Adherence to follow‐up after the exit cervical cancer screening test at age 60–64: A nationwide register‐based study

Abstract

Background: In Denmark, human papillomavirus (HPV) testing has replaced cytology in primary cervical cancer screening for women aged 60-64; at this age, women are invited for the last (exit) screening test within the national organized program. Aim:We investigated the adherence of these women to the recommended follow-up after a non-negative (positive or inadequate) HPV test and the overall resource use during that follow-up. Materials & Methods:We included all 2926 women aged 60-64 years with nonnegative HPV screening tests between March 2012 and December 2016. All relevant follow-up tests and procedures were retrieved until the end of 2020 from the highly complete Danish administrative health registers, and the data were linked at the individual level. We determined the extent to which the adherence patterns followed the national recommendations for follow-up and estimated the total numbers of tests and diagnostic procedures utilized during the entire process. Results:In total, only 26% of women had follow-up in accordance with the recommendations; 4% had no follow-up, 46% had insufficient follow-up, and 24% had more follow-up than recommended. We estimated that 17% of women remained in follow-up for longer than 4 years. The average numbers of diagnostic tests and procedures used after positive HPV screening were higher than expected, even among women who had insufficient follow-up, that is, those who received less invasive procedures than recommended, or experienced delays in receiving those procedures. Conclusion:To conclude, we found that the patterns of follow-up of women with nonnegative primary HPV screening tests at 60-64 often diverged from the recommendations. Addressing these inconsistencies in follow-up by providing evidence for optimal clinical management should help improve the quality of

Long-term risks of invasive cervical cancer following HPV infection: follow-up of two screening cohorts in Manchester

“…In England, one of the options proposed for primary screening is for women aged over 65 who test HPV-positive but show no abnormalities from cytology or colposcopy to exit the screening programme. In Denmark, nearly half of the women aged 60–64 did not receive adequate follow-up after a positive HPV test [ 15 ]. Our findings suggest that this is not safe.…”

Effect of Test History at Ages 50–64 on Later Cervical Cancer Risk: A Population-based Case–control Study

“…For instance, a recent study by Andersen and colleagues found that HPV screening almost doubled the sensitivity but somewhat lowered the specificity in detection of severe cervical lesions compared with cytology ( 43 ). In addition, the risk of acquiring a new infection at these ages is lower than in younger age groups ( 44, 45 ) which is partly why some countries, including Denmark and Australia, have utilized HPV tests as exit tests ( 46, 47 ). After a negative exit test, the screening program can cease for the individual as the protection is thought to be sufficient.…”

Do they cope or mope? A survey of GPs’ experiences with the changes in the Norwegian Cervical Cancer Screening Programme

“…The magnitude of inadequate follow-up of abnormal cervical screening results in Norway is currently unknown, but a recent American study estimated that as much as half of patients with discordant HPV and cytology results do not receive follow-up according to guidelines [ 15 ]. In Denmark, guideline-accordant follow-up of cervical screening exit tests was lower among women with previous abnormal test results [ 16 ]. Delegating follow-up of women who need individual assessments to gynaecologists with colposcopy expertise who also have access to all test results, could ease correct follow-up and alleviate GPs of their largest reported challenge with the NCCPS.…”

“…Delegating follow-up of women who need individual assessments to gynaecologists with colposcopy expertise who also have access to all test results, could ease correct follow-up and alleviate GPs of their largest reported challenge with the NCCPS. However, follow-up by gynaecologists may not increase guideline adherence [ 16 ], and the cost-effectiveness of changing the scheme would have to be evaluated.…”