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. 2023 Sep 20:26:100593.
doi: 10.1016/j.lana.2023.100593. eCollection 2023 Oct.

Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study

Arianis Tatiana Ramírez  1 , Joan Valls  1 , Armando Baena  1 , Freddy David Rojas  2 , Katherine Ramírez  2 , Rodrigo Álvarez  2 , Carmen Cristaldo  3 , Odessa Henríquez  4 , Adrián Moreno  5 , Daysi Colque Reynaga  6 , Hans González Palma  6 , Isabel Robinson  7 , Diana Carolina Hernández  8 , Rosa Bardales  9 , Lucia Cardinal  10 , Yuly Salgado  11 , Sandra Martínez  11 , Emmanuel González  12   13 , Diego Guillén  13   14 , Laura Fleider  10 , Silvio Tatti  10 , Verónica Villagra  15 , Gino Venegas  16   17 , Aurelio Cruz-Valdez  18 , Marleny Valencia  8 , Guillermo Rodríguez  19 , Carolina Terán  6 , María Alejandra Picconi  20 , Annabelle Ferrera  21 , Elena Kasamatsu  3 , Laura Mendoza  3 , Alejandro Calderon  2 , Silvana Luciani  22 , Nathalie Broutet  23 , Teresa Darragh  24 , Maribel Almonte  1   23 , Rolando Herrero  1   13 ; ESTAMPA Study Group
Collaborators, Affiliations

Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study

Arianis Tatiana Ramírez et al. Lancet Reg Health Am. .

Abstract

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.

Keywords: Cervical cytology; ESTAMPA; HPV testing; Screening.

PubMed Disclaimer

Conflict of interest statement

All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study population. ESTAMPA participants recruited between December 2012 and December 2021.
Fig. 2
Fig. 2
HPV prevalence by cytologic results and age.
Fig. 3
Fig. 3
Performance Forest plots of cytology (a) and HPV testing (b) for CIN3+ detection for 11 study centres.
See this image and copyright information in PMC

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