Cervical screening in Denmark – a success followed by stagnation

Lynge, Elsebeth; Andersen, Berit; Christensen, Jette; Ejersbo, Dorthe; Jochumsen, Kirsten Marie; Johansen, Tonje; Kristensen, Jette Kolding; Larsen, Lise Grupe; Mehnert, Frank; Mikkelsen, Ellen M.; Nielsen, Karsten; Rygaard, Carsten; Serizawa, Reza; Waldstrøm, Marianne

doi:10.1080/0284186x.2017.1355110

Cited by 41 publications

(40 citation statements)

References 15 publications

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“…In principle, further indication of vaccine effectiveness might be obtained from data on the national time trend in detection of ASCUS. Such data have, however, been reported only since 2013,29, 30 showing a relative stable proportion about 3% with some variation across the Danish regions.…”

Section: Discussionmentioning

confidence: 93%

Impact of HPV vaccination on outcome of cervical cytology screening in Denmark—A register‐based cohort study

Thamsborg

Napolitano

Larsen

et al. 2018

Intl Journal of Cancer

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4vHPV vaccination has been tested in randomized controlled trials under almost ideal conditions, and studies of real‐life use have compared outcome between vaccinated and unvaccinated women from the same birth cohort and mostly before screening age. Here we present the first—to our knowledge—evaluation of the impact of the 4vHPV vaccination in real life without selection bias in the reported data. The study has been carried out by comparing the results after first cervical screening between an HPV‐vaccinated and an unvaccinated birth cohort, consisting of women born in Denmark in 1993 and 1983, respectively. Cytology data covering an 8‐year period, from the age of 15 (age of HPV‐vaccination) to age 23 (age of invitation to first cervical screening), were retrieved from the Danish National Pathology Register. Abnormal cytology, defined as atypical squamous cell of undetermined significance and worse (ASCUS+) was detected in 9.4% of women born in 1993 as compared with 9.0% of women born in 1983; RR = 1.04 (95% CI 0.96–1.12), p = .29. Detection of high‐grade squamous intraepithelial lesion (HSIL) was statistically significantly lower in the 1993 than in the 1983 cohort, RR = 0.6 (95% CI 0.5–0.7), p < .0001, while the opposite pattern was seen for ASCUS RR = 1.4 (95% CI 1.2–1.6), p < .0001. The decrease in HSIL means that more women can be spared referral for colposcopy and biopsy. The increase of ASCUS could be explained by transition from conventional to liquid‐based cytology, but this observation requires further monitoring.

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Section: Discussionmentioning

confidence: 93%

Impact of HPV vaccination on outcome of cervical cytology screening in Denmark—A register‐based cohort study

Thamsborg

Napolitano

Larsen

et al. 2018

Intl Journal of Cancer

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“…In Denmark, cervical cancer screening is organized as a nationwide integrated program based on a call–recall invitational system, which keeps track of women in the screening population, including women entering the population, and those who are no longer subscribed to the program (eg, due to hysterectomy). 22 Danish women are invited for cervical cancer screening every 3 years when aged 23–49 years and every 5 years when aged 50–64 years. 23 The invitation is sent by letter advising the woman to book an appointment to have a liquid-based cervical cytology specimen collected by her general practitioner (GP).…”

Section: Methodsmentioning

confidence: 99%

HPV self-sampling in cervical cancer screening: the effect of different invitation strategies in various socioeconomic groups - a randomized controlled trial

Tranberg¹,

Bech²,

Blaakær³

et al. 2018

CLEP

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BackgroundParticipation in cervical cancer screening varies by socioeconomic status. The aims were to assess if offering human papilloma virus (HPV) self-sampling kits has an effect on screening participation among various socioeconomic groups and to determine if two invitation strategies for offering self-sampling influence the participation rate equally.MethodsThe study was based on registry data that were applied to data from a randomized controlled trial (n=9,791) measuring how offering HPV self-sampling affected screening participation. The women received either 1) a self-sampling kit mailed directly to their homes (directly mailed group); 2) an invitation to order the kit (opt-in group); or 3) a standard second reminder to attend regular cytology screening (control group). The participation data were linked to registries containing socioeconomic information.ResultsWomen in the directly mailed group participated significantly more than women in the control group, regardless of their socioeconomic status, but the largest effects were observed in Western immigrants (participation difference [PD]=18.1%, 95% CI=10.2%–26.0%) and social welfare recipients (PD=15.2%, 95% CI=9.7%–20.6%). Compared with the control group, opt-in self-sampling only had an insignificant effect on participation among women who were immigrants, retired, or less educated. Western immigrants had a significantly higher increase in participation than native Danish women when kits were mailed directly compared with the opt-in strategy (PD=18.1%, 95% CI=10.2%–26.2% and PD=5.5%, 95% CI=2.9%–8.1%, respectively, P=0.01).ConclusionAll socioeconomic groups benefited from the directly mailed strategy in terms of higher screening participation, but Western immigrants and lower socioeconomic groups seemed to benefit the most. Immigrants and some lower socioeconomic groups only had insignificant benefits of opt-in self-sampling. The directly mailed strategy might be preferable to opt-in self-sampling because it ensures that ethnic minority groups obtain benefits of introducing HPV self-sampling in an organized cervical cancer screening program.Trial registrationCurrent Controlled Trials NCT02680262. Registered February 10, 2016.

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“…During our study period, Aptima was used in the region of Southern Denmark, whereas Proofer was used in the other 4 regions (see Supplementary material, Table ) . The coverage of cervical cancer screening, rates of abnormal smears, and cervical cancer incidence did not substantially differ between the region of Southern Denmark and the other regions during the study period . Furthermore, we found a similar age distribution in women tested with Proofer and Aptima, and only women with no previous abnormal cervical results were included in the study.…”

Section: Discussionmentioning

confidence: 51%

Triage of low‐grade squamous intraepithelial lesions using human papillomavirus messenger ribonucleic acid tests—A prospective population‐based register study

Reinholdt

Juul

Dehlendorff

et al. 2019

Acta Obstet Gynecol Scand

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Abbreviations: ASCUS, atypical squamous cells of undetermined significance; CI, confidence interval; CIN, cervical intraepithelial neoplasia; CIN2+, cervical intraepithelial neoplasia grade 2 or worse; CIN3+, cervical intraepithelial neoplasia grade 3 or worse; HPV, human papillomavirus; LSIL, low-grade squamous intraepithelial lesions; NPV, negative predictive value; PPV, positive predictive value. AbstractIntroduction: The optimal clinical management of women diagnosed with low-grade squamous intraepithelial lesions (LSIL) during cervical cancer screening remains unclear. In this prospective cohort study, we compared the clinical performance of two human papillomavirus (HPV) mRNA tests for triage of women with LSIL in Denmark. Material and methods:In a nationwide pathology register, we identified women aged 23-65 years with LSIL during 2008-2012. We included women tested for HPV mRNA with the PreTect HPV Proofer test for five high-risk HPV types (n = 2176) or the Aptima assay for 14 high-risk HPV types (n = 426). Subsequent histological diagnoses of cervical intraepithelial neoplasia grades 2, 3 or cancer (CIN2+) were identified in the register. We calculated the sensitivity and specificity for CIN2+ at 18 and 36 months of follow up, and the cumulative incidence of CIN2+ among women testing positive and negative, overall and by age (23-29, 30-39, 40-65 years). Results:The proportion of women with a positive mRNA test at baseline was higher in women tested with Aptima (66.7%) than in women tested with Proofer (42.8%).After 18 months, Aptima had higher sensitivity for CIN2+ than Proofer (98% [95% CI 94% to 100%] vs 85% [95% CI 82% to 88%]), whereas Proofer showed higher specificity than Aptima (67% [95% CI 64% to 70%]) vs (40% [95% CI 33% to 46%]). Aptima had particularly low specificity in women aged <40 years (23-29: 19% [95% CI 5% to 36%]; 30-39: 10% [95% CI 0% to 33%]). The 36-month cumulative incidence of CIN2+ was higher in Proofer positive (54.3% [95% CI 50.9% to 57.8%]) than in Aptima positive women (37.6% [95% CI 31.2% to 44.8%]). In women with a negative mRNA test, the 36-month cumulative incidences of CIN2+ were 13.1% (95% CI 10.8% to 15.8%) and 5.9% (95% CI 1.7% to 19.0%) for Proofer and Aptima, respectively. Conclusions:In women with LSIL, Aptima had high sensitivity for CIN2+, but low specificity, especially in women aged <40 years. The Proofer test may be useful to limit immediate colposcopy referrals in younger women with LSIL, but given its low | 205 REINHOLDT ET aL. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Reinholdt K, Juul KE, Dehlendorff C, Munk C, Kjaer SK, Thomsen LT. Triage of low-grade squamous intraepithelial lesions using human papillomavirus messenger ribonucleic acid tests-A prospective population-based register study. Acta Obstet Gynecol Scand. 2020;99:204-212.

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Cervical screening in Denmark – a success followed by stagnation

Cited by 41 publications

References 15 publications

Impact of HPV vaccination on outcome of cervical cytology screening in Denmark—A register‐based cohort study

Impact of HPV vaccination on outcome of cervical cytology screening in Denmark—A register‐based cohort study

HPV self-sampling in cervical cancer screening: the effect of different invitation strategies in various socioeconomic groups - a randomized controlled trial

Triage of low‐grade squamous intraepithelial lesions using human papillomavirus messenger ribonucleic acid tests—A prospective population‐based register study

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