Screening for cervical cancer with the human papillomavirus test in an area of central Italy with no previous active cytological screening programme

Massimo Confortini, Paolo Giorgi Rossi, Paolo Barbarino, Anna Maria Passarelli, Letizia Orzella, Maria Concetta Tufi

Research output: Contribution to journalArticle

Abstract

Objective: We report performance indicators and costs of the first round of a cervical cancer screening programme based on the human papillomavirus (HPV)-DNA test. Methods: We implemented a demonstration study using HPV as the primary test in Guidonia, Italy (90,000 inhabitants). All women aged 25-64 were invited to undergo a Hybrid Capture II highrisk HPV test. Two cervical samplings, smear and liquid, were taken. The smear was dyed and interpreted only for HPV-positive (HPV+) women. Women with a non-negative Pap smear were referred for colposcopy, women HPV+/cytology negative were referred to one-year follow-up with HPV. A cost-analysis indicated the price at which the HPV-based and cytological screening would cost the same per screened woman and per lesion found. Results: Of 24,000 women invited, 7639 accepted and 427 (5.6%) were HPV+; 141 (34%) of these had a non-negative Pap test, and 20 cervical intraepithelial neoplasia (CIN) 2 or higher were found ( positive predictive value 15%). Compliance to one-year follow-up was 58% (166/286); 90 (54%) were HPV-positive and five additional lesions were found ( positive predictive value 9%; overall detection rate 3.4/1000). The cost analysis showed that at a price of 8.3 euros per HPVDNA test, the strategy using HPV as primary test followed by cytological triage would cost the same per screened woman, while at a price of 12.7 euros it would have the same cost per CIN2+ found. Conclusion: The workload for management of positive women was similar to cytological screening. Low compliance to one-year follow-up was the main barrier to effectiveness. The price of HPV test should be about 9 euros to maintain the same screening budget, and can go as high as 13 euros per lesion found.

Original languageEnglish
Pages (from-to)79-86
Number of pages8
JournalJournal of Medical Screening
Volume17
Issue number2
DOIs
Publication statusPublished - Jun 2010

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy

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