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Real-World Performance of HPV DNA-Based Screening in Health Resource-Limited Areas of China: A Multicenter
Xinhua Jia1,2, Xi'ao Da1,2, Jingyi Shi1,2
1School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Summary
Human papillomavirus (HPV) DNA testing is a feasible and effective primary screening strategy for cervical cancer in resource-limited areas of China. HPV testing significantly improves detection rates and referral efficiency compared to cytology alone.
Area of Science:
- Oncology
- Public Health
- Infectious Diseases
Background:
- Cervical cancer poses a significant health challenge in China.
- National cervical cancer screening policies permit Human Papillomavirus (HPV) DNA testing as a primary screening method.
- Limited resources in many Chinese counties hinder the adoption of HPV DNA testing due to costs of reagents and laboratory platforms.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of HPV DNA-based cervical cancer screening in health resource-limited settings in China.
- To compare the performance of different screening strategies: cytology alone, HPV DNA testing with cytology triage, and HPV DNA testing with visual inspection with acetic acid/lugol's iodine (VIA/VILI) triage.
Main Methods:
- A multicentre study involving 63,223 women aged 35-64 years across ten pilot counties in China.
- Screening strategies included cytology alone, HPV DNA testing with cytology triage, and HPV DNA testing with VIA/VILI triage.
- Key performance indicators analyzed were screen positivity rate, colposcopy rate, CIN2+ detection, positive predictive value (PPV), and number needed to refer (NNR), with adjustments for loss to follow-up using inverse probability weighting (IPW).
Main Results:
- HPV-based screening strategies demonstrated superiority over cytology alone across all measured indicators.
- CIN2+ detection rates were 2-3 times higher with HPV-based methods.
- The HPV DNA testing with cytology triage group exhibited the highest positive predictive value (21.9%) and the lowest number needed to refer (5.73), indicating enhanced referral efficiency.
- The HPV DNA testing with VIA/VILI triage strategy significantly reduced the loss to follow-up rate, with notable benefits observed in women aged 45 years and older.
Conclusions:
- HPV DNA-based cervical cancer screening is a feasible and highly effective approach in resource-limited areas of China within the first year of implementation.
- Flexible triage models, such as HPV DNA testing with VIA/VILI, can be successfully adapted.
- Findings support the integration of HPV DNA testing into national screening programs and underscore the need for robust follow-up systems, particularly in underserved populations.
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