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Dunlop KLA, Keogh LA, Smith AL, Aranda S, Aitken J, Watts CG, Smit AK, Janda M, Mann GJ, Cust AE, Rankin NM. Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants. PLoS One 2023; 18:e0287591. [PMID: 38091281 PMCID: PMC10718433 DOI: 10.1371/journal.pone.0287591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In Australia, opportunistic screening (occurring as skin checks) for the early detection of melanoma is common, and overdiagnosis is a recognised concern. Risk-tailored cancer screening is an approach to cancer control that aims to provide personalised screening tailored to individual risk. This study aimed to explore the views of key informants in Australia on the acceptability and appropriateness of risk-tailored organised screening for melanoma, and to identify barriers, facilitators and strategies to inform potential future implementation. Acceptability and appropriateness are crucial, as successful implementation will require a change of practice for clinicians and consumers. METHODS This was a qualitative study using semi-structured interviews. Key informants were purposively selected to ensure expertise in melanoma early detection and screening, prioritising senior or executive perspectives. Consumers were expert representatives. Data were analysed deductively using the Tailored Implementation for Chronic Diseases (TICD) checklist. RESULTS Thirty-six participants were interviewed (10 policy makers; 9 consumers; 10 health professionals; 7 researchers). Key informants perceived risk-tailored screening for melanoma to be acceptable and appropriate in principle. Barriers to implementation included lack of trial data, reluctance for low-risk groups to not screen, variable skill level in general practice, differing views on who to conduct screening tests, confusing public health messaging, and competing health costs. Key facilitators included the perceived opportunity to improve health equity and the potential cost-effectiveness of a risk-tailored screening approach. A range of implementation strategies were identified including strengthening the evidence for cost-effectiveness, engaging stakeholders, developing pathways for people at low risk, evaluating different risk assessment criteria and screening delivery models and targeted public messaging. CONCLUSION Key informants were supportive in principle of risk-tailored melanoma screening, highlighting important next steps. Considerations around risk assessment, policy and modelling the costs of current verses future approaches will help inform possible future implementation of risk-tailored population screening for melanoma.
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Affiliation(s)
- Kate L. A. Dunlop
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Louise A. Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea L. Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Sanchia Aranda
- School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Joanne Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Caroline G. Watts
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Surveillance, Evaluation & Research Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Amelia K. Smit
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Graham J. Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- John Curtin School of Medical Research, Australian National University, Acton, Australian Capital Territory, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Nicole M. Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Brotherton JM, McDermott T, Smith MA, Machalek DA, Shilling H, Prang KH, Jennett C, Nightingale C, Zammit C, Pagotto A, Rankin NM, Kelaher M. Implementation of Australia's primary human papillomavirus (HPV) cervical screening program: The STakeholders Opinions of Renewal Implementation and Experiences Study. Prev Med Rep 2023; 33:102213. [PMID: 37223565 PMCID: PMC10201842 DOI: 10.1016/j.pmedr.2023.102213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/25/2023] Open
Abstract
In this study, we aimed to document stakeholders' experiences of implementing Australia's renewed National Cervical Screening Program. In December 2017, the program changed from 2nd yearly cytology for 20-69 year olds to 5 yearly human papillomavirus (HPV) screening for women 25-74 years. We undertook semi-structured interviews with key stakeholders including government, program administrators, register staff, clinicians and health care workers, non-government organisations, professional bodies, and pathology laboratories from across Australia between Nov 2018 - Aug 2019. Response rate to emailed invitations was 49/85 (58%). We used Proctor et al's (2011) implementation outcomes framework to guide our questions and thematic analysis. We found that stakeholders were evenly divided over whether implementation was successful. There was strong support for change, but concern over aspects of the implementation. There was some frustration related to the delayed start, timeliness of communication and education, shortcomings in change management, lack of inclusion of Aboriginal and Torres Strait Islander people in planning and implementation, failure to make self-collection widely available, and delays in the National Cancer Screening Register. Barriers centred around a perceived failure to appreciate the enormity of the change and register build, and consequent failure to resource, project manage and communicate effectively. Facilitators included the good will and dedication of stakeholders, strong evidence base for change and the support of jurisdictions during the delay. We documented substantial implementation challenges, offering learnings for other countries transitioning to HPV screening. Sufficient planning, significant and transparent engagement and communication with stakeholders, and change management are critical.
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Affiliation(s)
- Julia M.L. Brotherton
- Formerly Employed at the Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Tracey McDermott
- Formerly Employed at the Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia
| | - Megan A. Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Dorothy A. Machalek
- Centre for Women’s Infectious Diseases, Royal Women’s Hospital Melbourne, Victoria, Australia
- Kirby Institute, University of NSW, New South Wales, Australia
| | - Hannah Shilling
- Centre for Women’s Infectious Diseases, Royal Women’s Hospital Melbourne, Victoria, Australia
| | - Khic-Houy Prang
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Chloe Jennett
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Claire Nightingale
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Claire Zammit
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Amy Pagotto
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia
| | - Nicole M. Rankin
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Øvestad IT, Engesæter B, Halle MK, Akbari S, Bicskei B, Lapin M, Austdal M, Janssen EAM, Krakstad C, Lillesand M, Nordhus M, Munk AC, Gudlaugsson EG. High-Grade Cervical Intraepithelial Neoplasia (CIN) Associates with Increased Proliferation and Attenuated Immune Signaling. Int J Mol Sci 2021; 23:ijms23010373. [PMID: 35008799 PMCID: PMC8745058 DOI: 10.3390/ijms23010373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023] Open
Abstract
Implementation of high-risk human papilloma virus (HPV) screening and the increasing proportion of HPV vaccinated women in the screening program will reduce the percentage of HPV positive women with oncogenic potential. In search of more specific markers to identify women with high risk of cancer development, we used RNA sequencing to compare the transcriptomic immune-profile of 13 lesions with cervical intraepithelial neoplasia grade 3 (CIN3) or adenocarcinoma in situ (AIS) and 14 normal biopsies from women with detected HPV infections. In CIN3/AIS lesions as compared to normal tissue, 27 differential expressed genes were identified. Transcriptomic analysis revealed significantly higher expression of a number of genes related to proliferation, (CDKN2A, MELK, CDK1, MKI67, CCNB2, BUB1, FOXM1, CDKN3), but significantly lower expression of genes related to a favorable immune response (NCAM1, ARG1, CD160, IL18, CX3CL1). Compared to the RNA sequencing results, good correlation was achieved with relative quantitative PCR analysis for NCAM1 and CDKN2A. Quantification of NCAM1 positive cells with immunohistochemistry showed epithelial reduction of NCAM1 in CIN3/AIS lesions. In conclusion, NCAM1 and CDKN2A are two promising candidates to distinguish whether women are at high risk of developing cervical cancer and in need of frequent follow-up.
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Affiliation(s)
- Irene Tveiterås Øvestad
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway; (S.A.); (B.B.); (E.A.M.J.); (M.L.); (M.N.); (E.G.G.)
- Correspondence: ; Tel.: +47-9093-2314
| | - Birgit Engesæter
- Section for Cervical Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway;
| | - Mari Kyllesø Halle
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway; (M.K.H.); (C.K.)
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5053 Bergen, Norway
| | - Saleha Akbari
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway; (S.A.); (B.B.); (E.A.M.J.); (M.L.); (M.N.); (E.G.G.)
| | - Beatrix Bicskei
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway; (S.A.); (B.B.); (E.A.M.J.); (M.L.); (M.N.); (E.G.G.)
| | - Morten Lapin
- Department of Haematology and Oncology, Stavanger University Hospital, 4011 Stavanger, Norway;
| | - Marie Austdal
- Section of Biostatistics, Department of Research, Stavanger University Hospital, 4011 Stavanger, Norway;
| | - Emiel A. M. Janssen
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway; (S.A.); (B.B.); (E.A.M.J.); (M.L.); (M.N.); (E.G.G.)
- Department of Chemistry, Bioscience and Environmental Technology, University of Stavanger, 4036 Stavanger, Norway
| | - Camilla Krakstad
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway; (M.K.H.); (C.K.)
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5053 Bergen, Norway
| | - Melinda Lillesand
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway; (S.A.); (B.B.); (E.A.M.J.); (M.L.); (M.N.); (E.G.G.)
| | - Marit Nordhus
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway; (S.A.); (B.B.); (E.A.M.J.); (M.L.); (M.N.); (E.G.G.)
| | - Ane Cecilie Munk
- Department of Gynaecology, Sørlandet Hospital, 4604 Kristiansand, Norway;
| | - Einar G. Gudlaugsson
- Department of Pathology, Stavanger University Hospital, 4011 Stavanger, Norway; (S.A.); (B.B.); (E.A.M.J.); (M.L.); (M.N.); (E.G.G.)
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Kim MH, Jung HJ, Park SI, Kim BJ. Self-obtained vaginal samples for HPV DNA testing to detect HPV-related cervical disease. Int J Gynaecol Obstet 2021; 154:127-132. [PMID: 33368281 DOI: 10.1002/ijgo.13574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/06/2020] [Accepted: 12/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate if a self-obtained vaginal sample (SOVAS) contains sufficient DNA for a human papillomavirus (HPV) test and if the results are comparable to those obtained via cervical samples (CS) collected by a physician. METHODS One hundred and fifty-one women who had abnormal cervical smears or who were HPV-positive were enrolled. Self-sampling was done after reading instructions and watching a 2-min-long video, whereas CS was obtained with a cervical cytobrush during a gynecologic examination. RESULTS A multiplex real-time polymerase chain reaction-based assay detected the prevalence of any type of HPV to be 67.5% in the SOVAS and 57.4% in the CS, and that of high-risk (HR-) HPV to be 58.7% in the SOVAS and 48.6% in the CS. The sensitivity of detection of HR-HPV in the SOVAS was 100% (95% confidence interval [CI] -0.09 to 0.32) for high-grade squamous intraepithelial lesion, 78% (95% CI -0.09 to 0.13) for atypical squamous cells of undetermined significance or worse, and 95% (95% CI -0.01 to 0.25) for low-grade squamous intraepithelial lesion or worse, which was statistically within the non-inferiority margin compared with that of CS. CONCLUSION Our study shows that the collection of a SOVAS is feasible and it is comparable to a CS for HPV DNA testing. Future studies are required to investigate the feasibility and cost-effectiveness of a mail-delivered SOVAS for cervical cancer screening.
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Affiliation(s)
- Moon-Hong Kim
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Hee-Jung Jung
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Sang-Il Park
- Department of Obstetrics and Gynecology, Dongnam Institute of Radiological & Medical Sciences, Busan, Republic of Korea
| | - Beob-Jong Kim
- Department of Obstetrics and Gynecology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Republic of Korea
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Kramer J. Eradicating cervical cancer: Lessons learned from Rwanda and Australia. Int J Gynaecol Obstet 2021; 154:270-276. [PMID: 33454969 DOI: 10.1002/ijgo.13601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/18/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022]
Abstract
Both Rwanda and Australia have made significant strides to eradicate cervical cancer. To understand the successes in Rwanda and Australia, a comparative policy analysis was conducted based on key informant interviews and a review of peer-reviewed literature and policy briefs. Notable findings were identified that offer lessons for countries across the income spectrum. To address cervical cancer, low- and middle-income countries can leverage foreign aid, international collaboration, and strong political advocacy, as Rwanda did. High-income countries can invest in translational research that builds capacity from basic science research to implementation of novel and impactful health products and services, as Australia did. All countries can consider rolling out HPV vaccination by targeting the social and/or physical environment (e.g., a school-based vaccination program, as both Rwanda and Australia did). Cervical cancer is preventable, and eradication is within reach for countries across the income spectrum around the world. Cervical cancer screening programs are needed to minimize the incidence of and mortality from cervical cancer in the short term, and HPV vaccination programs are the best strategy to eradicate cervical cancer in the long term.
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Affiliation(s)
- Julia Kramer
- UCSF Institute for Health and Aging, San Francisco, CA, USA
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Giambi C, Rezza G. HPV Vaccines: An Important Tool for STI Prevention. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Thamsborg LH, Andersen B, Larsen LG, Christensen J, Johansen T, Hariri J, Christiansen S, Rygaard C, Lynge E. Danish method study on cervical screening in women offered HPV vaccination as girls (Trial23): a study protocol. BMJ Open 2018; 8:e020294. [PMID: 29804060 PMCID: PMC5988093 DOI: 10.1136/bmjopen-2017-020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The first birth cohorts of women offered human papillomavirus (HPV) vaccination as girls are now entering cervical screening. However, there is no international consensus on how to screen HPV vaccinated women. These women are better protected against cervical cancer and could therefore be offered less intensive screening. Primary HPV testing is more sensitive than cytology, allowing for a longer screening interval. The aim of Trial23 is to investigate if primary HPV testing with cytology triage of HPV positive samples is a reasonable screening scheme for women offered HPV vaccination as girls. METHODS Trial23 is a method study embedded in the existing cervical screening programme in four out of five Danish regions. Without affecting the screening programme, women born in 1994 are randomised to present screening with liquid-based cytology every third year (present programme arm) or present screening plus an HPV test (HPV arm). The study started 1 February 2017 and will run over three screening rounds corresponding to 7-8 years. ANALYSES The primary endpoint is cervical intraepithelial neoplasia grade 3 or above. The trial is undertaken as a non-inferiority study including intention-to-treat and per-protocol analyses. The potential effect of primary HPV screening with a 6-year interval will be calculated from the observed data. ETHICS AND DISSEMINATION The study protocol has been submitted to the ethical committee and deemed a method study. All women are screened according to routine guidelines. The study will contribute new evidence on the future screening of HPV vaccinated birth cohorts of women. All results will be published in open-access journal. TRIAL REGISTRATION NCT03049553; Pre-results.
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Affiliation(s)
- Lise Holst Thamsborg
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Berit Andersen
- Department of Public Health Programs, Randers Regional Hospital, Randers, Denmark
| | | | - Jette Christensen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Tonje Johansen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Jalil Hariri
- Department of Pathology, Soenderjylland Hospital, Soenderborg, Denmark
| | | | - Carsten Rygaard
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, Denmark
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Ghosh T, VandeHaar MA, Rivera M, Henry MR. High-risk HPV genotype distribution in HPV co-test specimens: study of a predominantly Midwestern population. J Am Soc Cytopathol 2018; 7:99-105. [PMID: 31043259 DOI: 10.1016/j.jasc.2017.09.007] [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: 08/05/2017] [Revised: 09/19/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION High-risk HPV (HR-HPV) genoprevalence was assessed in cytologic specimens co-tested for HR-HPV in a predominantly Midwestern U.S. population, of which there are limited current data. These baseline data will aid in determining future shifts in HR-HPV genoprevalence. METHODS A total of 40,739 cervical/endocervical samples collected in PreservCyt (ThinPrep) media at Mayo Clinic, Rochester, MN, underwent HR-HPV co-testing between January 2014 and December 2016 in women aged 30-98 years. This included 37,656 negative for intraepithelial lesion (NIL), 1696 atypical squamous cells of undetermined significance (ASC-US), 159 atypical squamous cells, cannot exclude HSIL (ASC-H), 911 low-grade squamous intraepithelial lesion (LSIL), 188 high-grade intraepithelial lesion (HSIL), and 129 atypical glandular cells of undetermined significance (AGUS) cases. Roche cobas 4800 classified HR-HPV genotypes as 16, 18, or "other" (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68). RESULTS Of 40,739 co-tested specimens, 3786 were positive for at least one HR-HPV strain. "Other" only genotypes were most prevalent (74.3% of all HR-HPV cases). HPV16 and/or HPV18 were more common in the more significant diagnoses and were present in 59.1% of HSIL. HPV16-only was second most prevalent, with highest prevalence in HSIL (33.3%) and ASC-H (20.6%). HPV16 combined with "other" was third most prevalent, except in AGUS. HR-HPV (all genotypes) was most prevalent in those aged 30-39 years, decreasing with age (P < 0.0001). There was a trend toward HPV16 prevalence increasing with age (P = 0.4244). CONCLUSIONS HR-HPV "other" combination was most prevalent in all diagnoses except HSIL, in which HPV16 and/or HPV18 (exclusive of "other" genotypes) were most prevalent.
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Affiliation(s)
- Toshi Ghosh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
| | - Mark A VandeHaar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Michael Rivera
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Michael R Henry
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Vorsters A, Arbyn M, Baay M, Bosch X, de Sanjosé S, Hanley S, Karafillakis E, Lopalco PL, Pollock KG, Yarwood J, Van Damme P. Overcoming barriers in HPV vaccination and screening programs. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 4:45-53. [PMID: 29179869 PMCID: PMC7268103 DOI: 10.1016/j.pvr.2017.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/17/2023]
Abstract
The Human Papillomavirus Prevention and Control Board brought together experts to discuss optimizing HPV vaccination and screening programs. Board members reviewed the safety profile of licensed HPV vaccines based on clinical and post-marketing data, reaching a consensus that current safety data is reassuring. Successful vaccination programs used well-coordinated communication campaigns, integrating (social) media to spread awareness. Communication of evidence supporting vaccine effectiveness had beneficial effects on the perception of the vaccine. However, anti-vaccination campaigns have threatened existing programs in many countries. Measurement and monitoring of HPV vaccine confidence over time could help understand the nature and scale of waning confidence, define issues and intervene appropriately using context-specific evidence-based strategies. Finally, a broad group of stakeholders, such as teachers, health care providers and the media should also be provided with accurate information and training to help support prevention efforts through enhanced understanding of the risks and benefits of vaccination. Similarly, while cervical cancer screening through population-based programs is highly effective, barriers to screening exist: awareness in countries with population-based screening programs, access for vulnerable populations, and access and affordability in low- and middle-income countries. Integration of primary and secondary prevention has the potential to accelerate the decrease in cervical cancer incidence.
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Affiliation(s)
- Alex Vorsters
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Marc Baay
- P95, Epidemiology and Pharmacovigilance Consulting and Services, Leuven, Belgium
| | - Xavier Bosch
- Cancer Research Epidemiology Program, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Research Epidemiology Program, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain
| | - Sharon Hanley
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Kita Ku, Sapporo, Japan
| | - Emilie Karafillakis
- Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, London, UK
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | | | - Joanne Yarwood
- Immunisation, Hepatitis & Blood Safety Department, Public Health England, London, UK
| | - Pierre Van Damme
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
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Vasiljević N, Carter PD, Reuter C, Warman R, Brentnall AR, Carton JR, Cuzick J, Lorincz AT. Role of quantitative p16 INK4A mRNA assay and digital reading of p16 INK4A immunostained sections in diagnosis of cervical intraepithelial neoplasia. Int J Cancer 2017; 141:829-836. [PMID: 28509346 PMCID: PMC5949861 DOI: 10.1002/ijc.30783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/12/2017] [Accepted: 05/04/2017] [Indexed: 01/11/2023]
Abstract
Visual interpretation of cervical biopsies is subjective and variable, generally showing fair to moderate inter-reader agreement in distinguishing high from low grade cervical intraepithelial neoplasia (CIN). We investigated the performance of two objective p16 quantitative tests in comparison with visual assessment: (i) p16-mRNA assay and (ii) digital analysis of sections stained for p16 protein. The primary analysis considered 232 high-risk human papilloma virus positive (HPV+) samples from diagnostic cervical specimens. A p16 RT-qPCR (p16-mRNA assay) was run on mRNA extracted from formalin-fixed paraffin-embedded sections. Two p16 immunohistochemistry (IHC) readings, a visual read by a histopathologist (Visual IHC) and a digital read of a high-resolution scan (Digital IHC), were done on adjacent sections. The worst reviewed CIN grade (agreed by at least two histopathologists) from up to two biopsies and a loop excision was taken, with CIN2/3 as the primary endpoint. Visual IHC attained a specificity of 70% (95%CI 61-77) for 85% (95%CI 77-91%) sensitivity. The four-point Visual IHC staining area under the curve (AUC) was 0.77 (95%CI 0.71-0.82), compared with 0.71 (95%CI 0.64-0.77) for p16-mRNA and 0.67 (95%CI 0.60-0.74) for Digital IHC. Spearman rank-order correlations were: visual to p16-mRNA 0.41, visual to digital 0.49 and p16-mRNA to digital: 0.22. The addition of p16-mRNA assay to visual reading of p16 IHC improved the AUC from 0.77 to 0.84 (p = 0.0049). p16-mRNA testing may be complementary to visual IHC p16 staining for a more accurate diagnosis of CIN, or perhaps a substitute in locations with a lack of skilled pathologists.
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Affiliation(s)
- Nataša Vasiljević
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
| | - Paul D. Carter
- Centre for Molecular Pathology, Royal Marsden HospitalSuttonUnited Kingdom
| | - Caroline Reuter
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
| | - Rhian Warman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
| | - Adam R. Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
| | - James R. Carton
- Department of HistopathologyCharing Cross HospitalLondonUnited Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
| | - Attila T. Lorincz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of LondonCharterhouse SquareLondonUnited Kingdom
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11
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The performance of human papillomavirus biomarkers in predicting anal high-grade squamous intraepithelial lesions in gay and bisexual men. AIDS 2017; 31:1303-1311. [PMID: 28323757 DOI: 10.1097/qad.0000000000001462] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND We evaluate the performance of human papillomavirus (HPV) biomarkers in prediction of anal histological high-grade squamous intraepithelial lesions in gay and bisexual men (GBM) in Sydney, Australia. DESIGN Baseline analysis of a 3-year cohort study. METHODS The Study of the Prevention of Anal Cancer is natural history study of anal HPV infection in GBM aged at least 35 years. All participants completed cytological and histological assessments. Stored ThinPrep PreservCyt residua were tested for HPV genotyping (Linear Array and Cobas 4800) and viral load, E6/E7 mRNA expression (NucliSENS easyQ HPV v1) and dual cytology staining of p16/Ki 67 antibodies (CINtecPLUS). Performance of each biomarker was compared with liquid-based anal cytology. The hypothetical referral rates were defined as the proportion of men who had abnormal cytology or tested positive to each of the biomarkers. RESULTS The median age of the 617 participants was 49 years (range: 35-79), and 35.7% were HIV-positive. All biomarkers were strongly associated with the grade of HPV-associated anal lesions (P < 0.001 for all). High-risk HPV (HR-HPV) viral load with a 33% cut-off and HR-HPV E6/E7 mRNA had similar sensitivity to anal cytology (78.4 and 75.4 vs. 83.2%, respectively), improved specificity (68.0 and 69.4 vs. 52.4%, respectively) and lower referral rates (47.0 and 45.0 vs. 59.2%, respectively). Specificity was significantly higher in the HIV-negative for HR-HPV viral load (72.3 vs. 58.2%, P = 0.005). CONCLUSION HR-HPV viral load and E6/E7 mRNA had similar sensitivity and higher specificity in predicting histological anal high-grade squamous intraepithelial lesion with lower referrals in GBM than anal cytology.
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12
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Cornall AM, Poljak M, Garland SM, Phillips S, Tan JH, Machalek DA, Quinn MA, Tabrizi SN. Anyplex II HPV28 detection and Anyplex II HPV HR detection assays are highly concordant with other commercial assays for detection of high-risk HPV genotypes in women with high grade cervical abnormalities. Eur J Clin Microbiol Infect Dis 2016; 36:545-551. [PMID: 27822653 DOI: 10.1007/s10096-016-2831-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/23/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE to evaluate the performance of Anyplex II HPV28 and HPV HR Detection assays against the EuroArray HPV, Cobas 4800 HPV (Cobas), HPV Amplicor (Amp), Linear Array HPV (LA) and Hybrid Capture 2 (HC2) in detection of high-risk HPV (HR-HPV) from liquid-based cervical cytology samples. METHODS cervical specimens from 404 women undergoing management of high-grade cytological abnormality were evaluated by Anyplex II HPV28 and HPV HR Detection assays for detection of HR-HPV genotypes and prediction of histologically-confirmed cervical intraepithelial neoplasia grade 2 or higher (≥CIN2). The results were compared to EuroArray, HC2, Cobas, Amp, and LA. RESULTS specimens were evaluated from 404 women with an average age of 30 years, including 336 with a histological diagnosis of ≥ CIN2 and 68 with ≤ CIN1. Concordance of HR-HPV detection between Anyplex II HPV28 and other genotyping assays was 94.79 % (κ = 0.84; EuroArray) and 97.27 % (κ = 0.91; LA); and between Anyplex II HPV HR and other HR-HPV detection assays was 86.35 % (κ = 0.62; HC2), 96.03 % (κ = 0.87; Cobas) and 96.77 % (κ = 0.89; Amp). Using HR-HPV detection for prediction of ≥ CIN2 by Anyplex II HPV28 and HPV HR, sensitivity (90.18, 95 % CI 86.48-93.14; 90.77, 95 % CI 87.16-93.65) and specificity (both 67.16, 95 % CI 54.60-78.15) were not significantly different to the other HPV assays tested, with one exception. Both Anyplex assays had significantly higher sensitivity than HC2 (p < 0.0001), with a specificity of 96 % (p > 0.05) of HC2 in this high-risk population. CONCLUSIONS both Anyplex II HPV detection assays were concordant with other commercial assays for HR-HPV detection, with comparable sensitivity and specificity for ≥ CIN2 detection.
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Affiliation(s)
- A M Cornall
- Regional HPV Lab Net Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, 3052, Victoria, Australia.
- Murdoch Childrens Research Institute, Parkville, 3052, Victoria, Australia.
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, 3052, Victoria, Australia.
| | - M Poljak
- Regional HPV Lab Net Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, 3052, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, 3052, Victoria, Australia
| | - S M Garland
- Regional HPV Lab Net Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, 3052, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, 3052, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, 3052, Victoria, Australia
| | - S Phillips
- Regional HPV Lab Net Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, 3052, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, 3052, Victoria, Australia
| | - J H Tan
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, 3052, Victoria, Australia
- Oncology and Dysplasia Unit, Royal Women's Hospital, Parkville, 3052, Victoria, Australia
| | - D A Machalek
- Regional HPV Lab Net Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, 3052, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, 3052, Victoria, Australia
| | - M A Quinn
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, 3052, Victoria, Australia
- Oncology and Dysplasia Unit, Royal Women's Hospital, Parkville, 3052, Victoria, Australia
| | - S N Tabrizi
- Regional HPV Lab Net Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, 3052, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, 3052, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, 3052, Victoria, Australia
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13
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Berenson AB, Laz TH, Rahman M. Reduction in Vaccine-Type Human Papillomavirus Prevalence Among Women in the United States, 2009-2012. J Infect Dis 2016; 214:1961-1964. [PMID: 27821406 DOI: 10.1093/infdis/jiw515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/24/2016] [Indexed: 11/14/2022] Open
Abstract
Between 2009 and 2012, the proportion of young women in the United States completing the human papillomavirus (HPV) vaccine doubled. To understand how quickly this increased uptake is affecting women in the United States, we evaluated the prevalence of vaccine-type (VT) HPV strains among young women in national data sets from 2009-2010 and 2011-2012. Among 18-26-year-old women, the prevalence of VT HPV decreased markedly over a short interval, from 15.4% in 2009-2010 to 8.5% in 2011-2012 (prevalence ratio, 0.51; 95% confidence interval, .28-.92), and the prevalence of high-risk VT HPV decreased from 13.1% to 6.5% (0.46; .25-.86). Reductions in HPV-related diseases will probably follow.
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Affiliation(s)
- Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health.,Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston
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14
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Garland SM, Kjaer SK, Muñoz N, Block SL, Brown DR, DiNubile MJ, Lindsay BR, Kuter BJ, Perez G, Dominiak-Felden G, Saah AJ, Drury R, Das R, Velicer C. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clin Infect Dis 2016; 63:519-27. [PMID: 27230391 PMCID: PMC4967609 DOI: 10.1093/cid/ciw354] [Citation(s) in RCA: 314] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022] Open
Abstract
This systematic review assessed the global impact and effectiveness of quadrivalent human papillomavirus (HPV) vaccination on HPV infection and disease in real-world settings over a decade of use. Substantial reductions in HPV 6/11/16/18 infection, anogenital warts, and cervical lesions have been achieved. Prophylactic human papillomavirus (HPV) vaccination programs constitute major public health initiatives worldwide. We assessed the global effect of quadrivalent HPV (4vHPV) vaccination on HPV infection and disease. PubMed and Embase were systematically searched for peer-reviewed articles from January 2007 through February 2016 to identify observational studies reporting the impact or effectiveness of 4vHPV vaccination on infection, anogenital warts, and cervical cancer or precancerous lesions. Over the last decade, the impact of HPV vaccination in real-world settings has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. Maximal reductions of approximately 90% for HPV 6/11/16/18 infection, approximately 90% for genital warts, approximately 45% for low-grade cytological cervical abnormalities, and approximately 85% for high-grade histologically proven cervical abnormalities have been reported. The full public health potential of HPV vaccination is not yet realized. HPV-related disease remains a significant source of morbidity and mortality in developing and developed nations, underscoring the need for HPV vaccination programs with high population coverage.
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Affiliation(s)
- Suzanne M Garland
- Royal Women's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Victoria, Australia
| | - Susanne K Kjaer
- Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
| | - Nubia Muñoz
- Colombian National Institute of Cancer, Bogota
| | - Stan L Block
- Kentucky Pediatric and Adult Research, Bardstown
| | | | | | | | | | - Gonzalo Perez
- Merck & Co, Inc, Kenilworth, New Jersey Universidad del Rosario, Bogota, Colombia
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15
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Farnsworth A. Cervical cancer screening in Australia: Past and present. Cancer Cytopathol 2015; 124:231-4. [DOI: 10.1002/cncy.21642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Annabelle Farnsworth
- Douglass Hanly Moir Pathology, Cytology; Macquarie Park New South Wales Australia
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