Opportunistic and Organized Cervical Cancer Screening: Impact on Lesion Severity and Surgical Outcomes in 9830 Cervical Conizations

TL;DR

Organized cervical cancer screening detects severe lesions earlier and reduces invasive cancer risk compared to opportunistic screening.

Contribution

This study demonstrates that organized screening significantly lowers invasive cancer rates and reduces the severity of cervical lesions compared to opportunistic screening.

Findings

Organized screening patients had a 1.1% invasive cancer rate versus 2.7% in opportunistic screening.

HPV-based screening in organized models detected smaller high-grade lesions than cytology-based methods.

Organized screening was associated with a two-fold lower risk of invasive cancer compared to opportunistic screening.

Abstract

Objectives: To assess the impact of organized (OgS) versus opportunistic screening (OpS) on grade, extent, and surgical management of cervical lesions, and to evaluate human papillomavirus (HPV)-based versus cytology-based screening within OgS. Methods: This retrospective study analyzed 9830 women undergoing conization (1992–2021). Data included screening modality, histology, cervical intraepithelial neoplasia grade 3 (CIN3) linear extension, and cone volume. Statistical analysis employed chi-square test, Student’s t-tests, Cochran–Armitage test for trend, and Firth’s penalized multivariate logistic regression to identify independent predictors of invasive disease. Results: Of 9830 patients, 5097 (52%) were referred from OgS and 4733 (48%) from OpS. OgS patients were significantly older (40.0 vs. 37.0 years; p < 0.001). In the final decade, OgS achieved a significantly lower rate of invasive carcinomas compared to OpS (1.1% vs. 2.7%; p < 0.001). Mean CIN3 extension and cone volume were significantly lower in OgS (6.5 mm; 1150 mm3) than in OpS (7.1 mm; 1580 mm3; p < 0.001). Within OgS, HPV-detected CIN3 lesions were smaller than cytology-detected ones (5.9 vs. 6.4 mm; p < 0.001). Long-term analysis showed a borderline downward trend in invasive cancer for OgS (p = 0.089), whereas OpS remained stable at higher risk levels. Multivariate analysis confirmed the screening model as an independent predictor of invasiveness: OpS was associated with a two-fold increased risk of invasive cancer compared to OgS (adjusted odds ratio: 1.99; 95% confidence interval: 1.41–2.83; p < 0.001). Conclusions: OgS identifies high-grade precancers earlier and with smaller excisional requirements. OpS is associated with significantly higher invasive cancer rates and larger conizations. Multivariate data reinforce OgS as a superior framework, effectively halving the risk of invasive disease compared to OpS.

Figures