Background: HPV DNA testing has emerged as an effective alternative option to current recommendation for cervical cancer screening with cytology. There is limited data on the efficacy of primary HPV DNA testing strategy in Thailand.
Objectives: The aim of this study is to compare the efficacy of HPV 16/18 genotyping test, high risk HPV DNA testing alone and liquid-based cytology method in screening cervical cancer precursor, using Markov model.
Population: The hypothetical cohort of 100,000 healthy women aged 30 to 65 years were simulated in each strategy.
Method: A Markov model was used to describe the course of total detected cases of CIN2+ over 35 years. Screening program started at age 30 and performed every five years’ interval. The cohort model compared three strategies among HPV 16/18 genotyping test with reflex liquid based cytology triage, high-risk HPV testing alone followed by referral to colposcopy and cytology-based screening followed by referral to colposcopy. We assumed that the rate of lost follow-up of those referred to colposcopy would be 0%. The clinical parameter was estimated using the data from a recent prospective study of Thailand National Cancer Institute.
Results: Of the three screening strategies that were evaluated, high risk HPV DNA testing alone was the most effective strategy for detection of CIN2+ over 35 years. It detected 143 and 510 cases per 100,000 women more than HPV 16/18 genotyping test and cytology-based strategy respectively. Compare the HPV 16/18 genotyping test and cytology-based; HPV 16/18 genotyping test detected 368 cases per 100,000 women more than cytology-based. In addition, every five years’ interval, there were missed cases about half of detected cases screening by cytology strategy and 10% of detected cases screening by HPV 16/18 genotyping test.
Conclusion: This study strongly supports that HPV DNA testing is preferred to cytology-based screening for cervical cancer precursor. However, the balance between benefits, burden and cost of each screening program should be considered.