title: Human papillomavirus testing for cervical cancer screening: results from a 6-year prospective study in rural China.
abstract: Long-term follow-up evaluations of cervical screening approaches are limited in low-resource areas. This prospective study assessed the risk of future cervical intraepithelial neoplasia grade 2 or worse (CIN2+) associated with baseline human papillomavirus (HPV) and cytologic status. In rural China, 1,997 women were screened with 6 screening tests, including colposcopic evaluations, and underwent biopsies in 1999. In December 2005, 1,612 women with cervical intraepithelial neoplasia grade 1 or less at baseline were rescreened by visual inspection, liquid-based cytology, and HPV-DNA testing. All women underwent colposcopy at follow-up, with biopsies taken from women with visually apparent lesions or cytologic abnormalities. Twenty women developed incident CIN2+. The crude relative risk of CIN2+ for baseline HPV-positive women was 52 (95% confidence interval: 12.1, 222.5). The crude relative risk of CIN2+ was 167 (95% confidence interval: 21.9, 1,265) for baseline and follow-up repeatedly HPV-positive women compared with repeatedly HPV-negative women. Among 1,374 baseline HPV-negative women, 2 and no incident CIN2+ cases were detected in baseline cytologically normal and abnormal subgroups, respectively. Among 238 baseline HPV-positive women, 6 of 18 incident cases of CIN2+ developed in the cytologically normal group. This study demonstrates that a single oncogenic HPV-DNA test is more effective than cytology in predicting future CIN2+ status.
authors.affiliation: Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Ju-Fang
authors.initials: JF
authors.lastname: Shi
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Belinson
authors.forename: Fang-Hui
authors.initials: FH
authors.lastname: Zhao
authors.forename: Robert G
authors.initials: RG
authors.lastname: Pretorius
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Jun-Fei
authors.initials: JF
authors.lastname: Ma
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.forename: Wang
authors.initials: W
authors.lastname: Xiang
authors.forename: Qin-Jing
authors.initials: QJ
authors.lastname: Pan
authors.forename: Xun
authors.initials: X
authors.lastname: Zhang
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Zhang
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
mesh_terms: D000328:Adult; D002681:China; D003127:Colposcopy; D016001:Confidence Intervals; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012424:Rural Population / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D004279:DNA, Viral