Human Papillomavirus DNA Testing for Cervical Cancer Screening in Low-Resource Settings
Abstract
Background In many low-resource settings, there are barriers to cytologic screening for cervical cancer. This study evaluates human papillomavirus (HPV) DNA testing as an alternative screening method. Methods Cervical samples from 2944 previously unscreened South African women aged 35-65 years were tested for high-risk types of HPV with the use of the Hybrid Capture I (HCI) assay. Women also had a Pap smear, direct visual inspection of the cervix, and Cervicography(TM). Women positive on any screening test were referred for colposcopy. Samples from women with biopsy-confirmed, low-grade squamous intraepithelial lesions (SILs) (n = 95), high-grade SILs (n = 74), or invasive cervical cancer (n = 12) and a random sample of women with no cervical disease (n = 243) were retested for HPV DNA with the use of the more sensitive Hybrid Capture II (HCII) assay. All P values are two-sided. Results High-risk HPV DNA was detected in 73.3% and 88.4% of 86 women with high-grade SIL or invasive cancer and in 12.2% of 2680 and 18.1% of 243 women without evidence of cervical disease, with the use of the HCI and HCII assays, respectively. HPV DNA testing with the HCII assay was more sensitive than cytology for detecting high-grade SIL and invasive cancer (McNemar's test, P =.04), and testing with the HCI assay was of equivalent sensitivity (P =.61). Cytology had a statistically significantly better specificity (96.8%) than either the HCI assay (87.8%) or the HCII assay (81.9%) (P Conclusions HP…
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HPV testing is more sensitive than cytology at identifying CIN2/3 lesions but with lower specificity.
“Studies, particularly in developed countries, suggest that HPV testing is more sensitive than cytology at identifying CIN 2=3 lesions but with lower specificity.10,[20][21][22][23][24][25]”
From A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India (2005) · cites this paper as [20]
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- Authors
- Kuhn, L., Denny, L., Pollack, A., Lorincz, A., Richart, R. M., & Wright, T. C.
- Affiliations
- EngenderHealth (US)
- Corresponding author
- Kuhn, L.
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2000-05-17
- Volume
- 92
- Issue
- 10
- Pages
- 818-825
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2138766627
- Cited by
- 217
- References
- 22
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 4 · 2014: 5 · 2013: 8 · 2012: 5
- FWCI
- 11.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Cancer Association of South Africa
- University of Cape Town
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- human papillomavirus DNA testing, cervical cancer screening, resource-limited settings, Hybrid Capture 2, Pap smear, visual inspection with acetic acid, cervicography, high-risk HPV, high-grade squamous intraepithelial lesion, invasive cervical cancer, screening sensitivity and specificity, primary screening, South Africa
- MeSH terms
- Adult, Aged, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, DNA, Viral, Evaluation Studies as Topic, Female, Humans, Mass Screening, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, South Africa, Vaginal Smears, Papillomaviridae, Papanicolaou Test
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