LAUSR

Cervical cancer prevention is based on primary prevention with vaccines against Human Papillomavirus (HPV) and secondary prevention by screening with High‐Risk‐HPV (Hr‐HPV) detection. Since 2017, cervical cancer screening in women aged 25−60 years has been performed in Portugal using Hr‐HPV detection, followed by cytology in Hr‐HPV‐positive cases. Herein we report the prevalence of Hr‐HPV genotypes and cytological abnormalities among 462 401 women (mean age: 43.73 ± 10.79; median age: 45; range: 24−66 years) that participated in the Regional Cervical Cancer Screening Program of the Northern Region of Portugal, performed between August 2016 and December 2021. Overall, we describe a prevalence rate of 12.50% for Hr‐HPV varying from 20.76% at age 25% to 8.32% at age 64. The five most common Hr‐HPV genotypes identified were HPV‐68 (16.09%), HPV‐31 (15.30%), HPV‐51 (12.96%), HPV‐16 (11.06%), and HPV‐39 (11.01%). The prevalence of Hr‐HPV included in the nonavalent vaccine (HPV‐9valent) was 55.00% ranging from 47.78% to 59.18% across different age groups. Considering positive Hr‐HPV cases, 65.68% had a Negative for Intraepithelial Lesion or Malignancy (NILM) cytology, 20.83% atypical squamous cells of undetermined significance (ASC‐US), 8.85% Low‐Grade Squamous Intraepithelial Lesion (LSIL), 1.65% High‐Grade Squamous Intraepithelial Lesion (HSIL), 2.85% ASC‐H, 0.09% Atypical Glandular Cells, 0.02% Adenocarcinomas, and 0.02% Squamous Cell Carcinoma (SCC). Our analysis revealed that HPV‐9val genotypes were responsible for 52.13% NILM, 59.21% ASC‐US, 55.06% LSIL, 90.14% HSIL, 83.50% ASC‐H, and 100.00% SCC. Furthermore, multiple Hr‐HPV infections (risk ratio [RR] = 1.46; 95% confidence interval [CI] 1.34−1.58), HPV‐16/18 (RR = 5.16; 95% CI 4.75−5.93), or HPV‐9val genotypes (RR = 5.23; 95% CI 4.68−5.85) were associated with a significant risk of developing >  HSIL (p < 0.001). To date, this is the largest study on Hr‐HPV genotyping in cervical cancer screening that includes data from a complete cycle of the screening program. Our findings suggest a high prevalence of HPV‐9valent genotypes and a significant association with an increased risk of developing > HSIL. This constitutes important data for health authorities, which may help define the future of vaccination and cervical cancer screening strategies.