Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
Author(s)
Joan Valls
Armando Baena
Freddy David Rojas
Katherine Ramírez
Rodrigo Álvarez
Carmen Cristaldo
Odessa Henríquez
Adrián García-Moreno
Daysi Colque Reynaga
Hans González Palma
Isabel S. Robinson
Diana Hernández-Flórez
Rosa Bardales
Lucía Cardinal
Yuly Salgado
Sandra Martínez
Emmanuel González
Diego Guillén
Laura Fleider
Sílvio Tatti
Verónica Villagra
Gino Venegas
Aurelio Cruz-Valdéz
Marleny Valencia
Guillermo Rodríguez‐Domínguez
Carolina Terán
Marı́a Alejandra Picconi
Annabelle Ferrera
Elena Kasamatsu
Laura Mendoza
Alejandro Calderón
Silvana Luciani
Nathalie Broutet
Teresa M. Darragh
Maribel Almonte
Rolando Herrero
Mary Luz Rol
Eric Lucas
María de la Luz Hernández
Gloria Inés Sánchez
Raul Murillo
Jose Jerónimo
Catterina Ferreccio
María Isabel Rodríguez
Yessy Cabrera
Brenda Salgado
María Celeste Colucci
Maria Agustina Saino
Margarita Rodríguez de la Peña
Daniel Llanos Fernández
Laura García
Benedicta Caserta
Franco Doimi
Eduardo Lazcano-Ponce
Date Issued
20 de septiembre de 2023
Type
Article
Volume
26
Start Page
100593
End Page
100593
Abstract
Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30-64 years participating in the ESTAMPA study. Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0-53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3-96.7). Specificity was 96.5% (95% CI: 96.3-96.7) using cytology and 88.7% (95% CI: 88.3-89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%-100% and 83.6-90.8%, respectively). Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.
Subjects