title: HPV testing with cytology triage for cervical cancer screening in routine practice.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the feasibility and effectiveness of Viral Testing Alone with Pap (Papanicolaou) Triage for Screening Cervical Cancer in Routine Practice (VASCAR) in a publicly funded university-affiliated hospital in Montreal, Canada.
  
  
  METHODS
  Women who are 30-65 years old are screened with the Hybrid Capture-2 assay. Women with negative results are retested at 3-year intervals; women with positive results are triaged with conventional cytologic methods. Women with Papanicolaou positive test results (≥atypical squamous cells of undetermined significance) are referred to colposcopy; women with Papanicolaou negative test results are retested with Hybrid Capture-2 assay and a Papanicolaou test in 1 year. Results were compared with a historic era (annual cytology with ≥atypical squamous cells of undetermined significance threshold for colposcopy referral) in the 3 years before VASCAR.
  
  
  RESULTS
  VASCAR included 23,739 eligible women, among whom 1646 women (6.9%) tested positive for the human papillomavirus (HPV). Because of the need for subsequent sampling for cytologic testing, follow-up evaluation for cytologic triage was relatively poor; only 46% and 24% of HPV-positive women were Papanicolaou-triaged and underwent biopsy, respectively. Protocol violations occurred mainly in the early phases of implementation (12%). Detection of high-grade cervical intraepithelial neoplasia increased nearly 3-fold (rate ratio, 2.78; 95% confidence interval [CI], 2.1-3.7) during VASCAR, mostly because of a doubling in the rate of high-grade cervical intraepithelial neoplasia (34.0%; 95% CI, 21.2-48.8) compared with the historic cytology-only era (16.3%; 95% CI, 13.2-19.8). VASCAR reduced the median time to colposcopy from a positive screen from 11 months (95% CI, 10.48-11.50) to 3 months (95% CI, 2.64-3.80).
  
  
  CONCLUSIONS
  VASCAR is feasible; however, it requires cosampling for HPV and cytology and for continuous education of healthcare providers of the HPV-Papanicolaou triage protocol. Efficacy in disease detection and reduction in time to colposcopy referrals compared with the historic cytology era is encouraging but should be considered preliminary because of the small number of patients who were tested.
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.
authors.forename: Karolina
authors.initials: K
authors.lastname: Louvanto
authors.affiliation: Department of Pathology, McGill University and Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Myriam
authors.initials: M
authors.lastname: Chevarie-Davis
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.
authors.forename: Agnihotram Venkata
authors.initials: AV
authors.lastname: Ramanakumar
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.
authors.forename: Eduardo Luis
authors.initials: EL
authors.lastname: Franco
authors.affiliation: Department of Pathology, McGill University and Jewish General Hospital, Montreal, QC, Canada; Department of Obstetrics and Gynecology, McGill University and Jewish General Hospital, Montreal, QC, Canada. Electronic address: alex.ferenczy@mcgill.ca.
authors.forename: Alex
authors.initials: A
authors.lastname: Ferenczy
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D003127:Colposcopy; D004279:DNA, Viral / Q000302:isolation & purification; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007118:Immunoassay; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis*; D014218:Triage; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000821:virology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology*
chemical_list: D004279:DNA, Viral
keywords: HPV testing; HPV+/Papanicolaou triage; Papanicolaou test; colposcopy; primary cervical cancer screening