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Five‐year risk of CIN 3 after short‐term HPV ‐ DNA negativity in cytology‐negative women: a population‐based cohort study
Author(s) -
Del Mistro A,
Giorgi Rossi P,
Frayle H,
Pasquale L,
Campari C,
Ronco G,
Zorzi M
Publication year - 2019
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 - 10.1111/1471-0528.15893
Subject(s) - medicine , colposcopy , cervical intraepithelial neoplasia , cytology , gynecology , population , hpv infection , obstetrics , cervical cancer , confidence interval , cohort , oncology , cancer , pathology , environmental health
Objective To assess the 5‐year risk of high‐grade lesions in women with a transient high‐risk HPV infection. Design Population‐based cohort study. Setting HPV primary testing within population‐based organised cervical cancer screening programmes. Population Italian women enrolled in seven pilot projects and attending the second round. Methods On the basis of the cytology triage performed on HPV ‐positive women, immediate colposcopy or HPV repeat at 12 months was recommended. Data were collected at the subsequent round 3–4 years after HPV infection clearance. Main outcome measures Rates of HPV infection, CIN 2+ and CIN 3+ detection at subsequent round after HPV clearance, and relative risks ( RR ) in comparison with HPV ‐negative women (with 95% confidence interval). Results Data on 1230 women (1027 aged 25–64 years and 203 aged 35–64 years) have been analysed. Overall compliance with repeat HPV testing was 84%. In comparison with HPV ‐negative women, those with a transient HPV infection had higher proportions of HPV positivity (15% versus 3.7%) and of CIN 2+ lesions (0.87% versus 0.23%) in round two; most of these (7/10) were CIN 2; no cancers were detected, and CIN 3 occurred in 3/1230 (0.24%). Conclusions HPV ‐based protocols for cervical cancer screening allow long intervals for HPV ‐negative women; it is important to monitor the clinical outcome in the women with transient high‐risk HPV infection. CIN 3 detection is similar to that observed in routine European cytology‐based screening programmes ( CIN 3+: 2.7‰); 5‐year intervals may provide reasonable protection but longer intervals are not recommended. Tweetable abstract A screening interval of 5 years (but no longer) appears safe in women with transient HPV detection.