Effect of Sequential Rounds of Cervical Cancer Screening on Management of HPV-positive Women: A 15-year Population-based Cohort Study from China
Autor: | Shang-Ying Hu, Wen-hua Zhang, Fang-Hui Zhao, You-Lin Qiao, Qin-Jing Pan, Xun Zhang, Margaret E. Cruickshank, Feng Chen, Remila Rezhake, Jun-Fei Ma, Xiaoqian Xu |
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Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
Adult Cancer Research medicine.medical_specialty China Time Factors Referral Cytodiagnosis Uterine Cervical Neoplasms Cervical intraepithelial neoplasia 03 medical and health sciences 0302 clinical medicine Cytology medicine Humans Genotyping Papillomaviridae Early Detection of Cancer Colposcopy Vaginal Smears Cervical screening medicine.diagnostic_test Obstetrics business.industry Papillomavirus Infections virus diseases Middle Aged medicine.disease Prognosis Uterine Cervical Dysplasia Triage female genital diseases and pregnancy complications Confidence interval 030104 developmental biology Oncology 030220 oncology & carcinogenesis Female business Follow-Up Studies |
Zdroj: | Cancer prevention research (Philadelphia, Pa.). 14(3) |
ISSN: | 1940-6215 |
Popis: | Women are anticipated to go through more than two rounds of cervical screening in their lifetime. Human papillomavirus (HPV) testing is increasingly used as the primary cervical cancer screening test. However, triage strategies for HPV-positive women were usually evaluated at baseline screening. We assessed the effect of sequential rounds of cervical screening on several algorithms for HPV triage. A total of 1,997 women ages 35–45 years were enrolled in 1999 in Shanxi, P.R. China and followed up three times at approximately 5-year intervals. Cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) prevalence by prior HPV results and performance of 12 triage algorithms with cytology, genotyping, and prior HPV were examined among 229 HPV-positive women at the fourth round. CIN2+ prevalence varied from 56.5% (95% confidence interval, 36.8%–74.4%) following 15 years HPV persistence to 3.5% (1.2%–9.9%) with an incident HPV within 15 years. Triage with cytology (with threshold of atypical squamous cells of undetermined significance) yielded positive predictive value (PPV) of 21.4% (13.8%–29.0%), entailing immediate colposcopic referral, and negative predictive value (NPV) of 97.4% (94.6%–100%), permitting retesting at short intervals. Triage with genotyping (16/18/31/33/45/52/58) or prior HPV results showed comparable performance with cytology. Among 11 triage algorithms with similar NPV to cytology, triage with prior HPV results and reflex genotyping (16/18) achieved highest PPV of 28.9% (18.8%–39.1%) and lowest colposcopy referral of 33.2% (27.4%–39.5%). HPV persistence across rounds is an effective risk stratifier in HPV-positive women. Mainstream cytology and genotyping, with or without consideration of prior HPV results, remain effective for HPV triage at fourth round. Prevention Relevance: The study highlights the sustained effectiveness of mainstream HPV triage methods, such as cytology and genotyping, after sequential rounds of cervical screening. It also suggests that use of HPV persistence across rounds can improve management of HPV-positive women in cervical cancer screening. |
Databáze: | OpenAIRE |
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