Optional screening strategies for cervical cancer using standalone tests and their combinations among low- and medium-income populations in Latin America and Eastern Europe

Abstract

Background The performance of cervical cancer (CC) screening can be improved by combining Pap smear with human papillomavirus (HPV) testing or visual methods, addressing local demographic, clinical and economic characteristics. Objectives To examine the performance of standalone and combined screening tools in populations with variable prevalence of cervical intraepithelial neoplasia (CIN) and CC. Methods Merged data-sets from the Latin American Screening Study and New Independent States cohorts provided results for 15,000 women, screened using Pap smear, HPV testing and visual inspection with acetic acid, in Brazil, Argentina, Russia, Belarus and Latvia. Bayesian correction for verification bias was used. Results At CIN2+ cut-off, HPV detection alone was the most sensitive technique. There was an improvement (88.5% to 92.7%) in Hybrid Capture 2 (HC2) sensitivity among women ≥35 years old. Using HPV detection alone was the least specific screening tool, regardless of the age group (69.9% [95% CI 66.5-72.8%] and 86.4% [95% CI 84.6-88.2%], in < or ≥35 years, respectively). Of the test combinations, Pap smear (LSIL threshold) with HC2 had the highest specificity (98.7%; 95% CI 98.3-99.0%). However, in women ≥35 years, the sensitivity of Pap alone was superior to that of the combination. Conclusions The Pap test is a highly specific screening option in populations with medium-range CC prevalence. Combined testing for HPV in this scenario may yield slightly better positive predictive values in women ≥35 years of age with LSIL, but at a high incremental cost.