%0 Journal Article
%T Age-Stratified Evaluation of HPV E6/E7 mRNA–Based Primary Screening and Triage Strategies for Cervical Cancer in a Chinese Community Cohort
%A Lucas L. Zhang
%A Wei C. Zhang
%A Lucas Saleh
%A Jonas C. Wang
%A Daniel Miller
%A Anil Gonzalez
%J Asian Journal of Current Research in Clinical Cancer
%@ 3062-4444
%D 2023
%V 3
%N 1
%R 10.51847/6Jpy1yB21B
%P 178-186
%X Human papillomavirus (HPV)–based testing has become the preferred strategy for population-level cervical cancer (CC) screening. Compared with HPV DNA assays, detection of HPV E6/E7 mRNA using the Aptima HPV (AHPV) test offers improved specificity, making it a promising option for primary screening. However, evidence regarding its performance across different age groups and in combination with various triage strategies remains limited. This study assessed the age-dependent effectiveness of AHPV testing and compared multiple triage approaches with cytology to identify optimal screening strategies for Chinese women. Women participating in community-based cervical cancer screening programs were enrolled from 34 sites in Liaoning Province and Qingdao City, China, between April 2018 and December 2021. All participants underwent both liquid-based cytology (LBC) and AHPV testing as initial screening tests. Those with abnormal findings on either test were referred for colposcopic evaluation. HPV genotyping (AHPV-GT) was performed for all HPV-positive samples. Outcomes of interest included age-stratified HSIL+ detection rates, colposcopy referral proportions, and diagnostic accuracy metrics (sensitivity and specificity). Comparative analyses of AHPV-based screening and different triage strategies were conducted across predefined age categories. Among 9,911 women included in the final analysis, abnormal cytology was observed in 6.1%–8.0% of participants, with the highest frequency in the 45–54-year age group. HPV prevalence increased with age and peaked among women aged 55–64 years, exceeding that observed in women aged 35–44 and 45–54 years (14.1% vs. 12.2% and 11.6%, respectively; P = 0.048 and P = 0.002). In women aged 35–44 years, AHPV testing demonstrated markedly superior sensitivity for HSIL+ detection compared with LBC (96.6% [95% CI: 89.7–100.0] vs. 65.5% [95% CI: 48.3–82.8], P < 0.001). Implementation of AHPV genotyping with reflex LBC triage resulted in a higher HSIL+ detection rate than cytology alone (9.6‰ vs. 7.3‰) while simultaneously lowering colposcopy referrals (5.1% vs. 6.1%). In contrast, among women aged 45–54 years, HSIL+ detection using this triage strategy was marginally lower than that achieved by LBC alone (6.2‰ vs. 6.6‰). For women aged 55–64 years, AHPV testing again showed significantly greater sensitivity than cytology (97.2% [95% CI: 91.7–100.0] vs. 66.7% [95% CI: 50.0–80.6], P = 0.003). No statistically significant difference was observed between AHPV-GT with reflex LBC triage and LBC alone in terms of overall discriminatory ability, as reflected by comparable AUC values. The diagnostic performance of AHPV-based primary screening and subsequent triage approaches varied substantially by age. AHPV testing appears to be a reliable primary screening method for women aged 35–44 years and 55–64 years, whereas the addition of HPV genotyping followed by reflex cytology may provide particular benefit for women in the 35–44-year age group.
%U https://galaxypub.co/article/age-stratified-evaluation-of-hpv-e6e7-mrnabased-primary-screening-and-triage-strategies-for-cervic-fjcpjte1prqubok