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HPV testing with cytology triage for cervical cancer screening in routine practice.
Am J Obstet Gynecol 2014; 210(5):474.e1-7AJ

Abstract

OBJECTIVE

The purpose of this study was to evaluate the feasibility and effectiveness of Viral Testing Alone with Pap (Papanicolaou) Triage for Screening Cervical Cancer in Routine Practice (VASCAR) in a publicly funded university-affiliated hospital in Montreal, Canada.

STUDY DESIGN

Women who are 30-65 years old are screened with the Hybrid Capture-2 assay. Women with negative results are retested at 3-year intervals; women with positive results are triaged with conventional cytologic methods. Women with Papanicolaou positive test results (≥atypical squamous cells of undetermined significance) are referred to colposcopy; women with Papanicolaou negative test results are retested with Hybrid Capture-2 assay and a Papanicolaou test in 1 year. Results were compared with a historic era (annual cytology with ≥atypical squamous cells of undetermined significance threshold for colposcopy referral) in the 3 years before VASCAR.

RESULTS

VASCAR included 23,739 eligible women, among whom 1646 women (6.9%) tested positive for the human papillomavirus (HPV). Because of the need for subsequent sampling for cytologic testing, follow-up evaluation for cytologic triage was relatively poor; only 46% and 24% of HPV-positive women were Papanicolaou-triaged and underwent biopsy, respectively. Protocol violations occurred mainly in the early phases of implementation (12%). Detection of high-grade cervical intraepithelial neoplasia increased nearly 3-fold (rate ratio, 2.78; 95% confidence interval [CI], 2.1-3.7) during VASCAR, mostly because of a doubling in the rate of high-grade cervical intraepithelial neoplasia (34.0%; 95% CI, 21.2-48.8) compared with the historic cytology-only era (16.3%; 95% CI, 13.2-19.8). VASCAR reduced the median time to colposcopy from a positive screen from 11 months (95% CI, 10.48-11.50) to 3 months (95% CI, 2.64-3.80).

CONCLUSION

VASCAR is feasible; however, it requires cosampling for HPV and cytology and for continuous education of healthcare providers of the HPV-Papanicolaou triage protocol. Efficacy in disease detection and reduction in time to colposcopy referrals compared with the historic cytology era is encouraging but should be considered preliminary because of the small number of patients who were tested.

Authors+Show Affiliations

Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.Department of Pathology, McGill University and Jewish General Hospital, Montreal, QC, Canada.Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.Department of Pathology, McGill University and Jewish General Hospital, Montreal, QC, Canada; Department of Obstetrics and Gynecology, McGill University and Jewish General Hospital, Montreal, QC, Canada. Electronic address: alex.ferenczy@mcgill.ca.

Pub Type(s)

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

Language

eng

PubMed ID

24373948

Citation

Louvanto, Karolina, et al. "HPV Testing With Cytology Triage for Cervical Cancer Screening in Routine Practice." American Journal of Obstetrics and Gynecology, vol. 210, no. 5, 2014, pp. 474.e1-7.
Louvanto K, Chevarie-Davis M, Ramanakumar AV, et al. HPV testing with cytology triage for cervical cancer screening in routine practice. Am J Obstet Gynecol. 2014;210(5):474.e1-7.
Louvanto, K., Chevarie-Davis, M., Ramanakumar, A. V., Franco, E. L., & Ferenczy, A. (2014). HPV testing with cytology triage for cervical cancer screening in routine practice. American Journal of Obstetrics and Gynecology, 210(5), pp. 474.e1-7. doi:10.1016/j.ajog.2013.12.033.
Louvanto K, et al. HPV Testing With Cytology Triage for Cervical Cancer Screening in Routine Practice. Am J Obstet Gynecol. 2014;210(5):474.e1-7. PubMed PMID: 24373948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HPV testing with cytology triage for cervical cancer screening in routine practice. AU - Louvanto,Karolina, AU - Chevarie-Davis,Myriam, AU - Ramanakumar,Agnihotram Venkata, AU - Franco,Eduardo Luis, AU - Ferenczy,Alex, Y1 - 2013/12/25/ PY - 2013/09/17/received PY - 2013/11/19/revised PY - 2013/12/23/accepted PY - 2013/12/31/entrez PY - 2014/1/1/pubmed PY - 2014/9/10/medline KW - HPV testing KW - HPV+/Papanicolaou triage KW - Papanicolaou test KW - colposcopy KW - primary cervical cancer screening SP - 474.e1 EP - 7 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 210 IS - 5 N2 - OBJECTIVE: The purpose of this study was to evaluate the feasibility and effectiveness of Viral Testing Alone with Pap (Papanicolaou) Triage for Screening Cervical Cancer in Routine Practice (VASCAR) in a publicly funded university-affiliated hospital in Montreal, Canada. STUDY DESIGN: Women who are 30-65 years old are screened with the Hybrid Capture-2 assay. Women with negative results are retested at 3-year intervals; women with positive results are triaged with conventional cytologic methods. Women with Papanicolaou positive test results (≥atypical squamous cells of undetermined significance) are referred to colposcopy; women with Papanicolaou negative test results are retested with Hybrid Capture-2 assay and a Papanicolaou test in 1 year. Results were compared with a historic era (annual cytology with ≥atypical squamous cells of undetermined significance threshold for colposcopy referral) in the 3 years before VASCAR. RESULTS: VASCAR included 23,739 eligible women, among whom 1646 women (6.9%) tested positive for the human papillomavirus (HPV). Because of the need for subsequent sampling for cytologic testing, follow-up evaluation for cytologic triage was relatively poor; only 46% and 24% of HPV-positive women were Papanicolaou-triaged and underwent biopsy, respectively. Protocol violations occurred mainly in the early phases of implementation (12%). Detection of high-grade cervical intraepithelial neoplasia increased nearly 3-fold (rate ratio, 2.78; 95% confidence interval [CI], 2.1-3.7) during VASCAR, mostly because of a doubling in the rate of high-grade cervical intraepithelial neoplasia (34.0%; 95% CI, 21.2-48.8) compared with the historic cytology-only era (16.3%; 95% CI, 13.2-19.8). VASCAR reduced the median time to colposcopy from a positive screen from 11 months (95% CI, 10.48-11.50) to 3 months (95% CI, 2.64-3.80). CONCLUSION: VASCAR is feasible; however, it requires cosampling for HPV and cytology and for continuous education of healthcare providers of the HPV-Papanicolaou triage protocol. Efficacy in disease detection and reduction in time to colposcopy referrals compared with the historic cytology era is encouraging but should be considered preliminary because of the small number of patients who were tested. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/24373948/HPV_testing_with_cytology_triage_for_cervical_cancer_screening_in_routine_practice_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(13)02244-8 DB - PRIME DP - Unbound Medicine ER -