The ideal strategy for cervical cancer screening in Japan: Result from the Fukui Cervical Cancer Screening Study

The aims of the Fukui Cervical Cancer Screening ( FCCS ) study are to determine the frequency of women with high‐risk HPV (hr HPV ), whether HPV 16 or HPV 18 ( HPV 16/18), in the Japanese cancer screening population for the first time and to identify the best strategy for cervical cancer screening in Japan. Methods This study enrolled 7584 women aged ≥25 years who were undergoing routine screening. All women underwent LBC and cobas HPV tests. Women with abnormal cytology, whether hr HPV positive or negative; women with hr HPV positivity with either normal or abnormal cytology; and women randomly selected from women with normal cytology and negative hr HPV negative were referred for colposcopy. Results The prevalences of hr HPV positivity and HPV 16/18 positivity were 6.8% and 1.7%, respectively. The baseline data from the FCCS study showed that the combination of HPV tests and cytology was more sensitive than cytology with respect to the detection of intraepithelial neoplasia grade 2 or worse. However, the specificity (94.1%) of the co‐testing strategy that required all women with abnormal cytology or hr HPV positivity to be referred for colposcopy was much lower than that (97.8%) of cytology. The sensitivity and specificity of the co‐testing strategy that required only women with abnormal cytology or HPV 16/18 positivity to undergo colposcopy were 85.5% and 97.0%, respectively. Conclusion The baseline data from the FCCS study suggest that a cervical cancer screening strategy in which only women with abnormal cytology or HPV 16/18 positivity undergo colposcopy offers a more balanced sensitivity and specificity than other strategies.