Shanxi Province Cervical Cancer Screening Study: A Cross-Sectional Comparative Trial of Multiple Techniques to Detect Cervical Neoplasia

Objective. The aim of this study was to design a cervical cancer screening algorithm for the developing world that is highly sensitive for cervical intraepithelial neoplasia (CIN) II, III, and cancer and highly specific for CIN II and III, making it possible to ablate the transformation zone without histologic confirmation. Methods. In rural Shanxi Province, China, we examined 1997 women ages 35–45. Each subject underwent a self-test for intermediate and high-risk HPV (by HC-II assay), fluorescence spectroscopy, a liquid-based Pap (read manually and by computer and used as a direct test for HPV), a visual inspection (VIA) diagnosis, and colposcopy with multiple cervical biopsies. Results. Mean age was 39.1 ± 3.16 years, mean number of births was 2.6 ± 0.93. Based on tests administered, 4.3% subjects had ≥CIN II. All subjects with ≥CIN II had either a ThinPrep Pap (≥ASCUS) or a positive HPV direct test. The sensitivity and specificity for the detection of ≥CIN II were, respectively, 83 and 86% for the HPV self-test, 95 and 85% for the HPV direct test, 94 and 78% for the ThinPrep Pap (≥ASCUS), 77 and 98% for the ThinPrep Pap (≥HGSIL), 94 and 9% for fluorescence spectroscopy, 71 and 74% for VIA, and 81 and 77% for colposcopy. Conclusion. Based on these data and the existing healthcare infrastructure in China, we believe that further refinement of primary HPV screening using centralized labs is indicated. Self-testing in the local villages may be effective with improvements in the devices and techniques.