Human papillomavirus test with cytology triage in organized screening for cervical cancer

Veijalainen, Olga; Kares, Saara; Kujala, Paula; Tirkkonen, Mika; Vuento, Risto; Kholová, Ivana; Luukkaala, Tiina; Osuala, Veronika; Mäenpää, Johanna

doi:10.1111/aogs.13013

Cited by 19 publications

(24 citation statements)

References 27 publications

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“…This is the largest report of using hrHPV testing in any organised national programme in the developed world. 20 21 22 23 24 25 26 27 28 29 The largest report from Italy included 130 000 women screened with hrHPV testing and other reports were based on substantially smaller numbers of women or were limited to specific age groups, or both. We were able to identify even infrequent events with more accuracy in this large pilot, including the strongest data yet reported on outcomes from the subsequent incidence screening round(s).…”

Section: Discussionmentioning

confidence: 99%

Primary cervical screening with high risk human papillomavirus testing: observational study

Rebolj

Rimmer

Denton

et al. 2019

BMJ

136

174

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ObjectiveTo provide the first report on the main outcomes from the prevalence and incidence rounds of a large pilot of routine primary high risk human papillomavirus (hrHPV) testing in England, compared with contemporaneous primary liquid based cytology screening.DesignObservational study.SettingThe English Cervical Screening Programme.Participants578 547 women undergoing cervical screening in primary care between May 2013 and December 2014, with follow-up until May 2017; 183 970 (32%) were screened with hrHPV testing.InterventionsRoutine cervical screening with hrHPV testing with liquid based cytology triage and two early recalls for women who were hrHPV positive and cytology negative, following the national screening age and interval recommendations.Main outcome measuresFrequency of referral for a colposcopy; adherence to early recall; and relative detection of cervical intraepithelial neoplasia grade 2 or worse from hrHPV testing compared with liquid based cytology in two consecutive screening rounds.ResultsBaseline hrHPV testing and early recall required approximately 80% more colposcopies, (adjusted odds ratio 1.77, 95% confidence interval 1.73 to 1.82), but detected substantially more cervical intraepithelial neoplasia than liquid based cytology (1.49 for cervical intraepithelial neoplasia grade 2 or worse, 1.43 to 1.55; 1.44 for cervical intraepithelial neoplasia grade 3 or worse, 1.36 to 1.51) and for cervical cancer (1.27, 0.99 to 1.63). Attendance at early recall and colposcopy referral were 80% and 95%, respectively. At the incidence screen, the 33 506 women screened with hrHPV testing had substantially less cervical intraepithelial neoplasia grade 3 or worse than the 77 017 women screened with liquid based cytology (0.14, 0.09 to 0.23).ConclusionsIn England, routine primary hrHPV screening increased the detection of cervical intraepithelial neoplasia grade 3 or worse and cervical cancer by approximately 40% and 30%, respectively, compared with liquid based cytology. The very low incidence of cervical intraepithelial neoplasia grade 3 or worse after three years supports extending the screening interval.

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Section: Discussionmentioning

confidence: 99%

Primary cervical screening with high risk human papillomavirus testing: observational study

Rebolj

Rimmer

Denton

et al. 2019

BMJ

136

174

View full text Add to dashboard Cite

show abstract

“…The performance characteristics of our ‘test and treat’ algorithm based on point-of-care Xpert HPV testing alone might be considered sub-optimal compared with current practice in many high-income countries (hrHPV testing followed by liquid based cytology if hrHPV-positive, with referral for colposcopy and biopsy if HSIL or worse) [33] , [34] , [35] , [36] , [37] , [38] . However, same-day ‘test and treat’ strategies offer considerable advantages over two- or three-step algorithms in low-resource settings that offset potential differences in algorithm performance.…”

Section: Discussionmentioning

confidence: 99%

Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

Toliman

Kaldor

Badman

et al. 2018

Papillomavirus Research

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The performance of different clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal (‘V’) specimens, and visual inspection of the cervix with acetic acid (VIA) was evaluated in Papua New Guinea.Women aged 30–59 years provided V specimens that were tested at point-of-care using the Xpert HPV Test (Cepheid, Sunnyvale, CA). A clinician-collected cervical (‘C’) specimen was then collected for point-of-care Xpert testing, and liquid-based cytology (LBC). Following this, VIA examination was conducted, blind to HPV test results, and ablative cervical cryotherapy provided if indicated. Detection of high-grade squamous intraepithelial lesion (HSIL) by LBC was the reference standard used to evaluate clinical screening algorithms.Of 1005 women, 36 had HSIL+. Xpert HPV Test performance using V specimens (sensitivity 91.7%, specificity 87.0%, PPV 34.0%, NPV 99.3%) was superior to VIA examination alone (51.5%, 81.4%, 17.5%, 95.6% respectively) in predicting underlying HSIL+. A screening algorithm comprising V specimen HPV testing followed by VIA examination had low sensitivity (45.5%) but comparable specificity, PPV and NPV to HPV testing alone (96.3%, 45.5%, 96.3% respectively).A ‘test-and-treat’ screening algorithm based on point-of-care HPV testing of V specimens had superior performance compared with either VIA examination alone, or a combined screening algorithm comprising HPV testing plus VIA.

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“…Cytology education faces a number of challenges due to changing medical practices. For example, organised human papillomavirus test for cervical cancer screening is only used in the Tampere region of Finland at the moment and has not been rolled out to the rest of the country . If this screening does expand in Finland, Pap smear screening will decrease substantially.…”

Section: Discussionmentioning

confidence: 99%

“…For example, organised human papillomavirus test for cervical cancer screening is only used in the Tampere region of Finland at the moment and has not been rolled out to the rest of the country. 13 If this screening does expand in Finland, Pap smear screening will decrease substantially. It is also likely that the use of molecular biology methods will increase in cytology and there is a possibility that these competencies will partly replace traditional microscopy screening.…”

Section: Discussionmentioning

confidence: 99%

Cytotechnologists’ education and work in Finland

Liikanen

2019

Cytopathology

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Objective The aim of this study was to survey the work that cytotechnologists carry out in Finland. Methods An electronic questionnaire was planned with the Board of the Finnish Association of Cytotechnologists and an email containing the link was sent to all 107 of its members in January 2018. It included 17 questions on their age and work experience, education and work. There was also space for them to add other comments. Results Just under half (45%) replied. Their average age was 51 years (range 28‐64), 41% had a Bachelor's degree, 59% had college‐level training and they had spent an average of 15 years screening cytology specimens. After basic professional education, they had completed their cytology education in many ways and the most common routes were internship training (71%) and 1‐year cytology specialisation (38%). Most of the cytotechnologists (85%) had duties other than screening and they mostly included a combination of histotechnology and cytotechnology (37.5%) or just cytotechnology (17%) or histotechnology (9%). The other 15% only screened cytology specimens. All cytotechnologists screened Papanicolaou smears, 94% screened urinary and respiratory specimens, 82% screened effusions and 39% screened fine‐needle aspirations. Conclusions We found that internship training provided essential training for Finnish cytotechnologists after they complete their basic professional studies. They reported many other duties in addition to microscopy screening.

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Human papillomavirus test with cytology triage in organized screening for cervical cancer

Abstract: Human papillomavirus testing also seems to be more sensitive than cytology in detecting CIN2 lesions in the setting of a routine organized screening program, besides in the context of randomized trials. The problem of an increased colposcopy rate needs to be addressed in the future.

Cited by 19 publications

References 27 publications

Primary cervical screening with high risk human papillomavirus testing: observational study

Primary cervical screening with high risk human papillomavirus testing: observational study

Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

Cytotechnologists’ education and work in Finland

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