HPV immunisation and cervical screening - confirmation of changed performance of cytology as a screening test in immunised women

a retrospective population based cohort study

T. J. Palmer, M. McFadden, K. G. J. Pollock, K. Kavanagh, K. Cuschieri, M. Cruickshank, S. Cotton, S. Nicoll, C. Robertson

Research output: Contribution to journalArticle

29 Citations (Scopus)
4 Downloads (Pure)

Abstract

background: To document the effect of bivalent HPV immunisation on cervical cytology as a screening test and assess the implications of any change, using a retrospective analysis of routinely collected data from the Scottish Cervical Screening Programme (SCSP).
methods: Data were extracted from the Scottish Cervical Call Recall System (SCCRS), the Scottish Population Register and the Scottish Index of Multiple Deprivation. A total of 95 876 cytology records with 2226 linked histology records from women born between 1 January 1988 and 30 September 1993 were assessed. Women born in or after 1990 were eligible for the national catch-up programme of HPV immunisation. The performance of cervical cytology as a screening test was evaluated using the key performance indicators used routinely in the English and Scottish Cervical Screening Programmes (NHSCSP and SCSP), and related to vaccination status.
results: Significant reductions in positive predictive value (16%) and abnormal predictive value (63%) for CIN2+ and the mean colposcopy score (18%) were observed. A significant increase (38%) in the number of women who had to be referred to colposcopy to detect one case of CIN2+ was shown. The negative predictive value of negative- or low-grade cytology for CIN2+ increased significantly (12%). Sensitivity and specificity, as used by the UK cervical screening programmes, were maintained.
conclusions: The lower incidence of disease in vaccinated women alters the key performance indicators of cervical cytology used to monitor the quality of the screening programme. These findings have implications for screening, colposcopy referral criteria, colposcopy practice and histology reporting.
Original languageEnglish
Pages (from-to)582-589
Number of pages8
JournalBritish Journal of Cancer
Volume114
Issue number5
Early online date4 Feb 2016
DOIs
Publication statusPublished - 1 Mar 2016

Fingerprint

Colposcopy
Cell Biology
Immunization
Cohort Studies
Population
Histology
Immunization Programs
Registries
Vaccination
Referral and Consultation
Sensitivity and Specificity
Incidence

Keywords

  • cervical cancer
  • screening
  • cervical cytology
  • HPV immunisation
  • colposcopy

Cite this

HPV immunisation and cervical screening - confirmation of changed performance of cytology as a screening test in immunised women : a retrospective population based cohort study. / Palmer, T. J.; McFadden, M.; Pollock, K. G. J.; Kavanagh, K.; Cuschieri, K.; Cruickshank, M.; Cotton, S.; Nicoll, S.; Robertson, C.

In: British Journal of Cancer, Vol. 114, No. 5, 01.03.2016, p. 582-589.

Research output: Contribution to journalArticle

Palmer, T. J. ; McFadden, M. ; Pollock, K. G. J. ; Kavanagh, K. ; Cuschieri, K. ; Cruickshank, M. ; Cotton, S. ; Nicoll, S. ; Robertson, C. / HPV immunisation and cervical screening - confirmation of changed performance of cytology as a screening test in immunised women : a retrospective population based cohort study. In: British Journal of Cancer. 2016 ; Vol. 114, No. 5. pp. 582-589.
@article{60294e5c8bc9444683a45547456ee490,
title = "HPV immunisation and cervical screening - confirmation of changed performance of cytology as a screening test in immunised women: a retrospective population based cohort study",
abstract = "background: To document the effect of bivalent HPV immunisation on cervical cytology as a screening test and assess the implications of any change, using a retrospective analysis of routinely collected data from the Scottish Cervical Screening Programme (SCSP).methods: Data were extracted from the Scottish Cervical Call Recall System (SCCRS), the Scottish Population Register and the Scottish Index of Multiple Deprivation. A total of 95 876 cytology records with 2226 linked histology records from women born between 1 January 1988 and 30 September 1993 were assessed. Women born in or after 1990 were eligible for the national catch-up programme of HPV immunisation. The performance of cervical cytology as a screening test was evaluated using the key performance indicators used routinely in the English and Scottish Cervical Screening Programmes (NHSCSP and SCSP), and related to vaccination status.results: Significant reductions in positive predictive value (16{\%}) and abnormal predictive value (63{\%}) for CIN2+ and the mean colposcopy score (18{\%}) were observed. A significant increase (38{\%}) in the number of women who had to be referred to colposcopy to detect one case of CIN2+ was shown. The negative predictive value of negative- or low-grade cytology for CIN2+ increased significantly (12{\%}). Sensitivity and specificity, as used by the UK cervical screening programmes, were maintained.conclusions: The lower incidence of disease in vaccinated women alters the key performance indicators of cervical cytology used to monitor the quality of the screening programme. These findings have implications for screening, colposcopy referral criteria, colposcopy practice and histology reporting.",
keywords = "cervical cancer, screening, cervical cytology, HPV immunisation, colposcopy",
author = "Palmer, {T. J.} and M. McFadden and Pollock, {K. G. J.} and K. Kavanagh and K. Cuschieri and M. Cruickshank and S. Cotton and S. Nicoll and C. Robertson",
note = "We acknowledge funding (reference CZH/4/528) from the Chief Scientist Office (part of the Scottish Government Health and Social Care Directorates), which has supported this programme of work.",
year = "2016",
month = "3",
day = "1",
doi = "10.1038/bjc.2015.474",
language = "English",
volume = "114",
pages = "582--589",
journal = "British Journal of Cancer",
issn = "0007-0920",
publisher = "Nature Publishing Group",
number = "5",

}

TY - JOUR

T1 - HPV immunisation and cervical screening - confirmation of changed performance of cytology as a screening test in immunised women

T2 - a retrospective population based cohort study

AU - Palmer, T. J.

AU - McFadden, M.

AU - Pollock, K. G. J.

AU - Kavanagh, K.

AU - Cuschieri, K.

AU - Cruickshank, M.

AU - Cotton, S.

AU - Nicoll, S.

AU - Robertson, C.

N1 - We acknowledge funding (reference CZH/4/528) from the Chief Scientist Office (part of the Scottish Government Health and Social Care Directorates), which has supported this programme of work.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - background: To document the effect of bivalent HPV immunisation on cervical cytology as a screening test and assess the implications of any change, using a retrospective analysis of routinely collected data from the Scottish Cervical Screening Programme (SCSP).methods: Data were extracted from the Scottish Cervical Call Recall System (SCCRS), the Scottish Population Register and the Scottish Index of Multiple Deprivation. A total of 95 876 cytology records with 2226 linked histology records from women born between 1 January 1988 and 30 September 1993 were assessed. Women born in or after 1990 were eligible for the national catch-up programme of HPV immunisation. The performance of cervical cytology as a screening test was evaluated using the key performance indicators used routinely in the English and Scottish Cervical Screening Programmes (NHSCSP and SCSP), and related to vaccination status.results: Significant reductions in positive predictive value (16%) and abnormal predictive value (63%) for CIN2+ and the mean colposcopy score (18%) were observed. A significant increase (38%) in the number of women who had to be referred to colposcopy to detect one case of CIN2+ was shown. The negative predictive value of negative- or low-grade cytology for CIN2+ increased significantly (12%). Sensitivity and specificity, as used by the UK cervical screening programmes, were maintained.conclusions: The lower incidence of disease in vaccinated women alters the key performance indicators of cervical cytology used to monitor the quality of the screening programme. These findings have implications for screening, colposcopy referral criteria, colposcopy practice and histology reporting.

AB - background: To document the effect of bivalent HPV immunisation on cervical cytology as a screening test and assess the implications of any change, using a retrospective analysis of routinely collected data from the Scottish Cervical Screening Programme (SCSP).methods: Data were extracted from the Scottish Cervical Call Recall System (SCCRS), the Scottish Population Register and the Scottish Index of Multiple Deprivation. A total of 95 876 cytology records with 2226 linked histology records from women born between 1 January 1988 and 30 September 1993 were assessed. Women born in or after 1990 were eligible for the national catch-up programme of HPV immunisation. The performance of cervical cytology as a screening test was evaluated using the key performance indicators used routinely in the English and Scottish Cervical Screening Programmes (NHSCSP and SCSP), and related to vaccination status.results: Significant reductions in positive predictive value (16%) and abnormal predictive value (63%) for CIN2+ and the mean colposcopy score (18%) were observed. A significant increase (38%) in the number of women who had to be referred to colposcopy to detect one case of CIN2+ was shown. The negative predictive value of negative- or low-grade cytology for CIN2+ increased significantly (12%). Sensitivity and specificity, as used by the UK cervical screening programmes, were maintained.conclusions: The lower incidence of disease in vaccinated women alters the key performance indicators of cervical cytology used to monitor the quality of the screening programme. These findings have implications for screening, colposcopy referral criteria, colposcopy practice and histology reporting.

KW - cervical cancer

KW - screening

KW - cervical cytology

KW - HPV immunisation

KW - colposcopy

U2 - 10.1038/bjc.2015.474

DO - 10.1038/bjc.2015.474

M3 - Article

VL - 114

SP - 582

EP - 589

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 5

ER -