[Results and cost evaluation of triage with high risk HPV test in cervical cancer screening. A pilot study in Piedmont (North-West Italy)].
OBJECTIVE
causal relation between high risk Papilloma virus and cervical carcinoma is definitely ascertained. HPV test is suggested both as primary screening test and as triage test for selecting women who should undergo colposcopy examination. Evidence is clear for triage after ASC-US cytology. A recent study suggested the implementation after LSIL cytology in women 35 or older but the issue is controversial.We present a pilot study on the implementation of HPV test triage in the framework of cervical cancer screening. The study was conducted in respect to: participation, predictive value, and cost analysis, separately for ASC-US and LSIL cytology.


METHODS
HPV test was offered to women with Pap test result ASC-US or LSIL (35 and over), as an add-on to the "Prevenzione serena Screening Program" protocol. All samples were analyzed in the same specialized laboratory. HPV positive women were invited to colposcopy, negative will be invited at the scheduled interval for negative screening tests.


METHODS
Piedmont (NW Italy), LHAs of Novara and Verbano. In the 1-year study period 15,614 Pap tests were performed: 153 women were eligible for the triage.


METHODS
Participation at HPV test, HPV test results, costs.


RESULTS
ninety two percent of women invited to HPV test actually participated: 66.9% of them were positive (52.8% after ASC-US and 82.8% after LSIL). Regarding colposcopy and histological results, CIN2+ were 9.4% of positive HPV tests in ASC-US group and 17.1% in LSIL group. Cost analysis showed limited differences between triage (offered after ASC-US and LSIL cytology) and traditional protocol. Triage is economically convenient when limited to women with ASC-US cytology.


CONCLUSIONS
the pilot study demonstrated the feasibility of adding a triage phase with HPV test in cervical cancer screening protocol. Additional cost is balanced by the saving due to the reduction in the number of colposcopy exams: the process is economically convenient when limited to women with ASC-US cytology. When extended to LSIL cytology the marginal cost increases because of the higher prevalence of HPV positive results and total cost of triage with HPV test is close to the cost of immediate colposcopy referral.
SCDU epidemiologia dei tumori, CPO Piemonte, AOU Maggiore di Novara e Università del Piemonte orientale, Novara, Italy. corrado.magnani@cpo.it
Corrado
C
Magnani
Anna
A
Gillio Tos
Laura
L
De Marco
Maria
M
Calvia
Angela
A
Cipelletti
Piero
P
Bestagini
Eva
E
Pagano
Nereo
N
Segnan
Guglielmo
G
Ronco
D000328:Adult; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D003127:Colposcopy / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D015344:DNA Probes, HPV; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D052689:Gammapapillomavirus / Q000302:isolation & purification*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D065006:Papanicolaou Test / Q000191:economics / Q000706:statistics & numerical data*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015995:Prevalence; D012306:Risk; D014218:Triage / Q000191:economics / Q000706:statistics & numerical data*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D055815:Young Adult
D015344:DNA Probes, HPV