Effect of sequential rounds of cervical cancer screening on management of HPV-positive women: A 15-year population-based cohort study from China

Maggie Cruickshank* (Corresponding Author), Xiao-Qian Xu, Remila Rezhake, Shang-Ying Hu, Feng Chen, Xun Zhang, Qin-Jing Pan, Wen-Hua Zhang, Jun-Fei Ma, You-Lin Qiao, Fang-Hui Zhao

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Women are anticipated to go through more than two rounds of cervical screening in their lifetime. Human papillomavirus (HPV) testing is increasingly used as the primary cervical cancer screening test. However, triage strategies for HPV-positive women were usually evaluated at baseline screening. We assessed the effect of sequential rounds of cervical screening on several algorithms for HPV triage. A total of 1,997 women ages 35–45 years were enrolled in 1999 in Shanxi, P.R. China and followed up three times at approximately 5-year intervals. Cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) prevalence by prior HPV results and performance of 12 triage algorithms with cytology, genotyping, and prior HPV were examined among 229 HPV-positive women at the fourth round. CIN2+ prevalence varied from 56.5% (95% confidence interval, 36.8%–74.4%) following 15 years HPV persistence to 3.5% (1.2%–9.9%) with an incident HPV within 15 years. Triage with cytology (with threshold of atypical squamous cells of undetermined significance) yielded positive predictive value (PPV) of 21.4% (13.8%–29.0%), entailing immediate colposcopic referral, and negative predictive value (NPV) of 97.4% (94.6%–100%), permitting retesting at short intervals. Triage with genotyping (16/18/31/33/45/52/58) or prior HPV results showed comparable performance with cytology. Among 11 triage algorithms with similar NPV to cytology, triage with prior HPV results and reflex genotyping (16/18) achieved highest PPV of 28.9% (18.8%–39.1%) and lowest colposcopy referral of 33.2% (27.4%–39.5%). HPV persistence across rounds is an effective risk stratifier in HPV-positive women. Mainstream cytology and genotyping, with or without consideration of prior HPV results, remain effective for HPV triage at fourth round.

Prevention Relevance: The study highlights the sustained
effectiveness of mainstream HPV triage methods, such as
cytology and genotyping, after sequential rounds of cervical
screening. It also suggests that use of HPV persistence across
rounds can improve management of HPV-positive women
in cervical cancer screening.
Original languageEnglish
Pages (from-to)363–72
Number of pages10
JournalCancer Prevention Research
Issue number3
Early online date10 Dec 2020
Publication statusPublished - Mar 2021

Bibliographical note

We acknowledge the significant contributions of all the investigators in CICAMS and local health providers for their efforts in conducting the study and women who participated in this study. This work was supported by National Natural Science Foundation of China (81761128006) and National Key R&D Program of China (2018YFC1315504).

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.


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