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Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening.
J Natl Cancer Inst 2009; 101(2):88-99JNCI

Abstract

BACKGROUND

Primary cervical screening with both human papillomavirus (HPV) DNA testing and cytological examination of cervical cells with a Pap test (cytology) has been evaluated in randomized clinical trials. Because the vast majority of women with positive cytology are also HPV DNA positive, screening strategies that use HPV DNA testing as the primary screening test may be more effective.

METHODS

We used the database from the intervention arm (n = 6,257 women) of a population-based randomized trial of double screening with cytology and HPV DNA testing to evaluate the efficacy of 11 possible cervical screening strategies that are based on HPV DNA testing alone, cytology alone, and HPV DNA testing combined with cytology among women aged 32-38 years. The main outcome measures were sensitivity for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) within 6 months of enrollment or at colposcopy for women with a persistent type-specific HPV infection and the number of screening tests and positive predictive value (PPV) for each screening strategy. All statistical tests were two-sided.

RESULTS

Compared with screening by cytology alone, double testing with cytology and for type-specific HPV persistence resulted in a 35% (95% confidence interval [CI] = 15% to 60%) increase in sensitivity to detect CIN3+, without a statistically significant reduction in the PPV (relative PPV = 0.76, 95% CI = 0.52 to 1.10), but with more than twice as many screening tests needed. Several strategies that incorporated screening for high-risk HPV subtypes were explored, but they resulted in reduced PPV compared with cytology. Compared with cytology, primary screening with HPV DNA testing followed by cytological triage and repeat HPV DNA testing of HPV DNA-positive women with normal cytology increased the CIN3+ sensitivity by 30% (95% CI = 9% to 54%), maintained a high PPV (relative PPV = 0.87, 95% CI = 0.60 to 1.26), and resulted in a mere 12% increase in the number of screening tests (from 6,257 to 7,019 tests).

CONCLUSIONS

Primary HPV DNA-based screening with cytology triage and repeat HPV DNA testing of cytology-negative women appears to be the most feasible cervical screening strategy.

Authors+Show Affiliations

Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19141778

Citation

Naucler, Pontus, et al. "Efficacy of HPV DNA Testing With Cytology Triage And/or Repeat HPV DNA Testing in Primary Cervical Cancer Screening." Journal of the National Cancer Institute, vol. 101, no. 2, 2009, pp. 88-99.
Naucler P, Ryd W, Törnberg S, et al. Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening. J Natl Cancer Inst. 2009;101(2):88-99.
Naucler, P., Ryd, W., Törnberg, S., Strand, A., Wadell, G., Elfgren, K., ... Dillner, J. (2009). Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening. Journal of the National Cancer Institute, 101(2), pp. 88-99. doi:10.1093/jnci/djn444.
Naucler P, et al. Efficacy of HPV DNA Testing With Cytology Triage And/or Repeat HPV DNA Testing in Primary Cervical Cancer Screening. J Natl Cancer Inst. 2009 Jan 21;101(2):88-99. PubMed PMID: 19141778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening. AU - Naucler,Pontus, AU - Ryd,Walter, AU - Törnberg,Sven, AU - Strand,Anders, AU - Wadell,Göran, AU - Elfgren,Kristina, AU - Rådberg,Thomas, AU - Strander,Björn, AU - Forslund,Ola, AU - Hansson,Bengt-Göran, AU - Hagmar,Björn, AU - Johansson,Bo, AU - Rylander,Eva, AU - Dillner,Joakim, Y1 - 2009/01/13/ PY - 2009/1/15/entrez PY - 2009/1/15/pubmed PY - 2009/2/3/medline SP - 88 EP - 99 JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 101 IS - 2 N2 - BACKGROUND: Primary cervical screening with both human papillomavirus (HPV) DNA testing and cytological examination of cervical cells with a Pap test (cytology) has been evaluated in randomized clinical trials. Because the vast majority of women with positive cytology are also HPV DNA positive, screening strategies that use HPV DNA testing as the primary screening test may be more effective. METHODS: We used the database from the intervention arm (n = 6,257 women) of a population-based randomized trial of double screening with cytology and HPV DNA testing to evaluate the efficacy of 11 possible cervical screening strategies that are based on HPV DNA testing alone, cytology alone, and HPV DNA testing combined with cytology among women aged 32-38 years. The main outcome measures were sensitivity for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) within 6 months of enrollment or at colposcopy for women with a persistent type-specific HPV infection and the number of screening tests and positive predictive value (PPV) for each screening strategy. All statistical tests were two-sided. RESULTS: Compared with screening by cytology alone, double testing with cytology and for type-specific HPV persistence resulted in a 35% (95% confidence interval [CI] = 15% to 60%) increase in sensitivity to detect CIN3+, without a statistically significant reduction in the PPV (relative PPV = 0.76, 95% CI = 0.52 to 1.10), but with more than twice as many screening tests needed. Several strategies that incorporated screening for high-risk HPV subtypes were explored, but they resulted in reduced PPV compared with cytology. Compared with cytology, primary screening with HPV DNA testing followed by cytological triage and repeat HPV DNA testing of HPV DNA-positive women with normal cytology increased the CIN3+ sensitivity by 30% (95% CI = 9% to 54%), maintained a high PPV (relative PPV = 0.87, 95% CI = 0.60 to 1.26), and resulted in a mere 12% increase in the number of screening tests (from 6,257 to 7,019 tests). CONCLUSIONS: Primary HPV DNA-based screening with cytology triage and repeat HPV DNA testing of cytology-negative women appears to be the most feasible cervical screening strategy. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/19141778/Efficacy_of_HPV_DNA_testing_with_cytology_triage_and/or_repeat_HPV_DNA_testing_in_primary_cervical_cancer_screening_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djn444 DB - PRIME DP - Unbound Medicine ER -