Grand Rounds

How Frequently Should We Re-Screen Following a Negative HPV result?

BACKGROUND AND PURPOSE:

Studies have demonstrated higher sensitivity for high-risk HPV tests vs cytology
Zorzi et al. (BJOG, 2017) compared the results from an initial negative HPV test with re-screening CIN2+ results at 3 year follow-up

Population-based cohort study
- Women aged 25-64 years who received an HPV test
Protocol
- Initial screen: Both HPV testing (Hybrid Capture 2; Qiagen) and conventional smear (except for women who had never been sexually active, who underwent a Pap smear alone)
  - HPV-: re-screening at 3 years
- If HPV+, cyto ‘triage’ performed
  - HPV+/cyto-: re-screening at 1 year
  - HPV+/cyto+: referred for colposcopy
- If still HPV+at 1 year or was positive at the 3 year rescreening, patient was referred for colposcopy
Main outcomes
- Participation rate | Positivity at HPV and at triage | Referral rate to colposcopy | PPV for CIN2+ | Detection rate for CIN2+

48,751 initially screened
- 29,694 were HPV- and therefore re-invited for 3 year follow screening (second screening)
Compared with the first screening, the second screening showed significant reduction 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)
- PPV: for CIN2+ at colposcopy: RR 0.51 (95% CI 0.29–0.87)
PPV for CIN2+
- First screening: PPV 14.9%
- Second screening: PPV 7.7%
- Numbers of colposcopies needed to detect one CIN2+
  - First screening: 8.5
  - Second screening: 17.6
- No invasive cancers were detected at the second screening or at 1 year repeat of the first screening
  - There were 6 cancers detected at baseline

Authors acknowledge that PPV is based on local HPV infection rates and, therefore, data may not be generalizable
They conclude that low frequency of disease and low PPV demonstrate that 3 years may be too short a time interval for HPV screening follow up

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