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Comparison of cervical cancer screening strategies incorporating different combinations of cytology, HPV testing, and genotyping for HPV 16/18: results from the ATHENA HPV study.
Am J Obstet Gynecol 2013; 208(3):184.e1-184.e11AJ

Abstract

OBJECTIVE

The objective of the study was to compare 9 cervical cancer screening strategies to the current screening standard (cytology with human papillomavirus [HPV] triage of atypical squamous cells of undetermined significance) for the detection of high-grade cervical disease.

STUDY DESIGN

Women (n = 34,254) aged 30 years or older from the Addressing the Need for Advanced HPV Diagnostics (ATHENA) study underwent screening with cytology and HPV testing with simultaneous HPV16/18 genotyping; those with atypical squamous cells of undetermined significance cytology or greater or HPV-positive status were referred for colposcopy.

RESULTS

In general, screening strategies that offered greater sensitivity also required more referral to colposcopy. HPV testing was more sensitive than cytology for detection of cervical intraepithelial neoplasia grade 2 or greater, but strategies that depended on cytology for triage of HPV-positive women decreased this sensitivity. Various strategies of cotesting with cytology increased sensitivity but did so by increasing testing. Strategies that included integrated HPV16/18 testing provided more efficient referral to colposcopy.

CONCLUSION

Strategies that maximize detection of women at greatest risk of cervical intraepithelial neoplasia grade 3 or greater by immediate referral to colposcopy, with follow-up testing of women at intermediate risk, maximize the benefits of cervical cancer screening while decreasing the potential harm. Incorporating screening with HPV and triage of HPV-positive women by a combination of genotyping for HPV16/18 and cytology provided a good balance between maximizing sensitivity (benefit) and specificity by limiting the number of colposcopies (potential harm).

Authors+Show Affiliations

Student Health, University of California, Santa Barbara (retired), Santa Barbara, CA. tomcoxmd@aol.comNo 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

23174289

Citation

Cox, J Thomas, et al. "Comparison of Cervical Cancer Screening Strategies Incorporating Different Combinations of Cytology, HPV Testing, and Genotyping for HPV 16/18: Results From the ATHENA HPV Study." American Journal of Obstetrics and Gynecology, vol. 208, no. 3, 2013, pp. 184.e1-184.e11.
Cox JT, Castle PE, Behrens CM, et al. Comparison of cervical cancer screening strategies incorporating different combinations of cytology, HPV testing, and genotyping for HPV 16/18: results from the ATHENA HPV study. Am J Obstet Gynecol. 2013;208(3):184.e1-184.e11.
Cox, J. T., Castle, P. E., Behrens, C. M., Sharma, A., Wright, T. C., & Cuzick, J. (2013). Comparison of cervical cancer screening strategies incorporating different combinations of cytology, HPV testing, and genotyping for HPV 16/18: results from the ATHENA HPV study. American Journal of Obstetrics and Gynecology, 208(3), pp. 184.e1-184.e11. doi:10.1016/j.ajog.2012.11.020.
Cox JT, et al. Comparison of Cervical Cancer Screening Strategies Incorporating Different Combinations of Cytology, HPV Testing, and Genotyping for HPV 16/18: Results From the ATHENA HPV Study. Am J Obstet Gynecol. 2013;208(3):184.e1-184.e11. PubMed PMID: 23174289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of cervical cancer screening strategies incorporating different combinations of cytology, HPV testing, and genotyping for HPV 16/18: results from the ATHENA HPV study. AU - Cox,J Thomas, AU - Castle,Phillip E, AU - Behrens,Catherine M, AU - Sharma,Abha, AU - Wright,Thomas C,Jr AU - Cuzick,Jack, AU - ,, Y1 - 2012/11/19/ PY - 2012/07/20/received PY - 2012/10/12/revised PY - 2012/11/14/accepted PY - 2012/11/24/entrez PY - 2012/11/24/pubmed PY - 2013/4/24/medline SP - 184.e1 EP - 184.e11 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 208 IS - 3 N2 - OBJECTIVE: The objective of the study was to compare 9 cervical cancer screening strategies to the current screening standard (cytology with human papillomavirus [HPV] triage of atypical squamous cells of undetermined significance) for the detection of high-grade cervical disease. STUDY DESIGN: Women (n = 34,254) aged 30 years or older from the Addressing the Need for Advanced HPV Diagnostics (ATHENA) study underwent screening with cytology and HPV testing with simultaneous HPV16/18 genotyping; those with atypical squamous cells of undetermined significance cytology or greater or HPV-positive status were referred for colposcopy. RESULTS: In general, screening strategies that offered greater sensitivity also required more referral to colposcopy. HPV testing was more sensitive than cytology for detection of cervical intraepithelial neoplasia grade 2 or greater, but strategies that depended on cytology for triage of HPV-positive women decreased this sensitivity. Various strategies of cotesting with cytology increased sensitivity but did so by increasing testing. Strategies that included integrated HPV16/18 testing provided more efficient referral to colposcopy. CONCLUSION: Strategies that maximize detection of women at greatest risk of cervical intraepithelial neoplasia grade 3 or greater by immediate referral to colposcopy, with follow-up testing of women at intermediate risk, maximize the benefits of cervical cancer screening while decreasing the potential harm. Incorporating screening with HPV and triage of HPV-positive women by a combination of genotyping for HPV16/18 and cytology provided a good balance between maximizing sensitivity (benefit) and specificity by limiting the number of colposcopies (potential harm). SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/23174289/Comparison_of_cervical_cancer_screening_strategies_incorporating_different_combinations_of_cytology_HPV_testing_and_genotyping_for_HPV_16/18:_results_from_the_ATHENA_HPV_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(12)02075-3 DB - PRIME DP - Unbound Medicine ER -