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Cited by 629Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study

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Dillner, J., Rebolj, M., Birembaut, P., Petry, K.-U., Szarewski, A., Munk, C., de Sanjose, S., Naucler, P. +6 more·2008·BMJ
DOI 10.1136/bmj.a1754PMC PMC2658827
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Abstract

OBJECTIVE: To obtain large scale and generalisable data on the long term predictive value of cytology and human papillomavirus (HPV) testing for development of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+). DESIGN: Multinational cohort study with joint database analysis. SETTING: Seven primary HPV screening studies in six European countries. PARTICIPANTS: 24,295 women attending cervical screening enrolled into HPV screening trials who had at least one cervical cytology or histopathology examination during follow-up. MAIN OUTCOME MEASURE: Long term cumulative incidence of CIN3+. RESULTS: The cumulative incidence rate of CIN3+ after six years was considerably lower among women negative for HPV at baseline (0.27%, 95% confidence interval 0.12% to 0.45%) than among women with negative results on cytology (0.97%, 0.53% to 1.34%)). By comparison, the cumulative incidence rate for women with negative cytology results at the most commonly recommended screening interval in Europe (three years) was 0.51% (0.23% to 0.77%). The cumulative incidence rate among women with negative cytology results who were positive for HPV increased continuously over time, reaching 10% at six years, whereas the rate among women with positive cytology results who were negative for HPV remained below 3%. CONCLUSIONS: A consistently low six year cumulative incidence rate of CIN3+ among women negative for HPV suggests that cervical screening strategies in which women are screened for HPV every six years are safe and effective.

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  • HPV testing has high sensitivity for detecting precancerous lesions in WLHIV and inherent advantages of objectivity and reproducibility compared to visual inspection methods like VIA or subjective assessments like cytology.

    “The rationale for this choice lies in HPV testing’s high sensitivity for detecting precancerous lesions in WLHIV and its inherent advantages of objectivity and reproducibility compared to visual inspection methods like VIA or subjective assessments like cytology [19–23].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [23]

    The Introduction reports that HPV tests have higher sensitivity than cytology for detecting high-grade cervical lesions and that cytology has limited reproducibility. It does not establish those advantages specifically in women living with HIV, or compare HPV testing’s objectivity or reproducibility with visual inspection methods such as VIA. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The increased sensitivity of HPV testing for cervical precancerous lesions is due to earlier detection rather than overdiagnosis.

    “The increased sensitivity of HPV testing for cervical precancerous lesions has been shown to be due to earlier detection rather than overdiagnosis [22–25].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [23]

    The Discussion (Limitations and other considerations) says that some HPV-positive results that initially appear false positive prove to be earlier detections of CIN3+. But it says longer follow-up attenuates overdiagnosis, not that overdiagnosis is absent. The Introduction likewise says increased sensitivity is “not merely overdiagnosis,” a narrower claim than “rather than overdiagnosis.” (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Authors
Dillner, J., Rebolj, M., Birembaut, P., Petry, K.-U., Szarewski, A., Munk, C., de Sanjose, S., Naucler, P., Lloveras, B., Kjaer, S., Cuzick, J., van Ballegooijen, M., Clavel, C., & Iftner, T.
Affiliations
  • Lund University (SE)
  • Erasmus MC (NL)
  • Inserm (FR)
  • Cancer Research UK (GB)
  • Danish Cancer Society (DK)
  • Institut Català d'Oncologia (ES)
  • Universitätsklinikum Tübingen (DE)
Corresponding author
Dillner, J.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2008-10-13
Volume
337
Issue
oct13 1
Pages
a1754-a1754
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.a1754
PMC
PMC2658827
OpenAlex
W2142575677
Cited by
629
References
1
Citations by year
2026: 14 · 2025: 16 · 2024: 19 · 2023: 33 · 2022: 25 · 2021: 28 · 2020: 29 · 2019: 29 · 2018: 31 · 2017: 37 · 2016: 37 · 2015: 51 · 2014: 37 · 2013: 59 · 2012: 57
FWCI
31.03
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders
  • Sanofi
  • European Commission
  • Cancerfonden
  • Sanofi Pasteur
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
cervical cancer screening, HPV testing, cervical cytology, predictive value, cumulative incidence, screening frequency, long-term outcomes
MeSH terms
Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Cytological Techniques, Europe, Female, Humans, Mass Screening, Predictive Value of Tests, Prospective Studies, Vaginal Smears, Cohort Studies, Incidence, Papillomavirus Infections, Kaplan-Meier Estimate

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