Population-Based HPV Screening Program Evaluated in Van, Türkiye

A retrospective, record-based evaluation of the population-based cervical cancer screening programme in Van Province, eastern Türkiye, demonstrated that screening activity varied substantially across recent years while observed programme test positivity steadily decreased. Reporting in BMC Women’s Health, researchers Adem Yağan and Muhammed Tosun evaluated the regional initiative using aggregated programme data from 2022 through the first two months of 2026 alongside individual-level records for HPV-positive women identified between 2023 and 2025. Across the analyzed periods, observed programme test positivity fell from 3.17 percent in 2022 to 1.80 percent in 2025, demonstrating a statistically significant temporal downward trend.

The authors explained that province-level evidence regarding the practical implementation of population-based human papillomavirus (HPV) screening in eastern Türkiye has remained limited. To address this gap in empirical knowledge, the investigation was designed to describe screening activity relative to the target population defined by the health programme itself. In addition to measuring operational testing volume and programme positivity over time, the study set out to document recorded genotype patterns, examine histopathological diagnoses, and evaluate the completeness of follow-up care information captured within the provincial screening infrastructure.

In their methodological framework, the researchers calculated annual screening activity ratios by comparing recorded screening counts directly against programme-defined target populations. Temporal changes in programme HPV test positivity across the evaluation years were formally analyzed using the Cochran-Armitage trend test, which confirmed a statistically significant reduction with a p-value of less than 0.001. In addition, the authors characterized age distributions and recorded genotype patterns among women testing positive for the virus. Histopathological diagnoses and referral-related data were evaluated strictly as available programme records because the administrative system lacked individual-level linkage and complete care pathway denominators.

Across the evaluated study periods, annual screening records summed to a total of 94,123 entries, from which 2,078 HPV-positive results were identified, establishing an overall programme positivity rate of 2.21 percent. Screening coverage relative to target populations fluctuated markedly throughout the surveillance period. The annual screening activity ratio climbed sharply from 17.1 percent in 2022 to a peak of 95.5 percent in 2024, but subsequently decreased to 67.9 percent in 2025. Simultaneously, annual programme test positivity declined consistently from 3.17 percent in 2022 to 1.80 percent in 2025, demonstrating distinct year-to-year shifts in both participation metrics and diagnostic yield.

Detailed individual-level data were available for 1,810 HPV-positive women identified between 2023 and 2025, who had a mean age of 44.5 years. Type-specific analysis of recorded viral genotypes indicated that HPV16 was the most frequently documented specific genotype, detected in 36.4 percent of cases. When high-risk strains were evaluated together, HPV16, HPV18, or both genotypes were recorded in 43.8 percent of the women. Moreover, at least one recorded oncogenic genotype targeted by the nine-valent HPV vaccine was identified in 55.4 percent of the positive cohort, while 16.5 percent of the women had multiple specifically identified genotypes recorded in their programme files.

Administrative records from the programme documented 394 histopathological diagnoses during the 2023–2025 period, an aggregate that included three records of invasive cervical cancer. However, the evaluation highlighted major limitations in the registry’s capacity to monitor clinical pathways. Because individual-level linkage was unavailable across the administrative datasets, the existing records did not allow researchers to calculate rates of patient referral, hospital attendance, colposcopy examinations, diagnostic biopsies, or completed treatments.

In their conclusions, Yağan and Tosun emphasized that the observed decline in programme test positivity between 2022 and 2025 should not be interpreted as evidence of reduced HPV prevalence in the broader population. They noted that although recorded genotype findings were dominated by HPV16, variations in type-specific reporting over time limit meaningful temporal interpretation of viral patterns. To overcome these operational shortcomings, the authors stressed that improved standardization of genotype reporting alongside individual-level record linkage across screening, referral, clinical diagnosis, histopathology, and treatment is necessary to strengthen programme monitoring and evaluation.

Subject of Research: Population-based HPV screening program evaluation in Van, Türkiye

Article Title: Program-level evaluation of population-based HPV screening in Van, Türkiye: screening activity, test positivity, genotype distribution and follow-up data capture in a retrospective record-based study

Article References: Yağan, A., & Tosun, M. (2026). Program-level evaluation of population-based HPV screening in Van, Türkiye: screening activity, test positivity, genotype distribution and follow-up data capture in a retrospective record-based study. BMC Women's Health. https://doi.org/10.1186/s12905-026-05029-2

Image Credits: AI Generated

DOI: 10.1186/s12905-026-05029-2

Keywords: HPV screening, human papillomavirus, cervical cancer, Van Province, Türkiye, cancer screening, epidemiology, genotype distribution, Program-level, evaluation, population-based, screening