The screening interval for cervical cancer should be extended to 5 years instead of 3 years for women who test negative for human papillomavirus (HPV), suggests a new study of 1.3 million women from the UK.¹

Data from the NHS Cervical Screening Programme in England was analyzed by researchers from the NHS, King’s College London and the University of Manchester to find out the association between a negative HPV test on primary cervical screening and the risk of later cervical intraepithelial neoplasia (CIN) (Grade ≥3) or cervical cancer. A total of 1,341,584 women from the first two rounds of screening (2013-16, follow-up to end of 2019) were included.

Results showed that participants, aged 50 years of younger, who tested negative for HPV in the first round of screening were at significantly lower risk of detection of CIN3+ after the second round compared to cytology with 1.21 in 1000 testing positive for CIN3+ after a negative HPV screen versus 4.52 in 1000 people after a negative screening cytology (adjusted odds ratio 0.26). Similarly, the risk of interval cervical cancer was also lower (1.31 per 100,000 versus 2.90 per 100,000 woman years, adjusted hazard ratio 0.44). Women who had initially tested positive for HPV but without cytological abnormalities but tested negative for HPV on early recall visit were more likely to have CIN3+ at the time of second routine recall visit compared to women who were initially HPV negative (5.39 per 1000 versus 1.21 per 1000 women screened, aOR 3.27).

The odds of new onset CIN3+ in the second round of screening five years after a negative HPV test was 0.57 per 1000 women screened, in women older than 50 years compared to the risk in three years in women <50 years, which was 1.21 per 1000 women screened (aOR 0.46).

Based on these findings, the authors recommend that for women aged 25-49 years, the screening interval should be increased to 5 years after a negative HPV screen. This interval can be further prolonged in women aged 50 years and older. However, for women who test positive for HPV initially but subsequently test negative at early recall, the screening interval should be shorter, at 3 years.

FOGSI recommends screening to start at age 25 (age 30 years in resource-constrained settings) with cytology or primary HPV testing  and Co-testing (HPV test + cytology) at 30 years. Primary HPV Testing or co-testing should be repeated every 5 years and cytology every 3 years (every 5 years in resource-limited settings). For women aged 65, screening can be stopped if they have had negative tests all through the previous 15 years. Women aged 65, with no prior screening tests, should be tested at 65 years and if they test negative then no further screening required.²

Reference

1. Rebolj M, et al; HPV pilot steering group. Extension of cervical screening intervals with primary human papillomavirus testing: observational study of English screening pilot data. BMJ. 2022 May 31;377:e068776. doi: 10.1136/bmj-2021-068776.
2. FOGSI GCPR on Screening and Treatment of Preinvasive Lesions of Cervix & HPV vaccination. https://isccp.in/wp-content/uploads/2018/06/FOGSI-GCPR-on-screening-and-vaccination-for-prevention-of-carcinoma-cervix.pdf.