Muwonge R.,The Detection Group |
Wesley R.S.,Regional Cancer Center |
Nene B.M.,Nargis Dutt Memorial Cancer Hospital |
Shastri S.S.,Tata Memorial CenterTata Memorial Hospital |
And 4 more authors.
International Journal of Cancer | Year: 2014
Although virtually all cervical cancers and most cervical intraepithelial neoplasia (CIN) are caused by persistent human papillomavirus (HPV) infection, only a small proportion of HPV-positive women have or will develop CIN. Triaging HPV-positive women has been suggested to reduce the false-positive rate and proportion of women referred for CIN confirmation and/or treatment. In two cross-sectional studies and one randomized trial in India, we evaluated the impact of using cytology or visual inspection with acetic acid (VIA) to triage HPV-positive women on the proportion of women who would be referred for CIN confirmation and on the detection rates of high-grade CIN. We present the numbers of HPV test-positive women found and the CIN detected among them. We further assess the proportions that would be referred for CIN confirmation with colposcopy/biopsy and CIN that would be detected if cytology triage or VIA triage were used. Using cytology triage at atypical squamous cells of undetermined significance threshold or VIA triage reduced referrals for colposcopy by about 62% and 59%, respectively (p-value = 0.012), but missed around 16% and 18%, respectively, of the high-grade CIN (p-value = 0.539) indicating similar performance of both triaging approaches. The choice of a triage test in different low- and middle-income countries (LMIC) would depend on the availability and affordability in the particular setting. Cytology triage may be considered in settings where adequate infrastructure exists, whereas VIA triage may be suitable in settings with limited or no cytology infrastructure. What's new? Information on appropriate and feasible methods for the triage of HPV-positive women is lacking for low- and middle-income countries, even though it could reduce overtreatment or unnecessary colposcopy referral. Here, the use of cytology or visual inspection with acetic acid (VIA) were investigated for HPV-positive triage in India. Cytology and VIA were found to reduce referrals for colposcopy by about 62% and 59%, respectively. However, they also missed 16% and 18% of high-grade cervical intraepithelial neoplasias. The similar performance of the two approaches suggests that availability and affordability could influence their use in different settings. © 2013 UICC.