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

2013; Wiley; Volume: 120; Issue: 10 Linguagem: Inglês

10.1111/1471-0528.12272

1471-0528

Manuel Zorzi, Annarosa Del Mistro, Angelo Farruggio, L de' Bartolomeis, Helena Frayle, Lorena Baboçi, A Bertazzo, Pier Luigi Cocco, Chiara Fedato, Maria Laura Gennaro, Natalina Marchi, MG Penon, Carla Cogo, António Ferro,

Genital Health and Disease

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 I taly. Population Women aged 25–64 years invited to screening from A pril 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 P ap 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+ ( CIN 2+) at colposcopy, and detection rate for CIN 2+. Results Participation increased compared with the previous P ap programme (60.6 versus 43.9%). The HPV positivity rate was 7.0; 39.6% of P ap 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 P ap 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 CIN 2+ was 4.5 versus 1.5% of the P ap 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 CIN 2+. The most critical aspects were the reading of cytology in women that were positive for HPV and the increased workload at colposcopy.