Comparison of HPV-16 and HPV-18 Genotyping and Cytological Testing as Triage Testing Within Human Papillomavirus–Based Screening in Mexico

Abstract

This diagnostic study compares the efficiency and effectiveness of 6 triage testing scenarios for screening women with high-risk human papillomavirus (HPV) for referral for colposcopy.

The effectiveness of HPV16 and HPV18 genotyping and cytology with different thresholds for the triage of human papillomavirus-based screening on self-collected samples

“…The medical resources required and health care professionals, as well as healthy perceptions of women, are key factors that should be addressed to ensure effective cervical screening programs [27]. Of the 17 triage strategies, the one with positivity for HPV16 and/or �ASCUS and the one with positivity for (HPV16 and/or HPV18) and/or �ASCUS achieved favorable sensitivity and might reduce secondly loss to follow-up rate compared with the comparator; although with a little lower specificity compared with the comparator, these algorithms would reduce the referral rate to 5.0% and 5.6% respectively compared with 13.7% of that for HPV alone, and require less cytological test compare with the comparator.…”

“…Of the 17 triage strategies, the one with positivity for HPV16 and/or �ASCUS and the one with positivity for (HPV16 and/or HPV18) and/or �ASCUS achieved favorable sensitivity and might reduce secondly loss to follow-up rate compared with the comparator; although with a little lower specificity compared with the comparator, these algorithms would reduce the referral rate to 5.0% and 5.6% respectively compared with 13.7% of that for HPV alone, and require less cytological test compare with the comparator. Since women in lowresource areas are less likely to contact with health care services, early detection of cervical cancer and precancer will generally produce a better outcome for women's overall health as well as public health in the long run [27]. Moreover, screening algorithms with low sensitivity require frequent repetitions of cervical screening, which pose logistical barriers to adherence to follow-up advices for women in rural areas as well as inequity in access to services [27].…”

“…Since women in lowresource areas are less likely to contact with health care services, early detection of cervical cancer and precancer will generally produce a better outcome for women's overall health as well as public health in the long run [27]. Moreover, screening algorithms with low sensitivity require frequent repetitions of cervical screening, which pose logistical barriers to adherence to follow-up advices for women in rural areas as well as inequity in access to services [27]. Accordingly, when there is a clinical need to use a test with high potential sensitivity, such as women in low-resource settings where access to appropriate follow-up is challenging and women with serious stress or anxiety on HPV infection, these two strategies (HPV16 and/or �ASCUS; HPV16/18 and/or �ASCUS) may be appropriate alternatives to achieve the goal of preventing cervical cancer.…”

“…Implementing this effectively and still avoiding overtreatment should be the primary goal of cervical cancer screening [9]. In several studies, the approach of HPV primary screening and reflex with genotyping and cytology, despite the high colposcopy referral rate, was still found to be the most cost-effective relative to other strategies, including cytologybased screening, co-testing of HPV and cytology, and HPV primary screening with reflex to cytology [10,21,24,27]. There is no single screening modality that could cover all clinical needs; on the basis of our findings and prior studies [24,28], combination HPV16 or HPV18, with different thresholds of cytology offers personalized management for HPV-positive women in clinical practice.…”

Benefit of double‐reading cytology smears as a triage strategy among high‐risk human papillomavirus–positive women in Mexico

“…Our findings indicate that the performance of LBC to detect HSIL+ cases is improved by a double cytology reading, which could be implemented as a feasible strategy in Mexico. Although a double reading would be more costly and time‐consuming in the context of a Pap‐based screening program, the impact could be reduced if HPV testing was used for primary screening, as is the case in Mexico, 22 Australia, 23 and several countries in Europe 24 . Of the 36,212 women who participated in the FRIDA Study, only 3914 (11%) were hrHPV‐positive and underwent triage with LBC.…”