A 3-year interval is too short for re-screening women testing negative for human papillomavirus: a population-based cohort study

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. Design Population-based cohort study. Setting Two cervical service screening programmes in Italy. Population 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). Main outcome measures 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. Tweetable abstract Three years after a negative HPV the frequency of cervical disease is so low that re-screening is inefficient.