Cervical cancer screening: Comparison of conventional pap smear test, liquid-based cytology, and human papillomavirus testing as stand-alone or cotesting strategies

Linda A. Liang, Thomas Einzmann, Arno Franzen, Katja Schwarzer, Gunther Schauberger, Dirk Schriefer, Kathrin Radde, Sylke R. Zeissig, Hans Ikenberg, Chris J.L.M. Meijer, Charles J. Kirkpatrick, Heinz Kolbl, Maria Blettner, Stefanie J. Klug

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Background: Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study. Methods: The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ≥30 years (n ¼ 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants [ASC-USþ or high-risk HC2 (hrHC2)] and a random 5% sample of screen-negatives were referred to colposcopy. Post hoc HPV genotyping was conducted by GP5þ/6þ PCR-EIA with reverse line blotting. Sensitivity, specificity (adjusted for verification bias), and potential harms, including number of colposcopies needed to detect 1 precancerous lesion (NNC), were calculated. Results: In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) were lower than HC2 (95%) and PCR (79%) for CIN2þ. Cotesting demonstrated higher sensitivities (HC2 cotesting: 99%; PCR cotesting: 84%), but at the cost of lower specificities (92%–95%) compared with HPV stand-alone (HC2: 95%; PCR: 94%) and cytology (97% or 99%). Cotesting versus HPV stand-alone showed equivalent relative sensitivity [HC2: 1.06, 95% confidence interval (CI), 1.00–1.21; PCR: 1.07, 95% CI, 1.00–1.27]. Relative specificity of Pap cotesting with either HPV test was inferior to stand-alone HPV. LBC cotesting demonstrated equivalent specificity (both tests: 0.99, 95% CI, 0.99–1.00). NNC was highest for Pap cotesting. Conclusions: Cotesting offers no benefit in detection over standalone HPV testing, resulting in more false positive results and colposcopy referrals. Impact: HPV stand-alone screening offers a better balance of benefits and harms than cotesting.

Original languageEnglish
Pages (from-to)474-484
Number of pages11
JournalCancer Epidemiology Biomarkers and Prevention
Volume30
Issue number3
DOIs
StatePublished - Mar 2021

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