South African Medical Journal

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The agreement between cervical abnormalities identified by cytology and detection of high-risk types of human papillomavirus

Bruce R Allan, Dianne J Marais, Lynette Denny, Margaret Hoffman, Samuel Shapiro, Anna-Lise Williamson


Objectives and design. Human papilloma virus (HPV) is causally  associated  with cervical cancer. Using the Digene Hybrid Capture2 high-risk HPV test (HC2), we investigated the prevalence of high-risk HPV in cervical specimens, and compared results with those of Papanicolaou (Pap) smears taken concurrently.
Subjects and setting. Cervical specimens were obtained from women  attending hospitals/community health centres in the Western Cape   province of South Africa. They were participating in a case-control study of the association of hormonal contraceptives and invasive cervical cancer.
Results. Of 1 491 women tested, 254 (17%) were HPV DNA positive. The age-specific prevalence of HPVwas 36/97 (37.1%) in those aged <30  years,78/369 (21.1%)inthose aged 30-39 years, 78/603 (12.9%) in those aged 40 ~ 49 years and 62/422 (14.7%) in those aged 50- 59 years. In women with normal cytology the prevalence of HPV was 10.9% (138/1 264); in those with abnormal squamous cells of unknown significance (AS-CUS) it was 30.8%  (36/117); in those with low-grade squamous intraepitheliallesions (LSIL) it was 63.2%. (36 /57), and in those  with  high-grade squamous intraepitheliallesions (HSIL) it was 83% (44/53). The odds ratio between HPV and HSIL in women aged 40 - 59 years was 57J (confidence interval22.4- 170.7).
Conclusions. HC2 detected a high prevalence of HPV (17%) in this population. Most women with HSIL (83%) were positive, indicating that HPV testing of AS-CUS women may aid in management. When costs decrease, HC2 could be introduced as an adjunct to Pap smears in identifying women at risk for high-grade cervical disease and could be usefulin the maintenance of cervica1health inthosewho remain Pap smear negative

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