Papillomavirus: would a catch-up test be beneficial in women over 65?

In women over the age of 65, a “catch-up” human papillomavirus (or HPV) screening may improve prevention of cervical cancer, by detecting more precancerous lesions compared to women who do not have screening receipt. Here is the conclusion of a new study published in the journal PLOS by a Danish team that could change prevention: in Europe as in France, screening stops at 64 or 65 years old.

13 times more effective detection when remedial screening is offered

The study was conducted on a large sample. A total of 11,192 eligible women residing in one Danish region were invited to participate in HPV-based cervical cancer screening, either by making an appointment with a healthcare professional for a cervical cytology sample, or by ordering a vaginal self-sampling kit.

Eligible women (33,387) in the remaining four regions of Denmark were assigned to a control group where they received no invitation for screening, but were given the option of having a cervical cytology sample taken for any reason during of a routine examination. Among all participants, rates of precancerous lesions called cervical intraepithelial neoplasia (CIN) diagnosed as grade 2 or worse (CIN2+) were tracked for at least 13 months.

• Of the women in the intervention group, 6965 (62.2%) were screened within 12 months;
• Of those in the control group, 743 (2.2%) had cervical cytology.
• The detection rate of advanced precancerous lesions was 3.9 cases per 1,000 eligible women in the intervention group, compared with 0.3 cases per 1,000 eligible women in the control group. That is 13 times greater.

The study also demonstrated that women who were not adequately screened at age 50 to 64 had a higher prevalence of HPV and tended to have more CIN2+ lesions diagnosed compared to women adequately screened. and that underscreened women were more likely to request vaginal self-sampling.

Raising the screening age, a public health issue?

The study shows that this idea of ​​screening, with a professional or at home, could make it possible to better protect women at an advanced age. “A catch-up HPV screening test could potentially improve cervical cancer prevention in women aged 65 and over who have never been tested for HPV in their lifetime. Therefore, this screening modality could be ideal for identifying older women at risk for cervical cancer.” defends Mette Tranberg, author of the study.

High-risk HPV testing is generally replacing cytology as the primary screening test for cervical cancer in most countries, but many women over 65 have never had an HPV test. Moreover, the free screening program in force in various European countries does not include women over 65 years of age.

What about in France?

In France, for women aged 30 to 65, the screening test is the HPV-HR test or detection of HPV viruses (Human papillomavirus) at High Risk, is performed every 5 years on cells taken from the cervix, during the smear of the cervix. Unlike the cytological examination which looks at the appearance of the cells, the HPV-HR test looks for the presence of the high-risk HPV virus in women. It replaces the cytological examination of the smear. For those over 65, a screening test may be offered in the event of:

• The impossibility of verifying whether the last two screenings carried out were normal;
• Absence of regular gynecological follow-up and if no sample has been identified in the three years preceding the age of exit from screening.