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Chung SH. Cervical Cancer Screening after Perimenopause: How Is Human Papillomavirus Test Performed? J Menopausal Med 2016; 22:65-70. [PMID: 27617239 PMCID: PMC5016505 DOI: 10.6118/jmm.2016.22.2.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 11/23/2015] [Accepted: 12/11/2015] [Indexed: 11/25/2022] Open
Abstract
Cervical cancer is the third most prevalent cancer in women around the world. Recently in Korea, the incidence of cervical cancer has decreased, but in all stages of cervical intraepithelial neoplasia (CIN), CIN has shown a 91% increase from 1999 to 2008. Persistent human papillomavirus (HPV) infection has been found to be the main cause of cervical cancer. HPV types 16 and 18 have been found in 70% of cervical cancer patients around the world. Cervical cancer screening such as cytology has limitations in terms of sensitivity and specificity. A discussion about the need for the HPV test is becoming active in order to compensate for the limitation of cytology. After the role of HPV in cervical cancer was identified, the importance of HPV detection test as a screening was emphasized. Several tests have been developed and each test has its own advantages and disadvantages, and new test method to overcome the disadvantages is still being developed. Today's guidelines and tests are those you would choose from among the large number of cervical cancer screening guidelines and tests, based on the consideration that the selected guidelines and the test are effective.
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Affiliation(s)
- Soo-Ho Chung
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
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202
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Abstract
OPINION STATEMENT Since the publication of the American Cancer Society (ACS)/American Society for Colposcopy and Cervical Pathology (ASCCP)/American Society for Clinical Pathology (ASCP) clinical guidelines in 2012, the majority of practice organizations have reached a consensus on screening recommendations for a low-risk population. These guidelines were based on a thorough review of the evidence with reproducible methods to obtain high-quality, generalizable guidelines. Despite the strength of the evidence based recommendations comprising these guidelines, limitations in physician understanding and compliance remain with respect to reaching an unscreened population and defining and caring for women who are at "high risk." "High-risk" patients are poorly characterized but should include women with a history of a prior abnormal screening, as data has shown a subsequent increased risk of cervical intraepithelial neoplasia grade 2 (CIN2) or greater, even after treatment. These women warrant more intense screening than the general population-though there are no evidence-based guidelines for optimized screening protocols in this population. Emerging data in cervical cancer screening this year includes the FDA approval of primary high-risk human papillomavirus (HPV) testing. While the data is promising, its role in clinical practice, impact on rates of colposcopy in a non-study population, and long-term outcomes are not fully understood, and ongoing research is needed. Challenges remain in this shifting environment on the optimal interval and modality for cervical cancer screening to provide the greatest benefit in detection of precancerous lesions while minimizing the harm of overtreatment. While rapid advancements in research provide improved knowledge on how to treat and prevent this disease, it is often difficult for providers across multiple specialties to remain abreast of these changes and to educate their patients about the most current recommendations. Ultimately, provider and patient education is critical both for improving primary prevention with HPV vaccination, as well as for the uptake of evidence-based screening and management guidelines aimed at detecting and treating precancerous changes of the cervix.
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Affiliation(s)
- Michelle Davis
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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203
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Schwock J, Ko HM, Dubé V, Rouzbahman M, Cesari M, Ghorab Z, Geddie WR. Stratified Mucin-Producing Intraepithelial Lesion of the Cervix: Subtle Features Not to Be Missed. Acta Cytol 2016; 60:225-31. [PMID: 27442040 DOI: 10.1159/000447940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Stratified mucin-producing intraepithelial lesion (SMILE) is an uncommon premalignant lesion of the uterine cervix. A detailed examination of preinvasive SMILE cases including a comparison of the cytologic features with usual-type adenocarcinoma in situ (AIS) and human papillomavirus (HPV) genotyping was performed. STUDY DESIGN Excisions and preceding Papanicolaou (Pap) tests were retrieved from the files of 2 tertiary care centers. Histologic review estimated the lesional SMILE proportion. Pap tests were reviewed and assessed for architectural, cellular and background features. Cobas® HPV test was performed. RESULTS 13 cases were identified. Mean/median patient age was 35/33 years (range 23-51 years). Concurrent high-grade squamous intraepithelial lesion was found in 10/13 (77%) and AIS in 8/13 (62%) cases. In 6 cases, SMILE was dominant (≥50%) and represented in 5/6 corresponding Pap tests. Cytology interpretations differed more often in the SMILE-dominant group (p < 0.05). SMILE and AIS had overlapping features. Feathering and prominent nucleoli were absent in SMILE. HPV DNA was detected in all 12 cases tested. HPV 18 was most common (7/12). Excisions with positive/suspicious margins were reported in 5/6 SMILE-dominant versus 3/7 nondominant cases. CONCLUSION SMILE is best considered as an AIS variant for cytologic, etiologic and management purposes. Cytologic features overlap with AIS, but are more subtle and easily missed. HPV testing may play a role in facilitating SMILE detection.
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Affiliation(s)
- Joerg Schwock
- Department of Laboratory Medicine and Pathobiology, University of Toronto, and Laboratory Medicine Program, University Health Network, Toronto General Hospital, and Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada
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204
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McCarthy CM, Ramphul M, Madden M, Hickey K. The use and success of cold coagulation for the treatment of high grade squamous cervical intra-epithelial neoplasia: a retrospective review. Eur J Obstet Gynecol Reprod Biol 2016; 203:225-8. [PMID: 27343739 DOI: 10.1016/j.ejogrb.2016.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/26/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cold coagulation is recognised as a viable, cost-effective and successful treatment for cervical intraepithelial neoplasia (CIN), being used less frequently than excisional treatments for high grade lesions. We set out to demonstrate successful long term follow-up of patient with high grade CIN treated with cold coagulation. STUDY DESIGN We conducted a retrospective review over a one-year period of women with biopsy-proven CIN 2 and 3 who were treated with cold coagulation to the cervix, attending the colposcopy service of a large tertiary referral hospital. We examined follow-up cervical smear data for three years post treatment of low and high grade CIN, evaluated the success of treatment and re-treatment rates. RESULTS 93 patients were included in our study, with 39 (41.9%) having CIN 1 and 54 (58.1%) diagnosed with CIN 2 or 3. Follow-up smears revealed low levels of recurrent high grade changes in both groups, with 31 (79.5%) of our CIN 1 group having a negative smear one year following treatment with cold coagulation, compared to 44 (81.1%) of patients with CIN 2 and 3. Successful primary treatment (i.e. no requirement for further treatment after 3 year follow-up) occurred in 33 (84.6%) of the CIN 1 group, and 42 (77.7%) of the CIN 2/3 group, demonstrating no statistical significance between re-treatment rates between both groups. CONCLUSIONS This study demonstrates the effectiveness of cold coagulation for the treatment of high grade cervical intraepithelial neoplasia. High success rates, and low re-treatment rates confirm that this is an acceptable primary treatment for CIN 2 and 3.
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Affiliation(s)
- C M McCarthy
- Department of Gynaecology, University Hospital Limerick, Limerick, Ireland.
| | - M Ramphul
- Department of Gynaecology, University Hospital Limerick, Limerick, Ireland
| | - M Madden
- Department of Gynaecology, University Hospital Limerick, Limerick, Ireland
| | - K Hickey
- Department of Gynaecology, University Hospital Limerick, Limerick, Ireland
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205
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Abstract
The primary goal of cancer screening is to reduce cancer-related mortality without incurring significant harm. Screening efforts for solid tumors, therefore, have targeted the precursors of the most common and the most deadly cancers-breast, cervical, colorectal, lung and prostate cancer. Balancing risk and benefit has led to controversy regarding the timing of cancer screening-when to begin, how often to screen and when to stop-and the nature of the modality of cancer screening-invasive or noninvasive, laboratory-centered or imaging-centered. Evidence-based guidelines published by general medical societies, subspecialty societies and publicly funded task forces on population-based screening aid healthcare providers in making individualized decisions with their patients.
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Affiliation(s)
- S Calvin Thigpen
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi.
| | - Stephen A Geraci
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
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206
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Tawfik O, Davis M, Diaz FJ, Fan F. Cell Block Preparation versus Liquid-Based Thin-Layer Cervical Cytology: A Comparative Study Evaluating Human Papillomavirus Testing by Hybrid Capture-2/Cervista, in situ Hybridization and p16 Immunohistochemistry. Acta Cytol 2016; 60:145-53. [PMID: 27215562 DOI: 10.1159/000446207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/13/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cell block (CB) preparations from residual liquid-based Pap samples have been shown to be of diagnostic value. In this study we evaluated human papillomavirus (HPV) in situ hybridization (ISH) and p16 immunohistochemistry (IHC) on CB preparations and compared the results with the primary diagnosis and standard HPV tests. DESIGN In total, 197 HE-stained CB slides prepared from CBs from residual Pap samples (152 ASCUS, 2 ASC-H, 32 LGSIL, 4 HGSIL, 1 AGUS and 6 normal) were analyzed. Hybrid Capture-2 (HC-2)/Cervista testing and HPV ISH and p16 IHC were performed on the CB samples. The test performance characteristics were compared with HPV and p16 assay performances. RESULTS The cellular architecture was well maintained in CBs with excellent consistency. HPV ISH testing had an excellent concordance with the HC-2/Cervista methods (85%) with high sensitivity (82.6%; 95% CI 75.9, 89.4) and specificity (89.3%). Of all the p16 tests, 38% were positive (60 out of 159 samples). The overall concordance between p16 and HC-2/Cervista (64%), or between p16 and ISH (68%), was lower than the concordance between ISH and HC-2/Cervista (85%). CONCLUSIONS HPV ISH and p16 IHC testing is feasible, cost effective and practical. A combination of the two tests would ultimately improve diagnostic accuracy, leading to better therapeutic decisions.
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Affiliation(s)
- Ossama Tawfik
- Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, Kans., USA
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207
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Nowakowski A, Cybulski M, Buda I, Janosz I, Olszak-Wąsik K, Bodzek P, Śliwczyński A, Teter Z, Olejek A, Baranowski W. Cervical Cancer Histology, Staging and Survival before and after Implementation of Organised Cervical Screening Programme in Poland. PLoS One 2016; 11:e0155849. [PMID: 27196050 PMCID: PMC4873170 DOI: 10.1371/journal.pone.0155849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022] Open
Abstract
A population-based organised cervical cancer screening programme (OCCSP) was introduced in Poland in 2006. In this study we have aimed to analyse whether selected parameters related to invasive cervical cancer (ICC) of patients diagnosed in two distant gynaecological oncology centres changed after the first screening round of the programme run between 2006-2008. We have run a retrospective cross-sectional analysis of 189 women diagnosed with ICC between 2002-2005 (directly before introduction of the programme) and 165 patients diagnosed between 2009-2012 (just after the first screening round of the programme) and compared their age at diagnosis, histology, stage of tumours and overall survival (OS). Mean age of patients diagnosed in years 2002-2005 and 2009-2012 was 52.1 and 52.6 years respectively. Squamous cell carcinomas constituted 90.5% and 86.1% of tumours diagnosed in years 2002-2005 and 2009-2012 respectively and the rest of tumours had glandular and other histologies. 74.5% and 61.0% of women diagnosed in years 2002-2005 and 2009-2012 respectively had early ICC (FIGO-International Federation of Gynaecology and Obstetrics stages I-IIA) and the rest had advanced disease (FIGO IIB-IV). We have noticed no significant differences in mean age of patients, histology of tumours and OS of patients with ICC diagnosed before and after the first screening round of OCSSP in Poland. Advanced stages of ICC were more commonly diagnosed after the introduction of OCSSP. Changes only in some clinical parameters of patients with ICC were noticed before and after the first screening round of OCSSP in Poland but OS of patients remained the same.
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Affiliation(s)
- Andrzej Nowakowski
- Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine, Warsaw, Poland
| | - Marek Cybulski
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin, Poland
| | - Irmina Buda
- Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine, Warsaw, Poland
| | - Iwona Janosz
- Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia, Bytom, Poland
| | - Katarzyna Olszak-Wąsik
- Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia, Bytom, Poland
| | - Piotr Bodzek
- Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia, Bytom, Poland
| | | | | | - Anita Olejek
- Department of Obstetrics, Gynaecology and Oncological Gynaecology, Medical University of Silesia, Bytom, Poland
| | - Włodzimierz Baranowski
- Department of Gynaecology and Oncological Gynaecology, Military Institute of Medicine, Warsaw, Poland
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208
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Bansal A, Singh MP, Rai B. Human papillomavirus-associated cancers: A growing global problem. Int J Appl Basic Med Res 2016; 6:84-9. [PMID: 27127735 PMCID: PMC4830161 DOI: 10.4103/2229-516x.179027] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Human papillomavirus (HPV) infection is linked with several cancers such as cancer cervix, vagina, vulva, head and neck, anal, and penile carcinomas. Although there is a proven association of HPV with these cancers, questions regarding HPV testing, vaccination, and treatment of HPV-related cancers continue to remain unanswered. The present article provides an overview of the HPV-associated cancers.
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Affiliation(s)
| | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, PGIMER, Chandigarh, India
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209
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Lees BF, Erickson BK, Huh WK. Cervical cancer screening: evidence behind the guidelines. Am J Obstet Gynecol 2016; 214:438-443. [PMID: 26519782 DOI: 10.1016/j.ajog.2015.10.147] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/17/2015] [Accepted: 10/22/2015] [Indexed: 12/28/2022]
Abstract
Cervical cancer screening involves a complex process of cytology, human papillomavirus (HPV) testing, colposcopy, and a multitude of algorithms for the identification of preinvasive disease and prevention of invasive disease. High-risk HPV is a prerequisite for the development of almost all types of cervical cancer; therefore, a test for high-risk HPV has become an integral part of new screening strategies. Major changes to screening guidelines in the last decade include initiation of screening at age 21 years, conservative management of young women with abnormal cytology, extended screening intervals for women age ≥30 years, and cessation of screening in low-risk women at age 65 years. This review will focus on the evidence that has led to the current evidence-based guidelines. Evidence regarding primary HPV testing as well as postvaccine-based screening strategies will also be reviewed.
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Affiliation(s)
- Brittany F Lees
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL.
| | - Britt K Erickson
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL
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210
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Herbert A. Primary HPV testing: a proposal for co-testing in initial rounds of screening to optimise sensitivity of cervical cancer screening. Cytopathology 2016; 28:9-15. [PMID: 27005867 DOI: 10.1111/cyt.12334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Abstract
As explained by Kitchener in a previous issue of Cytopathology (2015;26:4-6), primary human papillomavirus (HPV) testing is likely to be introduced in the UK for all women aged 25-64 years following pilot site studies already in place. This will be necessary when the prevalence of cervical cancer and its precursors declines when vaccination takes effect but there is a risk in abandoning cytology as a primary test: a risk that would be most apparent in the present unvaccinated population in which the prevalence of cervical cancer and its precursors is exceptionally high. HPV testing is more sensitive than cytology but has a significant false-negative rate that could be detrimental to a successful screening programme if introduced without cytology backup. Accurate cytology would be needed for triage and could be compromised if HPV-negative tests were excluded from examination. This article proposes a compromise: cytology and HPV co-testing for the first two screening tests to optimise the sensitivity of the test as a whole. Registrations of invasive and in situ carcinoma of the uterine cervix in England indicate that the prevalence of the disease is highest in young women in the early rounds of screening. Calculations of the likely impact on the workload of this proposal have been based on a service evaluation of 295 cytology tests received at St Thomas' Hospital, which suggests that the volume of cytology tests would be reduced by approximately 60% compared with 80% for primary HPV testing alone. This proposal should be debated openly before irrevocable changes are made to a skilled workforce.
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Affiliation(s)
- A Herbert
- Cellular Pathology, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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211
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Poljak M, Oštrbenk A, Seme K, Šterbenc A, Jančar N, Vrtačnik Bokal E. Three-year longitudinal data on the clinical performance of the Abbott RealTime High Risk HPV test in a cervical cancer screening setting. J Clin Virol 2016; 76 Suppl 1:S29-S39. [DOI: 10.1016/j.jcv.2015.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/09/2015] [Accepted: 11/14/2015] [Indexed: 01/29/2023]
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212
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Huh WK, Ault KA, Chelmow D, Davey DD, Goulart RA, Garcia FA, Kinney WK, Massad LS, Mayeaux EJ, Saslow D, Schiffman M, Wentzensen N, Lawson HW, Einstein MH. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. J Low Genit Tract Dis 2016; 19:91-6. [PMID: 25574659 DOI: 10.1097/lgt.0000000000000103] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2011, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology updated screening guidelines for the early detection of cervical cancer and its precursors. Recommended screening strategies were cytology or cotesting (cytology in combination with high-risk HPV (hrHPV) testing). These guidelines also addressed the use of hrHPV testing alone as a primary screening approach, which was not recommended for use at that time. There is now a growing body of evidence for screening with primary hrHPV testing, including a prospective US-based registration study. Thirteen experts including representatives from the Society of Gynecologic Oncology, American Society for Colposcopy and Cervical Pathology, American College of Obstetricians and Gynecologists, American Cancer Society, American Society of Cytopathology, College of American Pathologists, and the American Society for Clinical Pathology, convened to provide interim guidance for primary hrHPV screening. This guidance panel was specifically triggered by an application to the FDA for a currently marketed HPV test to be labeled for the additional indication of primary cervical cancer screening. Guidance was based on literature review and review of data from the FDA registration study, supplemented by expert opinion. This document aims to provide information for health care providers who are interested in primary hrHPV testing and an overview of the potential advantages and disadvantages of this strategy for screening as well as to highlight areas in need of further investigation.
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Affiliation(s)
- Warner K Huh
- 1University of Alabama at Birmingham, Birmingham, AL, USA; 2University of Kansas Medical Center, Kansas City, KS, USA; 3Virginia Commonwealth University Medical Center, Richmond, VA, USA; 4University of Central Florida, Orlando, FL, USA; 5New England Pathology Associates, Springfield, MA, USA; 6Pima County Health Department, Tucson, AZ, USA; 7Kaiser Permanente, Sacramento, CA, USA; 8Washington University School of Medicine, St. Louis, MO, USA; 9University of South Carolina School of Medicine, Columbia, SC, USA; 10American Cancer Society, Atlanta, GA, USA; 11National Cancer Institute, Bethesda, MD, USA; 12American Society of Colposcopy and Cervical Pathology, Frederick, MD, USA; and 13Albert Einstein College of Medicine, Bronx, NY, USA
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213
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Sander B, Wong WWL, Yeung MW, Ormanidhi O, Atkin K, Murphy J, Krahn M, Deeks SL. The cost-utility of integrated cervical cancer prevention strategies in the Ontario setting - Can we do better? Vaccine 2016; 34:1936-44. [PMID: 26892739 DOI: 10.1016/j.vaccine.2016.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/15/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A universal, publicly funded, school-based human papillomavirus (HPV) vaccination program in grade eight girls was initiated in Ontario in 2007. We present a cost-utility analysis of integrated cervical cancer prevention programs from the healthcare payer perspective. METHODS Our analysis was based on linked HPV transmission and disease history models. We obtained data from the literature, provincial surveys and Ontario population-based linked health administrative datasets. We modeled combinations of vaccination and screening strategies. We considered vaccination based on the Ontario experience, as well as conservative and optimistic scenarios, varying coverage, vaccine effectiveness and duration of protection. We considered 900 screening scenarios (screening start age: 21-70 years, screening interval: 3-20 years; 1-year time steps). The current schedule screens every 3 years starting at age 21 years. We examined (1) first vaccinated cohort (low herd-immunity), and (2) steady state, i.e. all cohorts were vaccinated (high herd-immunity). RESULTS Adding vaccination to the current screening schedule was cost-effective (<C$10,000/quality-adjusted life year (QALY)) across all scenarios. Delaying screening start and/or extending screening intervals increased both expected QALYs and cost, and increased overall NHB for screening schedules with a start age of 25-35 years and 3-10-year intervals for most scenarios. CONCLUSION Delaying screening start age and/or extending screening intervals in vaccinated cohorts is likely to be cost-effective. Consideration should be given to both the short- and long-term implications of health policy decisions, particularly for infectious disease interventions that require long time intervals to reach steady state.
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Affiliation(s)
- Beate Sander
- Public Health Ontario, Canada; University of Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Canada.
| | - William W L Wong
- University of Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Canada
| | | | - Orges Ormanidhi
- Toronto Health Economics and Technology Assessment Collaborative, Canada
| | | | - Joan Murphy
- University of Toronto, Canada; Cancer Care Ontario, Canada; University Health Network, Toronto, Canada
| | - Murray Krahn
- University of Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Canada; University Health Network, Toronto, Canada
| | - Shelley L Deeks
- Public Health Ontario, Canada; University of Toronto, Canada
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214
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Wang GQ, Zhao WH, Zhao XX, Zhang J, Nan KJ. Association between IL-27 2905T/G genotypes and the risk and survival of cervical cancer: a case-control study. Biomarkers 2016; 21:272-5. [PMID: 26848614 DOI: 10.3109/1354750x.2015.1134665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Interleukin-27 (IL-27) has been recognized as a pleiotropic cytokine with both pro- and anti-inflammatory properties. PATIENTS AND METHODS A case-control study was conducted to investigate the possible associations of IL-27 gene polymorphisms with susceptibility to cervical cancer and clinical outcome. RESULTS Our results suggested that the IL-27 2905T/G was significantly associated with a decreased risk of cervical cancer. Further analysis showed IL-27 2905T/G genotypes were associated with advanced tumor stages of cervical cancer patients. More interestingly, the IL-27 2905T/G genotypes were statistically significantly associated with the survival in cervical cancer patients. CONCLUSION Our results showed that the IL-27 2905T/G genotypes were associated with decreased the susceptibility and development of cervical cancer in Chinese Han population.
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Affiliation(s)
- Guo-Qing Wang
- a Department of Internal Medicine-Oncology , the First Affiliated Hospital of Xi 'an Jiaotong University , Shaanxi , China .,b Department of Gynecologic Tumor and
| | - Wen-Hui Zhao
- c Department of Anesthesiology , Shaanxi Province Tumor Hospital , Shaanxi , China
| | | | - Jun Zhang
- b Department of Gynecologic Tumor and
| | - Ke-Jun Nan
- a Department of Internal Medicine-Oncology , the First Affiliated Hospital of Xi 'an Jiaotong University , Shaanxi , China
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215
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Zhao FH, Hu SY, Zhang Q, Zhang X, Pan QJ, Zhang WH, Gage JC, Wentzensen N, Castle PE, Qiao YL, Katki HA, Schiffman M. Risk assessment to guide cervical screening strategies in a large Chinese population. Int J Cancer 2016; 138:2639-47. [PMID: 26800481 DOI: 10.1002/ijc.30012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/16/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022]
Abstract
Three different cervical screening methods [cytology, human papillomavirus(HPV) testing and visual inspection with acetic acid(VIA)] are being considered in China for the national cervical screening program. Comparing risks of CIN3 and cervical cancer (CIN3+) for different results can inform test choice and management guidelines. We evaluated the immediate risk of CIN3+ for different screening results generated from individual and combined tests. We compared tests using a novel statistic designed for this purpose called Mean Risk Stratification (MRS), in a pooled analysis of 17 cross sectional population-based studies of 30,371 Chinese women screened with all 3 methods and diagnosed by colposcopically-directed biopsies. The 3 tests combined powerfully distinguished CIN3+ risk; triple-negative screening conferred a risk of 0.01%, while HPV-positive HSIL+ that was VIA-positive yielded a risk of 57.8%. Among the three screening tests, HPV status most strongly stratified CIN3+ risk. Among HPV-positive women, cytology was the more useful second test. In HPV-negative women, the immediate risks of CIN3+ ranged from 0.01% (negative cytology), 0.00% (ASC-US), 1.1% (LSIL), to 6.6 (HSIL+). In HPV-positive women, the CIN3+ risks were 0.9% (negative cytology), 3.6% (ASC-US), 6.3% (LSIL) and 38.5% (HSIL+). VIA results did not meaningful stratify CIN3+ risk among HPV-negative women with negative or ASC-US cytology; however, positive VIA substantially elevated CIN3+ risk for all other, more positive combinations of HPV and cytology compared with a negative VIA. Because all 3 screening tests had independent value in defining risk of CIN3+, different combinations can be optimized as pragmatic strategies in different resource settings.
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Affiliation(s)
- Fang-Hui Zhao
- Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, People's Republic of China.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD
| | - Shang-Ying Hu
- Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, People's Republic of China
| | - Qian Zhang
- Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, People's Republic of China
| | - Xun Zhang
- Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, People's Republic of China
| | - Qin-Jing Pan
- Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, People's Republic of China
| | - Wen-Hua Zhang
- Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, People's Republic of China
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD
| | | | - You-Lin Qiao
- Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, People's Republic of China
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MD
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Kim JJ, Tosteson AN, Zauber AG, Sprague BL, Stout NK, Alagoz O, Trentham-Dietz A, Armstrong K, Pruitt SL, Rutter CM. Cancer Models and Real-world Data: Better Together. J Natl Cancer Inst 2016; 108:djv316. [PMID: 26538628 PMCID: PMC4907359 DOI: 10.1093/jnci/djv316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/19/2015] [Accepted: 10/01/2015] [Indexed: 02/04/2023] Open
Abstract
Decision-analytic models are increasingly used to inform health policy decisions. These models synthesize available data on disease burden and intervention effectiveness to project estimates of the long-term consequences of care, which are often absent when clinical or policy decisions must be made. While models have been influential in informing US cancer screening guidelines under ideal conditions, incorporating detailed data on real-world screening practice has been limited given the complexity of screening processes and behaviors throughout diverse health delivery systems in the United States. We describe the synergies that exist between decision-analytic models and health care utilization data that are increasingly accessible through research networks that assemble data from the growing number of electronic medical record systems. In particular, we present opportunities to enrich cancer screening models by grounding analyses in real-world data with the goals of projecting the harms and benefits of current screening practices, evaluating the value of existing and new technologies, and identifying the weakest links in the cancer screening process where efforts for improvement may be most productively focused. We highlight the example of the National Cancer Institute-funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR), a collaboration to harmonize and analyze screening process and outcomes data on breast, colorectal, and cervical cancers across seven research centers. The pairing of models with such data can create more robust models to not only better inform policy but also inform health care systems about best approaches to improve the provision of cancer screening in the United States.
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Affiliation(s)
- Jane J Kim
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR).
| | - Anna Na Tosteson
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
| | - Ann G Zauber
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
| | - Brian L Sprague
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
| | - Natasha K Stout
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
| | - Oguzhan Alagoz
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
| | - Amy Trentham-Dietz
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
| | - Katrina Armstrong
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
| | - Sandi L Pruitt
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
| | - Carolyn M Rutter
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA (JJK); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT (BLS); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI (OA); Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI (ATD); Department of Medicine, Massachusetts General Hospital, Boston, MA (KA); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (SLP); RAND Corporation, Santa Monica, CA (CMR)
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217
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Leeds IL, Fang SH. Anal cancer and intraepithelial neoplasia screening: A review. World J Gastrointest Surg 2016; 8:41-51. [PMID: 26843912 PMCID: PMC4724586 DOI: 10.4240/wjgs.v8.i1.41] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/02/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors early in the disease process. It is thought that such a strategy of identifying early anal intraepithelial neoplasia will reduce the incidence of invasive anal cancer. The low prevalence of anal cancer in the general population prevents the use of routine screening. However, routine screening of selected populations has been shown to be a more promising strategy. Potential screening modalities include digital anorectal exam, anal Papanicolaou testing, human papilloma virus co-testing, and high-resolution anoscopy. Additional research associating high-grade dysplasia treatment with anal cancer prevention as well as direct comparisons of screening regimens is necessary to develop further anal cancer screening recommendations.
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218
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Zhou H, Mody RR, Luna E, Armylagos D, Xu J, Schwartz MR, Mody DR, Ge Y. Clinical performance of the Food and Drug Administration-Approved high-risk HPV test for the detection of high-grade cervicovaginal lesions. Cancer Cytopathol 2016; 124:317-23. [DOI: 10.1002/cncy.21687] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Haijun Zhou
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Roxanne R. Mody
- Department of Obstetrics and Gynecology; St Joseph's Hospital; Denver Colorado
| | - Eric Luna
- BioReference Laboratories; Houston Texas
| | | | - Jiaqiong Xu
- Center for Biostatistics; Houston Methodist Hospital Research Institute; Houston Texas
| | - Mary R. Schwartz
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
| | - Dina R. Mody
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
- Weill Medical College of Cornell University; New York New York
| | - Yimin Ge
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital; Houston Texas
- Weill Medical College of Cornell University; New York New York
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219
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McCarthy E, Ye C, Smith M, Kurtycz DFI. Molecular testing and cervical screening: will one test fit all? J Am Soc Cytopathol 2016; 5:331-338. [PMID: 31042544 DOI: 10.1016/j.jasc.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cervical screening has undergone significant changes in recent years, with molecular human papillomavirus (HPV) testing for HPV 16 and 18 at the forefront of clinical practice. But is molecular testing more effective than morphologic testing for cervical screening? Does current information on HPV hold true across all populations? As a public health laboratory serving high-risk, underserved populations, these remain important considerations for our practice. MATERIALS AND METHODS The subject population largely consisted of young women within 200% or less of the poverty line. Correlation of Papanicolaou and HPV results was performed via retrospective review, focusing on Papanicolaou cases with high-grade diagnoses and an associated HPV test using the cobas 4800 HPV test. Secondary HPV testing and typing was performed via PCR at an outside laboratory for 205 cases with sufficient residual material and negative for HPV 16/18 by cobas. RESULTS Of 20,211 cytology tests reviewed from July 2013 to May 2015, 521 were diagnosed as high-grade; 387 had concurrent HPV tests. Of those with concurrent HPV tests, 58% (225 of 387) of the high-grade Papanicolaou cases were not HPV 16/18 positive; furthermore, no HPV was detected in 14% (55 of 387) of these cases. Secondary testing revealed the presence of 25 unique genotypes. CONCLUSIONS With recent emphasis on molecular HPV testing, the results of this review are concerning. As we move forward with evolution of cervical screening practices, it will be important to explore these questions for the continued quality and integrity of women's health services.
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Affiliation(s)
- Erin McCarthy
- Section of Cytology, Disease Prevention Division, University of Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
| | - Changhong Ye
- Section of Cytology, Disease Prevention Division, University of Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
| | - Michele Smith
- Section of Cytology, Disease Prevention Division, University of Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
| | - Daniel F I Kurtycz
- Section of Cytology, Disease Prevention Division, University of Wisconsin State Laboratory of Hygiene, Madison, Wisconsin; Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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220
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Schiffman M, Wentzensen N. A Suggested Approach to Simplify and Improve Cervical Screening in the United States. J Low Genit Tract Dis 2016; 20:1-7. [PMID: 26704326 PMCID: PMC4692178 DOI: 10.1097/lgt.0000000000000170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cervical cancer prevention strategies in the United States have become complicated and even controversial, despite advanced understanding of carcinogenic human papillomavirus (HPV) infection as the necessary causal agent. Twenty years ago, etiologic and methodologic studies had already yielded 2 powerful preventive approaches. There are excellent vaccines to prevent the most carcinogenic types of HPV infection; reduced HPV endemicity will ultimately prevent a large fraction of cervical precancer and cancers. For prevention of cervical cancer in the interim, sensitive HPV tests that target women at risk of cancer, by detection of the DNA/RNA of approximately a dozen carcinogenic HPV types, permit early diagnosis and treatment of precancers.Although HPV vaccines and tests have continued to improve, implementation of these new HPV-based prevention methods has been relatively slow in the United States and in most places worldwide. Increasing vaccination rates is the clearest and most vital long-term priority. But, for decades to come, screening will also be important. To promote useful discussion, this commentary will raise some current critical issues in simplifying and speeding the rational introduction of HPV molecular methods into US cervical screening.
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Affiliation(s)
- Mark Schiffman
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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221
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Austin RM, Onisko A. Increased cervical cancer risk associated with extended screening intervals after negative human papillomavirus test results: Bayesian risk estimates using the Pittsburgh Cervical Cancer Screening Model. J Am Soc Cytopathol 2016; 5:9-14. [PMID: 31042540 DOI: 10.1016/j.jasc.2015.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Questions have recently been raised about the acceptability of increased cervical cancer risk projected with the new guideline-recommended rescreening interval of 5 years after negative cytology and human papillomavirus (HPV) cotest results. Additional data sources capable of evaluating cervical cancer risk over time are being sought. We employed the continuously updated Bayesian Pittsburgh Cervical Cancer Screening Model (PCCSM) to estimate invasive cancer risks for patients screened at extended screening intervals after negative HPV test results. MATERIALS AND METHODS The analyzed database included cervical screening data collected over 10 years (2005-2014) at Magee Womens Hospital with 976,624 liquid-based cytology (LBC) results, 285,351 companion high-risk US Food and Drug Administration-approved HPV test results from LBC vials, and 112,435 follow-up histopathologic results from surgical procedures with cervical tissue sampling. Histopathologic cervical cancer risk estimates for patients with prior double negative results with cervical LBC and from-the-vial HPV cotesting were computed using the PCCSM for women rescreened at intervals ranging from 1 to 9 years. Similar risks were computed for women with any negative HPV test result, not considering cytology results. RESULTS Histopathologic invasive cervical cancer risk computed following LBC and HPV cotesting double negative results progressively increased with rescreening intervals of 1 to 9 years. Cervical cancer risks computed following any HPV-negative result, not considering cytology results, were consistently even higher at each comparable extended rescreening interval. CONCLUSIONS The PCCSM is a new data source that allows evaluation of cervical cancer risk over time. Cervical cancer risk is minimized with more frequent cytology and HPV cotesting.
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Affiliation(s)
- R Marshall Austin
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania.
| | - Agnieszka Onisko
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh, 300 Halket Street, Pittsburgh, Pennsylvania; Faculty of Computer Science, Bialystok Technical Univeristy, Poland
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Cervical Cancer Screening in the United States-Affiliated Pacific Islands: Options and Opportunities. J Low Genit Tract Dis 2015; 20:97-104. [PMID: 26704332 DOI: 10.1097/lgt.0000000000000161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Successful cervical cancer screening in the United States-Affiliated Pacific Islands (USAPI) is limited by geographic, political, economic, and logistic factors. An expert panel convened to examine screening in each of the 6 island jurisdictions and to explore options beyond cytology-based screening. MATERIALS AND METHODS Forty-one representatives of American Congress of Obstetrics and Gynecology, American Society for Colposcopy and Cervical Pathology, government agencies, the World Health Organization, Pan American Health Organization, health representatives of the 6 Pacific island jurisdictions, Puerto Rico, and several academic institutions met in a 2-day meeting to explore options to improve access and coverage of cervical cancer screening in the USAPI. RESULTS Cytology-based screening is less widely accessed and less successful in the USAPI than in the United States in general. Barriers include geographic isolation, cultural factors, and lack of resources. Cytology-based screening requires multiple visits to complete the process from screening to treatment. Screen-and-treat regimens based on visual inspection with acetic acid or human papillomavirus requiring 1 or 2 visits have the potential to improve cervical cancer prevention in the USAPI. CONCLUSIONS The standard US algorithm of cytology screening followed by colposcopy and treatment is less effective in geographically and culturally isolated regions such as the USAPI. Alternate technologies, both high tech, such as primary human papillomavirus screening, and low tech, such as visual inspection with acetic acid, have shown promise in resource-poor countries and may have applicability in these US jurisdictions.
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223
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Shi J, Yuan M, Liu S, Duan X, Chen J. Correlation of IL-27 genetic polymorphisms with the risk and survival of cervical cancer in a Chinese Han population. Tumour Biol 2015; 37:6875-9. [PMID: 26662568 DOI: 10.1007/s13277-015-4512-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/25/2015] [Indexed: 12/18/2022] Open
Abstract
Interleukin-27 (IL-27) has been recognized as a pleiotropic cytokine with both pro- and anti-inflammatory properties. However, there are no data about the role of IL-27 polymorphism in the development of cervical cancer. A hospital-based case-control study was conducted in 380 patients with cervical cancer and 380 healthy controls to investigate the possible associations of IL-27 gene polymorphisms (-964A/G, 2905T/G, and 4730T/C), with susceptibility to cervical cancer and clinical outcome. Our results suggested that the IL-27 2905T/G was significantly associated with a decreased risk of cervical cancer (TG vs. TT, odds ratio (OR) = 0.77; 95 % confidence interval (CI) = 0.60-0.86; GG vs. TT, OR = 0.95; 95 % CI = 0.72-0.96; TG+GG vs. TT, OR = 0.87; 95 % CI = 0.65-0.94). However, the genotype and allele frequencies of IL-27 (-964A/G and 4730T/C) polymorphisms in cervical cancer patients were not significantly different from controls. Further analysis showed IL-27 2905T/G genotypes were associated with advanced tumor stages of cervical cancer patients. More interestingly, the IL-27 2905T/G genotypes were statistically significantly associated with the survival in cervical cancer patients. Our results showed that the IL-27 2905T/G genotypes were associated with decreased susceptibility and development of cervical cancer in Chinese Han population.
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Affiliation(s)
- Jian Shi
- Department of Medical Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.
| | - Meng Yuan
- College of Science and Technology, Yichang, 443002, Hubei, China
| | - Shuang Liu
- Department of Pathology, Bethune International Peace Hospital, Shijiazhuang, 050000, Hebei, China
| | - Xiaoyang Duan
- Department of Medical Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China
| | - Juan Chen
- Xingtai National Hospital, Xingtai, 054000, Hebei, China
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Luquain A, Belglaiaa E, Guenat D, Vrecko S, Riethmuller D, Valmary-Degano S, Bedgedjian I, Chouham S, Prétet JL, Mougin C. High prevalence of abnormal cervical smears in a hospital cohort of French women beyond the upper age limit screening program. Prev Med 2015; 81:157-62. [PMID: 26348451 DOI: 10.1016/j.ypmed.2015.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the prevalence of cytological abnormalities and high risk Human PapillomaVirus (hrHPV) in cervical smears from French women aged over 65 years who attended the referent Gynecology Clinic of the Besançon University Hospital. METHODS Between 2002 and 2012, 796 French women aged 66-99 years were cotested for cytology and hrHPV by Hybrid Capture 2 (hc2). hc2-positive cases were subjected to real time PCR for specific HPV 16/18/45 genotyping. Women with normal Pap smears and positive for hrHPV were followed-up every 12 months. RESULTS Cytological abnormalities were detected in more than 30% of women and cervical cancers (CC) in 2.9% of women. Benign lesions were more frequent in women aged 66-75 years while (pre)-malignant lesions were preferentially found in women over 76. The prevalence of hrHPV was 22.7%. HPV 16 was the most frequent (23.8%), followed by HPV 45 (7.7%) and HPV 18 (3.9%). The rate of hrHPV increased with the lesion severity and HPV 16 was identified in 50% of CC. Among the followed-up women, those who developed CIN3 were HPV16 positive at study entry. CONCLUSION The study provides important estimates of the prevalence of cervical abnormalities and hrHPV positivity in a French hospital based-population over 65. Findings suggest to consider this high risk population in regards to cervical cancer.
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Affiliation(s)
- Alexandra Luquain
- Centre Hospitalier Régional Universitaire de Besançon, F-25000, France.
| | - Essaada Belglaiaa
- Laboratoire de Biologie Cellulaire et Génétique Moléculaire, Faculté des Sciences, Université Ibn Zohr, Agadir, Maroc; Université Bourgogne Franche-Comté, F-25000 Besançon, France; EA 3181, LabEx LipSTIC ANR-11-LABX-0021, FED4234, CIC-1431F-25000 Besançon, France.
| | - David Guenat
- Centre Hospitalier Régional Universitaire de Besançon, F-25000, France; Université Bourgogne Franche-Comté, F-25000 Besançon, France.
| | - Sindy Vrecko
- Université Bourgogne Franche-Comté, F-25000 Besançon, France.
| | - Didier Riethmuller
- Centre Hospitalier Régional Universitaire de Besançon, F-25000, France; Université Bourgogne Franche-Comté, F-25000 Besançon, France; EA 3181, LabEx LipSTIC ANR-11-LABX-0021, FED4234, CIC-1431F-25000 Besançon, France.
| | - Séverine Valmary-Degano
- Centre Hospitalier Régional Universitaire de Besançon, F-25000, France; Université Bourgogne Franche-Comté, F-25000 Besançon, France; EA 3181, LabEx LipSTIC ANR-11-LABX-0021, FED4234, CIC-1431F-25000 Besançon, France.
| | | | - Said Chouham
- Laboratoire de Biologie Cellulaire et Génétique Moléculaire, Faculté des Sciences, Université Ibn Zohr, Agadir, Maroc.
| | - Jean-Luc Prétet
- Centre Hospitalier Régional Universitaire de Besançon, F-25000, France; Université Bourgogne Franche-Comté, F-25000 Besançon, France; EA 3181, LabEx LipSTIC ANR-11-LABX-0021, FED4234, CIC-1431F-25000 Besançon, France.
| | - Christiane Mougin
- Centre Hospitalier Régional Universitaire de Besançon, F-25000, France; Université Bourgogne Franche-Comté, F-25000 Besançon, France; EA 3181, LabEx LipSTIC ANR-11-LABX-0021, FED4234, CIC-1431F-25000 Besançon, France.
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Affiliation(s)
- R Marshall Austin
- Department of Pathology, Magee - Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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226
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Uhri M, Önal B. The route of science: Labyrinths and algorithms - Inspirations by human papillomavirus testing and cervical cancer. Cytojournal 2015; 12:24. [PMID: 26604977 PMCID: PMC4630718 DOI: 10.4103/1742-6413.168061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/28/2015] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mehmet Uhri
- Address: Department of Pathology, Istanbul K.S.S Training Hospital, Istanbul, Turkey
| | - Binnur Önal
- Department of Pathology and Cytology, Ankara Dıskapı Teaching and Research Hospital, Ankara, Turkey
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227
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El-Zein M, Richardson L, Franco EL. Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none. J Clin Virol 2015; 76 Suppl 1:S62-S68. [PMID: 26631958 DOI: 10.1016/j.jcv.2015.11.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 12/13/2022]
Abstract
Cervical cancer control includes primary prevention through vaccination to prevent human papillomavirus (HPV) infection and secondary prevention through screening to detect and treat cervical precancerous lesions. This review summarizes the evidence for the population impact of vaccines against oncogenic HPV types in reducing the prevalence of cervical precancerous lesions. We examine the gradual shift in screening technology from cervical cytology alone to cytology and HPV cotesting, and finally to the recognition that HPV testing can serve alone as the new screening paradigm, particularly in the initial post-vaccination era. We should expect an impact on screening performance and practices, as cohorts of HPV-vaccinated girls and adolescents reach cervical cancer screening age. In preparation for changes in the screening paradigm for the vaccination era, we propose that policymaking on cervical cancer screening should mirror current practices with other cancers as benchmarks. Cervical precancerous lesions will become a very rare condition following the widespread implementation of HPV vaccines with broader coverage in the number of preventable oncogenic types. Irrespective of screening technology, the false positive results will far outnumber the true positive ones, a tipping point that will herald a new period when the harms from cervical cancer screening will outweigh its benefits. We present a conceptual framework to guide decision making when we reach this point within 25-30 years.
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Affiliation(s)
- Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Lyndsay Richardson
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.
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Vijakururote L, Suprasert P, Srisomboon J, Siriaunkgul S, Settakorn J, Rewsuwan S. Histologic Outcomes in HPV-Positive and Cervical Cytology- Negative Women - Screening Results in Northern Thailand. Asian Pac J Cancer Prev 2015; 16:7271-5. [PMID: 26514523 DOI: 10.7314/apjcp.2015.16.16.7271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The objective of this study was to determine the prevalence of significant lesions defined as high grade squamous intraepithelial lesions (HSIL), adenocarcinoma in situ (AIS) and invasive carcinoma in women who had HPV-positive and cytology negative co-testing screening results. This retrospective study was conducted in Chiang Mai University Hospital between May, 2013 and August, 2014. Hybrid capture 2 (HC2) was used for HPV testing and conventional Pap smears for cytologic screening. A repeat liquid-based cytology (LBC) was performed in women with such co-testing results followed by colposcopy. Random biopsy was performed in cases of normal colposcopic findings. Further investigations were carried out according to the biopsy or the repeat LBC results. During the study period, 273 women met the criteria and participated in the study. The mean age of these women was 46.4 years with 30% of them reporting more than one partner. The median interval time to colposcopy was 165 days. About 40% showed an abnormality in the repeat cytology. Significant cervical lesions were found in 20 (7.3%) women, including 2 invasive cancers. Of interest was that only 2 of 20 significant lesions were diagnosed by colposcopic examination while the remainder were initially detected by cervical biopsy and abnormal repeat cytology. In conclusion, the prevalence of significant cervical lesions in HPV positive and cytology negative women in Northern Thailand was 7.3%. Further diagnostic work up with repeat cytology follow by colposcopy is recommended. Random biopsy should be performed even when the colposcopic findings are normal.
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Affiliation(s)
- Linlada Vijakururote
- Division of Gynecologic Pathology, Department of Pathology Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand E-mail :
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229
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Gage JC, Hunt WC, Schiffman M, Katki HA, Cheung LC, Cuzick J, Myers O, Castle PE, Wheeler CM. Risk Stratification Using Human Papillomavirus Testing among Women with Equivocally Abnormal Cytology: Results from a State-Wide Surveillance Program. Cancer Epidemiol Biomarkers Prev 2015; 25:36-42. [PMID: 26518316 DOI: 10.1158/1055-9965.epi-15-0669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/23/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical guidelines for cervical cancer screening have incorporated comparative risks of cervical intraepithelial neoplasia grade 3 or cancer (CIN3(+)) for various screening outcomes to determine management. Few cohorts are large enough to distinguish CIN3(+) risks among women with minor abnormalities versus negative cytology because of low incidence. The New Mexico Human Papillomavirus (HPV) Pap Registry offers a unique opportunity to evaluate cervical cancer screening in a diverse population across a broad-spectrum of health service delivery. METHODS Kaplan-Meier and logistic-Weibull survival models were used to estimate cumulative risks of CIN3(+) among women ages 21 to 64 who were screened in New Mexico between 2007 and 2011 with negative, equivocal or mildly abnormal cytology, that is, atypical squamous cells of undetermined significance (ASC-US; with or without HPV triage), or low-grade squamous intraepithelial lesions (LSIL). RESULTS We identified 452,045 women meeting the selection criteria. The 3-year CIN3(+) risks for women with negative, ASC-US, and LSIL cytology were 0.30%, 2.6%, and 5.2%, respectively. HPV triage of ASC-US stratified 3-year CIN3(+) risks were 0.72% for HPV-negative and 7.7% for HPV-positive. Risks tended to decline after age 30 for all screening results. CONCLUSIONS In this state-wide population-based cohort, cytology and HPV triage of ASC-US stratified women's CIN3(+) risk into similar patterns observed previously, suggesting the validity of screening guidelines for diverse populations in the United States. Absolute risk estimates should be compared across other large populations. IMPACT Strategies for HPV triage of ASC-US derived from clinical trials are upheld in large clinical practice settings and across diverse screening populations in the United States.
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Affiliation(s)
- Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, Maryland
| | - William C Hunt
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, Maryland
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, Maryland
| | - Li C Cheung
- Information Management Services Inc., Calverton, Maryland
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Orrin Myers
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | | | - Cosette M Wheeler
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
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Kim JJ, Campos NG, Sy S, Burger EA, Cuzick J, Castle PE, Hunt WC, Waxman A, Wheeler CM. Inefficiencies and High-Value Improvements in U.S. Cervical Cancer Screening Practice: A Cost-Effectiveness Analysis. Ann Intern Med 2015; 163:589-97. [PMID: 26414147 PMCID: PMC5104349 DOI: 10.7326/m15-0420] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of nonadherence in the screening process compared with recommended guidelines are uncertain. OBJECTIVE To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. DESIGN Model-based cost-effectiveness analysis. DATA SOURCES New Mexico HPV Pap Registry; medical literature. TARGET POPULATION Cohort of women eligible for routine screening. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION Current cervical cancer screening practice; improved adherence to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. OUTCOME MEASURES Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios, and incremental net monetary benefits (INMBs). RESULTS OF BASE-CASE ANALYSIS Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect adherence to screening every 3 years with cytologic testing and adherence to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1645. RESULTS OF SENSITIVITY ANALYSIS Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. LIMITATION The effect of human papillomavirus vaccination was not considered. CONCLUSIONS The added health benefit of improving adherence to guidelines, especially the 3-year interval for cytologic screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. PRIMARY FUNDING SOURCE U.S. National Cancer Institute.
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Affiliation(s)
- Jane J. Kim
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Nicole G. Campos
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Stephen Sy
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Emily A. Burger
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jack Cuzick
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Philip E. Castle
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - William C. Hunt
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Alan Waxman
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Cosette M. Wheeler
- From Harvard T.H. Chan School of Public Health, Boston, Massachusetts; University of Oslo, Oslo, Norway; Queen Mary University of London, London, United Kingdom; Albert Einstein College of Medicine, Bronx, New York; Global Coalition Against Cervical Cancer, Arlington, Virginia; University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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231
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Choi JW, Kim Y, Lee JH, Kim YS. The clinical performance of primary HPV screening, primary HPV screening plus cytology cotesting, and cytology alone at a tertiary care hospital. Cancer Cytopathol 2015; 124:144-52. [PMID: 26457676 DOI: 10.1002/cncy.21632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Algorithms for primary human papillomavirus (HPV) screening, primary HPV screening plus cytology cotesting, and cytology alone were evaluated previously in large cohort trials for cervical cancer detection, although the quality of cytology in those studies was controversial. To investigate whether these 3 algorithms would be applicable in routine practice at a tertiary care hospital, the authors compared their clinical performance. In addition, the prevalence of HPV genotypes was determined. METHODS Cervical cytology samples (n = 1000) were tested using liquid-based cytology (LBC), a nucleic acid hybridization assay, real-time polymerase chain reaction analysis, and direct HPV DNA sequencing. The clinical performance of the 3 algorithms was compared among women in different age groups (age range, 17-86 years; median age, 44.7 years). RESULTS For cervical intraepithelial neoplasia grade 2 or worse (CIN 2+), the sensitivity of primary HPV screening alone, cotesting, and LBC alone was 71.7%, 72.5%, and 63.8%, respectively; whereas the specificity was 87.5%, 96.5%, and 97.4%, respectively. Cotesting and LBC alone had slightly higher positive predictive values for CIN 2 + (97.8% and 98.9%, respectively) than primary HPV screening alone (91%), whereas primary HPV screening alone and cotesting demonstrated higher negative predictive values (63.6% and 62.5%, respectively) than LBC alone (43.2%). High-risk HPV types were detected in 24.3% of individuals. The most common type was HPV type 16 (HPV-16) followed by multiple HPV infections and HPV-58, HPV-52, HPV-31, HPV-35, HPV-51, HPV-39, HPV-56, HPV-33, HPV-18, HPV-59, and HPV-45. CONCLUSIONS Primary HPV screening alone in a tertiary care hospital demonstrated a performance that was equivalent to that of cotesting for CIN 2+, irrespective of patient age. With regard to the distribution of HPV genotypes, the nonavalent HPV vaccine would prevent approximately 60% of high-risk HPV.
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Affiliation(s)
- Jung-Woo Choi
- Department of Pathology, Korea University Ansan Hospital, Ansan, Korea
| | - Younghye Kim
- Department of Pathology, Korea University Ansan Hospital, Ansan, Korea
| | - Ju-Han Lee
- Department of Pathology, Korea University Ansan Hospital, Ansan, Korea
| | - Young-Sik Kim
- Department of Pathology, Korea University Ansan Hospital, Ansan, Korea
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Manga MM, Fowotade A, Abdullahi YM, El-Nafaty AU, Adamu DB, Pindiga HU, Bakare RA, Osoba AO. Epidemiological patterns of cervical human papillomavirus infection among women presenting for cervical cancer screening in North-Eastern Nigeria. Infect Agent Cancer 2015; 10:39. [PMID: 26435733 PMCID: PMC4592568 DOI: 10.1186/s13027-015-0035-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/23/2015] [Indexed: 12/18/2022] Open
Abstract
Background Sub-Saharan countries including Nigeria have the highest burden of Human Papillomavirus (HPV) infection in the world. Most studies on HPV surveillance in Nigeria were done in the southern part of the country. Geographical and socio-cultural diversity of Nigeria makes these data unlikely to be universally representative for the entire country. Northern Nigeria especially the North-East carries a higher prevalence of cervical cancer and many of its risk factors. The region may be harbouring a higher prevalence of HPV infection with a possibility of different genotypic distribution. This study was carried out to determine the burden and confirm the predominant HPV genotypes among women presenting for cervical cancer screening at the Federal Teaching Hospital Gombe (FTHG), North-eastern, Nigeria. Methods The study was an observational hospital based cross sectional study among women who presented for cervical cancer screening in FTHG. A total of 209 consenting women were tested for cervical HPV infection using PCR. DNA sequencing was carried out on positive samples to determine the prevalent HPV genotypes. Results The prevalence of cervical HPV infection among the participants with mean age of 39.6 ± 10.4 years was 48.1 %. The five most predominant genotypes were 18, 16, 33, 31 and 35, with prevalence of 44.7 %, 13.2 %, 7.9 %, 5.3 % and 5.3 % respectively. Other genotypes observed were 38, 45, 56, 58, 82 and KC5. Multiple HPV infections were detected among 7.9 % of participants. Risk factors such as level of education (X2 = 15.897; p = 0.007), age at sexual debut (X2 = 6.916; p = 0.009), parity (X2 = 23.767; p = 0.000), number of life time sexual partners (X2 = 7.805; p = 0.005), age at first pregnancy (X2 = 10.554; p = 0.005) and history of other malignancies (X2 = 7.325; p = 0.007) were found to have a statistically significant association with HPV infection. Conclusion This study identified a high burden of HPV infection in Northern Nigeria while also confirming HPV 18 and 16 as the most predominant genotypes. It further justifies the potential benefit of the currently available HPV vaccines in the area. A larger and community based study is however recommended for better representation of the area. Electronic supplementary material The online version of this article (doi:10.1186/s13027-015-0035-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammed Mohammed Manga
- Department of Medical Microbiology and Immunology, Federal Teaching Hospital Gombe, Gombe, Gombe state Nigeria
| | - Adeola Fowotade
- Department of Medical Microbiology and Parasitology, University College Hospital Ibadan, Ibadan, Oyo state Nigeria
| | | | - Aliyu Usman El-Nafaty
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital Gombe, Gombe, Gombe state Nigeria
| | - Danladi Bojude Adamu
- Department of Radiotherapy and Oncology, Federal Teaching Hospital Gombe, Gombe, Gombe state Nigeria
| | - Hamidu Umar Pindiga
- Department of Histopathology, Federal Teaching Hospital Gombe, Gombe, Gombe state Nigeria
| | - Rasheed Ajani Bakare
- Department of Medical Microbiology and Parasitology, University College Hospital Ibadan, Ibadan, Oyo state Nigeria
| | - Abimbola Olu Osoba
- Department of Medical Microbiology and Parasitology, University College Hospital Ibadan, Ibadan, Oyo state Nigeria
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233
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Katki HA, Cheung LC, Fetterman B, Castle PE, Sundaram R. A joint model of persistent human papillomavirus infection and cervical cancer risk: Implications for cervical cancer screening. JOURNAL OF THE ROYAL STATISTICAL SOCIETY. SERIES A, (STATISTICS IN SOCIETY) 2015; 178:903-923. [PMID: 26556961 PMCID: PMC4635446 DOI: 10.1111/rssa.12101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
New cervical cancer screening guidelines in the US and many European countries recommend that women get tested for human papillomavirus (HPV). To inform decisions about screening intervals, we calculate the increase in precancer/cancer risk per year of continued HPV infection. However, both time to onset of precancer/cancer and time to HPV clearance are interval-censored, and onset of precancer/cancer strongly informatively censors HPV clearance. We analyze this bivariate informatively interval-censored data by developing a novel joint model for time to clearance of HPV and time to precancer/cancer using shared random-effects, where the estimated mean duration of each woman's HPV infection is a covariate in the submodel for time to precancer/cancer. The model was fit to data on 9,553 HPV-positive/Pap-negative women undergoing cervical cancer screening at Kaiser Permanente Northern California, data that were pivotal to the development of US screening guidelines. We compare the implications for screening intervals of this joint model to those from population-average marginal models of precancer/cancer risk. In particular, after 2 years the marginal population-average precancer/cancer risk was 5%, suggesting a 2-year interval to control population-average risk at 5%. In contrast, the joint model reveals that almost all women exceeding 5% individual risk in 2 years also exceeded 5% in 1 year, suggesting that a 1-year interval is better to control individual risk at 5%. The example suggests that sophisticated risk models capable of predicting individual risk may have different implications than population-average risk models that are currently used for informing medical guideline development.
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Affiliation(s)
- Hormuzd A. Katki
- Division of Cancer Epidemilogy and Genetics, US National Cancer Institute, NIH, Bethesda MD, USA
| | - Li C. Cheung
- Infomation Management Services, Inc., Calverton MD, USA
| | | | | | - Rajeshwari Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville MD, USA
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234
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Human Papillomavirus (HPV) Testing for Secondary Prevention of Cervical Cancer. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0133-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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235
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Wentzensen N, Fetterman B, Castle PE, Schiffman M, Wood SN, Stiemerling E, Tokugawa D, Bodelon C, Poitras N, Lorey T, Kinney W. p16/Ki-67 Dual Stain Cytology for Detection of Cervical Precancer in HPV-Positive Women. J Natl Cancer Inst 2015; 107:djv257. [PMID: 26376685 DOI: 10.1093/jnci/djv257] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 08/18/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-based cervical cancer screening requires triage markers to decide who should be referred to colposcopy. p16/Ki-67 dual stain cytology has been proposed as a biomarker for cervical precancers. We evaluated the dual stain in a large population of HPV-positive women. METHODS One thousand five hundred and nine HPV-positive women screened with HPV/cytology cotesting at Kaiser Permanente California were enrolled into a prospective observational study in 2012. Dual stain cytology was performed on residual Surepath material, and slides were evaluated for dual stain-positive cells. Disease endpoints were ascertained from the clinical database at KPNC. We evaluated the clinical performance of the assay among all HPV-positive women and among HPV-positive, cytology-negative women. We used internal benchmarks for clinical management to evaluate the clinical relevance of the dual stain assay. We evaluated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the dual stain compared with Pap cytology. All statistical tests were two-sided. RESULTS The dual stain had lower positivity (45.9%) compared with cytology at an ASC-US threshold (53.4%). For detection of CIN2+, the dual stain had similar sensitivity (83.4% vs 76.6%, P = .1), and statistically higher specificity (58.9% vs 49.6%, P < .001), PPV (21.0% vs 16.6%, P < .001), and NPV (96.4% vs 94.2%, P = .01) compared with cytology. Similar patterns were observed for CIN3+. Women with a positive test had high enough risk for referral to colposcopy, while the risk for women with negative tests was below a one-year return threshold based on current US management guidelines. CONCLUSION Dual stain cytology showed good risk stratification for all HPV-positive women and for HPV-positive women with normal cytology. Additional follow-up is needed to determine how long dual stain negative women remain at low risk of precancer.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK).
| | - Barbara Fetterman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Shannon N Wood
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Eric Stiemerling
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Diane Tokugawa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Clara Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Nancy Poitras
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Thomas Lorey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
| | - Walter Kinney
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (NW, MS, SNW, CB); Kaiser Permanente TPMG Regional Laboratory, Berkeley, CA (BF, ES, DT, NP, TL); Global Coalition Against Cervical Cancer, Arlington, VA (PEC); Albert Einstein College of Medicine, Bronx, NY (PEC); Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (WK)
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Stoler MH, Austin RM, Zhao C. Point-Counterpoint: Cervical Cancer Screening Should Be Done by Primary Human Papillomavirus Testing with Genotyping and Reflex Cytology for Women over the Age of 25 Years. J Clin Microbiol 2015; 53:2798-804. [PMID: 25948606 PMCID: PMC4540928 DOI: 10.1128/jcm.01087-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Screening for cervical cancer with cytology testing has been very effective in reducing cervical cancer in the United States. For decades, the approach was an annual Pap test. In 2000, the Hybrid Capture 2 human papillomavirus (HPV) test was approved by the U.S. Food and Drug Administration (FDA) for screening women who have atypical squamous cells of underdetermined significance (ASCUS) detected by Pap test to determine the need for colposcopy. In 2003, the FDA approved expanding the use of the test to include screening performed in conjunction with a Pap test for women over the age of 30 years, referred to as "cotesting." Cotesting allows women to extend the testing interval to 3 years if both tests have negative results. In April of 2014, the FDA approved the use of an HPV test (the cobas HPV test) for primary cervical cancer screening for women over the age of 25 years, without the need for a concomitant Pap test. The approval recommended either colposcopy or a Pap test for patients with specific high-risk HPV types detected by the HPV test. This was based on the results of the ATHENA trial, which included more than 40,000 women. Reaction to this decision has been mixed. Supporters point to the fact that the primary-screening algorithm found more disease (cervical intraepithelial neoplasia 3 or worse [CIN3+]) and also found it earlier than did cytology or cotesting. Moreover, the positive predictive value and positive-likelihood ratio of the primary-screening algorithm were higher than those of cytology. Opponents of the decision prefer cotesting, as this approach detects more disease than the HPV test alone. In addition, the performance of this new algorithm has not been assessed in routine clinical use. Professional organizations will need to develop guidelines that incorporate this testing algorithm. In this Point-Counterpoint, Dr. Stoler explains why he favors the primary-screening algorithm, while Drs. Austin and Zhao explain why they prefer the cotesting approach to screening for cervical cancer.
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Affiliation(s)
- Mark H Stoler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - R Marshall Austin
- Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chengquan Zhao
- Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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237
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Schiffman M, Boyle S, Raine-Bennett T, Katki HA, Gage JC, Wentzensen N, Kornegay JR, Apple R, Aldrich C, Erlich HA, Tam T, Befano B, Burk RD, Castle PE. The Role of Human Papillomavirus Genotyping in Cervical Cancer Screening: A Large-Scale Evaluation of the cobas HPV Test. Cancer Epidemiol Biomarkers Prev 2015; 24:1304-10. [PMID: 26088703 PMCID: PMC4560647 DOI: 10.1158/1055-9965.epi-14-1353] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/15/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The cobas HPV Test ("cobas"; Roche Molecular Systems) detects HPV16 and HPV18 individually, and a pool of 12 other high-risk (HR) HPV types. The test is approved for (i) atypical squamous cells of undetermined significance (ASC-US) triage to determine need for colposcopy, (ii) combined screening with cytology ("cotesting"), and (iii) primary HPV screening. METHODS To assess the possible value of HPV16/18 typing, >17,000 specimens from a longitudinal cohort study of initially HPV-positive women (HC2, Qiagen) were retested with cobas. To study accuracy, cobas genotyping results were compared with those of an established method, the Linear Array HPV Genotyping Test (LA, Roche Molecular Systems). Clinical value of the typing strategy was evaluated by linking the cobas results (supplemented by other available typing results) to 3-year cumulative risks of CIN3+. RESULTS Grouped hierarchically (HPV16, else HPV18, else other HR types, else negative), the κ statistic for agreement between cobas and LA was 0.86 [95% confidence interval (CI), 0.86-0.87]. In all three scenarios, HPV16-positive women were at much higher 3-year risk of CIN3+ than HPV16-negative women: women ages 21 and older with ASC-US (14.5%; 95% CI, 13.5%-15.5% vs. 3.5%; 95% CI, 3.3-3.6); women ages 30 years and older that were HPV-positive cytology-negative (10.3%; 95% CI, 9.6-11.1 vs. 2.3%; 95% CI, 2.2-2.4); and all women 25 years and older that were HPV-positive (18.5%; 95% CI, 17.8-19.2 vs. 4.3%; 95% CI, 4.2-4.4). CONCLUSION The cobas and LA results show excellent agreement. The data support HPV16 typing. IMPACT HPV16 typing is useful in the management of HPV-positive/cytology-negative women in cotesting, of all HPV-positive women in primary HPV testing, and perhaps in the management of HPV-positive women with ASC-US. Cancer Epidemiol Biomarkers Prev; 24(9); 1304-10.
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Affiliation(s)
| | - Sean Boyle
- Roche Molecular Systems, Pleasanton, California
| | | | | | | | | | | | | | | | | | - Thanh Tam
- Roche Molecular Systems, Pleasanton, California
| | - Brian Befano
- Information Management Services, Calverton, Maryland
| | - Robert D Burk
- Albert Einstein College of Medicine, The Bronx, New York
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, The Bronx, New York. Global Coalition Against Cervical Cancer, Arlington, Virginia
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238
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Reid JL, Wright TC, Stoler MH, Cuzick J, Castle PE, Dockter J, Getman D, Giachetti C. Human papillomavirus oncogenic mRNA testing for cervical cancer screening: baseline and longitudinal results from the CLEAR study. Am J Clin Pathol 2015; 144:473-83. [PMID: 26276778 DOI: 10.1309/ajcphvd7mip3fyvv] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES This study determined the longitudinal clinical performance of a high-risk human papillomavirus (HR-HPV) E6/E7 RNA assay (Aptima HPV [AHPV]; Hologic, San Diego, CA) compared with an HR-HPV DNA assay (Hybrid Capture 2 [HC2]; Qiagen, Gaithersburg, MD) as an adjunctive method for cervical cancer screening. METHODS Women 30 years or older with a negative result for intraepithelial lesions or malignancy cytology (n = 10,860) positive by AHPV and/or HC2 assays and randomly selected women negative by both assays were referred to colposcopy at baseline. Women without baseline cervical intraepithelial neoplasia (CIN) grade 2 or higher (CIN2+) continued into the 3-year follow-up. RESULTS The specificity of AHPV for CIN2 or lower was significantly greater at 96.3% compared with HC2 specificity of 94.8% (P < .001). Estimated sensitivities and risks for detection of CIN2+ were similar between the two assays. After 3 years of follow-up, women negative by either human papillomavirus test had a very low risk of CIN2+ (<0.3%) compared with CIN2+ risk in women with positive AHPV results (6.3%) or positive HC2 results (5.1%). CONCLUSIONS These results support the use of AHPV as a safe and effective adjunctive cervical cancer screening method.
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Affiliation(s)
| | - Thomas C Wright
- Department of Pathology, Columbia University School of Medicine, New York, NY
| | - Mark H Stoler
- University of Virginia Health System, Charlottesville
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; and
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239
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Cervical screening program and the psychological impact of an abnormal Pap smear: a self-assessment questionnaire study of 590 patients. Arch Gynecol Obstet 2015. [PMID: 26202136 DOI: 10.1007/s00404-015-3821-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Invasive cervical cancer is today the fourth most common cancer of women in western civilization. Screening programs have led to a continuously decrease. Nevertheless, both screening and a positive test result are known to be associated with a negative psychological impact. Screening programs in European countries differ and thus psychological impact might as well. The aim of this study was to evaluate the psychological impact of women with an abnormal Pap smear in a German cohort. METHODS Between July 2013 and May 2014, a self-assessment questionnaire was distributed to 595 patients that were referred to a special clinic for cervical dysplasia for further evaluation of an abnormal Pap smear. Patients were recruited in five different centers. RESULTS Most patients (45.9 %) were informed about the test result via phone call by their doctor. 68.8 % of the patients felt anxious and 26.3 % even felt panic. After having talked to their physician, 51.4 % of our cohort still felt worried and only 24.4 % felt reassured. Concerning disease management, 48.4 % underwent a control Pap smear in 6 months. The preferred information source was the physician (63.9 %). Compared to the results in other European countries, our study cohort showed differences concerning age distribution, patients living in a partnership, number of children and especially disease management. CONCLUSION Cancer screening itself and abnormal test results have an impact on patient's feelings. To reduce the psychological impact, patients need to be better informed about the risks and benefits of cancer screening programs and in case of cervical cancer screening about the meaning of an abnormal test result. Our results underline the importance of a trustful physician-patient relationship in that matter.
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240
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Holl K, Nowakowski AM, Powell N, McCluggage WG, Pirog EC, Collas De Souza S, Tjalma WA, Rosenlund M, Fiander A, Castro Sánchez M, Damaskou V, Joura EA, Kirschner B, Koiss R, O'Leary J, Quint W, Reich O, Torné A, Wells M, Rob L, Kolomiets L, Molijn A, Savicheva A, Shipitsyna E, Rosillon D, Jenkins D. Human papillomavirus prevalence and type-distribution in cervical glandular neoplasias: Results from a European multinational epidemiological study. Int J Cancer 2015; 137:2858-68. [PMID: 26096203 PMCID: PMC5034816 DOI: 10.1002/ijc.29651] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 05/19/2015] [Indexed: 01/10/2023]
Abstract
Cervical glandular neoplasias (CGN) present a challenge for cervical cancer prevention due to their complex histopathology and difficulties in detecting preinvasive stages with current screening practices. Reports of human papillomavirus (HPV) prevalence and type-distribution in CGN vary, providing uncertain evidence to support prophylactic vaccination and HPV screening. This study [108288/108290] assessed HPV prevalence and type-distribution in women diagnosed with cervical adenocarcinoma in situ (AIS, N = 49), adenosquamous carcinoma (ASC, N = 104), and various adenocarcinoma subtypes (ADC, N = 461) from 17 European countries, using centralised pathology review and sensitive HPV testing. The highest HPV-positivity rates were observed in AIS (93.9%), ASC (85.6%), and usual-type ADC (90.4%), with much lower rates in rarer ADC subtypes (clear-cell: 27.6%; serous: 30.4%; endometrioid: 12.9%; gastric-type: 0%). The most common HPV types were restricted to HPV16/18/45, accounting for 98.3% of all HPV-positive ADC. There were variations in HPV prevalence and ADC type-distribution by country. Age at diagnosis differed by ADC subtype, with usual-type diagnosed in younger women (median: 43 years) compared to rarer subtypes (medians between 57 and 66 years). Moreover, HPV-positive ADC cases were younger than HPV-negative ADC. The six years difference in median age for women with AIS compared to those with usual-type ADC suggests that cytological screening for AIS may be suboptimal. Since the great majority of CGN are HPV16/18/45-positive, the incorporation of prophylactic vaccination and HPV testing in cervical cancer screening are important prevention strategies. Our results suggest that special attention should be given to certain rarer ADC subtypes as most appear to be unrelated to HPV.
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Affiliation(s)
| | - Andrzej M Nowakowski
- First Department of Oncologic Gynaecology and Gynaecology, Medical University of Lublin, Poland.,Department of Gynaecology and Oncologic Gynaecology, Military Institute of Medicine, Warsaw, Poland
| | - Ned Powell
- Institute of Cancer and Genetics, HPV Research Group, Cardiff University School of Medicine, Cardiff, Wales, United Kingdom
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Edyta C Pirog
- Department of Pathology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY
| | | | - Wiebren A Tjalma
- Multidisciplinary Breast Clinic-Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Mats Rosenlund
- IMS Health, Stockholm, Sweden.,Center for Pharmacoepidemiology, Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden
| | - Alison Fiander
- Institute of Cancer and Genetics, HPV Research Group, Cardiff University School of Medicine, Cardiff, Wales, United Kingdom
| | - Maria Castro Sánchez
- Obstetrics and Gynaecology Department, University Hospital Puerto De Hierro Majadahonda, Madrid, Spain
| | - Vasileia Damaskou
- Department of Anatomical Pathology, General Hospital of Patras, Achaia, Greece
| | - Elmar A Joura
- Comprehensive Cancer Center, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Benny Kirschner
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Copenhagen, Denmark
| | - Robert Koiss
- Department of Obstetrics and Gynecologic Oncology, St. Stephan Hospital, Budapest, Hungary
| | - John O'Leary
- CERVIVA Research Consortium, Funded by the Health Research Board Ireland, Based at the Department of Pathology, The Coombe Women and Infants University Hospital and Trinity College, Dublin, Ireland
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Aureli Torné
- Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Michael Wells
- Department of Oncology, University of Sheffield Medical School, Sheffield, England, United Kingdom
| | - Lukas Rob
- University Hospital Motol, Prague, Czech Republic
| | | | - Anco Molijn
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Alevtina Savicheva
- Laboratory of Microbiology, DO Ott Research Institute of Obstetrics and Gynaecology, St. Petersburg, Russia
| | - Elena Shipitsyna
- Laboratory of Microbiology, DO Ott Research Institute of Obstetrics and Gynaecology, St. Petersburg, Russia
| | | | - David Jenkins
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
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241
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Trends in the incidence of cervical cancer and severe precancerous lesions in Denmark, 1997–2012. Cancer Causes Control 2015; 26:1105-16. [DOI: 10.1007/s10552-015-0603-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/20/2015] [Indexed: 01/18/2023]
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242
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Weinmann S, Williams AE, Kamineni A, Buist DSM, Masterson EE, Stout NK, Stark A, Ross TR, Owens CL, Field TS, Doubeni CA. Cervical cancer screening and follow-up in 4 geographically diverse US health care systems, 1998 through 2007. Cancer 2015; 121:2976-83. [PMID: 25989253 DOI: 10.1002/cncr.29445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/15/2015] [Accepted: 03/18/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cervical cancer screening and follow-up guidelines have changed considerably in recent years, but to the authors' knowledge few published reports exist to estimate the impact of these changes in community-based settings. The authors examined the patterns and results of cervical cancer testing and follow-up over a decade in 4 geographically diverse US health care systems to inform the future evaluation of changes resulting from increased uptake of the human papillomavirus (HPV) vaccination. METHODS The authors studied women aged 21 to 65 years who were members of one of these health systems at any time between 1998 and 2007. Data were collected and standardized across sites, based on receipt of Papanicolaou (Pap) and HPV tests, HPV vaccination, cervical biopsies, and treatment of cervical dysplasia. Annual rates (per 1000 person-years) of Pap testing, HPV testing, and cervical biopsy and treatment procedures were calculated. Screening intervals and trends in the results of screening Pap tests and cervical biopsies also were examined. RESULTS Pap testing rates decreased (from 483 per 1000 person-years in 2000 to 412 per 1000 person-years in 2007) and HPV testing rates increased over the study period. Screening frequency varied across health care systems, and many women continued to receive annual testing. All 4 sites moved to less frequent screening over the study period without marked changes in the overall use of cervical biopsy or treatment. CONCLUSIONS Despite differences over time and across health plans in rates of cervical cancer testing and follow-up cervical procedures, the authors found no notable differences in Pap test results, diagnostic or treatment procedure rates, or pathological outcomes. This finding suggests that the longer screening intervals did not lead to more procedures or more cancer diagnoses.
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Affiliation(s)
- Sheila Weinmann
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | | | | | - Erin E Masterson
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Azadeh Stark
- Geisinger Center for Health Research, Danville, Pennsylvania
| | - Tyler R Ross
- Group Health Research Institute, Seattle, Washington
| | - Christopher L Owens
- Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, Reliant Medical Group, Worcester, Massachusetts
| | - Terry S Field
- Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, Reliant Medical Group, Worcester, Massachusetts
| | - Chyke A Doubeni
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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243
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Silver MI, Rositch AF, Burke AE, Chang K, Viscidi R, Gravitt PE. Patient concerns about human papillomavirus testing and 5-year intervals in routine cervical cancer screening. Obstet Gynecol 2015; 125:317-329. [PMID: 25568994 DOI: 10.1097/aog.0000000000000638] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To explore attitudes toward new cervical cancer screening options and understand factors associated with those beliefs among women in routine gynecologic care. METHODS We used an interviewer-administered survey of 551 women aged 36-62 years enrolled in the HPV in Perimenopause Study. Poisson regression with robust error variance was used to estimate prevalence ratios and 95% confidence intervals (CIs) to compare women's preferences for cervical cancer screening methods and frequency. RESULTS A majority of women (55.6%, 95% CI 51.4-59.8%) were aware that screening recommendations had changed, yet 74.1% (95% CI 70.3-77.7%) still believed women should be screened annually. If recommended by their doctor, 68.4% (95% CI 64.4-72.2%) were willing to extend screening to every 3 years, but only 25.2% (95% CI 21.9-29.2%) would extend screening to 5 years. Most women (60.7%, 95% CI 56.5-65.7%) expressed a strong preference for Pap testing, and 41.4% (95% CI 37.4-45.6%) expressed at least moderate concern over having a human papillomavirus (HPV) test without a Pap test. A desire for more frequent care, higher degree of worry and perceived risk, and abnormal screening history were all associated with reduced willingness to accept HPV testing and longer screening intervals. CONCLUSION A majority of routinely screened women indicated a willingness to adopt a cervical cancer screening strategy of cytology alone or Pap-HPV cotesting every 3 years if recommended by their physician. However, they remain concerned about HPV testing and extension of screening intervals to once every 5 years. Our results suggest continued reticence to accepting newer HPV-based screening algorithms among routinely screened women older than age 35 years.
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Affiliation(s)
- Michelle I Silver
- Departments of Epidemiology, Gynecology and Obstetrics, and Pediatrics and the Center for Immunization Research, Johns Hopkins School of Public Health, Baltimore, Maryland; and the Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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244
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Zheng B, Li Z, Griffith CC, Yan S, Chen C, Ding X, Liang X, Yang H, Zhao C. Prior high-risk HPV testing and Pap test results for 427 invasive cervical cancers in China's largest CAP-certified laboratory. Cancer Cytopathol 2015; 123:428-34. [PMID: 25954852 DOI: 10.1002/cncy.21557] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cervical cancer and its precursor lesions are caused by a persistent high-risk human papillomavirus (hrHPV) infection. hrHPV testing has been reported to have higher sensitivity than Papanicolaou (Pap) testing for the detection of cervical precursor lesions. However, limited data are available for prior human papillomavirus (HPV) testing results for patients later diagnosed with invasive cervical cancer, especially in countries lacking a national cervical cancer screening program such as China. This study investigated prior hrHPV testing results for patients with invasive cervical cancer in China. METHODS Cases with a histologic diagnosis of invasive cervical carcinoma were retrieved from Guangzhou KingMed Diagnostics (the largest independent pathology laboratory in China); prior hrHPV and Pap test results obtained within the year before the cancer diagnosis were recorded. RESULTS HPV testing was negative in 7.5% of 427 cases of invasive cervical carcinoma, including squamous cell carcinoma (5%) and adenocarcinoma (25%). In 155 cervical cancer cases with prior hrHPV and Pap testing, the negative rate for Pap testing was 1.9%, and the negative rate for HPV was 9.7%. Furthermore, when only cases of adenocarcinoma (n = 18) were examined, both the hrHPV-negative rate and the Pap-negative rate were higher at 33% and 5.6%, respectively. CONCLUSIONS These data demonstrate a considerable prior hrHPV-negative rate and a lower prior Pap-negative rate in patients with invasive cervical carcinoma (especially adenocarcinoma) from a population of women without access to an established screening program.
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Affiliation(s)
- Baowen Zheng
- Guangzhou KingMed Diagnostics, Guangzhou, People's Republic of China
| | - Zaibo Li
- Department of Pathology, Wexner Medical Center, Ohio State University, Columbus, Ohio
| | - Christopher C Griffith
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shanshan Yan
- Guangzhou KingMed Diagnostics, Guangzhou, People's Republic of China
| | - Congde Chen
- Guangzhou KingMed Diagnostics, Guangzhou, People's Republic of China
| | - Xiangdong Ding
- Guangzhou KingMed Diagnostics, Guangzhou, People's Republic of China
| | - Xiaoman Liang
- Guangzhou KingMed Diagnostics, Guangzhou, People's Republic of China
| | - Huaitao Yang
- Department of Pathology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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245
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Tao X, Griffith CC, Zhou X, Wang Z, Yan Y, Li Z, Zhao C. History of high-risk HPV and Pap test results in a large cohort of patients with invasive cervical carcinoma: Experience from the largest women's hospital in China. Cancer Cytopathol 2015; 123:421-7. [PMID: 25955972 DOI: 10.1002/cncy.21545] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Xiang Tao
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Christopher C. Griffith
- Department of Pathology; Magee-Womens Hospital of UPMC; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Xiangrong Zhou
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Zhiheng Wang
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Yabin Yan
- Department of Pathology; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Zaibo Li
- Department of Pathology; Ohio State University Wexner Medical Center; Columbus Ohio
| | - Chengquan Zhao
- Department of Pathology; Magee-Womens Hospital of UPMC; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
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246
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Schlichte MJ, Guidry J. Current Cervical Carcinoma Screening Guidelines. J Clin Med 2015; 4:918-32. [PMID: 26239455 PMCID: PMC4470206 DOI: 10.3390/jcm4050918] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 12/28/2022] Open
Abstract
A formidable threat to the health of women, cervical carcinoma can be prevented in many cases with adequate screening. The current guidelines for cervical carcinoma screening were created as joint recommendations of the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American Society for Clinical Pathology (ASCP) in 2012, and later accepted and promoted by the American Congress of Obstetricians and Gynecologists (ACOG). The 2012 recommendations underscore the utility of molecular testing as an adjunct to cytology screening for certain women and provide guidance to clinicians based on different risk-benefit considerations for different ages. This manuscript will review screening techniques and current recommendations for cervical cancer screening and human papilloma virus (HPV) testing, as well as possible future screening strategies.
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Affiliation(s)
| | - Jacqueline Guidry
- Center for Clinical Studies, 6655 Travis St #120, Houston, TX 77030, USA.
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247
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Abstract
Both primary and secondary prevention of cervical cancer are now available. Immunizations against human papillomavirus (HPV) types 16 and 18 have the potential to prevent 70% of cancers of the cervix plus a large percentage of other lower anogenital tract cancers. Screening guidelines were recently changed to recommend cotesting with cytology plus an HPV test. The addition of HPV testing increases the sensitivity and negative predictive value of screening over the Papanicolaou (Pap) test alone.
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Affiliation(s)
- Lauren Thaxton
- Department of Obstetrics and Gynecology, 1 University of New Mexico, MSC 10 5580, Albuquerque, NM 87131, USA
| | - Alan G Waxman
- Department of Obstetrics and Gynecology, 1 University of New Mexico, MSC 10 5580, Albuquerque, NM 87131, USA.
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248
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Bond S. Interim Guidelines Describe Using High-Risk Human Papillomavirus Testing as Alternative for Primary Cervical Cancer Screening. J Midwifery Womens Health 2015. [DOI: 10.1111/jmwh.12326_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nghiem VT, Davies KR, Beck JR, Follen M, MacAulay C, Guillaud M, Cantor SB. Economic evaluation of DNA ploidy analysis vs liquid-based cytology for cervical screening. Br J Cancer 2015; 112:1951-7. [PMID: 25919612 PMCID: PMC4580387 DOI: 10.1038/bjc.2015.95] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/30/2015] [Accepted: 02/15/2015] [Indexed: 11/30/2022] Open
Abstract
Background: DNA ploidy analysis involves automated quantification of chromosomal aneuploidy, a potential marker of progression toward cervical carcinoma. We evaluated the cost-effectiveness of this method for cervical screening, comparing five ploidy strategies (using different numbers of aneuploid cells as cut points) with liquid-based Papanicolaou smear and no screening. Methods: A state-transition Markov model simulated the natural history of HPV infection and possible progression into cervical neoplasia in a cohort of 12-year-old females. The analysis evaluated cost in 2012 US$ and effectiveness in quality-adjusted life-years (QALYs) from a health-system perspective throughout a lifetime horizon in the US setting. We calculated incremental cost-effectiveness ratios (ICERs) to determine the best strategy. The robustness of optimal choices was examined in deterministic and probabilistic sensitivity analyses. Results: In the base-case analysis, the ploidy 4 cell strategy was cost-effective, yielding an increase of 0.032 QALY and an ICER of $18 264/QALY compared to no screening. For most scenarios in the deterministic sensitivity analysis, the ploidy 4 cell strategy was the only cost-effective strategy. Cost-effectiveness acceptability curves showed that this strategy was more likely to be cost-effective than the Papanicolaou smear. Conclusion: Compared to the liquid-based Papanicolaou smear, screening with a DNA ploidy strategy appeared less costly and comparably effective.
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Affiliation(s)
- V T Nghiem
- 1] The University of Texas MD Anderson Cancer Center, Department of Health Services Research, 1515 Holcombe Blvd., Houston, TX 77030, USA [2] The University of Texas School of Public Health, Division of Management, Policy and Community Health, 1200 Pressler Street, Houston, TX 77030, USA
| | - K R Davies
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - J R Beck
- Fox Chase Cancer Center, Cancer Prevention and Control Program, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - M Follen
- Brookdale University Hospital & Medical Center, Department of Obstetrics & Gynecology, One Brookdale Plaza, Brooklyn, NY 11212, USA
| | - C MacAulay
- British Columbia Cancer Research Centre, Integrative Oncology Department, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada
| | - M Guillaud
- British Columbia Cancer Research Centre, Integrative Oncology Department, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada
| | - S B Cantor
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Schiffman M, Wentzensen N. Transitioning to a new era in cervical cancer screening. Gynecol Oncol 2015; 136:175-7. [PMID: 25680631 DOI: 10.1016/j.ygyno.2015.01.538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 01/04/2015] [Accepted: 01/13/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Mark Schiffman
- Room 6e544, 9609 Medical Center Drive, Rockville, MD 20850 (MS), United States.
| | - Nicolas Wentzensen
- Room 6e544, 9609 Medical Center Drive, Rockville, MD 20850 (MS), United States.
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