Comparison of Cervical Cancer Screening Results Among 256,648 Women in Multiple Clinical Practices

Overview

Journal Cancer Cytopathol

Specialty Oncology

Date 2015 Apr 14

PMID 25864682

Citations 41

Authors

Amy J Blatt

Ronald Kennedy

Ronald D Luff

R Marshall Austin

Douglas S Rabin

Affiliations

Soon will be listed here.

Abstract

Background: In the United States, human papillomavirus (HPV) and Papanicolaou (Pap) testing (cotesting) for cervical screening in women ages 30 to 65 years is the preferred strategy, and cytology alone is acceptable. Recently, a proprietary automated test for identifying high-risk HPV types for primary cervical screening was approved by the US Food and Drug Administration. The objective of the current study was to document extensive cervical screening among these screening options.

Methods: To investigate the sensitivity of various testing options for biopsy-proven cervical intraepithelial neoplasia grade 3 or worse (≥ CIN3) and cancer, the authors reviewed 256,648 deidentified results from women ages 30 to 65 years at the time of cotest who had a cervical biopsy specimen obtained within 1 year of the cotest.

Results: A positive cotest result was more sensitive (98.8%; 4040 of 4090 cotests) for diagnosing ≥ CIN3 than either a positive HPV-only test (94%; 3845 of 4090 HPV-only tests) or a positive Pap-only test (91.3%; 3734 of 4090 Pap-only tests; P < .0001). A positive Pap-only result was more specific (26.3%; 66,145 of 251,715 Pap-only tests) for diagnosing ≥ CIN3 than a positive HPV-only test (25.6%; 64,625 of 252,556 HPV-only tests) or a positive cotest (10.9%; 27,578 of 252,558 cotests; P < .0001). Of 526 cervical cancers, 98 (18.6%) were HPV-only negative, 64 (12.2%) were Pap-only negative, and 29 (5.5%) were cotest negative.

Conclusions: Compared with HPV-only testing, cotesting was more sensitive for the detection of ≥ CIN3 in women ages 30 to 65 years. The current data suggest that approximately 19% of women with cervical cancer may be misdiagnosed by an HPV-only cervical screen. It is important to consider these data as the guidelines for cervical cancer screening undergo revision. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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References

Tatsas A, Phelan D, Gravitt P, Boitnott J, Clark D . Practice patterns in cervical cancer screening and human papillomavirus testing. Am J Clin Pathol. 2012; 138(2):223-9. DOI: 10.1309/AJCPPVX91HQMNYZZ. View

McCredie M, Sharples K, Paul C, Baranyai J, Medley G, Jones R . Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol. 2008; 9(5):425-34. DOI: 10.1016/S1470-2045(08)70103-7. View

Cox J, Castle P, Behrens C, Sharma A, Wright Jr T, Cuzick J . Comparison of cervical cancer screening strategies incorporating different combinations of cytology, HPV testing, and genotyping for HPV 16/18: results from the ATHENA HPV study. Am J Obstet Gynecol. 2012; 208(3):184.e1-184.e11. DOI: 10.1016/j.ajog.2012.11.020. View

Katki H, Schiffman M, Castle P, Fetterman B, Poitras N, Lorey T . Five-year risks of CIN 3+ and cervical cancer among women who test Pap-negative but are HPV-positive. J Low Genit Tract Dis. 2013; 17(5 Suppl 1):S56-63. PMC: 3616446. DOI: 10.1097/LGT.0b013e318285437b. View

Kang W, Kim C, Cho M, Kim J, Kim Y, Choi H . Comparison of the hybrid capture II assay with the human papillomavirus DNA chip test for the detection of high-grade cervical lesions. Int J Gynecol Cancer. 2009; 19(5):924-8. DOI: 10.1111/IGC.0b013e3181a832a2. View

Li Z, Austin R, Guo M, Zhao C . Screening test results associated with cancer diagnoses in 287 women with cervical squamous cell carcinoma. Arch Pathol Lab Med. 2012; 136(12):1533-40. DOI: 10.5858/arpa.2011-0609-OA. View

Saslow D, Solomon D, Lawson H, Killackey M, Kulasingam S, Cain J . American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012; 62(3):147-72. PMC: 3801360. DOI: 10.3322/caac.21139. View

Zhao C, Li Z, Nayar R, Levi A, Winkler B, Moriarty A . Prior high-risk human papillomavirus testing and Papanicolaou test results of 70 invasive cervical carcinomas diagnosed in 2012: results of a retrospective multicenter study. Arch Pathol Lab Med. 2014; 139(2):184-8. DOI: 10.5858/arpa.2014-0028-OA. View

Bekker J, John T, Leiman G . Confirming suboptimal adherence to HPV cotesting guidelines in an academic center in Vermont. Am J Clin Pathol. 2013; 139(2):259-60. DOI: 10.1309/AJCP41LLYKYUGXVD. View

10.

Wright T, Stoler M, Behrens C, Sharma A, Zhang G, Wright T . Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015; 136(2):189-97. DOI: 10.1016/j.ygyno.2014.11.076. View

11.

Cuzick J, Clavel C, Petry K, Meijer C, Hoyer H, Ratnam S . Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006; 119(5):1095-101. DOI: 10.1002/ijc.21955. View

12.

Ronco G, Dillner J, Elfstrom K, Tunesi S, Snijders P, Arbyn M . Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet. 2013; 383(9916):524-32. DOI: 10.1016/S0140-6736(13)62218-7. View

13.

Poljak M, Kovanda A, Kocjan B, Seme K, Jancar N, Vrtacnik-Bokal E . The Abbott RealTime High Risk HPV test: comparative evaluation of analytical specificity and clinical sensitivity for cervical carcinoma and CIN 3 lesions with the Hybrid Capture 2 HPV DNA test. Acta Dermatovenerol Alp Pannonica Adriat. 2009; 18(3):94-103. View

14.

Kitchener H, Gilham C, Sargent A, Bailey A, Albrow R, Roberts C . A comparison of HPV DNA testing and liquid based cytology over three rounds of primary cervical screening: extended follow up in the ARTISTIC trial. Eur J Cancer. 2011; 47(6):864-71. DOI: 10.1016/j.ejca.2011.01.008. View

15.

Gage J, Schiffman M, Katki H, Castle P, Fetterman B, Wentzensen N . Reassurance against future risk of precancer and cancer conferred by a negative human papillomavirus test. J Natl Cancer Inst. 2014; 106(8). PMC: 4111283. DOI: 10.1093/jnci/dju153. View

16.

Naucler P, Ryd W, Tornberg S, Strand A, Wadell G, Elfgren K . Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening. J Natl Cancer Inst. 2009; 101(2):88-99. DOI: 10.1093/jnci/djn444. View

17.

Nayar R, Goulart R, Tiscornia-Wasserman P, Davey D . Primary human papillomavirus screening for cervical cancer in the United States-US Food and Drug Administration approval, clinical trials, and where we are today. Cancer Cytopathol. 2014; 122(10):720-9. DOI: 10.1002/cncy.21480. View

18.

Moreira M, Longato-Filho A, Taromaru E, Queiroz G, Jube L, Pinto S . Investigation of human papillomavirus by hybrid capture II in cervical carcinomas including 113 adenocarcinomas and related lesions. Int J Gynecol Cancer. 2006; 16(2):586-90. DOI: 10.1111/j.1525-1438.2006.00374.x. View

19.

Katki H, Schiffman M, Castle P, Fetterman B, Poitras N, Lorey T . Five-year risks of CIN 2+ and CIN 3+ among women with HPV-positive and HPV-negative LSIL Pap results. J Low Genit Tract Dis. 2013; 17(5 Suppl 1):S43-9. PMC: 3637971. DOI: 10.1097/LGT.0b013e3182854269. View

20.

Austin R, Zhao C . Is 58% sensitivity for detection of cervical intraepithelial neoplasia 3 and invasive cervical cancer optimal for cervical screening?. Cytojournal. 2014; 11:14. PMC: 4058958. DOI: 10.4103/1742-6413.132997. View