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van den Helder R, Steenbergen RDM, van Splunter AP, Mom CH, Tjiong MY, Martin I, Rosier-van Dunné FMF, van der Avoort IAM, Bleeker MCG, van Trommel NE. HPV AND DNA METHYLATION TESTING IN URINE FOR CERVICAL INTRAEPITHELIAL NEOPLASIA AND CERVICAL CANCER DETECTION. Clin Cancer Res 2022; 28:2061-2068. [PMID: 35266975 DOI: 10.1158/1078-0432.ccr-21-3710] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/28/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Biomarker detection in urine offers a potential solution to increase effectiveness of cervical cancer screening programs by attracting non-responders. In this prospective study, the presence of high-risk human papillomavirus (hrHPV DNA) and the performance of DNA methylation analysis was determined for the detection of cervical cancer and high-grade cervical intraepithelial neoplasia (CIN2/3) in urine, and compared to paired cervicovaginal self-samples and clinician-taken cervical scrapes. METHODS A total of 587 samples were included from 113 women with cervical cancer, 92 women with CIN2/3, and 64 controls. Samples were tested for hrHPV DNA and five methylation markers. Univariate and multivariate logistic regression and leave-one-out cross-validation were used to determine the methylation marker performance for CIN3 and cervical cancer (CIN3+) detection in urine. Agreement between samples was determined using Cohen's kappa statistics and the Spearman correlation coefficients. RESULTS HrHPV presence was high in all sample types, 79% to 92%. Methylation levels of all markers in urine significantly increased with increasing severity of disease. The optimal marker panel (ASCL1/LHX8) resulted in an AUC of 0.84 for CIN3+ detection in urine, corresponding to an 86% sensitivity at a 70% predefined specificity. At this threshold 96%(109/113) of cervical cancers, 68%(46/64) of CIN3 and 58%(14/24) of CIN2 were detected. Between paired samples, a strong agreement for HPV16/18 genotyping and a fair to strong correlation for methylation was found. CONCLUSION HrHPV DNA and DNA methylation testing in urine offers a promising solution to detect cervical cancer and CIN2/3 lesions, especially for women currently unreached by conventional screening methods.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nienke E van Trommel
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
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102
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Nguyen DTN, Simms KT, Keane A, Mola G, Bolnga JW, Kuk J, Toliman PJ, Badman SG, Saville M, Kaldor J, Vallely A, Canfell K. Towards the elimination of cervical cancer in low-income and lower-middle-income countries: modelled evaluation of the effectiveness and cost-effectiveness of point-of-care HPV self-collected screening and treatment in Papua New Guinea. BMJ Glob Health 2022; 7:bmjgh-2021-007380. [PMID: 35241461 PMCID: PMC8896000 DOI: 10.1136/bmjgh-2021-007380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/23/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction WHO has launched updated cervical screening guidelines, including provisions for primary HPV screen-and-treat. Papua New Guinea (PNG) has a high burden of cervical cancer, but no national cervical screening programme. We recently completed the first field trials of a screen-and-treat algorithm using point-of-care self-collected HPV and same-day treatment (hereafter self-collected HPV S&T) and showed this had superior clinical performance and acceptability to visual inspection of the cervix with acetic acid (VIA). We, therefore, evaluated the effectiveness, cost-effectiveness and resource implications of a national cervical screening programme using self-collected HPV S&T compared with VIA in PNG. Methods An extensively validated platform (‘Policy1-Cervix’) was calibrated to PNG. A total of 38 strategies were selected for investigation, and these incorporated variations in age ranges and screening frequencies and allowed for the identification of the optimal strategy across a wide range of possibilities. A selection of strategies that were identified as being the most effective and cost-effective were then selected for further investigation for longer-term outcomes and budget impact estimation. In the base case, we assumed primary HPV testing has a sensitivity to cervical intraepithelial neoplasia 2 (CIN2+) + of 91.8% and primary VIA of 51.5% based on our earlier field evaluation combined with evidence from the literature. We conservatively assumed HPV sampling and testing would cost US$18. Costs were estimated from a service provider perspective based on data from local field trials and local consultation. Results Self-collected HPV S&T was more effective and more cost-effective than VIA. Either twice or thrice lifetime self-collected HPV S&T would be cost-effective at 0.5× gross domestic product (GDP) per capita (incremental cost-effectiveness ratio: US$460–US$656/life-years saved; 1GDPper-capita: US$2829 or PGK9446 (year 2019)) and could prevent 33 000–42 000 cases and 23 000–29 000 deaths in PNG over the next 50 years, if scale-up reached 70% coverage from 2023. Conclusion Self-collected HPV S&T was effective and cost-effective in the high-burden, low-resource setting of PNG, and, if scaled-up rapidly, could prevent over 20 000 deaths over the next 50 years. VIA screening was not effective or cost-effective. These findings support, at a country level, WHO updated cervical screening guidelines and indicate that similar approaches could be appropriate for other low-resource settings.
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Affiliation(s)
| | - Kate T Simms
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam Keane
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Glen Mola
- Department of Reproductive Health, Obstetrics and Gynecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, CND, Papua New Guinea.,Department of Obstetrics and Gynecology, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - John Walpe Bolnga
- Department of Obstetrics and Gynecology, Modilion Hospital, Mango, Madang, Papua New Guinea
| | - Joseph Kuk
- Department of Obstetrics and Gynecology, Mt Hagen Provincial Hospital, Mt Hagen, Western Highlands Province, Papua New Guinea
| | - Pamela J Toliman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Steven G Badman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, Victoria, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Vallely
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Karen Canfell
- Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
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103
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Stoltzfus KC, Popalis ML, Reiter PL, Moss JL. Perspectives on self-sampling for cancer screening among rural and urban women: Multilevel factors related to acceptability. J Rural Health 2022; 38:391-397. [PMID: 34002407 PMCID: PMC8599503 DOI: 10.1111/jrh.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Self-sampling tests may be used to overcome barriers to screening that are more prevalent in rural populations compared to urban populations. This study aims to qualitatively examine the attitudes toward established and novel self-sampling tests for cervical and colorectal cancer among women, comparing themes from rural versus urban areas. METHODS We recruited women (ages 45-65) from 28 counties in Pennsylvania. Four focus groups were conducted with women from metropolitan counties, and 7 focus groups were conducted with women from nonmetropolitan counties. A brief survey was conducted prior to the focus group regarding general health and willingness to complete self-sampling tests for cervical and colorectal cancer. FINDINGS We identified 3 themes about the potential for self-sampling for cancer screening: advantages and disadvantages of self-sampling compared to traditional testing, impact of self-sampling on patient interactions with their health care providers/clinics, and implications for improving/worsening access to quality health care services. We detected differences in responses from rural versus urban participants in the potential impact of self-sampling for cancer screening. CONCLUSIONS There are several barriers and facilitators at the individual, interpersonal, and organizational levels that influence the feasibility of implementing self-sampling for cancer screening in routine clinical practice. Rural participants face unique barriers to cancer screening across all levels. These findings can be used to guide interventions aimed at increasing the use of self-sampling methods.
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Affiliation(s)
- Kelsey C. Stoltzfus
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Madyson L. Popalis
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Paul L. Reiter
- College of Public Health, The Ohio State University, Columbus, Ohio
| | - Jennifer L. Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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Arbyn M, Latsuzbaia A, Castle PE, Sahasrabuddhe VV, Broeck DV. HPV testing of self-samples: Influence of collection and sample handling procedures on clinical accuracy to detect cervical precancer. Lancet Reg Health Eur 2022; 14:100332. [PMID: 35243475 PMCID: PMC8857649 DOI: 10.1016/j.lanepe.2022.100332] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Sechi I, Elvezia CC, Martinelli M, Muresu N, Castriciano S, Sotgiu G, Piana A. Comparison of Different Self-Sampling Devices for Molecular Detection of Human Papillomavirus (HPV) and Other Sexually Transmitted Infections (STIs): A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10030459. [PMID: 35326937 PMCID: PMC8950387 DOI: 10.3390/healthcare10030459] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Cervical cancer is the fourth most common cancer in women, and it is well known that high-risk human papillomavirus (hrHPV) infections are the necessary carcinogenic factors for the development of cervical tumors. Moreover, the interaction between HPV and other sexually transmitted infections (STIs) may increase the risk of cancer progression. Self-sampling has been demonstrated to represent a valid and well-accepted alternative, favoring women’s participation in screening programs. This study aimed to investigate the use of FLOQSwabs® (FS) as compared to two other vaginal self-collection devices for the detection of hrHPV and other sexually transmitted infections. Methods: Cervical and vaginal self-samples were collected, using two different combinations of vaginal self-sampling devices, from 40 women referred to colposcopy for a documented abnormal Pap smear. All samples were tested for hrHPV and seven STI pathogens using two commercial molecular assays. Results: Data on hrHPV detection from the first group of women showed an almost perfect agreement (kappa: 0.89) between cervical vs. FS vaginal self-samples, and a substantial agreement (kappa: 0.79) between cervical and HerSwab™ (HS) samples. In the second group of women, an almost perfect agreement (kappa: 0.90) was demonstrated in the detection of hrHPV between cervical samples vs. FS, and a moderate agreement (kappa: 0.60) for cervical vs. Evalyn®Brush (EB) self-collected samples. STI detections showed a very good agreement (kappa: 0.89 and kappa: 1.00) both among FS vs. HS and FS vs. EB, respectively. There was no statistically significant difference between the different devices used. The most frequently detected hrHPV genotypes in the studied population were HPV 16, 31, 35, 51, and 56; whilst the most frequently identified STI pathogens were Ureaplasma parvum and Mycoplasma hominis. Overall, investigated women did not report any discomfort in using the different vaginal self-collection devices. Conclusion: Evaluation of the three different vaginal self-collection devices confirmed their overall good acceptability by the studied population, as well as a similar agreement for hrHPV detection as compared to cervical samples. Our study indicated that the use of self-collected samples offers an alternative strategy to improve women’s participation in cervical cancer screening programs, but also underlined the importance of evaluating the concordance in hrHPV detection of collection devices in combination with the molecular hrHPV assay.
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Affiliation(s)
- Illari Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street 4, 07029 Sassari, Italy; (I.S.); (N.M.); (A.P.)
| | - Cocuzza Clementina Elvezia
- Department of Medicine and Surgery, University of Milano-Bicocca, Cadore Street, 48, 20900 Milano, Italy;
- Correspondence:
| | - Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Cadore Street, 48, 20900 Milano, Italy;
| | - Narcisa Muresu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street 4, 07029 Sassari, Italy; (I.S.); (N.M.); (A.P.)
| | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street 4, 07029 Sassari, Italy;
| | - Andrea Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Padre Manzella Street 4, 07029 Sassari, Italy; (I.S.); (N.M.); (A.P.)
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106
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Lefeuvre C, De Pauw H, Le Duc Banaszuk AS, Pivert A, Ducancelle A, Rexand-Galais F, Arbyn M. Study Protocol: Randomised Controlled Trial Assessing the Efficacy of Strategies Involving Self-Sampling in Cervical Cancer Screening. Int J Public Health 2022; 67:1604284. [PMID: 35283720 PMCID: PMC8907121 DOI: 10.3389/ijph.2022.1604284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/26/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives: The cervical cancer screening coverage remains moderate (60%) in France. The aim of the study is to evaluate the efficacy of two experimental invitation strategies (offer of urine or vaginal self-sampling kits) to reach under-screened populations and compare them with the current invitation strategy in rural departments (low medical density and low participation rate) in France. Methods: The study is a randomised controlled trial with three arms: a control arm (conventional invitation letter) and two experimental arms (mailing of a urine or vaginal self-sampling kit). The target population includes women aged 30-65 years, who had no screening test recorded since more than 4 years and who did not respond to an invitation letter within 12 months before. The primary outcome measure is the participation rate in each arm. A team of psychologists will also investigate attitudes and experiences by semi-structured/focus-group interviews with voluntary CapU4 participants and with health professionals. Result and conclusion: CapU4 will identify effective strategies to reach women not responding to current screening invitations and will generate information about acceptance of self-sampling among women and health professionals.
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Affiliation(s)
- Caroline Lefeuvre
- Université d’Angers, HIFIH, UPRES EA 3859, Angers, France
- Département de Biologie des Agents Infectieux, Laboratoire de Virologie, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Hélène De Pauw
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Anne-Sophie Le Duc Banaszuk
- Centre Régional de Coordination de Dépistages des Cancers Pays de la Loire (CRCDC Pays de La Loire), Angers, France
| | - Adeline Pivert
- Université d’Angers, HIFIH, UPRES EA 3859, Angers, France
- Département de Biologie des Agents Infectieux, Laboratoire de Virologie, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Alexandra Ducancelle
- Université d’Angers, HIFIH, UPRES EA 3859, Angers, France
- Département de Biologie des Agents Infectieux, Laboratoire de Virologie, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Franck Rexand-Galais
- Laboratoire CLiPsy (BePsyLab), Faculté des Lettres, Langues et Sciences Humaines, Département Psychologie, Maison de la Recherche Germaine Tillon, Université d'Angers, Angers, France
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
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107
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Whop LJ, Butler TL, Lee N, Cunningham J, Garvey G, Anderson K, Condon JR, Tong A, Moore S, Maher CM, Mein JK, Warren EF, Brotherton JML. Aboriginal and Torres Strait Islander women's views of cervical screening by self-collection: a qualitative study. Aust N Z J Public Health 2022; 46:161-169. [PMID: 35112767 DOI: 10.1111/1753-6405.13201] [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: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to describe Aboriginal and Torres Strait Islander women's views of self-collection introduced in the renewed National Cervical Screening Program. METHODS A total of 79 Aboriginal and/or Torres Strait Islander women (50 screened in previous five years, 29 under-screened) from five clinics across three Australian states/territories participated. Topics discussed were perceptions of self-collection, the instruction card and suggestions for implementing self-collection. We employed yarning (a qualitative method), which established relationships and trust between participants and researchers to facilitate culturally safe conversations. Transcripts were analysed thematically. RESULTS Most women were unaware of self-collection before the yarn but found it to be an acceptable way to participate in cervical screening. Women perceived self-collection would be convenient, provide a sense of control over the screening experience, and maintain privacy and comfort. The instructions were perceived to be simple and easy to follow. Women had concerns about collecting the sample correctly and the accuracy of the sample (compared to clinician-collected samples). CONCLUSIONS Self-collection is acceptable to Aboriginal and Torres Strait Islander women. Implications for public health: Given the inequitable burden of cervical cancer experienced by Aboriginal and Torres Strait Islander women, self-collection is likely to significantly improve participation and ultimately improve cervical cancer outcomes.
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Affiliation(s)
- Lisa J Whop
- National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Tamara L Butler
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Natasha Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Gail Garvey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - Kate Anderson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,School of Public Health, University of Queensland, Queensland
| | - John R Condon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, New South Wales
| | - Suzanne Moore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Northern Territory
| | - Clare M Maher
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Jacqueline K Mein
- Tropical Public Health Services Cairns, Cairns and Hinterland Hospital Health Service, Queensland Health, Queensland
| | - Eloise F Warren
- Yerin Eleanor Duncan Aboriginal Health Centre, New South Wales
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, Victoria.,Melbourne School of Population and Global Health, University of Melbourne, Victoria
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108
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Cervical Cancer Prevention and High-Risk HPV Self-Sampling Awareness and Acceptability among Women Living with HIV: A Qualitative Investigation from the Patients’ and Providers’ Perspectives. Curr Oncol 2022; 29:516-533. [PMID: 35200547 PMCID: PMC8870184 DOI: 10.3390/curroncol29020047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Routine cervical cancer screening is important for women living with HIV (WLH) due to the greater incidence and persistence of high-risk HPV (HR-HPV) infection. HR-HPV self-sampling has been proposed to overcome barriers to in-office cervical cancer screening in underserved populations. However, little is known about baseline knowledge of HR-HPV and the acceptability of HR-HPV self-sampling among WLH. This paper describes WLH’s experiences and needs regarding cervical cancer screening, specifically HR-HPV self-sampling, and seeks to reconcile their experiences with the views of their providers. In total, 10 providers and 39 WLH participated in semi-structured interviews and group discussions, respectively. Knowledge of cervical cancer and HR-HPV was generally limited among WLH; when present, it was often due to personal experience of or proximity to someone affected by cervical cancer. Most WLH were not familiar with HR-HPV self-sampling but, despite some of the providers’ skepticism, expressed their willingness to participate in a mail-based HR-HPV self-sampling intervention and highlighted convenience, ease of use, and affordability as facilitators to the uptake of HR-HPV self-sampling. The experiences identified can be used to guide patient-centered communication aimed at improving cervical cancer knowledge and to inform interventions, such as HR-HPV self-sampling, designed to increase cervical cancer screening among under-screened WLH.
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109
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Comparative assessment of test characteristics of cervical cancer screening methods for implementation in low-resource settings. Prev Med 2022; 154:106883. [PMID: 34785209 DOI: 10.1016/j.ypmed.2021.106883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 12/31/2022]
Abstract
Cervical cancer disproportionately affects low-resource settings. Papanicolaou, human papillomavirus (HPV), and visual inspection of cervix with acetic acid (VIA) testing, each with different characteristics, will reduce cervical cancer burden. We conducted a critical literature review using PubMed, Cochrane, WHO, and grey literature from 1994 to 2020. We examined efficacy, harms, and comparative effectiveness of screening methods by age, human immunodeficiency virus, provider characteristics, and assessed implementation challenges in low-resource settings. Comprehensive data on utility and efficacy of screening tests indicates that each screening has strengths and shortcomings but all confer acceptable performance. HPV and VIA appear more promising. Primary HPV test-and-treat, self-testing, and co-testing have been studied but data on triage plans, cost, support system, implementation and sustainability is unclear in low-resource settings. HPV testing could help target subgroups of older or higher risk women. VIA offers local capacity-building and scalability. Quality VIA technique after HPV testing is still required to guide post-screening treatments. VIA competencies decline gradually with current standard trainings. Stationary cervicography improves VIA quality but isn't scalable. Affordable smartphones eliminate this barrier, enhance training through mentorship, and advance continuing education and peer-to-peer training. Smartphone-based VIA facilitates cervical image storage for patient education, health promotion, record-keeping, follow-up care, remote expert support, and quality control to improve VIA reliability and reproducibility and reduce mis-diagnoses and burden to health systems. Rather than ranking screening methods using test characteristics alone in study or higher-resource settings, we advocate for scalable strategies that maximize reliability and access and reduce cost and human resources.
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110
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Mamo L, Pérez AE, Rios L. Human papillomavirus self-sampling: A tool in cancer prevention and sexual health promotion. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:218-235. [PMID: 34904724 DOI: 10.1111/1467-9566.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
Abstract
This article examines human papillomavirus (HPV) self-sampling as an approach to cervical cancer prevention and the ways self-sampling kits are promoted directly to consumers in the United States. Public health, biomedicine and health tech have increasingly imagined self-sampling, which allows individuals to collect their own vaginal specimen, mail to a laboratory for testing and receive delivered results, as a component of cervical cancer prevention and sexual health promotion. This article examines the scientific and biomedical claims used to configure the problem in need of this solution and the ways persons, publics and markets are established. We analyse scientific literature, interviews with clinicians and other key actors, and websites of directly to consumers (DTC) companies. HPV self-sampling is constructed as both a solution to inequities and gaps in cervical cancer screening and a solution to the wants and needs of those already engaged in self-projects of body monitoring and risk reduction. These multidirectional biomedical tendencies also reveal how sexuality and sexual health and cervical cancer prevention and sexual health promotion are entangled objects. While we do not want to undermine the potential of HPV self-sampling, we encourage a focus on equity and care and not commodified markets that reinforce notions of 'good' patients monitoring their health.
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Affiliation(s)
- Laura Mamo
- Department of Public Health, San Francisco State University, San Francisco, California, USA
- Health Equity Institute, San Francisco State University, San Francisco, California, USA
| | - Ashley E Pérez
- Health Equity Institute, San Francisco State University, San Francisco, California, USA
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lucy Rios
- Public Health Sciences, University of California, Davis, California, USA
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111
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Joseph NT, Namuli A, Kakuhikire B, Baguma C, Juliet M, Ayebare P, Ahereza P, Tsai AC, Siedner MJ, Randall TR, Ngonzi J, Boatin AA. Implementing community-based human papillomavirus self-sampling with SMS text follow-up for cervical cancer screening in rural, southwestern Uganda. J Glob Health 2021; 11:04036. [PMID: 35003710 PMCID: PMC8709902 DOI: 10.7189/jogh.11.04036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Self-collected HPV screening may improve cervical cancer screening coverage in low resource countries, yet data guiding implementation and follow-up of abnormal results are sparse. METHODS This is a prospective cohort implementation study of HPV self-testing program in Mbarara, Uganda with mobile phones to facilitate result notification and referral for treatment at a regional hospital. The effectiveness of the interventions was analyzed using Proctor's model of implementation. Women were interviewed following screening and at 6 months to assess acceptability and barriers to follow-up. Data were analyzed using descriptive statistics. RESULTS 159 of 194 (82%) of eligible women underwent HPV self-sampling; of these, 27 (17%) returned positive for high-risk HPV subtypes. We sent SMS messages providing test results and follow-up instructions to all participants. Seventeen (63%) hrHPV-positive participants reported receiving SMS text instructions for follow-up, of whom 6 (35%) presented for follow-up. The most common reasons for not returning were: lack of transportation (n = 11), disbelief of results (n = 5), lack of childcare (n = 4), and lack of symptoms (n = 3). Confidence in test results was higher for self-screening compared to VIA (Likert score 4.8 vs 4.4, P = 0.001). CONCLUSIONS Despite the use of SMS text-based referrals, only one-third of women presented for clinical follow-up after abnormal HPV testing.
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Affiliation(s)
- Naima T Joseph
- Department of Obstetrics and Gynecology, Beth Isreal Deaconness Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alexcer Namuli
- Department of Obstetrics & Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Mark J Siedner
- Harvard Medical School, Boston, MA, USA
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas R Randall
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Ngonzi
- Department of Obstetrics & Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adeline A Boatin
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
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112
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Inturrisi F, Aitken CA, Melchers WJ, van den Brule AJ, Molijn A, Hinrichs JW, Niesters HG, Siebers AG, Schuurman R, Heideman DA, de Kok IM, Bekkers RL, van Kemenade FJ, Berkhof J. Clinical performance of high-risk HPV testing on self-samples versus clinician samples in routine primary HPV screening in the Netherlands: An observational study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 11:100235. [PMID: 34918001 PMCID: PMC8642706 DOI: 10.1016/j.lanepe.2021.100235] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background High-risk human papillomavirus (hrHPV) testing on self-collected samples has potential as a primary screening tool in cervical screening, but real-world evidence on its accuracy in hrHPV-based screening programmes is lacking. Methods In the Netherlands, women aged 30–60 years invited for cervical screening can choose between sampling at the clinician's office (Cervex Brush) or self-sampling at home (Evalyn Brush). HrHPV testing is performed using Roche Cobas 4800. We collected screening test results between January 2017 and March 2018 and histological follow-up until August 2019. The main outcome measures were mean cycle threshold (Ct) value, cervical intraepithelial neoplasia (CIN) grade 3 or cancer (CIN3+) and CIN grade 2 or worse (CIN2+). Findings 30,808 women had a self-collected and 456,207 had a clinician-collected sample. In hrHPV-positive women with adequate cytology, Ct values were higher for self-collection than clinician-collection with a mean Ct difference of 1·25 (95% CI 0·98–1·52) in women without CIN2+, 2·73 (1·75–3·72) in CIN2 and 3·59 (3·03–4·15) in CIN3+. The relative sensitivity for detecting CIN3+ was 0·94 (0·90–0·97) for self-collection versus clinician-collection and the relative specificity was 1·02 (1·02–1·02). Interpretation The clinical accuracy of hrHPV testing on a self-collected sample for detection of CIN3+ is high and supports its use as a primary screening test for all invited women. Because of the slightly lower sensitivity of hrHPV testing on a self-collected compared to a clinician-collected sample, an evaluation of the workflow procedure to optimise clinical performance seems warranted. Funding National Institute for Public Health and the Environment (the Netherlands) and the European Commission.
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Affiliation(s)
- Federica Inturrisi
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, 1081 HV Amsterdam, Netherlands
- Corresponding author at: Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Clare A. Aitken
- Erasmus MC University Medical Center, Public Health, 3015 GD Rotterdam, Netherlands
- Erasmus MC University Medical Center, Pathology, 3015 GD Rotterdam, Netherlands
| | - Willem J.G. Melchers
- Radboud University Medical Center, Medical Microbiology, 6525 GA Nijmegen, Netherlands
| | | | | | | | - Hubert G.M. Niesters
- University Medical Center Groningen, University of Groningen, Medical Microbiology, 9713 GZ Groningen, Netherlands
| | | | - Rob Schuurman
- University Medical Center Utrecht, Medical Microbiology, 3584 CX Utrecht, Netherlands
| | - Daniëlle A.M. Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, 1081 HV Amsterdam, Netherlands
| | - Inge M.C.M. de Kok
- Erasmus MC University Medical Center, Public Health, 3015 GD Rotterdam, Netherlands
| | - Ruud L.M. Bekkers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, Netherlands
- Catharina Hospital, 5623 EJ Eindhoven, Netherlands
| | | | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, 1081 HV Amsterdam, Netherlands
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113
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Nwaozuru U, Obiezu-Umeh C, Obi-Jeff C, Shato T, Gbaja-Biamila T, Oladele D, Idigbe I, Tucker J, Ezechi O, Iwelunmor J. A systematic review of randomized control trials of HPV self-collection studies among women in sub-Saharan Africa using the RE-AIM framework. Implement Sci Commun 2021; 2:138. [PMID: 34911573 PMCID: PMC8672475 DOI: 10.1186/s43058-021-00243-5] [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: 01/19/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Self-collection of samples for HPV testing may increase women’s access to cervical cancer screening in low- and middle-income settings. However, implementation remains poor in many regions. The purpose of this systematic review was to examine implementation data from randomized controlled trials evaluating human papillomavirus (HPV) self-collection testing among women in sub-Saharan Africa using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. Methods We searched four electronic databases (PubMed, CINAHL, Web of Science, and Global Health) for pragmatic randomized controlled trials that promote HPV self-collection among women in sub-Saharan Africa. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist. Two researchers independently extracted information from each article using a RE-AIM data extraction tool. The reporting of RE-AIM dimensions was summarized and synthesized across included interventions. Results We identified 2008 citations, and eight studies were included. These reported on five unique interventions. The five interventions were conducted in five countries: Cameroon, Ethiopia, Kenya, Nigeria, and Uganda. Intervention reach (80%) was the most commonly reported RE-AIM dimension, followed by adoption (56%), efficacy/effectiveness (52%), implementation (47%), and maintenance (0%). All the interventions described increased uptake of HPV testing among study participants (effectiveness). However, the majority of the studies focused on reporting internal validity indicators such as inclusion criteria (100%) and exclusion criteria (100%), and few reported on external validity indicators such as participation rate (40%), intervention cost (40%), staff selection (20%), and cost of maintenance (0%). Conclusions Our review highlights the under-reporting of external validity indicators such as participation rate, intervention, and maintenance costs in studies of self-collection for HPV testing among women in SSA. Future research should focus on including factors that highlight internal validity factors and external validity factors to develop a greater understanding of ways to increase not only reach but also implementation and long-term maintenance of these interventions. Such data may advance the translation of HPV interventions into practice and reduce health disparities in SSA. Findings highlight the need for innovative tools such as participatory learning approaches or open challenges to expand knowledge and assessment of external validity indicators to ultimately increase the uptake of HPV testing among women in SSA. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00243-5.
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Affiliation(s)
- Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette, Ave, Saint Louis, Missouri, 63104, USA
| | - Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette, Ave, Saint Louis, Missouri, 63104, USA
| | - Chisom Obi-Jeff
- Direct Consulting and Logistics, Federal Capital Territory, Abuja, Nigeria
| | - Thembekile Shato
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box, 1196, St. Louis, Missouri, 63130, USA
| | - Titilola Gbaja-Biamila
- Clinical Sciences Division, Nigerian Institute of Medical Research, Medical Compound, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - David Oladele
- Clinical Sciences Division, Nigerian Institute of Medical Research, Medical Compound, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Ifeoma Idigbe
- Clinical Sciences Division, Nigerian Institute of Medical Research, Medical Compound, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Joseph Tucker
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Ezechi
- Clinical Sciences Division, Nigerian Institute of Medical Research, Medical Compound, 6 Edmund Crescent, Yaba, Lagos, Nigeria
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette, Ave, Saint Louis, Missouri, 63104, USA.
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Han X, Song G, Li Y, Dong Z, Yan X, Wang S, Tian H, Wu X, Li C, Huo Y. Prevalence and genotype distribution of human papillomavirus infection among women aged 30-65 years in Xi'an, China: a population-based study of 14,655 women. Hum Vaccin Immunother 2021; 17:5439-5446. [PMID: 34893010 DOI: 10.1080/21645515.2021.2007709] [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] [Indexed: 12/16/2022] Open
Abstract
Cervical cancer is the fourth most common cancer among women worldwide in terms of both incidence and mortality. Persistent infection with high-risk human papillomavirus (HPV) has been identified as a cause of cervical intraepithelial neoplasia and invasive cervical cancer. The distribution of human papillomavirus genotypes varies regionally. To acquire baseline data on the population-based prevalence and genotype distribution of HPV infection, we investigated the molecular epidemiology of HPV infection among women in Xi'an, China. The study was conducted from September 2018 to December 2020. A total of 14,655 women aged 30-65 years were screened. The overall prevalence of HPV infection was 13.5% (95% confidence interval [CI]: 13.0-14.1%), with 10.4% of participants being positive for a single HPV type and 3.1% being positive for multiple HPV types. The prevalence of high-risk HPV (HR-HPV), low-risk HPV (LR-HPV) and mixed HPV infection was 10.1% (95% CI: 9.6-10.5%), 2.2% (95% CI: 2.0-2.4%), and 1.3% (95% CI: 1.1-1.5%), respectively. The five most frequently detected HR-HPV types were types 52 (2.6%), 16 (1.9%), 53 (1.8%), 58 (1.4%), and 51 (0.9%). The most frequently detected LR-HPV type was HPV-42 (1.1%). The prevalence and HPV genotype distribution varied by region and age. Age-specific HPV prevalence peaked in the over 60 years age group (18.8%), and Beilin District had the highest HPV prevalence (18.1%). The results of this first population-based study provide a reference for HPV-based cervical cancer screening and HPV vaccination programs in Xi'an.
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Affiliation(s)
- Xiaoxiao Han
- Department of Laboratory Medicine, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Guozhong Song
- Department of Laboratory Medicine, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Yufang Li
- Nuclear Medicine Diagnostic Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Zhaoqiang Dong
- Department of Laboratory Medicine, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Xianchun Yan
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, China
| | - Suqing Wang
- Department of Science and Education, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Huizhen Tian
- Department of Laboratory Medicine, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Xiaohong Wu
- Department of Women's Health, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Chen Li
- Department of Women's Health, Xi'an Maternal and Child Health Care Hospital, Xi'an, China
| | - Yi Huo
- Department of Laboratory Medicine, 941 Hospital of Joint Logistics Support Force of PLA, Xining, China.,State Key Laboratory of Cancer Biology, Department of Immunology, Fourth Military Medical University, Xi'an, China
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Viviano M, Vassilakos P, Meyer-Hamme U, Grangier L, Emery SL, Malinverno MU, Petignat P. HPV self-sampling in the follow-up of women after treatment of cervical intra-epithelial neoplasia: A prospective study in a high-income country. Prev Med Rep 2021; 24:101564. [PMID: 34976630 PMCID: PMC8683961 DOI: 10.1016/j.pmedr.2021.101564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/26/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Manuela Viviano
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
- Corresponding author at: Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Genève, Switzerland.
| | - Pierre Vassilakos
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
- Geneva Foundation for Medical Research, Geneva, Switzerland
| | | | - Lorraine Grangier
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Patrick Petignat
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
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Stanczuk GA, Currie H, Forson W, Baxter G, Lawrence J, Wilson A, Palmer T, Arbyn M, Cuschieri K. Self-sampling as the principal modality for population based cervical screening: Five-year follow-up of the PaVDaG study. Int J Cancer 2021; 150:1350-1356. [PMID: 34850395 PMCID: PMC9300001 DOI: 10.1002/ijc.33888] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 01/21/2023]
Abstract
Self-sampling provides a powerful means to engage women in cervical screening. In the original Papillomavirus Dumfries and Galloway study (PaVDaG), we demonstrated cross-sectional similarity of high-risk human papillomavirus (Hr-HPV) testing on self-taken vaginal vs clinician-taken samples for the detection of cervical intraepithelial neoplasia 2 or worse (CIN2+). Few data exist on the longitudinal performance of self-sampling; we present longitudinal outcomes of PaVDaG. Routinely screened women provided a self-taken and a clinician-collected sample. Ninety-one percent of 5136 women from the original cohort completed a further screening round. Sensitivity, specificity, positive predictive value and complement of the negative predictive value of the Hr-HPV test on self-samples for detection of CIN2+ and CIN3+ up-to 5 years after testing were determined. Additionally, clinical accuracy of Hr-HPV testing on vaginal and clinician-collected samples was assessed. A total of 183 CIN2+ and 102 CIN3+ lesions were diagnosed during follow-up. Risk of CIN2+ and CIN3+ following an Hr-HPV negative self-sample was 0.6% and 0.2%, respectively, for up to 5 years after testing. The relative sensitivity for CIN3+ and specificity for ≤CIN1 of Hr-HPV testing on self-taken specimens was slightly lower vs clinician-collected samples: 0.95 (95% CI: 0.90-0.99; PMcN = .0625) and 0.98 (95% CI: 0.95-1.00; PMcN = <.0000), respectively. The low risk of CIN2+ in women with Hr-HPV-self-sample(s) suggests, that the 3 to 5-year recall interval implemented in several cervical screening settings, based on clinician-taken samples, may be safe for self-samples. Future assessment will show if "universal" 5-year screening is appropriate for programs based on self-sampling.
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Affiliation(s)
- Grazyna A Stanczuk
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, UK.,Global Health Academy, University of Edinburgh, Edinburgh, UK
| | - Heather Currie
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - William Forson
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | | | - James Lawrence
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Allan Wilson
- Department of Pathology, Monklands Hospital, Airdrie, UK
| | - Timothy Palmer
- Department of Pathology, University of Edinburgh, Edinburgh, UK
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, Brussels, Belgium.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
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Sahlgren H, Sparén P, Elfgren K, Miriam Elfström K. Feasibility of sending a direct send HPV self-sampling kit to long-term non-attenders in an organized cervical screening program. Eur J Obstet Gynecol Reprod Biol 2021; 268:68-73. [PMID: 34875556 DOI: 10.1016/j.ejogrb.2021.11.430] [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: 10/04/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Non-participation in screening is a main risk factor for cervical cancer. Human-papillomavirus (HPV) self-sampling may be an alternative to repeated invitations for non-attenders. Several studies have concluded that participation among non-attenders increases significantly when offering self-sampling kits for HPV. However, participation rates are highly variable between settings, and therefore pilots to determine optimal implementation strategy have been recommended before routine roll out. MATERIALS AND METHODS All women who had not participated in the organized screening program for at least 10 years aged 33-62 in one Swedish county were identified through screening registers. HPV self-sampling kits were sent to all eligible women. Participation was defined as returning a self-sample kit or attending routine screening within 6 months. Women who did not submit the kit within 8 weeks were randomized to receive a written reminder. HPV-positive women were referred directly to colposcopy without prior triage. Biopsies for histopathologic confirmation were used as gold standard. RESULTS Among eligible women, 150/741 (20.2%) returned the self-sample kit or attended routine screening. A randomized written reminder was sent out to 319/591 non-responders and another 11 women returned the kit. In total, 23/147 (16.3%) of returned kits were HPV positive. Out of the 23 HPV-positive women, 17 (74%) attended colposcopy; 10/17 (59%) had a histopathological high-grade squamous intraepithelial lesions (HSIL) or cervical cancer. The most common HPV type was HPV 52, and 2 out of 3 women with HPV 16 had a histopathologically confirmed cancer. CONCLUSION The direct send kit strategy and referral of all HPV-positive women to colposcopy without prior triage appears to be feasible if resources are available and should be prioritized given the high prevalence of HSIL lesions and cancer among non-attenders. A written reminder might further increase attendance.
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Affiliation(s)
- Hanna Sahlgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Regional Cancer Center, Uppsala, Sweden.
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Kristina Elfgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Center for Cervical Cancer Prevention, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
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Abulizi G, Mijiti P, Naizhaer G, Tuerxun G, Abuduxikuer G, Zhang YY, Li H, Abulimiti T, Abudurexiti G, Aierken K, Lu L, Maimaiti A. At what age should the Uyghur minority initiate cervical cancer screening if screened using careHPV. Cancer Med 2021; 10:9022-9029. [PMID: 34816621 PMCID: PMC8683549 DOI: 10.1002/cam4.4409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 12/29/2022] Open
Abstract
Background The careHPV test as a primary screening method for cervical cancer has been proven to be the best option for Uyghur women in Xinjiang in a previous study. In this research, we aim to discuss the appropriate age for Uyghur women in Xinjiang to be screened for cervical cancer using careHPV. Methods Eleven thousand women aged 20–69 years old (mean age 38.93 ± 9.74) from South Xinjiang were screened using careHPV and liquid‐based cytology, and the positive results were referred for colposcopy and cervical biopsy. A questionnaire regarding basic social characteristics, sexual practices, and reproductive history was administered to each woman. The age‐specific prevalence of HPV positivity, cytology abnormality, and cervical intraepithelial neoplasia (CIN) 2+ in ≥25, ≥30, and ≥35 age groups were analyzed, and the diagnostic value of careHPV in the three age groups was evaluated. The chi‐squared test was used to compare the differences between age groups. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve were calculated. Results The women were mostly married (76.3%) and delivered at 15–19 years of age (61.4%). The HPV infection rate was 9.15% and detection rates of CIN2+ and invasive cervical cancer were 1.53% (1530/100,000) and 0.25% (250/100,000), respectively. The first peak of HPV(+) appeared at the age of 30–34, while CIN2+ appeared at 35–39. CareHPV performed similarly well in the three age groups. Conclusion Based on the results of our study, Uyghur women in Xinjiang should be recommended to initiate cervical cancer screening at the age of 30 years when screened using careHPV.
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Affiliation(s)
- Guzhalinuer Abulizi
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Patiman Mijiti
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Gulimire Naizhaer
- 3rd Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Gulixian Tuerxun
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Guzhanuer Abuduxikuer
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuan-Yuan Zhang
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Hua Li
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Tangnuer Abulimiti
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Guligeina Abudurexiti
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Kailibinuer Aierken
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Ling Lu
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Anaerguli Maimaiti
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
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Tiiti TA, Mashishi TL, Nkwinika VV, Molefi KA, Benoy I, Bogers J, Selabe SG, Lebelo RL. Evaluation of ILEX SelfCerv for Detection of High-Risk Human Papillomavirus Infection in Gynecology Clinic Attendees at a Tertiary Hospital in South Africa. J Clin Med 2021; 10:jcm10214817. [PMID: 34768334 PMCID: PMC8584638 DOI: 10.3390/jcm10214817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The SelfCerv Self-Collection Cervical Health Screening Kit (Ilex Medical Ltd., Johannesburg, South Africa) is an applicator tampon designed for self-collection of vaginal samples for the detection of human papillomavirus (HPV) deoxyribonucleic acid (DNA) and E6/E7 messenger ribonucleic acid (mRNA). The study aimed to evaluate the performance of the SelfCerv applicator tampon for the detection of hr-HPV for cervical cancer screening, and further to investigate women's experiences and preferences regarding self-sampling. METHODS Vaginal samples were collected from 527 gynecology clinic attendees aged ≥18 years at a tertiary hospital in Gauteng Province, South Africa. Self-samples were collected using the SelfCerv kit, followed by endocervical samples collected by a healthcare professional using Cervex-Brush® Combi. Participants completed a self-administered questionnaire on self-sampling experiences and preferences. Both samples were tested for 14 high-risk (hr) HPV types and E6/E7 mRNA using the Abbott RealTime HR-HPV and Aptima HR-HPV mRNA assays, respectively. RESULTS The overall agreement for hr-HPV typing between 527 paired samples was good (87.1%; κ =0.74) with high sensitivity (86.2%) and specificity (88.0%). HPV-16 (96.4%; κ = 0.83) had higher agreement rate than HPV-18 (96.8%; κ = 0.72) and the other 12 hr-HPVs (86.5%; κ = 0.72). Two hundred and eighty-five (285) sample pairs tested for E6/E7 mRNA showed fair agreement (70.2%; κ= 0.34). Furthermore, self-sampling was reported as comfortable (90.5%) and painless (86.7%), with 88.4% of women preferring self-collection. CONCLUSIONS Self-collected samples had good agreement with the healthcare professional-collected samples for the detection of hr-HPV DNA and the procedure was highly preferred by women. Self-sampling using SelfCerv can be used as an alternative to healthcare professional sampling in clinic-based routine cervical cancer screening.
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Affiliation(s)
- Teboho Amelia Tiiti
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
| | - Tebogo Loraine Mashishi
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
| | - Varsetile Varster Nkwinika
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Kgotlaethata Aaron Molefi
- Department of Obstetrics and Gynaecology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Ina Benoy
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, 2020 Antwerpen, Belgium
| | - Johannes Bogers
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, 2020 Antwerpen, Belgium
- Department of Anatomical Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Selokela Gloria Selabe
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- National Health Laboratory Service, Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Ramokone Lisbeth Lebelo
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- National Health Laboratory Service, Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Correspondence: ; Tel.: +27-12521-3038
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Cho HW, Shim SR, Lee JK, Hong JH. Accuracy of human papillomavirus tests on self-collected urine versus clinician-collected samples for the detection of cervical precancer: a systematic review and meta-analysis. J Gynecol Oncol 2021; 33:e4. [PMID: 34783207 PMCID: PMC8728664 DOI: 10.3802/jgo.2022.33.e4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The human papillomavirus (HPV) test is an effective screening tool to prevent cervical cancer. Urinary sampling for HPV detection improves the accessibility and participation of screening services and reduces the cost and burden on physicians. The clinical accuracy of urinary HPV test has yet to be determined via meta-analysis. This study assessed the clinical accuracy of these tests to detect cervical intraepithelial neoplasia (CIN) 2 or worse. Methods Relevant studies were identified using the PubMed, Embase, and Cochrane databases. Research eligibility was based on the clinical accuracy of HPV test on clinician-collected samples as a comparator test, and urine as an index test. The reference standard was the presence of CIN2 or worse. The pooled absolute, relative sensitivity, and specificity of the urinary HPV test versus clinician-collected samples were assessed using a bivariate model. Results The pooled sensitivity of urinary HPV test was significantly lower than that of clinician-collected samples (ratio=0.84, 95% confidence interval [CI]=0.78–0.91). However, some polymerase chain reaction (PCR)-based HPV test such as GP5+/6+ (relative sensitivity=0.98, 95% CI=0.91–1.05), SPF10 (relative sensitivity=0.98, 85% CI=0.88–1.08) and non GP5+/6+ PCR (relative sensitivity=1.00, 95% CI=0.88–1.14) showed similar sensitivity in both the urine and clinician-collected samples. Conclusion Our findings indicate that HPV test with some PCR-based assay on urine versus clinician-collected samples demonstrate similar clinical accuracy to detect CIN2 or worse. It suggests that urinary HPV test may present itself as a decent alternative screening tool for the detection of cervical pre-cancer. Trial Registration PROSPERO identifier: CRD42021227901 Some polymerase chain reaction-based human papillomavirus (HPV) tests showed similar accuracy in urine and cervical samples. Signal amplification or messenger RNA HPV test on urine is less sensitive than cervical test. High-risk HPV assays is the only significant factor to affect test accuracy. Urinary HPV test may be an alternative option for cervical cancer screening.
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Affiliation(s)
- Hyun-Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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CoCoss-Trial: Concurrent Comparison of Self-Sampling Devices for HPV-Detection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910388. [PMID: 34639688 PMCID: PMC8508434 DOI: 10.3390/ijerph181910388] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
High-risk human papillomavirus (hr-HPV) infection of the cervicovaginal tract is known to be the major cause of cervical cancer. Similar to various other countries, Germany introduced an organized combined screening including cytology and HPV testing in 2020. The participation rate was around 70% in the past. Self-testing for hr-HPV infections could be an option to increase the participation rate. Two dry vaginal self-sampling devices and a device for the self-collection of first-void urine were evaluated in combination with a PCR-based hr-HPV test regarding their clinical performance (sensitivity for high-grade cervical intraepithelial neoplasia, CIN 2+). A cervical smear taken by a clinician during colposcopy was used as reference. This open prospective multicenter trial recruited patients referred to the two participating colposcopy clinics (Hannover Medical School and IZD Hannover, Germany) with abnormal results from cervical cancer screening from 05/2020 to 11/2020. All patients received three CE-certified self-sampling devices (FLOQSwabs, COPAN, Italy; Evalyn Brush, Rovers Medical Devices, the Netherlands; Colli-Pee FV-5000, Novosanis, Wijnegem, Belgium) with instructions to read and apply at home in a pre-specified alternating order without medical assistance. HPV testing was performed after adequate preservation and DNA extraction. Histological results from colposcopy or cervical excisional surgery after self-sampling were used as the gold-standard. The data of 65 patients were analyzed. All invasive cancer cases and over 90% of the CIN 3 lesions were found to be hr-HPV positive with all three self-collection devices. All devices were considered easy to use without any difficulties following the written instructions. Hr-HPV testing of self-collected first-void urine and dry vaginal self-samples showed a high sensitivity for CIN 3+ comparable to that of a clinician-taken smear. Self-sampling was well accepted as it is convenient and easy to use.
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Brewer N, Bartholomew K, Grant J, Maxwell A, McPherson G, Wihongi H, Bromhead C, Scott N, Crengle S, Foliaki S, Cunningham C, Douwes J, Potter JD. Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 16:100265. [PMID: 34590066 PMCID: PMC8427317 DOI: 10.1016/j.lanwpc.2021.100265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/01/2021] [Accepted: 08/08/2021] [Indexed: 12/02/2022]
Abstract
Background Internationally, self-sampling for human papillomavirus (HPV) has been shown to increase participation in cervical-cancer screening. In Aotearoa New Zealand, there are long-standing ethnic inequalities in cervical-cancer screening, incidence, and mortality, particularly for indigenous Māori women, as well as Pacific and Asian women. Methods We invited never- and markedly under-screened (≥5 years overdue) 30-69-year-old Māori, Pacific, and Asian women to participate in an open-label, three-arm, community-based, randomised controlled trial, with a nested sub-study. We aimed to assess whether two specific invitation methods for self-sampling improved screening participation over usual care among the least medically served populations. Women were individually randomised 3:3:1 to: clinic-based self-sampling (CLINIC – invited to take a self-sample at their usual general practice); home-based self-sampling (HOME – mailed a kit and invited to take a self-sample at home); and usual care (USUAL – invited to attend a clinic for collection of a standard cytology sample). Neither participants nor research staff could be blinded to the intervention. In a subset of general practices, women who did not participate within three months of invitation were opportunistically invited to take a self-sample, either next time they attended a clinic or by mail. Findings We randomised 3,553 women: 1,574 to CLINIC, 1,467 to HOME, and 512 to USUAL. Participation was highest in HOME (14.6% among Māori, 8.8% among Pacific, and 18.5% among Asian) with CLINIC (7.0%, 5.3% and 6.9%, respectively) and USUAL (2.0%, 1.7% and 4.5%, respectively) being lower. In fully adjusted models, participation was statistically significantly more likely in HOME than USUAL: Māori OR=9.7, (95%CI 3.0-31.5); Pacific OR=6.0 (1.8-19.5); and Asian OR=5.1 (2.4-10.9). There were no adverse outcomes reported. After three months, 2,780 non-responding women were invited to participate in a non-randomised, opportunistic, follow-on substudy. After 6 months,192 (6.9%) additional women had taken a self-sample. Interpretation Using recruitment methods that mimic usual practice, we provide critical evidence that self-sampling increases screening among the groups of women (never and under-screened) who experience the most barriers in Aotearoa New Zealand, although the absolute level of participation through this population approach was modest. Follow-up for most women was routine but a small proportion required intensive support. Trial registration ANZCTR Identifier: ACTRN12618000367246 (date registered 12/3/2018) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371741&isReview=true; UTN: U1111-1189-0531 Funding Health Research Council of New Zealand (HRC 16/405) Protocol http://publichealth.massey.ac.nz/assets/Uploads/Study-protocol-V2.1Self-sampling-for-HPV-screening-a-community-trial.pdf
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Affiliation(s)
- Naomi Brewer
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Jane Grant
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Anna Maxwell
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | | | - Helen Wihongi
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand
| | - Collette Bromhead
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Nina Scott
- University of Auckland, Waikato District Health Board, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Sunia Foliaki
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Chris Cunningham
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - John D Potter
- Research Centre for Hauora and Health, Massey University, PO Box 756, Wellington 6140, New Zealand.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Dare AJ, Knapp GC, Romanoff A, Olasehinde O, Famurewa OC, Komolafe AO, Olatoke S, Katung A, Alatise OI, Kingham TP. High-burden Cancers in Middle-income Countries: A Review of Prevention and Early Detection Strategies Targeting At-risk Populations. Cancer Prev Res (Phila) 2021; 14:1061-1074. [PMID: 34507972 DOI: 10.1158/1940-6207.capr-20-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system-related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory C Knapp
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anya Romanoff
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Akinwumi O Komolafe
- Department of Morbid Anatomy and Forensic Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical College - Owo, Owo, Nigeria
| | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
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Dick A, Holyk T, Taylor D, Wenninger C, Sandford J, Smith L, Ogilvie G, Thomlinson A, Mitchell-Foster S. Highlighting strengths and resources that increase ownership of cervical cancer screening for Indigenous communities in Northern British Columbia: Community-driven approaches. Int J Gynaecol Obstet 2021; 155:211-219. [PMID: 34496052 PMCID: PMC9293094 DOI: 10.1002/ijgo.13915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Abstract
Objective To examine the unique and diverse strengths held by rural and remote Indigenous communities in northern British Columbia, including multi‐generational support systems in health and wellness, profound connections to the land, and strong cultural foundations, and harness these strengths, allowing communities to engage in innovative and empowering health and wellness programs. Methods Building on these pre‐existing and fundamental strengths, an alternative option to cervical cancer screening was introduced to nine Carrier Sekani health centers located in northern interior British Columbia in response to disparities in screening rates. Introduced in 2019, CervixCheck uses a self‐collection approach that is private, safe, convenient, and offered at local community health centers by trained and supportive health staff. Results Using a strengths‐based and community directed and descriptive approach, the process was outlined for a successful and ongoing health screening opportunity that is put into the hands of community members within Indigenous communities in the region of northern British Columbia. Conclusion Through collaborative partnerships, in‐person engagement sessions, and the utilization of pre‐existing infrastructure and health and wellness teams, this project was successfully integrated into primary care centers using culturally safe and community‐based approaches. Building on inherent strengths within rural and remote Indigenous communities leads to successful development and implementation of cervical cancer screening alternatives.
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Affiliation(s)
- Alexanne Dick
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Travis Holyk
- Carrier Sekani Family Services, Prince George, British Columbia, Canada.,First Nations Studies, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Darlene Taylor
- BC Women's Hospital, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Judith Sandford
- Carrier Sekani Family Services, Prince George, British Columbia, Canada
| | - Laurie Smith
- BC Women's Hospital, Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Cancer, Cancer Control Research, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- BC Women's Hospital, Women's Health Research Institute, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Thomlinson
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Sheona Mitchell-Foster
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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De Pauw H, Donders G, Weyers S, De Sutter P, Doyen J, Tjalma WAA, Vanden Broeck D, Peeters E, Van Keer S, Vorsters A, Arbyn M. Cervical cancer screening using HPV tests on self-samples: attitudes and preferences of women participating in the VALHUDES study. ACTA ACUST UNITED AC 2021; 79:155. [PMID: 34462004 PMCID: PMC8403820 DOI: 10.1186/s13690-021-00667-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
Background Interventions to reach women who do not participate regularly in screening may reduce the risk of cervical cancer. Self-collection of a vaginal specimen has been shown to increase participation. The relative clinical accuracy of human papillomavirus (HPV) testing on first-void urine (with Colli-Pee) and on vaginal self-samples versus on cervical clinician-collected samples is being investigated in the VALHUDES trial. The current study assesses attitudes and experiences regarding self-sampling among women enrolled in VALHUDES. Methods Questionnaires from 515 women (age 25–64 years [N = 498]; < 25 [N = 10], age ≥ 65 [N = 3], enrolled between December 2017 - January 2020) referred to colposcopy because of previous cervical abnormalities and enrolled in VALHUDES (NCT03064087) were analysed. Results Of the 515 participants, nearly all women confirmed that self-sampling may help in reaching under-screened women (93%). Nevertheless, 44% of the participants stated before starting collection that a clinician-collected sample is more effective than a self-collected sample. After self-sampling, the large majority of women (> 95%) declared that instructions for self-collection were clear, that collection was easy, and that they were confident about having performed the procedure correctly, for both urine and vaginal collection. However, a proportion of women found self-sampling unpleasant (9.5% [49/515] for urine collection; 18.6% [96/515] and 15.5% [80/515] for vaginal sampling with cotton swabs or plastic brushes, respectively). For their next screening round, 57% would prefer self-sampling whereas 41% opted for collection by a clinician. Among women preferring self-sampling, 53% would choose for urine collection, 38% for vaginal self-collection and 9% had no preference. Age did not modify preferences. Conclusion We conclude that both urine and vaginal self-sampling are well accepted by women, with a preference for urine sampling. Although the large majority of women are confident in their ability to perform self-sampling, four to five over ten women preferred specimen collection by a clinician. Trial registration The study VALHUDES was registered in ClinicalTrials.gov (identifier: NCT03064087). Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00667-4.
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Affiliation(s)
- Hélène De Pauw
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J. Wytsmanstreet 14, B1050, Brussels, Belgium
| | - Gilbert Donders
- Department of Obstetrics and Gynaecology of the General Regional Hospital Heilig Hart (RZ Tienen), Tienen, Belgium.,Femicare vzw, Clinical Research for Women, Tienen, Belgium.,Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital (UZ Ghent), Ghent, Belgium.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Philippe De Sutter
- Department of Gynaecology & Oncology, Universitair Ziekenhuis Brussel (UZ Brussel) - Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jean Doyen
- Department Gynaecology-Obstetrics, Liège University Hospital (CHU Liège), Liège, Belgium
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Edegem, Belgium.,Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Davy Vanden Broeck
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Antwerp, Belgium.,National Reference Centre for HPV, Brussels, Belgium.,AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium.,International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Eliana Peeters
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J. Wytsmanstreet 14, B1050, Brussels, Belgium.,Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Severien Van Keer
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J. Wytsmanstreet 14, B1050, Brussels, Belgium. .,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
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Andersson S, Megyessi D, Belkić K, Alder S, Östensson E, Mints M. Age, margin status, high-risk human papillomavirus and cytology independently predict recurrent high-grade cervical intraepithelial neoplasia up to 6 years after treatment. Oncol Lett 2021; 22:684. [PMID: 34434283 PMCID: PMC8335741 DOI: 10.3892/ol.2021.12945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to identify the factors that independently contribute to disease recurrence among women first-time treated for high-grade cervical intraepithelial neoplasia (CIN) during 4–6 years of follow-up. Overall, 529 of 530 eligible patients participated; these patients all attended a 1st follow-up appointment ~6 months post-conization, at which time high-risk human-papillomavirus (HPV) testing, liquid-based cytology and colposcopy were performed. Full data on margin excision status, other aspects of initial treatment and comorbidity were obtained. At least one subsequent follow-up was attended by 88% of patients. A total of 22 recurrent cases were detected during follow-up. Detected recurrence was the outcome of focus for multiple logistic regression analysis, with odds ratios (OR) and 95% confidence intervals (CI) computed. Four significant independent risk factors were identified: Age 45 years or above (OR=3.5, 95% CI=1.3–9.9), one or both unclear or uncertain margins (OR=5.3, 95% CI=2.0–14.2), positive HPV at 1st follow-up (OR=5.8, 95% CI=2.0–16.8), and abnormal cytology at 1st follow-up (OR=3.9, 95% CI=1.4–11.0). Bivariate analysis revealed that persistent HPV positivity was associated with recurrence (P<0.01). These findings indicated that incomplete excision of the CIN lesion may warrant more intensive subsequent screening, regardless of early post-conization HPV findings. Although early post-conization positive HPV was a powerful, independent predictor of recurrent high-grade CIN, over one-third of the patients with detected recurrence had a negative early post-conization HPV finding. These patients returned for routine screening, at which time, in most cases, HPV status was positive, thus indicating the need for repeated HPV evaluation. Especially during the on-going pandemic, home vaginal self-sampling is recommended. Particular attention is required for women aged ≥45 years. In addition, although not statistically significant, relevant comorbidities, especially autoimmune conditions, warrant consideration in clinical decision-making. Women who have been treated for high-grade CIN are at risk for recurrent disease and progression to cervical cancer; therefore, they require careful, individualized follow-up to avoid these adverse consequences.
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Affiliation(s)
- Sonia Andersson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - David Megyessi
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Community/Global Health, Claremont Graduate University, Claremont, CA 91711, USA.,Institute for Health Promotion & Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Susanna Alder
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Ellinor Östensson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Medical Sciences, Faculty of Medicine-Health, Örebrö University, SE-70182 Örebrö, Sweden
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Patient Satisfaction With Human Papillomavirus Self-Sampling in a Cohort of Ethnically Diverse and Rural Women in Yunnan Province, China. J Low Genit Tract Dis 2021; 24:349-352. [PMID: 32796262 PMCID: PMC7515469 DOI: 10.1097/lgt.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rural Yunnan Province is one of the most ethnically, culturally, and religiously diverse regions in China. The majority of its women have never been screened for cervical cancer. It is not known whether women would feel comfortable and ultimately even prefer using a human papillomavirus (HPV) self-swabbing method.
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Arbyn M, Simon M, Peeters E, Xu L, Meijer CJLM, Berkhof J, Cuschieri K, Bonde J, Ostrbenk Vanlencak A, Zhao FH, Rezhake R, Gultekin M, Dillner J, de Sanjosé S, Canfell K, Hillemanns P, Almonte M, Wentzensen N, Poljak M. 2020 list of human papillomavirus assays suitable for primary cervical cancer screening. Clin Microbiol Infect 2021; 27:1083-1095. [PMID: 33975008 DOI: 10.1016/j.cmi.2021.04.031] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Only clinically validated HPV assays can be accepted in cervical cancer screening. OBJECTIVES To update the list of high-risk HPV assays that fulfil the 2009 international validation criteria (Meijer-2009). DATA SOURCES PubMed/Medline, Embase, Scopus, references from selected studies; published in January 2014 to August 2020. STUDY ELIGIBILITY CRITERIA HPV test validation studies and primary screening studies, involving testing with an index HPV test and a comparator HPV test with reporting of disease outcome (occurrence of histologically confirmed cervical precancer; CIN2+). PARTICIPANTS Women participating in cervical cancer screening. INTERVENTIONS Testing with an index and a comparator HPV test of clinician-collected cervical specimens and assessment of disease outcome ( METHODS Assessment of relative clinical accuracy (including non-inferiority statistics index vs comparator assay) and test reproducibility in individual studies; random effects meta-analyses of the relative clinical sensitivity and specificity of index vs comparator tests. RESULTS Seven hrHPV DNA tests consistently fulfilled all validation criteria in multiple studies using predefined test positivity cut-offs (Abbott RealTime High Risk HPV, Anyplex II HPV HR Detection, BD Onclarity HPV Assay, Cobas 4800 HPV Test, HPV-Risk Assay, PapilloCheck HPV-Screening Test and Xpert HPV). Another assay (Alinity m HR HPV Assay) was fully validated in one validation study. The newer Cobas 6800 HPV Test, was validated in two studies against Cobas 4800. Other tests partially fulfilled the international validation criteria (Cervista HPV HR Test, EUROArray HPV, Hybribio's 14 High-Risk HPV, LMNX Genotyping Kit GP HPV, MALDI-TOF, RIATOL qPCR and a number of other in-house developed assays) since the non-inferior accuracy was reached after a posteriori cut-off optimization, inconsistent accuracy findings in different studies, and/or insufficient reproducibility assessment. The APTIMA HPV Assay targeting E6/E7 mRNA of hrHPV was fully validated in one formal validation study and showed slightly lower pooled sensitivity but higher specificity than the standard comparator tests in seven screening studies. However, the current international validation criteria relate to DNA assays. The additional requirement for longitudinal performance data required for non-DNA based HPV assays was not assessed in this review. CONCLUSIONS Eleven hrHPV DNA assays fulfil all requirements for use in cervical cancer screening using clinician-collected specimens.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium.
| | - Marie Simon
- Haute Autorité de Santé, Saint Denis, France
| | - Eliana Peeters
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Lan Xu
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chris J L M Meijer
- Department of Pathology, Amsterdam University Medical Centre, location VUMC, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anja Ostrbenk Vanlencak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, 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
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The 3rd Affiliated Teaching Hospital of Xinjiang Medical University (Affiliated Cancer Hospital), Urumqi, China
| | - Murat Gultekin
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Ankara, Turkey
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia
| | - Peter Hillemanns
- Departments of Gynaecology and Obstetrics, Hannover Medical School, Germany
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer, Institute, Bethesda, MD, USA
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Nyitray AG, Schick V, Swartz MD, Giuliano AR, Fernandez ME, Deshmukh AA, Ridolfi TJ, Ajala C, Brzezinski B, Sandoval M, Nedjai B, Smith JS, Chiao EY. Rationale and design of the Prevent Anal Cancer Self-Swab Study: a protocol for a randomised clinical trial of home-based self-collection of cells for anal cancer screening. BMJ Open 2021; 11:e051118. [PMID: 34187833 PMCID: PMC8245463 DOI: 10.1136/bmjopen-2021-051118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Squamous cell carcinoma of the anus is a common cancer among sexual minority men, especially HIV-positive sexual minority men; however, there is no evidenced-based national screening protocol for detection of anal precancers. Our objective is to determine compliance with annual anal canal self-sampling or clinician-sampling for human papillomavirus (HPV) DNA. METHODS AND ANALYSIS This is a prospective, randomised, two-arm clinical study to evaluate compliance with annual home-based versus clinic-based HPV DNA screening of anal canal exfoliated cells. The setting is primary care community-based clinics. Recruitment is ongoing for 400 HIV-positive and HIV-negative sexual minority men and transgender persons, aged >25 years, English or Spanish speaking, no current use of anticoagulants other than nonsteroidal anti-inflammatory drugs and no prior diagnosis of anal cancer. Participants are randomised to either receive a swab in the mail for home-based collection of an anal canal specimen at 0 and 12 months (arm 1) or attend a clinic for clinician collection of an anal canal specimen at 0 and 12 months (arm 2). Persons will receive clinic-based Digital Anal Rectal Examinations and high-resolution anoscopy-directed biopsy to assess precancerous lesions, stratified by study arm. Anal exfoliated cells collected in the study are assessed for high-risk HPV persistence and host/viral methylation. The primary analysis will use the intention-to-treat principle to compare the proportion of those who comply with 0-month and 12-month sampling in the home-based and clinic-based arms. The a priori hypothesis is that a majority of persons will comply with annual screening with increased compliance among persons in the home-based arm versus clinic-based arm. ETHICS AND DISSEMINATION The study has been approved by the Medical College of Wisconsin Human Protections Committee. Results will be disseminated to communities where recruitment occurred and through peer-reviewed literature and conferences. TRIAL REGISTRATION NUMBER NCT03489707.
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Affiliation(s)
- Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vanessa Schick
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Insitute, Tampa, Florida, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Timothy J Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher Ajala
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Micaela Sandoval
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Belinda Nedjai
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Jennifer S Smith
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Elizabeth Y Chiao
- Department Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Klischke L, von Ehr J, Kohls F, Kampers J, Hülse F, Schmitz M, Hennig A, Dörk T, Hillemanns P, Jentschke M. Performance of a six-methylation-marker assay on self-collected cervical samples - A feasibility study. J Virol Methods 2021; 295:114219. [PMID: 34175345 DOI: 10.1016/j.jviromet.2021.114219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In high-income countries, a high proportion of cervical cancers is diagnosed in screening non-attendees. One approach to improve screening coverage is to offer self-sampling for human papillomavirus (HPV) testing. However, especially young women are often HPV positive without having a precancerous lesion in need of treatment. To improve the rather low specificity of HPV testing additional markers such as DNA-methylation can be used. The aim of this feasibility study was to examine the performance of the methylation marker assay GynTect®, comprising six methylation markers, on dry self-collected cervico-vaginal samples compared to physician-taken samples. METHODS We recruited 89 patients from our colposcopy clinic of whom 87 qualified for the study. The women took a self-sample with the Evalyn-Brush. Afterwards the planned colposcopy was performed and smears for cytology and reference HPV testing were taken as well as a biopsy in cases of abnormalities. Physician-taken and self-collected samples were tested for HPV DNA and were analyzed with GynTect®. RESULTS We obtained 95.5 % valid results for the self-collected samples which was very close to the physician-taken samples. Only about half of the self-collected samples were GynTect® positive in comparison to the physician-taken samples. GynTect® scores were significantly lower for self-collected than for physician-taken samples (p = 0.001, paired t-test). The overall concordance for GynTect® results was moderate (kappa 0.394; p < 0.001). For HPV testing we obtained a good concordance (kappa 0.586; p < 0.001). The GynTect® results for the self-collected samples showed a sensitivity for the detection of cervical intraepithelial neoplasia 2 or worse (CIN2+) of 26.1 % (95 %-CI: 0.13-0.46) and a specificity of 95.6 % (95 %-CI: 0.85-0.99), in comparison to a sensitivity of 45.5 % (95 %-CI: 0.27-0.65) and a specificity of 78.3 % (95 %-CI: 0.64-0.88) for the physician-taken samples. CONCLUSIONS GynTect® methylation marker testing has a satisfactory amount of valid results on self-collected samples. However, the results of the self-collected samples differed clearly in comparison to the reference samples. To justify an application in screening, a larger study with more cases of high-grade cervical dysplasia and HPV positive patients will be needed.
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Affiliation(s)
- Lara Klischke
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Julia von Ehr
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fabian Kohls
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johanna Kampers
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Anne Hennig
- Oncgnostics GmbH, Winzerlaer Str. 2, 07745, Jena, Germany
| | - Thilo Dörk
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Clinical and analytical evaluation of the RealTime High Risk HPV assay in Colli-Pee collected first-void urine using the VALHUDES protocol. Gynecol Oncol 2021; 162:575-583. [PMID: 34172287 DOI: 10.1016/j.ygyno.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Urine self-sampling has gained increasing interest for cervical cancer screening. In contrast to analytical performance, little information is available regarding the clinical accuracy for high-risk Human Papillomavirus (hrHPV) testing on urine. METHODS VALHUDES is a diagnostic test accuracy study comparing clinical accuracy to detect high-grade cervical precancer (CIN2+) of HPV testing on self-collected compared to clinician-collected samples (NCT03064087). Disease outcome was assessed by colposcopy and histology. The Abbott RealTime High Risk HPV assay performance was evaluated on Colli-Pee collected first-void urine with cervical outcomes as comparator. RESULTS As no assay cut-off for urine has been clinically validated, we used the predefined cut-off for cervical samples (CN ≤ 32). Using this cut-off, hrHPV testing was similarly sensitive (relative sensitivity 0.95; 95% CI: 0.88-1.01) and specific (relative specificity 1.03; 95% CI: 0.95-1.13) for detection of CIN2+ compared to testing cervical samples. In the subgroup of women of 30 years and older, similar relative sensitivity (0.97; 95% CI: 0.89-1.05) and specificity (1.02; 95% CI: 0.93-1.12) was found. Additionally, an exploratory cut-off (CN ≤ 33.86) was defined which further improved sensitivity and analytical test performance. CONCLUSION HrHPV-DNA based PCR testing on home-collected first-void urine has similar accuracy for detecting CIN2+ compared to cervical samples taken by a clinician.
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Mbulawa ZZA, Somdyala NI, Mabunda SA, Williamson AL. High human papillomavirus prevalence among females attending high school in the Eastern Cape Province of South Africa. PLoS One 2021; 16:e0253074. [PMID: 34143816 PMCID: PMC8213156 DOI: 10.1371/journal.pone.0253074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/27/2021] [Indexed: 12/11/2022] Open
Abstract
As part of the human papillomavirus (HPV) vaccination strategy in South Africa, it is essential to have information on HPV prevalence, and HPV types distribution among the unvaccinated population. Information on the prevalence of HPV and the distribution of HPV types in adolescents and young women in South Africa’s Eastern Cape Province is minimal. Therefore, this study investigates the prevalence, distribution of HPV types, and factors associated with HPV infection amongst unvaccinated female learners. A sample composed of 213 sexually active female learners attending high schools in the Eastern Cape Province of South Africa; median age 18 years, who provided self-collected vaginal specimens. Roche Linear Array HPV genotyping assay that detects 37 HPV genotypes was used to detect HPV infection. HPV infection was detected in 76.06% (162/213) of participants. Of these 14.55% (31/213) were positive for HPV types targeted by the Cervarix® HPV vaccine (HPV-16 and/or 18), 20.66% (44/213) by Gardasil®4 (HPV-6, -11, -16 and/or -18) and 37.09% (79/213) by Gardasil®9 (HPV-6, -11, -16, -18, -31, -33, -45, -52 and/or -58). HPV-35, commonly detected in cervical cancer cases among women of African ancestry, was frequently detected (9.40%). Participants who reported to have ever consumed alcohol had a significantly higher risk of HPV infection (OR: 2.91, 95% CI: 1.38–6.11, p = 0.005). High HPV prevalence was observed among participants. The high prevalence of HPV types targeted by the Gardasil®9 vaccine encourages the introduction of the Gardasil®9 vaccine. Data from this study will inform both vaccination campaigns and monitor the impact on HPV types after vaccination.
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Affiliation(s)
- Zizipho Z. A. Mbulawa
- National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha, South Africa
- Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha, South Africa
- SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Nontuthuzelo I. Somdyala
- South African Medical Research Council, Burden of Disease Research Unit, Cape Town, South Africa
| | - Sikhumbuzo A. Mabunda
- SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Anna-Lise Williamson
- SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Alcalá HE, Keim-Malpass J, Mitchell EM. Sexual Assault and Cancer Screening Among Men and Women. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP6243-NP6259. [PMID: 30477387 DOI: 10.1177/0886260518812797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Emerging research has shown that experiences of sexual violence are associated with cancer screening behaviors. However, to date, little attention has been given to the impact of sexual assault on cancer screening behaviors, particularly among men. To address this, we used data from the 2014 Kansas Behavioral Risk Factor Surveillance System. This survey is conducted annually via telephone. Logistic regressions were used to calculate odds of ever engaging (i.e., lifetime) in specific screening behaviors (clinical breast exam [CBE], mammogram, Pap test, colonoscopy/sigmoidoscopy, fecal occult blood test and prostate-specific antigen [PSA] test) and current compliance with cancer screening recommendations (CBE, mammogram, Pap test, colorectal cancer screening, and PSA test), with lifetime sexual assault as the independent variables. Colorectal cancer screening models were stratified by gender. All models adjusted for confounders. Sexual assault was associated with lower odds of ever receiving a PSA test and, for women, higher odds of ever receiving a colonoscopy or sigmoidoscopy. Sexual assault was associated with lower odds of current compliance with CBE, mammogram, Pap test, and PSA test screening recommendations. A history of sexual assault was associated with lower odds of current compliance with cancer screening procedures, with the notable exception of colorectal cancer screening. Less consistent patterns were seen for lifetime screenings. Results suggest that alternatives to currently recommended procedures (like self-collection of HPV [human papilloma virus] DNA) or modified screening procedures may be a promising route to increase current compliance with cancer screening among a population that may avoid these procedures due to pain or fear of retraumatization.
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Self-collected versus clinician-collected cervical samples for the detection of HPV infections by 14-type DNA and 7-type mRNA tests. BMC Infect Dis 2021; 21:504. [PMID: 34058992 PMCID: PMC8165795 DOI: 10.1186/s12879-021-06189-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background HPV self-sampling has been widely supported by the scientific community following a strong body of literature on the subject. Self-sampling is important in cervical cancer screening as it has been shown to improve participation. It is well documented that HPV-testing has proven superior to cytology with regards to sensitivity in detection of CIN and cancer. The value of self-collected samples is reliant on the quality of the molecular testing performed, as well as the patients’ preference in sampling procedure and compliance to follow up on positive test results. Due to the incompatibility of self-samples and cytology, triage of HPV-DNA positives by testing for molecular biomarkers is highly warranted. Methods Our objective was to compare the detection rate of genital Human Papillomavirus (HPV) infection in self- and clinician-collected samples by a 14-type HPV-DNA test and a 7-type mRNA E6/E7 test. Results Five hundred five women were recruited. Each study participant had two sample collection procedures performed upon the same visit, alternating order in execution of the self-collection or the clinician-taken procedure first or second, 1010 samples in total. HPV-DNA prevalence was 22.8% in self-collected versus 19.2% in clinician-collected samples (P = 0.19). Overexpression of mRNA E6/E7 from 7 HPV types was 7.1 and 6.3%, respectively (P = 0.71). The difference between HPV-DNA and HPV-mRNA positivity rates were statistically significant in both self-collected (22.8% versus 7.1%, P < 0.001) and clinician-collected samples (19.2% versus 6.3%, P < 0.001). Overall agreement between the two collection methods was fair, with a concordance rate of 78.2% (390/505), k = 0.34 (95% CI: 0.25–0.44), P < 0.001, for the HPV-DNA test and 92.5% (467/505), k = 0.40 (95% CI, 0.25–0.56), P < 0.001, for the mRNA test, respectively. 96.8% of the participants reported they felt confident carrying out the self-collection themselves, and 88.8% reported no discomfort at all performing the procedure. Conclusions This comparative study of two sampling methods reports fair agreement of HPV positivity rates between the self-collected and clinician-collected specimens using Abbott hrHPV and PreTect HPV-Proofer’7 tests. Only one third of HPV-DNA positive women had overexpression of mRNA E6/E7. Trial registration ISRCTN77337300. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06189-2.
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Reques L, Rolland C, Lallemand A, Lahmidi N, Aranda-Fernández E, Lazzarino A, Bottero J, Hamers F, Bergeron C, Haguenoer K, Launoy G, Luhmann N. Comparison of cervical cancer screening by self-sampling papillomavirus test versus pap-smear in underprivileged women in France. BMC Womens Health 2021; 21:221. [PMID: 34039341 PMCID: PMC8157706 DOI: 10.1186/s12905-021-01356-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare cervical cancer screening by pap smear (PS) versus preliminary HPV testing based on self-collected samples (SC-HPV). METHODS Interventional study among underprivileged women from 25 to 65 years old in four French cities. The control group (CG) was referred for a PS. The experimental group (EG) conducted a SC-HPV test followed by a PS in case of positivity. Differences on screening completion and cytological abnormalities were analysed by logistic and Cox regression. RESULTS 383 women were assigned to the EG and 304 to the CG. The screening completion proportion was 39.5% in the CG compared to 71.3% in the EG (HR = 2.48 (CI 95% [1.99-3.08]; p < 0.001). The proportion of cytological abnormalities was 2.0% in the CG and 2.3% in the EG (OR = 1.20 (CI 95% [0.42-3.40]; p = 0.7). The proportion of participants lost to follow-up was 60.5% in the CG and 63.2% in the EG HPV positive (p = 0.18). CONCLUSION Providing an SC-HPV-test increased the participation of underprivileged women in CCS. Nevertheless, the significant number of lost to follow-up in both groups can undermine the initial benefits of the strategy for HPV positive women. Registration: Clinicaltrials.gov: NCT03118258.
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Affiliation(s)
- Laura Reques
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France.
| | | | - Anne Lallemand
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
| | - Najat Lahmidi
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
| | | | - Antonio Lazzarino
- EPISTATA - Agency for Clinical Research and Medical Statistics, London, UK
| | - Julie Bottero
- Unité de Maladies Infectieuses et Tropicales, Groupe Hospitalo-Universitaire Paris Seine St-Denis, AP-HP, Hôpital Jean Verdier, Bondy, France
| | - Françoise Hamers
- Santé Publique France (National Public Health Agency), Saint Maurice cedex, France
| | | | - Ken Haguenoer
- U1153, INSERM, Paris, France
- Cancer Screening Department, CHRU de Tours, 37000, Tours, France
| | - Guy Launoy
- Centre François Baclesse, INSERM, Avenue du Général Harris, 14076, Caen, France
| | - Niklas Luhmann
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
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Behnke AL, Krings A, Wormenor CM, Dunyo P, Kaufmann AM, Amuah JE. Female health-care providers' advocacy of self-sampling after participating in a workplace program for cervical cancer screening in Ghana: a mixed-methods study. Glob Health Action 2021; 13:1838240. [PMID: 33200671 PMCID: PMC7671662 DOI: 10.1080/16549716.2020.1838240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer is the second most common cancer among Ghanaian women and screening coverage is low. ACCESSING is a cross-sectional study investigating human papillomavirus (HPV) prevalence via self-sampling in rural communities of the North Tongu district in Ghana. Female health-care providers (HCPs) were invited to self-collect a cervicovaginal sample with a commercial sampler in order to acquaint themselves with the sampling method. OBJECTIVE This study set out to explore female HCPs' perceptions, advocacy for, and implications of self-sampling with the aim of enhancing self-sampling acceptability in the targeted screening population. METHODS A mixed-methods approach was used, consisting of (a) a survey among 52 female HCPs working in a district hospital and (b) 10 one-to-one semi-structured interviews with purposefully sampled HCPs. RESULTS The quantitative analysis of the survey (n = 52) showed that, among HCPs who took the sample themselves (50/52), all found it 'Easy' or 'Very Easy' and felt 'Very Comfortable' or 'Comfortable'. 82.7% indicated that they would undertake screening more often, and 98.1% indicated they would prefer self-sampling, if cervical cancer risk is as reliably determined as by clinician-directed cytobrush sampling. All interview participants (n = 10) indicated that they appreciated the program and would recommend the screening to their patients and/or family members and neighbours. Common reasons for preferring self-sampling were less (anticipated) pain compared to speculum examination and more privacy. CONCLUSIONS Self-sampling for cervical cancer screening is highly acceptable to female HCPs. Setting up a workplace screening program that entails the option of self-sampling could create greater awareness and positive attitudes among HCPs to educating their patients, families, and neighbours on cervical cancer risks and motivate HCPs to advocate for women's participation in screening.
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Affiliation(s)
- Anna-Lisa Behnke
- Clinic for Gynaecology (CBF), Laboratory for Gynaecologic Tumor Immunology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin , Berlin, Germany
| | - Amrei Krings
- Clinic for Gynaecology (CBF), Laboratory for Gynaecologic Tumor Immunology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin , Berlin, Germany
| | | | - Priscilla Dunyo
- Department of Obstetrics and Gynecology, Catholic Hospital Battor , Battor, Ghana
| | - Andreas M Kaufmann
- Clinic for Gynaecology (CBF), Laboratory for Gynaecologic Tumor Immunology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin , Berlin, Germany
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Nishimura H, Yeh PT, Oguntade H, Kennedy CE, Narasimhan M. HPV self-sampling for cervical cancer screening: a systematic review of values and preferences. BMJ Glob Health 2021; 6:e003743. [PMID: 34011537 PMCID: PMC8137189 DOI: 10.1136/bmjgh-2020-003743] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The WHO recommends human papillomavirus (HPV) cervical self-sampling as an additional screening method and HPV DNA testing as an effective approach for the early detection of cervical cancer for women aged ≥30 years. This systematic review assesses end user's values and preferences related to HPV self-sampling. METHODS We searched four electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature and Embase) using search terms for HPV and self-sampling to identify articles meeting inclusion criteria. A standardised data extraction form was used to capture study setting, population, sample size and results related to values and preferences. RESULTS Of 1858 records retrieved, 72 studies among 52 114 participants published between 2002 and 2018 were included in this review. Almost all studies were cross-sectional surveys. Study populations included end users who were mainly adolescent girls and adult women. Ages ranged from 14 to 80 years. Most studies (57%) were conducted in high-income countries. Women generally found HPV self-sampling highly acceptable regardless of age, income or country of residence. Lack of self-confidence with collecting a reliable sample was the most commonly cited reason for preferring clinician-collected samples. Most women preferred home-based self-sampling to self-sampling at a clinic. The cervical swab was the most common and most accepted HPV DNA sampling device. CONCLUSIONS HPV self-sampling is generally a highly accepted method of cervical cancer screening for end users globally. End user preferences for self-sampling device, method and setting can inform the development of new and expanded interventions to increase HPV screening.
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Affiliation(s)
- Holly Nishimura
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Habibat Oguntade
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
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High-risk Human Papillomavirus Messenger RNA Testing in Wet and Dry Self-collected Specimens for High-grade Cervical Lesion Detection in Mombasa, Kenya. Sex Transm Dis 2021; 47:464-472. [PMID: 32168174 DOI: 10.1097/olq.0000000000001167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Self-collection for high-risk human papillomavirus (hr-HPV) messenger RNA (mRNA) testing may improve cervical cancer screening. High-risk HPV mRNA with self-collected specimens stored dry could enhance feasibility and acceptance of specimen collection and storage; however, its performance is unknown. We compared the performance of hr-HPV mRNA testing with dry- as compared with wet-stored self-collected specimens for detecting high-grade squamous intraepithelial lesion or more severe (≥HSIL). METHODS A total of 400 female sex workers in Kenya participated (2013-2018), of which 50% were HIV positive based on enrollment procedures. Participants provided 2 self-collected specimens: one stored dry (sc-DRY) using a Viba brush (Rovers) and one stored wet (sc-WET) with Aptima media (Hologic) using an Evalyn brush (Rovers). Physician-collected specimens were collected for HPV mRNA testing (Aptima) and conventional cytology. We estimated test characteristics for each hr-HPV screening method using conventional cytology as the reference standard (≥HSIL detection). We also examined participant preference for sc-DRY and sc-WET collection. RESULTS High-risk HPV mRNA positivity was higher in sc-WET (36.8%) than sc-DRY samples (31.8%). Prevalence of ≥HSIL was 6.9% (10.3% HIV positive, 4.0% HIV negative). Sensitivity of hr-HPV mRNA for detecting ≥HSIL was similar in sc-WET (85%; 95% confidence interval [CI], 66%-96%), sc-DRY specimens (78%; 95% CI, 58%-91%), and physician-collected specimens (93%; 95% CI, 76%-99%). Overall, the specificity of hr-HPV mRNA for ≥HSIL detection was similar when comparing sc-WET with physician collection. However, specificity was lower for sc-WET (66% [61%-71%]) than sc-DRY (71% [66%-76%]). Women preferred sc-DRY specimen collection (46.1%) compared with sc-WET (31.1%). However, more women preferred physician collection (63.9%) compared with self-collection (36.1%). CONCLUSIONS Self-collected stored-dry specimens seemed to perform similarly to sc-WET for the detection of ≥HSIL.
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Urine HPV in the Context of Genital and Cervical Cancer Screening-An Update of Current Literature. Cancers (Basel) 2021; 13:cancers13071640. [PMID: 33915878 PMCID: PMC8036396 DOI: 10.3390/cancers13071640] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Despite the substantial scientific evolution in cervical cancer prevention and related infrastructures, a plethora of women still miss the opportunity to detect their precancerous lesions at a curable stage by not participating in existing screening programs. Implementing sensitive screening modalities combined with easy sampling methods with minimal pain or discomfort such as self-sampling of vaginal and urine samples is increasingly applied. Self-sampling HPV modalities aimed to address this inequity, besides facilitating HPV genotyping as well as the measurement of related biomarkers in HPV-caused lesions and genital cancer. The low costs inflicted, the non-invasive nature, and the favorable acceptability profile of urine HPV detection give the potential to become a most promising tool that could expand the possibilities in changing genital and cervical cancer prevention strategies as well as in the surveillance and management of genital precancer. Abstract Within the previous decades, following the widespread implementation of HPV-related biomarkers and computerization in liquid-based cytology, screening for lower genital tract malignancies has been optimized in several parts of the world. Many organized anogenital cancer prevention systems have reached a point at which efficacy is more a matter of population coverage and less of available infrastructures. Meanwhile, self-sampling modalities in which biologic material (vaginal secretions, urine, etc.) is obtained by the individual and not the clinician and subsequently undergoes examination for HPV biomarkers enjoy appreciating acceptance. Bygone the initial skepticism that vaginal or urine HPV represents “passenger” transient infections, extensive scientific work has been conducted to optimize high-risk HPV (hrHPV) detection from this “novel” biologic material. Nowadays, several state-of-the-art meta-analyses have illustrated that self-sampling techniques involving urine self-sampling represent a feasible alternative strategy with potentially enhanced population coverage possessing excellent performance and sensitivity. Recently published scientific work focusing on urine HPV was reviewed, and after a critical appraisal, the following points should be considered in the clinical application of hrHPV urine measurements; (i) use of first-void urine (FVU) and purpose-designed collection devices; (ii) using a preservation medium to avoid human/HPV DNA degradation during extraction and storage; (iii) using polymerase chain reaction (PCR) based assays, ideally with genotyping capabilities; (iv) processing of a sufficient volume of whole urine; and (v) the use of an analytically sensitive HPV test/recovery of cell-free HPV DNA in addition to cell-associated DNA.
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141
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Ørnskov D, Jochumsen K, Steiner PH, Grunnet IM, Lykkebo AW, Waldstrøm M. Clinical performance and acceptability of self-collected vaginal and urine samples compared with clinician-taken cervical samples for HPV testing among women referred for colposcopy. A cross-sectional study. BMJ Open 2021; 11:e041512. [PMID: 33674367 PMCID: PMC7939007 DOI: 10.1136/bmjopen-2020-041512] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To increase effectiveness of the cervical cancer screening program, self-sampling can be an option. Both self-collected vaginal samples (SCV) and urine samples may be useful alternatives to clinician-taken cervical samples (CS). DESIGN Cross-sectional study. SETTING Colposcopy clinic. PARTICIPANTS Women (n=305) referred to colposcopy after abnormal cervical screening result or conditions like postcoital bleeding. INTERVENTION All women self-collected a urine and a vaginal sample prior to colposcopy, where a CS and biopsies were taken. All samples were tested for high-risk human papillomavirus (HPV) using the Cobas HPV assay. The gold standard was histology diagnoses (CIN2+/CIN3+) from biopsies obtained at the same examination. PRIMARY OUTCOME Absolute and relative sensitivity and specificity of HPV testing on SCV and urine to detect CIN2+/CIN3+ compared with the CS. SECONDARY OUTCOME The acceptability by women of self-sampling. RESULTS Both the vaginal and urine sample were comparable to the CS in identifying severe intraepithelial neoplasia (CIN2+/CIN3+). Absolute sensitivity ranged from 93% for urine samples to 96% for SCV for detecting CIN2+, which is comparable to the sensitivity of CS (overlapping 95% CI).The relative sensitivity for detecting CIN2+ was 1.00 (95% CI 0.96 to 1.04) for SCV and 0.96 (95% CI 0.91 to 1.03) for urine samples. At CIN3+, the relative sensitivity was 1.00 (95% CI 0.96 to 1.08) and 0.97 (95% CI 0.89 to 1.07) for SCV and urine samples, respectively. There were no statistical differences between the self-collected samples and the CS (McNemar's test >0.05). The relative specificity was also similar (1.03 (95% CI 0.95 to 1.12) for SCV and 0.98 (95% CI 0.89 to 1.09) for urine samples) (McNemar's test >0.05).The acceptability of self-sampling was evaluated by questionnaire. The women found the instructions on sample collection easy to understand and were positive about self-sampling with a preference for the urine sample. CONCLUSION Self-sampling by SCV and urine is a clinically safe alternative to CS with a high degree of acceptability.
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Affiliation(s)
- Dorthe Ørnskov
- Clinical Pathology, Sygehus Lillebalt Vejle Sygehus, Vejle, Denmark
| | - Kirsten Jochumsen
- Department of Gynecology, Odense University Hospital, Odense, Denmark
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Schiffman M, Wentzensen N. The Orderly Incorporation of Continuing Technologic Advances Into Cervical Cancer Screening. J Natl Cancer Inst 2021; 113:231-233. [PMID: 32745173 DOI: 10.1093/jnci/djaa106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark Schiffman
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Nicolas Wentzensen
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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143
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Ambulatory anal self-sampling in MSM living with HIV, an acceptable and reliable screening method. PLoS One 2021; 16:e0246338. [PMID: 33561135 PMCID: PMC7872249 DOI: 10.1371/journal.pone.0246338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/18/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Anal cancer, usually driven by an oncogenic Human Papillomavirus, remains a leading cause of morbidity in men who have sex with men (MSM) living with HIV, despite combined antiretroviral therapy. Various recommendations advocate to perform regular examination and proctologist-performed samples to anticipate this risk and treat locally before cancer occurrence, an efficient strategy which has the drawback of requiring the proctologist’s availability. This study evaluates the acceptability, feasibility, and efficiency of self-performed samples to screen for HPV-infection and HPV-related anal dysplasia among MSM living with HIV followed in Hôtel-Dieu Hospital. Methods Between February 2015 and June 2015, MSM living with HIV and referred to the day-care hospital were offered to perform an anal self-sampling for cytologic and virologic evaluation. A self-sampling kit was provided, and a tutorial video was shown. A subset of participants had a proctology appointment after they did the self-sampling, and thus had a clinical examination and an anal swab sampling performed by the proctologist, using the same sampling material. Results Anal self-sampling was offered to 103 patients, and 100 accepted. Sixty-three samples were interpretable, of which 36 (57%) were normal and 27 (43%) showed abnormal results. Virologic analysis was performed for 60 (95%) interpretable samples: 50/60 (83%) of them were positive for HPV. Among HPV-carrier patients, 42/50 (84%) were infected with at least one HR-HPV. Twenty patients had a proctologist consultation. All clinician-performed samples were interpretable and 14 (70%) self-samples were interpretable. Conclusions This study highlights the acceptable accuracy of self-sampling screening method among MSM living with HIV and try out its acceptability and feasibility as a secondary prevention device. Although it cannot replace a proctologist consultation for high risk patients, self-sampling should be studied further as one of the ways of screening for anal cancer among low-risk outpatients.
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144
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Lim AWW. Will COVID-19 Be the Tipping Point for Primary HPV Self-sampling? Cancer Epidemiol Biomarkers Prev 2021; 30:245-247. [PMID: 33547144 DOI: 10.1158/1055-9965.epi-20-1538] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022] Open
Abstract
Self-sampling is poised to be a disruptor for cervical screening. So far, cancer screening has been a causality of COVID-19; however, the opposite may transpire for self-sampling. Self-sampling enables socially distanced cervical screening with an outreach that extends to underserved populations. As evidence mounts that self-sampling is noninferior to clinician-taken samples, the focus for self-sampling is now as a primary screening option for all women. Now, we have evidence from a modeling study (using Australia as an exemplar) to suggest that program effectiveness with primary self-sampling would be better than the current program, even if sensitivity is lower. Regulatory issues, suitable triage strategies, and clear communication about self-sampling are hurdles yet to be overcome. Nevertheless, existing evidence coupled with COVID-19 could be the tipping point for wider introduction of self-sampling.See related article by Smith et al., p. 268.
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Affiliation(s)
- Anita W W Lim
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, Comprehensive Cancer Centre, King's College London, London, United Kingdom.
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145
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Östensson E, Belkić K, Ramqvist T, Mints M, Andersson S. Self-sampling for high-risk human papillomavirus as a follow-up alternative after treatment of high-grade cervical intraepithelial neoplasia. Oncol Lett 2021; 21:240. [PMID: 33664804 PMCID: PMC7884875 DOI: 10.3892/ol.2021.12501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 01/19/2023] Open
Abstract
Women treated for high-grade cervical-intraepithelial-neoplasia (CIN) require long-term follow-up with high-risk human-papillomavirus (HPV) testing. Self-sampling for HPV is well-accepted among these patients, but its role in follow-up for this group requires investigation. The present study examined how well HPV findings from self-sampled vaginal (VSS) and urine specimens correctly identified women from this cohort with recurrent CIN2+ compared with samples collected by clinicians. At 1st post-conization follow-up, 531 patients (99.8% participation) gave urine samples, performed VSS, underwent colposcopy with punch biopsy of visible lesions and clinician-collected cervical sampling for HPV analysis and liquid-based cytology. A total of 113 patients with positive HPV and/or abnormal cytology at 1st follow-up underwent 2nd follow-up. At 1st follow-up, all patients with recurrent CIN3 had positive HPV results by all methods. Clinician sampling and VSS revealed HPV16 positivity in 50% of recurrent cases and urine sampling revealed HPV16 positivity in 25% of recurrent cases. At 2nd follow-up, all 7 newly-detected CIN2/3 recurrences were associated with HPV positivity on VSS and clinician-samples. Only clinician-collected samples detected HPV positivity for two adenocarcinoma-in-situ recurrences, and both were HPV18 positive. A total of 77 patients had abnormal cytology at 1st follow-up, for which HPV positivity via VSS yielded highest sensitivity. The HPV findings were positive from VSS in 12 patients with high-grade squamous-intraepithelial-lesions (HSIL), and 11 patients with HSIL had positive HPV findings in clinician-collected and urine samples. All methods for assessing HPV presence yielded significant age-adjusted odds ratios for predicting abnormal lesions at 1st follow-up. For overall HPV results, Cohen's kappa revealed substantial agreement between VSS and clinician sampling, and moderate agreement between urine and clinician sampling. Clinician sampling and VSS were highly concordant for HPV16. Insofar as the pathology was squamous (not glandular), VSS appeared as sensitive as clinician sampling for HPV in predicting outcome among the present cohort. Since VSS can be performed at home, this option can maximize participation in the required long-term follow-up for these women at high-risk.
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Affiliation(s)
- Ellinor Östensson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Community/Global Health, Claremont Graduate University, Claremont, CA 91711, USA.,Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Torbjörn Ramqvist
- Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Medical Sciences, Faculty of Medicine-Health, Örebrö University, SE-70182 Örebro, Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
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146
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Kim MH, Jung HJ, Park SI, Kim BJ. Self-obtained vaginal samples for HPV DNA testing to detect HPV-related cervical disease. Int J Gynaecol Obstet 2021; 154:127-132. [PMID: 33368281 DOI: 10.1002/ijgo.13574] [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: 08/30/2020] [Revised: 11/06/2020] [Accepted: 12/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate if a self-obtained vaginal sample (SOVAS) contains sufficient DNA for a human papillomavirus (HPV) test and if the results are comparable to those obtained via cervical samples (CS) collected by a physician. METHODS One hundred and fifty-one women who had abnormal cervical smears or who were HPV-positive were enrolled. Self-sampling was done after reading instructions and watching a 2-min-long video, whereas CS was obtained with a cervical cytobrush during a gynecologic examination. RESULTS A multiplex real-time polymerase chain reaction-based assay detected the prevalence of any type of HPV to be 67.5% in the SOVAS and 57.4% in the CS, and that of high-risk (HR-) HPV to be 58.7% in the SOVAS and 48.6% in the CS. The sensitivity of detection of HR-HPV in the SOVAS was 100% (95% confidence interval [CI] -0.09 to 0.32) for high-grade squamous intraepithelial lesion, 78% (95% CI -0.09 to 0.13) for atypical squamous cells of undetermined significance or worse, and 95% (95% CI -0.01 to 0.25) for low-grade squamous intraepithelial lesion or worse, which was statistically within the non-inferiority margin compared with that of CS. CONCLUSION Our study shows that the collection of a SOVAS is feasible and it is comparable to a CS for HPV DNA testing. Future studies are required to investigate the feasibility and cost-effectiveness of a mail-delivered SOVAS for cervical cancer screening.
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Affiliation(s)
- Moon-Hong Kim
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Hee-Jung Jung
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Sang-Il Park
- Department of Obstetrics and Gynecology, Dongnam Institute of Radiological & Medical Sciences, Busan, Republic of Korea
| | - Beob-Jong Kim
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
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147
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Arbyn M, Gultekin M, Morice P, Nieminen P, Cruickshank M, Poortmans P, Kelly D, Poljak M, Bergeron C, Ritchie D, Schmidt D, Kyrgiou M, Van den Bruel A, Bruni L, Basu P, Bray F, Weiderpass E. The European response to the WHO call to eliminate cervical cancer as a public health problem. Int J Cancer 2021; 148:277-284. [PMID: 32638362 PMCID: PMC7754400 DOI: 10.1002/ijc.33189] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 01/07/2023]
Abstract
The age-standardised incidence of cervical cancer in Europe varies widely by country (between 3 and 25/100000 women-years) in 2018. Human papillomavirus (HPV) vaccine coverage is low in countries with the highest incidence and screening performance is heterogeneous among European countries. A broad group of delegates of scientific professional societies and cancer organisations endorse the principles of the WHO call to eliminate cervical cancer as a public health problem, also in Europe. All European nations should, by 2030, reach at least 90% HPV vaccine coverage among girls by the age of 15 years and also boys, if cost-effective; they should introduce organised population-based HPV-based screening and achieve 70% of screening coverage in the target age group, providing also HPV testing on self-samples for nonscreened or underscreened women; and to manage 90% of screen-positive women. To guide member states, a group of scientific professional societies and cancer organisations engage to assist in the rollout of a series of concerted evidence-based actions. European health authorities are requested to mandate a group of experts to develop the third edition of European Guidelines for Quality Assurance of Cervical Cancer prevention based on integrated HPV vaccination and screening and to monitor the progress towards the elimination goal. The occurrence of the COVID-19 pandemic, having interrupted prevention activities temporarily, should not deviate stakeholders from this ambition. In the immediate postepidemic phase, health professionals should focus on high-risk women and adhere to cost-effective policies including self-sampling.
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Affiliation(s)
- Marc Arbyn
- Coordinator Unit Cancer EpidemiologyBelgian Cancer CentreSciensano, BrusselsBelgium
| | - Murat Gultekin
- Department of Obstetrics and Gynecology, Division of Gynaecological OncologyHacettepe University Faculty of MedicineAnkaraTurkey
| | - Philippe Morice
- Department of Gynecologic SurgeryGustave Roussy InstituteVillejuifFrance
| | - Pekka Nieminen
- Department of Obstetrics and GynaecologyUniversity of Helsinki and University Hospital of HelsinkiFinland
| | - Maggie Cruickshank
- Aberdeen Centre for Women's Health ResearchUniversity of AberdeenAberdeenUK
| | | | - Daniel Kelly
- School of Healthcare SciencesCardiff UniversityUK
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | | | - David Ritchie
- Association of European Cancer LeaguesBrusselsBelgium
| | - Dietmar Schmidt
- MVZ of Pathology, Cytology and Molecular Diagnostics, Trier, University of KielGermany
| | - Maria Kyrgiou
- Department of Gut, Metabolism and Reproduction & Department of Surgery and Cancer, Faculty of MedicineImperial College LondonUK
- West London Gynaecological Cancer CentreImperial College Healthcare NHS TrustLondonUK
| | | | - Laia Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology ‐ IDIBELLBarcelonaSpain
| | - Partha Basu
- International Agency for Research on CancerLyonFrance
| | - Freddie Bray
- International Agency for Research on CancerLyonFrance
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148
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Long term results of follow-up after HPV self-sampling with devices Qvintip and HerSwab in women non-attending cervical screening programme. Radiol Oncol 2021; 55:187-195. [PMID: 33764704 PMCID: PMC8042828 DOI: 10.2478/raon-2021-0001] [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: 10/01/2020] [Accepted: 12/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background We are presenting the results of the Slovenian human papillomaviruses (HPV) self-sampling pilot study in colposcopy population of National Cervical Cancer Screening Programme ZORA for the first time. One-year and four-year follow-up results are presented for two different self-sampling devices. Participants and methods A total of 209 women were enrolled in the study at colposcopy clinic. Prior to the gynaecological examination, all women performed self-collected vaginal swab at the clinic; 111 using Qvintip and 98 using HerSwab self-sampling device. After self-sampling, two cervical smears were taken by a clinician; first for conventional cytology and second for HPV test. After that, all women underwent colposcopy and a cervical biopsy if needed. We compared sensitivity, specificity, and predictive values of cytology (at the cut-off atypical squamous cells of undetermined significance or more [ASC-US+]) and HPV test (on self- and clinician-taken samples) for the detection of cervical intraepithelial neoplasia grade 2 or more (CIN2+) after one and four years of follow-up. Hybrid Capture 2 (HC2) assay was used for all HPV testing. Results The mean age of 209 women was 37.6 years and HPV positivity rate 67.0% (140/209), 36.9 years and 70.3% (78/111) in the Qvintip group and 38.4 years and 63.3% (62/98) in the HerSwab group, respectively. Overall, percent agreement between self and clinician-taken samples was 81.8% (kappa 0.534) in the Qvintip and 77.1% (kappa 0.456) in the HerSwab group. In the Qvintip group, the longitudinal sensitivity, specificity, positive and negative predictive values were 71.8%, 75.0%, 83.6%, 60.0% for cytology; 83.1%, 51.3%, 75.6% and 62.5% for HPV test of self-taken samples and 94.4%, 57.5%, 79.8% and 85.2% for HPV test on clinician-taken samples. In the HerSwab group, the corresponding results were 71.7%, 46.7%, 61.3%, 58.3% for cytology; 75.0%, 47.7%, 62.9% and 61.8% for HPV test on self-taken samples and 94.3%, 44.4%, 66.7% and 87.0% for clinician-taken samples, respectively. Conclusions The results confirm that HPV self-sampling is not as accurate as clinician sampling when HC2 is used. All HPV tests showed a higher sensitivity in detecting CIN2+ compared to cytology. Due to non-inferior longitudinal sensitivity of HPV self-sampling compared to cytology, HPV self-sampling might be an option for non-attenders to the National Cancer Screening Programme.
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149
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Saidu R, Kuhn L, Tergas A, Boa R, Moodley J, Svanholm-Barrie C, Persing D, Campbell S, Tsai WY, Wright TC, Denny L. Performance of Xpert HPV on Self-collected Vaginal Samples for Cervical Cancer Screening Among Women in South Africa. J Low Genit Tract Dis 2021; 25:15-21. [PMID: 33105451 PMCID: PMC7748046 DOI: 10.1097/lgt.0000000000000575] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Self-sampling may increase access to cervical cancer screening in low-resource settings. Using Xpert HPV, we compared test performance of self- and clinician-collected samples in HIV-positive and HIV-negative women in South Africa. MATERIALS AND METHODS Three hundred thirty HIV-positive and 375 HIV-negative women in the screening group and 202 HIV-negative and 200 HIV-positive women in the referral group, aged 30-65 years, participated in the study. All women self-collected a vaginal sample, and then, a cervical sample was collected by a clinician (both tested using Xpert HPV), followed by colposcopic examination and collection of histologic specimens. RESULTS There was good agreement between self- and clinician-collected samples for detection of any high-risk human papillomavirus (HPV, κ = 0.72 [95% CI = 0.669-0.771]). Prevalence of HPV and sensitivity of the test to detect cervical intraepithelial neoplasia 2+ was similar in self- and clinician-collected samples. Specificity was lower in self-collected than in clinician-collected samples in both HIV-negative (self: 77.5% [95% CI = 72.8-81.8] vs clinician: 86.9% [95% CI = 82.9-90.2]) and HIV-positive (self: 44.0% [95% CI = 38.0-50.1] vs clinician: 59.7% [95% CI = 53.6-65.6]) women. Restricting the definition of screen-positive to 3 of 5 channels on HPV Xpert improved specificity in both HIV-negative (self: 83.2% [95% CI = 78.8-87.0] vs clinician: 89.7% [95% CI = 86.1-92.7]) and HIV-positive (self: 54.2% [95% CI = 48.1-60.2] vs clinician: 67.4% [95% CI = 61.5-72.9]) women. CONCLUSIONS The self-collected sample had good agreement with the clinician-collected sample for the detection of HPV, and restricting the HPV types may improve the specificity in HIV-positive women.
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Affiliation(s)
- Rakiya Saidu
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Centre, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
| | - Ana Tergas
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
- Department of Obstetrics and Gynaecology, Vangelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
| | - Rosalind Boa
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
| | - Jennifer Moodley
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- Department of Public Health, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Centre, New York, NY
| | - Thomas C. Wright
- Department of Pathology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Centre, New York, NY
| | - Lynette Denny
- Department of Obstetrics and Gynaecology, Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecologic Cancer Research Centre (SAMRC GCRC), Old Main Building, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa
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Du H, Duan X, Liu Y, Shi B, Zhang W, Wang C, Qu X, Li J, Zhao C, Liu J, Jiang J, Jin H, Li H, Xiao A, Bao J, Duan L, Huang X, Luo H, Bian S, Zhang L, Wei L, Belinson JL, Wu R. Evaluation of Cobas HPV and SeqHPV Assays in the Chinese Multicenter Screening Trial. J Low Genit Tract Dis 2021; 25:22-26. [PMID: 33347045 DOI: 10.1097/lgt.0000000000000577] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the Cobas 4800 Assay and the SeqHPV Assay with self (S) and direct (D) cervical samples in the Chinese Multicenter Screening Trial (CHIMUST). MATERIALS AND METHODS The CHIMUST is a large population-based multicenter clinical trial, and 10,885 women aged 30-59 years from 15 sites in 7 provinces with no cervical cancer screening for 3 years were eligible. All participating women contributed one self-collected sample (S) and 1 physician-collected endocervical sample (DL). The self-collected sample was first applied to the solid media transport card (SS), and then, the brush placed in 6 mL of ThinPrepSolution (SL). All samples were tested with Cobas 4800 and SeqHPV high-risk HPV assays. Patients human papillomavirus positive (self or direct) were recalled for colposcopy and biopsies. RESULTS A total of 10,399 women had complete data. The mean age was 43.9 years. A total of 1.4% (142/10,399) had cervical intraepithelial neoplasia (CIN) 2+ and 0.5% (54/10,339) had CIN 3+. In the liquid specimens, the overall HPV infection rates were 10.8% for Cobas and 10.9% for SeqHPV in D sample, and 13.7% for Cobas and 11.6% for SeqHPV in SL sample, respectively. The sensitivity of Cobas-DL, Cobas-SL, SeqHPV-DL, and SeqHPV-SL for CIN 2+ was 95.07%, 95.07%, 94.33%, and 96.48%, respectively. The specificity of Cobas-DL, Cobas-SL, SeqHPV-DL, and SeqHPV-SL for CIN 2+ was 90.38%, 87.35%, 90.21%, and 89.53%, respectively. There were no differences in sensitivity when applying the 2 assays to both self- and directly collected samples in liquid transport media (p > .05). CONCLUSIONS Both Cobas and SeqHPV screening assays using both self-collected and directly endocervical collected specimens demonstrate similar sensitivity for the detection of CIN 2+ and CIN 3+.
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Affiliation(s)
| | - Xianzhi Duan
- Capital Medical University Beijing Tongren Hospital, Beijing, China
| | - Yan Liu
- Fudan University Huanshan Hospital North, Shanghai, China
| | - Bin Shi
- The second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Zhang
- Wuhan University Zhongnan Hospital, Wuhan, China
| | | | - Xinfen Qu
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Jingran Li
- Peking University People's Hospital, Beijing, China
| | - Chao Zhao
- Peking University People's Hospital, Beijing, China
| | - Juan Liu
- Fudan University Huanshan Hospital North, Shanghai, China
| | - Jing Jiang
- The second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hua Jin
- Wushenqi People's Hospital, Inner Mongolia, China
| | - Hanyi Li
- Pingxiang Ganxi Cancer Hospital, Jiangxi Province, China
| | | | | | | | | | - Hongxue Luo
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuhuang Bian
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Lijie Zhang
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Lihui Wei
- Peking University People's Hospital, Beijing, China
| | - Jerome L Belinson
- Preventive Oncology International, Inc, and the Cleveland Clinic, Cleveland, OH
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