{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T02:24:39Z","timestamp":1771035879431,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2022,3]]},"abstract":"Abstract<\/jats:title>Introduction<\/jats:title>The screening program for cervical cancer in Sweden recommends the use of primary human papillomavirus (HPV) screening for women aged \u226530 to 65\u00a0years. Co\u2010testing with both HPV analysis and cytology is recommended at the first screening after the age of 40 years. To fulfil co\u2010testing, all screened women aged 40\u201342 years within the region of Sk\u00e5ne were co\u2010tested. The aim of the audit was to investigate the proportion of severe dysplasia as diagnosed by cytology and histological follow\u2010up among women with Aptima HPV\u2010negative tests. We also calculated the cost of adding the cytology to the HPV primary screening program.<\/jats:p><\/jats:sec>Material and Methods<\/jats:title>The local cytology registry was used to identify women aged 40\u201342\u00a0years who attended screening and were co\u2010tested during the 4\u00a0years from January 2017 to December 2020. The Aptima HPV messenger RNA assay detects 14 HPV types. For Aptima HPV\u2010negative women with high\u2010grade cytology or histological high\u2010grade squamous intraepithelial lesions (HSILs), we performed extended HPV typing for 40 HPV types with polymerase chain reaction using modified GP5+\/6+ primers followed by a Luminex assay. To estimate the added cost of using cytology to identify each histologically confirmed cervical HSIL case among Aptima HPV\u2010negative women, we used the current cost of \u20ac21.2 per cytology evaluation at our laboratory.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 19\u00a0599 women, 5.8% (1137\/19\u00a0599) had abnormal cytology. Among Aptima HPV\u2010negative women, 0.11\u2030 (2\/18\u00a0132) had histologically confirmed HSIL. One of the women was infected with HPV18 and the other with HPV73 at the diagnosis of HSIL. The calculated cost to find one HSIL, by adding cytology to HPV\u2010negative cases, was approximately \u20ac200\u00a0000.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The clinical benefit of a single cytology co\u2010test added to an HPV\u2010based screening program in women aged 40\u201342\u00a0years appears doubtful and economically unreasonable.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14311","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T05:54:27Z","timestamp":1641448467000},"page":"374-378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Co\u2010testing in cervical screening among 40\u2010 to 42\u2010year\u2010old women is unreasonable"],"prefix":"10.1111","volume":"101","author":[{"given":"Christer","family":"Borgfeldt","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital Lund University Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anneli","family":"Leksell","sequence":"additional","affiliation":[{"name":"Department of Clinical Genetics and Pathology Laboratory Medicine Region Sk\u00e5ne Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6293-7286","authenticated-orcid":false,"given":"Ola","family":"Forslund","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Laboratory Medicine Region Sk\u00e5ne Lund University Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1990.202"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/92.9.690"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2019.09.006"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pvr.2017.10.003"},{"key":"e_1_2_10_7_1","first-page":"107","article-title":"HPV negative cervical cancers and primary HPV screening","volume":"10","author":"Tjalma W","year":"2018","journal-title":"Facts Views Vis Obgyn"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1586\/eri.10.104"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2018.04.007"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa071430"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21628"},{"key":"e_1_2_10_12_1","unstructured":"Swedish\u2010Regional\u2010Cancer\u2010Centers.Current care program for cervical cancer prevention. 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