Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study.
| Title: | Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study. |
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| Authors: | Ramírez AT; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.; Valls J; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.; Baena A; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.; Rojas FD; Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica.; Ramírez K; Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica.; Álvarez R; Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica.; Cristaldo C; Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay.; Henríquez O; Facultad de Ciencias de la Salud, UNITEC, Honduras.; Moreno A; Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina.; Reynaga DC; Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia.; Palma HG; Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia.; Robinson I; ASSE, Laboratorio RIEPS, Montevideo, Uruguay.; Hernández DC; Laboratorio de citología, IPS Universitaria, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia.; Bardales R; Departamento Laboratorio Clínico y Anatomía Patológica, Hospital Nacional Dos de Mayo, Lima, Perú.; Cardinal L; Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina.; Salgado Y; Instituto Nacional de Cancerología, Bogotá, Colombia.; Martínez S; Instituto Nacional de Cancerología, Bogotá, Colombia.; González E; Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Dr. Enrique Baltodano Briceño, Guanacaste, Costa Rica.; Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica.; Guillén D; Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica.; Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Max Peralta, Cartago, Costa Rica.; Fleider L; Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina.; Tatti S; Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina.; Villagra V; Laboratorio Central de Salud Pública, Asunción, Paraguay.; Venegas G; Clínica Angloamericana, Lima, Perú.; Escuela de Medicina Humana, Universidad de Piura, Lima, Perú.; Cruz-Valdez A; Instituto de Salud Pública de México, Morelos, Mexico.; Valencia M; Laboratorio de citología, IPS Universitaria, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia.; Rodríguez G; Comisión Honoraria de Lucha contra el Cáncer, Montevideo, Uruguay.; Terán C; Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia.; Picconi MA; Instituto Nacional de Enfermedades Infecciosas - ANLIS Malbrán, Buenos Aires, Argentina.; Ferrera A; Instituto de Infecciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras.; Kasamatsu E; Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay.; Mendoza L; Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay.; Calderon A; Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica.; Luciani S; Pan American Health Organization (PAHO), Washington, DC, USA.; Broutet N; Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland.; Darragh T; Department of Pathology, University of California, San Francisco, CA, USA.; Almonte M; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.; Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland.; Herrero R; Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.; Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica. |
| Corporate Authors: | ESTAMPA Study Group |
| Source: | Lancet regional health. Americas [Lancet Reg Health Am] 2023 Sep 20; Vol. 26, pp. 100593. Date of Electronic Publication: 2023 Sep 20 (Print Publication: 2023). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Ltd Country of Publication: England NLM ID: 9918232503006676 Publication Model: eCollection Cited Medium: Internet ISSN: 2667-193X (Electronic) Linking ISSN: 2667193X NLM ISO Abbreviation: Lancet Reg Health Am Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Oxford] : Elsevier Ltd., [2021]- |
| Abstract: | Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30-64 years participating in the ESTAMPA study.; Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated.; Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0-53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3-96.7). Specificity was 96.5% (95% CI: 96.3-96.7) using cytology and 88.7% (95% CI: 88.3-89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%-100% and 83.6-90.8%, respectively).; Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America.; Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.; (© 2023 Published by Elsevier Ltd.) |
| Competing Interests: | All other authors declare no competing interests. |
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| Grant Information: | 001 International WHO_ World Health Organization; UH2 CA202730 United States CA NCI NIH HHS; UH3 CA202730 United States CA NCI NIH HHS |
| Contributed Indexing: | Investigator: ML Rol; E Lucas; ML Hernández; GI Sánchez; R Murillo; J Jerónimo; C Ferreccio; MI Rodríguez; Y Cabrera; B Salgado; MC Colucci; MA Saino; M Rodríguez de la Peña; DL Fernández; L García; B Caserta; F Doimi; E Lazcano-Ponce; Keywords: Cervical cytology; ESTAMPA; HPV testing; Screening |
| Entry Date(s): | Date Created: 20230928 Latest Revision: 20250530 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC10520426 |
| DOI: | 10.1016/j.lana.2023.100593 |
| PMID: | 37766799 |
| Database: | MEDLINE |
Journal Article