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Cited by 17Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy

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Broquet, Celine, Vassilakos, Pierre, Ndam Nsangou, François Marcel, Kenfack, Bruno, Noubom, Michel, Tincho, Evelyn, Jeannot, Emilien, Wisniak, Ania +1 more·2022·BMJ Open
DOI 10.1136/bmjopen-2021-057234PMC PMC9791451
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Abstract

Objective: To explore the utility of extended Human Papillomavirus (HPV) genotyping to detect cervical intraepithelial neoplasia grade 2 or more (CIN2+) in a ‘screen-and-treat’ strategy for HPV-positive women in low-resource settings. Design: Prospective study of diagnostic accuracy. Setting: The study took place in West Cameroon between September 2018 and March 2020. Participants: 2014 women were recruited. Asymptomatic, non-pregnant women aged 30–49 years without history of CIN treatment, anogenital cancer or hysterectomy were eligible. Interventions: Participants performed self-sampling for HPV testing with GeneXpert followed by visual inspection with acetic acid and Lugol’s iodine (VIA) triage before treatment if required. Main outcome measures: Liquid-based cytology, biopsies and endocervical brushing were performed in HPV-positive women as quality control. We assessed the detection rate of CIN2+ by HPV genotyping (two pools of genotypes obtained from the Xpert system, pool_1 (HPV 16, 18, 45) and pool_2 (HPV 16, 18, 45, 31, 33, 35, 52, 58)), VIA and cytology. Results: 382 (18.2%) women were HPV-positive among which 11.5% (n=44) were CIN2+. Of those 44 participants, 41 were triaged positive by extended genotyping, versus 35 by VIA and 33 by cytology. Overall, triage positivity was of 68.4% for extended genotyping, 59.3% for VIA and 14.8% for cytology, with false positive rates of 83.4%, 84.1% and 37.7%, respectively. Extended genotyping had a higher sensitivity for CIN2+ detection (93.2%, CI: 81.3 to 98.6) than VIA (79.5%, CI: 64.7 to 90.2, p=0.034) and cytology (75.0%, CI: 59.7 to 86.8, p=0.005). No significant difference was observed in the overtreatment rate in triaged women by extended genotyping or VIA (9.9%, CI: 8.6 to 11.3, and 8.8%, CI: 7.7 to 10.1), with a ratio of 6.0 and 6.3 women treated per CIN2+ diagnosed. Conclusion: Triage of HPV-positive women with extended HPV genotyping improves CIN2+ detection compared with VIA with a minor loss of specificity and could be used to optimize the management of HPV-positive women. Trial registration number: NCT03757299 .

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  • Most women with a positive primary HPV test are overtreated because 90% of HPV-positive women do not have high-grade cervical lesions.

    “The drawback of this strategy is that most women with a positive primary HPV test are overtreated, since 90% of HPV‐positive women do not have high‐grade cervical lesions, although they could develop them in the next years [10, 11].”

    From Fertility and Miscarriage Incidence After Cervical Intraepithelial Neoplasia Treatment by Thermal Ablation: A Cohort Study (2025) · cites this paper as [11]

    The Results report that 44 of 382 HPV-positive women (11.5%) had CIN2+, supporting the approximate claim that 90% did not have high-grade lesions. The Introduction says a single HPV test can lead to overtreatment, but the study used triage rather than treating every HPV-positive woman; it does not show that most HPV-positive participants were actually overtreated. The copy also does not establish whether women without lesions developed them in subsequent years. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Authors
Broquet, C., Vassilakos, P., Ndam Nsangou, F. M., Kenfack, B., Noubom, M., Tincho, E., Jeannot, E., Wisniak, A., & Petignat, P.
Affiliations
  • University Hospital of Geneva (CH)
  • Department of Gynecology, Obstetrics and Maternal Health, University of Dschang, Dschang District Hospital, Dschang, Cameroon
  • Université de Dschang (CM)
  • Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
Corresponding author
Broquet, Celine
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2022-12
Volume
12
Issue
12
Pages
e057234
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2021-057234
PMC
PMC9791451
OpenAlex
W4312191172
Cited by
17
References
0
Citations by year
2026: 7 · 2025: 4 · 2024: 6
FWCI
1.80
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by-nc)
  • Uni Genf
Funders
Hôpitaux Universitaires de Genève (N/A)
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
HPV-positive women, cervical intraepithelial neoplasia, CIN2+ detection, screen-and-treat strategy, self-sampling, visual inspection with acetic acid, Lugol's iodine, GeneXpert, liquid-based cytology, diagnostic accuracy, resource-limited settings, Cameroon, cervical cancer prevention, HPV 16/18
MeSH terms
Human Papillomavirus Viruses, Cameroon, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Female, Genotype, Humans, Prospective Studies, Triage, Papillomaviridae, Papillomavirus Infections, Early Detection of Cancer

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