 population estimate^,. The first-round coverage was 58.7% (20,551/35,000). For reference, lines represent the projected cumulative population coverage for 5 years: 80% coverage (orange line) and 100% coverage (green line). The monthly mean of number HPV tests performed during the COVID-19 pandemic waves in Brazil were 33 tests/month in April-September 2020, 92 tests/month in December 2020-July 2021, and 158 tests/month in January-March 2022). Six months before and after the pandemic, the average tests/month was 396 (November 2019-February 2020) and 320 (April-September 2022). Excluding 17 months related to the ‘pandemic waves period’, the coverage increased to 77.8% (19,144/24,817).