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Abstract：
BACKGROUND: Danish women-who were HPV-vaccinated as girls-are now reaching an age where they are invited to cervical cancer screening. Because of their expected lower cervical cancer risk, we must reassess our screening strategies. We analyzed Danish HPV-vaccinated women\'s outcomes after the first screening test at age 23.
RESULTS: Our study was embedded in Danish routine cytology-based screening. We conducted an observational study and included women born in 1994, offered the 4-valent HPV vaccine at age 14, and subsequently invited to screening at age 23. Cervical cytology was used for diagnostics and clinical management. Residual material was HPV tested with Cobas® 4800/6800. The most severe histology diagnosis within 795 days of screening was found through linkage with the Danish National Pathology Register. We calculated the number of women undergoing follow-up (repeated testing and/or colposcopy) per detected cervical intraepithelial neoplasia (CIN2+). A total of 6021 women were screened; 92% were HPV-vaccinated; 12% had abnormal cytology; 35% were high-risk HPV-positive, including 0.9% HPV16/18 positive, and 20% had follow-up. In women that were cytology-abnormal and HPV-positive (Cyt+/HPV+), 610 (98.5%) had been followed up, and 138 CIN2+ cases were diagnosed, resulting in 4.4 (95% CI 3.9-5.2) women undergoing follow-up per detected CIN2+. In contrast to recommendations, 182 (12.2%) cytology-normal and HPV-positive (Cyt-/HPV+) women were followed up within 795 days, and 8 CIN2+ cases were found, resulting in 22.8 (95% CI 13.3-59.3) women undergoing follow-up per detected CIN2+.
CONCLUSIONS: Overall, HPV prevalence was high in HPV-vaccinated women, but HPV16/18 had largely disappeared. In the large group of cytology-normal and HPV-positive women, 23 had been followed up per detected CIN2+ case. Our data indicated that primary HPV screening of young HPV-vaccinated women would require very effective triage methods to avoid an excessive follow-up burden.
BACKGROUND: Trial registration number: NCT0304955.
RESULTS: Our study was embedded in Danish routine cytology-based screening. We conducted an observational study and included women born in 1994, offered the 4-valent HPV vaccine at age 14, and subsequently invited to screening at age 23. Cervical cytology was used for diagnostics and clinical management. Residual material was HPV tested with Cobas® 4800/6800. The most severe histology diagnosis within 795 days of screening was found through linkage with the Danish National Pathology Register. We calculated the number of women undergoing follow-up (repeated testing and/or colposcopy) per detected cervical intraepithelial neoplasia (CIN2+). A total of 6021 women were screened; 92% were HPV-vaccinated; 12% had abnormal cytology; 35% were high-risk HPV-positive, including 0.9% HPV16/18 positive, and 20% had follow-up. In women that were cytology-abnormal and HPV-positive (Cyt+/HPV+), 610 (98.5%) had been followed up, and 138 CIN2+ cases were diagnosed, resulting in 4.4 (95% CI 3.9-5.2) women undergoing follow-up per detected CIN2+. In contrast to recommendations, 182 (12.2%) cytology-normal and HPV-positive (Cyt-/HPV+) women were followed up within 795 days, and 8 CIN2+ cases were found, resulting in 22.8 (95% CI 13.3-59.3) women undergoing follow-up per detected CIN2+.
CONCLUSIONS: Overall, HPV prevalence was high in HPV-vaccinated women, but HPV16/18 had largely disappeared. In the large group of cytology-normal and HPV-positive women, 23 had been followed up per detected CIN2+ case. Our data indicated that primary HPV screening of young HPV-vaccinated women would require very effective triage methods to avoid an excessive follow-up burden.
BACKGROUND: Trial registration number: NCT0304955.
摘要：
背景：丹麦女性-在女孩时接种了HPV疫苗-现在已经达到了被邀请参加宫颈癌筛查的年龄。因为他们预期的宫颈癌风险较低，我们必须重新评估我们的筛查策略.我们分析了丹麦HPV疫苗接种的女性在23岁时进行首次筛查测试后的结果。
结果：我们的研究基于丹麦常规细胞学筛查。我们进行了一项观察性研究，纳入了1994年出生的女性，在14岁时提供了4价HPV疫苗，随后在23岁时被邀请进行筛查。宫颈细胞学检查用于诊断和临床管理。残余材料是用Cobas®4800/6800测试的HPV。通过与丹麦国家病理学登记处的联系，发现了筛查后795天内最严重的组织学诊断。我们计算了每次检测到的宫颈上皮内瘤变（CIN2）接受随访（重复测试和/或阴道镜检查）的女性人数。总共6021名妇女接受了筛查；92%的人接种了HPV疫苗；12%的人有细胞学异常；35%的人是高危型HPV阳性，包括0.9%的HPV16/18阳性，20%有随访。在细胞学异常和HPV阳性（Cyt+/HPV+）的女性中，已跟进610（98.5％），并诊断为138CIN2+病例，导致4.4（95％CI3.9-5.2）名女性接受随访，每次检测CIN2+。与建议相反，182例（12.2%）细胞学正常和HPV阳性（Cyt-/HPV+）女性在795天内随访，发现8CIN2+病例，导致22.8（95％CI13.3-59.3）女性接受随访，每次检测CIN2+。
结论：总体而言，在接种HPV疫苗的女性中，HPV的患病率很高，但HPV16/18已基本消失。在细胞学正常和HPV阳性的女性中，每个检测到的CIN2+病例随访23例。我们的数据表明，接种HPV疫苗的年轻女性的初次HPV筛查需要非常有效的分诊方法，以避免过度的随访负担。
背景：试验注册号：NCT0304955。
结果：我们的研究基于丹麦常规细胞学筛查。我们进行了一项观察性研究，纳入了1994年出生的女性，在14岁时提供了4价HPV疫苗，随后在23岁时被邀请进行筛查。宫颈细胞学检查用于诊断和临床管理。残余材料是用Cobas®4800/6800测试的HPV。通过与丹麦国家病理学登记处的联系，发现了筛查后795天内最严重的组织学诊断。我们计算了每次检测到的宫颈上皮内瘤变（CIN2）接受随访（重复测试和/或阴道镜检查）的女性人数。总共6021名妇女接受了筛查；92%的人接种了HPV疫苗；12%的人有细胞学异常；35%的人是高危型HPV阳性，包括0.9%的HPV16/18阳性，20%有随访。在细胞学异常和HPV阳性（Cyt+/HPV+）的女性中，已跟进610（98.5％），并诊断为138CIN2+病例，导致4.4（95％CI3.9-5.2）名女性接受随访，每次检测CIN2+。与建议相反，182例（12.2%）细胞学正常和HPV阳性（Cyt-/HPV+）女性在795天内随访，发现8CIN2+病例，导致22.8（95％CI13.3-59.3）女性接受随访，每次检测CIN2+。
结论：总体而言，在接种HPV疫苗的女性中，HPV的患病率很高，但HPV16/18已基本消失。在细胞学正常和HPV阳性的女性中，每个检测到的CIN2+病例随访23例。我们的数据表明，接种HPV疫苗的年轻女性的初次HPV筛查需要非常有效的分诊方法，以避免过度的随访负担。
背景：试验注册号：NCT0304955。
