A systematic review and meta‐analysis of diagnostic accuracy of HPV tests for the screening of cervical cancer in low‐resource settings

Abstract

Background HPV tests for the screening of cervical cancer in low‐income countries (LICs) might improve early detection and preventive efforts. Objectives To determine the diagnostic accuracy of HPV tests for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) in LICs. Search strategy The Cochrane Library, MEDLINE, and CINAHL databases were searched on June 1, 2020. References of relevant studies were hand‐searched. Selection criteria Diagnostic test accuracy studies were included if women had an HPV test for cervical cancer screening, followed by verification with colposcopy and colposcopy‐directed biopsy. The primary target was CIN2+. Data collection and analysis Two authors independently screened studies, extracted data, and assessed methodological quality. Bivariate diagnostic random‐effects meta‐analysis was used. Main results Eleven studies including 82 556 women were eligible, most of which were at low risk of bias. The pooled diagnostic odds ratio of hybrid capture test of samples collected from the cervix by healthcare providers for detecting CIN2+ and CIN3+ was 42.0 (95% confidence interval [CI] 20.7–76.3) and 97.1 (95% CI 35.3–215.0), respectively. Conclusions Evidence indicates that hybrid capture tests can be used for screening of cervical cancer in LICs. Future studies are warranted for self‐sampling and for low‐cost HPV tests.

Comparison of Different Self-Sampling Devices for Molecular Detection of Human Papillomavirus (HPV) and Other Sexually Transmitted Infections (STIs): A Pilot Study

“…Published meta-analyses confirmed the accuracy of HPV DNA testing on self-collected versus clinician-collected samples, using PCR-based assays [ 21 , 22 , 23 ]. This screening strategy can be particularly useful in cervical cancer prevention in disadvantaged populations and/or in low-resource settings [ 24 , 25 , 26 ].…”

Comparison of COVID-19 outcomes among shielded and non-shielded populations

“…Patients with cystic fibrosis and sickle cell disease were classified as high risk based on expert opinion 31 , 32 . While pregnant women with COVID-19 were found to have higher risk of poor maternal and perinatal outcomes 33 , 34 , outcomes were not investigated specifically for pregnant women with heart disease. There was no evidence of worse COVID-19 related complications among patients on immunosuppressants 35 .…”

Comparison between Urine and Cervical High-Risk HPV Tests for Japanese Women with ASC-US

“…This suggests at least 2-3% of women with HPV infection would be classified as negative. However, it is expected to detect more lesions than cytological screening in total for the higher sensitivity in hrHPV-related lesions [20][21][22][23][24]. Co-testing of cytology and hrHPV-DNA might reduce false negatives but significantly increase false positives, resulting in overdiagnosis [25][26][27].…”

“…Indeed, Kono et al reported the relationship between the experimental introduction of the hrHPV test in screening and a significantly higher referral rate in Japan [34]. It is partially controversial to detect CIN2 lesions by cervical cancer screening because they include more transient lesions in vaccine-underdeveloped areas [19,23,35]. We did not restrict the detection target and analyzed the sensitivities for both CIN2+ and CIN3+.…”