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HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications.
Br J Cancer 2012; 106(5):975-81BJ

Abstract

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.

Authors+Show Affiliations

Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands.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 available

Pub Type(s)

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

Language

eng

PubMed ID

22251922

Citation

Rijkaart, D C., et al. "HPV DNA Testing in Population-based Cervical Screening (VUSA-Screen Study): Results and Implications." British Journal of Cancer, vol. 106, no. 5, 2012, pp. 975-81.
Rijkaart DC, Berkhof J, van Kemenade FJ, et al. HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications. Br J Cancer. 2012;106(5):975-81.
Rijkaart, D. C., Berkhof, J., van Kemenade, F. J., Coupe, V. M., Rozendaal, L., Heideman, D. A., ... Meijer, C. J. (2012). HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications. British Journal of Cancer, 106(5), pp. 975-81. doi:10.1038/bjc.2011.581.
Rijkaart DC, et al. HPV DNA Testing in Population-based Cervical Screening (VUSA-Screen Study): Results and Implications. Br J Cancer. 2012 Feb 28;106(5):975-81. PubMed PMID: 22251922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications. AU - Rijkaart,D C, AU - Berkhof,J, AU - van Kemenade,F J, AU - Coupe,V M H, AU - Rozendaal,L, AU - Heideman,D A M, AU - Verheijen,R H M, AU - Bulk,S, AU - Verweij,W, AU - Snijders,P J F, AU - Meijer,C J L M, Y1 - 2012/01/17/ PY - 2012/1/19/entrez PY - 2012/1/19/pubmed PY - 2012/4/19/medline SP - 975 EP - 81 JF - British journal of cancer JO - Br. J. Cancer VL - 106 IS - 5 N2 - 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. SN - 1532-1827 UR - https://www.unboundmedicine.com/medline/citation/22251922/HPV_DNA_testing_in_population_based_cervical_screening__VUSA_Screen_study_:_results_and_implications_ L2 - http://dx.doi.org/10.1038/bjc.2011.581 DB - PRIME DP - Unbound Medicine ER -