Screening for high-grade cervical intra-epithelial neoplasia and cancer bytesting for high-risk HPV, routine cytology or colposcopy

The validity of testing for high-risk types of human papillomavirus (HPV) i n cervical cancer prevention programs is undetermined. We compared the perf ormance on primary screening of HPV DNA testing, cytology and colposcopy in detecting cervical intra-epithelial neoplasia (CIN) grade 2 or 3 or cancer . A cohort of 4,761 women, median age 35 years, was screened by routine cyt ology, routine colposcopy and testing for high-risk HPV by a PCR-based meth od. Within an 8-month period, women with abnormal findings on cytology or s creening colposcopy or in whom high-risk HPV types were detected were refer red for colposcopy and biopsy. Women negative on all initial screening test s were followed by a second screening examination. To correct for work-up b ias, the true prevalence of CIN 2 or 3 or cancer was estimated by projectio n from histologically verified subgroups. Cervical biopsies were taken in 3 64 women (7.6%), of whom 114 (2.4%) showed CIN 2 (n = 34) or CIN 3 (n = 71) or cancer (n = 9). High-risk HPV testing achieved bias-corrected performan ce measures of 89.4% sensitivity, 93.9% specificity, 35.8% positive predict ive value and 99.6% negative predictive value. Bias-corrected rates of true - and false-positives by high-risk HPV testing compared to cytology (colpos copy) were about 4.5 (6.7) and 19.1 (7.4) times higher, respectively. The q uality of routine cytology was controlled by computer-assisted review, and the observed number of true-positives more than doubled after adding automa ted review results. In middle-aged women, testing for high-risk HPV types, particularly when negative, may be used to increase the screening interval in programs for secondary prevention of cervical cancer. Int. J. Cancer(Pre d. Oncol.) 89:529-534, 2000. (C) 2000 Wiley-Liss, Inc.