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Istrate-Ofițeru AM, Berbecaru EIA, Ruican D, Nagy RD, Rămescu C, Roșu GC, Iovan L, Dîră LM, Zorilă GL, Țieranu ML, Iliescu DG. The Influence of SARS-CoV-2 Pandemic in the Diagnosis and Treatment of Cervical Dysplasia. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1101. [PMID: 34684138 PMCID: PMC8539291 DOI: 10.3390/medicina57101101] [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: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives. The risk of developing invasive cancer increased during the COVID-19 pandemic, especially in Romania, where the incidence of this disease is high due to limited medical education and broad screening. This study's objective is to analyze the number of patients admitted with different types of cervical dysplasia and the treatment applied for the lesions during the SARS-CoV-2 pandemic compared to the same period for the year before the pandemic. Materials and methods: This is a retrospective study that took place in the Obstetrics and Gynecology Clinics I/II (OG I/II) of the Emergency County Hospital of Craiova during the SARS-CoV-2 pandemic (SP) (15.03.2020-14.03.2021) and in the 12 months before (non-pandemic period) (NPP) (15.03.2019-14.03.2020). The study includes 396 patients with pathological PAP smear results. All the patients included in this study were clinically examined and with colposcopy. The patients with Low-Grade Dysplasia were managed in a conservatory manner and reevaluated after six months. The patients with High-Grade Dysplasia were admitted for an excisional biopsy of the lesion. The excised fragments were sent to the Pathological Anatomy Laboratory for a histopathological examination. Results: This study reveals a decrease of more than half in the number of patients admitted with cervical intraepithelial neoplasia (CIN) lesions during the pandemic compared to the same period of the year before. The number of biopsies and excisional procedures has been decreasing by more than a factor of three during the pandemic period compared to the year before. Conclusion: During the SARS-CoV-2 pandemic, we found that the patients' admission rate, diagnosis, and treatment was almost four times lower. As hospital restrictions were not dictated for cancer/precancer management during SP, we may assume that the differences were due to the fear of becoming infected with SARS-CoV-2 due to hospitalization. In the context of poor screening performance and high cervical cancer incidence, the influence of the SP may result in a further increase of severe cases related to this condition.
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Affiliation(s)
- Anca-Maria Istrate-Ofițeru
- Department of Histology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (A.-M.I.-O.); (G.-C.R.); (L.I.)
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - Elena-Iuliana-Anamaria Berbecaru
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - Dan Ruican
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - Rodica Daniela Nagy
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - Cătălina Rămescu
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - Gabriela-Camelia Roșu
- Department of Histology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (A.-M.I.-O.); (G.-C.R.); (L.I.)
| | - Larisa Iovan
- Department of Histology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania; (A.-M.I.-O.); (G.-C.R.); (L.I.)
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - Laurențiu Mihai Dîră
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - George-Lucian Zorilă
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - Maria-Loredana Țieranu
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
| | - Dominic-Gabriel Iliescu
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania; (E.-I.-A.B.); (D.R.); (R.D.N.); (C.R.); (L.M.D.); (G.-L.Z.); (D.-G.I.)
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Ribeiro A, Corrêa F, Migowski A, Leal A, Martins S, Raiol T, Marques CP, Torres KL, Novetsky AP, Marcus JZ, Wentzensen N, Schiffman M, Rodriguez AC, Gage JC. Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies. Cancer Prev Res (Phila) 2021; 14:919-926. [PMID: 34607876 DOI: 10.1158/1940-6207.capr-21-0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/05/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022]
Abstract
The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil's Unified Health System (SUS) is among the world's largest public health systems offering free cytology testing, follow-up colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community's reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.
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Affiliation(s)
- Ana Ribeiro
- Department of Pharmacy, Faculty of Health Sciences, University of Brasília (UNB), Brasília, District Federal, Brazil. .,Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil
| | - Flávia Corrêa
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Arn Migowski
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Aline Leal
- General Coordination of Specialized Care, Health Care Secretariat, Ministry of Health (MS), Brasília, District Federal, Brazil
| | - Sandro Martins
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil
| | - Tainá Raiol
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil
| | - Carla P Marques
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil.,Department of Public Health, Faculty of Ceilândia, University of Brasília (UNB), Brasília, District Federal, Brazil
| | - Katia L Torres
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil.,Amazon State Oncology Control Foundation (FCECON), Manaus, Amazonas, Brazil
| | - Akiva P Novetsky
- Rutgers New Jersey Medical School (NJMS), Newark, New Jersey.,Rutgers Cancer Institute of New Jersey (CINJ), New Brunswick, New Jersey
| | - Jenna Z Marcus
- Rutgers New Jersey Medical School (NJMS), Newark, New Jersey
| | - Nicolas Wentzensen
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Mark Schiffman
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Ana Cecilia Rodriguez
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Julia C Gage
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
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Smith MA, Burger EA, Castanon A, de Kok IMCM, Hanley SJB, Rebolj M, Hall MT, Jansen EEL, Killen J, O'Farrell X, Kim JJ, Canfell K. Impact of disruptions and recovery for established cervical screening programs across a range of high-income country program designs, using COVID-19 as an example: A modelled analysis. Prev Med 2021; 151:106623. [PMID: 34029578 PMCID: PMC9433770 DOI: 10.1016/j.ypmed.2021.106623] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 11/16/2022]
Abstract
COVID-19 has disrupted cervical screening in several countries, due to a range of policy-, health-service and participant-related factors. Using three well-established models of cervical cancer natural history adapted to simulate screening across four countries, we compared the impact of a range of standardised screening disruption scenarios in four countries that vary in their cervical cancer prevention programs. All scenarios assumed a 6- or 12-month disruption followed by a rapid catch-up of missed screens. Cervical screening disruptions could increase cervical cancer cases by up to 5-6%. In all settings, more than 60% of the excess cancer burden due to disruptions are likely to have occurred in women aged less than 50 years in 2020, including settings where women in their 30s have previously been offered HPV vaccination. Approximately 15-30% of cancers predicted to result from disruptions could be prevented by maintaining colposcopy and precancer treatment services during any disruption period. Disruptions to primary screening had greater adverse effects in situations where women due to attend for screening in 2020 had cytology (vs. HPV) as their previous primary test. Rapid catch-up would dramatically increase demand for HPV tests in 2021, which it may not be feasible to meet because of competing demands on the testing machines and reagents due to COVID tests. These findings can inform future prioritisation strategies for catch-up that balance potential constraints on resourcing with clinical need.
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Affiliation(s)
- Megan A Smith
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
| | - Emily A Burger
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Alejandra Castanon
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, United Kingdom.
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Sharon J B Hanley
- Department of Obstetrics and Gynaecology, Hokkaido University, Sapporo, Japan.
| | - Matejka Rebolj
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, United Kingdom.
| | - Michaela T Hall
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; School of Mathematics and Statistics, UNSW, Sydney, Australia.
| | - Erik E L Jansen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - James Killen
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
| | - Xavier O'Farrell
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
| | - Jane J Kim
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
| | - Karen Canfell
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
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Ruipérez Pacheco E, Ramírez Mena M, Coronado Martín P. Estudio del aclaramiento de la infección por el VPH de alto riesgo después de una conización. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Syler LB, Stobaugh CL, Foulis PR, Carlton GT, DeLand LA, Borkowski AA. Cervical Cancer Screening in South Florida Veteran Population, 2014 to 2020: Cytology and High-Risk Human Papillomavirus Correlation and Epidemiology. Cureus 2021; 13:e17247. [PMID: 34540473 PMCID: PMC8445854 DOI: 10.7759/cureus.17247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/16/2021] [Indexed: 01/09/2023] Open
Abstract
Objective This project aims to use our robust women's health patient data to analyze the correlation between cytology and high-risk human papillomavirus (Hr-HPV) testing, study the performance of Hr-HPV testing for detecting cytology lesions, and examine epidemiologic measures of human papillomavirus (HPV) infections in the women's veteran population. Methods We collected patient data from 2014 to 2020 from our computerized patient record system. We performed HPV assays using the cobas® 4800 system (Roche Diagnostics, Basel, Switzerland). The cobas HPV assay detects HPV 16, HPV 18, and 12 other HPV types (31, 33, 35, 39, 45, 51, 56, 58, 59, 66, and 68). We organized cytology results and Hr-HPV assays with Microsoft Access and Microsoft Excel (Microsoft Corporation, Washington, USA) for analysis. Results A total of 9437 cervical specimens were co-tested. High-grade cytology lesions - high-grade intraepithelial lesion (HSIL) or higher and atypical squamous cells, cannot exclude HSIL (ASC-H) - were overwhelmingly positive for Hr-HPV (94.1% and 87.2%, respectively). Low-grade cytology lesions - low-grade squamous intraepithelial lesion ((LSIL) and atypical squamous cells of undetermined significance (ASC-US) - were positive for Hr-HPV in lower percentages (72.6% and 54.9%, respectively). Hr-HPV testing had a sensitivity of 91.3%, a specificity of 93.1%, a positive predictive value of 16.4%, and a negative predictive value of 99.8% for detecting high-grade cytology lesions. Hr-HPV testing had a lower performance for detecting low-grade cytology lesions. Ten cases had high-grade cytology and negative Hr-HPV test. Out of 10 such patients, nine showed no dysplasia (six) or low-grade dysplasia (three) on subsequent biopsy. Overall, 14.4% of tests were positive for Hr-HPV. The highest positive Hr-HPV test rates were in the third and eighth decades of life, 25.1% and 22.0%, respectively. However, the eighth decade consisted of a small sample of only 50 women. In women over 30 years of age with Hr-HPV infections, HPV types 16 and 18 were present in 11.7% and 6.4% of tests, respectively. Other HPV types were present in 82.3% of tests. Conclusions Hr-HPV testing has a high performance in detecting high-grade cytology lesions and a lower performance for detecting low-grade cytology lesions. However, studies show that LSIL rarely progresses to cervical intraepithelial neoplasia grade 3 or higher (CIN3+), suggesting minimal to no impact on cervical cancer screening. We believe our findings are in accordance with recent studies and affirm the guidelines that recommend primary Hr-HPV testing as the preferred screening method. The percentage of positive Hr-HPV tests and rates for age and HPV types 16 and 18 in our women's veteran population suggest similar HPV prevalence to that of the general US population.
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Affiliation(s)
- Lee B Syler
- Pathology, University of South Florida, Tampa, USA
| | - Corinne L Stobaugh
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | - Philip R Foulis
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | - George T Carlton
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | | | - Andrew A Borkowski
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
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Safaeian M, Wright TC, Stoler MH, Ranger-Moore J, Rehm S, Aslam S, Fang Q, Volkir P, Ridder R. The IMproving Primary Screening And Colposcopy Triage trial: human papillomavirus, cervical cytology, and histopathologic results from the baseline and 1-year follow-up phase. Am J Obstet Gynecol 2021; 225:278.e1-278.e16. [PMID: 33852886 DOI: 10.1016/j.ajog.2021.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increase in human papillomavirus test volumes is expected in the near future because human papillomavirus-based screening protocols are expected to become more widely adopted. OBJECTIVE The IMproving Primary Screening And Colposcopy Triage trial, a prospective, multicenter, US-based cervical cancer screening trial, was conducted to obtain US Food and Drug Administration approvals for the new, high-throughput cobas human papillomavirus (cobas HPV) test for use on the cobas 6800/8800 Systems (cobas HPV) for detecting cervical precancerous and cancerous cells (cervical intraepithelial neoplasia of grade 2 or worse and grade 3 or worse). Here, the baseline demographics, human papillomavirus test results, cervical cytology, and histopathologic results are presented. In addition, the baseline and 1-year risks of cervical intraepithelial neoplasia grade 2 or worse and grade 3 or worse associated with the human papillomavirus results are reported. STUDY DESIGN In total, 35,263 women aged between 25 and 65 years undergoing routine screening were enrolled; liquid-based cytology and 2 polymerase chain reaction-based tests for high-risk human papillomavirus were performed. Women with abnormal Papanicolaou cytology, women positive for high-risk human papillomavirus by either of the 2 human papillomavirus tests, and a random subset of women negative according to the Papanicolaou cytology and the 2 human papillomavirus tests were referred for a colposcopy and cervical biopsy. Women who did not meet the study endpoint were eligible for the 1-year follow-up study phase. Verification bias-adjusted cervical disease prevalence and risks and 95% confidence intervals were computed. RESULTS The prevalence of atypical squamous cells of undetermined significance and worse than atypical squamous cells of undetermined significance cytology were 6.5% and 3.2%, respectively. Prevalence of high-risk human papillomavirus, human papillomavirus 16, and human papillomavirus 18 based on the new cobas HPV test were 15.1%, 3.1%, and 1.4%, respectively. Both cytologic abnormalities and human papillomavirus positivity declined with increasing age. Among women who had a colposcopy and biopsy, the prevalence of cervical intraepithelial neoplasia grade 2 or worse and grade 3 or worse were 8.8% and 3.6%, respectively. The baseline and 1-year cumulative risks for cervical intraepithelial neoplasia grade 3 or worse were 13.6% and 16.9%, respectively, among women who tested positive for human papillomavirus 16. Women who tested negative for human papillomavirus had the lowest 1-year cumulative risk for cervical intraepithelial neoplasia grade 3 or worse (0.06%). CONCLUSION The contemporary, age-specific prevalence of human papillomaviruses (including human papillomavirus 16 and 18), cytologic abnormalities, and cervical intraepithelial neoplasia in a large, US-based cervical cancer screening population provides benchmarks for healthcare policies, screening programs, and for laboratories and clinicians.
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Affiliation(s)
- Mahboobeh Safaeian
- Department of Medical Scientific Affairs, Roche Molecular Systems, Inc., Pleasanton, CA
| | - Thomas C Wright
- Department of Pathology, Columbia University, New York City, NY
| | - Mark H Stoler
- Department of Pathology, University of Virginia Health System, Charlottesville, VA
| | - James Ranger-Moore
- Department of Medical Scientific Affairs, Ventana Medical Systems Inc./Roche Tissue Diagnostics, Tucson, AZ
| | - Susanne Rehm
- Department of Clinical Operations and Biometrics, Roche Molecular Systems, Inc., Pleasanton, CA
| | - Shagufta Aslam
- Department of Clinical Operations and Biometrics, Roche Molecular Systems, Inc., Pleasanton, CA
| | - Qijun Fang
- Department of Clinical Operations and Biometrics, Roche Molecular Systems, Inc., Pleasanton, CA
| | - Patrick Volkir
- Department of Clinical Operations and Biometrics, Roche Molecular Systems, Inc., Pleasanton, CA
| | - Ruediger Ridder
- Department of Medical Scientific Affairs, Ventana Medical Systems Inc./Roche Tissue Diagnostics, Tucson, AZ
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Abstract
It is estimated that 5% of the global cancer burden, or approximately 690,000 cancer cases annually, is attributable to human papillomavirus (HPV). Primary prevention through prophylactic vaccination is the best option for reducing the burden of HPV-related cancers. Most high-income countries (HICs) have introduced the HPV vaccine and are routinely vaccinating adolescent boys and girls. Unfortunately, although they suffer the greatest morbidity and mortality due to HPV-related cancers, many lower- and middle-income countries (LMICs) have been unable to initiate and sustain vaccination programs. Secondary prevention in the form of screening has led to substantial declines in cervical cancer incidence in areas with established screening programs, but LMICs with absent or inadequate screening programs have high incidence rates. Meanwhile, HICs have seen incidence rates of anal and oropharyngeal cancers rise owing to the limited availability of organized screening for anal cancer and no validated screening options for oropharyngeal cancer. The implementation of screening programs for individuals at high risk of these cancers has the potential to reduce the burden of cervical cancer in LMICs, of anal and oropharyngeal cancers in HICs, and of anal cancer for highly selected HIV+ populations in LMICs. This review will discuss primary prevention of HPV-related cancers through vaccination and secondary prevention through screening of cervical, anal, and oropharyngeal cancers. Areas of concern and highlights of successes already achieved are included.
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Wang Y, Cai YB, James W, Zhou JL, Rezhake R, Zhang Q. Human papillomavirus distribution and cervical cancer epidemiological characteristics in rural population of Xinjiang, China. Chin Med J (Engl) 2021; 134:1838-1844. [PMID: 34267066 PMCID: PMC8367023 DOI: 10.1097/cm9.0000000000001441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical cancer remains a major public health issue for the Uyghur women and other women living mainly in rural areas of Xinjiang. This study aims to investigate the distribution of human papillomavirus (HPV) infection and cervical cancer in rural areas of Xinjiang, China. METHODS Cervical cancer screening was performed on rural women aged 35 to 64 years from Xinjiang, China in 2017 through gynecological examination, vaginal discharge smear microscopy, cytology, and HPV testing. If necessary, colposcopy and biopsy were performed on women with suspicious or abnormal screening results. RESULTS Of the 216,754 women screened, 15,518 received HPV testing. The HPV-positive rate was 6.75% (1047/15,518). Compared with the age 35-44 years group, the odds ratios (ORs) of HPV positivity in the age 45-54 years and 55-64 years groups were 1.18 (95% confidence interval [CI]: 1.02-1.37) and 1.84 (95% CI: 1.53-2.21), respectively. Compared with women with primary or lower education level, the ORs for HPV infection rates of women with high school and college education or above were 1.37 (95% CI: 1.09-1.72) and 1.62 (95% CI: 1.23-2.12), respectively. Uyghur women were less likely to have HPV infection than Han women, with an OR (95% CI) of 0.78 (0.61-0.99). The most prevalent HPV types among Xinjiang women were HPV 16 (24.00%), HPV 33 (12.70%), and HPV 52 (11.80%). The detection rate of cervical intraepithelial neoplasia (CIN)2+ was 0.14% and the early diagnosis rate of cervical cancer was 85.91%. The detection rates of vaginitis and cervicitis were 19.28% and 21.32%, respectively. CONCLUSIONS The HPV infection rate in Xinjiang is low, but the detection rate of cervical cancer and precancerous lesions is higher than the national average level. Cervical cancer is a prominent public health problem in Xinjiang, especially in southern Xinjiang.
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Affiliation(s)
- Yan Wang
- Affiliated Tumor Hospital of Xinjiang Medical University, Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang 830011, China
| | - Ying-Bin Cai
- Department of Gastroenterology, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - William James
- Biological Sciences Collegiate Division, University of Chicago, Chicago, IL 60637, USA
| | - Jian-Lin Zhou
- Health and Family Planning Commission of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830011, China
| | - Remila Rezhake
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qian Zhang
- Affiliated Tumor Hospital of Xinjiang Medical University, Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang 830011, China
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Jang D, Ratnam S, Smieja M, Speicher DJ, Arias M, Clavio A, Costescu D, Elit L, Huang S, Herrero-Garcia E, Joseph AM, Jiang H, Needle R, Chernesky M. Comparison of Alinity m HPV and cobas HPV assays on cervical specimens in diverse storage media. Tumour Virus Res 2021; 12:200224. [PMID: 34242835 PMCID: PMC8319351 DOI: 10.1016/j.tvr.2021.200224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/01/2021] [Accepted: 06/23/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the concordance of high-risk HPV (HR-HPV) testing with the Alinity assay on cervical samples collected with diverse collection/storage protocols (ThinPrep, SurePath, Cervicollect) and to assess inter-assay concordance of HR-HPV testing of cervical cell specimens with Alinity m HR HPV assay (Alinity) vs cobas® 4800 HPV assay (cobas). Methods Specimens were obtained from 560 women attending a Women's Health clinic. Two specimens were obtained from each woman with combinations of two of the three collection devices and aliquots were tested by the two assays. Results Alinity showed an agreement of 93.9%, Kappa = 0.89 (263/280) between ThinPrep and SurePath specimens; 97.5%, Kappa = 0.95 (347/356) and 92.9%, Kappa = 0.85 (104/112) between ThinPrep and SurePath aliquots taken before or after cytology processing, respectively. Cervi-Collect specimens showed an agreement of 94.6%, Kappa = 0.89 (265/280) with ThinPrep specimens. Compared to cobas, Alinity showed agreements of 94.3%, Kappa = 0.88 (395/419) and 91.8%, Kappa = 0.82 (257/280) between ThinPrep and SurePath specimens, respectively. Alinity and cobas detected genotypes 16/18 and other high-risk HPV types at similar rates and showed similar correlations with cytology grades. Conclusions Compared to cobas, Alinity performed equally well for detecting HPV in cervical specimens obtained with ThinPrep and SurePath. The Cervi-Collect device compared well to the other collection methods. Alinity is a reliable assay for simultaneous detection of HPV-16/18 and other high-risk genotypes in cervical specimens. Alinity m HR HPV assay demonstrated very good agreement with ThinPrep and SurePath pre- and post-cytology cervical specimens. Alinity m HR HPV had very good agreement with ThinPrep and Cervi-Collect specimens. Alinity m HR HPV and cobas 4800 HPV had very good agreement and identified HPV-16/18 and other HR types.
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Affiliation(s)
- Dan Jang
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Sam Ratnam
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada; Memorial University, Faculty of Medicine, St. John's, Newfoundland, Canada; McGill University, Montreal, Quebec, Canada
| | - Marek Smieja
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - David J Speicher
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Manuel Arias
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Avery Clavio
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Dustin Costescu
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Laurie Elit
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Shihai Huang
- Abbott Molecular Inc., 1300, E Touhy Ave, Des Plaines, IL, USA
| | | | - Ajith M Joseph
- Abbott Molecular Inc., 1300, E Touhy Ave, Des Plaines, IL, USA
| | - Hao Jiang
- Abbott Molecular Inc., 1300, E Touhy Ave, Des Plaines, IL, USA
| | - Robert Needle
- Eastern Health, Public Health and Microbiology Laboratory, St. John's, Newfoundland, Canada
| | - Max Chernesky
- St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada.
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60
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Castanon A, Rebolj M, Burger EA, de Kok IMCM, Smith MA, Hanley SJB, Carozzi FM, Peacock S, O'Mahony JF. Cervical screening during the COVID-19 pandemic: optimising recovery strategies. Lancet Public Health 2021; 6:e522-e527. [PMID: 33939965 PMCID: PMC8087290 DOI: 10.1016/s2468-2667(21)00078-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Disruptions to cancer screening services have been experienced in most settings as a consequence of the COVID-19 pandemic. Ideally, programmes would resolve backlogs by temporarily expanding capacity; however, in practice, this is often not possible. We aim to inform the deliberations of decision makers in high-income settings regarding their cervical cancer screening policy response. We caution against performance measures that rely solely on restoring testing volumes to pre-pandemic levels because they will be less effective at mitigating excess cancer diagnoses than will targeted measures. These measures might exacerbate pre-existing inequalities in accessing cervical screening by disregarding the risk profile of the individuals attending. Modelling of cervical screening outcomes before and during the pandemic supports risk-based strategies as the most effective way for screening services to recover. The degree to which screening is organised will determine the feasibility of deploying some risk-based strategies, but implementation of age-based risk stratification should be universally feasible.
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Affiliation(s)
- Alejandra Castanon
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
| | - Matejka Rebolj
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Emily Annika Burger
- Harvard T H Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Megan A Smith
- Daffodil Centre, University of Sydney-Cancer Council, Sydney, NSW, Australia
| | - Sharon J B Hanley
- Department of Obstetrics and Gynaecology, Hokkaido University, Sapporo, Japan
| | | | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada; Department of Cancer Control Research, BC Cancer, Vancouver, BC, Canada; Canadian Centre for Applied Research in Cancer Control, Vancouver, BC, Canada
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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61
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Basak M, Mitra S, Agnihotri SK, Jain A, Vyas A, Bhatt MLB, Sachan R, Sachdev M, Nemade HB, Bandyopadhyay D. Noninvasive Point-of-Care Nanobiosensing of Cervical Cancer as an Auxiliary to Pap-Smear Test. ACS APPLIED BIO MATERIALS 2021; 4:5378-5390. [PMID: 35007017 DOI: 10.1021/acsabm.1c00470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A potential cancer antigen (Ag), protein-phosphatase-1-gamma-2 (PP1γ2), with a restricted expression in testis and sperms has been identified as a biomarker specific to cervical cancer (CaCx). Detection of this cancer biomarker antigen (NCB-Ag) in human urine opens up the possibility of noninvasive detection of CaCx to supplement the dreaded and invasive Pap-smear test. A colorimetric response of an assembly of gold nanoparticles (Au NPs) has been employed for the quantitative, noninvasive, and point-of-care-testing of CaCx in the urine. In order to fabricate the immunosensor, Au NPs of sizes ∼5-20 nm have been chemically modified with a linker, 3,3'-di-thio-di-propionic-acid-di(n-hydroxy-succinimide-ester) (DTSP) to attach the antibody (Ab) specific to the NCB-Ag. Interestingly, the addition of Ag to the composite of Ab-DTSP-Au NPs leads to a significant hypsochromic shift due to a localized surface plasmon resonance phenomenon, which originates from the specific epitope-paratope interaction between the NCB-Ag and Ab-DTSP-Au NPs. The variations in the absorbance and wavelength shift during such attachments of different concentrations of NCB-Ag on the Ab-DTSP-Au NPs composite have been employed as a calibration to identify NCB-Ag in human urine. An in-house prototype has been assembled by integrating a light-emitting diode of a narrow range wavelength in one side of a cuvette in which the reaction has been performed while a sensitive photodetector to the other side to transduce the transmitted signal associated with the loading of NCB-Ag in the Ab-DTSP-Au NPs composite. The proposed immunosensing platform has been tested against other standard proteins to ensure noninterference alongside proving the proof-for-specificity of the NCB detection.
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Affiliation(s)
- Mitali Basak
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Shirsendu Mitra
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Saurabh Kumar Agnihotri
- Endocrinology, Division, CSIR-Central Drug Research Institute Lucknow, Lucknow, Uttar Pradesh 226 031, India
| | - Ankita Jain
- Endocrinology, Division, CSIR-Central Drug Research Institute Lucknow, Lucknow, Uttar Pradesh 226 031, India
| | - Akanksha Vyas
- Endocrinology, Division, CSIR-Central Drug Research Institute Lucknow, Lucknow, Uttar Pradesh 226 031, India
| | | | - Rekha Sachan
- King George's Medical University, Lucknow, Uttar Pradesh 226 003, India
| | - Monika Sachdev
- Endocrinology, Division, CSIR-Central Drug Research Institute Lucknow, Lucknow, Uttar Pradesh 226 031, India
| | - Harshal B Nemade
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Dipankar Bandyopadhyay
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India.,Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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62
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Wentzensen N, Lahrmann B, Clarke MA, Kinney W, Tokugawa D, Poitras N, Locke A, Bartels L, Krauthoff A, Walker J, Zuna R, Grewal KK, Goldhoff PE, Kingery JD, Castle PE, Schiffman M, Lorey TS, Grabe N. Accuracy and Efficiency of Deep-Learning-Based Automation of Dual Stain Cytology in Cervical Cancer Screening. J Natl Cancer Inst 2021; 113:72-79. [PMID: 32584382 PMCID: PMC7781458 DOI: 10.1093/jnci/djaa066] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/18/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background With the advent of primary human papillomavirus testing followed by cytology for cervical cancer screening, visual interpretation of cytology slides remains the last subjective analysis step and suffers from low sensitivity and reproducibility. Methods We developed a cloud-based whole-slide imaging platform with a deep-learning classifier for p16/Ki-67 dual-stained (DS) slides trained on biopsy-based gold standards. We compared it with conventional Pap and manual DS in 3 epidemiological studies of cervical and anal precancers from Kaiser Permanente Northern California and the University of Oklahoma comprising 4253 patients. All statistical tests were 2-sided. Results In independent validation at Kaiser Permanente Northern California, artificial intelligence (AI)-based DS had lower positivity than cytology (P < .001) and manual DS (P < .001) with equal sensitivity and substantially higher specificity compared with both Pap (P < .001) and manual DS (P < .001), respectively. Compared with Pap, AI-based DS reduced referral to colposcopy by one-third (41.9% vs 60.1%, P < .001). At a higher cutoff, AI-based DS had similar performance to high-grade squamous intraepithelial lesions cytology, indicating a risk high enough to allow for immediate treatment. The classifier was robust, showing comparable performance in 2 cytology systems and in anal cytology. Conclusions Automated DS evaluation removes the remaining subjective component from cervical cancer screening and delivers consistent quality for providers and patients. Moving from Pap to automated DS substantially reduces the number of colposcopies and also achieves excellent performance in a simulated fully vaccinated population. Through cloud-based implementation, this approach is globally accessible. Our results demonstrate that AI not only provides automation and objectivity but also delivers a substantial benefit for women by reduction of unnecessary colposcopies.
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Affiliation(s)
- Nicolas Wentzensen
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Bernd Lahrmann
- Steinbeis Transfer Center for Medical Systems Biology, Heidelberg, Germany
| | - Megan A Clarke
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Walter Kinney
- Global Coalition Against Cervical Cancer, Arlington, VA, USA
| | - Diane Tokugawa
- Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA, USA
| | - Nancy Poitras
- Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA, USA
| | - Alex Locke
- Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA, USA
| | - Liam Bartels
- Hamamatsu Tissue Imaging and Analysis Center (TIGA), BIOQUANT, University Heidelberg, Heidelberg, Germany.,National Center of Tumor Diseases, Medical Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexandra Krauthoff
- Hamamatsu Tissue Imaging and Analysis Center (TIGA), BIOQUANT, University Heidelberg, Heidelberg, Germany.,National Center of Tumor Diseases, Medical Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Joan Walker
- University of Oklahoma, Oklahoma City, OK, USA
| | | | | | | | - Julie D Kingery
- Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA, USA
| | | | - Mark Schiffman
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Thomas S Lorey
- Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA, USA
| | - Niels Grabe
- Steinbeis Transfer Center for Medical Systems Biology, Heidelberg, Germany.,Hamamatsu Tissue Imaging and Analysis Center (TIGA), BIOQUANT, University Heidelberg, Heidelberg, Germany.,National Center of Tumor Diseases, Medical Oncology, University Hospital Heidelberg, Heidelberg, Germany
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63
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Grimes DR, Corry EMA, Malagón T, O’Riain C, Franco EL, Brennan DJ. Modeling Cervical Cancer Screening Strategies With Varying Levels of Human Papillomavirus Vaccination. JAMA Netw Open 2021; 4:e2115321. [PMID: 34190993 PMCID: PMC8246311 DOI: 10.1001/jamanetworkopen.2021.15321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Cervical cancer screening is a lifesaving intervention, with an array of approaches, including liquid-based cytology (LBC), molecular testing for human papillomavirus (HPV) infection, and combinations via parallel cotesting or sequential triage. Maximizing screening efficacy while minimizing overtreatment is vital, especially when considering how the HPV vaccine will affect the interpretation of results. OBJECTIVES To estimate the likely outcomes of different screening modalities and to model how the increasing uptake of the HPV vaccine could affect the interpretation of screening results. DESIGN, SETTING, AND PARTICIPANTS This decision analytic model established a simple Markov model to compare the outcomes of different cervical cancer screening modalities on a simulated population of women (aged ≥25 years), considering different levels of HPV vaccination. MAIN OUTCOMES AND MEASURES The number of cases of cervical intraepithelial neoplasia (CIN) grade 2 and 3 detected and missed, the number of false positives, and the number of tests required to achieve a given level of accuracy. Positive and negative predictive values of different modalities were simulated under varying levels of HPV vaccination and therefore HPV prevalence. RESULTS In a simulated population of 1000 women aged 25 years and older with an HPV prevalence of 2%, HPV-based modalities outperformed LBC-based approaches, detecting 19% more true positives (HPV test sensitivity, 89.9% [95% CI, 88.6%-91.1%]; LBC test sensitivity, 75.5% [95% CI, 66.6%-82.7%]). While cotesting markedly reduced missed cases, detecting 29% more true positives than LBC alone (19.5 [95% CI, 19.3-19.7] per 1000 women screened vs 15.1 [95% CI, 13.3-16.5] per 1000 women screened), it unacceptably increased excess colposcopy referral by 94% (184.4 [95% CI, 181.8-188.0] false positives per 1000 women screened vs 95.1 [95% CI, 93.1-97.0] false positives per 1000 women screened). By contrast, triage testing with reflex screening substantially reduced false positives by a factor of approximately 10 (eg, HPV with LBC triage, 9.6 [95% CI, 9.3-10.0] per 1000 women screened). Over a lifetime of screening, reflex approaches with appropriate test intervals maximized therapeutic efficacy; as HPV vaccination rates increased, HPV-based screening approaches resulted in fewer unnecessary colposcopies than LBC approaches (HPV testing, 80% vaccine coverage: 44.1 [95% CI, 40-45.9] excess colposcopies; LBC testing, 80% vaccine coverage: 96.9 [95% CI, 96.8-97.0] excess colposcopies). CONCLUSIONS AND RELEVANCE In this decision analytic model, the effectiveness of cervical cancer screening was dependent on the prevalence of cervical dysplasia and/or HPV infection or vaccination in a population as well as the sensitivity and specificity of various modalities. Although screening is lifesaving, overtesting or modalities inappropriate to the target population may cause significant harm, including overtreatment.
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Affiliation(s)
- David Robert Grimes
- School of Physical Sciences, Dublin City University, Glasnevin, Dublin, Ireland
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Edward M. A. Corry
- Department of Gynaecological Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Ciaran O’Riain
- Department of Histopathology, St James’s Hospital, Dublin, Ireland
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Donal J. Brennan
- Department of Gynaecological Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
- Systems Biology Ireland, University College Dublin School of Medicine, Belfield, Dublin, Ireland
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64
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Atchison S, Shilling H, Balgovind P, Machalek DA, Hawkes D, Garland SM, Saville M, Murray G, Molano M, Danielewski J, Phillips S. Evaluation of the Roche MagNA Pure 96 nucleic acid extraction platform for the Seegene Anyplex II HPV28 detection assay. J Appl Microbiol 2021; 131:2592-2599. [PMID: 33942451 DOI: 10.1111/jam.15126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
AIM Validate the Roche, MagNAPure96 (MP96) nucleic acid extraction platform for Seegene Anyplex II HPV28 (Anyplex28) detection of Human Papillomavirus. METHODS AND RESULTS Comparisons were made for Anyplex28 genotyping from 115 cervical samples extracted on the Hamilton, STARlet and the MP96. Two DNA concentrations were used for the MP96, one matched for sample input to the STARlet and another 5× concentration (laboratory standard). Agreement of HPV detection was 89·8% (κ = 0·798; P = 0·007), with HPV detected in 10 more samples for the MP96. There was a high concordance of detection for any oncogenic HPV genotype (κ = 0·77; P = 0·007) and for any low-risk HPV genotype (κ = 0·85; P = 0·008). DNA extracted at laboratory standard had a lower overall agreement 85·2% (κ = 0·708; P < 0·001), with 17/115 discordant positive samples that tested negative after STARlet extraction. Of the discordant genotypes, 72·7% were detected in the lowest signal range for Anyplex28 ('+'). CONCLUSIONS MP96 performed with high concordance to STARlet, although produced DNA with a higher analytical sensitivity on the Anyplex28. SIGNIFICANCE AND IMPACT OF THE STUDY This analysis supports the use of samples extracted on the MP96 for HPV genotyping using the Anyplex28. Furthermore, an increase in DNA concentration increased analytical sensitivity of the Anyplex28, particularly appropriate for prevalence studies.
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Affiliation(s)
- S Atchison
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - H Shilling
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - P Balgovind
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - D A Machalek
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia.,The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D Hawkes
- VCS Foundation, Melbourne, Vic, Australia.,Department of Biochemistry and Pharmacology, University of Melbourne, Melbourne, Vic, Australia.,Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia
| | - S M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
| | - M Saville
- VCS Foundation, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - G Murray
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
| | - M Molano
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia
| | - J Danielewski
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - S Phillips
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Vic, Australia.,Murdoch Children's Research Institute, Melbourne, Vic, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
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65
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Castanon A, Rebolj M, Pesola F, Sasieni P. Recovery strategies following COVID-19 disruption to cervical cancer screening and their impact on excess diagnoses. Br J Cancer 2021; 124:1361-1365. [PMID: 33558708 PMCID: PMC8039040 DOI: 10.1038/s41416-021-01275-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/13/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted cervical cancer screening services. Assuming increases to screening capacity are unrealistic, we propose two recovery strategies: one extends the screening interval by 6 months for all and the other extends the interval by 36/60 months, but only for women who have already missed being screened. METHODS Using routine statistics from England we estimate the number of women affected by delays to screening. We used published research to estimate the proportion of screening age women with high-grade cervical intraepithelial neoplasia and progression rates to cancer. Under two recovery scenarios, we estimate the impact of COVID-19 on cervical cancer over one screening cycle (3 years at ages 25-49 and 5 years at ages 50-64 years). The duration of disruption in both scenarios is 6 months. In the first scenario, 10.7 million women have their screening interval extended by 6 months. In the second, 1.5 million women (those due to be screened during the disruption) miss one screening cycle, but most women have no delay. RESULTS Both scenarios result in similar numbers of excess cervical cancers: 630 vs. 632 (both 4.3 per 100,000 women in the population). However, the scenario in which some women miss one screening cycle creates inequalities-they would have much higher rates of excess cancer: 41.5 per 100,000 delayed for screened women compared to those with a 6-month delay (5.9 per 100,000). CONCLUSION To ensure equity for those affected by COVID-19 related screening delays additional screening capacity will need to be paired with prioritising the screening of overdue women.
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Affiliation(s)
- Alejandra Castanon
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, UK.
| | - Matejka Rebolj
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, UK
| | - Francesca Pesola
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, UK
| | - Peter Sasieni
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, UK
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66
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Gustinucci D, Ciccocioppo L, Coppola L, Negri G, Zannoni G, Passamonti B, Cesarini E, Ianzano C, Andreano T, Pireddu A, Giorgi-Rossi P. Multicentre Evaluation of Hepika Test Clinical Accuracy in Diagnosing HPV-Induced Cancer and Precancerous Lesions of the Uterine Cervix. Diagnostics (Basel) 2021; 11:619. [PMID: 33808260 PMCID: PMC8066214 DOI: 10.3390/diagnostics11040619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the clinical accuracy of Hepika test to identify cancer/precancerous lesions of the uterine cervix. MATERIALS AND METHODS A multicentre retrospective study was carried out in 2018 and included 330 liquid-based cytology samples from three Italian centres of women aged 25-64 who had been tested for the human papillomavirus (HPV) and whose histology or follow-up outcome was known. Hepika is an enzyme-linked immunosorbent assay (ELISA) targeting the protein complexes E6#p53 and E7#pRb. After excluding samples without sufficient residual material, the clinical accuracy of Hepika test was evaluated in 274 samples: adenocarcinoma (ADC) (4), squamous cell carcinoma (SCC) (7), adenocarcinoma in situ (AIS) (1), cervical intraepithelial neoplasia (CIN) grade 3 (60), CIN2 (51), CIN1 (34), and negative histology (117). Association, sensitivity, and specificity for carcinoma, CIN3+ and CIN2+ are reported. RESULTS Positive Hepika test was associated with a high probability of carcinoma (odds ratio (DOR) = 33.68, 95% confidence interval (CI) 7.0-163.1); sensitivity was 81.8%, specificity, 88.2%. A positive Hepika test showed a weaker association with CIN3+ lesions (DOR = 3.5; 95% CI 1.75-6.99) and lower sensitivity (27.8%). CONCLUSION The Hepika test was found to be an accurate biomarker for HPV-induced cervical carcinoma. Population-based prospective studies are needed to confirm the clinical usefulness of the Hepika test in the differential diagnosis of HPV-induced invasive lesions.
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Affiliation(s)
- Daniela Gustinucci
- Laboratorio Unico di Screening USL Umbria 1, 06124 Perugia, Italy; (B.P.); (E.C.)
| | - Lucia Ciccocioppo
- Cytopathology Unit, Renzetti Hospital, 66034 Lanciano, Italy; (L.C.); (C.I.)
| | - Luigi Coppola
- Pathology Unit, San Filippo Neri Hospital, 00135 Rome, Italy;
| | - Giovanni Negri
- Pathology Unit, Central Hospital Bolzano, 39100 Bolzano, Italy;
| | - Gianfranco Zannoni
- Department of Woman, Child and Public Health Sciences, Gynecopathology and Breast Pathology Unit, Catholic University of Sacred Hearth, 00168 Rome, Italy;
| | - Basilio Passamonti
- Laboratorio Unico di Screening USL Umbria 1, 06124 Perugia, Italy; (B.P.); (E.C.)
| | - Elena Cesarini
- Laboratorio Unico di Screening USL Umbria 1, 06124 Perugia, Italy; (B.P.); (E.C.)
| | - Ciro Ianzano
- Cytopathology Unit, Renzetti Hospital, 66034 Lanciano, Italy; (L.C.); (C.I.)
| | | | - Anjuta Pireddu
- Pathology Unit, USL Umbria 1, 06012 Città di Castello, Italy;
| | - Paolo Giorgi-Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale—Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, 42123 Reggio Emilia, Italy;
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67
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Cervical screening in high-income countries: the need for quality assurance, adjunct biomarkers and rational adaptation to HPV vaccination. Prev Med 2021; 144:106382. [PMID: 33359012 DOI: 10.1016/j.ypmed.2020.106382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
We here discuss human papillomavirus (HPV)-based screening avenues to achieve elimination of cervical cancer as a public health problem in high-income country (HIC) settings, covering both the most recent data on the performance of HPV testing, as well as the currently most robust triage methods that are known. We also provide an outlook to several other promising, yet not fully established, options for triage that have been proposed, including methylation, dual staining, machine learning, and artificial intelligence. Finally, we discuss the key issue of how to adapt screening in the presence of programmatic HPV vaccination, and how this combination can best be leveraged for comprehensive cancer control. We conclude that, for the HIC setting, evidence-based and effective cervical screening methods are readily available, but whichever method or platform is chosen, we would propose that recurring audits of performance and population attendance remain common denominators for maintaining successful disease prevention.
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68
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Hortlund M, van Mol T, Van de Pol F, Bogers J, Dillner J. Human papillomavirus load and genotype analysis improves the prediction of invasive cervical cancer. Int J Cancer 2021; 149:684-691. [PMID: 33586149 DOI: 10.1002/ijc.33519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 01/15/2023]
Abstract
Human papillomavirus (HPV)-based cervical screening is a globally recommended health policy. Different HPV types have different risk for cervical cancer. For optimal HPV screening, the sensitivity and specificity for each HPV type at different viral loads should be known in a screening setting. HPV test results in about 1 million cervical samples analyzed during 2006 to 2014 were compared for 319 women who had developed invasive cervical cancer up to 8.5 years later and for 1911 matched control women. Detection including low viral loads resulted in markedly increased sensitivity for cervical cancer only for HPV types 16 and 18. Testing for HPV types 31, 33, 45 and 52 also increased the sensitivity for prediction of cervical cancer, but for these viruses, detection of low viral load did not further increase sensitivity. HPV types 35, 39, 51, 56, 58, 59, 66 and 68 only predicted occasional additional cervical cancer cases. Testing for HPV16/18 at low viral load plus testing for HPV31, 33, 45 and 52 at >3000 copies/μL predicted 86.5% of cancers occurring within a year after testing, similar to the 89.4% that were predicted by testing for 14 HPV types. By contrast, the type and viral load-restricted testing greatly increased specificity: 6.3% of healthy women tested positive as compared to 11.7% of healthy women testing positive for the 14 HPV types commonly screened for today. Adequate HPV screening sensitivity, with considerable increase in specificity, can be obtained by testing only for HPV16/18/31/33/45/52, with detection of low viral load required only for HPV16/18.
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Affiliation(s)
- Maria Hortlund
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tine van Mol
- Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | - Frederik Van de Pol
- Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | - Johannes Bogers
- Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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69
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Sundström K, Lamin H, Dillner J. Validation of the cobas 6800 human papillomavirus test in primary cervical screening. PLoS One 2021; 16:e0247291. [PMID: 33606755 PMCID: PMC7894810 DOI: 10.1371/journal.pone.0247291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022] Open
Abstract
Evaluation of Human Papillomavirus (HPV) testing systems suitable for large-scale organized cervical screening programs is required. We evaluated the cobas 6800 HPV test system for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) when nested in an organized primary HPV screening program, using the cobas 4800 test as comparator. The Karolinska University Hospital Cervical Cytology Biobank, containing frozen cervical samples from >700,000 women participating in organized cervical screening, was linked to the Swedish national cervical screening registry to identify 470 stored cervical samples taken <180 days before histopathological diagnosis of CIN3+. Two controls per case, with no abnormal results for 2 screening rounds, matched for age and sampling time were also retrieved. Aliquots from 1406 women were retrieved and re-tested on the cobas 4800 system and tested on the cobas 6800 system. There was high reproducibility between the original cobas 4800 HPV test results, and the cobas 4800 HPV re-testing performed on the samples retrieved from biobank storage. 462/464 biobanked samples from women with CIN3+ tested HPV-positive on the cobas 6800 system, corresponding to a relative sensitivity of 99.6%. 925/932 biobanked samples from control women tested HPV-negative on the cobas 6800 platform, corresponding to a relative specificity of 99.2%. By conventional criteria, the cobas 6800 was non-inferior both regarding relative sensitivity of >90% (non-inferiority p-value <0.0001) and relative specificity of >98% (non-inferiority p-value 0.006). We conclude that the cobas 6800 HPV test system had similar, high performance as the cobas 4800 such, when evaluated using cervical samples taken before CIN3+ in a real-life primary HPV screening program.
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Affiliation(s)
- Karin Sundström
- Department of Laboratory Medicine, Center for Cervical Cancer Prevention, Karolinska Institutet and Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Lamin
- Department of Laboratory Medicine, Center for Cervical Cancer Prevention, Karolinska Institutet and Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Center for Cervical Cancer Prevention, Karolinska Institutet and Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
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70
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Aarnio R, Isacson I, Sanner K, Gustavsson I, Gyllensten U, Olovsson M. Comparison of vaginal self-sampling and cervical sampling by medical professionals for the detection of HPV and CIN2+: A randomized study. Int J Cancer 2021; 148:3051-3059. [PMID: 33497465 DOI: 10.1002/ijc.33482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 11/06/2022]
Abstract
Primary screening with human papillomavirus (HPV) test is more effective in reducing cervical cancer incidence than cytology and it also offers the opportunity to self-sample. We conducted a randomized study to compare vaginal self-sampling with cervical sampling by medical professionals for HPV testing concerning prevalence of HPV and detection of cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) or grade 3 or worse (CIN3+) in primary screening. In total, 11 951 women aged 30-60 years were randomized into two groups, 5961 for self-sampling (SS arm) and 5990 for sampling by medical professionals (SMP arm). Sampling was performed with a RoversViba-brush in the SS arm and a cytobrush in the SMP arm. All samples were applied to an indicating FTA elute card and analyzed for HPV using a clinically validated real-time PCR test (hpVIR). All HPV-positive women performed repeated sampling about 6 months later using the same procedure as used initially. All HPV-positive women in the second sampling were referred to colposcopy. The prevalence of HPV in the first test did not differ between the SS arm (6.8%, 167/2466) and the SMP arm (7.8%, 118/1519) (P = .255). The prevalence of CIN2+ per 1000 screened women was 17 (43/2466 × 1000) (95%CI 13-24) in the SS arm and 21 (32/1519 × 1000) (95%CI 15-30) in the SMP arm. For CIN3+, the prevalence per 1000 screened women was 14 (35/2466 × 1000) (95%CI 10-20) in the SS arm and 15 (23/1519 × 1000) (95%CI 10-23) in the SMP arm. In conclusion, self-sampling and sampling by medical professionals showed the same prevalence of HPV and detection rate of CIN2+ and CIN3+ in histology.
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Affiliation(s)
- Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isabella Isacson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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71
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Gupta A, Singh AK, Loka M, Pandey AK, Bishayee A. Ferulic acid-mediated modulation of apoptotic signaling pathways in cancer. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2021; 125:215-257. [PMID: 33931140 DOI: 10.1016/bs.apcsb.2020.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ferulic acid (4-hydroxy-3-methoxycinnamic acid, FA), a hydroxycinnamic acid derived from various seeds, nuts, leaves, and fruits, exists in a free form as well as is covalently conjugated with polysaccharides, glycoproteins, polyamines, lignin, and hydroxy fatty acids of plant cell walls. It exhibits a variety of pharmacological effects, such as antioxidant, anti-inflammatory, vasodilatory, antithrombotic, antimicrobial, anti-allergic, antiviral, hepatoprotective, and anticancer activities. FA induces the expression of cell cycle-related proteins, such as p53 and p21, and reduces cyclin D1 and cyclin E levels. Moreover, FA triggers apoptosis and autophagic cell death depending on intracellular reactive oxygen species production in various cancer cell lines. The potential apoptotic action of FA is mediated by altered expression of procaspase-3, procaspase-8, procaspase-9, poly (ADP ribose) polymerase, Bcl-2, and Bax. It blocks the activation of both the canonical Smad and noncanonical extracellular-signal-regulated kinase/Akt (protein kinase B) pathways in various cancer cells. However, due to low solubility and permeability, its availability to biological systems is limited. Therefore, encapsulation of FA into chitosan tripolyphosphate nanoparticles may enhance its cytocompatibility, solubility, and anticancer potential. The nanohybrids of FA and double layered hydroxide exhibit cellular delivery properties of intercalated molecules on cancer cell lines. This chapter summarizes the anticancer efficacy of FA with an emphasis on the role of apoptosis, and underlying molecular mechanisms involving various signaling pathways in tumor cells.
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Affiliation(s)
- Ashutosh Gupta
- Department of Biochemistry, University of Allahabad, Prayagraj, Uttar Pradesh, India
| | - Amit Kumar Singh
- Department of Biochemistry, University of Allahabad, Prayagraj, Uttar Pradesh, India
| | - Mariam Loka
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, United States
| | - Abhay Kumar Pandey
- Department of Biochemistry, University of Allahabad, Prayagraj, Uttar Pradesh, India.
| | - Anupam Bishayee
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, United States.
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72
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Mandić A, Stevanović N, Gutic B, Maričić S, Nikin Z, Šolajić N. Histopathological correlation of cervical biopsy and tissue after excision in patients with precancerous lesions of the cervix. Arch Gynecol Obstet 2021; 304:223-230. [PMID: 33389101 DOI: 10.1007/s00404-020-05911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cervical intraepithelial neoplasia (CIN) are precancerous lesion of cervix, with incidence of 1.6 per 1000 for CIN 1 lesion and 1.2 per 1000 for CIN 3 lesion in USA. According to IARC incidence is higher in less developed and developing countries. Taking into account the fact that the sensitivity, specificity and accuracy of Papanicolaou swab and colposcopy vary, the final diagnosis is made by colposcopically guided biopsy and by excisions of the cervix. AIM OF THE STUDY Comparing the histopathological findings of cervical biopsy and definitive histopathological findings after cervical excision in precancerous lesions of the cervix in relation to the degree of lesion, age and institution, where the biopsy was performed. MATERIALS AND METHODS The study was retrospective and was conducted on a group of patients who underwent some excision techniques on the cervix after obtaining a histological finding of the cervical biopsy. RESULTS In a total sample of 168 patients, a correlation of histopathological analysis of biopsy material and excision techniques was observed in 62.5% (105/168). This correlation was statistically significant (χ2 = 5.333, df 1; p = 0.0209). The greater correlation of histopathological material of biopsies and final histopathological material after excisions were obtained in Oncology Institute of Vojvodina (OIV) without statistical significance. CONCLUSION A statistically significant accuracy of biopsy was noted in examined group of patients.
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Affiliation(s)
- Aljoša Mandić
- Oncology Institute of Vojvodina Sremska Kamenica, Sremska Kamenica, Serbia. .,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
| | - Nemanja Stevanović
- Oncology Institute of Vojvodina Sremska Kamenica, Sremska Kamenica, Serbia
| | - Bojana Gutic
- Oncology Institute of Vojvodina Sremska Kamenica, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Slobodan Maričić
- Oncology Institute of Vojvodina Sremska Kamenica, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zoran Nikin
- Oncology Institute of Vojvodina Sremska Kamenica, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nenad Šolajić
- Oncology Institute of Vojvodina Sremska Kamenica, Sremska Kamenica, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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73
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Gottschlich A, van Niekerk D, Smith LW, Gondara L, Melnikow J, Cook DA, Lee M, Stuart G, Martin RE, Peacock S, Franco EL, Coldman A, Krajden M, Ogilvie G. Assessing 10-Year Safety of a Single Negative HPV Test for Cervical Cancer Screening: Evidence from FOCAL-DECADE Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:22-29. [PMID: 33082202 PMCID: PMC8284866 DOI: 10.1158/1055-9965.epi-20-1177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Long-term safety of a single negative human papillomavirus (HPV) test for cervical cancer screening is unclear. The HPV FOr cerviCAL Cancer Trial (FOCAL) was a randomized trial comparing HPV testing with cytology. The FOCAL-DECADE cohort tracked women who received one HPV test during FOCAL, and were HPV negative, for up to 10 years to identify cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+) detected through a provincial screening program. METHODS FOCAL participants who received one HPV test, were negative, and had at least one post-FOCAL cervix screen were included (N = 5,537). We constructed cumulative incidence curves of CIN2+/CIN3+ detection, analyzed cumulative risk of detection at intervals post-HPV test, calculated average incidence rates for detection, and compared hazard across ages. RESULTS Ten years after one negative HPV test, the probability of CIN2+ detection was lower than 1%, with most lesions detected 7 years or later. Average incidence rates of CIN2+/CIN3+ lesions over follow-up were 0.50 [95% confidence interval (CI), 0.31-0.78] and 0.18 (95% CI, 0.07-0.36) per 1,000 person-years, respectively. Hazards were higher for younger ages (nonsignificant trend). CONCLUSIONS Among women with a single negative HPV test, long-term risk of CIN2+ detection was low, particularly through 7 years of follow-up; thus, one negative HPV test appears to confer long-term protection from precancerous lesions. Even 10-year risk is sufficiently low to support extended testing intervals in average-risk populations. IMPACT Our findings support the safety of screening policies using HPV testing alone at 5-year or longer intervals.
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Affiliation(s)
- Anna Gottschlich
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- Lower Mainland Laboratories, Vancouver, British Columbia, Canada
- Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie W Smith
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
- Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California
| | - Darrel A Cook
- Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marette Lee
- Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Gavin Stuart
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ruth E Martin
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Andrew Coldman
- Cervical Cancer Screening Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Mel Krajden
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Badman SG, Vallely AJ, Pardo C, Mhango LP, Cornall AM, Kaldor JK, Whiley D. A comparison of ThinPrep against four non-volatile transport media for HPV testing at or near the point of care. Pathology 2020; 53:264-266. [PMID: 33358758 DOI: 10.1016/j.pathol.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
The Xpert HPV Test is used at point of care for cervical screening in a number of low and middle income countries (LMIC). It is validated for use with ThinPrep-PreservCyt transport medium which has a high methanol content and is therefore classified as a dangerous good for shipping, making cost, transportation and use challenging within LMIC. We compared the performance of ThinPrep against four non-volatile commercially available media for human papillomavirus (HPV) point of care testing. Ten-fold serial dilutions were prepared using three HPV cell lines each positive for 16, 18 or 31 and with each suspended in five different media types. The media types consisted of Phosphate Buffered Saline (ThermoFisher Scientific, USA), Sigma Virocult (Medical Wire and Equipment, UK), MSwab (Copan, Italy) Xpert Transport Media (Cepheid, USA) and ThinPrep-PreservCyt (Hologic, USA). A total of 105 Xpert HPV tests were conducted in a laboratory setting, with seven 10-fold dilutions of each of the three HPV genotypes tested in all five media types. The lowest HPV 10-fold dilution detected for any media, or cell line was the fifth dilution. MSwab was the only medium to detect HPV to the fifth dilution across all three cell types. MSwab transport media may be a suitable alternative to ThinPrep for Xpert HPV point of care testing. A field based, head to head comparison of both media types using the Xpert HPV assay is warranted to confirm these laboratory based findings.
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Affiliation(s)
- S G Badman
- Kirby Institute, UNSW Sydney, NSW, Australia.
| | - A J Vallely
- Kirby Institute, UNSW Sydney, NSW, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - C Pardo
- Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
| | - L P Mhango
- Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
| | - A M Cornall
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Vic, Australia; Molecular Microbiology Research Group, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic, Australia
| | - J K Kaldor
- Kirby Institute, UNSW Sydney, NSW, Australia
| | - D Whiley
- Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia
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75
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Inturrisi F, Bogaards JA, Heideman DAM, Meijer CJLM, Berkhof J. Risk of Cervical Intraepithelial Neoplasia Grade 3 or Worse in HPV-Positive Women with Normal Cytology and Five-Year Type Concordance: A Randomized Comparison. Cancer Epidemiol Biomarkers Prev 2020; 30:485-491. [PMID: 33293342 DOI: 10.1158/1055-9965.epi-20-1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In human papillomavirus (HPV)-based cervical screening programs, management of HPV-positive women with normal cytology is debated. Longitudinal information on HPV type persistence may be employed for risk stratification. METHODS We assessed the risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) after repeatedly testing positive for the same HPV type(s) in the randomized population-based screening study Amsterdam (POBASCAM). We compared 18-month CIN3+ risks in HPV-positive women (intervention, n = 1,066) to those in HPV-positive/cytology-negative women who tested HPV-positive in the next screening round (control, n = 111) five years later, stratified for HPV type concordance. RESULTS The 18-month CIN3+ risk was 15% in HPV-positive women in the intervention group, 40% in the control group after two-round type concordance (relative risk 2.6, 95% confidence interval 1.9-3.4), and 20% in the control group after a type switch (1.3, 0.5-3.2). The relative increase in CIN3+ risk after two-round type concordance was similar in <35-year-old (3.0, 2.0-4.4) and older women (2.2, 1.4-3.5), and was high in high-risk HPV-positive women who were HPV16/18/31/33/45-negative in both rounds (9.9, 4.4-21.9). CONCLUSIONS Five-year HPV type concordance signals high CIN3+ risk and warrants referral for colposcopy without additional cytology triage. IMPACT HPV screening programs become highly efficient when HPV-positive women with negative triage testing at baseline are offered repeat HPV genotyping after five years.
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Affiliation(s)
- Federica Inturrisi
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands.
| | - Johannes A Bogaards
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands.,Amsterdam UMC, University of Amsterdam, Epidemiology and Data Science, Academic Medical Centre, Amsterdam, the Netherlands
| | - Daniëlle A M Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands
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da Silva BEB, Santos VS, Santos IER, Araújo ED, Alves MV, Silva LADS, de Aragão Batista MV, de Lemos LMD. Prevalence and genotype distribution of human papillomavirus in women living with HIV/AIDS in an area of Northeast Brazil. J Med Virol 2020; 92:3279-3287. [PMID: 32330294 DOI: 10.1002/jmv.25935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/06/2023]
Abstract
Women infected by human immunodeficiency virus (HIV) are more likely to manifest oncogenic viral infections including human papillomavirus (HPV). It was investigated the HPV prevalence, genotype distribution and HPV relationship with cervical lesions among women living with HIV in Sergipe state, Northeast Brazil. A prevalence survey was conducted including 270 HIV-infected women who attended the reference center for HIV in Sergipe from August 2014 to November 2017. Cervical samples were processed by the polymerase chain reaction for HPV-DNA detection. Among the 270 HIV-infected women, 190 (70.4%) were between 26 and 49 years old and 159 (55.6%) were coinfected with HPV. Among the coinfected women, 24 viral types were identified; 113 (72%) subjects had high-risk HPV types, and the most prevalent was HPV 16 (53/35.3%). Positive HPV status was statistically associated with having 0 to 8 years of schooling compared with ≥9 years of schooling; and have been diagnosed with HIV infection less than 5 years ago compared with more than 10 years. Cytological abnormalities were found in 13.4% (31/231) of women, most with high-grade squamous intraepithelial lesions (16/51.6%). However, of women who had no cytological lesions or malignancy (200/86.6%), almost half were HPV DNA-positive (99/49.5%). In conclusion, the prevalence of HPV among women living with HIV in Sergipe was high. There was a high frequency of high-risk HPV infection, and a wide diversity of genotypes were detected, with HPV 16 being the most frequent.
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Affiliation(s)
| | - Victor Santana Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
- Department of Nursing, Federal University of Alagoas, Arapiraca, Brazil
| | | | | | | | | | | | - Lígia Mara Dolce de Lemos
- Graduate Programme in Nursing, Federal University of Sergipe, São Cristóvão, Brazil
- Department of Nursing, Federal University of Sergipe, Aracaju, Brazil
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77
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Lv A, Tu Z, Huang Y, Lu W, Xie B. Circulating exosomal miR-125a-5p as a novel biomarker for cervical cancer. Oncol Lett 2020; 21:54. [PMID: 33281965 PMCID: PMC7709555 DOI: 10.3892/ol.2020.12316] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/24/2020] [Indexed: 01/07/2023] Open
Abstract
Exosomal microRNAs (miRs/miRNAs) have been reported to be associated with cervical cancer. The aim of the present study was to investigate circulating exosomal miRNA as a biomarker for cervical cancer diagnosis. In the present study, samples from 6 patients with cervical cancer and 6 healthy control subjects were retrieved for exosomal RNA-sequencing. The results revealed that a total of 39 miRNAs were differentially expressed between patients with cervical cancer and healthy controls (P<0.001; fold-change >2.0). Exosomal miR-125a-5p was further quantified in plasma from 60 subjects, which included 22 healthy individuals and 38 patients with cervical cancer. miR-16a-5p served as the reference miRNA for quantitative PCR analysis of exosomal miR-125a-5p in patients with cervical cancer and healthy individuals. The results revealed that exosomal miR-125a-5p expression levels in the patients with cervical cancer were significantly lower than those in the healthy controls (P<0.001). Receiver operating characteristic (ROC) curve analyses were performed and the results revealed that the level of plasma exosomal miR-125a-5p was a potential marker for differentiating between non-cervical cancer and cervical cancer, with an ROC area under the curve of 0.7129. At the cut-off value of 2.537 for miR-125a-5p, cervical cancer diagnostic sensitivities and specificities were 59.1 and 84.2%, respectively. The present study provides confirmation that exosomal miR-125a-5p could potentially serve as a biomarker for cervical cancer diagnosis. The present study involved only a small number of clinical samples; more samples are required to support the conclusions of the present study.
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Affiliation(s)
- Aixia Lv
- Reproductive Center, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, Gansu 730050, P.R. China
| | - Zengrong Tu
- Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Yunhua Huang
- Reproductive Medicine Center, Hainan Maternal and Children's Medical Center, Haikou, Hainan 570206, P.R. China
| | - Weiying Lu
- Reproductive Medicine Center, Hainan Maternal and Children's Medical Center, Haikou, Hainan 570206, P.R. China.,Reproductive Medicine Center, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, P.R. China
| | - Baoguo Xie
- Reproductive Medicine Center, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, P.R. China
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78
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Soper BC, Nygård M, Abdulla G, Meng R, Nygård JF. A hidden Markov model for population-level cervical cancer screening data. Stat Med 2020; 39:3569-3590. [PMID: 32854166 DOI: 10.1002/sim.8681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022]
Abstract
The Cancer Registry of Norway has been administrating a national cervical cancer screening program since 1992 by coordinating triennial cytology exam screenings for the female population between 25 and 69 years of age. Up to 80% of cancers are prevented through mass screening, but this comes at the expense of considerable screening activity and leads to overtreatment of clinically asymptomatic precancers. In this article, we present a continuous-time, time-inhomogeneous hidden Markov model which was developed to understand the screening process and cervical cancer carcinogenesis in detail. By leveraging 1.7 million individual's multivariate time-series of medical exams performed over a 25-year period, we simultaneously estimate all model parameters. We show that an age-dependent model reflects the Norwegian screening program by comparing empirical survival curves from observed registry data and data simulated from the proposed model. The model can be generalized to include more detailed individual-level covariates as well as new types of screening exams. By utilizing individual screening histories and covariate data, the proposed model shows potential for improving strategies for cancer screening programs by personalizing recommended screening intervals.
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Affiliation(s)
- Braden C Soper
- Computing Directorate, Lawrence Livermore National Laboratory, Livermore, California, USA
| | - Mari Nygård
- Research Department, Cancer Registry of Norway, Oslo, Norway
| | - Ghaleb Abdulla
- Computing Directorate, Lawrence Livermore National Laboratory, Livermore, California, USA
| | - Rui Meng
- Department of Statistics, University of California, Santa Cruz, California, USA
| | - Jan F Nygård
- Registry Informatics Department, Cancer Registry of Norway, Oslo, Norway
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79
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Molina MA, Carosi Diatricch L, Castany Quintana M, Melchers WJ, Andralojc KM. Cervical cancer risk profiling: molecular biomarkers predicting the outcome of hrHPV infection. Expert Rev Mol Diagn 2020; 20:1099-1120. [PMID: 33044104 DOI: 10.1080/14737159.2020.1835472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cervical cancer affects half a million women worldwide annually. Given the association between high-risk human papillomavirus (hrHPV) infection and carcinogenesis, hrHPV DNA testing became an essential diagnostic tool. However, hrHPV alone does not cause the disease, and, most importantly, many cervical lesions regress to normal in a year because of the host immune system. Hence, the low specificity of hrHPV DNA tests and their inability to predict the outcome of infections have triggered a further search for biomarkers. AREAS COVERED We evaluated the latest viral and cellular biomarkers validated for clinical use as primary screening or triage for cervical cancer and assessed their promise for prevention as well as potential use in the future. The literature search focused on effective biomarkers for different stages of the disease, aiming to determine their significance in predicting the outcome of hrHPV infections. EXPERT OPINION Biomarkers such as p16/Ki-67, hrHPV genotyping, hrHPV transcriptional status, and methylation patterns have demonstrated promising results. Their eventual implementation in the screening programs may support the prompt diagnosis of hrHPV infection and its progression to cancer. These biomarkers will help in making clinical management decisions on time, thus, saving the lives of hrHPV-infected women, particularly in developing countries.
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Affiliation(s)
- Mariano A Molina
- Department of Microbiology, Faculty of Science, Radboud University , Nijmegen, The Netherlands.,Department of Medical Microbiology, Radboud university medical center , Nijmegen, The Netherlands
| | | | - Marina Castany Quintana
- Department of Medical Microbiology, Radboud university medical center , Nijmegen, The Netherlands
| | - Willem Jg Melchers
- Department of Medical Microbiology, Radboud university medical center , Nijmegen, The Netherlands
| | - Karolina M Andralojc
- Department of Medical Microbiology, Radboud university medical center , Nijmegen, The Netherlands.,Department of Biochemistry, Radboud Institute for Molecular Life Sciences , Nijmegen, The Netherlands
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80
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Castle PE, Pierz AJ, Adcock R, Aslam S, Basu PS, Belinson JL, Cuzick J, El-Zein M, Ferreccio C, Firnhaber C, Franco EL, Gravitt PE, Isidean SD, Lin J, Mahmud SM, Monsonego J, Muwonge R, Ratnam S, Safaeian M, Schiffman M, Smith JS, Swarts A, Wright TC, Van De Wyngard V, Xi LF. A Pooled Analysis to Compare the Clinical Characteristics of Human Papillomavirus-positive and -Negative Cervical Precancers. Cancer Prev Res (Phila) 2020; 13:829-840. [PMID: 32655005 DOI: 10.1158/1940-6207.capr-20-0182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/16/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
Given that high-risk human papillomavirus (HPV) is the necessary cause of virtually all cervical cancer, the clinical meaning of HPV-negative cervical precancer is unknown. We, therefore, conducted a literature search in Ovid MEDLINE, PubMed Central, and Google Scholar to identify English-language studies in which (i) HPV-negative and -positive, histologically confirmed cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) were detected and (ii) summarized statistics or deidentified individual data were available to summarize proportions of biomarkers indicating risk of cancer. Nineteen studies including 3,089 (91.0%) HPV-positive and 307 (9.0%) HPV-negative CIN2+ were analyzed. HPV-positive CIN2+ (vs. HPV-negative CIN2+) was more likely to test positive for biomarkers linked to cancer risk: a study diagnosis of CIN3+ (vs. CIN2; 18 studies; 0.56 vs. 0.24; P < 0.001) preceding high-grade squamous intraepithelial lesion cytology (15 studies; 0.54 vs. 0.10; P < 0.001); and high-grade colposcopic impression (13 studies; 0.30 vs. 0.18; P = 0.03). HPV-negative CIN2+ was more likely to test positive for low-risk HPV genotypes than HPV-positive CIN2+ (P < 0.001). HPV-negative CIN2+ appears to have lower cancer risk than HPV-positive CIN2+. Clinical studies of human high-risk HPV testing for screening to prevent cervical cancer may refer samples of HPV test-negative women for disease ascertainment to correct verification bias in the estimates of clinical performance. However, verification bias adjustment of the clinical performance of HPV testing may overcorrect/underestimate its clinical performance to detect truly precancerous abnormalities.
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Affiliation(s)
- Philip E Castle
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York.
| | - Amanda J Pierz
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York
| | - Rachael Adcock
- Queen Mary University of London, Centre for Cancer Prevention, London, United Kingdom
| | | | - Partha S Basu
- International Agency for Research on Cancer, Screening Group, Lyon, France
| | - Jerome L Belinson
- Preventive Oncology International and the Cleveland Clinic, Cleveland, Ohio
| | - Jack Cuzick
- Queen Mary University of London, Centre for Cancer Prevention, London, United Kingdom
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS, Santiago, Chile
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | - Patti E Gravitt
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Sandra D Isidean
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | - John Lin
- HPV Research Group, University of Washington, Seattle, Washington
| | - Salaheddin M Mahmud
- Rady Faculty of Health Sciences, Department of Community Health, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Joseph Monsonego
- Institute of the Cervix, Federation Mutualiste Parisienne, Paris, France
| | - Richard Muwonge
- International Agency for Research on Cancer, Screening Group, Lyon, France
| | - Samuel Ratnam
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | | | - Mark Schiffman
- Division of Cancer Epidemiology & Genetics, NIH, NCI, Bethesda, Maryland
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Avril Swarts
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas C Wright
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Vanessa Van De Wyngard
- Advanced Center for Chronic Diseases, ACCDiS, Santiago, Chile
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Long Fu Xi
- HPV Research Group, University of Washington, Seattle, Washington
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81
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Fogelberg S, Clements MS, Pedersen K, Sy S, Sparén P, Kim JJ, Burger EA. Cost-effectiveness of cervical cancer screening with primary HPV testing for unvaccinated women in Sweden. PLoS One 2020; 15:e0239611. [PMID: 32997696 PMCID: PMC7526933 DOI: 10.1371/journal.pone.0239611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sweden revised their cervical cancer screening program in 2017 to include cytology-based screening for women aged 23-29 years and primary human papillomavirus (HPV) testing for women aged 30-64 years; however, alternative strategies may be preferred. To inform cervical cancer prevention policies for unvaccinated women, we evaluated the cost-effectiveness of alternative screening strategies, including the current Swedish guidelines. METHODS We adapted a mathematical simulation model of HPV and cervical cancer to the Swedish context using primary epidemiologic data. We compared the cost-effectiveness of alternative screening strategies that varied by the age to start screening, the age to switch from cytology to HPV testing, HPV strategies not preceded by cytology, screening frequency, and management of HPV-positive/cytology-negative women. RESULTS We found that the current Swedish guidelines were more costly and less effective than alternative primary HPV-based strategies. All cost-efficient strategies involved primary HPV testing not preceded by cytology for younger women. Given a cost-effectiveness threshold of €85,619 per quality-adjusted life year gained, the optimal strategy involved 5-yearly primary HPV-based screening for women aged 23-50 years and 10-yearly HPV-based screening for women older than age 50 years. CONCLUSIONS Primary screening based on HPV alone may be considered for unvaccinated women for those countries with similar HPV burdens.
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Affiliation(s)
- Sara Fogelberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark S. Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Stephen Sy
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jane J. Kim
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emily A. Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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82
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Nygård M, Hansen BT, Kjaer SK, Hortlund M, Tryggvadóttir L, Munk C, Lagheden C, Sigurdardottir LG, Campbell S, Liaw KL, Dillner J. Human papillomavirus genotype-specific risks for cervical intraepithelial lesions. Hum Vaccin Immunother 2020; 17:972-981. [PMID: 32990181 PMCID: PMC8018444 DOI: 10.1080/21645515.2020.1814097] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Prevalence of different HPV genotypes is changing after HPV vaccination. The associated risks are needed for optimizing cervical cancer screening.To estimate HPV type-specific prevalence, odds ratio (OR), and positive predictive value (PPV) for cervical cytological abnormalities, we determined 41 different HPV genotypes in cervical samples from a population-based sample of 8351 women aged 18-51 years before HPV vaccination era (V501-033; NCT01077856).Prevalence of HPV16 was 4.9% (95% CI: 4.4-5.5) with the PPV for high-grade cytology 11.2%, and OR 11.9 (95% CI: 8.5-16.5). Carcinogenic HPVs included in the nonavalent vaccine (HPV16,18,31,33,45,52,58) had a population prevalence of 14.4% (95% CI: 13.5-15.4), with PPV of 8.0% (95% CI: 6.8-9.3) and OR 23.7 (95% CI: 16.0-63.5) for high-grade cytology. HPV types currently included in most screening tests, but not vaccinated against (HPV35,39,51,56,59,66,68) had a joint prevalence of 8.5% (95% CI: 7.8-9.2) with PPV of 4.4% (95% CI: 3.3-5.7) and OR of 2.9 (95% CI: 2.0-4.0) for high-grade cytology. The other 27 non-carcinogenic genotypes had a prevalence of 11.8%, PPV of 2.9% (95% CI:2.1-3.9), and OR 1.5 (95% CI: 1.1-2.2.) for high-grade cytology.These results suggest that HPV screening tests in the post-vaccination era might perform better if restricted to the HPV types in the nonavalent vaccine and screening for all 14 HPV types might result in suboptimal balance of harms and benefits.
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Affiliation(s)
- Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Gynecologic Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Hortlund
- Formerly at WHO HPV LabNet Global Reference Laboratory, Clinical Microbiology, Skåne University Hospital, Malmö, Sweden.,International HPV Reference Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadóttir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christian Munk
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Camilla Lagheden
- Formerly at WHO HPV LabNet Global Reference Laboratory, Clinical Microbiology, Skåne University Hospital, Malmö, Sweden.,International HPV Reference Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Kai-Li Liaw
- Merck Research Laboratories, Merck Sharp & Dohme, Kenilworth, NJ, USA
| | - Joakim Dillner
- Formerly at WHO HPV LabNet Global Reference Laboratory, Clinical Microbiology, Skåne University Hospital, Malmö, Sweden.,International HPV Reference Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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83
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Khoo SP, Lim WT, Rajasuriar R, Nasir NH, Gravitt P, Woo YL. The Acceptability and Preference of Vaginal Self-sampling for Human Papillomavirus (HPV) Testing among a Multi-ethnic Asian Female Population. Cancer Prev Res (Phila) 2020; 14:105-112. [PMID: 32917643 DOI: 10.1158/1940-6207.capr-20-0280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/24/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
Vaginal self-sampling for human papillomavirus (HPV) testing can potentially increase cervical screening coverage. This study aimed to investigate the acceptability of vaginal self-sampling for HPV testing and factors that might influence a woman's preference for this as a cervical screening method. This was a cross-sectional study that recruited 725 women from the urban and suburban areas of Selangor, Malaysia. All study participants were instructed to self-collect vaginal sample using a dry flocked swab before responding to a detailed questionnaire documenting their experience and preference for self-sampling. Most of the study participants (>80%) perceived vaginal self-sampling as easy, convenient, not embarrassing, comfortable, and were confident in performing the test. This suggests high acceptability toward vaginal self-sampling for HPV testing. Of the 725 women, 83% preferred self-sampling HPV testing over healthcare personnel sampling HPV testing and Pap test. Women with higher household income and full-time employment status were more likely to prefer self-sampling. Those who had not undergone Pap test also expressed preference for self-sampling HPV testing. Convenience and women's confidence in performing a vaginal self-sampling for HPV testing were the independent key factors that influenced the preference for self-sampling method. Vaginal self-sampling for HPV testing is highly acceptable among Malaysian women. It is the preferred choice as a primary cervical screening method and serves as an alternative to healthcare-acquired sample for Pap test. PREVENTION RELEVANCE: Organized cervical cancer screening remains unachievable in many countries. Self-sampling HPV testing is an evidence-based method that can remove barriers to cervical screening. This is particularly important for developing countries in order to achieve the WHO global strategy to accelerate cervical cancer elimination.
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Affiliation(s)
- Su Pei Khoo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur Malaysia
| | - Wen Tzien Lim
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur Malaysia
| | - Reena Rajasuriar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Patti Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur Malaysia.
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84
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The Future of Anticancer Drugs: A Cytotoxicity Assessment Study of CdSe/ZnS Quantum Dots. JOURNAL OF NANOTHERANOSTICS 2020. [DOI: 10.3390/jnt1010003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Quantum dots (QDs), including CdSe/ZnS, are nanoparticles emitting various wavelengths of fluorescent light depending on their size. Fluorescence allows them to be exploited for in vivo sensing/imaging of cancer cells. Nevertheless, thorough assessments of the effects of these commonly used QDs on cell stability are essentially required prior to their full applications. To investigate the effects of Cd QDs on the growth of human cervical cancer cells (HeLa), we utilized a growth assay, a reactive oxygen species (ROS) assay, an apoptosis assay, and RNA-seq. The growth assay results showed significant proliferation inhibition of HeLa cells by CdSe/ZnS. We revealed that smaller green CdSe/ZnS exerts more toxic effects than slightly larger yellow CdSe/ZnS. There were no significant increases of ROSs under the treatment of Cd QDs, which is consistent with the notion that low concentration of Cd QDs does not cause significant production of ROSs. In addition, we found that Cd QDs induced late apoptosis. RNA-Seq-based transcriptome analysis revealed that the exposure to green Cd QDs significantly upregulated antiapoptotic, antiproliferative, and antitumorigenic functions. The transcriptome profile also noted the downregulation of pro-proliferation, mitochondrial respiratory chain, detoxification, and receptor-mediated endocytosis. Taken together, our findings provide evidence that green CdSe/ZnS can be an alternative anticancer drug. In addition, our transcriptome analysis provides new insights into alteration of physiological state induced by CdSe/ZnS QDs in HeLa cancer cells.
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85
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Landy R, Sasieni PD, Mathews C, Wiggins CL, Robertson M, McDonald YJ, Goldberg DW, Scarinci IC, Cuzick J, Wheeler CM. Impact of screening on cervical cancer incidence: A population-based case-control study in the United States. Int J Cancer 2020; 147:887-896. [PMID: 31837006 PMCID: PMC7282928 DOI: 10.1002/ijc.32826] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 12/03/2022]
Abstract
Cervical cancer is widely preventable through screening, but little is known about the duration of protection offered by a negative screen in North America. A case-control study was conducted with records from population-based registries in New Mexico. Cases were women diagnosed with cervical cancer in 2006-2016, obtained from the Tumor Registry. Five controls per case from the New Mexico HPV Pap Registry were matched to cases by sex, age and place of residence. Dates and results of all cervical screening and diagnostic tests since 2006 were identified from the pap registry. We estimated the odds ratio of nonlocalized (Stage II+) and localized (Stage I) cervical cancer associated with attending screening in the 3 years prior to case-diagnosis compared to women not screened in 5 years. Of 876 cases, 527 were aged 25-64 years with ≥3 years of potential screening data. Only 38% of cases and 61% of controls attended screening in a 3-year period. Women screened in the 3 years prior to diagnosis had 83% lower risk of nonlocalized cancer (odds ratio [OR] = 0.17, 95% CI: 0.12-0.24) and 48% lower odds of localized cancer (OR = 0.52, 95% CI: 0.38-0.72), compared to women not screened in the 5 years prior to diagnosis. Women remained at low risk of nonlocalized cancer for 3.5-5 years after a negative screen compared to women with no negative screens in the 5 years prior to diagnosis. Routine cervical screening is effective at preventing localized and nonlocalized cervical cancers; 3 yearly screening prevents 83% of nonlocalized cancers, with no additional benefit of more frequent screening. Increasing screening coverage remains essential to further reduce cervical cancer incidence.
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Affiliation(s)
- Rebecca Landy
- Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUnited Kingdom
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human ServicesBethesdaMD
| | - Peter D. Sasieni
- School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUnited Kingdom
| | - Christopher Mathews
- School of Cancer & Pharmaceutical SciencesKing's College LondonLondonUnited Kingdom
| | - Charles L. Wiggins
- Department of Internal MedicineUniversity of New Mexico Comprehensive Cancer Center and University of New Mexico Health Sciences CenterAlbuquerqueNM
| | - Michael Robertson
- The Center for HPV PreventionUniversity of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences CenterAlbuquerqueNM
| | - Yolanda J. McDonald
- Department of Human and Organizational DevelopmentVanderbilt UniversityNashvilleTN
| | | | - Isabel C. Scarinci
- Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAL
| | - Jack Cuzick
- Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUnited Kingdom
| | - Cosette M. Wheeler
- Department of Pathology and Obstetrics & GynecologyUniversity of New Mexico Health Sciences CenterAlbuquerqueNM
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86
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Malagón T, Volesky KD, Bouten S, Laprise C, El-Zein M, Franco EL. Cumulative risk of cervical intraepithelial neoplasia for women with normal cytology but positive for human papillomavirus: Systematic review and meta-analysis. Int J Cancer 2020; 147:2695-2707. [PMID: 32363604 DOI: 10.1002/ijc.33035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022]
Abstract
Most women positive for human papillomavirus (HPV) are cytology normal. The optimal screen-management of these women is unclear given their risk of developing precancer. We performed a systematic review and meta-analysis of progression rates to precancer and cancer for HPV-positive, cytology normal women. We searched MEDLINE, EMBASE and Scopus for prospective studies measuring the cumulative incidence of precancer and cervical cancer in HPV-positive, cytology/histology normal women. Record screening was performed independently by two reviewers. We modeled the cumulative incidence over time using a multilevel random-effects meta-regression model. We used the model to predict HPV type-specific risks of precancer and cancer over follow-up. Data from 162 unique records were used in our analysis. The average incidence rate of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) in high-risk HPV positive but cytology/histology normal women was 1.0 per 100 women-years (95% CI: 1.0-1.1). This corresponds to an average cumulative risk at 1, 3 and 5 years of 2.1% (95% prediction interval 0.0-9.5), 4.3% (95% prediction interval 0.0-11.5) and 6.4% (95% prediction interval 0.0-13.5). HPV type was a strong predictor of the risk of oncogenic progression. There was substantial heterogeneity in the background precancer risk across studies (P-value < .0001). Our HPV type-specific progression risk estimates can help inform risk-based cervical cancer screening guidelines for HPV-positive women. However, precancer and cervical cancer risks are highly variable and may not be generalizable between populations.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Karena D Volesky
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sheila Bouten
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Claudie Laprise
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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87
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Wang Z, Liu T, Wang Y, Gu Y, Wang H, Liu J, Cui B, Yang X. Risk of cervical lesions in high-risk HPV positive women with normal cytology: a retrospective single-center study in China. Infect Agent Cancer 2020; 15:34. [PMID: 32477424 PMCID: PMC7240930 DOI: 10.1186/s13027-020-00291-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/01/2020] [Indexed: 01/30/2023] Open
Abstract
Background To investigate high-risk HPV (hr-HPV) genotype distributions and the association between hr-HPV infection with severity of the cervical lesions in women with normal cytology. Methods In this cross-sectional study, the result of the hr-HPV test and biopsy of colposcopy of women with normal cytology from January 2012 to January 2019 were analyzed. The detection rate of high-grade squamous intraepithelial lesion (HSIL) and cervical cancer were calculated among different hr-HPV genotypes, viral load group, and age groups. Results Five thousand eight hundred eighty women were enrolled in this study. Overall, 59.97% had normal histological results, 19.32% had HSIL, and 1.07% had cervical cancer. The detection rate of HSIL or worse (HSIL+) in women with single HPV16(34.00%), HPV31(27.50%), HPV33(25.58%), and HPV52(20.88%) infection were higher significantly than single HPV18 (15.59%) infection, respectively. The HSIL+ detection rate between HPV16 single infection and multiple infections (excluding HPV18) was no significant difference (34% vs 35.47%, P = 0.638), contrary to HPV18(12.59% vs 21.67%, P = 0.022). In women without HPV16/18 infections, HSIL+ detection rates for single, double, and triple or more hr-HPV infections were 12.28, 20.31, and 37.50%, the risk of detection of HSIL+ significantly increasing. With the hr-HPV DNA load increases, the risk of detection of HSIL+ (χ2 = 91.01, P < 0.0001) and invasive cervical cancer (χ2 = 5.757, P = 0.016) increase. In age < 30, 31–40, 41–50, 51–60, > 60 group, HSIL+ detection rate were 24.80%、22.10%、19.59%、14.29, and 12.61%, respectively. Conclusion Women who have normal cytology with HPV 16/18/31/33/52/58 infections, multiple HPV infections and high viral load, have a higher detection rate of HSIL+.
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Affiliation(s)
- Zhiling Wang
- 1Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Ting Liu
- 1Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yunjian Wang
- 2West China School of Medicine, Sichuan University, Chengdu, China
| | - Ying Gu
- 1Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Wang
- 1Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Jingkang Liu
- 1Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Baoxia Cui
- 1Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Xingsheng Yang
- 1Department of Gynecology, Qilu Hospital of Shandong University, Jinan, China
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Demarco M, Hyun N, Carter-Pokras O, Raine-Bennett TR, Cheung L, Chen X, Hammer A, Campos N, Kinney W, Gage JC, Befano B, Perkins RB, He X, Dallal C, Chen J, Poitras N, Mayrand MH, Coutlee F, Burk RD, Lorey T, Castle PE, Wentzensen N, Schiffman M. A study of type-specific HPV natural history and implications for contemporary cervical cancer screening programs. EClinicalMedicine 2020; 22:100293. [PMID: 32510043 PMCID: PMC7264956 DOI: 10.1016/j.eclinm.2020.100293] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND HPV testing is replacing cytology for cervical cancer screening because of greater sensitivity and superior reassurance following negative tests for the dozen HPV genotypes that cause cervical cancer. Management of women testing positive is unresolved. The need for identification of individual HPV genotypes for clinical use is debated. Also, it is unclear how long to observe persistent infections when precancer is not initially found. METHODS In the longitudinal NCI-Kaiser Permanente Northern California Persistence and Progression (PaP) Study, we observed the clinical outcomes (clearance, progression to CIN3+, or persistence without progression) of 11,573 HPV-positive women aged 30-65 yielding 14,158 type-specific infections. FINDINGS Risks of CIN3+ progression differed substantially by type, with HPV16 conveying uniquely elevated risk (26% of infections with seven-year CIN3+ risk of 22%). The other carcinogenic HPV types fell into 3 distinct seven-year CIN3+ risk groups: HPV18, 45 (13% of infections, risks >5%, with known elevated cancer risk); HPV31, 33, 35, 52, 58 (39%, risks >5%); and HPV39, 51, 56, 59, 68 (23%, risks <5%). In the absence of progression, HPV clearance rates were similar by type, with 80% of infections no longer detected within three years; persistence to seven years without progression was uncommon. The predictive value of abnormal cytology was most evident for prevalent CIN3+, but less evident in follow-up. A woman's age did not modify risk; rather it was the duration of persistence that was important. INTERPRETATION HPV type and persistence are the major predictors of progression to CIN3+; at a minimum, distinguishing HPV16 is clinically important. Dividing the other HPV types into three risk-groups is worth considering.
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Key Words
- AGC, Atypical glandular cells
- AIS, Adenocarcinoma in-situ
- ASC-H+, Atypical squamous cells - cannot exclude HSIL
- ASC-US, Atypical squamous cells of undetermined significance
- BD, Becton Dickinson
- CIN, Cervical intraepithelial neoplasia
- HC2, Hybrid Capture 2
- HPV genotype
- HPV outcome, Clearance
- HPV, human papillomavirus
- KPNC, Kaiser Permanente Northern California
- LSIL, Low-grade squamous intraepithelial lesion
- NCI, National Cancer Institute
- NILM, Negative for intraepithelial lesion or malignancy
- PCR, Polymerase chain reaction
- PaP, Persistence and Progression
- Persistence
- Progression
- STM, Specimen transport medium
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Affiliation(s)
- Maria Demarco
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- University of Maryland School of Public Health, College Park, MD, United States
| | - Noorie Hyun
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Tina R. Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Li Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Xiaojian Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Anne Hammer
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Nicole Campos
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Walter Kinney
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States
| | - Julia C. Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Brian Befano
- Information Management Services Inc., Calverton, MD, United States
| | - Rebecca B. Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, MA, United States
| | - Xin He
- University of Maryland School of Public Health, College Park, MD, United States
| | - Cher Dallal
- University of Maryland School of Public Health, College Park, MD, United States
| | - Jie Chen
- University of Maryland School of Public Health, College Park, MD, United States
| | - Nancy Poitras
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States
| | - Marie-Helene Mayrand
- Department of Obstetrics and Gynecology, Université de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Francois Coutlee
- Department of Microbiology, Université de Montréal and CRCHUM, Montreal, Canada
| | - Robert D. Burk
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
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Padhy RR, Davidov A, Madrigal L, Alcide G, Spahiu A. Detection of high-risk human papillomavirus RNA in urine for cervical cancer screening with HPV 16 & 18/45 genotyping. Heliyon 2020; 6:e03745. [PMID: 32346629 PMCID: PMC7182776 DOI: 10.1016/j.heliyon.2020.e03745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/16/2020] [Accepted: 04/01/2020] [Indexed: 12/31/2022] Open
Abstract
Objective To detect high-risk human papillomavirus (hrHPV) messenger-RNA (mRNA) in urine samples, compare their concordance with cervical samples including HPV 16 & 18/45 genotyping, and to determine the utility in detecting ≥ CIN 2 lesions. Methods A cohort of 189 non-pregnant patients (age ≥ 25) was recruited in three groups: Group 1 with abnormal pap-smears and hrHPV positivity, Group 2 with normal pap-smears and hrHPV positivity, and Group 3 with normal pap-smears and hrHPV negativity. Urine samples were tested for hrHPV-mRNA and subsequent hrHPV-mRNA genotype if positive. High-risk HPV detection and genotyping were performed using Aptima assays which are validated for cervical HPV testing. Colposcopy results from groups 1 & 2 were analyzed. Results The sensitivity of urine hrHPV-mRNA detection was 31.5% while the specificity and PPV were above 95% (96.9% & 95.1% respectively) (p < 0.001). The kappa agreement with cervical samples was fair (0.22, p = 0.04). The sensitivity and specificity of urine hrHPV-mRNA genotyping were 20.0% & 100% respectively (p < 0.001) with 100% genotype-specific concordance. The kappa agreement with cervical samples was fair (0.25, p = 0.16). For urine hrHPV-mRNA detection of ASC-H/HSIL when grouped by age ≥ 30, the sensitivity and specificity were 45.4% & 63.9% respectively (p = 0.009). For urine hrHPV-mRNA detection of ≥ CIN 2 for all ages, the sensitivity and specificity were 45.5% & 75.0% respectively (p = 0.03). Conclusion Using the Aptima Assay, urine hrHPV-mRNA detection is suboptimal for cervical cancer screening but given the high specificity, it has the potential to identify high-grade lesions (≥ CIN 2). Urine hrHPV-mRNA genotyping via this modality is not beneficial in triage settings of normal or abnormal cytology to determine the need for colposcopy.
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Affiliation(s)
- Radha Rani Padhy
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Adi Davidov
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Louise Madrigal
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Gina Alcide
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Almir Spahiu
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
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90
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Detection of HPV E6 oncoprotein from urine via a novel immunochromatographic assay. PLoS One 2020; 15:e0232105. [PMID: 32320451 PMCID: PMC7176116 DOI: 10.1371/journal.pone.0232105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
Cervical cancer is a significant public health problem, especially in low- and middle-income countries, where women have little access to cervical cancer screening; consequently 80% of cervical cancer related mortality occurs in these regions. The development of screening methods that need less infrastructure thus represents an urgent medical need. The study aims to compare the detection rates of high-risk human papillomavirus 16 and 18 E6 oncoprotein in urine, vaginal self-collected, and cervical scrapes of women using the OncoE6™ Cervical Test and compare the HPV16 and/or HPV18 E6 detection rates with the HPV DNA testing. Paired urine, vaginal self-collected and cervical specimens were collected from 124 women who participated in cervical cancer screening or treatment in this proof-of-concept study and underwent to HPV16/18-E6 testing and high-risk HPV DNA testing prior to treatment of cervical neoplasia or cancer. Concordance between urinary, vaginal and cervical HPV16/18-E6 and HPV-DNA testing was evaluated for patients classified as negative group (<CIN2) and histological positive group (CIN2, CIN3 and invasive carcinoma). Overall, HPV16/18-E6 oncoprotein was detected in 30.6% of cervical samples, 20.3% of self-collected vaginal samples and 21% of urine samples. Regarding the clinical sensitivity, the HPV16/18-E6 oncoprotein was not detected in CIN2 cases, and was detected at low rates in CIN3 cases. The clinical sensitivity of the HPV16/18-E6 oncoprotein for detecting invasive cervical cancer was 70% for cervical scrapes, 55% for self-collected vaginal samples and 52% for urine samples. This study reports the urinary detection of E6 oncoprotein in vivo for the first time and our results suggest that this detection is only for invasive/microinvasive lesions. Then, further protocol development and standardization to achieve a clinical sensitivity for CIN2/3 detection close to what can be achieved for invasive lesions using the physician collected cervical is needed.
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91
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Coldman AJ, van Niekerk D, Krajden M, Smith LW, Cook D, Gondara L, Ceballos K, Quinlan DJ, Lee M, Elwood-Martin R, Gentile L, Peacock S, Stuart GCE, Franco EL, Ogilvie GS. Disease detection at the 48-month exit round of the HPV FOCAL cervical cancer screening trial in women per-protocol eligible for routine screening. Int J Cancer 2020; 146:1810-1818. [PMID: 31245842 DOI: 10.1002/ijc.32524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/18/2019] [Indexed: 11/10/2022]
Abstract
HPV FOCAL is a randomized control trial of cervical cancer screening. The intervention arm received baseline screening for high-risk human papillomavirus (HPV) and the control arm received liquid-based cytology (LBC) at baseline and 24 months. Both arms received 48-month exit HPV and LBC cotesting. Exit results are presented for per-protocol eligible (PPE) screened women. Participants were PPE at exit if they had completed all screening and recommended follow-up and had not been diagnosed with cervical intraepithelial neoplasia Grade 2 or worse (CIN2+) earlier in the trial. Subgroups were identified based upon results at earlier trial screening. There were 9,457 and 9,552 and women aged 25-65 randomized to control and intervention and 7,448 (77.8%) and 8,281 (86.7%), respectively, were PPE and screened. Exit cotest results were similar (p = 0.11) by arm for PPE and the relative rate (RR) of CIN2+ for intervention vs. control was RR = 0.83 (95% CI: 0.56-1.23). The RR for CIN2+ comparing intervention women baseline HPV negative to control women with negative cytology at baseline and at 24 months, was 0.68 (95% CI: 0.43-1.06). PPE women who had a negative or CIN1 colposcopy in earlier rounds had elevated rates (per 1,000) of CIN2+ at exit, control 31 (95% CI: 14-65) and intervention 43 (95% CI: 25-73). Among PPE women HPV negative at exit LBC cotesting identified little CIN2+, Rate = 0.3 (95% CI: 0.1-0.7). This per-protocol analysis found that screening with HPV using a 4-year interval is as safe as LBC with a 2-year screening interval. LBC screening in HPV negative women at exit identified few additional lesions.
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Affiliation(s)
| | - Dirk van Niekerk
- Cervical Cancer Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Laurie W Smith
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, BC, Canada
| | | | - Kathy Ceballos
- Cervical Cancer Screening Program, BC Cancer, Vancouver, BC, Canada
| | - David J Quinlan
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Marette Lee
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Ruth Elwood-Martin
- School of Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Laura Gentile
- Cervical Cancer Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada
| | - Gavin C E Stuart
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Gina S Ogilvie
- Women's Health Research Institute, Vancouver, BC, Canada
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92
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Shah UJ, Nasiruddin M, Dar SA, Khan MKA, Akhter MR, Singh N, Rabaan AA, Haque S. Emerging biomarkers and clinical significance of HPV genotyping in prevention and management of cervical cancer. Microb Pathog 2020; 143:104131. [PMID: 32169490 DOI: 10.1016/j.micpath.2020.104131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/10/2020] [Accepted: 03/06/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer is a growing and serious problem world-wide in women, but more acute in developing countries especially in Indian subcontinent. The main causative agent for the disease is Human Papilloma Virus (HPV). The history of the cervical cancer goes back to eighteenth century as the HPV infection is reported since 1800s. Presently, the genetic structure of HPV is well defined. Several screening tests including cytology and visual based screening and high risk HPV testing are available. Also available are various clinical and commercial diagnostic tests. However due to the lack of awareness and population-based screening programs, the morbidity and mortality rate is alarmingly high. There are new emerging biomarkers including E6/E7 mRNA, p16ink4a, markers of aberrant S-phase induction, chromosomal abnormalities and miRNAs along with advanced genotyping methods. These markers have clinical significance and are helpful in disease prevention and management. Further, recent advancement in the field of metagenomics has increased the prospects of identifying newer microbes, viruses hitherto reported thus far in the context of HPV infection. Analysis of HPV cases using modern tools including genotyping using more powerful biomarkers is envisaged to enhance the prospects of early diagnosis, better prognosis, more reliable treatment and eventual management of the disease.
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Affiliation(s)
- Ushma Jaykamal Shah
- MedGenome Labs Ltd., Kailash Cancer Hospital and Research Center, Muni Seva Ashram, P.O. Goraj, Tal. Waghodia, Dist. Vadodara, 391760, Gujarat, India
| | - Mohammad Nasiruddin
- Anand Diagnostic Laboratory (A Neuberg Associate), Neuberg Anand Reference Laboratory, Anand Tower, 54, Bowring Hospital Road, Shivajinagar, Bangalore - 560001, India.
| | - Sajad Ahmad Dar
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Md Khurshid Alam Khan
- School of Life Sciences, BS Abdur Rahman Crescent Institute of Science and Technology, Chennai, 600048, Tamil Nadu, India
| | - Mohammad Riyaz Akhter
- MedGenome Labs Ltd., 3rd Floor, Narayana Nethralaya Building, Narayana Health City, # 258/A, Bommasandra, Hosur Road, Bangalore, 560099, Karnataka, India
| | - Nidhi Singh
- Department of Obstetrics and Gynecology, Prasad Institute of Medical Sciences, Lucknow, 226401, Uttar Pradesh, India
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Saudi Aramco, Dhahran, 31311, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, 45142, Saudi Arabia.
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93
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Bhatla N, Singhal S. Primary HPV screening for cervical cancer. Best Pract Res Clin Obstet Gynaecol 2020; 65:98-108. [PMID: 32291178 DOI: 10.1016/j.bpobgyn.2020.02.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/24/2022]
Abstract
Cytology-based cervical screening had unequivocal success in reducing the incidence and mortality of cervical cancer in the last century. The recognition of the role of human papillomavirus (HPV) as a necessary cause of cervical cancer led to the development of HPV testing. Gradually, there has been a shift from reflex HPV testing for mild cytological abnormalities, to co-testing with cytology and HPV, and lately to primary HPV screening, based on evidence from well-designed large randomized controlled trials and meta-analyses. Advantages of primary HPV screening include higher sensitivity to detect pre-neoplastic lesions, better re-assurance with a negative test, and safe prolongation of screening intervals. However, clinicians and policy makers must ensure the availability of clinically validated HPV assays and triage protocols of screen positive cases prior to implementation of primary HPV screening. This is likely to reduce potential harm from over-treatment as well as extra burden on the health care system.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
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94
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Wang P, Wang T, Hong J, Yan X, Liang M. Nanozymes: A New Disease Imaging Strategy. Front Bioeng Biotechnol 2020; 8:15. [PMID: 32117909 PMCID: PMC7015899 DOI: 10.3389/fbioe.2020.00015] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/09/2020] [Indexed: 12/27/2022] Open
Abstract
Nanozymes are nanomaterials with intrinsic enzyme-like properties. They can specifically catalyze substrates of natural enzymes under physiological condition with similar catalytic mechanism and kinetics. Compared to natural enzymes, nanozymes exhibit the unique advantages including high catalytic activity, low cost, high stability, easy mass production, and tunable activity. In addition, as a new type of artificial enzymes, nanozymes not only have the enzyme-like catalytic activity, but also exhibit the unique physicochemical properties of nanomaterials, such as photothermal properties, superparamagnetism, and fluorescence, etc. By combining the unique physicochemical properties and enzyme-like catalytic activities, nanozymes have been widely developed for in vitro detection and in vivo disease monitoring and treatment. Here we mainly summarized the applications of nanozymes for disease imaging and detection to explore their potential application in disease diagnosis and precision medicine.
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Affiliation(s)
- Peixia Wang
- CAS Engineering Laboratory for Nanozyme, Key Laboratory of Protein and Peptide Pharmaceutical, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Experimental Center of Advanced Materials School of Materials Science & Engineering, School of Materials Science & Engineering, Beijing Institute of Technology, Beijing, China.,College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Juanji Hong
- Experimental Center of Advanced Materials School of Materials Science & Engineering, School of Materials Science & Engineering, Beijing Institute of Technology, Beijing, China
| | - Xiyun Yan
- CAS Engineering Laboratory for Nanozyme, Key Laboratory of Protein and Peptide Pharmaceutical, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Minmin Liang
- Experimental Center of Advanced Materials School of Materials Science & Engineering, School of Materials Science & Engineering, Beijing Institute of Technology, Beijing, China
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95
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Ding S, Huang X, Zhu J, Xu B, Xu L, Gu D, Zhang W. ADH7, miR-3065 and LINC01133 are associated with cervical cancer progression in different age groups. Oncol Lett 2020; 19:2326-2338. [PMID: 32194732 PMCID: PMC7039144 DOI: 10.3892/ol.2020.11348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/12/2019] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to identify potential therapeutic targets that serve crucial roles in the progression of cervical cancer. Clinical data, RNA sequencing (RNAseq)-counts and micro (mi)RNA data regarding cervical squamous cell carcinoma were retrieved from The Cancer Genome Atlas, and analyses were performed using the University of California Santa Cruz database. RNAseq and miRNA data were stratified into 3 groups (according to the patients' age), and genes were re-annotated and preprocessed prior to Mfuzz time clustering analysis. Subsequently, enrichment analyses were performed in order to identify differentially expressed mRNAs (DEmRNAs) and a protein-protein interaction analysis network was constructed. miRNA-gene, miRNA-lncRNA, and long non-coding (lnc)RNA-mRNA pairs were collected and the lncRNA-miRNA-mRNA competing endogenous (ce)RNA network was established. Further enrichment analyses were performed in order to identify crucial mRNAs in the ceRNA network. Finally, survival and drug association analyses were implemented. A total of 269 DEmRNAs [including alcohol dehydrogenase 7 (ADH7), vestigial-like family member 3 (VGLL3) and cytochrome P450, family 26, subfamily B, polypeptide 1 (CYP26B1)], 274 DElncRNAs (including LINC01133) and 16 DEmiRNAs (including miR-3065 and miR-330) were identified. There were 102 lncRNAs, 15 miRNAs, 15 mRNAs and 522 interaction pairs in the ceRNA network. In particular, ADH7 was regulated by miR-3065, and miR-3065 interacted with LINC01133 in the ceRNA network. Furthermore, ADH7 and CYP26B1 were enriched in the retinoic acid metabolic process and the retinol metabolism pathway. ADH7 and VGLL3 were significantly associated with the cervical cancer survival rate. ADH7, VGLL3, CYP26B1, miR-3065, miR-330, miR-499a and LINC01133 play pivotal roles in the progression of cervical cancer in different age groups.
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Affiliation(s)
- Shengdi Ding
- Department of Obstetrics and Gynecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, P.R. China
| | - Xiaohong Huang
- Department of Obstetrics and Gynecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, P.R. China
| | - Junmei Zhu
- Department of Obstetrics and Gynecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, P.R. China
| | - Bing Xu
- Department of Obstetrics and Gynecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, P.R. China
| | - Limin Xu
- Central Laboratory, Huzhou Central Hospital, Huzhou, Zhejiang 313000, P.R. China
| | - Donghua Gu
- Department of Pathology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, P.R. China
| | - Wenyuan Zhang
- Department of Obstetrics and Gynecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, P.R. China
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Hu SY, Rezhake R, Chen F, Zhang X, Pan QJ, Ma JF, Qiao YL, Zhao FH. Outcomes in women with biopsy-confirmed cervical intraepithelial neoplasia grade 1 or normal cervix and related cofactors: A 15-year population-based cohort study from China. Gynecol Oncol 2020; 156:616-623. [PMID: 31937451 DOI: 10.1016/j.ygyno.2019.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate long-term outcomes of biopsy-confirmed cervical intraepithelial neoplasia grade 1 (CIN1) or normal cervix and identify the cofactors during disease progression. METHODS In 1999, a cervical cancer screening cohort in Shanxi, China, enrolled 1997 women aged 35-45. They were followed up at year 6, 11, and 15 after enrollment with high-risk human papillomavirus (hrHPV) DNA testing, liquid-based cytology, and visual inspection with acetic acid. Progression, persistence, and regression rates were calculated, stratified by baseline hrHPV and cytological status. Risk factors associated with hrHPV acquisition, persistence, and progression were examined. RESULTS The cumulative rates of progression to CIN2+ among CIN1 over 6, 11, and 15 years were 7.5%, 21.4%, and 24.0%, respectively; the regression rates to normal cervix were 85.0%, 76.7%, and 72.9%, respectively. Over 6, 11, and 15 years, 0.7%, 2.9%, and 5.2% of normal cervix developed CIN2+, respectively, but over 90% remained normal after 15 years. CIN1 or normal cervix positive for hrHPV had significantly higher progression rates to CIN2+ than those without hrHPV. Similarly, the severity of cytological status was found to be associated with an increased risk of developing CIN2+. Women who had an earlier sexual debut were at a higher risk of acquiring new HPV infection and repeated HPV infections. CONCLUSIONS Clinical follow-up strategies for women with CIN1 or normal cervix could be adjusted accordingly based on hrHPV/cytology status.
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Affiliation(s)
- Shang-Ying Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Remila Rezhake
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xun Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin-Jing Pan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun-Fei Ma
- Xiangyuan Maternal and Child Health Care and Family Planning Service Center, Changzhi, China
| | - You-Lin Qiao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang-Hui Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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97
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Curty G, de Carvalho PS, Soares MA. The Role of the Cervicovaginal Microbiome on the Genesis and as a Biomarker of Premalignant Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer. Int J Mol Sci 2019; 21:ijms21010222. [PMID: 31905652 PMCID: PMC6981542 DOI: 10.3390/ijms21010222] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 12/24/2022] Open
Abstract
The microbiome is able to modulate immune responses, alter the physiology of the human organism, and increase the risk of viral infections and development of diseases such as cancer. In this review, we address changes in the cervical microbiota as potential biomarkers to identify the risk of cervical intraepithelial neoplasia (CIN) development and invasive cervical cancer in the context of human papillomavirus (HPV) infection. Current approaches for clinical diagnostics and the manipulation of microbiota with the use of probiotics and through microbiota transplantation are also discussed.
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98
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Costa RFA, Longatto-Filho A, de Lima Vazquez F, Pinheiro C, Zeferino LC, Fregnani JHTG. The Quality of Pap Smears from the Brazilian Cervical Cancer Screening Program According to the Human Development Index. Cancer Prev Res (Phila) 2019; 13:299-308. [PMID: 31836602 DOI: 10.1158/1940-6207.capr-19-0306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/13/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022]
Abstract
Brazil is a country with strong socioeconomic disparities, which may explain the different rates of cervical cancer incidence and mortality and influence the quality of cervical cancer screening tests. The aim of this study was to perform a trend analysis of some quality indicators of Pap smears according to the Municipal Human Development Index (MHDI). Information about cytopathological exams (approximately 65,000,000) performed from 2006 to 2014 in women ages 25 to 64 years was obtained from the Cervical Cancer Information System (SISCOLO). The average annual percentage change (AAPC) for each indicator was calculated using the Joinpoint Regression Program, according to MHDI levels. Very low frequencies of unsatisfactory cases (<5%) were observed at different MHDI levels. Although the positivity index in the low- and medium-MHDI groups has increased, the values remained below international recommendations (3%-10%). The HSIL (high-grade squamous intraepithelial lesion) percentage remained stationary at all levels of the MHDI. In the low- and medium-MHDI groups, most quality indicators were below the recommendations by Brazilian National Cancer Institute INCA, with no improvement trend; in the high-MHDI group, the majority of the indicators also presented no improvement, although they show slightly better quality indicators. The MHDI should be considered in the definition of the policies of the screening program for cervical cancer in Brazil, and the current program may require adjustments to achieve improved efficiency.
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Affiliation(s)
- Ricardo Filipe Alves Costa
- Graduate Program on Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. .,Barretos School of Health Sciences Dr. Paulo Prata-FACISB, Barretos, São Paulo, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Laboratory of Medical Investigation (LIM 14), Faculty of Medicine, São Paulo University, FMUSP, São Paulo, Brazil.,Life and Health Sciences Research Institute, ICVS, School of Health Sciences, Minho University, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Céline Pinheiro
- Barretos School of Health Sciences Dr. Paulo Prata-FACISB, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Luiz Carlos Zeferino
- School of Medical Sciences, Women's Hospital CAISM, Unicamp, Campinas, São Paulo, Brazil
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99
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Skroumpelos A, Agorastos T, Constantinidis T, Chatzistamatiou K, Kyriopoulos J. Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece. PLoS One 2019; 14:e0226335. [PMID: 31830114 PMCID: PMC6907825 DOI: 10.1371/journal.pone.0226335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 11/24/2019] [Indexed: 11/20/2022] Open
Abstract
Background HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV test as primary screening method for CC. Methods A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25–65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted. Results All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized. Conclusions HPV 16/18 genotyping as a primary screening method for CC appears to be one of the most effective strategies and dominates current practice in respect to both cost and outcomes. Even when compared with all other strategies, the outcomes that it generates justify the cost that it requires, representing a good value for money alternative.
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Affiliation(s)
| | | | | | | | - John Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
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100
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Wagner S, Roberson D, Boland J, Kreimer AR, Yeager M, Cullen M, Mirabello L, Dunn ST, Walker J, Zuna R, Porras C, Cortes B, Sampson J, Herrero R, Rodriguez AC, Quint W, Van Doorn LJ, Hildesheim A, Schiffman M, Wentzensen N. Evaluation of TypeSeq, a Novel High-Throughput, Low-Cost, Next-Generation Sequencing-Based Assay for Detection of 51 Human Papillomavirus Genotypes. J Infect Dis 2019; 220:1609-1619. [PMID: 31536132 PMCID: PMC6782103 DOI: 10.1093/infdis/jiz324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomaviruses (HPV) cause over 500 000 cervical cancers each year, most of which occur in low-resource settings. Human papillomavirus genotyping is important to study natural history and vaccine efficacy. We evaluated TypeSeq, a novel, next-generation, sequencing-based assay that detects 51 HPV genotypes, in 2 large international epidemiologic studies. METHODS TypeSeq was evaluated in 2804 cervical specimens from the Study to Understand Cervical Cancer Endpoints and Early Determinants (SUCCEED) and in 2357 specimens from the Costa Rica Vaccine Trial (CVT). Positive agreement and risks of precancer for individual genotypes were calculated for TypeSeq in comparison to Linear Array (SUCCEED). In CVT, positive agreement and vaccine efficacy were calculated for TypeSeq and SPF10-LiPA. RESULTS We observed high overall and positive agreement for most genotypes between TypeSeq and Linear Array in SUCCEED and SPF10-LiPA in CVT. There was no significant difference in risk of precancer between TypeSeq and Linear Array in SUCCEED or in estimates of vaccine efficacy between TypeSeq and SPF10-LiPA in CVT. CONCLUSIONS The agreement of TypeSeq with Linear Array and SPF10-LiPA, 2 well established standards for HPV genotyping, demonstrates its high accuracy. TypeSeq provides high-throughput, affordable HPV genotyping for world-wide studies of cervical precancer risk and of HPV vaccine efficacy.
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Affiliation(s)
- Sarah Wagner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - David Roberson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - Joseph Boland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Meredith Yeager
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - Michael Cullen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - S Terence Dunn
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Joan Walker
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Rosemary Zuna
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomedicas, San José, Costa Rica
| | - Bernal Cortes
- Agencia Costarricense de Investigaciones Biomedicas, San José, Costa Rica
| | - Joshua Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Rolando Herrero
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | | | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Mark Schiffman
- 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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