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- Title
A 3-year interval is too short for re-screening women testing negative for human papillomavirus: a population-based cohort study.
- Authors
Zorzi, M; Frayle, H; Rizzi, M; Fedato, C; Rugge, M; Penon, MG; Bertazzo, A; Callegaro, S; Campagnolo, M; Ortu, F; Del Mistro, A; Baracco, Susanna; Baboci, Lorena; Amadori, Alberto; Montaguti, Adriana; Turrin, Anna; Farruggio, Angelo; Cocco, Patrizia; Tumaini, Lucio; Gerace, Pierfrancesco
- Abstract
<bold>Objective: </bold>To compare the results from an initial negative human papillomavirus (HPV) test with re-screening after 3 years in women attending two HPV-based screening programmes.<bold>Design: </bold>Population-based cohort study.<bold>Setting: </bold>Two cervical service screening programmes in Italy.<bold>Population: </bold>Women aged 25-64 years invited to screening from April 2009 to October 2015.<bold>Methods: </bold>Eligible women were invited to undergo an HPV test. Those with a negative HPV test went on to the next screening round 3 years later. Cytology triage was performed for HPV+ (HPV by Hybrid Capture 2) samples, with immediate colposcopy (if abnormal) and HPV re-testing 1 year later (if negative).<bold>Main Outcome Measures: </bold>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+.<bold>Results: </bold>We present the results from 48 751 women at the first screening and 22 000 women at re-screening 3 years later. The response rate was slightly higher at the second screening (74.5 versus 72.1% at the first screening; referral rate, RR 1.11; 95% confidence interval, 95% CI, 1.07-1.14). Compared with the first screening, we observed a significant reduction at the second screening in terms of HPV positivity (RR 0.55, 95% CI 0.51-0.60), referral rate to colposcopy (RR 0.47, 95% CI 0.41-0.53), CIN2+ detection rate (RR 0.24, 95% CI 0.13-0.39), and positive predictive value (PPV) for CIN2+ at colposcopy (RR 0.51, 95% CI 0.29-0.87).<bold>Conclusions: </bold>The very low frequency of disease and inadequate PPV at colposcopy indicate that a 3-year interval after a negative HPV test is too short.<bold>Tweetable Abstract: </bold>Three years after a negative HPV the frequency of cervical disease is so low that re-screening is inefficient.
- Subjects
PAPILLOMAVIRUS disease diagnosis; DIAGNOSIS of diseases in women; MEDICAL screening; POPULATION-based case control; COHORT analysis; CERVIX uteri; COLPOSCOPY; COMPARATIVE studies; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MEDICAL referrals; MENTAL health surveys; PAP test; PAPILLOMAVIRUS diseases; PAPILLOMAVIRUSES; RESEARCH; TIME; CERVIX uteri tumors; EVALUATION research; PREDICTIVE tests; EARLY detection of cancer; DISEASE complications; DIAGNOSIS
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2017, Vol 124, Issue 10, p1585
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.14575