Use of a high-risk human papillomavirus DNA test as the primary test in a cervical cancer screening programme: A population-based cohort study

M. Zorzi, A. Del Mistro, A. Farruggio, L. De'Bartolomeis, H. Frayle-Salamanca, L. Baboci, A. Bertazzo, P. Cocco, C. Fedato, M. Gennaro, N. Marchi, M. G. Penon, C. Cogo, A. Ferro

Research output: Contribution to journalArticle

Abstract

Objective: To present the results of the first 2 years of a human papillomavirus (HPV) test-based screening programme outside the research context. Design: Population-based cohort study. Setting: A cervical service screening programme in Italy. Population: Women aged 25-64 years invited to screening from April 2009 to April 2011. Methods: Eligible women were invited to undergo an HPV test: those with a negative HPV test went on to the next screening episode; those with a positive HPV went on to triage with a Pap smear. Women with positive cytology (i.e. positive for atypical squamous cells of undetermined significance or worse, ASC-US+) were referred to colposcopy, whereas those with negative cytology were referred to repeat HPV testing 1 year later. Main outcome measures: Participation rate, positivity at HPV and at triage, referral rate to colposcopy, positive predictive value for cervical intraepithelial neoplasia grade 2+ (CIN2+) at colposcopy, and detection rate for CIN2+. Results: Participation increased compared with the previous Pap programme (60.6 versus 43.9%). The HPV positivity rate was 7.0; 39.6% of Pap smears were scored as positive, and therefore 2.8% of the women screened were referred for immediate colposcopy. The compliance of women who scored positive for HPV and negative for Pap for repeat HPV testing at 12 months was 78.6%, and the HPV positivity rate was 56.6%. The overall referral rate to colposcopy was 4.6%. The overall detection rate for CIN2+ was 4.5 versus 1.5% of the Pap programme (25-34 years, 8.2%; 35+ years, 3.6%). Conclusions: Compared with the traditional Pap test, the HPV programme recorded a higher response to invitation and an increased DR for CIN2+. The most critical aspects were the reading of cytology in women that were positive for HPV and the increased workload at colposcopy.

Original languageEnglish
Pages (from-to)1260-1268
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume120
Issue number10
DOIs
Publication statusPublished - Sep 2013

Keywords

  • Cervical cancer screening
  • HPV DNA test
  • human papillomavirus

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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    Zorzi, M., Del Mistro, A., Farruggio, A., De'Bartolomeis, L., Frayle-Salamanca, H., Baboci, L., Bertazzo, A., Cocco, P., Fedato, C., Gennaro, M., Marchi, N., Penon, M. G., Cogo, C., & Ferro, A. (2013). Use of a high-risk human papillomavirus DNA test as the primary test in a cervical cancer screening programme: A population-based cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 120(10), 1260-1268. https://doi.org/10.1111/1471-0528.12272