Use of a high-risk human papillomavirus DNA test as the primary test in a cervical cancer screening programme: a population-based cohort study
Article first published online: 21 JUN 2013
© 2013 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 120, Issue 10, pages 1260–1268, September 2013
How to Cite
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 2013;120:1260–1268., , , , , , , , , , , , , .
- Issue published online: 13 AUG 2013
- Article first published online: 21 JUN 2013
- Manuscript Accepted: 20 FEB 2013
- Foundation Cassa di Risparmio di Padova e Rovigo
- Cervical cancer screening;
- human papillomavirus;
- HPV DNA test
To present the results of the first 2 years of a human papillomavirus (HPV) test-based screening programme outside the research context.
Population-based cohort study.
A cervical service screening programme in Italy.
Women aged 25–64 years invited to screening from April 2009 to April 2011.
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+.
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%).
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.