Evidence map›Paper›PMID 41653081›Full record

ArticleInternational journal of cancer2026

Health care policy trial of primary human papillomavirus-based cervical screening in Denmark: Comparison of three triage algorithms.

Jeppe Bennekou Schroll, Jesper Bonde, Elsebeth Lynge, Marianne Waldstrøm, Petra Hall Viborg, Anna Frandsen, Rikke Holst Andersen, Susanne Merete Nielsen, Bettina Kjær Kristensen, Doris Schledermann and 2 more

Abstract readComparative Study
In one paragraph

Article in International journal of cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Jeppe Bennekou SchrollCochrane Denmark & Centre for Evidence-Based Medicine Odense (CEBMO), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.ORCID https://orcid.org/0000-0002-1776-0562
Jesper BondeMolecular Pathology Laboratory, Department of Pathology, afs. 134, AHH-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark.ORCID https://orcid.org/0000-0003-4853-6747
Elsebeth LyngeDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark.ORCID https://orcid.org/0000-0003-4785-5236
Marianne WaldstrømDepartment of Pathology, Aarhus University Hospital, Aarhus, Denmark.
Petra Hall ViborgThe Danish Healthcare Quality Institute (DHQI), Rigshospitalet, Copenhagen, Denmark.
Anna FrandsenDepartment of Pathology, Aalborg University Hospital, Ålborg, Denmark.
Rikke Holst AndersenDepartment of Pathology, Region Hospital Randers, Randers, Denmark.
Susanne Merete NielsenDepartment of Pathology, Region Zealand, Næstved, Denmark.
Bettina Kjær KristensenUNICCA, University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.
Doris SchledermannDepartment of Pathology, Lille Baelt Hospital, Vejle, Denmark.
Berit AndersenDepartment of Clinical Medicine, Aarhus University, Aarhus, Denmark.
National Danish Cervical Cancer Screening Steering Committee

Funding

Danish Regions
6 · The paper itself

Abstract

Women 30-59 years were allocated to either HPV-based screening or cytology-based screening in this Danish health care policy trial. The optimal triage of HPV-positive women could be a combination of cytology triage with HPV genotyping or p16/Ki67 staining. We report number of screen positives, colposcopies, and cervical lesions of three different triage algorithms (p16/Ki67, HPV16/18, or HPV16/18/31/33/52) in HPV-positive women with low-grade cytological abnormalities. We included 178,317 women with a sample in 2021 of which 91,517 were screened with HPV and 86,800 with cytology. All women were followed for 18 months. Almost three times as many women screened positive with HPV-based screening compared to cytology-based screening (RR 2.99, 95% 2.93-3.05) and colposcopies derived from the screening program were also more common (RR 1.68, 95% 1.63-1.73). p16/Ki67 triage resulted in more colposcopies (RR 1.86, 95% 1.76-1.95) than HPV16/18 (RR 1.54, 95% 1.44-1.65) and HPV16/18/31/33/52 (RR 1.63, 95% 1.55-1.71). The excess in colposcopy referrals was reduced when non-screening-derived colposcopies were included (intention-to-treat). Nevertheless, more women with CIN2 or worse were detected in the HPV group than in the cytology group per screened woman; in the p16/Ki67 triage group (RR 1.65, 95% 1.54-1.77), in the HPV16/18 group (RR 1.36, 95% 1.23-1.50), and in the HPV16/18/31/33/52 group (RR 1.48, 95% 1.37-1.59). HPV-based screening, as compared with cytology screening, resulted in more screen positives, but all three triage algorithms substantially reduced the excess number of referrals to colposcopy. p16/Ki67 compared to triage with HPV16/18 may detect more cervical lesions.

Indexed as

AlgorithmsEarly Detection of CancerPapillomavirus InfectionsTriageUterine Cervical DysplasiaUterine Cervical NeoplasmsAdultColposcopyCyclin-Dependent Kinase Inhibitor p16DenmarkFemaleGenotypeHumansKi-67 AntigenMass ScreeningMiddle AgedCyclin-Dependent Kinase Inhibitor p16Ki-67 Antigencervical cancer screeningdual stainhealth care policyHPVHPV genotypetriage

Identifiers

PMID41653081
PMCPMC13106925

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.