title: Population-based cervical cancer screening using high-risk HPV DNA test and liquid-based cytology in northern Thailand.
abstract: BACKGROUND
  Northern Thailand is a region with a high cervical cancer incidence. Combined high-risk HPV (hrHPV) DNA testing and cytology (co-testing) has increasingly gained acceptance for cervical cancer screening. However, to our knowledge, data from a population-based screening using co-testing have not been available in this region. This study therefore aimed to evaluate the performance of cytology and hrHPV test in women in northern Thailand.
  
  
  METHODS
  Cervical samples were collected for hybrid capture 2 (HC2) testing and liquid-based cytology from women aged 30 to 60 years who were residents in 3 prefectures of Chiang Mai in northern Thailand between May and September 2011. Women with positive cytology were referred to colposcopy, while women with positive for HC2 only were followed for 2 years.
  
  
  RESULTS
  Of 2,752 women included in this study, 3.0% were positive in both tests, 4.1% for HC2 only, and 1.3% had positive cytology only. At baseline screening, positive HC2 was observed in 70.6% among cytology-positive women compared with 4.3% among cytology-negative women. The prevalence of positive HC2 or cytology peaked in the age group 35-39 years and was lowest in the age group 55-60 years. High-grade squamous intraepithelial lesion or worse lesions (HSIL+) were histologically detected in 23.5% of women with positive baseline cytology and in 9.8% of women with positive baseline HC2 only on follow-up. All women with histologic HSIL+ had positive baseline HC2.
  
  
  CONCLUSIONS
  The hrHPV test is superior to cytology in the early detection of high-grade cervical epithelial lesions. In this study, the prevalence of histologic HSIL+ on follow-up of women with positive hrHPV test was rather high, and these women should be kept under careful surveillance. In northern Thailand, hrHPV testing has a potential to be used as a primary screening test for cervical cancer with cytology applied as a triage test.
authors.affiliation: Department of Pathology, Faculty of Medicine, 3Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand E-mail : skhunamo@yahoo.com.
authors.forename: Sumalee
authors.initials: S
authors.lastname: Siriaunkgul
authors.forename: Jongkolnee
authors.initials: J
authors.lastname: Settakorn
authors.forename: Kornkanok
authors.initials: K
authors.lastname: Sukpan
authors.forename: Jatupol
authors.initials: J
authors.lastname: Srisomboon
authors.forename: Prapaporn
authors.initials: P
authors.lastname: Suprasert
authors.forename: Nongyao
authors.initials: N
authors.lastname: Kasatpibal
authors.forename: Surapan
authors.initials: S
authors.lastname: Khunamornpong
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000166:cytology* / Q000473:pathology; D003127:Colposcopy; D004279:DNA, Viral / Q000032:analysis; D055088:Early Detection of Cancer; D005260:Female; D061809:Human Papillomavirus DNA Tests / Q000379:methods*; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D012680:Sensitivity and Specificity; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis*; D013785:Thailand; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D004279:DNA, Viral