Clinical relevance of partial HPV genotyping in cervical cancer screening

TL;DR

This study shows that identifying HPV types 16 and 18 can improve cervical cancer screening by better predicting high-risk cases.

Contribution

The study demonstrates the clinical benefit of partial HPV genotyping, particularly for HPV16 and HPV18, in improving triage and screening efficiency.

Findings

HPV16-positive women had the highest prevalence of high-grade lesions (37.3%) compared to other HR-HPV types.

HPV16 infections showed higher persistence and higher odds of high-grade lesions compared to other HR-HPV types.

Age-specific strategies and immediate referral for HPV16/18-positive women could enhance screening efficiency.

Abstract

Partial human papillomavirus (HPV) genotyping is increasingly used to triage high-risk (HR)-HPV-positive women in national cervical cancer screening. This study evaluated whether separate triage for HPV genotypes 16 and 18 could enhance the effectiveness of Finland’s program. Data from 76,482 women participating in primary HPV screening in Tampere and surrounding municipalities (2012–2023) were analyzed. Partial genotyping identified HPV16, HPV18, and 12 other HR-HPV-types, and the association between genotype and high-grade squamous intraepithelial lesions or worse (HSIL +) detection was assessed. Among 6031 HR-HPV-positive women, HSIL + prevalence was highest in HPV16-positive women (37.3%) followed by HPV18 (26.0%) and other HR-HPV types (20.3%). HSIL + detection declined with age: 26.2%(age < 45), 15.9%(age 45–50), and 11%(age > 50)(p < 0.001). HPV16 showed the highest persistence upon re-testing (69.6% single; 84.6% co-infections), compared to 53.8% for other HR-HPV types. Among women with NILM cytology, HPV16 infections conferred a significantly higher risk of HSIL + compared to infections with other HR-HPV types. This risk was evident for both single HPV16 infection (OR 2.41;95%CI:1.55–3.75) and HPV16 coinfections (OR 3.86;95%CI:2.14–6.96). These findings support the integration of age-specific strategies and partial HPV16/18 genotyping into Finland’s screening program. A refined triage model, including immediate colposcopy referral for HPV16/18-positive women, could improve patient management and screening efficiency.

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