Risk assessment to guide cervical screening strategies in a large Chinese population

Fang Hui Zhao, Shang Ying Hu, Qian Zhang, Xun Zhang, Qin Jing Pan, Wen Hua Zhang, Julia C. Gage, Nicolas Wentzensen, Philip E. Castle, You Lin Qiao, Hormuzd A. Katki, Mark Schiffman

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Three different cervical screening methods [cytology, human papillomavirus(HPV) testing and visual inspection with acetic acid(VIA)] are being considered in China for the national cervical screening program. Comparing risks of CIN3 and cervical cancer (CIN3+) for different results can inform test choice and management guidelines. We evaluated the immediate risk of CIN3+ for different screening results generated from individual and combined tests. We compared tests using a novel statistic designed for this purpose called Mean Risk Stratification (MRS), in a pooled analysis of 17 cross sectional population-based studies of 30,371Chinese women screened with all 3 methods and diagnosed by colposcopically-directed biopsies. The 3 tests combined powerfully distinguished CIN3+ risk; triple-negative screening conferred a risk of 0.01%, while HPV-positive HSIL+ that was VIA-positive yielded a risk of 57.8%. Among the three screening tests, HPV status most strongly stratified CIN3+ risk. Among HPV-positive women, cytology was the more useful second test. In HPV-negative women, the immediate risks of CIN3+ ranged from 0.01% (negative cytology), 0.00% (ASC-US), 1.1% (LSIL), to 6.6 (HSIL+). In HPV-positive women, the CIN3+ risks were 0.9% (negative cytology), 3.6% (ASC-US), 6.3% (LSIL) and 38.5% (HSIL+). VIA results did not meaningful stratify CIN3+ risk among HPV-negative women with negative or ASC-US cytology; however, positive VIA substantially elevated CIN3+ risk for all other, more positive combinations of HPV and cytology compared with a negative VIA. Because all 3 screening tests had independent value in defining risk of CIN3+, different combinations can be optimized as pragmatic strategies in different resource settings.

Original languageEnglish (US)
Pages (from-to)2639-2647
Number of pages9
JournalInternational Journal of Cancer
Issue number11
StatePublished - Jun 1 2016
Externally publishedYes


  • HPV DNA testing
  • VIA
  • cervical screening
  • cytology
  • risk assessment

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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