Human papillomavirus testing for cervical cancer screening: results from a 6-year prospective study in rural China.
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.
Shi
Ju-Fang
JF
Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
Belinson
Jerome L
JL
Zhao
Fang-Hui
FH
Pretorius
Robert G
RG
Li
Jing
J
Ma
Jun-Fei
JF
Chen
Feng
F
Xiang
Wang
W
Pan
Qin-Jing
QJ
Zhang
Xun
X
Zhang
Wen-Hua
WH
Qiao
You-Lin
YL
Smith
Jennifer S
JS
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*
D004279:DNA, Viral