Untiet Sarah, Vassilakos Pierre, McCarey Catherine, Tebeu Pierre-Marie, Kengne-Fosso Gisèle, Menoud Pierre-Alain, Boulvain Michel, Navarria Isabelle, Petignat Patrick
Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
Int J Cancer. 2014 Oct 15;135(8):1911-7. doi: 10.1002/ijc.28834. Epub 2014 Apr 4.
Our objective was (i) to assess if a self-collected test for human papillomavirus (HPV) may serve as a primary cervical cancer screening method in a low-resource setting, (ii) to evaluate its implication in a screen and treat approach and (iii) to identify the most eligible age group in a screening program. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to participants by a health-care professional to carry out an unsupervised self-collected HPV-test (Self-HPV), followed by a physician-collected cervical sample for HPV testing (Physician-HPV) and cytology. Differences in performance between Self-HPV versus Physician-HPV and their ability to detect abnormal cytology results (ASC-US+) were evaluated. Descriptive analyses were used to examine the correlation between HPV positivity and cervical abnormalities by age. A sample of 789 women was prospectively enrolled. HPV prevalence was 14.6% and 12.7% for Self-HPV and Physician-HPV, respectively (Cohen's kappa = 0.74). HPV positivity by cytological diagnosis for ASC-US+ was similar with the two tests. positive predictive value of the Self-HPV for ASC-US+ was 20.4; odds ratio and number needed to treat were 6.5 (3.2-13.4) and 6 (4.2-10.9), respectively. We observed a trend of increasing cytological abnormalities in 30-49 year-old women and a concomitant trend of decreasing HPV prevalence supporting that this age group might be the most eligible group for screening. In conclusion, Self-HPV can be used as a primary screening test but needs to be followed by a triaging test that would identify the subset of women affected by clinically significant precancer or cancer.
（i）评估人乳头瘤病毒（HPV）自采样检测是否可作为资源匮乏地区宫颈癌的主要筛查方法；（ii）评估其在筛查和治疗方案中的意义；（iii）确定筛查项目中最适合的年龄组。通过在喀麦隆开展的宫颈癌筛查活动招募女性。由医护人员向参与者提供书面和口头指导，以进行无监督的HPV自采样检测（Self-HPV），随后由医生采集宫颈样本进行HPV检测（Physician-HPV）和细胞学检查。评估Self-HPV与Physician-HPV在检测性能上的差异以及它们检测异常细胞学结果（ASC-US+）的能力。采用描述性分析来研究HPV阳性与不同年龄宫颈异常之间的相关性。前瞻性纳入了789名女性样本。Self-HPV和Physician-HPV的HPV患病率分别为14.6%和12.7%（科恩kappa系数=0.74）。两种检测方法对ASC-US+的HPV细胞学诊断阳性率相似。Self-HPV对ASC-US+的阳性预测值为20.4；比值比和治疗所需人数分别为6.5（3.2-13.4）和6（4.2-10.9）。我们观察到30-49岁女性的细胞学异常呈上升趋势，同时HPV患病率呈下降趋势，这表明该年龄组可能是最适合筛查的群体。总之，Self-HPV可作为主要筛查检测方法，但后续需要进行分流检测，以识别受临床意义重大的癌前病变或癌症影响的女性亚组。
