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Stoler MH, Wright TC, Parvu V, Yanson K, Eckert K, Kodsi S, Cooper C. HPV Testing With 16, 18, and 45 Genotyping Stratifies Cancer Risk for Women With Normal Cytology. Am J Clin Pathol 2019; 151:433-442. [PMID: 30649177 PMCID: PMC6396747 DOI: 10.1093/ajcp/aqy169] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives To determine the BD Onclarity human papillomavirus (HPV) assay performance and risk values for cervical intraepithelial neoplasia grade 2 (CIN2) or higher and cervical intraepithelial neoplasia grade 3 (CIN3) or higher during Papanicolaou/HPV cotesting in a negative for intraepithelial lesions or malignancies (NILM) population. Methods In total, 22,383 of the 33,858 enrolled women were 30 years or older with NILM cytology. HPV+ and a subset of HPV– patients (3,219/33,858 combined; 9.5%) were referred to colposcopy/biopsy. Results Overall, 7.9% of women were Onclarity positive; HPV 16 had the highest prevalence (1.5%). Verification bias-adjusted (VBA) CIN2 or higher and CIN3 or higher prevalences were 0.9% and 0.3%, respectively. Onclarity had VBA CIN2 or higher (44.1%) and CIN3 or higher (69.5%) sensitivities, as well as CIN2 or higher (92.4%) and CIN3 or higher (92.3%) specificities—all similar to Hybrid Capture 2. HPV 16, 18, 45, and the other 11 genotypes had CIN3 or higher risks of 6.9%, 2.6%, 1.1%, and 2.2%, respectively. Conclusions Onclarity is clinically validated for cotesting in NILM women. Genotyping actionably stratifies women at greater CIN3 or higher risk.
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Affiliation(s)
- Mark H Stoler
- University of Virginia Health System, Charlottesville
| | | | - Valentin Parvu
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
| | - Karen Yanson
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
| | - Karen Eckert
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
| | - Salma Kodsi
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
| | - Charles Cooper
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
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Polman NJ, Snijders PJF, Kenter GG, Berkhof J, Meijer CJLM. HPV-based cervical screening: Rationale, expectations and future perspectives of the new Dutch screening programme. Prev Med 2019; 119:108-117. [PMID: 30594536 DOI: 10.1016/j.ypmed.2018.12.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022]
Abstract
Based on scientific data showing that HPV testing provides better protection against cervical precancer and cancer than cytology, in 2011 the Dutch Health Council advised the Minister of Welfare, Health and Sports to replace cytology by HPV testing in the Dutch population-based screening programme. After a successful evaluation of the feasibility of HPV-based screening in 2014, primary HPV testing for cervical screening was implemented in 2017. The Netherlands has been one of the first countries worldwide to implement nationwide HPV-based screening and its experience with the new programme is therefore followed with great interest. In this manuscript, we present an overview of the studies that were instrumental in the choice of HPV assay and triage strategy, the adjustment of screening starting and exit ages and intervals, and the implementation of HPV self-sampling. Finally, we review the cost-effectiveness of the proposed new screening algorithm and we explore future perspectives. The rationale behind the new Dutch HPV-based screening programme, which is based on risk management, could serve as a guidance to other countries that are planning to implement HPV-based screening in the near future.
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Affiliation(s)
- N J Polman
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - P J F Snijders
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G G Kenter
- Department of Gynecologic Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - C J L M Meijer
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Polman NJ, Ebisch RMF, Heideman DAM, Melchers WJG, Bekkers RLM, Molijn AC, Meijer CJLM, Quint WGV, Snijders PJF, Massuger LFAG, van Kemenade FJ, Berkhof J. Performance of human papillomavirus testing on self-collected versus clinician-collected samples for the detection of cervical intraepithelial neoplasia of grade 2 or worse: a randomised, paired screen-positive, non-inferiority trial. Lancet Oncol 2019; 20:229-238. [PMID: 30658933 DOI: 10.1016/s1470-2045(18)30763-0] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/30/2018] [Accepted: 10/08/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) testing on self-collected samples is a potential alternative to HPV testing on clinician-collected samples, but non-inferiority of its clinical accuracy remains to be assessed in the regular screening population. The IMPROVE study was done to evaluate the clinical accuracy of primary HPV testing on self-collected samples within an organised screening setting. METHODS In this randomised, non-inferiority trial, women aged 29-61 years were invited to participate in the study as part of their regular screening invitation in the Netherlands. Women who provided informed consent were randomly allocated (1:1, with a block size of ten stratified by age) to one of two groups: a self-sampling group, in which women were requested to collect their own cervicovaginal sample using an Evalyn Brush (Rovers Medical Devices BV, Oss, Netherlands); or a clinician-based sampling group, in which samples were collected by a general practitioner with a Cervex-Brush (Rovers Medical Devices BV). All samples were tested for HPV using the clinically validated GP5+/6+ PCR enzyme immunoassay (Labo Biomedical Products BV, Rijswijk, Netherlands). HPV-positive women in both groups were retested with the other collection method and triaged by cytology and repeat cytology in accordance with current Dutch screening guidelines. Primary endpoints were detection of cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+). Non-inferiority of HPV testing on self-collected versus clinician-collected samples was evaluated against a margin of 90% for the relative sensitivity and 98% for the relative specificity. This study is registered at the Dutch Trial register (NTR5078) and has been completed. FINDINGS Of the 187 473 women invited to participate, 8212 were randomly allocated to the self-sampling group and 8198 to the clinician-based sampling group. After exclusion of women who met the exclusion criteria or who did not return their sample, 7643 women were included in the self-sampling group and 6282 in the clinician-based sampling group. 569 (7·4%) self-collected samples and 451 (7·2%) clinician-collected samples tested positive for HPV (relative risk 1·04 [95% CI 0·92-1·17]). Median follow-up duration for HPV-positive women was 20 months (IQR 17-22). The CIN2+ sensitivity and specificity of HPV testing did not differ between self-sampling and clinician-based sampling (relative sensitivity 0·96 [0·90-1·03]; relative specificity 1·00 [0·99-1·01]). For the CIN3+ endpoint, relative sensitivity was 0·99 (0·91-1·08) and relative specificity was 1·00 (0·99-1·01). INTERPRETATION HPV testing done with a clinically validated PCR-based assay had similar accuracy on self-collected and clinician-collected samples in terms of the detection of CIN2+ or CIN3+ lesions. These findings suggest that HPV self-sampling could be used as a primary screening method in routine screening. FUNDING Ministry of Health, Welfare, and Sport (Netherlands), and the European Commission.
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Affiliation(s)
- Nicole J Polman
- Cancer Centre Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renée M F Ebisch
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Daniëlle A M Heideman
- Cancer Centre Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Chris J L M Meijer
- Cancer Centre Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Peter J F Snijders
- Cancer Centre Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam, Netherlands.
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Polman NJ, Veldhuijzen NJ, Heideman DAM, Snijders PJF, Meijer CJLM, Berkhof J. Management of HPV-positive women in cervical screening using results from two consecutive screening rounds. Int J Cancer 2019; 144:2339-2346. [PMID: 30565673 DOI: 10.1002/ijc.32004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/21/2018] [Accepted: 10/31/2018] [Indexed: 11/11/2022]
Abstract
We studied whether triage of human papillomavirus (HPV)-positive women participating in an HPV-based screening programme can be improved by including the HPV result at the previous screen in the triage algorithm. We analyzed data of a subgroup of 366 women from the POBASCAM trial, screened by cytology and HPV cotesting. Women were included if they tested HPV-positive in the second HPV-based screening round. We evaluated the clinical performance of 16 strategies, consisting of cytology, HPV genotyping, and/or previous screen HPV result. The clinical endpoint was cervical precancer or cancer (CIN3+). The current Dutch triage testing policy for HPV-positive women is to refer women for colposcopy if they have abnormal cytology at baseline or after 6-18 months. In the second HPV-based screening round, this strategy yielded a negative predictive value (NPV) of 95.8% (95% confidence interval: 91.9-98.2) and colposcopy referral rate of 37.6% (32.3-43.2%). Replacing repeat cytology by the previous screen HPV result yielded a similar NPV (96.9%, 93.3-98.9) and colposcopy referral rate (38.8%, 33.4-44.4). A higher NPV (99.2%, 96.3-100%) at the cost of a higher colposcopy referral rate (49.2%, 43.6-54.8) was achieved when cytology was combined with HPV16/18 genotyping. The other 13 triage strategies yielded a lower NPV, a higher colposcopy referral rate or performed similarly but required additional testing. HPV-positive women in the second HPV-based screening round can be suitably managed by cytology, HPV16/18 genotyping and the HPV result at the previous screen, obviating the need for repeat testing of HPV-positive, cytology negative women.
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Affiliation(s)
- Nicole J Polman
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nienke J Veldhuijzen
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle A M Heideman
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter J F Snijders
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris J L M Meijer
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Chrysostomou AC, Stylianou DC, Constantinidou A, Kostrikis LG. Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:E729. [PMID: 30572620 PMCID: PMC6315375 DOI: 10.3390/v10120729] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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Affiliation(s)
- Andreas C Chrysostomou
- Department of Biological Sciences, University of Cyprus, 1 University Avenue, Aglantzia 2109, Nicosia, Cyprus.
| | - Dora C Stylianou
- Department of Biological Sciences, University of Cyprus, 1 University Avenue, Aglantzia 2109, Nicosia, Cyprus.
| | - Anastasia Constantinidou
- Medical School, University of Cyprus, Shakolas Educational Center for Clinical Medicine, Palaios dromos Lefkosias Lemesou No.215/6 2029 Aglantzia, Nicosia, Cyprus.
| | - Leondios G Kostrikis
- Department of Biological Sciences, University of Cyprus, 1 University Avenue, Aglantzia 2109, Nicosia, Cyprus.
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Guenat D, Dalstein V, Mauny F, Saunier M, Briolat J, Clavel C, Riethmuller D, Mougin C, Prétet JL. Development and interlaboratory agreement of real-time PCR for HPV16 quantification in liquid-based cervical samples. PAPILLOMAVIRUS RESEARCH 2018; 6:27-32. [PMID: 30343011 PMCID: PMC6202657 DOI: 10.1016/j.pvr.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/10/2018] [Accepted: 10/16/2018] [Indexed: 11/18/2022]
Abstract
High risk HPV infection is the necessary cause for the development of precancerous and cancerous lesions of the cervix. Among HPV, HPV16 represents the most carcinogenic type. Since the determination of HPV16 DNA load could be clinically useful, we assessed quantitative real-time PCR targeting E6HPV16 and albumin genes on two different platforms. Series of SiHa cells diluted in PreservCyt were used to assess repeatability and reproducibility of two in-house real-time PCR techniques run in two different laboratories to determine HPV16 load. Furthermore, 97 HPV16 positive cervical samples were evaluated to estimate inter-center variability using Bland-Alman plots. As a whole, both techniques presented coefficients of variation for HPV16 load measurement similar to those established for other virus quantification with commercial kits. Moreover, the two real-time PCR techniques showed a very good agreement for HPV16 load calculation. Finally, we emphasize that robust HPV16 DNA quantification requires normalization of viral load by the cell number. HPV16 viral load could be a useful biomarker for the management of HPV positive women. Coefficient of variation for HPV16 viral load ranged from 7% to 62%. HPV16 viral load quantification requires normalization by the cell number. HPV16 viral load precision increases with the use of an internal calibrator.
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Affiliation(s)
- David Guenat
- EA3181, Université de Franche-Comté, COMUE Université Bourgogne Franche-Comté, LabExLipSTIC ANR-11-LABX-0021, Boulevard Alexandre Fleming, F-25030 Besançon Cedex, France; Centre National de Référence Papillomavirus, CIC 1431, CHU Besançon, F-25000, France
| | - Véronique Dalstein
- INSERM, UMR-S 1250, Reims, France; Champagne-Ardenne, Faculté de Médecine, Reims, France; CHU Reims, Laboratoire Biopathologie, Reims, France
| | | | - Maëlle Saunier
- EA3181, Université de Franche-Comté, COMUE Université Bourgogne Franche-Comté, LabExLipSTIC ANR-11-LABX-0021, Boulevard Alexandre Fleming, F-25030 Besançon Cedex, France
| | - Jenny Briolat
- INSERM, UMR-S 1250, Reims, France; Champagne-Ardenne, Faculté de Médecine, Reims, France; CHU Reims, Laboratoire Biopathologie, Reims, France
| | - Christine Clavel
- INSERM, UMR-S 1250, Reims, France; Champagne-Ardenne, Faculté de Médecine, Reims, France; CHU Reims, Laboratoire Biopathologie, Reims, France
| | - Didier Riethmuller
- EA3181, Université de Franche-Comté, COMUE Université Bourgogne Franche-Comté, LabExLipSTIC ANR-11-LABX-0021, Boulevard Alexandre Fleming, F-25030 Besançon Cedex, France
| | - Christiane Mougin
- EA3181, Université de Franche-Comté, COMUE Université Bourgogne Franche-Comté, LabExLipSTIC ANR-11-LABX-0021, Boulevard Alexandre Fleming, F-25030 Besançon Cedex, France; Centre National de Référence Papillomavirus, CIC 1431, CHU Besançon, F-25000, France
| | - Jean-Luc Prétet
- EA3181, Université de Franche-Comté, COMUE Université Bourgogne Franche-Comté, LabExLipSTIC ANR-11-LABX-0021, Boulevard Alexandre Fleming, F-25030 Besançon Cedex, France; Centre National de Référence Papillomavirus, CIC 1431, CHU Besançon, F-25000, France.
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Risk of Anal Cancer in Women With a Human Papillomavirus-Related Gynecological Neoplasm: Puerto Rico 1987-2013. J Low Genit Tract Dis 2018; 22:225-230. [PMID: 29649025 DOI: 10.1097/lgt.0000000000000395] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR). MATERIALS AND METHODS We identified 9,489 women who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987-2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer. RESULTS A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p < .05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p < .05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non-HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79). CONCLUSIONS Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non-HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.
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Xu L, Padalko E, Oštrbenk A, Poljak M, Arbyn M. Clinical Evaluation of INNO-LiPA HPV Genotyping EXTRA II Assay Using the VALGENT Framework. Int J Mol Sci 2018; 19:ijms19092704. [PMID: 30208597 PMCID: PMC6165258 DOI: 10.3390/ijms19092704] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022] Open
Abstract
In this diagnostic test validation study, we assessed the clinical accuracy and HPV genotyping performance of the INNO-LiPA HPV Genotyping Extra II (INNO-LiPA) within the VALGENT-3 framework. VALGENT is designed to assess the analytical and clinical performance of HPV tests with genotyping capacity. The VALGENT-3 panel comprised 1300 consecutive cervical cell specimens enriched with 300 samples with abnormal cytology obtained from women attending the Slovenian cervical cancer screening programme. The INNO-LiPA allows type-specific detection of 32 HPV types; however, for the clinical accuracy assessment, we considered it as high-risk (hr)HPV positive when at least one of the following HPV types was present: HPV16, HPV18, HPV31, HPV33, HPV35, HPV39, HPV45, HPV51, HPV52, HPV56, HPV58, HPV59, and HPV68. Clinical accuracy for detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was compared between INNO-LiPA and Hybrid Capture 2 (HC2), which is a standard comparator test for HPV tests used in cervical cancer screening. In addition, hrHPV and type-specific detection HPV types were compared between INNO-LiPA and Linear Array HPV Genotyping Test (Linear Array). The prevalence of hrHPV determined by INNO-LiPA was 17.1% (95% CI, 15.0⁻19.2%) in the screening population. HrHPV testing with INNO-LiPA had a sensitivity for CIN2+ of 96.9% (95% CI, 92.1⁻99.1%) which was non-inferior to HC2 (relative sensitivity of 1.01; 95% CI, 0.97⁻1.04; pn.inf = 0.0002) and a specificity for ≤CIN1 of 85.3% (95% CI, 83.2⁻87.3%) which was inferior to HC2 (relative specificity of 0.95; 95% CI, 0.93⁻0.97; pn.inf = 0.9998). Genotyping agreement between INNO-LiPA and Linear Array was excellent for hrHPV, HPV16, HPV18, HPV35, HPV45, HPV58 and HPV59, but good or fair for other HPV types. To conclude, INNO-LiPA demonstrated non-inferior clinical sensitivity but lower specificity compared to HC2 in addition to excellent concordance compared to Linear Array for hrHPV and some genotypes.
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Affiliation(s)
- Lan Xu
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano (Previously Scientific Institute of Public Health), 1050 Brussels, Belgium.
| | - Elizaveta Padalko
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, 9000 Gent, Belgium.
| | - Anja Oštrbenk
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano (Previously Scientific Institute of Public Health), 1050 Brussels, Belgium.
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Opportunities and challenges for introducing HPV testing for cervical cancer screening in sub-Saharan Africa. Prev Med 2018; 114:205-208. [PMID: 30031013 PMCID: PMC6095940 DOI: 10.1016/j.ypmed.2018.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022]
Abstract
To protect women against cervical cancer, the World Health Organization recommends that women aged 30 to 49 years be screened with tests that detect human papillomavirus (HPV). If the countries that have the greatest burden of this disease-especially those in sub-Saharan Africa-are not to be left behind, we must understand the challenges they face and identify measures that can help them take full advantage now of innovations that are transforming screening services in wealthier countries. We reviewed policy documents and published literature related to Kenya, Tanzania, and Uganda, and met with key personnel from government and nongovernmental organizations. National policy makers understand the value of HPV testing in terms of its superior sensitivity and the programmatic advantages that could result from using self-collected samples. However, while these countries have national cervical cancer prevention strategies, and some have national departments or units for cervical cancer prevention, screening is rare, funding scarce, and quality low. Age guidelines are not strictly followed, with scarce resources being used to screen many women younger than the recommended ages. Published evidence of the benefits of HPV testing-including performance, safety, and cost-effectiveness-must be provided to ministry of health leaders, along with information on anticipated costs for training personnel, purchasing supplies, providing facility space, and maintaining test kits. Despite the obstacles, a joint effort on the part of global and national stakeholders to introduce molecular screening methods can bring better protection to the women who need it most.
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Tifaoui N, Maudelonde T, Combecal J, Vallo R, Doutre S, Didelot MN, Nagot N, Segondy M, Boulle N. High-risk HPV detection and associated cervical lesions in a population of French menopausal women. J Clin Virol 2018; 108:12-18. [PMID: 30196012 DOI: 10.1016/j.jcv.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/10/2018] [Accepted: 08/30/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND With population ageing, post-menopausal women represent a new group to be considered in cervical cancer screening strategies, including the significance of High Risk (HR)-HPV detection. OBJECTIVES A retrospective analysis was conducted in a cohort of 406 menopausal women attending routine gynaecological consultation at the Hospital of Montpellier (France). STUDY DESIGN All women benefited from a cervical smear and HR-HPV detection using Hybrid Capture 2 (HC2) test. The prevalence of cytological abnormalities, HR-HPV detection and risk factors associated with HR-HPV detection were analyzed. Evolution of both tests was evaluated in a sub-group of women with adequate follow-up. RESULTS Five women (1.2%) had an abnormal cervical smear at baseline. HR-HPV was detected in 40 women (9.9%), including 36 women with normal cytology (9%). Risk factors associated with HR-HPV detection at enrolment were a previous history of Cervical Intraepithelial Neoplasia and a high socio-economic level, but not hormone replacement therapy. When cytology and HR-HPV detection were negative at enrolment, both remained negative for 95% (230/241) of women during follow-up (median duration of follow-up: 60 months). HR-HPV persistence was observed for 55% (18/33) of women with normal cytology and positive HR-HPV test. Finally, all women with a final diagnosis of high-grade (CIN2+) cervical lesion (N = 7) had a positive HR-HPV test with or without abnormal cytology. CONCLUSIONS HR-HPV was detected in 9.9% of menopausal women. HR-HPV detection was a better predictor of CIN2+ lesions than cytology in this population. Women with previous CIN history should benefit from HR-HPV testing and need long term follow-up.
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Affiliation(s)
- Naouel Tifaoui
- Department of Gynecology and Obstetrics, CHU Nîmes, Nîmes, France
| | - Thierry Maudelonde
- Department of Gynecology and Obstetrics, CHU Montpellier, Montpellier, France; Laboratory of Biostatistics, Epidemiology and Clinical Research, EA2415, University of Montpellier, Montpellier, France
| | - Jacques Combecal
- Department of Gynecology and Obstetrics, CHU Montpellier, Montpellier, France
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Sylviane Doutre
- Departement of Pathology and Oncobiology, Laboratory of Solid Tumors, CHU Montpellier, Montpellier, France
| | - Marie-Noëlle Didelot
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Michel Segondy
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
| | - Nathalie Boulle
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France; Departement of Pathology and Oncobiology, Laboratory of Solid Tumors, CHU Montpellier, Montpellier, France.
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Cuschieri K, Ronco G, Lorincz A, Smith L, Ogilvie G, Mirabello L, Carozzi F, Cubie H, Wentzensen N, Snijders P, Arbyn M, Monsonego J, Franceschi S. Eurogin roadmap 2017: Triage strategies for the management of HPV-positive women in cervical screening programs. Int J Cancer 2018; 143:735-745. [PMID: 29341110 DOI: 10.1002/ijc.31261] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 01/04/2023]
Abstract
Cervical cancer screening will rely, increasingly, on HPV testing as a primary screen. The requirement for triage tests which can delineate clinically significant infection is thus prescient. In this EUROGIN 2017 roadmap, justification behind the most evidenced triages is outlined, as are challenges for implementation. Cytology is the triage with the most follow-up data; the existence of an HR-HPV-positive, cytology-negative group presents a challenge and retesting intervals for this group (and choice of retest) require careful consideration. Furthermore, cytology relies on subjective skills and while adjunctive dual-staining with p16/Ki67 can mitigate inter-operator/-site disparities, clinician-taken samples are required. Comparatively, genotyping and methylation markers are objective and are applicable to self-taken samples, offering logistical advantages including in low and middle income settings. However, genotyping may have diminishing returns in immunised populations and type(s) included must balance absolute risk for disease to avoid low specificity. While viral and cellular methylation markers show promise, more prospective data are needed in addition to refinements in automation. Looking forward, systems that detect multiple targets concurrently such as next generation sequencing platforms will inform the development of triage tools. Additionally, multistep triage strategies may be beneficial provided they do not create complex, unmanageable pathways. Inevitably, the balance of risk to cost(s) will be key in decision making, although defining an acceptable risk will likely differ between settings. Finally, given the significant changes to cervical screening and the variety of triage strategies, appropriate education of both health care providers and the public is essential.
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Affiliation(s)
- Kate Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
| | - Guglielmo Ronco
- Centre for Cancer Prevention (CPO), AOU Città della Salute e della Scienza via Cavour 39, Torino, 10123, Italy
| | - Attila Lorincz
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom
| | - Laurie Smith
- University of British Columbia and BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Francesca Carozzi
- Cancer Prevention Regional Laboratory, ISPO, Cancer Prevention and Research Institute, Florence, Italy
| | - Heather Cubie
- Global Health Academy, University of Edinburgh, Teviot Quad, Edinburgh, EH8 9PG, United Kingdom
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Peter Snijders
- Department of Pathology, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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Dual staining for p16/Ki67 is a more specific test than cytology for triage of HPV-positive women. Virchows Arch 2018; 473:599-606. [PMID: 30094492 DOI: 10.1007/s00428-018-2432-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/29/2018] [Accepted: 08/01/2018] [Indexed: 12/18/2022]
Abstract
Globally, cervical cancer (CC) screening is moving from cytology-based to HPV screening or a combination of both (co-testing). Most HPV-positive women clear the virus and do not develop relevant disease. Additional triage approaches are needed to reduce unnecessary colposcopy referrals. The p16/Ki67 dual stain cytology test (DSCT) is one of the most promising, but it has not (yet) been included as a recommendation in European guidelines. Previous studies in Spain on this issue are lacking. We studied the performance of p16/Ki67 DSCT for the triage of HPV-positive women in Navarra to detect precursor lesions (PLs) and CC compared to cytology only. We selected 1865 HPV-positive women with p16/Ki67 DSCT results and 304 women with an available biopsy result. Sensitivity, specificity and predictive values of the p16/Ki67 DSCT to detect underlying PLs and CC compared to cytology were calculated, using the biopsy as the gold standard. Cytology and p16/Ki67 DSCT showed similar sensitivity (99.0% vs. 98.0%), but cytology had significantly lower specificity (6.9 vs. 39.1%). Of the CIN2+/HPV+ women, triage using cytology only would have resulted in 40.2% true PLs and CC, while using p16/Ki67 DSCT this was 98.0% qualifying the women for colposcopy referral. Our results show that p16/Ki67 DSCT detects more than twice as many true PLs and CC than cytology only in this population. Thus, this test can be considered as an important additional tool in HPV testing-based screening strategies, to avoid unnecessary colposcopy referrals and to reduce health care costs.
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Pernot S, Boucheron P, Péré H, Lucas ML, Veyer D, Fathallah N, de Parades V, Pavie J, Netter J, Collias L, Taieb J, Grabar S, Weiss L. Comparison of anal cancer screening strategies including standard anoscopy, anal cytology, and HPV genotyping in HIV-positive men who have sex with men. Br J Cancer 2018; 119:381-386. [PMID: 30026613 PMCID: PMC6068120 DOI: 10.1038/s41416-018-0176-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is no consensus on screening strategy of high-grade intraepithelial neoplasia (HGAIN). Guidelines range from clinical examination with digital anorectal examination followed by standard anoscopy (SA), to anal cytology (Pap)+/- HPV genotyping. We compared screening strategy yields based on Pap, SA, and HPV-16 genotyping alone or in combination in HIV-MSM. METHODS Pap, SA, and HPV-16 genotyping were performed in all HIV-MSM attending a first anal cancer screening consultation in Paris, France. High-resolution anoscopy, the gold standard to detect HGAIN, was performed in the case of HPV-16 positivity or abnormal cytology. Yield was defined as the number of patients with HGAIN relative to the total number of patients screened. RESULTS On 212 patients, the complete strategy (SA + Pap + HPV genotyping) yield (12.7%) was significantly higher than that of SA (3.3%, p < 0.001) and HPV-16 alone (6.6%, p < 0.05). Although none of the other strategies were significantly different from the complete strategy, Pap + HPV-16 and Pap + SA had closer yields (about 11%), with OR = 0.83 (95% CI [0.44;1.57]) and 0.87 (95% CI [0.46;1.64]), respectively. CONCLUSIONS Pap combined with HPV-16 genotyping or SA tended towards higher yields compared to Pap alone, and closer to that of the complete strategy.
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Affiliation(s)
- Simon Pernot
- Department of Hepato-Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, APHP, Paris, France.
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Pauline Boucheron
- Department of Biostatistics and Epidemiology, Cochin-Hôtel Dieu Hospital, APHP, Paris, France
| | - Hélène Péré
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Virology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Marie-Laure Lucas
- Department of Clinical Immunology, Georges Pompidou European Hospital, APHP, Paris, France
| | - David Veyer
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Virology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Nadia Fathallah
- Department of Proctology, Saint-Joseph Hospital, Paris, France
| | | | - Juliette Pavie
- Department of Clinical Immunology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Jeanne Netter
- Department of Hepato-Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Lio Collias
- Department of Clinical Immunology, Georges Pompidou European Hospital, APHP, Paris, France
| | - Julien Taieb
- Department of Hepato-Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, APHP, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Sophie Grabar
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Biostatistics and Epidemiology, Cochin-Hôtel Dieu Hospital, APHP, Paris, France
| | - Laurence Weiss
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
- Department of Clinical Immunology, Georges Pompidou European Hospital, APHP, Paris, France.
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64
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Clarke MA, Wentzensen N. Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta-analysis of cytology, HPV testing, and other biomarkers. Cancer Cytopathol 2018; 126:447-460. [PMID: 29797691 DOI: 10.1002/cncy.22018] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/26/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Abstract
Anal cancer incidence and mortality have been increasing over the past decade. Although the incidence in the general population remains low, it is much higher in certain subgroups, including those living with human immunodeficiency virus and men who have sex with men. Approximately 90% of anal squamous cell cancers are caused by infection with carcinogenic human papillomavirus (HPV). Given the common etiology between anal and cervical carcinogenesis, screening for anal cancer has been proposed in certain high-risk populations using strategies adapted from cervical cancer prevention. In this review, the authors discuss important differences in anal and cervical cancer regarding the populations at risk, disease natural history, and clinical procedures and outcomes that need to be considered when evaluating strategies for anal cancer screening. They also performed a systematic review and meta-analysis of the performance of anal cytology, anal HPV testing, and various biomarkers for the detection of anal precancers and cancers. The implications of these performance estimates are summarized in the context of risk-based screening and management of anal precancers, and important research gaps are highlighted that need to be addressed to fully understand the benefits and harms of anal cancer screening. Cancer Cytopathol 2018. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Preparing for the Next Round of ASCCP-Sponsored Cervical Screening and Management Guidelines. J Low Genit Tract Dis 2018; 21:87-90. [PMID: 28244885 DOI: 10.1097/lgt.0000000000000300] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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66
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Vintermyr OK, Andersland MS, Bjørge T, Skar R, Iversen OE, Nygård M, Haugland HK. Human papillomavirus type specific risk of progression and remission during long-term follow-up of equivocal and low-grade HPV-positive cervical smears. Int J Cancer 2018; 143:851-860. [PMID: 29569718 DOI: 10.1002/ijc.31390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/09/2018] [Accepted: 02/26/2018] [Indexed: 01/21/2023]
Abstract
The prevalence of clinically relevant HPV types and their specific risk for progression and regression in women with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) were studied in a routine screening population. A 4-year cohort of women (n = 820) with ASCUS/LSIL and a positive HPV test in triage were followed for 6-9 years. The progression risks for CIN2+/CIN3+ were determined for single (71.2%) and multiple HPV infections (28.8%). The CIN2+ progression risk for all HPV 16, all HPV 35, single HPV 16 and single HPV 35 infections were 65.3% (95% CI: 59.6-71.0), 64.4% (95% CI: 50.4-78.4), 63.8% (95% CI: 56.2-71.4) and 73.7% (95% CI: 53.9-93.5), respectively. Based on CIN2+ progression risks four main groups were defined; the HPV 16 group, the HPV 31/33/35 group, the HPV 18/45/51/52 group and the HPV 39/56/58/59/66/68 group with progression risks of 65.3% (95% CI: 59.6-71.0), 62.1% (95% CI: 54.8-69.4), 52.6 (95% CI: 45.9-59.3) and 39.5 (95% CI: 33.0-46.0), respectively. In multivariate analyses, women in the age group 40-49 years had an increased risk of CIN2+ progression. As for CIN3+, HPV 16 had a higher progression risk than other HPV risk groups (p < 0.05). In multiple infections only HPV 16 had a significant additive CIN3+ progression risk (p < 0.05) as compared to other HPV risk groups. In summary, HPV types 16 and 35, including the HPV risk group 31/33/35, had a similar CIN2+ progression risk, but only HPV 16 had a higher risk for CIN3+ progression.
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Affiliation(s)
- Olav Karsten Vintermyr
- Department of Pathology, Haukeland University Hospital, Bergen, Norway.,The Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Robert Skar
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Ole Erik Iversen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Women's Clinic, Haukeland University Hospital, Bergen, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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67
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Affiliation(s)
- K. Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney Medical School, School of Public Health, University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, UNSW Australia, Sydney, Australia
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68
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Basu P, Mittal S, Bhadra Vale D, Chami Kharaji Y. Secondary prevention of cervical cancer. Best Pract Res Clin Obstet Gynaecol 2018; 47:73-85. [PMID: 28988647 DOI: 10.1016/j.bpobgyn.2017.08.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/27/2017] [Indexed: 01/04/2023]
Abstract
Cervical cancer affects women in their reproductive ages. Screening is an important secondary prevention strategy. The long process of carcinogenic transformation from human papillomavirus (HPV) infection to invasive cancer provides ample opportunities to detect the disease at a stage when treatment is highly effective. Suitable screening tests are cytology, visual inspection after acetic acid application and HPV detection tests. Evidence of effectiveness of the tests to reduce cervical cancer mortality and the cost-effectiveness of screening programs have been demonstrated. Cervical intraepithelial neoplasia grade 2 and grade 3 are the high-grade cervical cancer precursors and need to be treated. Treatment is safe and effective with ablative or excisional techniques. The World Health Organization recommends screening women at least once in a lifetime between 30 and 49 years of age and ensuring effective treatment of the detected abnormalities. Combination of HPV vaccination and population-based screening will be instrumental in eliminating cervical cancer.
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Affiliation(s)
- Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France.
| | - Srabani Mittal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Diama Bhadra Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
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Lew JB, Simms KT, Smith MA, Saville M, Hammond I, Canfell K. Cost-effectiveness estimates: the need for complete reporting - Authors' reply. LANCET PUBLIC HEALTH 2017; 2:e212. [PMID: 29253485 DOI: 10.1016/s2468-2667(17)30076-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Jie-Bin Lew
- Cancer Council NSW, Cancer Research Division, Sydney, 2011 NSW, Australia
| | - Kate T Simms
- Cancer Council NSW, Cancer Research Division, Sydney, 2011 NSW, Australia
| | - Megan A Smith
- Cancer Council NSW, Cancer Research Division, Sydney, 2011 NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Marion Saville
- Victorian Cytology Service, Carlton, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - Ian Hammond
- School of Women's and Infant's Health, University of Western Australia, Perth, WA, Australia
| | - Karen Canfell
- Cancer Council NSW, Cancer Research Division, Sydney, 2011 NSW, Australia; School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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70
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Wentzensen N, Clarke MA. From clinical epidemiology to practice recommendations: Knowledge gaps and uncertainty in the management of anal precancers. Cancer 2017; 123:4530-4534. [PMID: 28949415 PMCID: PMC8771459 DOI: 10.1002/cncr.31033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/25/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022]
Abstract
We discuss the existing data on anal precancers and demonstrate the impact of evidence gaps and uncertainty on a clinical decision model developed to provide clinical guidance for management of anal precancers.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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71
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Schiffman M, Wentzensen N. Effective use of human papillomavirus testing for cervical cancer screening requires extended intervals to target persistent infections and precancerous lesions. Prev Med 2017; 105:378-380. [PMID: 29056320 DOI: 10.1016/j.ypmed.2017.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022]
Abstract
Invited editorial for PM 17 348R2, a CDC survey regarding primary HPV testing.
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72
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Winer RL, Tiro JA, Miglioretti DL, Thayer C, Beatty T, Lin J, Gao H, Kimbel K, Buist DSM. Rationale and design of the HOME trial: A pragmatic randomized controlled trial of home-based human papillomavirus (HPV) self-sampling for increasing cervical cancer screening uptake and effectiveness in a U.S. healthcare system. Contemp Clin Trials 2017; 64:77-87. [PMID: 29113956 DOI: 10.1016/j.cct.2017.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/23/2017] [Accepted: 11/01/2017] [Indexed: 01/14/2023]
Abstract
Women who delay or do not attend Papanicolaou (Pap) screening are at increased risk for cervical cancer. Trials in countries with organized screening programs have demonstrated that mailing high-risk (hr) human papillomavirus (HPV) self-sampling kits to under-screened women increases participation, but U.S. data are lacking. HOME is a pragmatic randomized controlled trial set within a U.S. integrated healthcare delivery system to compare two programmatic approaches for increasing cervical cancer screening uptake and effectiveness in under-screened women (>3.4years since last Pap) aged 30-64years: 1) usual care (annual patient reminders and ad hoc outreach by clinics) and 2) usual care plus mailed hrHPV self-screening kits. Over 2.5years, eligible women were identified through electronic medical record (EMR) data and randomized 1:1 to the intervention or control arm. Women in the intervention arm were mailed kits with pre-paid envelopes to return samples to the central clinical laboratory for hrHPV testing. Results were documented in the EMR to notify women's primary care providers of appropriate follow-up. Primary outcomes are detection and treatment of cervical neoplasia. Secondary outcomes are cervical cancer screening uptake, abnormal screening results, and women's experiences and attitudes towards hrHPV self-sampling and follow-up of hrHPV-positive results (measured through surveys and interviews). The trial was designed to evaluate whether a programmatic strategy incorporating hrHPV self-sampling is effective in promoting adherence to the complete screening process (including follow-up of abnormal screening results and treatment). The objective of this report is to describe the rationale and design of this pragmatic trial.
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Affiliation(s)
- Rachel L Winer
- Department of Epidemiology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Division of Biostatistics, University of California Davis, Med Sci 1C, Room 145, One Shields Avenue, Davis, CA 95616, USA.
| | - Chris Thayer
- Kaiser Permanente Washington, 2715 Naches Ave SW, PO Box 9010, Renton, WA 98057, USA.
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - John Lin
- Department of Pathology, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104, USA.
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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73
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The human papillomavirus replication cycle, and its links to cancer progression: a comprehensive review. Clin Sci (Lond) 2017; 131:2201-2221. [DOI: 10.1042/cs20160786] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022]
Abstract
HPVs (human papillomaviruses) infect epithelial cells and their replication cycle is intimately linked to epithelial differentiation. There are over 200 different HPV genotypes identified to date and each displays a strict tissue specificity for infection. HPV infection can result in a range of benign lesions, for example verrucas on the feet, common warts on the hands, or genital warts. HPV infects dividing basal epithelial cells where its dsDNA episomal genome enters the nuclei. Upon basal cell division, an infected daughter cell begins the process of keratinocyte differentiation that triggers a tightly orchestrated pattern of viral gene expression to accomplish a productive infection. A subset of mucosal-infective HPVs, the so-called ‘high risk’ (HR) HPVs, cause cervical disease, categorized as low or high grade. Most individuals will experience transient HR-HPV infection during their lifetime but these infections will not progress to clinically significant cervical disease or cancer because the immune system eventually recognizes and clears the virus. Cancer progression is due to persistent infection with an HR-HPV. HR-HPV infection is the cause of >99.7% cervical cancers in women, and a subset of oropharyngeal cancers, predominantly in men. HPV16 (HR-HPV genotype 16) is the most prevalent worldwide and the major cause of HPV-associated cancers. At the molecular level, cancer progression is due to increased expression of the viral oncoproteins E6 and E7, which activate the cell cycle, inhibit apoptosis, and allow accumulation of DNA damage. This review aims to describe the productive life cycle of HPV and discuss the roles of the viral proteins in HPV replication. Routes to viral persistence and cancer progression are also discussed.
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74
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Litwin TR, Clarke MA, Dean M, Wentzensen N. Somatic Host Cell Alterations in HPV Carcinogenesis. Viruses 2017; 9:v9080206. [PMID: 28771191 PMCID: PMC5580463 DOI: 10.3390/v9080206] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022] Open
Abstract
High-risk human papilloma virus (HPV) infections cause cancers in different organ sites, most commonly cervical and head and neck cancers. While carcinogenesis is initiated by two viral oncoproteins, E6 and E7, increasing evidence shows the importance of specific somatic events in host cells for malignant transformation. HPV-driven cancers share characteristic somatic changes, including apolipoprotein B mRNA editing catalytic polypeptide-like (APOBEC)-driven mutations and genomic instability leading to copy number variations and large chromosomal rearrangements. HPV-associated cancers have recurrent somatic mutations in phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) and phosphatase and tensin homolog (PTEN), human leukocyte antigen A and B (HLA-A and HLA-B)-A/B, and the transforming growth factor beta (TGFβ) pathway, and rarely have mutations in the tumor protein p53 (TP53) and RB transcriptional corepressor 1 (RB1) tumor suppressor genes. There are some variations by tumor site, such as NOTCH1 mutations which are primarily found in head and neck cancers. Understanding the somatic events following HPV infection and persistence can aid the development of early detection biomarkers, particularly when mutations in precancers are characterized. Somatic mutations may also influence prognosis and treatment decisions.
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Affiliation(s)
- Tamara R Litwin
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD 20850, USA.
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA.
| | - Megan A Clarke
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD 20850, USA.
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA.
| | - Michael Dean
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Gaithersburg, MD 20850, USA.
| | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA.
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75
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Marlow L, Waller J. The changing landscape of cervical screening-What does the future hold for primary care? Eur J Cancer Care (Engl) 2017; 26:e12693. [PMID: 28436064 DOI: 10.1111/ecc.12693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2017] [Indexed: 11/30/2022]
Abstract
The landscape of cervical cancer prevention is changing in many countries thanks to the introduction of vaccination against high-risk types of human papillomavirus (HPV) and the incorporation of HPV DNA testing into cervical screening algorithms. In addition to this, uptake of screening is falling year on year in the UK and elsewhere. These factors present challenges and opportunities for health professionals working in primary care-in terms of communicating programmatic changes to women; responding to questions about the meaning and implications of HPV test results; and delivering interventions to increase screening uptake.
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Affiliation(s)
- L Marlow
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, UCL, London, UK
| | - J Waller
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, UCL, London, UK
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The frequency of Human Papillomavirus Genotypes in Invasive Cervical Cancer of Romanian Patients. REV ROMANA MED LAB 2017. [DOI: 10.1515/rrlm-2017-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hellner K, Dorrell L. Recent advances in understanding and preventing human papillomavirus-related disease. F1000Res 2017; 6:F1000 Faculty Rev-269. [PMID: 28357043 PMCID: PMC5357030 DOI: 10.12688/f1000research.9701.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/19/2022] Open
Abstract
High-risk human papillomaviruses (hrHPV) are responsible for anogenital and oropharyngeal cancers, which together account for at least 5% of cancers worldwide. Industrialised nations have benefitted from highly effective screening for the prevention of cervical cancer in recent decades, yet this vital intervention remains inaccessible to millions of women in low- and middle-income countries (LMICs), who bear the greatest burden of HPV disease. While there is an urgent need to increase investment in basic health infrastructure and rollout of prophylactic vaccination, there are now unprecedented opportunities to exploit recent scientific and technological advances in screening and treatment of pre-invasive hrHPV lesions and to adapt them for delivery at scale in resource-limited settings. In addition, non-surgical approaches to the treatment of cervical intraepithelial neoplasia and other hrHPV lesions are showing encouraging results in clinical trials of therapeutic vaccines and antiviral agents. Finally, the use of next-generation sequencing to characterise the vaginal microbial environment is beginning to shed light on host factors that may influence the natural history of HPV infections. In this article, we focus on recent advances in these areas and discuss their potential for impact on HPV disease.
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Affiliation(s)
- Karin Hellner
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford, NDM Research Building, Old Road Campus, Headington, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, The Joint Research Office, Block 60, Churchill Hospital, Old Road, Headington, Oxford, UK
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