Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
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 c...
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2023
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| author | Arianis Tatiana Ramírez Joan Valls Armando Baena Freddy David Rojas Katherine Ramírez Rodrigo Álvarez Carmen Cristaldo Odessa Henríquez Adrián García-Moreno Daysi Colque Reynaga Hans González Palma Isabel S. Robinson Diana Hernández-Flórez Rosa Bardales Lucía Cardinal Yuly Salgado Sandra Martínez Emmanuel González Diego Guillén Laura Fleider Sílvio Tatti Verónica Villagra Gino Venegas Aurelio Cruz-Valdéz Marleny Valencia Guillermo Rodríguez‐Domínguez Carolina Terán Marı́a Alejandra Picconi Annabelle Ferrera Elena Kasamatsu Laura Mendoza Alejandro Calderón Silvana Luciani Nathalie Broutet Teresa M. Darragh Maribel Almonte Rolando Herrero Mary Luz Rol Eric Lucas María de la Luz Hernández Gloria Inés Sánchez Raul Murillo Jose Jerónimo Catterina Ferreccio María Isabel Rodríguez Yessy Cabrera Brenda Salgado María Celeste Colucci Maria Agustina Saino Margarita Rodríguez de la Peña Daniel Llanos Fernández Laura García Benedicta Caserta Franco Doimi Eduardo Lazcano-Ponce |
| author_browse | Adrián García-Moreno Alejandro Calderón Annabelle Ferrera Arianis Tatiana Ramírez Armando Baena Aurelio Cruz-Valdéz Benedicta Caserta Brenda Salgado Carmen Cristaldo Carolina Terán Catterina Ferreccio Daniel Llanos Fernández Daysi Colque Reynaga Diana Hernández-Flórez Diego Guillén Eduardo Lazcano-Ponce Elena Kasamatsu Emmanuel González Eric Lucas Franco Doimi Freddy David Rojas Gino Venegas Gloria Inés Sánchez Guillermo Rodríguez‐Domínguez Hans González Palma Isabel S. Robinson Joan Valls Jose Jerónimo Katherine Ramírez Laura Fleider Laura García Laura Mendoza Lucía Cardinal Margarita Rodríguez de la Peña Maria Agustina Saino Maribel Almonte Marleny Valencia Mary Luz Rol María Celeste Colucci María Isabel Rodríguez María de la Luz Hernández Marı́a Alejandra Picconi Nathalie Broutet Odessa Henríquez Raul Murillo Rodrigo Álvarez Rolando Herrero Rosa Bardales Sandra Martínez Silvana Luciani Sílvio Tatti Teresa M. Darragh Verónica Villagra Yessy Cabrera Yuly Salgado |
| author_facet | Arianis Tatiana Ramírez Joan Valls Armando Baena Freddy David Rojas Katherine Ramírez Rodrigo Álvarez Carmen Cristaldo Odessa Henríquez Adrián García-Moreno Daysi Colque Reynaga Hans González Palma Isabel S. Robinson Diana Hernández-Flórez Rosa Bardales Lucía Cardinal Yuly Salgado Sandra Martínez Emmanuel González Diego Guillén Laura Fleider Sílvio Tatti Verónica Villagra Gino Venegas Aurelio Cruz-Valdéz Marleny Valencia Guillermo Rodríguez‐Domínguez Carolina Terán Marı́a Alejandra Picconi Annabelle Ferrera Elena Kasamatsu Laura Mendoza Alejandro Calderón Silvana Luciani Nathalie Broutet Teresa M. Darragh Maribel Almonte Rolando Herrero Mary Luz Rol Eric Lucas María de la Luz Hernández Gloria Inés Sánchez Raul Murillo Jose Jerónimo Catterina Ferreccio María Isabel Rodríguez Yessy Cabrera Brenda Salgado María Celeste Colucci Maria Agustina Saino Margarita Rodríguez de la Peña Daniel Llanos Fernández Laura García Benedicta Caserta Franco Doimi Eduardo Lazcano-Ponce |
| author_sort | Arianis Tatiana Ramírez |
| collection | Producción científica |
| description | 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. |
| format | Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/1365 |
| institution | UPeU |
| language | English |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| record_format | dspace |
| spelling | oai:cris.upeu.edu.pe:20.500.15037/13652026-10-30T16:15:40ZPerformance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA studyArianis Tatiana RamírezJoan VallsArmando BaenaFreddy David RojasKatherine RamírezRodrigo ÁlvarezCarmen CristaldoOdessa HenríquezAdrián García-MorenoDaysi Colque ReynagaHans González PalmaIsabel S. RobinsonDiana Hernández-FlórezRosa BardalesLucía CardinalYuly SalgadoSandra MartínezEmmanuel GonzálezDiego GuillénLaura FleiderSílvio TattiVerónica VillagraGino VenegasAurelio Cruz-ValdézMarleny ValenciaGuillermo Rodríguez‐DomínguezCarolina TeránMarı́a Alejandra PicconiAnnabelle FerreraElena KasamatsuLaura MendozaAlejandro CalderónSilvana LucianiNathalie BroutetTeresa M. DarraghMaribel AlmonteRolando HerreroMary Luz RolEric LucasMaría de la Luz HernándezGloria Inés SánchezRaul MurilloJose JerónimoCatterina FerreccioMaría Isabel RodríguezYessy CabreraBrenda SalgadoMaría Celeste ColucciMaria Agustina SainoMargarita Rodríguez de la PeñaDaniel Llanos FernándezLaura GarcíaBenedicta CasertaFranco DoimiEduardo Lazcano-PonceCytologyColposcopyMedicineCervical intraepithelial neoplasiaCervical cancerGynecologyObstetricsCervical screeningCancerInternal medicinePathologyCytologyColposcopyMedicineCervical intraepithelial neoplasiaCervical cancerGynecologyObstetricsCervical screeningCancerInternal medicinePathologyHealth Sciences Medicine Epidemiology Cervical Cancer and HPV ResearchHealth Sciences Medicine Obstetrics and Gynecology Endometrial and Cervical Cancer TreatmentsHealth Sciences Medicine Public Health, Environmental and Occupational Health Women's cancer prevention and managementBackground: 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.Articlehttps://pubmed.ncbi.nlm.nih.gov/37766799https://doi.org/10.1016/j.lana.2023.10059310.1016/j.lana.2023.100593https://hdl.handle.net/20.500.15037/1365W4386906521enThe Lancet Regional Health - Americas2667-193X2023-09-202026-06-13T09:55:39Z2026-06-13T09:55:39Z |
| spellingShingle | Cytology Colposcopy Medicine Cervical intraepithelial neoplasia Cervical cancer Gynecology Obstetrics Cervical screening Cancer Internal medicine Pathology Cytology Colposcopy Medicine Cervical intraepithelial neoplasia Cervical cancer Gynecology Obstetrics Cervical screening Cancer Internal medicine Pathology Health Sciences Medicine Epidemiology Cervical Cancer and HPV Research Health Sciences Medicine Obstetrics and Gynecology Endometrial and Cervical Cancer Treatments Health Sciences Medicine Public Health, Environmental and Occupational Health Women's cancer prevention and management Arianis Tatiana Ramírez Joan Valls Armando Baena Freddy David Rojas Katherine Ramírez Rodrigo Álvarez Carmen Cristaldo Odessa Henríquez Adrián García-Moreno Daysi Colque Reynaga Hans González Palma Isabel S. Robinson Diana Hernández-Flórez Rosa Bardales Lucía Cardinal Yuly Salgado Sandra Martínez Emmanuel González Diego Guillén Laura Fleider Sílvio Tatti Verónica Villagra Gino Venegas Aurelio Cruz-Valdéz Marleny Valencia Guillermo Rodríguez‐Domínguez Carolina Terán Marı́a Alejandra Picconi Annabelle Ferrera Elena Kasamatsu Laura Mendoza Alejandro Calderón Silvana Luciani Nathalie Broutet Teresa M. Darragh Maribel Almonte Rolando Herrero Mary Luz Rol Eric Lucas María de la Luz Hernández Gloria Inés Sánchez Raul Murillo Jose Jerónimo Catterina Ferreccio María Isabel Rodríguez Yessy Cabrera Brenda Salgado María Celeste Colucci Maria Agustina Saino Margarita Rodríguez de la Peña Daniel Llanos Fernández Laura García Benedicta Caserta Franco Doimi Eduardo Lazcano-Ponce 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 |
| title_full | Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study |
| title_fullStr | Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study |
| title_full_unstemmed | Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study |
| title_short | Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study |
| title_sort | performance of cervical cytology and hpv testing for primary cervical cancer screening in latin america an analysis within the estampa study |
| topic | Cytology Colposcopy Medicine Cervical intraepithelial neoplasia Cervical cancer Gynecology Obstetrics Cervical screening Cancer Internal medicine Pathology Cytology Colposcopy Medicine Cervical intraepithelial neoplasia Cervical cancer Gynecology Obstetrics Cervical screening Cancer Internal medicine Pathology Health Sciences Medicine Epidemiology Cervical Cancer and HPV Research Health Sciences Medicine Obstetrics and Gynecology Endometrial and Cervical Cancer Treatments Health Sciences Medicine Public Health, Environmental and Occupational Health Women's cancer prevention and management |
| topic_facet | Cytology Colposcopy Medicine Cervical intraepithelial neoplasia Cervical cancer Gynecology Obstetrics Cervical screening Cancer Internal medicine Pathology Cytology Colposcopy Medicine Cervical intraepithelial neoplasia Cervical cancer Gynecology Obstetrics Cervical screening Cancer Internal medicine Pathology Health Sciences Medicine Epidemiology Cervical Cancer and HPV Research Health Sciences Medicine Obstetrics and Gynecology Endometrial and Cervical Cancer Treatments Health Sciences Medicine Public Health, Environmental and Occupational Health Women's cancer prevention and management |
| url | https://pubmed.ncbi.nlm.nih.gov/37766799 https://doi.org/10.1016/j.lana.2023.100593 https://hdl.handle.net/20.500.15037/1365 |
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