Maija Vahteristo

Long‐term human papillomavirus genotype‐specific risk of cervical high‐grade intraepithelial lesion and cancer—By age group and triage cytology

Abstract Human papillomavirus (HPV) genotypes possess different cervical high‐grade intraepithelial lesion and cancer (CIN2+) risks. HPV genotyping is a promising method to increase the specificity of primary HPV screening, but the optimal management of the infections with different genotypes has not been established. We aimed to assess long‐term HPV genotype‐specific CIN2+ risks, stratified by age and triage cytology result in a population‐based cervical cancer screening program. This is a prospective study of 5253 HPV‐positive individuals from the Finnish randomized HPV screening trial, with up to 18 years of follow‐up. HPV‐positive samples were genotyped using Luminex and BD Onclarity assays. The genotyping data were linked to data from four different nationwide health registries. The primary outcome was HPV genotype‐specific cumulative incidence of CIN2+. The CIN2+ cumulative incidence was the highest for HPV16 (38.1%), followed by HPV33/58 (25.4%) and HPV31 (22.2%). The lowest incidences were observed for HPV56/59/66 (4.4%), HPV35/39/68 (6.5%), and HPV51 (7.5%). Individuals aged 50 or older at the entry test had lower cumulative incidences for the highest‐risk genotypes. The cytology stratification showed that for the infections with the highest risks, normal cytology triage did not guarantee a low CIN2+ risk. On the other hand, HPV51 and HPV56/59/66 had a low risk even with an abnormal cytology result. The findings suggest that individuals with HPV16, HPV33/58, and HPV31 infections could be referred immediately to colposcopy. Sending individuals with low‐risk genotypes, HPV35/39/68, HPV51, or HPV56/59/66 infections with normal cytology back to routine screening could increase screening specificity.

Factors affecting young women's participation in organized cervical cancer screening and non-organized testing – A population-based survey study

Objectives Organized cervical cancer screening reduces cervical cancer incidence and mortality and is widely implemented across Europe. However, non-organized cervical cancer testing remains common. Frequent testing may lead to overdiagnosis and unnecessary treatment, especially among young women. This study aims to identify factors influencing young women's participation in organized cervical cancer screening and non-organized cervical cancer testing. Methods We surveyed 1411 women aged 15–35 living in Finland, assessing their knowledge and attitudes toward cervical cancer testing. Survey responses were linked to sociodemographic registry data and cervical cancer testing records. Descriptive statistics of survey responses and logistic regression were used to identify factors influencing participation in both organized screening and non-organized testing. Results Human papillomavirus vaccination status, medical contraception use, and gynecologist visit frequency were key predictors of non-organized testing. Human papillomavirus-vaccinated women were 50% less likely to undergo non-organized testing compared to those unvaccinated. Medical contraception users were 5.3 times more likely compared to non-users, and frequent gynecologist visitors were 1.5 times more likely to undergo non-organized testing compared to infrequent visitors. For organized screening, women with tertiary education were 4.1 times more likely to participate than those with primary education. Women appreciated the flexibility in screening times and locations. Human papillomavirus awareness was high with 91.3% of respondents having heard of the virus. Conclusions To address non-organized testing among young women, comprehensive education about human papillomavirus and cervical cancer screening is essential, both for screened women and healthcare professionals. Aligning screening practices with women's preferences may improve adherence to organized screening, ultimately benefiting public health outcomes.