To evaluate if time to colonoscopy after a positive fecal blood test is associated with the risk of colorectal cancer or adenoma and to identify a safety-threshold.

To define the complication rate and the 30-days mortality rate after colonoscopy within the colorectal cancer screening programs of the Veneto Region (North East of Italy) and to identify the variables associated with complications.

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+ ( CIN 2+) at colposcopy, and detection rate for CIN 2+. 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), CIN 2+ detection rate ( RR 0.24, 95% CI 0.13–0.39), and positive predictive value ( PPV ) for CIN 2+ 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.

Objective Colorectal cancer (CRC) screening programmes based on the guaiac faecal occult blood test (gFOBT) reduce CRC-specific mortality. Several studies have shown higher sensitivity with the faecal immunochemical test (FIT) compared with gFOBT. We carried out an ecological study to evaluate the impact of FIT-based screening programmes on CRC mortality. Design In the Veneto Region (Italy), biennial FIT-based screening programmes that invited 50–69-year-old residents were introduced in different areas between 2002 and 2009. We compared CRC mortality rates from 1995 to 2011 between the areas where screening started in 2002–2004 (early screening areas (ESA)) and areas that introduced the screening in 2008–2009 (late screening areas (LSA)) using Poisson regression models. We also compared available data on CRC incidence rates (1995–2007) and surgical resection rates (2001–2012). Results Before the introduction of screening, CRC mortality and incidence rates in the two areas were similar. Compared with 1995–2000, 2006–2011 mortality rates were 22% lower in the ESA than in the LSA (rate ratio (RR)=0.78; 95% CI 0.68 to 0.89). The reduction was larger in women (RR=0.64; CI 0.51 to 0.80) than in men (RR=0.87; CI 0.73 to 1.04). In the ESA, incidence and surgery rates peaked during the introduction of the screening programme and then returned to the baseline (2006–2007 incidence) or dropped below initial values (surgery after 2007). Conclusions FIT-based screening programmes were associated with a significant reduction in CRC mortality. This effect took place much earlier than reported by gFOBT-based trials and observational studies.

ObjectiveTo present the results of the first 2 years of a human papillomavirus (HPV) test‐based screening programme outside the research context.DesignPopulation‐based cohort study.SettingA cervical service screening programme in Italy.PopulationWomen aged 25–64 years invited to screening from April 2009 to April 2011.MethodsEligible women were invited to undergo an HPV test: those with a negative HPV test went on to the next screening episode; those with a positive HPV went on to triage with a Pap smear. Women with positive cytology (i.e. positive for atypical squamous cells of undetermined significance or worse, ASC‐US+) were referred to colposcopy, whereas those with negative cytology were referred to repeat HPV testing 1 year later.Main outcome measuresParticipation 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+.ResultsParticipation increased compared with the previous Pap programme (60.6 versus 43.9%). The HPV positivity rate was 7.0; 39.6% of Pap smears were scored as positive, and therefore 2.8% of the women screened were referred for immediate colposcopy. The compliance of women who scored positive for HPV and negative for Pap for repeat HPV testing at 12 months was 78.6%, and the HPV positivity rate was 56.6%. The overall referral rate to colposcopy was 4.6%. The overall detection rate for CIN2+ was 4.5 versus 1.5% of the Pap programme (25–34 years, 8.2%; 35+ years, 3.6%).ConclusionsCompared with the traditional Pap test, the HPV programme recorded a higher response to invitation and an increased DR for CIN2+. The most critical aspects were the reading of cytology in women that were positive for HPV and the increased workload at colposcopy.