Colposcopic and histopathologic evaluation of women with HPV persistence exiting an organized screening program

Abstract Background Human Papillomavirus (HPV)-based screening has a higher sensitivity for precursors of cervical cancer compared to cytology-based screening. However, more evidence is needed on optimal management of HPV-positive women. Objective To compare the risk of histopathologically confirmed CIN2+ after 1 and 3 years of HPV persistence, respectively and evaluate the clinical management of HPV-positive women in the 56-60 years age group. Study design A randomized health care policy offering HPV screening to 50% of resident women aged 56-60 in the Stockholm/Gotland region of Sweden during January 2012-May 2014. Women who were HPV positive/cytology negative at baseline were referred for a repeat test after 1 or 3 years. In case of HPV persistence, women were referred for colposcopy, including biopsies and endocervical sampling. Results The HPV prevalence was 5.5% (405 women/7,325 attending). Among the 405 HPV-positive women, 313 were reflex test cytology-negative at baseline and referred for a repeat HPV test, 176 women after 1 year and 137 women after 3 years. After 1 year, 91/176 (52%) were persistently HPV-positive and after 3 years 55/137 (40%) (p=0.042). In repeat cytology, 10/91 the (12%) were positive after 1 year and 15/55 (33%) after 3 years (p=0.005). The attendance rates for colposcopy were similar: 82/91 (90%) in the 1year group and 45/55 (82%) in the 3 year group. All women attending colposcopy were postmenopausal and endocervical sampling and punch biopsies was performed to facilitate colposcopic management, with a PPV of 43-50% and 28-31%, respectively. Histopathologically confirmed CIN2+ was found in 19/82 women (23%) and 9/45 women (20%) in the 1 year and 3 year groups, respectively, and registry linkage follow-up found no cancers in either group. HPV genotyping was predictive of CIN2+ and HPV 16 was the most common genotype at HPV persistence occurring in 18% of the cases in the 1 year group and 20% in the 3 year group. Conclusion It was safe to postpone repeat HPV tests for 3 years in postmenopausal women attending the organized cervical screening program. There was a high risk for CIN2+ at follow-up and noteworthy yields from HPV genotyping as well as endocervical sampling and random biopsies in the absence of visible colposcopic lesions.