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Impact of the transition to HPV-based primary screening in Portugal's organized cervical cancer screening program

2026-06Artigo científico Acesso aberto
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dc.contributor.authorSousa, Rita
dc.contributor.authorFonseca-Moutinho, José Alberto
dc.contributor.authorGomes, Fábio
dc.contributor.authorLoureiro, Fernanda
dc.contributor.authorGoes, Ana Rita
dc.contributor.authorSoares, Patrícia
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - Pólo ENSP
dc.contributor.institutionCentro de Investigação em Saúde Pública (CISP/PHRC)
dc.contributor.institutionEscola Nacional de Saúde Pública (ENSP)
dc.contributor.institutionLaboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP)
dc.contributor.pblElsevier
dc.date.accessioned2026-07-06T14:43:02Z
dc.date.available2026-07-06T14:43:02Z
dc.date.issued2026-06
dc.descriptionPublisher Copyright: © 2026 The Authors.
dc.description.abstractObjectives To evaluate the impact of transitioning from cytology to primary human papillomavirus (HPV) testing on cervical cancer screening (CCS) performance in Portugal's Central Region. Study design Retrospective, population-based evaluation using a controlled interrupted time-series (CITS) approach. Methods CCS registry data (2014–2023) were analyzed in six-month intervals. Three performance indicators (participation, test positivity, and priority referrals) were modeled using negative binomial regression with appropriate offsets. A COVID-19 covariable (national lockdown, March–June 2020) adjusted for the temporary suspension of screening services. The organized breast cancer screening (BCS) program served as an external control to distinguish CCS-specific effects from system-wide temporal fluctuations. Results The analysis included 594,074 CCS and 888,184 BCS screening episodes. Following HPV implementation, CCS evolved differently from the control group across all outcomes. Priority referrals showed the strongest effect, with a four-fold immediate increase in CCS not observed in BCS (IRR: 4.31; 95% CI: 3.89-4.79). Participation and test positivity also diverged between programs, although with smaller magnitude changes. Post-intervention trends differed across all outcomes, although the COVID-19 pandemic, occurring shortly after implementation, complicates the interpretation of temporal patterns. Conclusions Transition to HPV-based screening was associated with changes in screening processes, including increased identification of high-risk cases requiring priority referral while maintaining participation. By incorporating an external control, the CITS approach strengthens attribution of observed effects to HPV implementation rather than background system dynamics. These findings support HPV-based screening within organized programs and highlight its role in improving risk stratification and program performance.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1449044
dc.identifier.doi10.1016/j.puhip.2026.100792
dc.identifier.issn2666-5352
dc.identifier.otherPURE: 167264867
dc.identifier.otherPURE UUID: 379f18c5-b47f-4269-b0a0-5c03c6bfd68c
dc.identifier.otherScopus: 105037714203
dc.identifier.otherPubMed: 42111615
dc.identifier.otherPubMedCentral: PMC13157080
dc.identifier.otherWOS: 001765265900001
dc.identifier.urihttp://hdl.handle.net/10362/204361
dc.identifier.urlhttps://www.scopus.com/pages/publications/105037714203
dc.language.isoeng
dc.peerreviewedyes
dc.subjectEarly detection of cancer
dc.subjectHealth policy evaluation
dc.subjectHPV DNA tests
dc.subjectInterrupted time series analysis
dc.subjectMass screening
dc.subjectUterine cervical neoplasms
dc.subjectHealth Policy
dc.subjectPublic Health, Environmental and Occupational Health
dc.subjectSDG 3 - Good Health and Well-being
dc.titleImpact of the transition to HPV-based primary screening in Portugal's organized cervical cancer screening programen
dc.title.subtitleA controlled interrupted time-series analysis (2014-2023)en
dc.typejournal article
degois.publication.titlePublic Health in Practice
degois.publication.volume11
dspace.entity.typePublication
rcaap.rightsopenAccess

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