Management of HPV‐positive women in cervical screening using results from two consecutive screening rounds

• Published in: International journal of cancer Vol. 144; no. 9; pp. 2339 - 2346
• Main Authors: Polman, Nicole J., Veldhuijzen, Nienke J., Heideman, Daniëlle A.M., Snijders, Peter J.F., Meijer, Chris J.L.M., Berkhof, Johannes
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.05.2019; Wiley Subscription Services, Inc
• Subjects: Cancer; cancer screening; Cellular biology; Cervical cancer; cervical intraepithelial neoplasia (CIN); Cervix; Colposcopy; Cytology; Data processing; Genotyping; high‐risk human papillomavirus (HPV); Human papillomavirus; Medical research; Medical screening; triage; cancer screening; cervical cancer; triage; cervical intraepithelial neoplasia (CIN); high-risk human papillomavirus (HPV)
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.32004

We studied whether triage of human papillomavirus (HPV)‐positive women participating in an HPV‐based screening programme can be improved by including the HPV result at the previous screen in the triage algorithm. We analyzed data of a subgroup of 366 women from the POBASCAM trial, screened by cytology and HPV cotesting. Women were included if they tested HPV‐positive in the second HPV‐based screening round. We evaluated the clinical performance of 16 strategies, consisting of cytology, HPV genotyping, and/or previous screen HPV result. The clinical endpoint was cervical precancer or cancer (CIN3+). The current Dutch triage testing policy for HPV‐positive women is to refer women for colposcopy if they have abnormal cytology at baseline or after 6–18 months. In the second HPV‐based screening round, this strategy yielded a negative predictive value (NPV) of 95.8% (95% confidence interval: 91.9–98.2) and colposcopy referral rate of 37.6% (32.3–43.2%). Replacing repeat cytology by the previous screen HPV result yielded a similar NPV (96.9%, 93.3–98.9) and colposcopy referral rate (38.8%, 33.4–44.4). A higher NPV (99.2%, 96.3–100%) at the cost of a higher colposcopy referral rate (49.2%, 43.6–54.8) was achieved when cytology was combined with HPV16/18 genotyping. The other 13 triage strategies yielded a lower NPV, a higher colposcopy referral rate or performed similarly but required additional testing. HPV‐positive women in the second HPV‐based screening round can be suitably managed by cytology, HPV16/18 genotyping and the HPV result at the previous screen, obviating the need for repeat testing of HPV‐positive, cytology negative women. What's new? The management of HPV‐positive women in the second HPV‐based screening round may be different from the management in the first round. We showed that HPV‐positive women in the second HPV‐based screening round can be suitably managed by cytology, HPV16/18 genotyping and the HPV result at the previous screen, obviating the need for repeat testing of HPV‐positive, cytology negative women.