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Eur J Cancer. 2016 Nov;68:148-155. doi: 10.1016/j.ejca.2016.09.008. Epub 2016 Oct 15.

Impact of variations in triage cytology interpretation on human papillomavirus-based cervical screening and implications for screening algorithms.

Author information

1
Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy. Electronic address: guglielmo.ronco@cpo.it.
2
Institute for Cancer Study and Prevention (ISPO), Florence, Italy.
3
International Agency for Research on Cancer (IARC), Lyon, France.
4
Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy; Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Piemonte Orientale, Novara, Italy.
5
Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy.
6
Veneto Oncology Institute IRCCS, Padua, Italy.
7
Registro Tumori del Veneto, Regione Veneto, Padova, Italy.
8
Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Italy; Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy.
9
CPO Piemonte, Italy.
10
ASL Valle Camonica Sebino, Italy.
11
Ospedale S. Chiara, Trento, Italy.
12
Regione Veneto, Italy.
13
ULSS 12 Venezia, Italy.
14
ULSS 15 Alta Padovana, Italy.
15
ULSS 16 Padova, Italy.
16
ULSS 17 Este-Monselice, Italy.
17
ULSS 18 Rovigo, Italy.
18
ULSS 19 Adria, Italy.
19
AUSL Reggio Emilia, Italy.
20
ISPO, Firenze, Italy.
21
Regione Lazio, Italy.
22
ASL Roma G, Italy.
23
ASL Latina, Italy.
24
ASL Teramo, Italy.
25
ASL Pescara, Italy.
26
ASL Av-Sulmona-L'Aquila, Italy.
27
ASL Lanciano-Vasto-Chieti, Italy.

Abstract

BACKGROUND:

Women positive to human papillomavirus (HPV+) testing at cervical screening need triage, typically cytology and immediate colposcopy in case of atypical squamous cells of undetermined significance (ASCUS) or worse (ASCUS+) or, in cytology-normal HPV+ women, HPV test repeat after 1 year and colposcopy referral if still HPV+. Our hypothesis was that substantial variations in triage positivity and sensitivity may produce little variation in overall referral to colposcopy and on sensitivity of the entire screening process.

METHODS:

Centre- and age-aggregated data from 72,869 women aged 35-64 years were derived from 10 organised screening programmes which have piloted HPV screening in Italy since 2012. Overall colposcopy referral was evaluated as a function of immediate colposcopy referral and overall CIN2+ detection as a function of the proportion of all CIN2+ detected by immediate referral (a proxy of cytology's sensitivity). We fitted additive regression models, adjusted for centre, age, compliance to HPV retesting and to colposcopy, by generalised estimation equations.

RESULTS:

The proportion of HPV+ women directly referred to colposcopy varied across programmes (20-57%; average 37%) and so did CIN2+ detection (49-94%; average 77%). Overall, 63% (range 41-75%) of HPV+ were referred to colposcopy either immediately or at HPV repeat. An absolute 10% increase in immediate colposcopy referral resulted in 4.2% (95% CI: 3.3-5.1%) increase in overall referral. An absolute 10% increase in cytology's sensitivity resulted in a 1.1% (95% CI: 0.1-2.0%) increase in overall CIN2+ detection.

CONCLUSIONS:

Repeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged.

KEYWORDS:

Cervical cancer; Cytology; Human papillomavirus; Screening; Triage

PMID:
27755998
DOI:
10.1016/j.ejca.2016.09.008
[Indexed for MEDLINE]
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