Estimating cervical precancer and cancer risk based on HPV testing, cervical cytology and colposcopic impression: results from the ESTAMPA multicentric study in Latin America

@article{valls2026estimating,
  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}},
  author = {Joan Valls and José Jerónimo and Gino Venegas and Marcela Celis and Mauricio González and Carlos Sosa and Jorge Luis Santin and Marina Ortega and Ana Soilán and Elmer Turcios and Jacqueline Figueroa and Oscar Lora and Alex Montoya and Margarita Rodríguez de la Peña and Gabriela Natalia Kaznowiecki and Andrea Verónica Beracochea and Natalia Pérez and Josefina Martínez-Better and Julio Yamil Jiménez and Diana Giménez and Maria Liz Bobadilla and Laura Fleider and Daniel Llanos and Juan Carlos Mejía Henao and Odessa Henríquez Rivas and Carolina Lopez Uran and Agustina Saino and Ana Soskin and Elena Kasamatsu and Benedicta Caserta Orona and Fatima Muñoz and Lucía Cardinal and Franco Doimi and Diego Guillén and Emmanuel González and Yuly Salgado and Sandra Martínez and Yenny Bellido-Fuentes and Bettsy Flores and Ana Patricia Ortiz and Arianis Tatiana Ramírez and Maryluz Rol and Mariluz Hernandez and Silvio Tatti and Verónica Villagra and Aurelio Cruz-Valdez and Gloria Inés Sánchez and Guillermo Rodríguez and Maria Alejandra Picconi and Carolina Terán and Annabelle Ferrera and Laura Mendoza and Alejandro Calderón and Raul Murillo and Carolina Wiesner and Silvana Luciani and Nicolas Wentzensen and Teresa Darragh and Armando Baena and Rolando Herrero},
  journal = {The Lancet Regional Health. Americas},
  year = {2026},
  month = nov,
  doi = {10.1016/j.lana.2026.101685},
  url = {https://doi.org/10.1016/j.lana.2026.101685},
  note = {CC BY},
}

TY  - JOUR
TI  - Estimating cervical precancer and cancer risk based on HPV testing, cervical cytology and colposcopic impression: results from the ESTAMPA multicentric study in Latin America
AU  - Joan Valls
AU  - José Jerónimo
AU  - Gino Venegas
AU  - Marcela Celis
AU  - Mauricio González
AU  - Carlos Sosa
AU  - Jorge Luis Santin
AU  - Marina Ortega
AU  - Ana Soilán
AU  - Elmer Turcios
AU  - Jacqueline Figueroa
AU  - Oscar Lora
AU  - Alex Montoya
AU  - Margarita Rodríguez de la Peña
AU  - Gabriela Natalia Kaznowiecki
AU  - Andrea Verónica Beracochea
AU  - Natalia Pérez
AU  - Josefina Martínez-Better
AU  - Julio Yamil Jiménez
AU  - Diana Giménez
AU  - Maria Liz Bobadilla
AU  - Laura Fleider
AU  - Daniel Llanos
AU  - Juan Carlos Mejía Henao
AU  - Odessa Henríquez Rivas
AU  - Carolina Lopez Uran
AU  - Agustina Saino
AU  - Ana Soskin
AU  - Elena Kasamatsu
AU  - Benedicta Caserta Orona
AU  - Fatima Muñoz
AU  - Lucía Cardinal
AU  - Franco Doimi
AU  - Diego Guillén
AU  - Emmanuel González
AU  - Yuly Salgado
AU  - Sandra Martínez
AU  - Yenny Bellido-Fuentes
AU  - Bettsy Flores
AU  - Ana Patricia Ortiz
AU  - Arianis Tatiana Ramírez
AU  - Maryluz Rol
AU  - Mariluz Hernandez
AU  - Silvio Tatti
AU  - Verónica Villagra
AU  - Aurelio Cruz-Valdez
AU  - Gloria Inés Sánchez
AU  - Guillermo Rodríguez
AU  - Maria Alejandra Picconi
AU  - Carolina Terán
AU  - Annabelle Ferrera
AU  - Laura Mendoza
AU  - Alejandro Calderón
AU  - Raul Murillo
AU  - Carolina Wiesner
AU  - Silvana Luciani
AU  - Nicolas Wentzensen
AU  - Teresa Darragh
AU  - Armando Baena
AU  - Rolando Herrero
PY  - 2026
DA  - 2026/11/04
JO  - The Lancet Regional Health. Americas
DO  - 10.1016/j.lana.2026.101685
UR  - https://doi.org/10.1016/j.lana.2026.101685
AB  - 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.
SN  - 2667-193X
ER  -