HPV screening, invasive cervical cancer and screening policy in Australia

Brian Cox; Mary Jane Sneyd

doi:10.1016/j.jasc.2018.07.003

HPV screening, invasive cervical cancer and screening policy in Australia

J Am Soc Cytopathol. 2018 Nov-Dec;7(6):292-299. doi: 10.1016/j.jasc.2018.07.003. Epub 2018 Jul 19.

Authors

Brian Cox¹, Mary Jane Sneyd²

Affiliations

¹ Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: brian.cox@otago.ac.nz.
² Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

PMID: 31043298
DOI: 10.1016/j.jasc.2018.07.003

Abstract

Introduction: The new cervical screening policy in Australia replaces 2-yearly cytology with 5-yearly human papillomavirus (HPV) screening. However, 2 of 5 randomized trials that have reported the number of women with cervical cancer found the incidence rate of invasive cervical cancer during follow-up to be higher for HPV compared with cytology screening. Therefore, we have estimated the possible impact of the new policy on cervical cancer incidence in Australia.

Materials and methods: Available estimates of the relative protection from cytology screening, estimates of the coverage of the 2-yearly cytology screening policy of the Australian national cervical screening program, and estimates of screening test sensitivity were used to estimate the change in the incidence of cervical cancer from the introduction of the new policy.

Results: HPV screening 5-yearly was predicted to increase the annual incidence of cervical cancer in women screened to 121% (95% CI: 73%-169%) of current incidence after 10 years. The overall incidence of cervical cancer in Australia was predicted to increase by 39.2% (95% CI: 34.0%-44.4%) with an additional 222 women developing cervical cancer each year after 10 years.

Conclusions: Measures of the screening sensitivity of HPV testing and cervical cytology suggest the introduction of 5-yearly HPV primary screening may increase the incidence cervical cancer in Australia.

Keywords: Cervical cancer; HPV; Incidence; Screening; Sensitivity.