High-risk human papillomavirus cervical infection prevalence in France, 2020-2023: a nationwide, large-scale, and spatially resolved retrospective study comparing opportunistic and organised screening

Background

In France, cervical cancer screening for females aged 30 to 65 primarily targets high-risk human papillomavirus (HPV) infections using DNA tests (‘HR HPV test’).

Aim

The primary goal was to map the prevalence of cervical infections caused by HPV16 and/or 18, or by any of 12 other carcinogenic genotypes (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). The secondary goal was to compare prevalence estimates obtained from tests conducted after spontaneous medical visits (‘opportunistic screening’) or as part of the national screening programme (‘organised screening’).

Methods

The analytic sample contained 362,963 results of HR HPV tests collected, between 2020 and 2023, in metropolitan France. A full hierarchical Bayesian model was used to compute spatially resolved prevalence maps at the postcode level.

Results

Among samples from organised and opportunistic screening, 2.9% and 3.8% were positive for HPV16 and/or 18, respectively. For other genotypes, these percentages were 6.9% and 9.4%, respectively.

During the last week of the study period, among females aged 30, opportunistic screening was associated with a greater HPV infection prevalence for HPV16 and/or 18 (other genotypes) in 97.2 [72.9,100.0]% (99.9 [99.3,100.0]%) of postcodes. The probability of this percentage being lower among females aged 66 was below 95% for both genotype groups.

After correcting for this effect, a pronounced northwest/southeast gradient in HR HPV infection prevalence was found across France, for both genotype groups, with some hotspots located at the border with Spain and Italy and Switzerland.

Conclusion

Opportunistic screening is associated with systematic inflation in HR HPV infection prevalence.