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Capsule Commentary on Jin et. al., Cost-Effectiveness of Primary HPV Testing, Cytology and Co-testing as Cervical Cancer Screening for Women above Age 30 Years
American
College of Obstetricians and Gynecologists. Obstet Gynecol
Capsule Commentary on Jin et. al., Cost-Effectiveness of Primary HPV Testing, Cytology and Co-testing as Cervical Cancer Screening for Women above Age 30 Years
Judith Walsh 0
0 Division of General Internal Medicine, Women's Health Center of Excellence, University of California San Francisco , San Francisco, CA , USA
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I evaluated 99,549 women who received co-testing with
n a creative retrospective cohort study, Jin and colleagues
cytology and HPV for primary cervical cancer screening
during a 3-year screening interval.1 They modeled three primary
screening strategies, (1) primary cytology, (2) co-testing with
cytology and HPV and (3) HPV testing alone. Co-testing was
the most sensitive followed by primary HPV and primary
cytology. The positive predictive value was highest for primary
HPV testing (12 %), followed by co-testing (10.3 %) and primary
cytology (9.6 %). The negative predictive value was comparable
for the three testing strategies. Primary HPV testing detected
more cases than cytology alone. Co-testing detected more cases,
at a higher cost. The authors conclude that primary HPV testing is
more effective and less expensive than primary cytology and is a
cost-effective alternative to co-testing.
Should this study change our approach to cervical cancer
screening? An important caveat to consider is that
Bcosteffectiveness^ cannot be shown unless the intervention is actually
shown to be effective. Although there is some evidence to
support primary HPV testing for cervical cancer screening, the
evidence is limited. Limitations of the HPV alone strategy are the
reliance on CIN3 plus as the main outcome rather than cervical
cancer mortality and on the relatively short follow-up of the
primary HPV screening studies so far.
Although the American Society for Colposcopy and
Cervical Cytology and the Society of Gynecologic Oncology
suggest that HPV testing is an alternative screening option,
this approach is not broadly endorsed.2 USPSTF guidelines
for women ≥30 years old are that either primary cytology or
co-testing is a reasonable cervical cancer screening
alternative.3 The American College of Gynecology recommends
primary cytology or co-testing, with co-testing as the
Bpreferred screening strategy.^ They state that Bprimary HPV
testing every 3 years can be considered for women ≥25,^
while acknowledging that the options of cytology alone or
co-testing Bremain the options specifically recommended in
most major society guidelines.^4 In conclusion, although
primary HPV testing is not broadly endorsed by major society
guidelines, if it is performed, it appears to be a cost-effective
alternative to other more established screening strategies.
Compliance with ethical standards:
Conflict of interest: The author has no conflicts of interest with this
article. (...truncated)