Repeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged.

Background Sending faecal occult blood tests (FOBT) by mail has been proposed both as a method to increase participation and a way to reduce staff costs in colorectal cancer screening. Methods Two multicentre randomized controlled trials (ISRCTN10351276) were performed: one randomly assigned 3196 individuals who had previously participated in colorectal screening to receive a FOBT kit at home or a standard invitation; in the second, 4219 people aged 50 -69 years who did not respond to a screening invitation were either sent a FOBT or a standard recall letter. The cost per returned kit was calculated in each arm.Results Participation was higher with direct FOBT mailing in both trials: relative risk 1.11 (95% CI 1.06 -1.17) and 1.36 (95% CI 1.16 -1.60) for previous responders and non-responders, respectively. The cost per returned kit for previous responders ranged from 4.24E to 16.10E, and from 3.29E to 7.36E with FOBT mailing and standard invitation, respectively, not including staff costs; for non-responders it ranged from 17.13E to 46.80E, and from 7.36E to 18.30E with FOBT mailing and standard recall, respectively. Conclusions The FOBT mailing strategy modestly increased participation. This method can be used on a population of previous responders to reduce personnel costs and workload. When used as a reminder to non-responders, this method increases costs.

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P16-INK4A overexpression has been proposed as a prognostic marker to manage the follow up of women with positive cytology and/or HPV test but without high-grade cervical intraepithelial neoplasia (CIN21). This study measures the relative risk (RR) of CIN21 of p16 positive versus negative in these women. All the women referred to colposcopy from October 2008 to September 2010 with negative or CIN1 colposcopy-guided biopsy were included in the study; women surgically treated or having a CIN2-3 were excluded. All baseline biopsies were dyed with hematoxylin and eosin and p16. Women were followed up according to screening protocols, with cytology or colposcopy at 6 or 12 months. CIN2/3 RRs and 95% confidence intervals (95%CI) were computed. Of 442 eligible women, 369 (83.5%) had at least one follow-up episode. At baseline, 113 (30.6%) were CIN1, 248 (67.2%) negative, and 8 (2.2%) inadequate histology; 293 (79.4%) were p16-negative, 64 (17.3%) p16 positive and 12 (3.2%) not valid. During follow up, we found ten CIN2 and three CIN3; of these, six were p16 positive (sensitivity 46%, 95% CI 19-75). The absolute risk among p16 positives was 9.4/100 compared to 1.7/100 of the p16 negatives (RR 5.5; 95% CI 1.7-17.4). The risk was also higher for CIN1 than for histologically negative women (RR 4.4; 95% CI 1.3-14.3). The RR for p16 in CIN1 did not change (RR 5.2; 95% CI 0.6-47.5). P16 overexpression is a good candidate for modulating follow-up intensity after a negative colposcopy but is limited by its low prospective sensitivity.Cervical cancer is the third most common cancer in women worldwide, and the seventh overall, with an estimated 530,000 new cases in 2008. However, while persistent infection of the cervix with oncogenic human papillomavirus types-the most common sexually contracted infection in humans-is its necessary cause, 1-3 cervical cancer is in fact rare; only a very small proportion of infected women will develop a high-grade intraepithelial lesion (CIN21) and even fewer will develop cancer. 4More than 85% of the global cervical cancer burden occurs in developing countries, where it accounts for 13% of all female cancers. 5 In fact, cervical cancer is a wellKey words: cervical cancer, screening, cervical intraepithelial neoplasia, p16, colposcopy, cohort study, prognostic value Novelty and impact: P16 overexpression has been proposed as a prognostic marker for CIN progression, but a few prospective studies tested the prognostic value of histological p16 in post-colposcopy follow up. In a 2 years cohort study, we found low prognostic sensitivity for CIN21 (6/13), but a 5.5 relative risk (95% CI 1.7-17.4) for women p16 positive at baseline compared to negative. P16 overexpression is a good candidate for modulating follow up intensity after a negative colposcopy.