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Cervical cancer screening by cytology and human papillomavirus testing during pregnancy in french women with poor adhesion to regular cervical screening

In France, cervical screening is opportunistic and approximately 40% of women do not attend regular screening programs. The aim of this study was (1) to assess the prevalence of human papillomavirus (HPV) cervical infection and of cytological abnormalities in a population of young pregnant women with poor adherence to cervical cancer screening and (2) to evaluate the adherence to a screening strategy combining HPV testing and cytology during pregnancy. For this purpose, pregnant women benefited from a cervical smear associated with HPV DNA detection. High‐risk HPV types were detected and identified using the HC2 assay and the INNO‐LiPA HPV genotyping Extra assay. Two hundred forty‐seven women (mean age 26.6 ± 5.1 years) were enrolled. Among them, 76.8% did not attend regular cervical cancer screening programs. High‐risk HPV types were detected in 50 (20.2%) samples, HPV 16 being the most frequent (N = 12; 14.5%), with multiple HPV infection in 17 samples (27%). Nine (3.6%) abnormal cervical smears were diagnosed. Follow‐up of women with abnormal cytology and/or infection with high‐risk HPV was obtained in 29 cases (55.8%), showing 12 persistent high‐risk HPV infections. Nine women had colposcopy with a final diagnosis of four normal cervixes, three cervical intraepithelial neoplasia grade 1 and two cervical intraepithelial neoplasia grade 2. Overall, women adherence to the free post‐partum follow‐up visit was 53.5%. This study suggests that a screening program combining HPV testing with cervical cytology during pregnancy may be one option to target young women with poor adhesion to regular cervical cancer screening. J. Med. Virol. 86:536–545, 2014. © 2013 Wiley Periodicals, Inc.