HPV screening performance indicators in women who previously tested HPV-negative: The second round of Vallecamonica screening programme, Northern Italy. (December 2020)

• Record Type: Journal Article
• Authors: Pasquale, Luigi; Rossi, Paolo G; Carozzi, Francesca; Domenighini, Serena; Ruggeri, Cristina; Cecconami, Lorella; Morana, Corrado; Chiaramonte, Margherita; Chiudinelli, Daniela; Piccolomini, Manuela; Marchione, Roberta; Confortini, Massimo
• Is Part Of: Journal of medical screening. Volume 27:Number 4(2020)
• Page Start: 207
• Page End: 214
• Publication Date: 2020-12
• Subjects: Human papilloma virus -- HPV DNA test -- mass screening -- cervical cancer -- cervical intraepithelial neoplasia; Medical screening -- Periodicals; 362.177
• DOI: 10.1177/0969141320905325
• Languages: English
• ISSNs: 0969-1413

Abstract

Objective: To present performance indicators from the second round of the Vallecamonica-Sebino HPV screening programme in women who had tested negative about four years earlier (mean 45 months). Methods: From 2010 to 2012, the target female population (aged 25–64) was invited to the first HPV screening round. In 2013–2017, women were rescreened for the second round. HPV-negative women at the first round were initially rescreened after three years. The interval was gradually increased to five years. HPV-positive women underwent cytology triage: positives were referred to colposcopy and negatives to repeat testing after one year. If HPV was persistently positive, women were referred to colposcopy, if negative, to normal interval rescreening. Results: In the second round, of 13, 824 previously HPV-negative women, 598 were HPV-positive (4.3%), of whom 297 were positive at cytology triage. Of those referred to one-year HPV test, 291 complied (98.0%), 133 (50.2%) of whom were persistently positive. Total referral was 3.1% compared with 6.6% in the first round (age-adjusted relative referral 0.59, 95% CI: 0.53–0.65). There were 24 cervical intraepithelial neoplasia 2+ (three cervical intraepithelial neoplasia 3+). Detection was 0.17%, compared with 0.9% in the first round. Age-adjusted relative detections were 0.25 (95% CI: 0.16–0.39) and 0.18 (95% CI: 0.05–0.61) for cervical intraepithelial neoplasia 2+ and cervical intraepithelial neoplasia 3+, respectively. Positive predictive value was 5.7%, compared with 14.6% in the first round. Conclusions: At second round, referral was half that at first round, while cervical intraepithelial neoplasia 2+ detection decreased nine-fold. Consequently, positive predictive value decreased dramatically. Rescreening four years after an HPV-negative test makes the process inefficient due to the low prevalence of lesions.