Co-testing for detection of high-grade cervical intraepithelial neoplasia and cancer compared with cytology alone: a meta-analysis of randomized controlled trials

Background Human papillomavirus (HPV) DNA testing combined with cytology has been recommended as a primary cervical cancer screening strategy. Methods PubMed/MEDLINE, Embase, the Cochrane Library and the NIH trial registry were searched for randomized controlled trials comparing co-testing with cyto...

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Published in:	Journal of public health (Oxford, England) Vol. 36; no. 1; pp. 46 - 55
Main Authors:	Bouchard-Fortier, Geneviève, Hajifathalian, Kaveh, McKnight, Marla D., Zacharias, David G., Gonzalez-Gonzalez, Luis Alonso
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01-03-2014
Subjects:	Adult Aged Cervical Intraepithelial Neoplasia - diagnosis DNA, Viral - genetics Early Detection of Cancer - methods Female Health Protection Humans Middle Aged Papillomaviridae - genetics Papillomavirus Infections - diagnosis Randomized Controlled Trials as Topic Sensitivity and Specificity Uterine Cervical Neoplasms - diagnosis Vaginal Smears - methods screening cancer gynaecological disorders
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Summary:	Background Human papillomavirus (HPV) DNA testing combined with cytology has been recommended as a primary cervical cancer screening strategy. Methods PubMed/MEDLINE, Embase, the Cochrane Library and the NIH trial registry were searched for randomized controlled trials comparing co-testing with cytology alone for the detection of high-grade CIN lesions and cancers. Of 1156 articles identified, four met inclusion criteria. The performance of co-testing and cytology alone was compared at baseline screening, second round screening and overall. Cumulative meta-analysis, Begg's test, Egger's test and sensitivity analysis were performed. Results At baseline, co-testing was associated with a significantly higher detection rate of CIN 2+ [risk ratio (RR) = 1.41, 95% confidence interval (CI): 1.12, 1.76] and a non-significantly higher CIN 3+ detection rate (RR = 1.15, 95% CI: 0.99, 1.33). At second round screening, cotesting was associated with significantly lower detection rates of both CIN 2+ and CIN 3+ (RR = 0.77, 95% CI: 0.63, 0.93; RR = 0.68, 95% CI: 0.55, 0.85). The overall detection rate did not differ between co-testing and cytology alone for CIN 2+ (RR: 1.19, 95% CI: 0.99, 1.46) or CIN3+ (RR: 0.99, 95% CI: 0.87, 1.14). Conclusion Co-testing increases the detection of CIN2+ lesions at baseline and significantly decreases the detection rates of CIN2+ or CIN3+ lesions at subsequent screening compared with cytology alone.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1741-3842 1741-3850
DOI:	10.1093/pubmed/fdt057