Effectiveness of cervical cancer screening with cytology and human papillomavirus co-testing: A 12-year retrospective study in Oyama district, Japan
This study aimed to evaluate the effectiveness of cervical cancer screening with cytology and human papillomavirus (HPV) co-testing in Japan. The study was conducted in Oyama district, Japan, where cytology and HPV co-testing has been implemented since 2012. Data for 2012-2020 were retrospectively analyzed; results were compared with those of cytology-alone screening conducted from 2009 to 2011. Screening outcomes, including referral rate and cervical intraepithelial neoplasia (CIN)2, CIN3/adenocarcinoma in situ, and invasive carcinoma detection rates, were assessed. Co-testing and cytology-alone screening were performed in 62,155 and 34,040 individuals, respectively; the corresponding referral rates were 4.1 % and 1.9 %. Co-testing resulted in significantly higher referral rates but decreasing trends over time (4.6 %, 4.0 %, and 3.8 % in 2012-2014, 2015-2017, and 2018-2020, respectively). The CIN2 detection rate, which was 0.2 % during the era of cytology alone, significantly increased to 0.49 % during 2012-2014 after the introduction of co-testing and remained higher at 0.31 % during 2015-2017 and 0.37 % during 2018-2020. In contrast, the CIN3 + detection rate increased from 0.13 % during the era of cytology alone to 0.19 % during 2012-2014 but significantly decreased to 0.14 % and 0.06 % during 2015-2017 and 2018-2020, respectively. Our long-term data and comparison with historical controls indicate that co-testing resulted in a higher CIN2 detection rate, potentially reducing CIN3 + community incidence. Although referral rate initially increased with co-testing, a decreasing trend was noted over time.