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You are here: Home / NEWS . . . . . . . . / Science & Medicine / HPV Science / HPV Testing / Screening for cervical cancer with the human papillomavirus test in an area of central Italy with no previous active cytological screening programme

Screening for cervical cancer with the human papillomavirus test in an area of central Italy with no previous active cytological screening programme

July 27, 2010 By Jonathan Leave a Comment

Journal of Medical Screening

J Med Screen 2010;17:79-86
doi:10.1258/jms.2010.009092
© 2010 Medical Screening Society

Massimo Confortini, Biologist and Director of Molecular Diagnostic Department , Analytical and Biomolecular Cytology Unit, Cancer Prevention and Research Institute, ISPO, Florence, Italy

Paolo Giorgi Rossi, Epidemiologist , Laziosanità – Agency for Public Health, Lazio Region, Rome, Italy

Paolo Barbarino, Gynaecologist , UOC Screening e Prevenzione ASL Roma G, Tivoli (Rome), Italy

Anna Maria Passarelli, Biologist and Laboratory Director , Laboratori Analisi ASL Roma G, Tivoli (Rome), Italy

Letizia Orzella, Economist , Laziosanità – Agency for Public Health, Lazio Region, Rome, Tivoli (Rome), Italy

Maria Concetta Tufi, Gynaecologist and Screening Unit Director , UOC Screening e Prevenzione ASL Roma G, Tivoli (Rome), Italy

Correspondence to: Paolo Giorgi Rossi, Laziosanità – Agency for Public Health, Lazio Region, Rome, Via di S Costanza 53–, Rome 00198, Italy; giorgirossi@asplazio.it

Objective We report performance indicators and costs of the first round of a cervical cancer screening programme based on the human papillomavirus (HPV)-DNA test.

Methods We implemented a demonstration study using HPV as the primary test in Guidonia, Italy (90,000 inhabitants). All women aged 25–64 were invited to undergo a Hybrid Capture II high-risk HPV test. Two cervical samplings, smear and liquid, were taken. The smear was dyed and interpreted only for HPV-positive (HPV+) women. Women with a non-negative Pap smear were referred for colposcopy, women HPV+/cytology negative were referred to one-year follow-up with HPV. A cost-analysis indicated the price at which the HPV-based and cytological screening would cost the same per screened woman and per lesion found.

Results Of 24,000 women invited, 7639 accepted and 427 (5.6%) were HPV+; 141 (34%) of these had a non-negative Pap test, and 20 cervical intraepithelial neoplasia (CIN) 2 or higher were found (positive predictive value 15%). Compliance to one-year follow-up was 58% (166/286); 90 (54%) were HPV-positive and five additional lesions were found (positive predictive value 9%; overall detection rate 3.4/1000). The cost analysis showed that at a price of 8.3 euros per HPV-DNA test, the strategy using HPV as primary test followed by cytological triage would cost the same per screened woman, while at a price of 12.7 euros it would have the same cost per CIN2+ found.

Conclusion The workload for management of positive women was similar to cytological screening. Low compliance to one-year follow-up was the main barrier to effectiveness. The price of HPV test should be about 9 euros to maintain the same screening budget, and can go as high as 13 euros per lesion found.

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