The HPV test has similar sensitivity but more overdiagnosis than the Pap test—A randomised health services study on cervical cancer screening in Finland

Abstract

We compared test sensitivity (in terms of prevented cancers) and overdiagnosis (in terms of non-progressive pre-invasive lesions) between the human papillomavirus test (HPV test, Hybrid Capture 2) and the traditional Pap test in routine screening for cervical cancer. The design was a randomised (1:1) health services study in Finland with intake between 2003 and 2007. We estimated sensitivity by the incidence method within one screening round. Overdiagnosis was based on the rate of cervical intraepithelial Grade 3 (CIN3) lesions diagnosed at screen and during the following interval. Out of 203,788 randomised women 132,298 attended (65% in both study arms) and 600,753 person-years accumulated among attenders up to the end of 2010. In all attenders, 34 invasive cervical cancers and 288 CIN3 lesions were diagnosed at screen or during the following interval. The interval cancer incidence was 2.5/10 5 person-years (sensitivity 0.87) and 1.4 (sensitivity 0.93) in the HPV arm and Pap test arm, respectively. The rate of CIN3 lesions was 57.1 and 38.8, respectively. In conclusion, sensitivity of HPV testing was similar to that of Pap testing but caused more overdiagnosis. Therefore, implementation of HPV testing needs to be reconsidered especially in countries with well organised programmes.Recommendations concerning new screening tests for cervical cancer are mostly based on cross-sectional studies and on detection rates of pre-invasive lesions. 1-5 The few follow-up studies have focused on pre-invasive lesions and on the length of reassurance that a negative test provides. 6-10 Only few studies have had emphasis on public health aspects. 11,12 The purpose of screening is to prevent invasive cervical cancer and the demonstration of this effect requires follow-up for incident invasive cancers after the screen. In fact, detection (at screen) of pre-invasive lesions results in both benefit and harm; benefit through preventing some of the lesions from progressing to invasive cancer, and harm by detecting also such pre-invasive lesions that would never have progressed to invasive cancers. These two types of pre-invasive lesions cannot be separated and thus, both types have to be treated if diagnosed.Sensitivity measures a screening test's ability to correctly identify unrecognised disease. It can be estimated in several ways. The most common way is called the detection method 4 which is based on screen detected lesions, both pre-invasive and invasive ones. However, the sensitivity estimate is usually biased and too big (closer to one) due to overdiagnosis of the detection of pre-invasive lesions. Sensitivity can also be estimated by the incidence method 13 that is based on failures of screening.The purpose of the present study was to compare the human papillomavirus (HPV) test to the traditional Pap test in cervical cancer screening in terms of sensitivity (detection of progressive lesions) and overdiagnosis (detection of nonprogressive lesions). Material and methodsIn Finland, women between 30 and 60 years of age (sometimes ...

The clinical performance of computer‐assisted liquid‐based cytology, primary hrHPV screening, and cotesting at a Turkish Tertiary Care Hospital

“…In and thus overtreatment consists of unnecessary interventions leading to both human and financial implications in the society (eg, increased anxiety, fear, reduced fertility from cervical stenosis, and problems in pregnancy and delivery). 19,20 The difference between our results and some of the previous stud- They found a significant increase in LSIL (37%) and HSIL (42%) detection with the ThinPrep Imaging System compared to manual screening and observed false-negative rates to reduce by half.…”

Use of primary high-risk human papillomavirus testing for cervical cancer screening: Interim clinical guidance

“…They consistently demonstrate an improved sensitivity of primary hrHPV screening for detecting cervical cancer precursor lesions (cervical intraepithelial neoplasia grades 2 and 3 (CIN2 and CIN3)) compared to cytology alone [5][6][7][8][9][10]. Some of these trials reported that primary hrHPV screening continues to have a sensitivity advantage over cytology after multiple rounds of screening.…”

“…The review of abstracts yielded eleven papers that were reviewed by panel members [5][6][7][8][9][10][11][12][13][14][15]. In addition, significant papers published prior to November 2011 were evaluated.…”

Reconsidering Primary HPV Testing in Cervical Cancer Screening

“…Giving the fact that HPV testing has been shown to have similar sensitivity but more overdiagnosis than the Pap test [25][26][27][28], and also giving the fact that false negative results may be higher than previously suspected [25,26,32], primary screening with HPV testing in European countries as well as in the U.S. should be reconsidered. Resources saved in molecular testing may well be addressed in implementing vaccination strategies that are still underused and possibly must include males as well as women [44,45].…”

“…warned that the sensitivity of HPV testing is similar to that of cytology but causes more overdiagnosis [27]. In another study, Patanwala and coll.…”