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Prevalence of positive screening test results and agreement between cytology and human papillomavirus testing in primary cervical cancer screening in North-Western Romania

Şuteu, Ofeliaa,d; Blaga, Mihaiela L.a; Nygård, Marig; Leinonen, Maarit K.g; Nicula, Floriana; Păiş, Rodicab; Coza, Danielaa; Cadariu, Patriciu A.c,e; Melnic, Adrianaf; Andreassen, Trudeg,h; Hashim, Danag,h,j; Weiderpass, Elisabeteg,i,k,l

doi: 10.1097/CEJ.0000000000000522
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Using data from a pilot study conducted in North-Western Romania, we aimed to estimate the prevalence of abnormal cytology and positive high-risk human papillomavirus (hr-HPV) test results in an ethnically diverse screening population and to assess the agreement between cytology and hr-HPV testing to evaluate the feasibility of integrating the latter as a primary test in the national cervical cancer screening program. The cross-sectional pilot study included Roma women, other ethnic minorities, and women in rural remote areas. Samples were taken for liquid-based cytology and hr-HPV testing (Hybrid Capture 2 DNA test) by a mobile health unit. The prevalence of positive screening results and the agreement between cytology and hr-HPV testing were estimated by κ coefficient. A total of 1019 women were included in the study. The population prevalence of positive screening results was similar for both tests (12%). The prevalence of abnormal cytology increased with increasing age, whereas the prevalence of positive hr-HPV test showed a bimodal age pattern. Substantial differences in the prevalence of abnormal cytology were found by ethnicity, with highest prevalence in Romanian women (14%), followed by Roma women (6%) and women of other ethnicities (5%) (P=0.002). Similar ethnic differences in the prevalence of positive hr-HPV test were not observed. The overall agreement of positive screening results between the two methods was fair (κ=0.25; 95% confidence interval=0.18–0.30, P<0.001) and ranged from poor to substantial depending on the age group. The prevalence of abnormal cytology result was high and similar to the prevalence of positive hr-HPV test result, which could allow for the implementation of hr-HPV testing as a primary test in the cervical cancer screening program in Romania.

Departments of aPrevention and Cancer Control

bAnatomopathology

cSurgical Oncology, Institute of Oncology ‘Prof. Dr. Ion Chiricuţă’

Departments of dEpidemiology

eSurgical Oncology, ‘Iuliu Ha[Latin Small Letter t with comma below]ieganu’ University of Medicine and Pharmacy

fRomanian Cancer Society, Cluj-Napoca, Romania

gDepartment of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research

hInstitute of Basic Medical Sciences, University of Oslo, Oslo, Norway

iDepartment of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway

jDepartment of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA

kDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

lGenetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland

Correspondence to Maarit K. Leinonen, MD, PhD, Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379 Oslo, Norway Tel: +47 22 928 864; e-mail: maarit.leinonen@kreftregisteret.no

Received December 16, 2018

Accepted April 3, 2019

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