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A pilot study of HPV DNA and cytology testing in 50,159 women in the routine Mexican Social Security Program

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Abstract

Introduction

We present a large feasibility evaluation of high-risk HPV (HR-HPV) DNA testing and cervical cytology as a primary screening strategy for cervical cancer precursor lesions in Mexican women, as part of a routine cancer control program (CCP).

Methods

A community-based study was carried out in 50,159 women aged 20–70 years who visited the CCP in 12 federal entities located in Northern, Central, and Southern Mexico, including a total of 48 primary health care units of the Instituto Mexicano del Seguro Social (IMSS). Cervical specimens for cytology and HR-HPV tests were collected at baseline. Women with cytological abnormalities (ASCUS or greater) were referred to colposcopy for further evaluation and treatment if necessary. A subset of HR-HPV-positive women without cervical lesions, in Morelos state, were tested again for HR-HPV DNA within a year, and repeat-positive women were referred to colposcopy.

Results

HR-HPV prevalence among all women was 8.6% (95% CI: 8.3–8.9). Prevalence by age group was 12.2% (95% CI: 11.0–13.3) before 30 years of age and decreased to 7.4% (95% CI: 6.7–8.0) between 46 and 50 years of age. A second minor prevalence peak (8.1%; 95% CI: 7.2–9.0) was observed in women more than 55 years of age. Overall prevalence of cytological abnormalities was relatively low (2.2%; 95% CI: 2.0–2.3) with the highest frequency of abnormal cytology (ASCUS or greater) in the 41–45 year age group (2.5%: 95% CI 2.1–2.7). No correlation between cervical abnormalities and HR-HPV prevalence, by region, was observed. A total of 370 (0.7%) women had an abnormal cytology as well as a positive HR-HPV result; 736 (1.5%) had an abnormal cytology and a negative HR-HPV test; 3,941 (7.9%) women had a positive HR-HPV test and a normal cytology; and 45,112 (89.9%) women were negative in both tests. The first two groups were immediately referred to colposcopy, 72.7% of the women from the cytology-positive and HR-HPV-positive group and 58.0% from the cytology-positive and HR-HPV-negative group successfully completing evaluation. Among the 269 cytology-positive and HR-HPV-positive women, 53 (19.7%) CIN2/3+ cases were detected, whereas among the 427 cytology-positive and HR-HPV-negative participants, only 13 (3.0%) CIN2/3+ cases were documented. In Morelos state, a sample of 287 women with a negative cytology smear and a positive HR-HPV test at baseline were re-screened after ~12 months, by means of cytology and HR-HPV testing. Among these women, 106 (36.9%) were again HR-HPV positive and were referred to colposcopy. Of whom, 76 (71.7%) were successfully evaluated; among these women, 9 CIN2/3+ (11.8%) were documented. Sensitivity of cervical cytology for detecting histologically confirmed CIN2/3+ cases was only 40.0% (95% CI 38.5–41.4) compared to 93.3% (95% CI 92.5–94.0) for HPV DNA testing considering the additional cases detected among women with persistent HPV infection. The specificity of cytology was 97.0 vs. 89.2% for the HPV DNA test.

Discussion

Population-based programs using HR-HPV testing can improve cervical cancer prevention and control in Mexican and other populations where cytological screening is inadequate for detecting precursors of cervical cancer.

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Authors and Affiliations

  1. Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Colonia Sta. Ma, Ahuacatitlán, 62508, Cuernavaca, Morelos, Mexico

    Eduardo Lazcano-Ponce, Jorge Salmerón, Aurelio Cruz & Pilar Hernández

  2. Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, London, United Kingdom

    Attila T. Lörincz

  3. Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico

    Jorge Salmerón

  4. Public Health Coordination, Instituto Mexicano del Seguro Social, Mexico, DF, Mexico

    Irma Fernández & Ivonne Mejia

  5. Under-Secretariat for Disease Prevention and Control, Secretariat of Health, Mexico, DF, Mexico

    Mauricio Hernández-Ávila

Authors
  1. Eduardo Lazcano-Ponce
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  2. Attila T. Lörincz
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  3. Jorge Salmerón
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  4. Irma Fernández
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  5. Aurelio Cruz
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  6. Pilar Hernández
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  7. Ivonne Mejia
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  8. Mauricio Hernández-Ávila
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Correspondence to Eduardo Lazcano-Ponce.

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Lazcano-Ponce, E., Lörincz, A.T., Salmerón, J. et al. A pilot study of HPV DNA and cytology testing in 50,159 women in the routine Mexican Social Security Program. Cancer Causes Control 21, 1693–1700 (2010). https://doi.org/10.1007/s10552-010-9598-2

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  • DOI: https://doi.org/10.1007/s10552-010-9598-2

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