A comparison of human papillomavirus testing of clinician-collected and self-collected samples during follow-up after screen-and-treat
✍ Scribed by Sylvia Taylor; Chunhui Wang; Thomas C. Wright; Lynette Denny; Louise Kuhn
- Book ID
- 102271028
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- French
- Weight
- 375 KB
- Volume
- 129
- Category
- Article
- ISSN
- 0020-7136
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
Screen‐and‐treat cervical cancer prevention programs based on high‐risk human papillomavirus (HPV) testing and cryotherapy have been shown to be effective in resource‐limited settings. However, because cryotherapy is not 100% effective, follow‐up is needed after treatment to detect post‐treatment failures. We compared the test performances of high‐risk HPV testing (Hybrid Capture 2) using self‐collected and clinician‐collected samples as well as cervical cytology for identifying cervical intraepithelial neoplasia grades 2 or 3 or invasive cervical cancer (CIN2+) among women who did (n = 812) and did not (n = 1858) undergo cryotherapy in a South African screen‐and‐treat trial. At 6 months after enrolment (and after cryotherapy, if performed), women were tested using all three screening methods and then underwent colposcopy/biopsy. A predefined subset of women (n = 1,455) had extended follow‐up with colposcopy/biopsy at 12 months. A total of 33 and 91 cases of CIN2+ were detected among treated and untreated women, respectively. The sensitivity of HPV testing using clinician‐collected samples and cervical cytology did not differ by treatment status. HPV testing of clinician‐collected samples detected the most cases of CIN2+ among both treated (85%) and untreated (91%) women (p = 0.31). Cytology (at a cutoff of atypical squamous cells of undetermined significance or greater) detected 76% of cases among both treated and untreated women. However, the sensitivity of HPV testing using self‐collected samples was significantly lower among treated versus untreated women (55% vs. 78%, p = 0.01). HPV testing using self‐collected vaginal specimens may be useful in primary screening but performs poorly for detecting post‐treatment failures.