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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
Author(s) -
Zorzi M,
Del Mistro A,
Farruggio A,
Bartolomeis L,
FrayleSalamanca H,
Baboci L,
Bertazzo A,
Cocco P,
Fedato C,
Gennaro M,
Marchi N,
Pe MG,
Cogo C,
Ferro A
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12272
Subject(s) - cervical cancer , test (biology) , human papillomavirus , medicine , oncology , cohort , population , cohort study , cancer , gynecology , environmental health , biology , paleontology
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.