IARC 60th Anniversary - 19-21 May 2026
Session : 21/05/26 - Posters
Review of CIN3+ and cervical cancer outcomes to inform screening intervals after a negative HPV test
MUWONGE R. 1, TAGHAVI K. 1, ARMAROLI P. 2, GILHAM C. 3, WESTENZEN N. 4, BERKHOF H. 5, DILLNER J. 6, ELFSTROM M. 6, IVANUS U. 7, RUSSELL N. 8, RAMIREZ A. 1, NEAMTIU L. 1, NOWAKOWSKI A. 9, GIORGI ROSSI P. 10, BHATLA N. 11, LAUBY-SECRETAN B. 1, BROUTET N. 12, QASEEM A. 13, BASU P. 1, ARBYN M. 14,15
1 International Agency for Research on Cancer/ World Health Organisation, Lyon, France; 2 Cancer Epidemiology Unit and Centre for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy; 3 Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom; 4 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States; 5 Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands; 6 Center for cervical cancer prevention, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; 7 Department of Cervical Cancer Screening, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia; 8 Department of Obstetrics and Gynaecology, University College Cork, College Road, Cork, Ireland; 9 Maria Sklodowska-Curie National Cancer Institute, Warsaw, Poland; 10 Epidemiology Unit, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy; 11 Department of Preventive Oncology, National Cancer Institute, AIIMS Delhi, New Delhi, India; 12 Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; 13 American College of Physicians, Philadelphia, Pennsylvania, United States; 14 Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium; 15 Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
Background: The European Commission Initiative on Cervical Cancer has made a strong recommendation for primary HPV screening over cervical cytology or co-testing. Determining safe screening intervals after a negative HPV test requires evidence on the cumulative risk of high-grade precancer (CIN3+) and cervical cancer over time.
Objective: To synthesise evidence on the cumulative risk of CIN3+ and cervical cancer outcomes following a baseline negative HPV screening test, to inform recommendations on screening interval within which the risk is still minimal and clinically acceptable.
Methods: We conducted a review of studies reporting CIN3+ and cervical cancer detection following a negative HPV test. MEDLINE and EMBASE were searched up to December 2024. Two reviewers independently screened records, extracted data, and assessed risk of bias. Where necessary we contacted authors for additional data needed for analysis. Evidence was synthesised across large cohort studies and trials. Relative and absolute risks after a negative test were summarised at 7-, and 10- compared to 5- year time interval, including age-stratified estimates (<40 years and ≥40 years) where available. Findings were considered alongside modelling evidence within the GRADE Evidence-to-Decision (EtD) framework supporting the strength of EC-CvC recommendations.
Results: Nine studies contributed CIN3+ outcomes after a negative HPV test. Compared with 5-yearly screening, extending the interval to 7 years increased CIN3+ detection (RR 1.71, 95% CI 1.31–2.24; +51 per 100,000 per women) and cervical cancer detection (RR 2.26, 95% CI 1.13–4.53; +9 per 100,000 per women), judged as small undesirable effects using the EC-CvC scale to judge the magnitude of effects. Age-stratified estimates suggested a greater increase in cumulative CIN3+ risk in individuals aged <40 years (0.09% at 5 years to 0.17% at 10 years) than in those aged ≥40 years (0.07% at 5 years to 0.11% at 10 years), with a negligible increase in cervical cancer among those aged ≥40 years. Extending the interval to 10 years further increased CIN3+ detection (RR 1.93, 95% CI 1.57–2.38) and cervical cancer detection (RR 4.6, 95% CI 1.3–15.5), judged a moderate undesirable effect overall. These findings were considered alongside evidence on desirable effects, values and preferences, resource use and costs, equity, feasibility, and acceptability within the GRADE Evidence-to-Decision framework.
Conclusion: Extending screening intervals beyond 5 years after a negative HPV test results in a small undesirable effect that are mostly driven by the balance of desirable and undesirable effects among individuals <40 and ≥40 years old. The undesirable effects of extending screening intervals become negligible among women >40 years and the EC-CVC WG have suggested 5-yearly screening for individuals aged <40 years and a 7-year interval for individuals aged ≥40 years.