JAMA Oncology: High-risk HPV detection is used in cervical cancer screening in China

In low- and middle-income countries, cervical cancer has a high incidence and mortality rate.
2009, China launched a major initiative on cervical cancer screening, and by 2012, the national plan had been expanded to 10 million women a year.
of cervical cancer by papyric smears and staining with acetate and Lugo iodine (VIA/VILI).
, however, the programme can meet less than 30 per cent of the actual public health needs.
high-risk human papillomavirus (hrHPV) test has been shown to be an effective method for cervical cancer screening.
-looking tests abroad have shown that HPV-based screening is better than cytological examinations.
cross-sectional studies in China have found that hrHPV detection has a high sensitivity to the detection sensitivity of endotranoma level 2 or worse in the cervix endotranoma (CIN2 plus), but the specificity is lower than that of cytological detection.
The World Health Organization (WHO) has proposed a medium-term goal for the elimination of cervical cancer, which is to test 70% of women aged 35 to 45 with high precision (similar in performance to HPV) by 2030.
because Chinese number of mouthfuls, this goal put enormous pressure on the screening system.
, can the introduction of hrHPV testing in national plans better detect high-level CIN cases under normal conditions? To this end, a team of research experts from Peking University, University of Science and Technology, Huaxi Medical College and other universities conducted a clinical study aimed at assessing the effectiveness, cost-effectiveness and service system capabilities of screening based on hrHPV in primary health care institutions.
results were published in the journal JAMA oncology.
the crowd-based, multi-center, open-label randomized clinical trial was conducted at 20 primary health care centers in urban and rural China.
3,000 women aged 35-64 participated in each location, and a total of 60,732 female participants were assessed.
baseline, women are randomly assigned to cytology, hrHPV testing, or VIA/VILI testing.
who tested positive for hrHPV were randomly assigned to cytology-sub-diagnosis, VIA/VILI-sub-diagnosis, or direct vaginal mirror examination.
24 months, all women who tested positive were transferred to a vaginal mirror after a combined screening of cytology, hrHPV testing and VIA/VILI.
study outcomes were cervical endothys or CIN2 plus and CIN3 plus.
secondary result was a referral rate for a vaginal examination.
study included 60,732 women with a median age of 47 (41-52 years).
urban women, 8,955 were randomly tested for cytology, 18,176 for hrHPV genotyping, 11,136 for rural women, 7,080 for cytology and 15,385 for hrHPV.
, participants who tested positive for hrHPV with direct vascopy had a higher risk of disease benefit ratio at baseline (urban hrHPV vs cytology, CIN2 plus RR=2.2; CIN3 plus RR=2.0; rural HRHPV vs cytology, RR=2.6 and 2.7; Rural HRHPV vs VIA/VILI, RR=2.0 and 2.3).
24 months, baseline-negative women had significantly lower risk ratios in rural areas than women with CIN2 plus (RR=0.3 and 0.3) and CIN3 plus (RR=0.3 and 0.4).
the referral rate of hrHPV-positive rural women was reduced to 2.8% through cell credit flow, and the detection rate of CIN2 plus was significantly higher than that of cytology (RR=2.1) or VIA/VILI (RR=1.6).
compared with hrHPV genotype and cell credit flow, the referral rate of vaginal mirror examination in urban women was significantly reduced (RR-0.8).
results suggest that hrHPV testing is an effective screening method for cervical cancer screening in primary health care centers.
the inclusion of hrHPV testing in China's national screening program is a reasonable and effective measure.
: Zhang J, et al. Effectiveness of High-risk Human Papillomavirus Testing for Cervical Cancer Screening in China: A Multicenter, Open-Label, Randomized Clinical Trial. JAMA Oncol. 2020 Dec 30. doi: 10.1001/jamaoncol.2020.6575.MedSci Original Source: MedSci Original Copyright Notice: All noted on this website "Source: Met Medical" or "Source: MedSci Original" text, images and audio and video materials, copyrights are owned by Metz Medicine, without authorization, no media, website or individual may reproduce, authorized to reproduce with the words "Source: Mets Medicine".
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