Evaluation of multiple primary and combination screening strategies in postmenopausal women for detection of cervical cancer in China

Abstract

As China's population ages, the importance of determining prevalence of cervical disease and accurate cervical cancer screening strategies for postmenopausal women is increasing. Seventeen population-based studies were analyzed to determine prevalence of cervical neoplasia in postmenopausal women. All women underwent HPV DNA testing, visual inspection with acetic acid (VIA) and cytology testing. Diagnostic values for primary and combinations screening methods included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), referral rate and area under curve (AUC) were calculated using directed biopsy or four quadrants biopsy as reference standard. Premenopausal and postmenopausal women had equal HPV infection and cervical neoplasia rates (p > 0.05). HPV DNA testing CIN3+ sensitivity, specificity, PPV, NPV, referral rate and AUC were 97.9% (95% CI: 90.2-99.9%), 84.2% (95% CI: 82.8-85.5%), 9.9% (95% CI: 7.4-12.8%), 100% (95% CI: 99.8-100%), 17.2% (95% CI: 15.9-18.7%), 0.911, respectively. VIA values were 41.7% (95% CI: 28.4-55.9%), 94.5% (95% CI: 93.6-95.3%), 11.8% (95% CI: 7.5-17.3%), 98.9% (95% CI: 98.5-99.3%), 6.2% (95% CI: 5.3-7.1%) and 0.681, respectively. Values for VIA with HPV triage were 39.6% (95% CI: 26.6-53.8%), 99.2% (95% CI: 98.8-99.5%), 45.2% (95% CI: 30.8-60.4%), 98.9% (95% CI: 98.5-99.3%), 1.5% (95% CI: 1.1-2.0%) and 0.694, respectively. VIA and HPV DNA co-test values were 100% (95% CI: 94.0-100%), 79.5% (95% CI: 78.0-81.0%), 8.0% (95% CI: 6.0-10.3%), 100% (95% CI: 99.9-100%), 21.9% (95% CI: 20.4-23.4%) and 0.898, respectively. VIA sensitivity decreases significantly in postmenopausal women compared to premenopausal performance. HPV DNA testing maintains performance between pre- and postmenopausal women and is the most accurate primary modality for screening postmenopausal populations in low resource areas of China.

Accuracy of triage strategies for human papillomavirus DNA-positive women in low-resource settings: A cross-sectional study in China

“…Our data show that VIA triage of either primary self-careHPV or physician-careHPV testing decreased sensitivity too low for population-based screening programs and suggest that in areas where VIA performance is poor, other biomarkers for cervical precancerous disease should be explored. VIA performance has been shown to improve with provider training (21), and so in areas where VIA performance is currently low, further provider training can be utilized to make the screening strategy of HPVpositive women followed by VIA triage a feasible cervical cancer screening option. Meanwhile, the sensitivity of VIA is also related with the age, which decreases significantly in postmenopausal women compared to premenopausal performance (22).…”

HPV self-sampling acceptability in rural and indigenous communities in Guatemala: a cross-sectional study

“…Since more than 90% of cervical cancers are caused by the HPV virus, HPV testing has been suggested as a possible alternative, primary form of cervical cancer screening 10–12. When used in combination with visual inspection with acetic acid (VIA) or Pap smears in low-income settings, HPV testing has been shown to provide significant improvements in the detection of advanced premalignant lesions and cancer in sensitivity as compared with VIA or Pap smear alone, as only women who test positive for HPV need to follow-up with further screening 13–16. Previous studies have also confirmed that HPV self-swab kits are comparable to physician-administered samples in their ability to detect carcinogenic, high-risk HPV 17 18.…”

Proteomic analysis of human cervical adenocarcinoma mucus to identify potential protein biomarkers

“…Menopause is a life phenomenon with characteristics of estrogen secretion depletion and the cessation of menstruation. The majority of women enter menopause between the ages of 49 and 52 ( Takahashi & Johnson, 2015 ) and some studies show no statistically significant difference in cervical cancer rates of premenopausal and postmenopausal women ( Holt et al, 2017 ; Zhang et al, 2018 ). A total of 8 of the 9 individuals used in this study were premenopausal and the postmenopausal individual was within the age range of normal menopause.…”