Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women

Clavel, Christine; Masure, Marie; Bory, J; Putaud, Isabelle; Mangeonjean, C; Lee, Marianne; Nazeyrollas, Pierre; Gabriel, Rene Faustino; Quereux, C.; Birembaut, Philippe

doi:10.1054/bjoc.2001.1845

Cited by 401 publications

(277 citation statements)

References 45 publications

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“…Studies, particularly in developed countries, suggest that HPV testing is more sensitive than cytology at identifying CIN 2=3 lesions but with lower specificity. 10,[20][21][22][23][24][25] It is likely that higher detection rates reported for HPV testing in other studies may be due to poor-quality concurrent cytology. In a multicenter cross-sectional study in India, HPV testing had similar sensitivity to detect CIN 2=3 lesions as cytology and VIA.…”

Section: Discussionmentioning

confidence: 99%

A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

Sankaranarayanan

Nene

Dinshaw

et al. 2005

Intl Journal of Cancer

175

147

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The impact of screening by visual inspection with acetic acid (VIA), cytology or HPV testing on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in India. We report findings after the screening phase, when 52 clusters, with a total of 142,701 women aged 30-59 years in Osmanabad District, India, were randomized into 4 arms for a single round of screening by trained midwives with either VIA, cytology or HPV testing as well as a control group. All laboratory tests were done locally. Test-positive women underwent investigations (colposcopy=biopsy) and treatment in the base hospital. Data on participation, test positivity, positive predictive value and detection rates of cervical neoplasia were analyzed using cluster design methodology. Of the eligible women, 72-74% were screened. Test positivity rates were 14.0% for VIA, 7.0% for cytology and 10.3% for HPV. The detection rate of high-grade lesions was similar in all intervention arms (0.7% for VIA, 1.0% for cytology and 0.9% for HPV testing) (p 5 0.06, Mann-Whitney test). While the detection rate for VIA dropped to 0.5% with declining test positivity during the course of the study, it remained constant for cytology and HPV testing. Over 85% of women with high-grade lesions received treatment. Our results show that a high level of participation and good-quality cytology can be achieved in low-resource settings. VIA is a useful alternative but requires careful monitoring. Detection rates obtained by HPV testing were similar to cytology, despite higher investments. ' 2005 Wiley-Liss, Inc.Key words: visual inspection with acetic acid; cytology; human papillomavirus testing; cervical cancer; screening Cervical cancer is an important public health problem of adult women in many developing countries. 1,2 Cytology screening programs have resulted in a marked decline of this disease in developed countries. 2 However, the considerable financial, technical and logistic inputs necessary for effective cytology programs means that the results obtained in developing countries have been, at best, mediocre. 3,4 Hence, it is important to evaluate the effectiveness of alternative methods of screening, such as VIA and HPV testing, that may be more readily implemented in different settings.VIA is simple and inexpensive and can be provided by midwives, nurses and other HWs. Its accuracy at detecting cervical neoplasia has been extensively studied and found to be satisfactory. [5][6][7] The role of persistent infection with oncogenic types of HPV in the etiology of cervical cancer has encouraged the evaluation of HPV testing as a screening tool. [8][9][10] The ultimate proof of efficacy of a screening test for cervical neoplasia is its ability to prevent invasive cancer when implemented in a program setting. Whether a screening program using VIA or HPV testing will be followed by a reduction in disease burden and the cost-effectiveness of these alternate approaches based on real program-based information remain to be established. These appro...

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Section: Discussionmentioning

confidence: 99%

A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

Sankaranarayanan

Nene

Dinshaw

et al. 2005

Intl Journal of Cancer

175

147

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“…Thus, some women will fall into the category of having normal cervical cytology with a positive high-risk HPV analysis. Clavel et al 22 followed up such patients and found that only 4% of such women had findings of CIN 2 or higher. This has led to the recommendation, restated in the 2006 consensus guidelines, that women with negative cervical cytology and positive high-risk HPV be followed up with a repeat of both tests at 12 months.…”

Section: Normal Papanicolaou Test With or Without High-risk Hpv Deoxymentioning

confidence: 99%

Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease

Hunter

Monk

Tewari

2008

American Journal of Obstetrics and Gynecology

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Cervical cancer screening is an essential component of prenatal care. The diagnosis and management of cervical intraepithelial neoplasia (CIN) during pregnancy are challenging, and sufficient information does not exist to allow for a definitive evidence-based approach. The American Society for Colposcopy and Cervical Pathology has recently published guidelines regarding the evaluation of abnormal Papanicolaou tests and the treatment of CIN in this setting. Many techniques traditionally recommended in the evaluation of abnormal cervical cytology and the treatment of CIN in the nonpregnant woman, such as colposcopy, cervical biopsy, and electrosurgical excision, can be applied to the pregnant patient with important exceptions. The vascular cervix associated with the gravid condition and the risk of premature pregnancy loss mandates deviation from existing consensus guidelines in screening for cervical cancer in pregnancy and treating associated CIN. In the present review, current guidelines regarding cervical cancer screening are reviewed, and data from studies of pregnant populations are summarized.

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“…After 50 years of cytology as the sole test in cervical cancer prevention, new methods are appearing to palliate the Achilles' heel of cytology, which is sensitivity. Indeed, many reports (Belinson et al, 1999;Kuhn et al, 2000;Ratnam et al, 2000;Schiffman et al, 2000;Wright et al, 2000;Clavel et al, 2001;Kulasingam et al, 2002;Petry et al, 2003) have established a higher sensitivity for HPV than for cytology, although published results are not unanimous (de Cremoux et al, 2003). The main study objective was to confirm the better sensitivity of HPV testing, especially in the context of routine clinical practice.…”

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confidence: 98%

The probability for a Pap test to be abnormal is directly proportional to HPV viral load: results from a Swiss study comparing HPV testing and liquid-based cytology to detect cervical cancer precursors in 13 842 women

Bigras¹,

Marval²

2005

Br J Cancer

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In a study involving 13 842 women and 113 gynaecologists, liquid-based cytology and HPV testing for detecting cervical cancer were compared. A total of 1334 women were found to be positive for one or both tests and were invited for colposcopy with biopsy. A total of 1031 satisfactory biopsies on 1031 women were thereafter collected using a systematic biopsy protocol, which was random in the colposcopically normal-appearing cervix or directed in the abnormal one. In all, 502 women with negative tests were also biopsied. A total of 82 histologic high-grade squamous intraepithelial lesion (HSIL) were reported in biopsies, all from the group with one or both tests positive. Sensitivity and specificity to detect histologic HSIL were 59 and 97% for cytology, and 97 and 92% for HPV. In total, 14% of reviewed negative cytological preparations associated with histologic HSIL contained no morphologically abnormal cells despite a positive HPV test. This suggested a theoretical limit for cytology sensitivity. HPV viral load analysis of the 1143 HPVpositive samples showed a direct relationship between abnormal Pap test frequency and HPV viral load. Thus, not only does the HPV testing have a greater sensitivity than cytology but the probability of the latter being positive can also be defined as a function of the associated HPV viral load.

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Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women

Cited by 401 publications

References 45 publications

A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India

Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease

The probability for a Pap test to be abnormal is directly proportional to HPV viral load: results from a Swiss study comparing HPV testing and liquid-based cytology to detect cervical cancer precursors in 13 842 women

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