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Human Papillomavirus Testing for Cervical Cancer Screening: Results From a 6-Year Prospective Study in Rural China
American Journal of Epidemiology, 08/20/09

Shi J–F et al. – This prospective study assessed the risk of future cervical intraepithelial neoplasia grade 2 or worse (CIN2+) associated with baseline human papillomavirus (HPV) and cytologic status...This study demonstrates that a single oncogenic HPV–DNA test is more effective than cytology in predicting future CIN2+ status.

• In rural China, 1,997 women were screened with 6 screening tests, including colposcopic evaluations, and underwent biopsies in 1999.
• In December 2005, 1,612 women with cervical intraepithelial neoplasia grade 1 or less at baseline were rescreened by visual inspection, liquid–based cytology, and HPV–DNA testing.
• All women underwent colposcopy at follow–up, with biopsies taken from women with visually apparent lesions or cytologic abnormalities.

• Twenty women developed incident CIN2+.
• The crude relative risk of CIN2+ for baseline HPV–positive women was 52 (95% confidence interval: 12.1, 222.5).
• The crude relative risk of CIN2+ was 167 (95% confidence interval: 21.9, 1,265) for baseline and follow–up repeatedly HPV–positive women compared with repeatedly HPV–negative women.
• Among 1,374 baseline HPV–negative women, 2 and no incident CIN2+ cases were detected in baseline cytologically normal and abnormal subgroups, respectively.
• Among 238 baseline HPV–positive women, 6 of 18 incident cases of CIN2+ developed in the cytologically normal group.

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