Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian Scotland, Edinburgh, UK.
BJOG. 2022 Jul;129(8):1278-1288. doi: 10.1111/1471-0528.17058. Epub 2022 Jan 18.
To report detailed age-specific outcomes from the first round of an English pilot studying the implementation of high-risk human papillomavirus (HR-HPV) testing in primary cervical screening.
Observational study with screening in 2013-2016, followed by two early recalls and/or colposcopy until the end of 2019.
Six NHS laboratory sites.
A total of 1 341 584 women undergoing screening with HR-HPV testing or liquid-based cytology (LBC).
Early recall tests and colposcopies were recommended, depending on the nature of the screening-detected abnormality.
We reported standard screening process indicators, e.g. proportions with an abnormality, including high-grade cervical intraepithelial neoplasia (CIN2+) or cancer, and the positive predictive value (PPV) of colposcopy for CIN2+, by screening test and age group.
Among unvaccinated women screened with HR-HPV testing at age 24-29 years, 26.9% had a positive test and 10.4% were directly referred to colposcopy following cytology triage, with a PPV for CIN2+ of 47%. At 50-64 years of age, these proportions were much lower: 5.3%, 1.2% and 27%, respectively. The proportions of women testing positive for HR-HPV without cytological abnormalities, whose early recall HR-HPV tests returned negative results, were similar across the age spans: 54% at 24-29 years and 55% at 50-64 years. Two-thirds of infections at any age were linked to non-16/18 genotypes. Among women with CIN2, CIN3 or cervical cancer, however, the proportion of non-16/18 infections increased with age. As expected, the detection of abnormalities was lower following screening with LBC.
These data provide a reliable reference for future epidemiological studies, including those concerning the effectiveness of HPV vaccination.
Data from the English pilot study provide a comprehensive overview of abnormalities detected through HPV screening.
报告首轮英语试点研究中特定年龄组高危型人乳头瘤病毒（HR-HPV）检测在初级宫颈筛查中的实施结果。
2013-2016 年进行筛查的观察性研究，随后进行两次早期召回和/或阴道镜检查，直至 2019 年底。
6 个英国国民保健署实验室。
共 1 341 584 名接受 HR-HPV 检测或液基细胞学（LBC）筛查的女性。
根据筛查发现异常的性质，建议进行早期召回检测和阴道镜检查。
我们报告了标准筛查过程指标，例如异常比例，包括高级别宫颈上皮内瘤变（CIN2+）或癌症，以及阴道镜检查对 CIN2+的阳性预测值（PPV），按筛查试验和年龄组进行分类。
在 24-29 岁接受 HR-HPV 检测筛查的未接种疫苗女性中，26.9%的人 HR-HPV 检测呈阳性，10.4%的人在细胞学分流后直接转至阴道镜检查，CIN2+的 PPV 为 47%。在 50-64 岁年龄组中，这些比例要低得多：分别为 5.3%、1.2%和 27%。在各年龄组中，HR-HPV 检测阳性但细胞学正常的女性中，早期召回 HR-HPV 检测结果为阴性的比例相似：24-29 岁为 54%，50-64 岁为 55%。任何年龄的感染有三分之二与非 16/18 基因型有关。然而，在 CIN2、CIN3 或宫颈癌女性中，非 16/18 感染的比例随着年龄的增长而增加。正如预期的那样，LBC 筛查的异常检出率较低。
这些数据为未来的流行病学研究提供了可靠的参考，包括 HPV 疫苗有效性的研究。
来自英国试点研究的数据全面概述了 HPV 筛查发现的异常情况。
