Liang, Linda A., Einzmann, Thomas, Franzen, Arno, Schwarzer, Katja, Schauberger, Gunther ORCID: 0000-0002-0392-1580, Schriefer, Dirk ORCID: 0000-0002-7524-7628, Radde, Kathrin, Zeissig, Sylke R., Ikenberg, Hans, Meijer, Chris J. L. M., Kirkpatrick, Charles J., Koelbl, Heinz, Blettner, Maria and Klug, Stefanie J. ORCID: 0000-0003-3523-1362 (2021). Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-alone or Cotesting Strategies. Cancer Epidemiol. Biomarkers Prev., 30 (3). S. 474 - 485. PHILADELPHIA: AMER ASSOC CANCER RESEARCH. ISSN 1538-7755

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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 = 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants [ASC-US+ or high-risk HC2 (hrHC2)] and a random 5% sample of screen-negatives were referred to colposcopy. Post hoc HPV genotyping was conducted by GP5+/6+ 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 CIN2+. 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 stand-alone 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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Liang, Linda A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Einzmann, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Franzen, ArnoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwarzer, KatjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schauberger, GuntherUNSPECIFIEDorcid.org/0000-0002-0392-1580UNSPECIFIED
Schriefer, DirkUNSPECIFIEDorcid.org/0000-0002-7524-7628UNSPECIFIED
Radde, KathrinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zeissig, Sylke R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ikenberg, HansUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meijer, Chris J. L. M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kirkpatrick, Charles J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koelbl, HeinzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Blettner, MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Klug, Stefanie J.UNSPECIFIEDorcid.org/0000-0003-3523-1362UNSPECIFIED
URN: urn:nbn:de:hbz:38-599038
DOI: 10.1158/1055-9965.EPI-20-1003
Journal or Publication Title: Cancer Epidemiol. Biomarkers Prev.
Volume: 30
Number: 3
Page Range: S. 474 - 485
Date: 2021
Publisher: AMER ASSOC CANCER RESEARCH
Place of Publication: PHILADELPHIA
ISSN: 1538-7755
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
QUALITY-ASSURANCE; EUROPEAN GUIDELINES; HPV; WOMEN; TECHNOLOGIES; ACCURACY; PREVENTION; EVALUATE; GERMANY; ASSAYSMultiple languages
Oncology; Public, Environmental & Occupational HealthMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/59903

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