Risk factors triage on high-risk human papillomavirus testing screening

Testing for high-risk (HR) human papillomavirus (HPV) infection, a prerequisite of invasive cervical cancer (ICC), has been proposed for primary cervical cancer screening. However, the low specificity limits its clinical significance. Although the risk factors for ICC have been extensively studied, whether the existence of risk factors is associated with the specificity of HR-HPV testing in primary screening is unknown. Our study aimed to evaluate the effects of triage by risk factors on HR-HPV testing for detecting cervical intraepithelial neoplasia grade 2 or worse in cervical cancer screening.

A hospital-based case-control study was conducted to explore the risk factors of ICC, and the predictors obtained were selected as potential triage factors. In population-based screening, potential triage factors associated with cervical intraepithelial neoplasia grade 2 or worse were selected as triage factors, and the performance of HR-HPV testing with triage factors was evaluated.

Lifetime number of sexual partners was selected as a triage factor. With the triage factor, the specificity of HR-HPV testing increased significantly, both in the strata of normal (P = 0.000) and abnormal cytological examination findings (P = 0.030). While stratified by age, no significant differences were observed for women younger than 30 years, but the specificity and the accuracy of the HR-HPV testing increased significantly (P = 0.000 and P = 0.000, respectively) among women aged 30 years or older.

Triage by risk factors is a potentially simple and feasible method to increase the specificity of HR-HPV testing for cervical cancer screening.