Transition from Opportunistic Cytological to Organized Screening Program with DNA-HPV Testing Detected Prevalent Cervical Cancers 10 Years in Advance

Q: What problem does Brazil’s current cervical cancer screening approach face?

Screening is opportunistic and based on cytology, with low coverage and many diagnoses occurring in advanced stages, limiting mortality impact.

Q: How was the DNA-HPV screening program evaluated in the first round?

The PREVENTIVO program screened 20,551 women using DNA-HPV testing, reporting coverage, compliance, and test outcome distributions over the first-round period.

Q: What did the study find compared with the previous cytology program?

Organized DNA-HPV screening detected more high-grade precursor lesions and cervical cancers earlier than the prior cytology-based program.

Sep 21, 2026

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Population-based screening in Brazil has historically relied on opportunistic cytology with low coverage and frequent detection of cervical cancer at advanced stages, without clear mortality impact. A five-year first-round evaluation reports DNA-HPV testing performance in a Brazilian city under the PREVENTIVO model for transitioning toward organized screening. Results show 58.7% coverage and 99.4% compliance in the targeted age range, with coverage rising to 77.8% outside the pandemic period, high negative-test rates, and substantial detection of high-grade precursors and cervical cancers earlier than the prior cytology program.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Results

Program performance and coverage

Test positivity and referrals

Detected lesions and cancers

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Transition from opportunistic cytological to organized screening program with DNA‑HPV testing detected prevalent cervical cancers 10 years in advance Julio Cesar Teixeira*, Diama Bhadra Vale, Cirbia Silva Campos, Ilana Polegatto, Joana Froes Bragança, Michelle Garcia Discacciati & Luiz Carlos Zeferino Cervical cancer screening in Brazil is opportunistic, based on cytology and offered for women aged 25–64 years, with low coverage (30%) and 70% of cancer diagnoses done in advanced stages, without impact on mortality. The current study reports 5‑year first‑round results of a population‑based DNA‑ HPV testing screening program in a Brazilian city, which intended to be a model for transition to amore efficient program. Program flowchart is simple and current, indicating repetition of a negative test after five years. The first‑round (October 2017‑September 2022) screened 20,551 women by DNA‑HPV testing with 58.7% coverage and 99.4% compliance with the program’s targeted age range. Coverage increases to 77.8% when excluding the‘pandemic period’. The DNA‑HPV testing was 87.2% negative with 6.2% colposcopy referrals and 84.8% colposcopies performed. A total of 258 high‑grade precursor lesions and 29 cervical cancers (mean age = 41.4 years, 83% Stage I) were detected. As a reference, 41,387 cytology tests from the previous program (2012–2016) detected 36 cervical cancers (mean age = 52.0 years, p = 0.0005), with 67% in advanced stages (p < 0.0001). Organizing cervical cancer screening using DNA‑HPV testing demonstrated good coverage, high age and colposcopy compliance, and detection of more precancerous lesions and cervical cancers 10 years in advance. Globally, annual deaths from cervical cancer are high, especially in low-and middle-income countries 1. In Brazil, 17,010 new cervical cancer cases are expected in 2023 with 6606 deaths, or one death every 80 minutes2. Population-based screening is thus essential to reduce mortality. The Brazilian cervical cancer screening program began in 1984 and was based on conventional cytology (Pap-test)3. The latest National Cancer Institute (INCA) guideline (2016), recommends Pap-test screening every 3 years in women aged 25–64 years4. The public health system (Sistema Unico de Saude, SUS) offers free testing, diagnosis, and treatment to women with a cervix who are sexually active, including transsexual men and non-transsexual binary individuals designated women at birth4. Despite these national program and strategic initiatives, coverage remains low, and cervical cancer incidence and mortality rates have remained relatively stable for decades2. The primary factor impeding progress maybe the opportunistic pattern of Brazil’s current screening program, in which testing is conducted on demand. Due to excess cytology performed outside the official guidelines and low effective coverage, 60–70% of cervical cancers are diagnosed in advanced stages5,6. In the 1990s, some European countries transitioned from opportunistic to organized screening programs, resulting in sustainable reductions in cervical cancer mortality7,8. Successful screening programs must be wellorganized, inform the population, achieve good coverage, ensure access to diagnosis and treatment, and maintain guideline-compliant quality and continuous monitoring3. Cervical cancer is thought to be caused by persistent infection with high-risk human papillomaviruses (hrHPVs), primarily HPV-16 and HPV-189. Several studies demonstrated the superiority of population-based screening using primary DNA-HPV testing10, 11. In 2013, the World Health Organization (WHO) recommended replacing cytology-based careening with HPV test-based screening. Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas,(SP) 13098-340, Brazil. *[email: juliotex@unicamp.br](email: juliotex@unicamp.br) [www. nature.com/scientificreports/](www. nature

FAQs

What problem does Brazil’s current cervical cancer screening approach face?

Screening is opportunistic and based on cytology, with low coverage and many diagnoses occurring in advanced stages, limiting mortality impact.

How was the DNA-HPV screening program evaluated in the first round?

The PREVENTIVO program screened 20,551 women using DNA-HPV testing, reporting coverage, compliance, and test outcome distributions over the first-round period.

What did the study find compared with the previous cytology program?

Organized DNA-HPV screening detected more high-grade precursor lesions and cervical cancers earlier than the prior cytology-based program.

Sep 21, 2026

Upload by Theodore