{
  "abstract": "Background: Cervical cancer is largely preventable, yet major gaps persist in detection and timely management of cervical precancer, particularly in low- and middle-income countries. Using data from the ESTAMPA multicentric study, we derived stratified absolute risk estimates for cervical precancer and cancer based on HPV testing, cervical cytology, and colposcopic impression. Methods: ESTAMPA is a multicenter cervical cancer screening study (NCT01881659) that recruited women aged 30–64 years across 12 centres, comprising primary and secondary care facilities, hospitals, laboratories, and universities, across nine Latin American countries: Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay. The aims of the study were (1) to investigate the performance of emerging cervical cancer screening and triage techniques among women 30 years and older and (2) to evaluate the feasibility of different approaches for implementation of organised HPV-based screening programmes. Women were screened with HPV testing and cervical cytology. Those with positive screening results were referred to colposcopy using a standardised protocol including colposcopic impression, directed biopsies, and treatment as indicated. Women with normal colposcopy or histology less than CIN2 were recalled after 18 months for repeat HPV testing and colposcopy if HPV-positive. Absolute risks of histologically confirmed CIN3+ detected at baseline or follow-up were estimated integrating HPV testing, cytology, and colposcopic impression. Findings: Between December 12, 2012, and August 31, 2022, 44,135 women with a valid HPV test were included, of whom 6236 (14.1%) were HPV-positive. Overall, 764 CIN3+ lesions were detected (1.73%; 95% CI 1.61–1.86). CIN3+ risk was 12.0% (747/6236; 95% CI 11.2–12.8) among HPV-positive women compared with 0.04% (17/37,899; 95% CI 0.03–0.07) among HPV-negative women. Among HPV-positive women, risk increased with cervical cytological severity, reaching 62.9% (95% CI 57.1–68.5) for HSIL+, 22.4% (95% CI 18.4–26.8) for LSIL, and 19.1% (95% CI 15.1–23.6) for ASC-US; a positive colposcopic impression further increased CIN3+ risk to 70.2% (95% CI 64.1–75.9), 28.5% (95% CI 23.5–34.0), and 24.5% (95% CI 19.4–30.2), respectively. Among HPV16/18-positive women, CIN3+ risk was 32.8% (95% CI 28.9–37.0) increasing to 46.2% (95% CI 40.8–51.6) when abnormal colposcopy was present. Interpretation: We confirmed a high underlying risk of CIN3+ in the Latin American population, with risk strongly stratified by HPV positivity, increasing cervical cytological severity, and positive colposcopic impression. These estimates may support WHO-aligned cervical screening and risk-based management strategies in LMICs and contribute to accelerating cervical cancer elimination. Funding: International Agency for Research on Cancer (IARC/WHO); UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP/WHO); Pan American Health Organization (PAHO); US National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development and Innovation and National Cancer Institute of Argentina; National Cancer Institute of Colombia; Costa Rican Social Security Fund (CCSS); National Council for Science and Technology (CONACYT), Paraguay; and other local funders.",
  "abstract_shown": true,
  "affiliations": [
    "International Agency for Research on Cancer (IARC/WHO), Lyon, France; University of Lleida, Lleida, Spain; Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain; Corresponding author. International Agency for Research on Cancer (IARC/WHO), Lyon, France.",
    "Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), NIH, Bethesda, MD, USA",
    "Clínica Anglo Americana, Lima, Peru; Escuela de Medicina Humana, Universidad de Piura, Lima, Peru",
    "Instituto Nacional de Cancerología, Bogotá, Colombia; Departamento de Ginecología, Obstetricia y Reproducción Humana, Fundación Santa Fe de Bogotá, Bogotá, Colombia",
    "Instituto Nacional de Cancerología, Bogotá, Colombia",
    "Hospital Monseñor Víctor Manuel Sanabria Martínez, Puntarenas, Costa Rica",
    "Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay",
    "Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, Paraguay",
    "Hospital General San Felipe, Departamento de Oncología, Tegucigalpa, Honduras",
    "Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia",
    "Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina",
    "Centro de Salud Ciudad de la Costa / Hospital Policial, Montevideo, Uruguay",
    "Hospital de Clínicas, Facultad de Medicina, Montevideo, Uruguay",
    "Hospital Antonio Roldán Betancur, Apartadó, Colombia",
    "Instituto de Salud Pública de México, Morelos, Mexico",
    "Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Paraguay",
    "Laboratorio Central de Salud Pública, Asunción, Paraguay",
    "Hospital de Clínicas José de San Martín, Buenos Aires, Argentina",
    "Hospital Universitario Fundación Valle del Lili, Cali, Colombia",
    "Facultad de Ciencias de la Salud, Universidad Tecnológica Centroamericana (UNITEC), Tegucigalpa, Honduras",
    "Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia",
    "Universidad Nacional de Asunción, Instituto de Investigaciones en Ciencias de la Salud, San Lorenzo, Paraguay",
    "Unidad Académica de Anatomía Patológica, Hospital de Clínicas, Montevideo, Uruguay",
    "Laboratorio Central de Salud Pública, Asunción, Paraguay; Dirección de Anatomía Patológica, Ministerio de Salud Publica y Bienestar Socia, Asunción, Paraguay",
    "Laboratorio Patologia AUNA, Peru",
    "Caja Costarricense de Seguro Social, San José, Costa Rica",
    "Liga Contra el Cáncer, Lima, Peru",
    "Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA; Cancer Comprehensive Center, University of Puerto Rico, Puerto Rico",
    "International Agency for Research on Cancer (IARC/WHO), Lyon, France",
    "Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland",
    "Comisión Honoraria de Lucha contra el Cáncer, Montevideo, Uruguay",
    "Instituto Nacional de Enfermedades Infecciosas – ANLIS Malbrán, Buenos Aires, Argentina",
    "Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras",
    "Instituto Nacional de Cancerología, Bogotá, Colombia; Pontificia Universidad Javeriana, Bogotá, Colombia",
    "Pan American Health Organization (PAHO), Washington, DC, USA",
    "Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA",
    "Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, Costa Rica"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 61,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Joan Valls"
    },
    {
      "affs": [
        1
      ],
      "name": "José Jerónimo"
    },
    {
      "affs": [
        2
      ],
      "name": "Gino Venegas"
    },
    {
      "affs": [
        3
      ],
      "name": "Marcela Celis"
    },
    {
      "affs": [
        4
      ],
      "name": "Mauricio González"
    },
    {
      "affs": [
        5
      ],
      "name": "Carlos Sosa"
    },
    {
      "affs": [
        5
      ],
      "name": "Jorge Luis Santin"
    },
    {
      "affs": [
        6
      ],
      "name": "Marina Ortega"
    },
    {
      "affs": [
        7
      ],
      "name": "Ana Soilán"
    },
    {
      "affs": [
        8
      ],
      "name": "Elmer Turcios"
    },
    {
      "affs": [
        8
      ],
      "name": "Jacqueline Figueroa"
    },
    {
      "affs": [
        9
      ],
      "name": "Oscar Lora"
    },
    {
      "affs": [
        9
      ],
      "name": "Alex Montoya"
    },
    {
      "affs": [
        10
      ],
      "name": "Margarita Rodríguez de la Peña"
    },
    {
      "affs": [
        10
      ],
      "name": "Gabriela Natalia Kaznowiecki"
    },
    {
      "affs": [
        11
      ],
      "name": "Andrea Verónica Beracochea"
    },
    {
      "affs": [
        12
      ],
      "name": "Natalia Pérez"
    },
    {
      "affs": [
        13
      ],
      "name": "Josefina Martínez-Better"
    },
    {
      "affs": [
        14
      ],
      "name": "Julio Yamil Jiménez"
    },
    {
      "affs": [
        15
      ],
      "name": "Diana Giménez"
    },
    {
      "affs": [
        16
      ],
      "name": "Maria Liz Bobadilla"
    },
    {
      "affs": [
        17
      ],
      "name": "Laura Fleider"
    },
    {
      "affs": [
        9
      ],
      "name": "Daniel Llanos"
    },
    {
      "affs": [
        18
      ],
      "name": "Juan Carlos Mejía Henao"
    },
    {
      "affs": [
        19
      ],
      "name": "Odessa Henríquez Rivas"
    },
    {
      "affs": [
        20
      ],
      "name": "Carolina Lopez Uran"
    },
    {
      "affs": [
        10
      ],
      "name": "Agustina Saino"
    },
    {
      "affs": [
        6
      ],
      "name": "Ana Soskin"
    },
    {
      "affs": [
        21
      ],
      "name": "Elena Kasamatsu"
    },
    {
      "affs": [
        22
      ],
      "name": "Benedicta Caserta Orona"
    },
    {
      "affs": [
        23
      ],
      "name": "Fatima Muñoz"
    },
    {
      "affs": [
        17
      ],
      "name": "Lucía Cardinal"
    },
    {
      "affs": [
        24
      ],
      "name": "Franco Doimi"
    },
    {
      "affs": [
        25
      ],
      "name": "Diego Guillén"
    },
    {
      "affs": [
        25
      ],
      "name": "Emmanuel González"
    },
    {
      "affs": [
        4
      ],
      "name": "Yuly Salgado"
    },
    {
      "affs": [
        4
      ],
      "name": "Sandra Martínez"
    },
    {
      "affs": [
        26
      ],
      "name": "Yenny Bellido-Fuentes"
    },
    {
      "affs": [
        9
      ],
      "name": "Bettsy Flores"
    },
    {
      "affs": [
        27
      ],
      "name": "Ana Patricia Ortiz"
    },
    {
      "affs": [
        28
      ],
      "name": "Arianis Tatiana Ramírez"
    },
    {
      "affs": [
        28
      ],
      "name": "Maryluz Rol"
    },
    {
      "affs": [
        29
      ],
      "name": "Mariluz Hernandez"
    },
    {
      "affs": [
        17
      ],
      "name": "Silvio Tatti"
    },
    {
      "affs": [
        16
      ],
      "name": "Verónica Villagra"
    },
    {
      "affs": [
        14
      ],
      "name": "Aurelio Cruz-Valdez"
    },
    {
      "affs": [
        20
      ],
      "name": "Gloria Inés Sánchez"
    },
    {
      "affs": [
        30
      ],
      "name": "Guillermo Rodríguez"
    },
    {
      "affs": [
        31
      ],
      "name": "Maria Alejandra Picconi"
    },
    {
      "affs": [
        9
      ],
      "name": "Carolina Terán"
    },
    {
      "affs": [
        32
      ],
      "name": "Annabelle Ferrera"
    },
    {
      "affs": [
        21
      ],
      "name": "Laura Mendoza"
    },
    {
      "affs": [
        24
      ],
      "name": "Alejandro Calderón"
    },
    {
      "affs": [
        33
      ],
      "name": "Raul Murillo"
    },
    {
      "affs": [
        4
      ],
      "name": "Carolina Wiesner"
    },
    {
      "affs": [
        34
      ],
      "name": "Silvana Luciani"
    },
    {
      "affs": [
        1
      ],
      "name": "Nicolas Wentzensen"
    },
    {
      "affs": [
        35
      ],
      "name": "Teresa Darragh"
    },
    {
      "affs": [
        1
      ],
      "name": "Armando Baena"
    },
    {
      "affs": [
        36
      ],
      "name": "Rolando Herrero"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bvzkmqjmpy9vp.bib",
  "cited_by": 0,
  "doi": "10.1016/j.lana.2026.101685",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2667193X26003157",
  "id": "bvzkmqjmpy9vp",
  "issns": [
    "2667-193X"
  ],
  "landing_url": "https://doi.org/10.1016/j.lana.2026.101685",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RA1-1270"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-04",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/bvzkmqjmpy9vp.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T14:20:46Z",
      "native_id": "05c26fc6c1d64c51a143f4ea96b6a2f2",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.lana.2026.101685"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RA1-1270",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Estimating cervical precancer and cancer risk based on HPV testing, cervical cytology and colposcopic impression: results from the ESTAMPA multicentric study in Latin America",
  "title_text": "Estimating cervical precancer and cancer risk based on HPV testing, cervical cytology and colposcopic impression: results from the ESTAMPA multicentric study in Latin America",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T14:20:10Z",
  "url": "https://research.draconitic.com/paper/bvzkmqjmpy9vp",
  "venue": "The Lancet Regional Health. Americas",
  "versions": []
}