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Lower cost strategies for triage of human papillomavirus DNA‐positive women
Author(s) -
Qiao YouLin,
Jeronimo Jose,
Zhao FangHui,
Schweizer Johannes,
Chen Wen,
Valdez Melissa,
Lu Peter,
Zhang Xun,
Kang LeNi,
Bansil Pooja,
Paul Proma,
Mahoney Charles,
BerardBergery Marthe,
Bai Ping,
Peck Roger,
Li Jing,
Chen Feng,
Stoler Mark H.,
Castle Philip E.
Publication year - 2013
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.28616
Subject(s) - triage , medicine , cervical cancer , cervical intraepithelial neoplasia , human papillomavirus , population , hybrid capture , dna testing , colposcopy , cancer , gynecology , obstetrics , oncology , biology , emergency medicine , genetics , environmental health
Using human papillomavirus (HPV) testing for cervical cancer screening in lower‐resource settings (LRS) will result in a significant number of screen‐positive women. This analysis compares different triage strategies for detecting cervical precancer and cancer among HPV‐positive women in LRS. This was a population‐based study of women aged 25–65 years living in China ( n = 7,541). Each woman provided a self‐collected and two clinician‐collected specimens. The self‐collected and one clinician‐collected specimen were tested by two HPV DNA tests— care HPV™ and Hybrid Capture 2; the other clinician‐collected specimen was tested for HPV16/18/45 E6 protein. C are HPV™‐positive specimens were tested for HPV16/18/45 DNA. HPV DNA‐positive women underwent visual inspection with acetic acid (VIA) and then colposcopic evaluation with biopsies. The performance for detection of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) among HPV DNA‐positive women was assessed for different triage strategies: HPV16/18/45 E6 or DNA detection, VIA, colposcopic impression, or higher signal strength (≥10 relative light units/positive control [rlu/pc]). The percent triage positive ranges were 14.8–17.4% for VIA, 17.8–20.9% for an abnormal colposcopic impression; 7.9–10.5% for HPV16/18/45 E6; 23.4–28.4% for HPV16/18/45 DNA; and 48.0–62.6% for higher signal strength (≥10 rlu/pc), depending on the HPV test/specimen combination. The positivity for all triage tests increased with severity of diagnosis. HPV16/18/45 DNA detection was approximately 70% sensitive and had positive predictive values (PPV) of approximately 25% for CIN3+. HPV16/18/45 E6 detection was approximately 50% sensitive with a PPV of nearly 50% for CIN3+. Different triage strategies for HPV DNA‐positive women provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for prevalent CIN3+.