Assessment of a Risk-Based Stratified Management Strategy for Cervical Cancer Screening in Central China: A Real-World Study across Diverse Populations of 223,533 Opportunistic and 43,102 Health Check-up Participants Over a Decade

Background : The evolving landscape of cervical cancer screening emphasizes risk-based stratification for effective management. This study aims to assess the applicability of a risk-based cervical cancer screening and management strategy in opportunistic screening populations at outpatient clinics and regular health check-up populations in central China. Methods : The study validated the screening management strategy recommended by the 2019 ASCCP guidelines for 1-year and 3-year follow-up intervals in opportunistic screening and health check-up populations. Data were collected from a large tertiary hospital in central China, including 223,533 outpatient records from April 2012 to April 2022 and 43,102 health check-up records from April 2017 to April 2022. High-risk human papillomavirus (hrHPV) infection rates, cytology results, and subsequent high-grade cervical intraepithelial neoplasia (CIN3+) incidences were evaluated across different age groups. Follow-up data were examined to discern the effectiveness of risk-based management. Results : The study revealed significant prevalence of hrHPV infection, with overall positivity rates of 18.17% in opportunistic screening and 13.22% in health check-up populations. Among screened individuals, the prevalence of CIN3+ exhibited age-related differences. Specifically, among individuals meeting the follow-up criteria, only the 25-65 years old group in the 1-year follow-up cohort had CIN3+ detection, with a prevalence of 0.47% in the outpatient population and 0.09% in the health check-up population. Conclusions : The CIN3+ detection rates align with expectations, supporting the applicability of the ASCCP approach in varied screening settings. This study provides valuable insights into the real-world implementation of risk-based cervical cancer screening, contributing to the ongoing paradigm shift towards risk-based stratification. It underscores the importance of continuous efforts to refine screening protocols on a global scale.