101
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Skroumpelos A, Agorastos T, Constantinidis T, Chatzistamatiou K, Kyriopoulos J. Economic evaluation of HPV DNA test as primary screening method for cervical cancer: A health policy discussion in Greece. PLoS One 2019; 14:e0226335. [PMID: 31830114 PMCID: PMC6907825 DOI: 10.1371/journal.pone.0226335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 11/24/2019] [Indexed: 11/20/2022] Open
Abstract
Background HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV test as primary screening method for CC. Methods A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25–65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted. Results All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized. Conclusions HPV 16/18 genotyping as a primary screening method for CC appears to be one of the most effective strategies and dominates current practice in respect to both cost and outcomes. Even when compared with all other strategies, the outcomes that it generates justify the cost that it requires, representing a good value for money alternative.
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Affiliation(s)
| | | | | | | | - John Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
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102
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Wagner S, Roberson D, Boland J, Kreimer AR, Yeager M, Cullen M, Mirabello L, Dunn ST, Walker J, Zuna R, Porras C, Cortes B, Sampson J, Herrero R, Rodriguez AC, Quint W, Van Doorn LJ, Hildesheim A, Schiffman M, Wentzensen N. Evaluation of TypeSeq, a Novel High-Throughput, Low-Cost, Next-Generation Sequencing-Based Assay for Detection of 51 Human Papillomavirus Genotypes. J Infect Dis 2019; 220:1609-1619. [PMID: 31536132 PMCID: PMC6782103 DOI: 10.1093/infdis/jiz324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomaviruses (HPV) cause over 500 000 cervical cancers each year, most of which occur in low-resource settings. Human papillomavirus genotyping is important to study natural history and vaccine efficacy. We evaluated TypeSeq, a novel, next-generation, sequencing-based assay that detects 51 HPV genotypes, in 2 large international epidemiologic studies. METHODS TypeSeq was evaluated in 2804 cervical specimens from the Study to Understand Cervical Cancer Endpoints and Early Determinants (SUCCEED) and in 2357 specimens from the Costa Rica Vaccine Trial (CVT). Positive agreement and risks of precancer for individual genotypes were calculated for TypeSeq in comparison to Linear Array (SUCCEED). In CVT, positive agreement and vaccine efficacy were calculated for TypeSeq and SPF10-LiPA. RESULTS We observed high overall and positive agreement for most genotypes between TypeSeq and Linear Array in SUCCEED and SPF10-LiPA in CVT. There was no significant difference in risk of precancer between TypeSeq and Linear Array in SUCCEED or in estimates of vaccine efficacy between TypeSeq and SPF10-LiPA in CVT. CONCLUSIONS The agreement of TypeSeq with Linear Array and SPF10-LiPA, 2 well established standards for HPV genotyping, demonstrates its high accuracy. TypeSeq provides high-throughput, affordable HPV genotyping for world-wide studies of cervical precancer risk and of HPV vaccine efficacy.
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Affiliation(s)
- Sarah Wagner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - David Roberson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - Joseph Boland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Meredith Yeager
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - Michael Cullen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Maryland
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - S Terence Dunn
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Joan Walker
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Rosemary Zuna
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomedicas, San José, Costa Rica
| | - Bernal Cortes
- Agencia Costarricense de Investigaciones Biomedicas, San José, Costa Rica
| | - Joshua Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Rolando Herrero
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | | | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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103
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Low-Risk Human Papillomavirus Types in Cervical Intraepithelial Neoplasia 2–3 and in Invasive Cervical Cancer Patients. J Low Genit Tract Dis 2019; 23:248-252. [DOI: 10.1097/lgt.0000000000000486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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104
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Kim J, Kim BK, Jeon D, Lee CH, Roh JW, Kim JY, Park SY. Type-Specific Viral Load and Physical State of HPV Type 16, 18, and 58 as Diagnostic Biomarkers for High-Grade Squamous Intraepithelial Lesions or Cervical Cancer. Cancer Res Treat 2019; 52:396-405. [PMID: 31476849 PMCID: PMC7176961 DOI: 10.4143/crt.2019.152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/21/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose High rate of false-positive tests is a major obstacle to use human papillomavirus (HPV) detection as a diagnostic tool for high-grade squamous intraepithelial lesions or cervical cancer (HSIL+). We investigated whether type-specific viral load or physical state of HPV 16, 18, and 58 are useful biomarkers for HSIL+. Materials and Methods Type-specific viral loads of E6 and E2 genes in cervical cells from 240, 83, and 79 HPV 16–, 18–, and 58–infected women, respectively, were determined using real-time polymerase chain reaction. Viral loads were normalized to cellular DNA (copy/cell). Total and integrated viral loads and physical state were compared between HSIL+ and controls, and diagnostic value was determined using receiver operating characteristic analysis. Results Viral loads of HPV 16, 18, and 58 were significantly different in lesions in the same pathologic grade. High type-specific total viral loads were significantly associated with HSIL+ (odds ratio [OR], 14.065, 39.472, and 7.103 for HPV 16, 18, and 58, respectively). High integrated viral load was related to HSIL+ in women with HPV 16 (OR, 8.242), and integrated state was associated with HSIL+ in women with HPV 18 (OR, 9.443). Type-specific total viral load was significantly associated with HSIL+ (area under curve, 0.914, 0.937, and 0.971 for HPV 16, 18, and 58, respectively), indicating an excellent performance in detecting HSIL+. Conclusion Type-specific total viral load may be a powerful diagnostic marker for HSIL+ in HPV 16–, 18–, and 58–infected HSIL+ lesions. If demonstrated in all other high-risk HPV types, this method can lead to a paradigm shift in the strategy of equivocal cytologic abnormalities.
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Affiliation(s)
- Jongseung Kim
- Department of Family Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Bu Kyung Kim
- Department of Tumor Biology, Seoul National University, Seoul, Korea
| | - Dongsoo Jeon
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Gumi, Korea
| | - Chae Hyeong Lee
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ju-Won Roh
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Joo-Young Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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105
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The Next Generation of Cervical Cancer Screening: Should Guidelines Focus on Best Practices for the Future or Current Screening Capacity? J Low Genit Tract Dis 2019; 22:91-96. [PMID: 29570563 PMCID: PMC5895142 DOI: 10.1097/lgt.0000000000000378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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106
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Schiffman M, Kinney WK, Cheung LC, Gage JC, Fetterman B, Poitras NE, Lorey TS, Wentzensen N, Befano B, Schussler J, Katki HA, Castle PE. Relative Performance of HPV and Cytology Components of Cotesting in Cervical Screening. J Natl Cancer Inst 2019; 110:501-508. [PMID: 29145648 DOI: 10.1093/jnci/djx225] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/26/2017] [Indexed: 12/24/2022] Open
Abstract
Background The main goal of cervical screening programs is to detect and treat precancer before cancer develops. Human papillomavirus (HPV) testing is more sensitive than cytology for detecting precancer. However, reports of rare HPV-negative, cytology-positive cancers are motivating continued use of both tests (cotesting) despite increased testing costs. Methods We quantified the detection of cervical precancer and cancer by cotesting compared with HPV testing alone at Kaiser Permanente Northern California (KPNC), where 1 208 710 women age 30 years and older have undergone triennial cervical cotesting since 2003. Screening histories preceding cervical cancers (n = 623) and precancers (n = 5369) were examined to assess the relative contribution of the cytology and HPV test components in identifying cases. The performances of HPV testing and cytology were compared using contingency table methods, general estimating equation models, and nonparametric statistics; all statistical tests were two-sided. Results HPV testing identified more women subsequently diagnosed with cancer (P < .001) and precancer (P < .001) than cytology. HPV testing was statistically significantly more likely to be positive for cancer at any time point (P < .001), except within 12 months (P = .10). HPV-negative/cytology-positive results preceded only small fractions of cases of precancer (3.5%) and cancer (5.9%); these cancers were more likely to be regional or distant stage with squamous histopathology than other cases. Given the rarity of cancers among screened women, the contribution of cytology to screening translated to earlier detection of at most five cases per million women per year. Two-thirds (67.9%) of women found to have cancer during 10 years of follow-up at KPNC were detected by the first cotest performed. Conclusions The added sensitivity of cotesting vs HPV alone for detection of treatable cancer affected extremely few women.
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Affiliation(s)
- Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Walter K Kinney
- Regional Laboratory, The Permanente Medical Group, Oakland, CA
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Nancy E Poitras
- Regional Laboratory, The Permanente Medical Group, Oakland, CA
| | - Thomas S Lorey
- Regional Laboratory, The Permanente Medical Group, Oakland, CA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | | | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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107
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Beltrán-García J, Osca-Verdegal R, Mena-Mollá S, García-Giménez JL. Epigenetic IVD Tests for Personalized Precision Medicine in Cancer. Front Genet 2019; 10:621. [PMID: 31316555 PMCID: PMC6611494 DOI: 10.3389/fgene.2019.00621] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
Epigenetic alterations play a key role in the initiation and progression of cancer. Therefore, it is possible to use epigenetic marks as biomarkers for predictive and precision medicine in cancer. Precision medicine is poised to impact clinical practice, patients, and healthcare systems. The objective of this review is to provide an overview of the epigenetic testing landscape in cancer by examining commercially available epigenetic-based in vitro diagnostic tests for colon, breast, cervical, glioblastoma, lung cancers, and for cancers of unknown origin. We compile current commercial epigenetic tests based on epigenetic biomarkers (i.e., DNA methylation, miRNAs, and histones) that can actually be implemented into clinical practice.
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Affiliation(s)
- Jesús Beltrán-García
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,Department of Physiology, School of Medicine and Dentistry, Universitat de València (UV), Valencia, Spain
| | - Rebeca Osca-Verdegal
- INCLIVA Biomedical Research Institute, Valencia, Spain.,Department of Physiology, School of Medicine and Dentistry, Universitat de València (UV), Valencia, Spain
| | - Salvador Mena-Mollá
- Department of Physiology, School of Medicine and Dentistry, Universitat de València (UV), Valencia, Spain.,EpiDisease S.L. Spin-Off of CIBERER (ISCIII), Valencia, Spain
| | - José Luis García-Giménez
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,Department of Physiology, School of Medicine and Dentistry, Universitat de València (UV), Valencia, Spain.,EpiDisease S.L. Spin-Off of CIBERER (ISCIII), Valencia, Spain
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108
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Flanagan MB. Primary High-Risk Human Papillomavirus Testing for Cervical Cancer Screening in the United States: Is It Time? Arch Pathol Lab Med 2019; 142:688-692. [PMID: 29848034 DOI: 10.5858/arpa.2018-0001-ra] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - The most recent update to cervical cancer screening guidelines offers interim guidance on the use of primary human papillomavirus (HPV) screening, with algorithms for management of results. After decades of screening with pure cytology and a shorter time with adjunctive HPV or cotesting with Papanicolaou (Pap) test and HPV, this is a significant change to our screening methods. OBJECTIVE - To briefly review the history of cervical cancer screening, the evidence upon which these interim guidelines were based, the arguments for and against primary HPV testing, and the current state of the field. DATA SOURCES - Primary studies, review articles, and commentaries were reviewed. CONCLUSIONS - While there is evidence both for and against primary HPV testing, there are a growing number of countries adopting the practice. It would be worthwhile to be informed and prepared for such a change in the United States as well.
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Affiliation(s)
- Melina B Flanagan
- From the Department of Pathology, West Virginia University School of Medicine, Morgantown
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109
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Aro K, Nieminen P, Louvanto K, Jakobsson M, Virtanen S, Lehtinen M, Dillner J, Kalliala I. Age-specific HPV type distribution in high-grade cervical disease in screened and unvaccinated women. Gynecol Oncol 2019; 154:354-359. [PMID: 31176553 DOI: 10.1016/j.ygyno.2019.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Age-specific type-distribution of high-risk human papillomavirus (hrHPV) in cervical precancerous lesions is subject to change in the HPV vaccination era. Knowing the pre-vaccination type-distribution helps to anticipate changes induced by mass vaccination and optimize screening. METHODS We recruited 1279 women referred to colposcopy for abnormal cytology into a population-based study on HPV type distribution in diagnostic cervical samples (ISRCTN10933736). The HPV genotyping findings were grouped as: HPV16/18+, other hrHPV+ (HPV31/33/35/39/45/51/52/56/58/59/66/68), non-vaccine targeted hrHPV+ (HPV35/39/51/56/59/66/68), low-risk HPV, and HPV negative. We estimated the HPV group-specific prevalence rates according to diagnostic histopathological findings in the age groups of <30 (n = 339), 30-44.9 (n = 614), and ≥45 (n = 326). RESULTS Altogether 503 cases with high grade squamous intraepithelial lesion or worse (HSIL+) were diagnosed. More than half, 285 (56.7%) of HSIL+ cases were associated with HPV16/18: 64.3% (101/157) in women <30 years (reference group), 58.4% (157/269) in women 30-44.9 years (risk ratio (RR) 0.91, 95% confidence interval (95% CI) 0.78-1.06), and 35.1% (27/77) in women ≥45 years of age (RR 0.55, 95% CI 0.39-0.75). Conversely, other hrHPV's were associated with 191 (38.0%) of HSIL+: 31.9% (50/157) in women <30, 36.8% (99/269) in women 30-44.9 years, 54.6% (42/77) and in women ≥45 (RR 1.71, 95% CI 1.26-2.33). The proportion of non-vaccine targeted hrHPV and HPV negative HSIL+ increased with advancing age. CONCLUSIONS Pre-vaccination HPV type distribution in HSIL+ was distinctly polarised by age with HPV16/18 attributed disease being markedly more prevalent in women aged <30. In the older women the other hrHPV types, however, dominated suggesting a need for more age-dependent screening strategies.
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Affiliation(s)
- Karoliina Aro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Karolina Louvanto
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Seppo Virtanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, SE-171 77 Stockholm, Sweden.
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, SE-171 77 Stockholm, Sweden.
| | - Ilkka Kalliala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
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110
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Šarenac T, Mikov M. Cervical Cancer, Different Treatments and Importance of Bile Acids as Therapeutic Agents in This Disease. Front Pharmacol 2019; 10:484. [PMID: 31214018 PMCID: PMC6558109 DOI: 10.3389/fphar.2019.00484] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/16/2019] [Indexed: 01/15/2023] Open
Abstract
Cervical cancer can be cured, because it has a long preinvasive period. Early diagnosis and treatment of cervical cancer at women are crucial for reducing of rate mortality. Today, there are many methods for detecting premalignant lesions and one of them is a conventional Papanicolaou test. Cervical cancer develops through a series of changes in the epithelium called cervical intraepithelial neoplasia (CIN). The biological and genetic characteristics of the cells at cancer in situ are irreversibly altered and abnormal cells have the potential to metastasize to others anatomical regions. Infection with human Papillomavirus, which is transmitted sexually, is considered the main cause and represent the necessary, but not the only factor for the development of cervical cancer. Types of high risk human Papillomavirus are often associated with invasive cervical cancer. The carcinogenic types of HPV 16 and 18 are responsible for 70% of cervical cancer and about 50% of CIN 3. Primary prevention of cervical cancer is aimed at reducing incidence, control of causes and risk factors. In this scientific work, in addition to explaining the various treatments necessary for the treatment of cervical carcinoma, we were discussed about the anticancer effects of the synthetic derivative of ursodeoxycholic acid, such as HS-1183, and synthetic derivatives of chenodeoxycholic acid such as HS-1199 and HS-1200. Also, the effects of bile acid complexes with metals such as platinum, zinc, nickel, and copper were considered in the effective treatment of cervical cancer. KEY POINTS • Lymphogenic spreading of cervical cancer occurs relatively early in the regional lymph nodes, while this sort of progression of cervical cancer is rarer in the juxtaregional (paraaortic), mediastinal and supraclavicular nodes. Clinically proven supraclavicular metastases are not a rarity. In stages IIb and IIIa with metastases in paraaortal nodes occur a 20% metastases at the neck lymph nodes. Hematogenic metastases are relatively rare and occur in the posterior phase. Distant metastases are detected in the lungs and liver. Preinvasive and microinvasive stages of cervical cancer are without symptoms. With deeper invasion of the strome, certain clinical symptoms such as prolonged menstruation, increased vaginal secretions, vaginal bleeding between the two periods, contact bleeding (after coitus), unilateral pelvic pain with spreading in hip joint (infiltration of the pelvic nerve plexus), dysuric disturbance, anemia, islet of the lower extremities. In order to diagnose the level spreading of primary lesion of cervical cancer most commonly are used the supplemental searches such as cytoscopy, rectoscopy, urography, irigography, lung and bone radiography, scintigraphy of the liver, kidney and bone, lymphography, CT (MR) of abdomen and pelvis, as well as laboratory analysis. Surgical treatment consists of transvaginal hysterectomy, transabdominal removal of the uterus (via laparotomy), bilateral adenectomy (removal of the ovaries and the fallopian tubes), upper and middle third of the vagina and lymphonodectomy of the regional lymph nodes. The most commonly used radiotherapy, intracavitary brachytherapy, manual afterloading technique and remote afterloading techniques. The synthetic derivatives of ursodeoxycholic acid and chenodeoxycholic acid such as HS-1183, HS-1199, and HS-1200 are used to treat cervical cancer. These derivatives of chenodeoxycholic acid and ursodeoxycholic acid are capable of inhibiting cell proliferation and inducing apoptosis in SiHa human cells of cervix. Platinum compounds are used as catalysts in cervical cancer therapy. Clinical use of platinum complexes for which the bile acids bind is based on the desire to achieve the death of tumor cells and the spectrum of drug activity in the treatment of cervical cancer. Bisursodeoxycholate (ethylenediamine) platinum (II) [Pt(UDC)2(en)] is characterized by important cytotoxicity against HeLa cervical carcinoma cells and this effect already being clearly detectable after 24 h.
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Affiliation(s)
- Tanja Šarenac
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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111
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Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia. Gynecol Oncol 2019; 152:465-471. [PMID: 30876490 DOI: 10.1016/j.ygyno.2018.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Australia's HPV vaccination and HPV-based cervical screening programs are changing the landscape in cervical cancer prevention. We aim to identify areas which can make the biggest further impact on cervical cancer burden. This protocol describes the first stage of a program of work called Pathways-Cervix that aims to generate evidence from modelled evaluations of interventions across the cervical cancer spectrum. METHODS Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified. RESULTS Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level; vaccinating older women; increasing screening participation; methods for triaging HPV-positive women; improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer; treating cervical abnormalities and cancer; and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes. CONCLUSIONS Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
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Hall MT, Smith MA, Lew JB, O'Hallahan J, Fentiman G, Neal H, Sage M, Canfell K. The combined impact of implementing HPV immunisation and primary HPV screening in New Zealand: Transitional and long-term benefits, costs and resource utilisation implications. Gynecol Oncol 2019; 152:472-479. [PMID: 30876491 DOI: 10.1016/j.ygyno.2018.10.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/16/2018] [Accepted: 10/30/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND In response to emergent evidence, many countries are transitioning from cytology-based to HPV screening. We evaluated the impact of an upcoming transition on health outcomes and resource utilisation in New Zealand. METHODS An extensively validated model of HPV transmission, vaccination, natural history and cervical screening ('Policy1-Cervix') was utilised to simulate a transition from three-yearly cytology for women 20-69 years to five-yearly HPV screening with 16/18 genotyping for women 25-69 years, accounting for population growth and the impact of HPV immunisation. Cervical cancer rates, resources use (test volumes), costs, and test positivity rates from 2015 to 2035 were estimated. FINDINGS By 2035, the transition to HPV screening will result in declines in cervical cancer incidence and mortality rates by 32% and 25%, respectively, compared to 2018. A potentially detectable 5% increase in cervical cancer incidence due to earlier detection is predicted for the year of transition. Annual numbers of women screened will fluctuate with the five-year screening interval. Cytology volumes will reduce by over 80% but colposcopy volumes will be similar to pre-transition rates, and program costs will be reduced by 16%. A 9% HPV test positivity rate is expected in the first round of HPV screening (2019-2023), with 2.7% of women referred for colposcopy. Transitioning from cytology to primary HPV cervical screening could avert 149 cancer cases and 45 deaths by 2035. CONCLUSION Primary HPV screening and vaccination will reduce cervical cancer and resources use. A small transient apparent increase of invasive cancer rates due to earlier detection may be detectable at the population level, reflecting the introduction of a more sensitive screening test. These findings can be used to inform health services planning and public communications surrounding program implementation.
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Affiliation(s)
- Michaela T Hall
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Mathematics and Statistics, University of New South Wales, Sydney, Australia.
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia
| | - Jie-Bin Lew
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | | | | | | | | | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia.
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Olivas AD, Barroeta JE, Lastra RR. Role of Ancillary Techniques in Gynecologic Cytopathology Specimens. Acta Cytol 2019; 64:63-70. [PMID: 30889579 DOI: 10.1159/000496569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/02/2019] [Indexed: 12/15/2022]
Abstract
The association between high-risk genotypes of human papillomavirus (hr-HPV) and cervical cancer is well established. As hr-HPV testing is rapidly becoming a part of routine cervical cancer screening, either in conjunction with cytology or as primary testing, the management of hr-HPV-positive women has to be tailored in a way that increases the detection of cervical abnormalities while decreasing unnecessary colposcopic biopsies or other invasive procedures. In this review, we discuss the overall utility and strategies of hr-HPV testing, as well as the advantages and limitations of potential triage strategies for hr-HPV-positive women, including HPV genotyping, p16/Ki-67 dual staining, and methylation assays.
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Affiliation(s)
- Andrea D Olivas
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Julieta E Barroeta
- Department of Pathology, Cooper University Hospital, Camden, New Jersey, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois, USA,
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Stoler MH, Wright TC, Parvu V, Yanson K, Eckert K, Kodsi S, Cooper C. HPV Testing With 16, 18, and 45 Genotyping Stratifies Cancer Risk for Women With Normal Cytology. Am J Clin Pathol 2019; 151:433-442. [PMID: 30649177 PMCID: PMC6396747 DOI: 10.1093/ajcp/aqy169] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives To determine the BD Onclarity human papillomavirus (HPV) assay performance and risk values for cervical intraepithelial neoplasia grade 2 (CIN2) or higher and cervical intraepithelial neoplasia grade 3 (CIN3) or higher during Papanicolaou/HPV cotesting in a negative for intraepithelial lesions or malignancies (NILM) population. Methods In total, 22,383 of the 33,858 enrolled women were 30 years or older with NILM cytology. HPV+ and a subset of HPV– patients (3,219/33,858 combined; 9.5%) were referred to colposcopy/biopsy. Results Overall, 7.9% of women were Onclarity positive; HPV 16 had the highest prevalence (1.5%). Verification bias-adjusted (VBA) CIN2 or higher and CIN3 or higher prevalences were 0.9% and 0.3%, respectively. Onclarity had VBA CIN2 or higher (44.1%) and CIN3 or higher (69.5%) sensitivities, as well as CIN2 or higher (92.4%) and CIN3 or higher (92.3%) specificities—all similar to Hybrid Capture 2. HPV 16, 18, 45, and the other 11 genotypes had CIN3 or higher risks of 6.9%, 2.6%, 1.1%, and 2.2%, respectively. Conclusions Onclarity is clinically validated for cotesting in NILM women. Genotyping actionably stratifies women at greater CIN3 or higher risk.
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Affiliation(s)
- Mark H Stoler
- University of Virginia Health System, Charlottesville
| | | | - Valentin Parvu
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
| | - Karen Yanson
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
| | - Karen Eckert
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
| | - Salma Kodsi
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
| | - Charles Cooper
- Becton, Dickinson and Company, BD Life Sciences–Diagnostic Systems, Sparks, MD
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115
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Vassilakos P, Petignat P. [P. Vassilakos and P. Petignat in reply to the article entitled: "Organized cervical screening at last in France!!". Gynecol Obstet Fertil Senol 2019;47:1-2]. ACTA ACUST UNITED AC 2019; 47:391-392. [PMID: 30818038 DOI: 10.1016/j.gofs.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Indexed: 11/25/2022]
Affiliation(s)
- P Vassilakos
- Geneva Foundation for Medical Education and Research, Genève, Suisse; Service de gynécologie, Hôpitaux Universitaires de Genève, 1205 Genève, Suisse
| | - P Petignat
- Service de gynécologie, Hôpitaux Universitaires de Genève, 1205 Genève, Suisse.
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116
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Castle PE, Pierz A. (At Least) Once in Her Lifetime: Global Cervical Cancer Prevention. Obstet Gynecol Clin North Am 2019; 46:107-123. [DOI: 10.1016/j.ogc.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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117
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Abstract
The rapidly increasing incidence and mortality of cancer calls for a focused effort to increase the effect of cancer‐prevention efforts. In the area of early detection, there are major differences in the preventive impact of implemented screening policies, even when solid, evidence‐based international recommendations are issued. Studies are needed to determine why evidence‐based interventions are not used and to investigate why effects are less than predicted by solid research on the subject. Currently, population‐based screening is recommended only for three forms of cancer (cervical, breast and colorectal cancer) but, given the increasing cancer burden, efforts are required to facilitate the discovery of new biomarkers for screening, as well as the identification of barriers to implementation of new cancer screening discoveries. The creation of a network of excellence in research on Cancer Prevention (Cancer Prevention Europe) is likely to significantly contribute to progress in these areas. In the present review, some possible strategies to ensure progress are discussed, with specific examples from the cervical cancer screening area.
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Affiliation(s)
- Joakim Dillner
- Center for Cervical Cancer Prevention, Department of Pathology, Karolinska University Laboratory and Karolinska Institutet, Stockholm, Sweden
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118
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Limitations of simulation models for cervical cancer screening – Authors' reply. Lancet Oncol 2019; 20:e69. [DOI: 10.1016/s1470-2045(19)30012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 11/21/2022]
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119
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Allende G, Surriabre P, Cáceres L, Bellot D, Ovando N, Torrico A, Calle P, Ascarrunz C, Alexander S, Bossens M, Fontaine V, Rodríguez P. Evaluation of the self-sampling for cervical cancer screening in Bolivia. BMC Public Health 2019; 19:80. [PMID: 30654774 PMCID: PMC6337790 DOI: 10.1186/s12889-019-6401-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022] Open
Abstract
Background Incidence and mortality rates of cervical cancer in Bolivia are the highest in Latin America. Vaginal cell self-sampling can improve screening coverage. Information on common reasons for low screening coverage and preferences for future screening are essential to reduce cervical cancer incidence. We aimed to evaluate the knowledge about human papillomavirus (HPV) and cervical cancer of Bolivian women from urban, peri-urban and rural areas of Cochabamba and to determine their degree of acceptability and confidence towards vaginal HPV self-sampling. In addition, we assessed the impact of self-sampling on cervical cancer screening coverage in a selected peri-urban area. Methods We gathered information from women living in urban, peri-urban and rural areas of Cochabamba province in Bolivia using two different structured questionnaires. In Survey1, we collected information from 222 women about their knowledge on HPV and cervical cancer. In Survey 2, the acceptance and confidence towards vaginal HPV self-sampling compared to the physician-sampling was assessed in 221 women. A non-probabilistic stratified sampling by areas was carried out for the two questionnaires. In the third phase of the study, we determined the impact of HPV self-sampling collection on screening coverage in a peri-urban area of Cochabamba. Results Bolivian women knew little or nothing about cervical cancer and HPV infection in all areas. They all found self-sampling collection easier to perform (86.9 to 93.2%) and more comfortable (79.4 to 83.3%) compared to physician sampling. Sampling accuracy to detect cervical cancer was probably higher in their point of view when it was taken by physician (35.1 to 63.5%). However in rural areas women preferred self-sampling. Accordingly, the campaign of vaginal HPV self-sampling in this peri-urban area increased screening coverage, reaching in three months the annual rate average. Conclusions The knowledge about cervical cancer and HPV infection is poor in Bolivia. Despite greater acceptance of the vaginal HPV self-sampling in all areas, women kept greater confidence in the screening performed by the gynecologist although HPV self-sampling improved coverage rate. Electronic supplementary material The online version of this article (10.1186/s12889-019-6401-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gustavo Allende
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.,Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles (U.L.B.), CP205/2, Campus Plaine, Boulevard du Triomphe, 1050, Brussels, Belgium
| | - Pedro Surriabre
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.,Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles (U.L.B.), CP205/2, Campus Plaine, Boulevard du Triomphe, 1050, Brussels, Belgium
| | - Leyddy Cáceres
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Diego Bellot
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Neli Ovando
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Andrea Torrico
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Pamela Calle
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Carla Ascarrunz
- Institute of Social Sciences Research (INCISO). Faculty of Social Sciences, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | - Sophie Alexander
- Ecole de Santé Publique, Université Libre de Bruxelles (U.L.B.), CP596, route de Lennik 808, 1070, Brussels, Belgium
| | - Michel Bossens
- Research laboratory in human reproduction, Campus Erasme, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Fontaine
- Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, Université Libre de Bruxelles (U.L.B.), CP205/2, Campus Plaine, Boulevard du Triomphe, 1050, Brussels, Belgium
| | - Patricia Rodríguez
- Laboratorio Virología, Facultad de Medicina, Universidad Mayor de San Simón, Cochabamba, Bolivia.
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Iftner T, Neis KJ, Castanon A, Landy R, Holz B, Woll-Herrmann A, Iftner A, Staebler A, Wallwiener D, Hann von Weyhern C, Neis F, Haedicke-Jarboui J, Martus P, Brucker S, Henes M, Sasieni P. Longitudinal Clinical Performance of the RNA-Based Aptima Human Papillomavirus (AHPV) Assay in Comparison to the DNA-Based Hybrid Capture 2 HPV Test in Two Consecutive Screening Rounds with a 6-Year Interval in Germany. J Clin Microbiol 2019; 57:e01177-18. [PMID: 30355760 PMCID: PMC6322477 DOI: 10.1128/jcm.01177-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/08/2018] [Indexed: 11/20/2022] Open
Abstract
Longitudinal data on the E6/E7 mRNA-based Aptima human papillomavirus (AHPV) assay exceeding three years in comparison to the gold standard Digene Hybrid Capture 2 (HC2) test are not available. We previously reported the cross-sectional data of the German AHPV Screening Trial (GAST) in which 10,040 women were recruited and tested by liquid-based cytology, the HC2 assay, and the AHPV assay. Four hundred eleven test-positive women were followed for up to six years. In addition, 3,295 triple-negative women were screened after a median time of six years. Overall, 28 high-grade cervical intraepithelial neoplasia (CIN3) cases were detected. The absolute risk of developing high-risk HPV-positive CIN3+ over six years among those women that tested negative at baseline was 2.2 (95% confidence interval [95% CI], 1.0 to 4.9) and 3.1 (95% CI, 1.7 to 5.7) per 1,000 women screened by the HC2 and the AHPV tests; the additional risk for those with AHPV-negative compared with HC2-negative results was 0.9 (95% CI, -0.2 to 2.1) per 1,000. In comparison, the absolute risk following a negative LBC test was 9.3 (95% CI, 2.9 to 30.2). The relative sensitivity of AHPV compared to HC2 was 91.5% for CIN3+, and the negative predictive values were 99.8% (95% CI, 99.5 to 99.9%) for HC2 and 99.7% (95% CI, 99.4 to 99.8%) for AHPV. Our data show that the longitudinal performance of the AHPV test over six years is comparable to the performance of the HC2 test and that the absolute risk of CIN3+ over six years following a negative AHPV result in a screening population is low. (This study is registered at ClinicalTrials.gov under registration number NCT02634190.).
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Affiliation(s)
- Thomas Iftner
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | - Alejandra Castanon
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Rebecca Landy
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | - Barbara Holz
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | - Angelika Iftner
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Annette Staebler
- Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Diethelm Wallwiener
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Claus Hann von Weyhern
- Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Felix Neis
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Juliane Haedicke-Jarboui
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Peter Martus
- Medical Faculty Tübingen, Institute for Clinical Epidemiology and Applied Biometry, Tübingen, Germany
| | - Sara Brucker
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Melanie Henes
- Department of Gynaecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Peter Sasieni
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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121
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Toliman PJ, Kaldor JM, Badman SG, Gabuzzi J, Silim S, Kumbia A, Kombuk B, Kombati Z, Munnull G, Guy R, Vallely LM, Kelly-Hanku A, Wand H, Ryan C, Tan G, Brotherton J, Saville M, Mola GDL, Garland SM, Tabrizi SN, Vallely AJ. Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea. PAPILLOMAVIRUS RESEARCH 2018; 6:70-76. [PMID: 30391365 PMCID: PMC6250751 DOI: 10.1016/j.pvr.2018.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/16/2018] [Accepted: 10/29/2018] [Indexed: 11/19/2022]
Abstract
The performance of different clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal (‘V’) specimens, and visual inspection of the cervix with acetic acid (VIA) was evaluated in Papua New Guinea. Women aged 30–59 years provided V specimens that were tested at point-of-care using the Xpert HPV Test (Cepheid, Sunnyvale, CA). A clinician-collected cervical (‘C’) specimen was then collected for point-of-care Xpert testing, and liquid-based cytology (LBC). Following this, VIA examination was conducted, blind to HPV test results, and ablative cervical cryotherapy provided if indicated. Detection of high-grade squamous intraepithelial lesion (HSIL) by LBC was the reference standard used to evaluate clinical screening algorithms. Of 1005 women, 36 had HSIL+. Xpert HPV Test performance using V specimens (sensitivity 91.7%, specificity 87.0%, PPV 34.0%, NPV 99.3%) was superior to VIA examination alone (51.5%, 81.4%, 17.5%, 95.6% respectively) in predicting underlying HSIL+. A screening algorithm comprising V specimen HPV testing followed by VIA examination had low sensitivity (45.5%) but comparable specificity, PPV and NPV to HPV testing alone (96.3%, 45.5%, 96.3% respectively). A ‘test-and-treat’ screening algorithm based on point-of-care HPV testing of V specimens had superior performance compared with either VIA examination alone, or a combined screening algorithm comprising HPV testing plus VIA.
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Affiliation(s)
- Pamela J Toliman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Kirby Institute, UNSW Sydney, Australia.
| | | | | | - Josephine Gabuzzi
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Selina Silim
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | | | | | | | - Gloria Munnull
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | | | | | - Angela Kelly-Hanku
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | | | | | - Grace Tan
- Victorian Cytology Service, Melbourne, Australia.
| | | | | | - Glen D L Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
| | - Suzanne M Garland
- Department of Clinical Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia.
| | - Sepehr N Tabrizi
- Department of Clinical Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia.
| | - Andrew J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
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van Leeuwen RW, Oštrbenk A, Poljak M, van der Zee AGJ, Schuuring E, Wisman GBA. DNA methylation markers as a triage test for identification of cervical lesions in a high risk human papillomavirus positive screening cohort. Int J Cancer 2018; 144:746-754. [PMID: 30259973 PMCID: PMC6587981 DOI: 10.1002/ijc.31897] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/03/2018] [Accepted: 08/23/2018] [Indexed: 12/20/2022]
Abstract
Objective triage strategies are required to prevent unnecessary referrals for colposcopy in population‐based screening programs using primary high‐risk human papillomavirus (hrHPV) testing. We have identified several DNA methylation markers with high sensitivity and specificity for detection of high‐grade cervical intraepithelial neoplasia or worse (CIN2+) in women referred for colposcopy. Our study assessed diagnostic potential of these methylation markers in a hrHPV‐positive screening cohort. All six markers (JAM3, EPB41L3, C13orf18, ANKRD18CP, ZSCAN1 and SOX1) showed similar association across histology in the hrHPV‐positive cohort when compared to the Dutch cohort (each p > 0.15). Sensitivity for CIN2+ was higher using methylation panel C13orf18/EPB41L3/JAM3 compared to the other 2 panels (80% vs. 60% (ANKRD18CP/C13orf18/JAM3) and 63% (SOX1/ZSCAN1), p = 0.01). For CIN3+ all three methylation panels showed comparable sensitivity ranging from 68% (13/19) to 95% (18/19). Specificity of SOX1/ZSCAN1 panel (84%, 167/200) was considerably higher compared to ANKRD18CP/C13orf18/JAM3 (68%, 136/200, p = 2 × 10−5) and C13orf18/EPB41L3/JAM3 (66%, 132/200, p = 2 × 10−7). High negative predictive value (NPV) (91–95% and 96–99%) was observed for CIN2+ and CIN3+, for all three methylation panels, while positive predictive value (PPV) varied from 25 to 40% for CIN2+ and 15–27% for CIN3+. Interestingly, 118/235 samples were negative for all six markers (including 106 controls (89.8%), 6 CIN1 (5.1%), 5 CIN2 (4.2%) and 1 CIN3 (0.8%)). Methylation results from both independent cohorts were comparable as well as high sensitivity for detection of cervical cancer and its high‐grade precursors in hrHPV‐positive population. Our study therefore validates these methylation marker panels as triage test either in hrHPV‐based or abnormal cytology‐based screening programs. What's new? In cervical cancer screening, HPV testing provides greater sensitivity than cytology, but its lower specificity leads to some unnecessary treatment referrals. DNA methylation assays could potentially provide better specificity for identifying CIN2+ in women carrying high risk HPV. These authors investigated six previously identified CIN2+ methylation markers. They tested three different combinations of markers, and found high levels of sensitivity and specificity, making these markers potentially useful as part of a population‐based screening program.
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Affiliation(s)
- Robert W van Leeuwen
- Department of Gynaecologic Oncology, Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Anja Oštrbenk
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ate G J van der Zee
- Department of Gynaecologic Oncology, Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology, Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - G Bea A Wisman
- Department of Gynaecologic Oncology, Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Anticipating the Impact of Human Papillomavirus Vaccination on US Cervical Cancer Prevention Strategies. J Low Genit Tract Dis 2018; 22:123-125. [PMID: 29474243 DOI: 10.1097/lgt.0000000000000385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cervical cancer prevention guidelines are benchmarked to risk of cervical precancer. In younger age cohorts, vaccination against high-risk types of human papillomavirus (HPV) has reduced HPV 16/18 prevalence and cervical intraepithelial neoplasia. Lower prevalence of precancer will impair the sensitivity of cytology and colposcopy, but negative predictive value will rise. Training and skills maintenance will become more difficult as abnormalities become less common. Primary screening with HPV assays will become more attractive but will require HPV genotyping as most positive HPV tests will reflect non-16/18 infections with lower oncogenicity. Screening will begin later and will occur at longer intervals. Colposcopy and treatment thresholds will become more stringent. Historical data sets will become inappropriate for guidelines development. As women immunized using nonavalent vaccine reach screening age, these trends will become still more pronounced.
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124
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Forslund O, Miriam Elfström K, Lamin H, Dillner J. HPV-mRNA and HPV-DNA detection in samples taken up to seven years before severe dysplasia of cervix uteri. Int J Cancer 2018; 144:1073-1081. [PMID: 30125346 DOI: 10.1002/ijc.31819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 11/06/2022]
Abstract
Randomized clinical trials using human papillomavirus (HPV) DNA testing have found increased protection against cervical cancer and HPV-based screening is globally recommended for women ≥30 years of age. HPV-mRNA is a promising alternative target for cervical screening tests, but assessing equivalence requires longitudinal evaluation over at least the length of a screening interval. Our aim is to analyze the longitudinal sensitivity of HPV-mRNA and HPV-DNA in cervical samples taken up to 7 years before severe cervical intraepithelial neoplasia or worse (CIN3+). From a population-based cohort of 95,023 women in Sweden, cervical samples were frozen at -80°C between May 2007 and January 2012. Registry linkages identified that 1,204 of these women had CIN3+ 4 months to 7 years after enrolment. Baseline samples were analyzed for HPV-mRNA (Aptima, Hologic) and for HPV-DNA (Cobas 4800, Roche) and results from both tests obtained for 1,172 women. For both women <30 and ≥ 30 years, HPV-mRNA had similar sensitivity for CIN3+ as HPV-DNA (p = 0.0217 and p = 0.0123 in noninferiority testing for at least 90% relative sensitivity, respectively). Among women ≥30 years, the longitudinal sensitivities for CIN3+ occurring 5-7 years later were comparable [76.3% (95% CI: 65.8%-84.3%) and 82.5% (95% CI: 72.6%-89.4%)] as were the longitudinal negative predictive values for absence of CIN3+ [99.97% (95% CI: 99.95-99.98) and 99.98% (95% CI: 99.96-99.99)], for the HPV-mRNA and HPV-DNA test. In conclusion, HPV-mRNA testing has similar longitudinal sensitivity as HPV-DNA, implying that HPV-mRNA testing can safely be used for cervical screening.
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Affiliation(s)
- Ola Forslund
- Laboratory Medicine, Medical Microbiology, Lund University, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Sweden.,Unit for Screening, Regional Cancer Center of Stockholm-Gotland, Sweden
| | - Helena Lamin
- Karolinska University Laboratory, Karolinska University Hospital, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Sweden.,Karolinska University Laboratory, Karolinska University Hospital, Sweden
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Ruan G, Song Y, Dong B, Mao X, Lin F, Kang Y, Xu S, Chen X, Wu Q, Sun P. Cervical cancer screening using the Cervista high-risk human papillomavirus test: opportunistic screening of a hospital-based population in Fujian province, China. Cancer Manag Res 2018; 10:3227-3235. [PMID: 30233239 PMCID: PMC6130297 DOI: 10.2147/cmar.s169822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives The Cervista® high-risk human papillomavirus (HR-HPV) test was evaluated as a primary screening method for cervical cancer in women aged ≥21 years and was compared with different screening and triage combinations. Materials and methods A nested case–control study within the Fujian provincial Cervical Lesion Screening Cohorts was used to evaluate the Cervista test as the primary cervical screening method in a hospital-based population. Strategy 1 primarily screened using a cytology screen with HR-HPV testing used for triage. Strategy 2 primarily screened using cytology and HR-HPV co-testing. Strategy 3 primarily screened using HR-HPV testing and triaged HPV-positive women based on cytology. Strategy 4 primarily screened using HR-HPV testing and referred A9 pool HPV-positive women to colposcopy directly, whereas non-A9 HPV-positive women were triaged using cytology. Results There were 10,183 women included in this study; 16.49% (1677/10,183) were HR-HPV-positive, 9.52% had abnormal cytology, and 9907 women were normal during followup. A total of 276 women were diagnosed with cervical intraepithelial neoplasia 2 or worse (CIN2+), 197 with CIN3 or worse (CIN3+), and 70 with cervical cancer. Moreover, 10.15% (20/197) women who were CIN3+ were identified as cytology-negative, while 8.63% (17/197) were HR-HPV negative (P>0.05). The cumulative risk rate for HPV–/cytology– was 0.836 (95% CI, 0.424–1.648) in CIN3+ cases. Strategy 4 yielded the highest sensitivity for CIN2+ or CIN3+ and the lowest positive predictive value for CIN2+ or CIN3+ among the four screening strategies. Conclusion The Cervista HR-HPV test can provide a reliable and sensitive clinical reference for the cervical cancer primary screen.
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Affiliation(s)
- Guanyu Ruan
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
| | - Yiyi Song
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
| | - Binhua Dong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
| | - Xiaodan Mao
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
| | - Fen Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
| | - Yafang Kang
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
| | - Shuxia Xu
- Department of Pathology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xianjing Chen
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
| | - Qibin Wu
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China, .,Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China,
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Turner SA, Deharvengt SJ, Lyons KD, Espinal JAP, LaRochelle EP, Bejarano S, Kennedy L, Tsongalis GJ. Implementation of Multicolor Melt Curve Analysis for High-Risk Human Papilloma Virus Detection in Low- and Middle-Income Countries: A Pilot Study for Expanded Cervical Cancer Screening in Honduras. J Glob Oncol 2018; 4:1-8. [PMID: 30241169 PMCID: PMC6180764 DOI: 10.1200/jgo.17.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cervical cancer is a leading cause of cancer-related mortality in low- and middle-income countries (LMICs) and screening in LMICs is extremely limited. We aimed to implement on-site high-risk human papillomavirus (hrHPV) DNA testing in cohorts of women from an urban factory and from a rural village. METHODS A total of 802 women were recruited for this study in partnership with La Liga Contra el Cancer through the establishment of women's health resource fairs at two locations in Honduras: a textile factory (n = 401) in the city of San Pedro Sula and the rural village of El Rosario (n = 401) in Yoro. Participants received a routine cervical examination during which three sterile cytobrushes were used to collect cervical samples for testing. hrHPV genotyping was performed using a hrHPV genotyping assay and a real-time polymerase chain reaction instrument. RESULTS hrHPV status across all participants at both sites was 13% hrHPV positive and 67% hrHPV negative. When hrHPV status was compared across all three testing sites, hrHPV-positive rates were approximately equal among the factory (13%), village (12%), and confirmatory testing at Dartmouth-Hitchcock Medical Center (Lebanon, NH; 14%). hrHPV genotype was compared across sites, with HPV16 showing the highest infection rate (15%), followed by HPV59 (12%), and HPV68 (11%). There was a low prevalence of HPV18 observed in both populations compared with the hrHPV-positive population in the United States. CONCLUSION In collaboration with oncologists and pathologists from La Liga Contra el Cancer, we were able to provide a continuum of care once health-fair testing was performed. We established a method and implementation plan for hrHPV testing that is sustainable in LMICs.
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Affiliation(s)
- Scott A. Turner
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Sophie J. Deharvengt
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Kathleen Doyle Lyons
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Jorge Arturo Plata Espinal
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Ethan P.M. LaRochelle
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Suyapa Bejarano
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Linda Kennedy
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Gregory J. Tsongalis
- Scott A. Turner, Sophie J. Deharvengt,
Kathleen Doyle Lyons, Linda Kennedy, and
Gregory J. Tsongalis, Dartmouth-Hitchcock Medical Center,
Lebanon; Ethan P.M. LaRochelle, Dartmouth College, Hanover, NH;
Jorge Arturo Plata Espinal and Suyapa Bejarano, La
Liga Contra el Cancer, San Pedro Sula, Honduras
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Perkins RB, Schiffman M, Guido RS. The next generation of cervical cancer screening programs: Making the case for risk-based guidelines. Curr Probl Cancer 2018; 42:521-526. [DOI: 10.1016/j.currproblcancer.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
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Rizzo AE, Feldman S. Update on primary HPV screening for cervical cancer prevention. Curr Probl Cancer 2018; 42:507-520. [DOI: 10.1016/j.currproblcancer.2018.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/30/2018] [Indexed: 02/07/2023]
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Jin MS, Lee H, Kim MA, Park IA, Lee C, An HJ, Shim B, Moon JH, Won JK, Ryu HS. Novel cytomorphologic characteristics suggesting human papillomavirus infection in patients diagnosed as negative for intraepithelial lesion or malignancy and a comparison of diagnostic performance of three human papillomavirus tests. Diagn Cytopathol 2018; 46:833-839. [DOI: 10.1002/dc.24049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/22/2018] [Accepted: 07/10/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Min-Sun Jin
- Department of Pathology; Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Bucheon Gyeonggi-do South Korea
| | - Hyebin Lee
- Department of Radiation Oncology; Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Min A. Kim
- Department of Pathology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul South Korea
| | - In Ae Park
- Department of Pathology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul South Korea
| | - Chul Lee
- Department of Pathology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul South Korea
| | - Hyoung Jin An
- Department of Pathology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul South Korea
| | - Bobae Shim
- Department of Pathology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul South Korea
| | - Ji Hye Moon
- Department of Pathology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul South Korea
| | - Jae Kyung Won
- Department of Pathology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul South Korea
| | - Han Suk Ryu
- Department of Pathology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul South Korea
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Murenzi G, Dusingize JC, Rurangwa T, Sinayobye JD, Munyaneza A, Murangwa A, Zawadi T, Hebert T, Mugenzi P, Adedimeji A, Mutesa L, Anastos K, Castle PE. Protocol for the study of cervical cancer screening technologies in HIV-infected women living in Rwanda. BMJ Open 2018; 8:e020432. [PMID: 30082342 PMCID: PMC6078254 DOI: 10.1136/bmjopen-2017-020432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The optimal method(s) for screening HIV-infected women, especially for those living in sub-Saharan Africa, for cervical precancer and early cancer has yet to be established. METHODS AND ANALYSIS A convenience sample of >5000 Rwandan women, ages 30-54 years and living with HIV infection, is being consented and enroled into a cross-sectional study of cervical cancer screening strategies. Participants are completing an administered short risk factor questionnaire and being screened for high-risk human papillomavirus (hrHPV) using the Xpert HPV assay (Cepheid, Sunnyvale, California, USA), unaided visual inspection after acetic acid (VIA) and aided VIA using the Enhanced Visual Assessment (EVA) system (Mobile ODT, Tel Aviv, Israel). Women positive for hrHPV and/or by unaided VIA undergo colposcopy, which includes the collection of two cervical specimens prior to undergoing a four-quadrant microbiopsy protocol. The colposcopy-collected specimens are being tested by dual immunocytochemical staining for p16INK4a and Ki-67 (CINtec PLUS Cytology, Ventana, Tucson, Arizona, USA) and for E6 or E7 oncoprotein for 8 hrHPV genotypes (HPV16, 18, 31, 33, 35, 45, 52 and 58) using the next-generation AV Avantage hrHPV E6/E7 test (Arbor Vita Corporation, Freemont, California, USA). Women with a local pathology diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe (CIN2+) or pathology review diagnosis of CIN grade three or more severe (CIN3+) will receive treatment. Clinical performance and cost-effectiveness (eg, sensitivity, specificity and predictive values) of different screening strategies and algorithms will be evaluated. ETHICS AND DISSEMINATION The protocol was approved by local and institutional review boards for human subjects research. At the completion of the study, results will be disseminated to the scientific community through peer-reviewed publication and to the Rwandan stakeholders through an external advisory panel.
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Affiliation(s)
| | | | | | | | | | | | | | - Tiffany Hebert
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Leon Mutesa
- Rwanda Military Hospital, Kigali, Rwanda
- University of Rwanda, Kigali, Rwanda
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Tranberg M, Jensen JS, Bech BH, Blaakær J, Svanholm H, Andersen B. Good concordance of HPV detection between cervico-vaginal self-samples and general practitioner-collected samples using the Cobas 4800 HPV DNA test. BMC Infect Dis 2018; 18:348. [PMID: 30053836 PMCID: PMC6062874 DOI: 10.1186/s12879-018-3254-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/13/2018] [Indexed: 12/03/2022] Open
Abstract
Background Studies comparing self-samples and clinician-collected samples for high-risk human papillomavirus (HPV) detection using clinically validated PCR-based HPV DNA assays are limited. We measured the concordance of HPV detection between home-based self-sampling and general practitioner (GP) sampling using the Cobas 4800 HPV DNA test and studied women’s accept of home-based self-sampling. Methods Paired GP-collected samples and cervico-vaginal self-samples were obtained from 213 women aged 30–59 years diagnosed with ASC-US within the cervical cancer screening program. After undergoing cervical cytology at their GP, the women collected a self-sample with the Evalyn Brush at home and completed a questionnaire. Both samples were HPV-tested using the Cobas 4800 test. Histology results were available for those who tested HPV positive in GP-collected samples. Results We observed good concordance for HPV detection between self-samples and GP-collected samples (κ: 0.70, 95% CI: 0.58–0.81). No underlying CIN2+ cases were missed by self-sampling. Women evaluated that self-sampling was easy (97.2%, 95% CI: 93.9–98.9%) and comfortable (94.8%, 95% CI: 90.9–97.4%). Conclusions Home-based self-sampling using the Evalyn Brush and the Cobas 4800 test is an applicable and reliable alternative to GP-sampling.
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Affiliation(s)
- Mette Tranberg
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NØ, Denmark. .,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Jørgen Skov Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Jan Blaakær
- Department of Obstetrics and Gynecology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.,Department of Clinical Medicine, University of Southern Denmark, J.B. Winslows Vej 25, 5000, Odense C, Denmark
| | - Hans Svanholm
- Department of Pathology, Randers Regional Hospital, Østervangsvej 48, 8930, Randers NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NØ, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Packet B, Poppe W, Weynand B, Vanherck M. The use of p16/Ki-67 dual staining technology on cervical cytology of patients undergoing a LLETZ procedure. Eur J Obstet Gynecol Reprod Biol 2018; 228:191-196. [PMID: 30007246 DOI: 10.1016/j.ejogrb.2018.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The main objective of this prospective observational study was to investigate the diagnostic performance of the p16/Ki-67 dual stain technique (DST) for detecting CIN 2+ in a LLETZ referral setting. Test performances were compared with HR-HPV testing and Pap cytology. METHODS All patients referred for a LLETZ procedure were candidates for participation in this trial. A total of 110 patients were enrolled between October 2016 and March 2017. From each participant, a cervical cytology sample was obtained before the onset of the LLETZ procedure. On each sample, the dual stain technique (Roche CINtec PLUS ® test), Pap cytology and an HPV DNA assay (identifying 17 different HPV types) were performed. RESULTS The overall disease prevalence of CIN 2+ was 56%. The mean age was 41 years, with 38% of patients being younger than 35 years. The overall sensitivity and specificity of the dual stain technique for detecting CIN 2+ was 94% (95% CI: 84.30-98.21%) and 58% (95% CI: 43.21-72.93%) respectively with a PPV of 74% (95% CI: 67.34-80.31%) and a NPV of 88% (95% CI: 72.48-94.90%). HR-HPV testing results in a similar sensitivity of 92% (95% CI: 82.17-97.33%) but considerable lower specificity of 21% (95% CI: 11.17-33.35%) compared to the dual stain technique. At an ASCUS or worse threshold, Pap cytology had the lowest sensitivity of 89% (95% CI 78.11-95.34%) compared to dual staining and HR-HPV testing. Specificity was better (48% with 95% CI of 33.29-62.81%) than that of HR-HPV testing but not as good as the DST. CONCLUSION p16/Ki-67 dual staining provides high sensitivity and improved specificity compared to HR-HPV testing and Pap cytology for detecting CIN 2+, making it an interesting tool for identifying relevant disease in patients referred for a LLETZ procedure.
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Affiliation(s)
- Bram Packet
- Department of Gynaecology - University Hospitals of Leuven, Herestraat 49, Leuven, Belgium.
| | - Willy Poppe
- Department of Gynaecology - University Hospitals of Leuven, Herestraat 49, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology - University Hospitals of Leuven, Herestraat 49, Leuven, Belgium
| | - Miet Vanherck
- Department of Pathology - University Hospitals of Leuven, Herestraat 49, Leuven, Belgium
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133
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Affiliation(s)
- L Stewart Massad
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri
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134
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Ogilvie GS, van Niekerk D, Krajden M, Smith LW, Cook D, Gondara L, Ceballos K, Quinlan D, Lee M, Martin RE, Gentile L, Peacock S, Stuart GCE, Franco EL, Coldman AJ. Effect of Screening With Primary Cervical HPV Testing vs Cytology Testing on High-grade Cervical Intraepithelial Neoplasia at 48 Months: The HPV FOCAL Randomized Clinical Trial. JAMA 2018; 320:43-52. [PMID: 29971397 PMCID: PMC6583046 DOI: 10.1001/jama.2018.7464] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE There is limited information about the relative effectiveness of cervical cancer screening with primary human papillomavirus (HPV) testing alone compared with cytology in North American populations. OBJECTIVE To evaluate histologically confirmed cumulative incident cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) detected up to and including 48 months by primary HPV testing alone (intervention) or liquid-based cytology (control). DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted in an organized Cervical Cancer Screening Program in Canada. Participants were recruited through 224 collaborating clinicians from January 2008 to May 2012, with follow-up through December 2016. Women aged 25 to 65 years with no history of CIN2+ in the past 5 years, no history of invasive cervical cancer, or no history of hysterectomy; who have not received a Papanicolaou test within the past 12 months; and who were not receiving immunosuppressive therapy were eligible. INTERVENTIONS A total of 19 009 women were randomized to the intervention (n = 9552) and control (n = 9457) groups. Women in the intervention group received HPV testing; those whose results were negative returned at 48 months. Women in the control group received liquid-based cytology (LBC) testing; those whose results were negative returned at 24 months for LBC. Women in the control group who were negative at 24 months returned at 48 months. At 48-month exit, both groups received HPV and LBC co-testing. MAIN OUTCOMES AND MEASURES The primary outcome was the cumulative incidence of CIN3+ 48 months following randomization. The cumulative incidence of CIN2+ was a secondary outcome. RESULTS Among 19 009 women who were randomized (mean age, 45 years [10th-90th percentile, 30-59]), 16 374 (8296 [86.9%] in the intervention group and 8078 [85.4%] in the control group) completed the study. At 48 months, significantly fewer CIN3+ and CIN2+ were detected in the intervention vs control group. The CIN3+ incidence rate was 2.3/1000 (95% CI, 1.5-3.5) in the intervention group and 5.5/1000 (95% CI, 4.2-7.2) in the control group. The CIN3+ risk ratio was 0.42 (95% CI, 0.25-0.69). The CIN2+ incidence rate at 48 months was 5.0/1000 (95% CI, 3.8-6.7) in the intervention group and 10.6/1000 (95% CI, 8.7-12.9) in the control group. The CIN2+ risk ratio was 0.47 (95% CI, 0.34-0.67). Baseline HPV-negative women had a significantly lower cumulative incidence of CIN3+ at 48 months than cytology-negative women (CIN3+ incidence rate, 1.4/1000 [95% CI, 0.8-2.4]; CIN3+ risk ratio, 0.25 [95% CI, 0.13-0.48]). CONCLUSIONS AND RELEVANCE Among women undergoing cervical cancer screening, the use of primary HPV testing compared with cytology testing resulted in a significantly lower likelihood of CIN3+ at 48 months. Further research is needed to understand long-term clinical outcomes as well as cost-effectiveness. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN79347302.
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Affiliation(s)
- Gina Suzanne Ogilvie
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- Lower Mainland Laboratories, Vancouver, British Columbia, Canada
- Cervical Cancer Screening Program, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Mel Krajden
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Laurie W. Smith
- Cervical Cancer Screening Program, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Darrel Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Cervical Cancer Screening Program, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Cervical Cancer Screening Program, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Kathy Ceballos
- Cervical Cancer Screening Program, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - David Quinlan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marette Lee
- Cervical Cancer Screening Program, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Gentile
- Cervical Cancer Screening Program, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Gavin C. E. Stuart
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eduardo L. Franco
- Departments of Oncology and Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Andrew J. Coldman
- Cervical Cancer Screening Program, British Columbia Cancer, Vancouver, British Columbia, Canada
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Landy R, Cheung LC, Schiffman M, Gage JC, Hyun N, Wentzensen N, Kinney WK, Castle PE, Fetterman B, Poitras NE, Lorey T, Sasieni PD, Katki HA. Challenges in risk estimation using routinely collected clinical data: The example of estimating cervical cancer risks from electronic health-records. Prev Med 2018; 111:429-435. [PMID: 29222045 PMCID: PMC5930038 DOI: 10.1016/j.ypmed.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
Abstract
Electronic health-records (EHR) are increasingly used by epidemiologists studying disease following surveillance testing to provide evidence for screening intervals and referral guidelines. Although cost-effective, undiagnosed prevalent disease and interval censoring (in which asymptomatic disease is only observed at the time of testing) raise substantial analytic issues when estimating risk that cannot be addressed using Kaplan-Meier methods. Based on our experience analysing EHR from cervical cancer screening, we previously proposed the logistic-Weibull model to address these issues. Here we demonstrate how the choice of statistical method can impact risk estimates. We use observed data on 41,067 women in the cervical cancer screening program at Kaiser Permanente Northern California, 2003-2013, as well as simulations to evaluate the ability of different methods (Kaplan-Meier, Turnbull, Weibull and logistic-Weibull) to accurately estimate risk within a screening program. Cumulative risk estimates from the statistical methods varied considerably, with the largest differences occurring for prevalent disease risk when baseline disease ascertainment was random but incomplete. Kaplan-Meier underestimated risk at earlier times and overestimated risk at later times in the presence of interval censoring or undiagnosed prevalent disease. Turnbull performed well, though was inefficient and not smooth. The logistic-Weibull model performed well, except when event times didn't follow a Weibull distribution. We have demonstrated that methods for right-censored data, such as Kaplan-Meier, result in biased estimates of disease risks when applied to interval-censored data, such as screening programs using EHR data. The logistic-Weibull model is attractive, but the model fit must be checked against Turnbull non-parametric risk estimates.
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Affiliation(s)
- Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Noorie Hyun
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Walter K Kinney
- Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA, USA
| | | | - Barbara Fetterman
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, USA
| | - Nancy E Poitras
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, USA
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, USA
| | - Peter D Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
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Thamsborg LH, Andersen B, Larsen LG, Christensen J, Johansen T, Hariri J, Christiansen S, Rygaard C, Lynge E. Danish method study on cervical screening in women offered HPV vaccination as girls (Trial23): a study protocol. BMJ Open 2018; 8:e020294. [PMID: 29804060 PMCID: PMC5988093 DOI: 10.1136/bmjopen-2017-020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The first birth cohorts of women offered human papillomavirus (HPV) vaccination as girls are now entering cervical screening. However, there is no international consensus on how to screen HPV vaccinated women. These women are better protected against cervical cancer and could therefore be offered less intensive screening. Primary HPV testing is more sensitive than cytology, allowing for a longer screening interval. The aim of Trial23 is to investigate if primary HPV testing with cytology triage of HPV positive samples is a reasonable screening scheme for women offered HPV vaccination as girls. METHODS Trial23 is a method study embedded in the existing cervical screening programme in four out of five Danish regions. Without affecting the screening programme, women born in 1994 are randomised to present screening with liquid-based cytology every third year (present programme arm) or present screening plus an HPV test (HPV arm). The study started 1 February 2017 and will run over three screening rounds corresponding to 7-8 years. ANALYSES The primary endpoint is cervical intraepithelial neoplasia grade 3 or above. The trial is undertaken as a non-inferiority study including intention-to-treat and per-protocol analyses. The potential effect of primary HPV screening with a 6-year interval will be calculated from the observed data. ETHICS AND DISSEMINATION The study protocol has been submitted to the ethical committee and deemed a method study. All women are screened according to routine guidelines. The study will contribute new evidence on the future screening of HPV vaccinated birth cohorts of women. All results will be published in open-access journal. TRIAL REGISTRATION NCT03049553; Pre-results.
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Affiliation(s)
- Lise Holst Thamsborg
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Berit Andersen
- Department of Public Health Programs, Randers Regional Hospital, Randers, Denmark
| | | | - Jette Christensen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Tonje Johansen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Jalil Hariri
- Department of Pathology, Soenderjylland Hospital, Soenderborg, Denmark
| | | | - Carsten Rygaard
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, Denmark
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Rendle KA, Schiffman M, Cheung LC, Kinney WK, Fetterman B, Poitras NE, Lorey T, Castle PE. Adherence patterns to extended cervical screening intervals in women undergoing human papillomavirus (HPV) and cytology cotesting. Prev Med 2018; 109:44-50. [PMID: 29288782 DOI: 10.1016/j.ypmed.2017.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/03/2023]
Abstract
Although guidelines have recommended extended interval cervical screening using concurrent human papillomavirus (HPV) and cytology ("cotesting") for over a decade, little is known about its adoption into routine care. Using longitudinal medical record data (2003-2015) from Kaiser Permanente Northern California (KPNC), which adopted triennial cotesting in 2003, we examined adherence to extended interval screening. We analyzed predictors of screening intervals among 491,588 women undergoing routine screening, categorizing interval length into early (<2.5years), adherent (2.5<3.5years), or late (3.5<6.0years). We also examined repeated early screening in a subgroup of 50,691 women. Predictors examined included: cohort year (defined by baseline cotest, 2003-2009), race/ethnicity, and baseline age. Compared to the 2003 cohort, women in the 2009 cohort were significantly less likely to screen early (aOR=0.22, 95% CI=0.21, 0.23) or late (aOR=0.47, 95% CI=0.45, 0.49). African American (AA) and Hispanic women were less adherent overall than Non-Hispanic White women, with increased early [(AA: aOR=1.21, 95%CI=1.17, 1.25) (Hispanic: aOR=1.08, 95%CI=1.06, 1.11)] and late screening [(AA: aOR=1.23, 95%CI=1.19, 1.27) (Hispanic: aOR=1.06, 95%CI=1.03, 1.08)]. Asian women were slightly more likely to screen early (aOR=1.03, 95%CI=1.01, 1.05), and less likely to screen late (aOR=0.92, 95% CI=0.90, 0.94). Women aged 60-64years were most likely to screen early for two consecutive intervals (aOR=2.09, 95%CI=1.91, 2.29). Our study found that widespread and rapid adoption of extended interval cervical cancer screening is possible, at least in this managed care setting. Further research examining multilevel drivers promoting or restricting extended interval screening across diverse healthcare settings is needed.
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Affiliation(s)
- Katharine A Rendle
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States.
| | - Mark Schiffman
- Clinical Genetics Branch, Division of Clinical Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Li C Cheung
- Biostatistics Branch, Division of Clinical Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Walter K Kinney
- Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA, United States.
| | - Barbara Fetterman
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Nancy E Poitras
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Philip E Castle
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
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Affiliation(s)
- K. Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney Medical School, School of Public Health, University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, UNSW Australia, Sydney, Australia
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Test performance and acceptability of self- versus provider-collected swabs for high-risk HPV DNA testing in female-to-male trans masculine patients. PLoS One 2018. [PMID: 29538411 PMCID: PMC5851532 DOI: 10.1371/journal.pone.0190172] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background High-risk human papillomavirus (hrHPV) causes virtually all cervical cancers. Trans masculine (TM) people (those assigned female at birth who identify with a gender other than female) have low uptake of conventional cervical cancer screening. Self-collected hrHPV DNA testing has high levels of acceptability among cisgender (non-transgender) females and may support increased cervical cancer screening uptake in TM individuals. Objective To assess the test performance and acceptability of self-collected vaginal specimens in comparison to provider-collected cervical swabs for hrHPV DNA detection in TM individuals ages 21–64 years. Methods Between March 2015-September 2016, 150 TM participants with a cervix (mean age = 27.5 years; SD = 5.7) completed a one-time study visit comprised of a self-report survey, self-collected vaginal HPV DNA swab, clinician-administered cervical HPV swab, and brief interview on acceptability of clinical procedures. Participants were randomized to complete either self- or provider-collection first to minimize ordering effects. Self- and provider-collected samples were tested for 13 hrHPV DNA types using a DNA Hybridization Assay. The primary outcome variable was the concordance (kappa statistic) and performance (sensitivity, specificity) of self-collected vaginal HPV DNA specimens versus provider-collected cervical HPV swabs as the gold standard. Results Of the 131 participants completing both the self- and provider-collected HPV tests, 21 cases of hrHPV were detected by the provider cervical swab (gold standard; 16.0% hrHPV prevalence); 15 of these cases were accurately detected by the self-collected vaginal swab (71.4% concordance) (Kappa = 0.75, 95% Confidence Interval [CI]: 0.59, 0.92; p<0.001). Compared to the provider-collected cervical hrHPV DNA sample (gold standard), the self-collected vaginal hrHPV DNA test demonstrated a sensitivity of 71.4% (95% CI: 0.52, 0.91; p = 0.0495) and specificity of 98.2% (95% CI: 0.96, 1.00; p<0.0001). Over 90% of participants endorsed a preference for the self-collected vaginal swab over provider-collected cervical swab. Conclusion Self-collected vaginal swabs are highly acceptable to TM as a means to test for hrHPV DNA. Test performance of this self-collection method for hrHPV detection in TM is consistent with previous studies in cisgender females. Self-collected vaginal swab testing for hrHPV DNA represents a reasonable and patient-centered strategy for primary cervical cancer screening in TM patients unwilling to undergo provider collection of specimens via speculum exam.
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Martins TR, Longatto-Filho A, Cohen D, Viscondi JYK, Fuza LM, Cury L, Villa LL, Levi JE, Eluf-Neto J. Influence of Prior Knowledge of Human Papillomavirus Status on the Performance of Cytology Screening. Am J Clin Pathol 2018; 149:316-323. [PMID: 29471316 DOI: 10.1093/ajcp/aqx163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the influence of prior knowledge of human papillomavirus (HPV) status in cervical cytopathology readings. METHODS Participants comprised 2,376 women who underwent parallel cytology and HPV-DNA testing. Smears were read twice by the same team, first with previous knowledge of HPV-DNA status. RESULTS Overall, 239 (10.2%) smears had their cytology classification altered by the HPV-informed review. Cytology readings with prior knowledge of the HPV status revealed 10.5% of abnormal smears (atypical squamous cells of undetermined significance or higher), while without prior knowledge, this rate dropped to 7.6%. When HPV status was informed, a significant increase in all categories of altered smears was observed. Cytology with prior knowledge of HPV status detected more cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) compared with blinded: 86.7% vs 60.0%. CONCLUSIONS Our data indicate that cytology interpreted with prior knowledge of the HPV status provides higher sensitivity for CIN 2+ lesions while marginally reducing the overall specificity compared with HPV status blinded cytology.
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Affiliation(s)
- Toni Ricardo Martins
- Institute of Tropical Medicine, Virology Laboratory, Universidade de São Paulo, São Paulo, Brazil
- Department of Infectious Diseases, Universidade de São Paulo School of Medicine, São Paulo, Brazil
| | - Adhemar Longatto-Filho
- Laboratory of Medical Investigation (LIM) 14, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil
- Liffe and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Instituto Nacional de Ciência e Tecnologia das Doenças do Papilomavírus Humano, São Paulo, Brazil
| | - Diane Cohen
- Fundação Oncocentro de São Paulo, São Paulo, Brazil
| | | | - Luiz Mario Fuza
- Institute of Tropical Medicine, Virology Laboratory, Universidade de São Paulo, São Paulo, Brazil
- Fundação Oncocentro de São Paulo, São Paulo, Brazil
| | - Lise Cury
- Fundação Oncocentro de São Paulo, São Paulo, Brazil
| | - Luisa Lina Villa
- Instituto Nacional de Ciência e Tecnologia das Doenças do Papilomavírus Humano, São Paulo, Brazil
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - José Eduardo Levi
- Institute of Tropical Medicine, Virology Laboratory, Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia das Doenças do Papilomavírus Humano, São Paulo, Brazil
| | - José Eluf-Neto
- Instituto Nacional de Ciência e Tecnologia das Doenças do Papilomavírus Humano, São Paulo, Brazil
- Fundação Oncocentro de São Paulo, São Paulo, Brazil
- Department of Preventive Medicine
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Toliman PJ, Kaldor JM, Tabrizi SN, Vallely AJ. Innovative approaches to cervical cancer screening in low- and middle-income countries. Climacteric 2018; 21:235-238. [PMID: 29488817 DOI: 10.1080/13697137.2018.1439917] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The estimated cervical cancer burden is over ten-fold greater in low- and middle-income countries (LMICs) than in high-income countries. This health gap is thought to be primarily due to limited access to effective screening and treatment programs for cervical pre-cancer and cancer in such settings. The World Health Organization advocates a policy of 'screen and treat' approach to cervical screening in LMICs and subsequently visual inspection of the cervix with acetic acid (VIA) or Lugo's iodine (VILI), followed by ablative cervical cryotherapy if indicated, and this policy has been implemented in many high-burden settings. The performance of VIA/VILI as a primary screening tool for the detection of cervical pre-cancer and cancer has, however, been inconsistent. Recently, many high-income countries have integrated HPV-DNA testing into their cervical cancer screening programs. The comparatively high cost and resource requirements of HPV-based screening have to date prevented many LMICs from doing the same. A significant development has been the entrance of innovative, easy-to-use and highly accurate HPV tests that can be provided at point of care; these could enable LMICs to implement 'test and treat' approaches for cervical cancer screening.
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Affiliation(s)
- P J Toliman
- a Sexual and Reproductive Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea.,b Public Health Interventions Research Group , The Kirby Institute, UNSW , Sydney , Australia
| | - J M Kaldor
- b Public Health Interventions Research Group , The Kirby Institute, UNSW , Sydney , Australia
| | - S N Tabrizi
- c Department of Microbiology and Infectious Disease , The Royal Women's Hospital , Parkville , VIC , Australia.,d Department of Obstetrics and Gynaecology , University of Melbourne , Parkville , VIC , Australia
| | - A J Vallely
- a Sexual and Reproductive Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea.,b Public Health Interventions Research Group , The Kirby Institute, UNSW , Sydney , Australia
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O'Leary JJ, White C, Spillane C, Naik P, O'Brien R, Reynolds S, Pham T, Pilkington L, Sharkey Ochoa I, Bolger N, Barry O'Crowley J, Tewari P, O'Toole S, Sweeney M, Keegan H, Normand C, Sharp L, Flannelly G, Martin C. Cervical screening: A new way forward (tests of risk and tests of disease). HRB Open Res 2018. [DOI: 10.12688/hrbopenres.12794.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cervical screening has been a highly successful health promotion initiative. The way cervical screening is delivered is about to change dramatically, with the introduction of 'tests of risk' and 'tests of disease' based on primary HPV testing and the use of cell host response biomarkers. This article addresses the fundamental basis of this change in clinical practice and offers insights into how the future of cervical screening will look.
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Saville M, Hawkes D, Mclachlan E, Anderson S, Arabena K. Self-collection for under-screened women in a National Cervical Screening Program: pilot study. Curr Oncol 2018; 25:e27-e32. [PMID: 29507492 PMCID: PMC5832287 DOI: 10.3747/co.25.3915] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Commencing 1 December 2017, Australia introduced human papillomavirus (hpv)-based cervical screening. As part of this Australian renewed National Cervical Screening Program (ncsp) women who are either never- or under-screened and who refuse a practitioner collected sample will be able to collect their own sample for cervical screening. The aim of this study is to examine the quantitative results of a pilot study into the acceptability of the self-collection alternative pathway. METHODS Eligible participants were offered the opportunity to collect their own sample. Those who agreed were given a flocked swab and an instruction sheet and took their own sample in an area of the health care clinic that afforded them adequate privacy. These samples were then given to clinic staff who returned them to Victorian Cytology Service (vcs) Pathology for hpv nucleic acid testing. RESULTS Of 98 eligible women, seventy-nine undertook self-collection for hpv-based cervical screening. Seventy-seven produced valid results, 14 were positive for oncogenic hpv, with 10 undertaking follow-up. Three women were found to have cervical squamous abnormalities with two of those being high-grade intraepithelial squamous lesions. CONCLUSION The pilot study for self-collection for cervical screening produced quantitative data that were similar to that already reported in the literature, but had a much higher rate of acceptance compared with self-collection programs based in the home.
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Affiliation(s)
- M. Saville
- Victorian Cytology Service, Carlton, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - D Hawkes
- Victorian Cytology Service, Carlton, Victoria, Australia; Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria, Australia
| | - E. Mclachlan
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia; and
| | - S. Anderson
- Ballarat and District Aboriginal Collective, Baarlinjan Medical Clinic, Ballarat, Victoria, Australia
| | - K. Arabena
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia; and
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Basu P, Mittal S, Bhadra Vale D, Chami Kharaji Y. Secondary prevention of cervical cancer. Best Pract Res Clin Obstet Gynaecol 2018; 47:73-85. [PMID: 28988647 DOI: 10.1016/j.bpobgyn.2017.08.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/27/2017] [Indexed: 01/04/2023]
Abstract
Cervical cancer affects women in their reproductive ages. Screening is an important secondary prevention strategy. The long process of carcinogenic transformation from human papillomavirus (HPV) infection to invasive cancer provides ample opportunities to detect the disease at a stage when treatment is highly effective. Suitable screening tests are cytology, visual inspection after acetic acid application and HPV detection tests. Evidence of effectiveness of the tests to reduce cervical cancer mortality and the cost-effectiveness of screening programs have been demonstrated. Cervical intraepithelial neoplasia grade 2 and grade 3 are the high-grade cervical cancer precursors and need to be treated. Treatment is safe and effective with ablative or excisional techniques. The World Health Organization recommends screening women at least once in a lifetime between 30 and 49 years of age and ensuring effective treatment of the detected abnormalities. Combination of HPV vaccination and population-based screening will be instrumental in eliminating cervical cancer.
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Affiliation(s)
- Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France.
| | - Srabani Mittal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Diama Bhadra Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
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Abstract
Objective The aim of this study was to determine the value of human papillomavirus (HPV) testing for primary cervical cancer screening in Japan. Methods In total, 5065 women who underwent primary screening with cytology and HPV between January 2005 and December 2006 were enrolled. In the baseline phase, these women were stratified by age, and the rates of HPV-positive and abnormal cytology were compared between women younger than and older than 30 years. In the follow-up phase, women aged 20 to 69 years and cytology negative for intraepithelial lesions or malignancy at baseline were followed up until December 2011 (n = 2383). Progression to grade 2/3 cervical intraepithelial neoplasia or worse (CIN2+/CIN3+) was compared between the HPV-positive and HPV-negative groups. Results In the baseline phase, HPV-positive rates were significantly higher in women younger than 30 years at 20.7% (95% confidence interval [CI], 18.4–22.9; 255/1234) compared with women 30 years or older at 7.2% (95% CI, 6.4%–8.0%; 275/3831; P < 0.001). However, there was no statistical difference for high-grade squamous intraepithelial lesion or worse rates between them, at 2.7% (95% CI, 1.8%–3.6%; 33/1234) and 2.4% (95% CI, 1.9%–2.9%; 91/3831), respectively, P = 0.55. In the follow-up phase, the rate of progression to CIN2+/CIN3+ was significantly higher in the HPV-positive group than in the HPV-negative group (P < 0.001). Moreover, relative risk of progression to CIN2+ was 15.9 times higher in the HPV-positive group, and that of progression to CIN3+ was 16.1 times higher in the HPV-positive group. Conclusions Human papillomavirus testing is a useful test for predicting progression to CIN and is recommended as a primary screening tool. However, screening with cytology alone is still appropriate for younger women, younger than 30 years, because HPV testing yields more false-positive results in younger women.
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Canfell K, Saville M, Caruana M, Gebski V, Darlington-Brown J, Brotherton J, Heley S, Castle PE. Protocol for Compass: a randomised controlled trial of primary HPV testing versus cytology screening for cervical cancer in HPV-unvaccinated and vaccinated women aged 25-69 years living in Australia. BMJ Open 2018; 8:e016700. [PMID: 29374658 PMCID: PMC5829592 DOI: 10.1136/bmjopen-2017-016700] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Australia's National Cervical Screening Program (NCSP) currently recommends 2-year cytology in women aged 18-69 years. Following a review of the NCSP prompted by the implementation of human papillomavirus (HPV) vaccination, the programme will transition in 2017 to 5-year primary HPV screening with partial genotyping for HPV16/18 in women aged 25-74 years. Compass is a sentinel experience for the renewed NCSP and the first prospectively randomised trial of primary HPV screening compared with cytology to be conducted in a population with high uptake of HPV vaccination. This protocol describes the main Compass trial, which commenced after a pilot study of ~5000 women completed recruitment. METHODS AND ANALYSIS Women aged 25-69 years will be randomised at a 1:2 allocation to (1) 2.5-year image-read, liquid-based cytology (LBC) screening with HPV triage of low-grade smears (active control Arm A) or (2) 5-year HPV screening with partial genotyping and referral of HPV16/18-positive women to colposcopy (intervention Arm B). Women in Arm B positive for other oncogenic HPV (not 16/18) will undergo secondary randomisation at a 1:1 allocation to either LBC or dual-stained (p16INK4a and Ki-67) cytology testing (dual-stained cytology). The primary outcome is cumulative CIN3+ (CIN3, adenocarcinoma in situ and invasive cervical cancer) following a 5-year HPV exit testing round in both arms, in women randomised to the HPV arm versus women randomised to the LBC arm, based on an intention-to-treat analysis. The primary outcome will first be tested for non-inferiority and if declared, the primary outcome will be tested for superiority. A total of 36 300 women in birth cohorts not offered vaccination and 84 700 women in cohorts offered vaccination will be recruited, bringing the final sample size to 121 000. The trial is powered for the secondary outcome of cumulative CIN3+ in screen-negative women, adjusted for censoring after CIN2+ treatment and hysterectomy. ETHICS AND DISSEMINATION Approved by the Bellberry Ethics Committee (2014-11-592). Findings will be reported in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT02328872; Pre-results.
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Affiliation(s)
- Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Marion Saville
- Victorian Cytology Service Ltd, Carlton, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Caruana
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Julia Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Registries Division, Victorian Cytology Service Ltd, Carlton, Victoria, Australia
| | - Stella Heley
- Victorian Cytology Service Ltd, Carlton, Victoria, Australia
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
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Yu LL, Chen W, Lei XQ, Qin Y, Wu ZN, Pan QJ, Zhang X, Chang BF, Zhang SK, Guo HQ, Qiao YL. Evaluation of p16/Ki-67 dual staining in detection of cervical precancer and cancers: a multicenter study in China. Oncotarget 2018; 7:21181-9. [PMID: 27029033 PMCID: PMC5008277 DOI: 10.18632/oncotarget.8307] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/10/2016] [Indexed: 01/09/2023] Open
Abstract
Purpose To analyze the clinical performance of p16/Ki-67 dual-stained cytology identifying high-grade cervical intraepithelial neoplasia (CIN2+) in Chinese women. Methods 1079 women attending ongoing cervical cancer screening and 211 “enriched” women aged ≥30yrs with biopsy-confirmed CIN2+ from five Chinese hospitals were enrolled during year 2014-2015. Cervical specimens were collected for high-risk human papillomavirus (HR-HPV) DNA analysis, Liquid-based cytology (LBC) and p16/Ki-67 dual staining. Colposcopy and biopsy were performed on women with any abnormal result. Results p16/Ki-67 positivity increased with histologic severity. It was 18.4%(183/996) in normal histology, 54.0%(34/63) in CIN1, 81.0%(34/42) in CIN2, 93.3%(111/119) in CIN3, 71.4% (5/7) in adenocarcinoma and 95.2%(60/63) in squamous cell carcinoma. Compared with the HR-HPV negatives, p16/Ki-67 expression was significantly higher in the HPV16/18 positive (OR: 35.45(95%CI: 23.35-53.84)) and other 12 HR-HPV types positive group (OR: 8.01(95%CI: 5.81-11.05). The sensitivity and specificity of p16/Ki-67 to detect CIN2+ in the entire population were 90.9% and 79.5%, respectively. In women with ASC-US and LSIL, sensitivity and specificity for detection of CIN2+ were 87.5% and 66.4%, respectively, with a referral rate of 43.8%. In women who tested positive for HR-HPV, sensitivity and specificity of dual-staining for detection of CIN2+ were 92.7% and 52.7%, respectively, and the referral rate was 68.7%. Conclusions p16/Ki-67 dual-stained cytology provided a high sensitivity and moderate specificity to detect underlying cervical precancer and cancers in various settings, and might be considered as an efficient screening tool in China.
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Affiliation(s)
- Lu-Lu Yu
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Wen Chen
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Xiao-Qin Lei
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Yu Qin
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Ze-Ni Wu
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Qin-Jing Pan
- Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Xun Zhang
- Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Bai-Feng Chang
- Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Shao-Kai Zhang
- Department of Cancer Epidemiology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Henan Office for Cancer Control and Research, Zhengzhou, P. R. China
| | - Hui-Qin Guo
- Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
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148
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Zhao XL, Hu SY, Zhang Q, Dong L, Feng RM, Han R, Zhao FH. High-risk human papillomavirus genotype distribution and attribution to cervical cancer and precancerous lesions in a rural Chinese population. J Gynecol Oncol 2018; 28:e30. [PMID: 28541628 PMCID: PMC5447139 DOI: 10.3802/jgo.2017.28.e30] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/12/2017] [Accepted: 01/29/2017] [Indexed: 11/30/2022] Open
Abstract
Objective To explore the genotype distribution of high-risk human papillomavirus (HR-HPV) and its attribution to different grades of cervical lesions in rural China, which will contribute to type-specific HPV screening tests and the development of new polyvalent HPV vaccines among the Chinese population. Methods One thousand two hundred ninety-two subjects were followed based on the Shanxi Province Cervical Cancer Screening Study I (SPOCCS-I), and screened by HPV DNA testing (hybrid capture® 2 [HC2]), liquid-based cytology (LBC), and if necessary, directed or random colposcopy-guided quadrant biopsies. HPV genotyping with linear inverse probe hybridization (SPF10-PCR-LiPA) was performed in HC2 positive specimens. Attribution of specific HR-HPV type to different grades of cervical lesions was estimated using a fractional contribution approach. Results After excluding incomplete data, 1,274 women were included in the final statistical analysis. Fifteen point two percent (194/1,274) of women were HR-HPV positive for any of 13 HR-HPV types (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) and the most common HR-HPV types were HPV16 (19.1%) and HPV52 (16.5%). The genotypes most frequently detected in HR-HPV-positive cervical intraepithelial neoplasia grade 1 (CIN1) were HPV52 (24.1%), HPV31 (20.7%), HPV16 (13.8%), HPV33 (13.8%), HPV39 (10.3%), and HPV56 (10.3%); in HR-HPV-positive cervical intraepithelial neoplasia grade 2 or worse (CIN2+): HPV16 (53.1%), HPV58 (15.6%), HPV33 (12.5%), HPV51 (9.4%), and HPV52 (6.3%). HPV52, 31, 16, 33, 39, and 56 together contributed to 89.7% of HR-HPV-positive CIN1, and HPV16, 33, 58, 51, and 52 together contributed to 87.5% of CIN2+. Conclusion In summary, we found substantial differences in prevalence and attribution of CINs between different oncogenic HPV types in a rural Chinese population, especially for HPV16, 31, 33, 52, and 58. These differences may be relevant for both clinical management and the design of preventive strategies.
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Affiliation(s)
- Xue Lian Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shang Ying Hu
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian Zhang
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Dong
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Mei Feng
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ross Han
- Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Fang Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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149
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Silver MI, Rositch AF, Phelan-Emrick DF, Gravitt PE. Uptake of HPV testing and extended cervical cancer screening intervals following cytology alone and Pap/HPV cotesting in women aged 30-65 years. Cancer Causes Control 2018; 29:43-50. [PMID: 29124542 PMCID: PMC5754229 DOI: 10.1007/s10552-017-0976-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the adoption of HPV testing and recommended extended cervical cancer screening intervals in clinical practice, we described yearly uptake of Pap/HPV cotesting and estimated length of time between normal screens by patient characteristics. METHODS We examined 55,575 Pap/HPV records from 27,035 women aged 30-65 years from the Johns Hopkins Hospital Pathology Data System between 2006 and 2013. Cotest uptake and median times to next screening test for cotests and cytology only were calculated. Adjusted hazard ratios were estimated using Cox proportional hazards models, with random effects adjustment for clustering within clinic. RESULTS Cotest usage increased from < 10% in 2006 to 78% in 2013. The median time to next screening test following normal cytology alone remained constant around 1.5 years. Screening intervals following a dual-negative cotest increased from 1.5 years in 2006/2007 to 2.5 years in 2010, coincident with increases in the proportion of women cotested. Intervals following a dual negative cotest were longer among Medicare patients (3 years) compared with privately insured women (2.5 years), and shorter among black (2 years) compared with white women (2.8 years). CONCLUSION By mid-2013 we observed broad adoption of Pap/HPV cotesting in routine screening in a large academic medical center. Increased screening intervals were observed only among cotested women, while those screened by cytology alone continued to be screened almost annually. The influence of different combinations of race and insurance on screening intervals should be further evaluated to ensure balance of screening risks and benefits in the U.S. POPULATION
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Affiliation(s)
- Michelle I Silver
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, 6E584, Rockville, MD, 20850, USA.
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Darcy F Phelan-Emrick
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patti E Gravitt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department Global Health, George Washington University, Washington, DC, USA
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Castanon A, Landy R, Pesola F, Windridge P, Sasieni P. Prediction of cervical cancer incidence in England, UK, up to 2040, under four scenarios: a modelling study. Lancet Public Health 2018; 3:e34-e43. [PMID: 29307386 PMCID: PMC5765529 DOI: 10.1016/s2468-2667(17)30222-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the next 25 years, the epidemiology of cervical cancer in England, UK, will change: human papillomavirus (HPV) screening will be the primary test for cervical cancer. Additionally, the proportion of women screened regularly is decreasing and women who received the HPV vaccine are due to attend screening for the first time. Therefore, we aimed to estimate how vaccination against HPV, changes to the screening test, and falling screening coverage will affect cervical cancer incidence in England up to 2040. METHODS We did a data modelling study that combined results from population modelling of incidence trends, observable data from the individual level with use of a generalised linear model, and microsimulation of unobservable disease states. We estimated age-specific absolute risks of cervical cancer in the absence of screening (derived from individual level data). We used an age period cohort model to estimate birth cohort effects. We multiplied the absolute risks by the age cohort effects to provide absolute risks of cervical cancer for unscreened women in different birth cohorts. We obtained relative risks (RRs) of cervical cancer by screening history (never screened, regularly screened, or lapsed attender) using data from a population-based case-control study for unvaccinated women, and using a microsimulation model for vaccinated women. RRs of primary HPV screening were relative to cytology. We used the proportion of women in each 5-year age group (25-29 years to 75-79 years) and 5-year period (2016-20 to 2036-40) who have a combination of screening and vaccination history, and weighted to estimate the population incidence. The primary outcome was the number of cases and rates per 100 000 women under four scenarios: no changes to current screening coverage or vaccine uptake and HPV primary testing from 2019 (status quo), changing the year in which HPV primary testing is introduced, introduction of the nine-valent vaccine, and changes to cervical screening coverage. FINDINGS The status quo scenario estimated that the peak age of cancer diagnosis will shift from the ages of 25-29 years in 2011-15 to 55-59 years in 2036-40. Unvaccinated women born between 1975 and 1990 were predicted to have a relatively high risk of cervical cancer throughout their lives. Introduction of primary HPV screening from 2019 could reduce age-standardised rates of cervical cancer at ages 25-64 years by 19%, from 15·1 in 2016 to 12·2 per 100 000 women as soon as 2028. Vaccination against HPV types 16 and 18 (HPV 16/18) could see cervical cancer rates in women aged 25-29 years decrease by 55% (from 20·9 in 2011-15 to 9·5 per 100 000 women by 2036-40), and introduction of nine-valent vaccination from 2019 compared with continuing vaccination against HPV 16/18 will reduce rates by a further 36% (from 9·5 to 6·1 per 100 000 women) by 2036-40. Women born before 1991 will not benefit directly from vaccination; therefore, despite vaccination and primary HPV screening with current screening coverage, European age-standardised rates of cervical cancer at ages 25-79 years will decrease by only 10% (from 12·8 in 2011-15 to 11·5 per 100 000 women in 2036-40). If screening coverage fell to 50%, European age-standardised rates could increase by 27% (from 12·8 to 16·3 per 100 000 by 2036-40). INTERPRETATION Going forward, focus should be placed on scenarios that offer less intensive screening for vaccinated women and more on increasing coverage and incorporation of new technologies to enhance current cervical screening among unvaccinated women. FUNDING Jo's Cervical Cancer Trust and Cancer Research UK.
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Affiliation(s)
- Alejandra Castanon
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Rebecca Landy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Windridge
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; Bermondsey Wing, Guy's and St Thomas', Kings College London, London, UK
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