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

Research output: Contribution to journalArticle


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.


  • Joakim Dillner
  • Matejka Rebolj
  • Philippe Birembaut
  • Karl-Ulrich Petry
  • Anne Szarewski
  • Christian Munk
  • Silvia de Sanjose
  • Pontus Naucler
  • Belen Lloveras
  • Susanne Kjaer
  • Jack Cuzick
  • Marjolein van Ballegooijen
  • Christine Clavel
  • Thomas Iftner
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Microbiology in the medical area


  • Uterine Cervical Neoplasms: virology, Uterine Cervical Neoplasms: epidemiology, Uterine Cervical Neoplasms: diagnosis, Papillomavirus Infections: epidemiology, Papillomavirus Infections: diagnosis, Europe: epidemiology, Cervical Intraepithelial Neoplasia: virology, Cervical Intraepithelial Neoplasia: diagnosis, Cervical Intraepithelial Neoplasia: epidemiology
Original languageEnglish
Article numbera1754
JournalBMJ (Clinical research ed.)
Publication statusPublished - 2008
Publication categoryResearch