HPV Test: A Tool Against Inequity in Healthcare? Cytology: A Prognostic Factor? Lessons Learned From a Cervical Cancer Screening Program via Co-Testing at a University Hospital in Buenos Aires - Latin American Overview

Background: In 2020, cervical cancer was the fourth most common cancer globally, with an incidence of 13·3. In Argentina, 7548 new cases are diagnosed each year, with 3932 women dying from this cause. This study aims to show the clinical implementation of a cervical cancer screening program by concurrent HPV testing and cervical cytology (co-testing), in women aged 30-65 years, at a University Hospital setting; and to analyze the five-year cumulative incidence rate of cervical cancer. Methods: Between July 2013 and June 2018, cervical samples were collected from women between the ages of 30 to 65 for cervical cancer screening via co-testing (HC2/PAP). Descriptive statistical analysis, multinomial logistic regression and classification metrics were applied over the data. Findings: A total of 2273 women were included. 91·11% of the participants tested double negative, 2·55% double positive, 5·90% HC2-positive/PAP-negative, and 0·44% HC2-negative/PAP-positive. Of the 171 women with follow-up who tested HC2-positive, 39·77% cleared the viral infection, 37·43% showed viral persistence, and 22·81% were treated after the detection via colposcopy/biopsy of histological HSIL. Interpretation: The prevalence of hrHPV in this population was 0·08, with HSIL histology detection rates of 17·32 per 1000 screened women. Cytology could be considered a prognostic factor in women with an HC2-positive test, an association which has not yet been described. This evidence suggests that the introduction of co-testing could diminish the burden of cervical cancer in low- and middle-income countries, acting as a tool against inequity in healthcare. Funding: The implementation of this program was possible thanks to the inclusion of cotesting into CEMIC’s private health insurance coverage. Declaration of Interest: VD has received personal fees (as a consultant and/or speaker bureau) from Thermo Fisher, BMS, Novartis, Amgen, and Roche; and their researches are sponsored by BMS, Novartis, Amgen, AstraZeneca, and Roche, unrelated to the current work. FvP has been sponsored by Roche and Megablabs (academic grant/attending meetings), unrelated to the current work. VF has been sponsored by Roche (academic grant), unrelated to the current work. AA has been sponsored by AMGEN (academic grant), unrelated to the current work. FM has been sponsored by Tecnolab and Roche (academic grant/attending meetings), unrelated to the current work. The other authors declare no conflict of interest. Ethical Approval: This protocol was reviewed and approved by the local Institutional Review Board (IRB).