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

• Published in: International journal of cancer Vol. 140; no. 3; pp. 544 - 554
• Main Authors: Holt, Hunter K., Zhang, Li, Zhao, Fang‐Hui, Hu, Shang‐Ying, Zhao, Xue‐Lian, Zhang, Xun, Pan, Qin‐Jing, Zhang, Wen‐Hua, Smith, Jennifer S., Qiao, You‐Lin
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-02-2017
• Subjects: Acetic Acid - chemistry; Adolescent; Adult; Biopsy - methods; Cancer; Cervical cancer; China; Colposcopy - methods; cytology; DNA, Viral - genetics; Early Detection of Cancer - methods; Female; HPV; HPV DNA testing; Human Papillomavirus DNA Tests - methods; Humans; Mass Screening - methods; Medical research; Medical screening; Menopause; Middle Aged; Papillomaviridae - genetics; Papillomavirus Infections - diagnosis; Postmenopause; Predictive Value of Tests; prevalence; Sensitivity and Specificity; Triage - methods; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Vaginal Smears - methods; visual inspection with acetic acid; Young Adult; cytology; prevalence; menopause; China; cervical cancer; visual inspection with acetic acid; HPV; HPV DNA testing
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.30468

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.
What's new?
Our study sought to investigate feasible screening strategies for the increasing postmenopausal population in China. There is a similar disease burden in premenopausal and postmenopausal women. VIA had a significant drop in diagnostic performance for postmenopausal women compared to premenopausal diagnostic performance. While HPV DNA testing has the best sensitivity in postmenopausal women and does not have a significant difference in performance between pre‐ and postmenopausal women.