title: A 3-year interval is too short for re-screening women testing negative for human papillomavirus: a population-based cohort study.
abstract: OBJECTIVE
  To compare the results from an initial negative human papillomavirus (HPV) test with re-screening after 3 years in women attending two HPV-based screening programmes.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Two cervical service screening programmes in Italy.
  
  
  METHODS
  Women aged 25-64 years invited to screening from April 2009 to October 2015.
  
  
  METHODS
  Eligible women were invited to undergo an HPV test. Those with a negative HPV test went on to the next screening round 3 years later. Cytology triage was performed for HPV+ (HPV by Hybrid Capture 2) samples, with immediate colposcopy (if abnormal) and HPV re-testing 1 year later (if negative).
  
  
  METHODS
  Participation rate, positivity at HPV and at triage, referral rate to colposcopy, positive predictive value for cervical intraepithelial neoplasia grade 2+ (CIN2+) at colposcopy, and detection rate for CIN2+.
  
  
  RESULTS
  We present the results from 48 751 women at the first screening and 22 000 women at re-screening 3 years later. The response rate was slightly higher at the second screening (74.5 versus 72.1% at the first screening; referral rate, RR 1.11; 95% confidence interval, 95% CI, 1.07-1.14). Compared with the first screening, we observed a significant reduction at the second screening in terms of HPV positivity (RR 0.55, 95% CI 0.51-0.60), referral rate to colposcopy (RR 0.47, 95% CI 0.41-0.53), CIN2+ detection rate (RR 0.24, 95% CI 0.13-0.39), and positive predictive value (PPV) for CIN2+ at colposcopy (RR 0.51, 95% CI 0.29-0.87).
  
  
  CONCLUSIONS
  The very low frequency of disease and inadequate PPV at colposcopy indicate that a 3-year interval after a negative HPV test is too short.
  
  
  CONCLUSIONS
  Three years after a negative HPV the frequency of cervical disease is so low that re-screening is inefficient.
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zorzi
authors.affiliation: Immunologia Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy.
authors.forename: H
authors.initials: H
authors.lastname: Frayle
authors.affiliation: Immunologia Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rizzi
authors.affiliation: Organizational Unit Prevention and Public Health, Veneto Region, Venezia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Fedato
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padova, Italy.|Department of Medicine DIMED Pathology and Cytopathology Unit, University of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rugge
authors.affiliation: Department of Prevention, Local Health Unit 17 Monselice, Este, Italy.
authors.forename: M G
authors.initials: MG
authors.lastname: Penon
authors.affiliation: Department of Prevention, Local Health Unit 17 Monselice, Este, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bertazzo
authors.affiliation: Department of Prevention, Local Health Unit 15 Alta Padovana, Camposampiero, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Callegaro
authors.affiliation: Department of Prevention, Local Health Unit 15 Alta Padovana, Camposampiero, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Campagnolo
authors.affiliation: Department of Prevention, Local Health Unit 15 Alta Padovana, Camposampiero, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ortu
authors.affiliation: Immunologia Diagnostica Molecolare Oncologica, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Del Mistro
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000821:virology; D015331:Cohort Studies; D003127:Colposcopy / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears / Q000706:statistics & numerical data
keywords: CIN2+; Cervical cancer; HPV DNA test; screening interval