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American Journal of Epidemiology Advance Access originally published online on August 19, 2009
American Journal of Epidemiology 2009 170(6):708-716; doi:10.1093/aje/kwp188
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Human Papillomavirus Testing for Cervical Cancer Screening: Results From a 6-Year Prospective Study in Rural China

Ju-Fang Shi, Jerome L. Belinson, Fang-Hui Zhao, Robert G. Pretorius, Jing Li, Jun-Fei Ma, Feng Chen, Wang Xiang, Qin-Jing Pan, Xun Zhang, Wen-Hua Zhang, You-Lin Qiao and Jennifer S. Smith

Correspondence to Prof. You-Lin Qiao, Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, Chaoyang District, Beijing 100021, People's Republic of China (e-mail: qiaoy{at}cicams.ac.cn).

Received for publication April 8, 2009. Accepted for publication June 8, 2009.

Long-term follow-up evaluations of cervical screening approaches are limited in low-resource areas. This prospective study assessed the risk of future cervical intraepithelial neoplasia grade 2 or worse (CIN2+) associated with baseline human papillomavirus (HPV) and cytologic status. In rural China, 1,997 women were screened with 6 screening tests, including colposcopic evaluations, and underwent biopsies in 1999. In December 2005, 1,612 women with cervical intraepithelial neoplasia grade 1 or less at baseline were rescreened by visual inspection, liquid-based cytology, and HPV-DNA testing. All women underwent colposcopy at follow-up, with biopsies taken from women with visually apparent lesions or cytologic abnormalities. Twenty women developed incident CIN2+. The crude relative risk of CIN2+ for baseline HPV-positive women was 52 (95% confidence interval: 12.1, 222.5). The crude relative risk of CIN2+ was 167 (95% confidence interval: 21.9, 1,265) for baseline and follow-up repeatedly HPV-positive women compared with repeatedly HPV-negative women. Among 1,374 baseline HPV-negative women, 2 and no incident CIN2+ cases were detected in baseline cytologically normal and abnormal subgroups, respectively. Among 238 baseline HPV-positive women, 6 of 18 incident cases of CIN2+ developed in the cytologically normal group. This study demonstrates that a single oncogenic HPV-DNA test is more effective than cytology in predicting future CIN2+ status.

cervical intraepithelial neoplasia; China; follow-up studies; human papillomavirus; mass screening

Abbreviations: ASCUS, atypical squamous cells of undetermined significance; CI, confidence interval; CIN, cervical intraepithelial neoplasia; hc2, Hybrid Capture 2; HPV, human papillomavirus; RR, relative risk; SPOCCS-I, Shanxi Province Cervical Cancer Screening Study I


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