title: Human papillomavirus test with cytology triage in organized screening for cervical cancer.
abstract: BACKGROUND
  In randomized studies, testing for high-risk (HR) human papillomavirus (hrHPV) has been more sensitive than conventional cytology in detecting cervical intraepithelial neoplasia (CIN). The aim of this study was to evaluate the performance of HPV testing in the setting of an organized routine screening program.
  
  
  METHODS
  Since 2012, 35- to 60-year-old women living in the city of Tampere have been screened with the Abbott RealTime hrHPV test. HPV-negative women are referred to the next screening round in five years. HPV-positive women are triaged with conventional cytology, and women with at least low-grade squamous intraepithelial lesion (LSIL+) are referred to colposcopy. The remaining HPV-positive women are referred for re-testing after 12 months, and then all HPV-positive women are referred to colposcopy. The data from the last cohort with cytological screening (screened in 2011) is presented for comparison.
  
  
  RESULTS
  A total 5637 (70%) women attended the first round of HPV screening, and 369 were HPV-positive. Of them, 54 women LSIL+were referred to colposcopy, resulting in 16 CIN2+lesions found. Of the remaining HPV-positive women, 66% were still positive one year later, and were referred to colposcopy, with 18 additional CIN2+lesions found. The attendance rate to the last round of cytological screening was 71% (5814 women). Sixty-four women with LSIL+cytology were referred to colposcopy, and 11 CIN2+lesions were found. Of the 777 women with borderline cytology and scheduled for reflex screening in the following year, 109 (19%) had ASC-US+, and 57 underwent colposcopy, resulting in six additional CIN2+lesions found. The total detection rate of CIN2+was significantly higher in the HPV-screened cohort (6.0/1000 vs. 2.9/1000, p = 0.015). However, the total colposcopy rate was 4% vs. 2%, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Human papillomavirus testing also seems to be more sensitive than cytology in detecting CIN2+lesions in the setting of a routine organized screening program, besides in the context of randomized trials. The problem of an increased colposcopy rate needs to be addressed in the future.
authors: Department of Obstetrics and Gynecology, Vaasa Central Hospital, Vaasa, Finland. olga.veijalainen@vshp.fi.
authors: Olga
authors: O
authors: Veijalainen
authors: Pathology, Fimlab Laboratories Ltd, Tampere, Finland.
authors: Saara
authors: S
authors: Kares
authors: Pathology, Fimlab Laboratories Ltd, Tampere, Finland.
authors: Paula
authors: P
authors: Kujala
authors: Pathology, Fimlab Laboratories Ltd, Tampere, Finland.
authors: Mika
authors: M
authors: Tirkkonen
authors: Microbiology, Fimlab Laboratories Ltd, Tampere, Finland.
authors: Risto
authors: R
authors: Vuento
authors: Pathology, Fimlab Laboratories Ltd, Tampere, Finland.
authors: Ivana
authors: I
authors: Kholová
authors: Science Center, Pirkanmaa Hospital District and School of Health Sciences, University of Tampere, Tampere, Finland.
authors: Tiina
authors: T
authors: Luukkaala
authors: Obstetrics and Gynecology, Municipal Hospital of Tampere, Tampere, Finland.
authors: Veronika
authors: V
authors: Osuala
authors: Department of Obstetrics and Gynecology, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland.
authors: Johanna
authors: J
authors: Mäenpää
mesh_terms: D000328:Adult; D003127:Colposcopy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
keywords: Human papillomavirus; cervical cancer; cervical intraepithelial neoplasia; cervix; infections