Journal: International journal of cancer
This nationwide, population-based retrospective cohort study from Estonia evaluated the real-world performance of an hrHPV-based cervical cancer screening program, focusing on follow-up after positive primary tests.
Methods:
- Data sources: Estonian Health Insurance Fund and Population Register.
- Population: 44,282 women aged 30–65 invited for hrHPV-based screening from January 2021 to December 2022, with follow-up through March 2024.
Key findings:
- Screening uptake: Screening uptake was modest: 45.7% of invited women attended.
- hrHPV positivity: hrHPV positivity among attendees was 8.0%.
- Follow-up as a major weakness:
- No documented follow-up: 57.7% of hrHPV-positive women had no documented repeat hrHPV test, colposcopy, or post-colposcopy care within 12 months.
- Colposcopy among those referred: Among those referred, 77.9% received colposcopy within 6 months.
- Treatment quality for high-grade disease:
- HSIL treatment: 85.5% of women with HSIL received treatment, typically within 3 months.
- Factors associated with lower adherence: Lower adherence to follow-up was associated with older age and residence in South Estonia.
Interpretation:
The program is limited by both suboptimal initial participation and substantial loss to follow-up after a positive hrHPV result, despite relatively high treatment rates once HSIL is identified. These gaps significantly undermine the impact of screening on cervical cancer prevention and reflect challenges seen in other organized screening settings. The authors emphasize the need for targeted strategies to improve follow-up adherence to advance progress toward cervical cancer elimination goals.