Premium
Evaluation of multiple primary and combination screening strategies in postmenopausal women for detection of cervical cancer in China
Author(s) -
Holt Hunter K.,
Zhang Li,
Zhao FangHui,
Hu ShangYing,
Zhao XueLian,
Zhang Xun,
Pan QinJing,
Zhang WenHua,
Smith Jennifer S.,
Qiao YouLin
Publication year - 2016
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.30468
Subject(s) - medicine , population , cervical cancer , gynecology , colposcopy , obstetrics , cancer , gastroenterology , environmental health
As China's population ages, the importance of determining prevalence of cervical disease and accurate cervical cancer screening strategies for postmenopausal women is increasing. Seventeen population‐based studies were analyzed to determine prevalence of cervical neoplasia in postmenopausal women. All women underwent HPV DNA testing, visual inspection with acetic acid (VIA) and cytology testing. Diagnostic values for primary and combinations screening methods included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), referral rate and area under curve (AUC) were calculated using directed biopsy or four quadrants biopsy as reference standard. Premenopausal and postmenopausal women had equal HPV infection and cervical neoplasia rates ( p > 0.05). HPV DNA testing CIN3+ sensitivity, specificity, PPV, NPV, referral rate and AUC were 97.9% (95% CI: 90.2–99.9%), 84.2% (95% CI: 82.8–85.5%), 9.9% (95% CI: 7.4–12.8%), 100% (95% CI: 99.8–100%), 17.2% (95% CI: 15.9–18.7%), 0.911, respectively. VIA values were 41.7% (95% CI: 28.4–55.9%), 94.5% (95% CI: 93.6–95.3%), 11.8% (95% CI: 7.5–17.3%), 98.9% (95% CI: 98.5–99.3%), 6.2% (95% CI: 5.3–7.1%) and 0.681, respectively. Values for VIA with HPV triage were 39.6% (95% CI: 26.6–53.8%), 99.2% (95% CI: 98.8–99.5%), 45.2% (95% CI: 30.8–60.4%), 98.9% (95% CI: 98.5–99.3%), 1.5% (95% CI: 1.1–2.0%) and 0.694, respectively. VIA and HPV DNA co‐test values were 100% (95% CI: 94.0–100%), 79.5% (95% CI: 78.0–81.0%), 8.0% (95% CI: 6.0–10.3%), 100% (95% CI: 99.9–100%), 21.9% (95% CI: 20.4–23.4%) and 0.898, respectively. VIA sensitivity decreases significantly in postmenopausal women compared to premenopausal performance. HPV DNA testing maintains performance between pre‐ and postmenopausal women and is the most accurate primary modality for screening postmenopausal populations in low resource areas of China.