Article

A systematic review of randomized trials assessing human papillomavirus testing in cervical cancer screening

University of California San Francisco School of Medicine, San Francisco, California.
American journal of obstetrics and gynecology (Impact Factor: 3.97). 11/2012; 208(5). DOI: 10.1016/j.ajog.2012.11.013
Source: PubMed

ABSTRACT Our objective was to assess the sensitivity and specificity of HPV testing for cervical cancer screening in randomized trials. We conducted a systematic literature search of the following databases: MEDLINE, CINAHL, EMBASE, Cochrane. Eligible studies were randomized trials comparing HPV-based to cytology-based screening strategies, with disease status determined by colposcopy/biopsy for participants with positive results. Disease rates (cervical intraepithelial neoplasia [CIN]2+ and 3+), sensitivity and positive predictive value were abstracted or calculated from the articles. Six studies met inclusion criteria. Relative sensitivities for detecting CIN3+ of HPV testing-based strategies versus cytology ranged from 0.8-2.1. The main limitation of our study was that testing methodologies and screening/management protocols were highly variable across studies. Screening strategies in which a single initial HPV-positive test led to colposcopy were more sensitive than cytology, but resulted in higher colposcopy rates. These results have implications for co-testing with HPV and cytology as recommended in the U.S.

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