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. 2025 Oct 3.
doi: 10.1038/s41416-025-03193-0. Online ahead of print.

Short-term repeat HPV testing for triaging HPV-positive women in cervical cancer screening

Armando Baena  1   2 , Maria Alejandra Picconi  3 , Laura Mendoza  4 , Annabelle Ferrera  5 , David Mesher  6 , Johana Lineros  7 , Marisol Brizuela  8 , Pamela Mongelos  4 , Yessy Cabrera  5 , Maria Dolores Fellner  3 , Osmalia Zambrana  9 , Laura García  10 , Pilar Hernández  11 , Maria Liz Bobadilla  12 , Maria Ramon  13 , Gino Venegas  14   15 , Verónica Villagra  12 , Aurelio Cruz  11 , Guillermo Rodríguez  16 , Carolina Terán  9 , Alejandro Calderón  8 , Carolina Wiesner  7 , Rolando Herrero  17   18 , Maribel Almonte  17   19 ; ESTAMPA study group
Collaborators, Affiliations

Short-term repeat HPV testing for triaging HPV-positive women in cervical cancer screening

Armando Baena et al. Br J Cancer. .

Abstract

Background: Persistent HPV infection causes cervical cancer, but most infections are transient. Triage methods identify high-risk women needing further evaluation or treatment. We assessed short-term repeat HPV testing as an alternative triage option.

Methods: In ESTAMPA, women aged 30-64 years were screened with HPV testing (HC2 or Cobas) and cytology. Screen positives were referred to colposcopy approximately two months after screening, where cervical samples were collected again for repeat HPV testing. We evaluated the performance of repeat HPV for CIN3+ among HPV-positive women and explored its combination with limited HPV genotyping (HPV16/18).

Results: Among 5390 HPV-positive women (including 629 CIN3 cases and 53 cancers), 61% retested positive at ~2 months (median: 1.8, interquartile range: 1.2-2.8). Repeat HPV sensitivity for CIN3+ was 81.5% (95% CI 77.2-85.2) for HC2 and 87.7% (83.7-90.8) for Cobas. Specificity was <50% with referral rates of 57.4% (55.7-59.0) and 68.2% (66.1-70.2) for HC2 and Cobas. HPV16/18 genotyping followed by repeat HPV among non-HPV16/18-positive women did not greatly improve performance. However, HPV16/18 positivity doubled the risk of CIN3+, supporting its combination with repeat HPV when available.

Conclusions: Short-term repeat HPV testing could be a practical option for triaging HPV-positive women, either alone or in combination with limited HPV genotyping.

Trial registration: ClinicalTrials.gov, NCT01881659.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The ESTAMPA protocol was approved by the Ethics Committee of the International Agency for Research on Cancer of the World Health Organization (IARC/WHO) (IEC Project 12–27-A7), the Pan American Health Organization (PAHO) Ethical Committee, and Ethical Committees at study centres. The study is considered of minimal risk as procedures are standard clinical practice. All women were informed by trained providers of the procedures and signed informed consent. This study is registered with ClinicalTrials.gov (NCT01881659).

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