Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study

Scientists from the International Agency for Research on Cancer (IARC) and partner institutions have completed the largest ever study on cervical cancer screening methods in Latin America. They found that testing for human papillomavirus (HPV) was almost twice as likely to detect cervical precancers compared with cytology, which remains the main screening method used in countries in Latin America. The findings are part of the Estudio Multicéntrico de Tamizaje y Triaje de Cáncer de Cuello Uterino con Pruebas del Virus del Papiloma Humano (ESTAMPA) study. The results were published in The Lancet Regional Health – Americas.

The study team included 30 606 participants in the analysis. A total of 440 histologically confirmed cases of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) and 30 cervical cancers were diagnosed. Of these 470 cases, cytology missed more than half (52%, 242 of 470), whereas HPV testing successfully detected almost all of them, missing only 2% (9 of 470). Without HPV testing, 242 cases may have gone undetected if screening relied only on cervical cytology. Use of HPV testing to screen for cervical cancer resulted in a net benefit of 233 extra cases being detected compared with relying on cytology alone.

In addition, the sensitivity – the likelihood that a positive test result actually indicates the presence of CIN – of HPV testing was much more stable than that of cytology. The sensitivity of HPV testing was consistently above 96%, compared with a sensitivity range of 32–88% for cytology.

These findings provide regional evidence that can guide evidence-based decision-making by policy-makers to accelerate the transition from cytology to HPV testing for primary cervical cancer screening instead of improving current cytology capacity. The results may have an important impact to fill evidence gaps regarding screening with cytology and HPV testing in large populations not only in Latin American countries but also in other low- and middle-income countries where cytology is still widely used.

Ramírez AT, Valls J, Baena A, Rojas FD, Ramírez K, Álvarez R, et al.; on behalf of the ESTAMPA Study Group
Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study
Lancet Reg Health Am, Published online 20 September 2023;
https://doi.org/10.1016/j.lana.2023.100593