Adult; Alphapapillomavirus/genetics; Cervical Intraepithelial Neoplasia/diagnosis/prevention & control/virology; Cervix Uteri/cytology/pathology/virology; Cytological Techniques; DNA, Viral/analysis; Early Detection of Cancer/methods; Female; Humans; Mass Screening/methods; Middle Aged; Papillomavirus Infections/diagnosis/virology; Uterine Cervical Neoplasms/diagnosis/prevention & control/virology
Abstract :
[en] BACKGROUND: Human papillomavirus (HPV) testing is more sensitive than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN). We evaluated the performance of high-risk HPV (hrHPV) testing in routine screening. METHODS: In all, 25,871 women (29-61) enrolled in our population-based cohort study were offered both cytology and hrHPV testing. High-risk HPV-positive women with normal cytology and an age-matched subcohort of hrHPV-negative women with normal cytology were invited for repeat testing after 1 and/or 2 years and were referred for colposcopy if they presented with abnormal cytology and/or a positive hrHPV test. The hrHPV-positive women with borderline or mild dyskaryosis (BMD) and all women with moderate dyskaryosis or worse (>BMD) were directly referred for colposcopy. Women with BMD and an hrHPV-negative test were advised to repeat cytology at 6 and 18 months and were referred for colposcopy if the repeat cytology test was abnormal. The main outcome measure was CIN grade 3 or worse (CIN3+). Results were adjusted for non-attendance at repeat testing. RESULTS: The hrHPV-positive women with abnormal cytology had a CIN3+ risk of 42.2% (95% confidence interval (CI): 36.4-48.2), whereas the hrHPV-positive women with normal cytology had a much lower risk of 5.22% (95% CI: 3.72-7.91). In hrHPV-positive women with normal cytology, an additional cytology step after 1 year reduced the CIN3+ risk to only 1.6% (95% CI: 0.6-4.9) if the repeat test was normal. The CIN3+ risk in women with hrHPV-positive normal cytology was higher among women invited for the first time (29-33 years of age) (9.1%; 95% CI: 5.6-14.3) than among older women (3.0%; 95% CI: 1.5-5.5). CONCLUSION: Primary hrHPV screening with cytology triage in women aged >/=30 years is an effective way to stratify women on CIN3+ risk and seems a feasible alternative to cytological screening. Repeat cytology after 1 year for hrHPV-positive women with normal cytology is however necessary before returning women to routine screening.
Disciplines :
Genetics & genetic processes
Author, co-author :
Rijkaart, D. C.
Berkhof, J.
van Kemenade, F. J.
Coupe, V. M. H.
Rozendaal, L.
Heideman, D. A. M.
Verheijen, R. H. M.
BULK, Saskia ; Centre Hospitalier Universitaire de Liège - CHU > Génétique
Verweij, W.
Snijders, P. J. F.
Meijer, C. J. L. M.
Language :
English
Title :
HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications.
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