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Liang, Linda A.; Einzmann, Thomas; Franzen, Arno; Schwarzer, Katja; Schauberger, Gunther; Schriefer, Dirk; Radde, Kathrin; Zeissig, Sylke R.; Ikenberg, Hans; Meijer, Chris J.L.M.; Kirkpatrick, Charles J.; Kölbl, Heinz; Blettner, Maria; Klug, Stefanie J.

Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-alone or Cotesting Strategies

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  • Media type: E-Article
  • Title: Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-alone or Cotesting Strategies
  • Contributor: Liang, Linda A.; Einzmann, Thomas; Franzen, Arno; Schwarzer, Katja; Schauberger, Gunther; Schriefer, Dirk; Radde, Kathrin; Zeissig, Sylke R.; Ikenberg, Hans; Meijer, Chris J.L.M.; Kirkpatrick, Charles J.; Kölbl, Heinz; Blettner, Maria; Klug, Stefanie J.
  • imprint: American Association for Cancer Research (AACR), 2021
  • Published in: Cancer Epidemiology, Biomarkers & Prevention
  • Language: English
  • DOI: 10.1158/1055-9965.epi-20-1003
  • ISSN: 1055-9965; 1538-7755
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background:</jats:title> <jats:p>Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ≥30 years (n = 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants [ASC-US+ or high-risk HC2 (hrHC2)] and a random 5% sample of screen-negatives were referred to colposcopy. Post hoc HPV genotyping was conducted by GP5+/6+ PCR-EIA with reverse line blotting. Sensitivity, specificity (adjusted for verification bias), and potential harms, including number of colposcopies needed to detect 1 precancerous lesion (NNC), were calculated.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) were lower than HC2 (95%) and PCR (79%) for CIN2+. Cotesting demonstrated higher sensitivities (HC2 cotesting: 99%; PCR cotesting: 84%), but at the cost of lower specificities (92%–95%) compared with HPV stand-alone (HC2: 95%; PCR: 94%) and cytology (97% or 99%). Cotesting versus HPV stand-alone showed equivalent relative sensitivity [HC2: 1.06, 95% confidence interval (CI), 1.00–1.21; PCR: 1.07, 95% CI, 1.00–1.27]. Relative specificity of Pap cotesting with either HPV test was inferior to stand-alone HPV. LBC cotesting demonstrated equivalent specificity (both tests: 0.99, 95% CI, 0.99–1.00). NNC was highest for Pap cotesting.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals.</jats:p> </jats:sec> <jats:sec> <jats:title>Impact:</jats:title> <jats:p>HPV stand-alone screening offers a better balance of benefits and harms than cotesting.</jats:p> <jats:p>See related commentary by Wentzensen and Clarke, p. 432</jats:p> </jats:sec>
  • Access State: Open Access