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

METHODS:

• 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+

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

A 3 year interval is too short for re-screening women testing negative for human papillomavirus: a population-based cohort study

Related ObG Topics:

USPSTF Releases Final Cervical Cancer Screening Guidelines – Including ‘HPV Only’ Option

Screening for Cervical Cancer in the Woman at Average Risk

HPV Vaccine Recommendations Including Guidance for Ages 27 to 45

HPV Testing vs PAP Smear: Results of the HPV FOCAL Trial

What to Do with a Normal Pap but Positive HPV, ASC-US, LSIL and ASC-H