Age‐specific effectiveness of primary human papillomavirus screening versus cytology in a cervical cancer screening program: a nationwide cross‐sectional study

Abstract

Background Primary human papillomavirus (HPV) screening is recommended for the detection of cervical intraepithelial neoplasia (CIN) in the general population; however, the triage for HPV‐positive women remains a challenge. This study aimed to evaluate the age‐specific effectiveness of primary HPV screening versus primary cytology screening for identifying optimal strategies for women of different ages. Methods The dataset of the prevalence round screening was derived from the National Cervical Cancer Screening Program in China. Primary cervical screening protocols included cytology only, HPV testing with cytology triage, and HPV testing with HPV‐16/18 genotyping plus cytology triage. The primary outcomes were age‐specific detection rate, colposcopy referral rate and positive predictive value (PPV) for CIN2+. Multivariate Poisson regression was used to evaluate the relative effectiveness of HPV testing and cytology according to age groups. The I2 statistic with a random‐effect model was used to test the heterogeneity in relative effectiveness of HPV testing versus cytology between age groups. Results This study included 1,160,981 women. HPV testing with HPV‐16/18 genotyping plus cytology triage significantly increased the CIN2+ detection by 36% (rate ratio [RR]: 1.36, 95% confidential interval [CI] 1.21–1.54) for women aged 35‐44 years and by 34% (RR: 1.34, 95% CI 1.20‐1.51) for women aged 45‐54 years compared with cytology only. HPV testing with cytology triage had similar CIN2+ detection rate compared with cytology only. The PPVs were substantially increased for both HPV testing groups. Among women aged 55‐64 years old, HPV testing with HPV‐16/18 genotyping plus cytology triage increased the colposcopy referral rate by 19% (RR 1.19, 95% CI 1.10‐1.29) compared with cytology only, but did not increase the CIN2+ detection (1.09, 0.91–1.30). The effectiveness of HPV testing with cytology triage did not change in older women. The between‐age‐group heterogeneity in the effectiveness was statistically significant for HPV testing with HPV‐16/18 genotyping plus cytology triage versus cytology only. Conclusions Our results suggested that the effectiveness of primary HPV screening with different triage strategies differed among age groups. HPV testing with HPV‐16/18 genotyping plus cytology triage could be used for women aged 35‐54 years to detect more lesions, and HPV testing with cytology triage could balance the CIN2+ detection and the number of colposcopies for women aged 55‐64 years. Longitudinal data including both prevalence and incidence screening rounds are warranted to assess age‐specific triage strategies.

Epidemiological study of HPV infection in 40,693 women in Putian: a population study based on screening for high-risk HPV infection

“…However, the prevention and treatment of cervical cancer in China has not obtained promising results, and cervical cancer has become prevalent in young people [26,27]. Globally, young women (< 25 years of age) are prone to peak HPV infection rates, whereas a second peak in older women has been observed in regions such as China, East Africa and Latin America [28][29][30]. A second peak in invasive cancers used to be seen (in the UK) in the early 1990s, but this has largely disappeared as screening has detected and treated much of the CIN in younger women.…”

Multiple Center Research on Relationship Between Screening Quality and Detection of Cervical Cancer — Six Provinces, China, June–December 2021

“…A study from Chongqing Hospital reported that among 1,055 participants, 211 cases were ≥cervical intraepithelial neoplasia 2 (CIN2), resulting in a detection rate of 20% ( 4 ). Previous studies have reported that the detection of CIN and ICC ranged from 4.1 to 6.0 per 1,000 in different age groups with different cervical cancer screening methods in the general population ( 5 ). In hospitals, most patients had abnormal cervical screening results, making them a high-risk population, thus the detection rate of cervical cancer was much higher than in the general population.…”

Performance of human papillomavirus E6/E7 mRNA assay for primary cervical cancer screening and triage: Population-based screening in China

“…Second, longitudinal follow-up should be carried out in women with both negative LBC and AHPV results. Finally, the performance of primary HPV screening with different triage strategies differed among age groups ( Bao et al., 2022 ). Evaluation of the age-specific effectiveness of primary AHPV screening and possible triage strategies is warranted.…”