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Projected Impact of HPV and LBC Primary Testing on Rates of Referral for Colposcopy in a Canadian Cervical Cancer
Andrew J Coldman1, Norm Phillips1, Dirk van Niekerk2
1Population Oncology, BC Cancer Agency, Vancouver BC.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|July 14, 2015
Summary
Primary human papilloma virus (HPV) screening, compared to liquid-based cytology (LBC), increased colposcopy referrals in women aged 25-29. Implementing either HPV or LBC screening is predicted to double current referral rates.
Area of Science:
- Gynecology
- Public Health
- Oncology
Background:
- Cervical cancer screening programs are evolving with new technologies.
- Human papillomavirus (HPV) testing and liquid-based cytology (LBC) are key screening methods.
- Understanding the impact of these methods on colposcopy referral rates is crucial for program planning.
Purpose of the Study:
- To estimate the effect of primary HPV screening versus LBC on four-year colposcopy referral rates in British Columbia.
- To compare referral patterns between HPV testing and LBC in a randomized controlled trial (RCT) and population data.
Main Methods:
- Utilized data from the HPV FOCAL RCT comparing HPV testing (4-year interval) with LBC (2-year interval).
- Incorporated population screening data using conventional cytology for women aged 25-69.
- Estimated the impact of adopting trial protocols on colposcopy referral rates using age- and screening-specific rates weighted by program distribution.
Main Results:
- HPV testing initially increased colposcopy referrals but showed similar four-year cumulative rates to LBC, except in women aged 25-29 where excess referrals persisted.
- Colposcopy referral rates decreased with age across all screening methods (HPV, LBC, conventional cytology).
- Implementing either HPV or LBC screening province-wide could double current colposcopy referral rates.
Conclusions:
- Primary HPV screening increased colposcopy referrals primarily in younger women (25-29 years) compared to LBC.
- Referral decisions were predominantly influenced by management protocols for abnormal results rather than the specific screening test used (HPV vs. LBC).
- The findings have implications for resource allocation and management strategies in cervical cancer screening programs.
