HPV prevalence and accuracy of HPV testing to detect high-grade cervical intraepithelial neoplasia

✍ Scribed by Paolo Giorgi-Rossi; Silvia Franceschi; Guglielmo Ronco

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: French
• Weight: 322 KB
• Volume: 130
• Category: Article
• ISSN: 0020-7136
• DOI: 10.1002/ijc.26147

✦ Synopsis

Abstract

Concern was raised on using testing for high‐risk (HR) human papillomavirus (HPV) in cervical cancer screening in populations where HPV prevalence is high. The impact of HR HPV prevalence on the efficiency of HPV test‐based screening has never been directly evaluated. A meta‐regression of the relationship between HR HPV prevalence and the specificity and positive predictive value (PPV) of HPV DNA testing for the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was performed. Only studies that used Hybrid Capture 2 (HC2) were included. Country income (low–medium vs. high) was used as a proxy of previous screening. Twenty‐six populations from 20 studies were included. For a 10% increase in HR HPV prevalence, HC2 specificity decreased by 8.41% [95% confidence interval (CI): 8.02–8.81], whereas PPV increased by 4.74% (95% CI: 2.45–7.03). HR HPV prevalence explained 98% of the variability in HC2 specificity and 38% of the variability in PPV. Country income did not affect specificity, but low–medium income was associated with higher PPV (3.81%; 95% CI: 1.53–6.10) after adjustment for HR HPV prevalence. When HR HPV prevalence is high, the specificity of HPV testing for CIN2+ decreases, but PPV does not decrease and it is high in inadequately screened populations. The number of HPV‐positive women needing further assessment or treatment per CIN2+ case detected will therefore decrease and screening efficiency will improve. This is explained by the fact that HR HPV causes CIN2+: an increase in HR HPV prevalence is inevitably accompanied by an increase in CIN2+.