Incomplete follow-up of positive HPV tests: overview of randomised controlled trials on primary cervical screening.
BACKGROUND
It has been suggested that adjustment for incomplete compliance with follow-up in women with positive human papillomavirus (HPV) tests would be appropriate for estimating the true sensitivity of cervical screening with HPV testing. We assessed the compliance and its impact on > or =CIN3 detection in all eight randomised controlled trials (RCT) with published baseline-round data.


METHODS
We extracted data on recommended follow-up procedures, follow-up compliance, and > or =CIN3 detection for both arms of each RCT, and assessed their correlation.


RESULTS
Compliance with a direct referral for colposcopy was around 90% in all RCTs, whereas compliance with repeated testing among HPV-positive/cytology-negative women was around 60% in three RCTs and 73% in one RCT. Detection of > or =CIN3 was significantly increased in two out of six RCTs with reported data. The correlation between compliance with follow-up in HPV-positive women and relative > or =CIN3 detection was 0.48 (P=0.33).


CONCLUSIONS
There is at present scant evidence to support the view that the measured sensitivity of HPV screening is a simple reflection of compliance with follow-up. Adjustment of measured cervical intraepithelial neoplasia detection on the basis of compliance data may not always be justifiable, and if adjustment is made, it should be used very judiciously.
Rebolj
M
M
Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 København K, Denmark. m.rebolj@pubhealth.ku.dk
Lynge
E
E
D000328:Adult; D003127:Colposcopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D010349:Patient Compliance / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000821:virology