Age-related performance of human papillomavirus testing used as an adjunct to cytology for cervical carcinoma screening in a population with a low incidence of cervical carcinoma

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Abstract
BACKGROUND High‐risk human papillomavirus (HR‐HPV) testing has been proposed as a replacement for cytology or as an adjunct to cytology for primary cervical carcinoma screening. The objective of this study was to assess the age‐specific prevalence of HR‐HPV infection and the correlation between HR‐HPV status and cytologic diagnosis. METHODS The authors enrolled 7254 women receiving routine cytologic screening in a cross‐sectional study that was conducted during 12 months. Cervical samples were collected using liquid‐based cytology to perform both Papanicolaou smears and HR‐HPV testing. Analyses were performed using age stratification, and the cytologic results were considered as the reference diagnosis for parameter analysis tests. RESULTS The overall rate of HR‐HPV infection was 11.4% (95% confidence interval, 9–12%) and was higher in younger women compared with older women (age < 30 years vs. ≥ 30 years; 16% vs. 8.5%, respectively; P < 0.0001). The overall rate of abnormal cytology was 3.2% and, similarly, was more prevalent in younger women (6.1% vs. 2.4%; P < 0.0001). The best balance between sensitivity and specificity for high‐grade lesions or worse occurred predominantly in older age groups (age ≥ 50 years). CONCLUSIONS The prevalence of HR‐HPV was age‐dependent, with the strongest correlation between HR‐HPV positivity and disease observed among older women, who potentially may derive the most benefit. Cancer (Cancer Cytopathol) 2005. © 2005 American Cancer Society.