In human papillomavirus (HPV) based screening, several options are available for triaging HPV-positive women. The performance of a triage strategy can be measured by the positive predictive value for detection of underlying CIN3+ and the three to five year CIN3+ risk after a negative result.
We examined published screening studies with long-term follow-up and evaluated the performance of cytology, repeat HPV testing, and HPV16/18 genotyping. We also evaluated whether the performance of triage tests changes after multiple rounds of HPV-based screening.
Cytology and HPV16/18 genotyping have good performance in the first round after a program switch from cytology-based to HPV-based screening. Repeat HPV testing after 6 to 12 months among HPV positive women with normal cytology is associated with a low CIN3+ risk at the cost of a considerable number of extra colposcopy referrals. HPV-positive, triage-negative women have an elevated CIN3+ risk in comparison to HPV-negative women, suggesting that screening intervals should be determined separately for HPV-positive and HPV-negative women. After multiple rounds of HPV-based screening, risk differentiation by cytology remains strong but may be somewhat diminished for HPV 16/18 genotyping because of a larger proportion of incident infections.