Cervical cancer screening with HPV testing in the Valcamonica (Italy) screening programme

Area of Science:

• Gynecology
• Oncology
• Public Health

Background:

• Cervical cancer screening programs have historically relied on Papanicolaou (Pap) tests.
• Human Papillomavirus (HPV) testing has emerged as a more sensitive primary screening method.
• The Valcamonica region has a history of Pap test screening since 2002.

Purpose of the Study:

• To evaluate the outcomes of the first screening round and the initial year of the second round of a pilot HPV screening project in Valcamonica.
• To compare HPV-based screening with the established Pap test screening in terms of participation, referral rates, and detection rates.

Main Methods:

• The study involved inviting the entire target female population (aged 25-64) for HPV screening between 2010 and 2012.
• HPV-negative women were scheduled for screening every three years.
• HPV-positive women underwent cytological smear testing, with positive results referred for colposcopy and negative results for repeat HPV testing after one year.

Main Results:

• 18,728 women were screened in the first round, with a participation rate slightly higher than the Pap test.
• The HPV positivity rate was 8.7%, leading to a 4.5% referral rate for cytology triage.
• The total referral rate (6.4%) and detection rate (9.2/1000) for HPV screening were higher than the Pap test (3.7% and 5.0/1000, respectively).
• In the second round, HPV prevalence among previously negative women was 3.9%, with a detection rate of 0.8/1000 in HPV-positive, cytology-positive women.

Conclusions:

• HPV-based screening significantly increases the number of colposcopies and the detection rate in the initial screening round.
• The lower HPV prevalence and detection rates in the second round support the efficacy of longer screening intervals for HPV-negative individuals.
• The findings underscore the potential benefits of HPV testing in improving cervical cancer detection and management strategies.