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Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study

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 c...

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Autores principales: Ramírez, Arianis Tatiana, Valls, Joan, Baena, Armando, Rojas, Freddy David, Ramírez, Katherine, Álvarez, Rodrigo, Cristaldo, Carmen, Henríquez, Odessa, Moreno, Adrián, Reynaga, Daysi Colque, Palma, Hans González, Robinson, Isabel, Hernández, Diana Carolina, Bardales, Rosa, Cardinal, Lucia, Salgado, Yuly, Martínez, Sandra, González, Emmanuel, Guillén, Diego, Fleider, Laura, Tatti, Silvio, Villagra, Verónica, Venegas, Gino, Cruz-Valdez, Aurelio, Valencia, Marleny, Rodríguez, Guillermo, Terán, Carolina, Picconi, María Alejandra, Ferrera, Annabelle, Kasamatsu, Elena, Mendoza, Laura, Calderon, Alejandro, Luciani, Silvana, Broutet, Nathalie, Darragh, Teresa, Almonte, Maribel, Herrero, Rolando
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520426/
https://www.ncbi.nlm.nih.gov/pubmed/37766799
http://dx.doi.org/10.1016/j.lana.2023.100593
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author Ramírez, Arianis Tatiana
Valls, Joan
Baena, Armando
Rojas, Freddy David
Ramírez, Katherine
Álvarez, Rodrigo
Cristaldo, Carmen
Henríquez, Odessa
Moreno, Adrián
Reynaga, Daysi Colque
Palma, Hans González
Robinson, Isabel
Hernández, Diana Carolina
Bardales, Rosa
Cardinal, Lucia
Salgado, Yuly
Martínez, Sandra
González, Emmanuel
Guillén, Diego
Fleider, Laura
Tatti, Silvio
Villagra, Verónica
Venegas, Gino
Cruz-Valdez, Aurelio
Valencia, Marleny
Rodríguez, Guillermo
Terán, Carolina
Picconi, María Alejandra
Ferrera, Annabelle
Kasamatsu, Elena
Mendoza, Laura
Calderon, Alejandro
Luciani, Silvana
Broutet, Nathalie
Darragh, Teresa
Almonte, Maribel
Herrero, Rolando
author_facet Ramírez, Arianis Tatiana
Valls, Joan
Baena, Armando
Rojas, Freddy David
Ramírez, Katherine
Álvarez, Rodrigo
Cristaldo, Carmen
Henríquez, Odessa
Moreno, Adrián
Reynaga, Daysi Colque
Palma, Hans González
Robinson, Isabel
Hernández, Diana Carolina
Bardales, Rosa
Cardinal, Lucia
Salgado, Yuly
Martínez, Sandra
González, Emmanuel
Guillén, Diego
Fleider, Laura
Tatti, Silvio
Villagra, Verónica
Venegas, Gino
Cruz-Valdez, Aurelio
Valencia, Marleny
Rodríguez, Guillermo
Terán, Carolina
Picconi, María Alejandra
Ferrera, Annabelle
Kasamatsu, Elena
Mendoza, Laura
Calderon, Alejandro
Luciani, Silvana
Broutet, Nathalie
Darragh, Teresa
Almonte, Maribel
Herrero, Rolando
author_sort Ramírez, Arianis Tatiana
collection PubMed
description 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: 10.13039/100008700IARC/10.13039/100004423WHO, 10.13039/100016195UNDP, HRP/10.13039/100004423WHO, NCI and local funders.
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spelling pubmed-105204262023-09-27 Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study Ramírez, Arianis Tatiana Valls, Joan Baena, Armando Rojas, Freddy David Ramírez, Katherine Álvarez, Rodrigo Cristaldo, Carmen Henríquez, Odessa Moreno, Adrián Reynaga, Daysi Colque Palma, Hans González Robinson, Isabel Hernández, Diana Carolina Bardales, Rosa Cardinal, Lucia Salgado, Yuly Martínez, Sandra González, Emmanuel Guillén, Diego Fleider, Laura Tatti, Silvio Villagra, Verónica Venegas, Gino Cruz-Valdez, Aurelio Valencia, Marleny Rodríguez, Guillermo Terán, Carolina Picconi, María Alejandra Ferrera, Annabelle Kasamatsu, Elena Mendoza, Laura Calderon, Alejandro Luciani, Silvana Broutet, Nathalie Darragh, Teresa Almonte, Maribel Herrero, Rolando Lancet Reg Health Am Articles 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: 10.13039/100008700IARC/10.13039/100004423WHO, 10.13039/100016195UNDP, HRP/10.13039/100004423WHO, NCI and local funders. Elsevier 2023-09-20 /pmc/articles/PMC10520426/ /pubmed/37766799 http://dx.doi.org/10.1016/j.lana.2023.100593 Text en © 2023 Published by Elsevier Ltd. https://creativecommons.org/licenses/by-nc-nd/3.0/igo/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/).
spellingShingle Articles
Ramírez, Arianis Tatiana
Valls, Joan
Baena, Armando
Rojas, Freddy David
Ramírez, Katherine
Álvarez, Rodrigo
Cristaldo, Carmen
Henríquez, Odessa
Moreno, Adrián
Reynaga, Daysi Colque
Palma, Hans González
Robinson, Isabel
Hernández, Diana Carolina
Bardales, Rosa
Cardinal, Lucia
Salgado, Yuly
Martínez, Sandra
González, Emmanuel
Guillén, Diego
Fleider, Laura
Tatti, Silvio
Villagra, Verónica
Venegas, Gino
Cruz-Valdez, Aurelio
Valencia, Marleny
Rodríguez, Guillermo
Terán, Carolina
Picconi, María Alejandra
Ferrera, Annabelle
Kasamatsu, Elena
Mendoza, Laura
Calderon, Alejandro
Luciani, Silvana
Broutet, Nathalie
Darragh, Teresa
Almonte, Maribel
Herrero, Rolando
Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
title Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
title_full Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
title_fullStr Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
title_full_unstemmed Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
title_short Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
title_sort performance of cervical cytology and hpv testing for primary cervical cancer screening in latin america: an analysis within the estampa study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10520426/
https://www.ncbi.nlm.nih.gov/pubmed/37766799
http://dx.doi.org/10.1016/j.lana.2023.100593
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