title: Human papillomavirus testing for primary screening of cervical cancer precursors.
abstract: Our objective was to determine whether the addition of human papillomavirus (HPV) testing to screening cytology improves the detection of cervical cancer precursors. Women of ages 18-69 years underwent conventional Pap cytology and HPV DNA testing in a multicenter study in Newfoundland, Canada. Those with positive cytology and/or HPV and a random sample of those with dual negative results were referred for colposcopy. The study enrolled 2098 women. The relative sensitivity of HPV testing was significantly higher than cytology for all-grade squamous intraepithelial lesions [SILs; 73%; 95% confidence interval (CI), 62-82] and high grade SILs (HSILs; 90%; 95% CI, 74-97) but had lower relative specificity (62% for all-grade SILs and 51% for HSILs) than most cytological cutpoints. The rate of combined correct results for all-grade lesions was higher for HPV testing (68.8%) than for any cytological cutpoint (equivocal, 52.3%; LSILs, 51.6%; HSILs, 44.5%). The combination of HPV and an LSIL cutpoint had a negative predictive value of 68% (95% CI, 52-80) for all SILs and 100% (95% CI, 91-100) for HSILs, while referring for colposcopy only 12% of the women. We concluded that HPV testing in conjunction with cytology improved the screening efficacy of cytology alone and may allow for a more effective and safe primary screening program with increased screening intervals.
authors.affiliation: Newfoundland Public Health Laboratory, Department of Health, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Ratnam
authors.forename: E L
authors.initials: EL
authors.lastname: Franco
authors.forename: A
authors.initials: A
authors.lastname: Ferenczy
mesh_terms: D000293:Adolescent; D000328:Adult; D015982:Bias; D015344:DNA Probes, HPV; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009523:Newfoundland and Labrador; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis; D011230:Precancerous Conditions / Q000175:diagnosis; D012680:Sensitivity and Specificity; D014412:Tumor Virus Infections / Q000175:diagnosis; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology*; D014626:Vaginal Smears
chemical_list: D015344:DNA Probes, HPV; D004279:DNA, Viral