{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T23:28:06Z","timestamp":1773358086895,"version":"3.50.1"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009457","name":"Region Sj\u00e6lland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009457","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Region Syddanmark"},{"DOI":"10.13039\/100008363","name":"Kr\u00e6ftens Bek\u00e6mpelse","doi-asserted-by":"publisher","award":["R247-A14608"],"award-info":[{"award-number":["R247-A14608"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010347","name":"Fabrikant Einar Willumsens Mindelegat","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010347","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Danish women exit cervical cancer screening at age 65 years, but 23% of cervical cancer cases occur beyond this age. In addition, due to gradual implementation of cervical cancer screening, older women are underscreened by today\u00b4s standards. A one-time screening with HPV test was therefore offered to Danish women born before 1948.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Register based study reporting histology diagnoses and conizations in women found HPV positive in the one-time screening. Number and proportion of women with severe or non-severe histology results were calculated for screened and HPV-positive women by age group or region of residence. Number of women with biopsy and\/or conization per case of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) or CIN3+ were also calculated by age groups and region.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>4,479 (4.1% of screened women) had positive HPV test. 94% of these had one or more additional tests. 2,785 (62%) of HPV-positive women had histology results, and conization was performed in 1,076 (24% of HPV-positive and 1% of all screened women). HPV positivity and CIN3+ detection varied little between regions, but the proportions of HPV positive women undergoing histology varied between regions from 40% to 86% and the proportion with conization from 13% to 36%. Correspondingly, the number of histologies and conizations per CIN3+ detected varied from 5.9 to 11.2 and 1.8 to 4.7, respectively. In total, 514 CIN2+ (0.47% of screened women, 11% of HPV-positive) and 337 CIN3+ (0.31% of screened women, 7.5% of HPV-positive) were diagnosed, including 37 cervical cancer cases.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>HPV screening of insufficiently screened birth cohorts can potentially prevent morbidity and mortality from cervical cancer but longer follow-up is needed to see if cancer incidence declines in the screened women in the coming years. Management strategies differed among regions which influenced the proportions undergoing biopsy\/conization.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0246902","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T08:14:02Z","timestamp":1613117642000},"page":"e0246902","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Histological outcomes in HPV-screened elderly women in Denmark"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4981-1125","authenticated-orcid":true,"given":"Gry","family":"St-Martin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra Hall","family":"Viborg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ane Birgitte Tel\u00e9n","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berit","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jette","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorthe","family":"Ejersbo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanne N\u00f8rgaard","family":"Heje","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsten Marie","family":"Jochumsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonje","family":"Johansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lise Grupe","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elsebeth","family":"Lynge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reza Rafiolsadat","family":"Serizawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne","family":"Waldstr\u00f8m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"issue":"3","key":"pone.0246902.ref001","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1080\/0284186X.2017.1355110","article-title":"Cervical screening in Denmark\u2014a success followed by stagnation","volume":"57","author":"E Lynge","year":"2018","journal-title":"Acta Oncol Stockh Swed"},{"key":"pone.0246902.ref002","unstructured":"Europe: Human papillomavirus and related diseases summary report 2019 [Internet. https:\/\/hpvcentre.net\/statistics\/reports\/XEX.pdf?t=1588516266397."},{"issue":"3","key":"pone.0246902.ref003","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.ygyno.2016.08.229","article-title":"Cervical cancer screening in women over 65. CON: Reasons for uncertainty","volume":"142","author":"GF Sawaya","year":"2016","journal-title":"Gynecol Oncol"},{"issue":"3","key":"pone.0246902.ref004","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.ygyno.2016.08.230","article-title":"Cervical screening in women over 65. PRO: Are we asking the right question?","volume":"142","author":"L Elit","year":"2016","journal-title":"Gynecol Oncol"},{"key":"pone.0246902.ref005","unstructured":"Cancerregisteret [Internet]. https:\/\/www.esundhed.dk\/Registre\/Cancerregisteret [retrieved 12 June 2020]. Danish."},{"key":"pone.0246902.ref006","unstructured":"Danish Health Authority. Screening for livmoderhalskr\u00e6ft\u2014anbefalinger. 2012. http:\/\/www.sst.dk\/~\/media\/B1211EAFEDFB47C5822E883205F99B79.ashx [retrieved 12 June 2020]. Danish."},{"key":"pone.0246902.ref007","unstructured":"Danish Health Authority. Screening for livmoderhalskr\u00e6ft. Anbefalinger. SST; 2018: https:\/\/www.sst.dk\/da\/sygdom-og-behandling\/screening\/~\/media\/5466AB0B06184ED0969BC31DA397610D.ashx [retrieved 12 June 2020]. Danish."},{"key":"pone.0246902.ref008","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ejca.2016.12.021","article-title":"Cervical cancer incidence in elderly women-biology or screening history?","volume":"74","author":"E Lynge","year":"2017","journal-title":"Eur J Cancer Oxf Engl"},{"issue":"1","key":"pone.0246902.ref009","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ygyno.2019.04.680","article-title":"HPV-prevalence in elderly women in Denmark","volume":"154","author":"B Andersen","year":"2019","journal-title":"Gynecol Oncol"},{"key":"pone.0246902.ref010","unstructured":"Government of Denmark. Kr\u00e6ftplan IV. Sundheds- og \u00c6ldreministeriet; 2016. https:\/\/www.sum.dk\/Temaer\/Kraeftplan-IV.aspx [retrieved 12 June 2020]. Danish."},{"issue":"7 Suppl","key":"pone.0246902.ref011","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1177\/1403494810393563","article-title":"The Danish Pathology Register","volume":"39","author":"B Bjerregaard","year":"2011","journal-title":"Scand J Public Health"},{"issue":"1","key":"pone.0246902.ref012","doi-asserted-by":"crossref","first-page":"e0189300","DOI":"10.1371\/journal.pone.0189300","article-title":"HPV prevalence and HPV-related dysplasia in elderly women","volume":"13","author":"RS Hermansson","year":"2018","journal-title":"PloS One"},{"issue":"3","key":"pone.0246902.ref013","doi-asserted-by":"crossref","first-page":"e0229758","DOI":"10.1371\/journal.pone.0229758","article-title":"Incidence of HPV and HPV related dysplasia in elderly women in Sweden","volume":"15","author":"L Lann\u00e9r","year":"2020","journal-title":"PloS One"},{"issue":"12","key":"pone.0246902.ref014","doi-asserted-by":"crossref","first-page":"e0207714","DOI":"10.1371\/journal.pone.0207714","article-title":"Cervical dysplasia in elderly women performing repeated self-sampling for HPV testing","volume":"13","author":"AK Lindstr\u00f6m","year":"2018","journal-title":"PloS One"},{"key":"pone.0246902.ref015","unstructured":"NORDCAN [Internet]. http:\/\/www-dep.iarc.fr\/NORDCAN\/DK\/frame.asp."},{"key":"pone.0246902.ref016","unstructured":"Petersen LK. National klinisk retningslinje for celleforandringer p\u00e5 livmoderhalsen. Udredning, behandling og opf\u00f8lgning med fokus p\u00e5 kvinder over 60 \u00e5r. DSOG 2019. https:\/\/app.magicapp.org\/summary\/guideline_3484.html [retrieved 12 June 2020]. Danish."},{"issue":"1","key":"pone.0246902.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0147326","article-title":"Human Papillomavirus Assays and Cytology in Primary Cervical Screening of Women Aged 30 Years and Above","volume":"11","author":"M Rebolj","year":"2016","journal-title":"PLoS ONE"},{"issue":"10","key":"pone.0246902.ref018","doi-asserted-by":"crossref","first-page":"e1002414","DOI":"10.1371\/journal.pmed.1002414","article-title":"Effectiveness of cervical screening after age 60 years according to screening history: Nationwide cohort study in Sweden","volume":"14","author":"J Wang","year":"2017","journal-title":"PLoS Med"},{"issue":"1","key":"pone.0246902.ref019","doi-asserted-by":"crossref","first-page":"e1001585","DOI":"10.1371\/journal.pmed.1001585","article-title":"Cervical screening at age 50\u201364 years and the risk of cervical cancer at age 65 years and older: population-based case control study","volume":"11","author":"A Casta\u00f1\u00f3n","year":"2014","journal-title":"PLoS Med"},{"issue":"1","key":"pone.0246902.ref020","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1002\/cam4.1926","article-title":"Cervical cancer screening history prior to a diagnosis of cervical cancer in Danish women aged 60 years and older-A national cohort study","volume":"8","author":"A Hammer","year":"2019","journal-title":"Cancer Med"},{"issue":"1","key":"pone.0246902.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/LGT.0000000000000351","article-title":"Temporal Patterns of Cervical Cancer Screening Among Danish Women 55 Years and Older Diagnosed With Cervical Cancer","volume":"22","author":"A Hammer","year":"2018","journal-title":"J Low Genit Tract Dis"},{"key":"pone.0246902.ref022","unstructured":"Statistics Denmark: Statistikbanken [Internet]. https:\/\/www.statistikbanken.dk\/statbank5a\/default.asp?w=1536."},{"key":"pone.0246902.ref023","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.pvr.2015.06.006","article-title":"European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination","volume":"1","author":"L von Karsa","year":"2015","journal-title":"Papillomavirus Res"},{"issue":"7","key":"pone.0246902.ref024","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1001\/jama.2018.10897","article-title":"Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement","volume":"320","author":"US Preventive Services Task Force","year":"2018","journal-title":"JAMA"},{"issue":"Suppl 1","key":"pone.0246902.ref025","first-page":"65","article-title":"Trends in gynecologic cancer among elderly women in Denmark, 1980\u20132012","volume":"55","author":"Academy of Geriatric Cancer Research (AgeCare)","year":"2016","journal-title":"Acta Oncol Stockh Swed"},{"issue":"2","key":"pone.0246902.ref026","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.mcna.2014.11.002","article-title":"Screening for cancer: when to stop?: A practical guide and review of the evidence","volume":"99","author":"MC Soung","year":"2015","journal-title":"Med Clin North Am. marts"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0246902","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T08:15:04Z","timestamp":1613117704000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0246902"}},"subtitle":[],"editor":[{"given":"Clement A.","family":"Adebamowo","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,2,11]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0246902","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,11]]}}}