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Fujita M, Nagashima K, Shimazu M, Suzuki M, Tauchi I, Sakuma M, Yamamoto S, Hanaoka H, Shozu M, Tsuruoka N, Kasai T, Hata A. Effectiveness of self-sampling human papillomavirus test on precancer detection and screening uptake in Japan: The ACCESS randomized controlled trial. Int J Cancer 2024; 155:905-915. [PMID: 38648390 DOI: 10.1002/ijc.34970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
Japan is lagging in cervical cancer prevention. The effectiveness of a self-sampling human papillomavirus (HPV) test, a possible measure to overcome this situation, has not yet been evaluated. A randomized controlled trial was performed to evaluate the effectiveness of a self-sampling HPV test on detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and screening uptake. Women between 30 and 58 years old who did not participate in the cervical cancer screening program for ≥3 years were eligible and assigned to the intervention group (cytology or self-sampling HPV test) or control group (cytology). Participants assigned to the intervention group were sent a self-sampling kit according to their ordering (opt-in strategy). A total of 7337 and 7772 women were assigned to the intervention and control groups, respectively. Screening uptake in the intervention group was significantly higher than that in the control group (20.0% vs. 6.4%; risk ratio: 3.10; 95% confidence interval [CI]: 2.82, 3.42). The compliance rate with cytology triage for HPV-positive women was 46.8% (95% CI: 35.5%, 58.4%). CIN2+ was detected in five and four participants in the intervention and control groups, respectively; there was no difference for intention-to-screen analysis (risk ratio: 1.32; 95% CI: 0.36, 4.93). Self-sampling of HPV test increased screening uptake; however, no difference was observed in the detection of CIN2+, probably due to the low compliance rate for cytology triage in HPV-positive women. Efforts to increase cytology triage are essential to maximize precancer detections.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Japan
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tachikawa, Japan
| | - Minobu Shimazu
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | | | | | | | | | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Makio Shozu
- Evolution and Reproduction Biology, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
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Drysdale H, Marlow LAV, Lim A, Waller J. Experiences of Self-Sampling and Future Screening Preferences in Non-Attenders Who Returned an HPV Vaginal Self-Sample in the YouScreen Study: Findings From a Cross-Sectional Questionnaire. Health Expect 2024; 27:e14118. [PMID: 38953514 PMCID: PMC11217896 DOI: 10.1111/hex.14118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/25/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND We assessed experiences of human papillomavirus (HPV) vaginal self-sampling and future screening preferences in an ethnically and socio-economically diverse group of women overdue for cervical screening. SETTING AND PARTICIPANTS A postal questionnaire was embedded in the YouScreen self-sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non-completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow-up test if HPV-positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self-sampling. RESULTS Most kit-completers reported high confidence in self-sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free-text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self-sampling in the future (71.3% vs. 10.4% for a clinician-taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self-tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. CONCLUSIONS Kit-completers were confident, found the test easy to complete, and trusted the self-sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self-sampling in the future, but it was not a universal preference, so offering a choice will be important. PATIENT OR PUBLIC CONTRIBUTION We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). TRIAL REGISTRATION This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934.
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Affiliation(s)
- Hannah Drysdale
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
| | - Laura A V Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
- Centre for Cancer Prevention, Screening and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anita Lim
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
- Centre for Cancer Prevention, Screening and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Feltri G, Valenti G, Isidoro E, Kaur J, Treleani M, Bartelloni A, Mauro C, Spiga F, Ticich G, Di Napoli M, Biagi C, Pachetti M, Centonze S, Castriciano S, Zanchiello S, Giudici F, Gerin D, Zanconati F. Evaluation of self-sampling-based cervical cancer screening strategy using HPV Selfy CE-IVD test coupled with home-collection kit: a clinical study in Italy. Eur J Med Res 2023; 28:582. [PMID: 38072937 PMCID: PMC10712215 DOI: 10.1186/s40001-023-01263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 08/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Primary human papillomaviruses (HPV) cervical cancer screening can be strengthened by offering home-collection of biological specimen as a valuable option to increase screening coverage. As recommended by World Health Organization (WHO), screening programs should consider whether the inclusion of HPV self-sampling as a complementary option within their existing screening algorithms could address the gaps in current coverage. However, few HPV screening tests are validated for self-sampling according to international guidelines. This study aimed to test a self-sampling-based screening strategy, complementary to the main screening program based on clinician-collected cervical samples. The study took place in Trieste, Italy, and it aimed to evaluate the feasibility of self-testing at home under an opt-in system during COVID-19 pandemic in order to exploit self-sampling to reduce the screening delay generated by the lockdown. METHODS 500 women, who should have received the screening call in 2020, were asked, via phone call, to participate in the study. To whom agreed, a home-collection kit, including a vaginal dry swab for specimen collection, was sent. The recipients performed the sample self-collection and sent back the swab through traditional mail using a prepaid envelope. Once received by the hospital, the samples were analyzed with HPV Selfy (Ulisse BioMed, Italy), a CE-IVD HPV screening test specifically validated for self-collection. Results were further compared using cobas® 4800 HPV (Roche, Switzerland). RESULTS 80% women sent back their swab, showing one of the highest return rate obtained in comparable studies. 34 HPV-positive women were followed up and underwent the Pap test, that revealed 8 low squamous intraepithelial lesions (LSIL) cases, later triaged to colposcopy. HPV Selfy was confirmed to be an adequate test for self-sampling-based screening. CONCLUSIONS This study further confirmed the feasibility of self-test at home screening strategy based on self-sampling with an opt-in system as a support method to enhance cervical cancer screening coverage in Italy. Enrolled women showed a high appreciation for this approach. HPV Selfy test demonstrated to be a valuable assay for cervical cancer screening based on home self-collection. TRIAL REGISTRATION ASUGI Trieste n. 16008/2018 and amendment 02-11/09/2020.
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Affiliation(s)
- Giulia Feltri
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | | | - Erica Isidoro
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | - Jaspreett Kaur
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marianna Treleani
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Aurora Bartelloni
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Claudia Mauro
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Federica Spiga
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giulia Ticich
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | - Michela Di Napoli
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | - Claudia Biagi
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy
| | | | - Sandro Centonze
- Clinical Research Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | | | - Fabiola Giudici
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Équipe Labellisée Ligue Contre le Cancer, Oncostat, U1018, Inserm, Université Paris-Saclay, Villejuif, France
| | - Daniela Gerin
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Fabrizio Zanconati
- UCO/SC Anatomia e Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina, Cattinara Hospital, Trieste, Italy.
- Department of Medical Science, University of Trieste, Trieste, Italy.
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Rebolj M, Sargent A, Njor SH, Cuschieri K. Widening the offer of human papillomavirus self-sampling to all women eligible for cervical screening: Make haste slowly. Int J Cancer 2023; 153:8-19. [PMID: 36385698 PMCID: PMC10952475 DOI: 10.1002/ijc.34358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/20/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
Self-collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among underscreened women and will likely form a crucial part of the WHO's strategy to eliminate cervical cancer by 2030. In high-income countries with long-standing, organised cervical screening programmes, self-collection is increasingly becoming available as a routine offer for women regardless of their screening histories, including under- and well-screened women. For these contexts, a validated microsimulation model determined that adding self-collection to clinician collection is likely to be cost-effective on the condition that it meets specific thresholds relating to (1) uptake and (2) sensitivity for the detection of high-grade cervical intraepithelial neoplasia (CIN2+). We used these thresholds to review the 'early-adopter' programme-level evidence with a mind to determine how well and how consistently they were being met. The available evidence suggested some risk to overall programme performance in the situation where low uptake among underscreened women was accompanied by a high rate of substituting clinician sampling with self-collection among well-screened women. Risk was further compounded in a situation where the slightly reduced sensitivity of self-sampling vs clinician sampling for the detection of CIN2+ was accompanied with lack of adherence to a follow-up triage test that required a clinician sample. To support real-world programmes on their pathways toward implementation and to avoid HPV self-collection being introduced as a screening measure in good faith but with counterproductive consequences, we conclude by identifying a range of mitigations and areas worthy of research prioritisation.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Alexandra Sargent
- Cytology Department, Manchester Royal InfirmaryManchester University NHS Foundation TrustManchesterUK
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Department of Public Health ProgrammesRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian ScotlandEdinburghUK
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Di Gennaro G, Licata F, Trovato A, Bianco A. Does self-sampling for human papilloma virus testing have the potential to increase cervical cancer screening? An updated meta-analysis of observational studies and randomized clinical trials. Front Public Health 2022; 10:1003461. [PMID: 36568753 PMCID: PMC9773849 DOI: 10.3389/fpubh.2022.1003461] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives A meta-analysis was conducted to examine the effectiveness of HPV self-sampling proposal on cervical cancer screening (CCS) uptake when compared with an invitation to have a clinician to collect the sample. Secondary outcomes were acceptability and preference of self-sampling compared to clinician-collected samples. Methods The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining the CCS uptake comparing self-sampling over invitation to be sampled by an healthcare professional and examining the proportion of women accepting or preferring self-sampling vs. clinician-collected sampling were included. The CCS uptake was also explored according to strategy of self-samplers' distribution, collection device type and screening status. Peters' test and Funnel Plot inspection were used to assess the publication bias. Quality of the studies was assessed through Cochrane Risk of Bias and NIH Quality Assessment tools. Results One hundred fifty-four studies were globally identified, and 482,271 women were involved. Self-sampling procedures nearly doubled the probability (RR: 1.8; 95% CI: 1.7-2.0) of CCS uptake when compared with clinician-collected samples. The opt-out (RR: 2.1; 95% CI: 1.9-2.4) and the door-to-door (RR: 1.8; 95% CI: 1.6-2.0) did not statistically significant differ (p = 1.177) in improving the CCS uptake. A higher relative uptake was shown for brushes (RR: 1.6; 95% CI: 1.5-1.7) and swabs (RR: 2.5; 95% CI: 1.9-3.1) over clinician-collected samples. A high between-studies variability in characteristics of sampled women was shown. In all meta-analyses the level of heterogeneity was consistently high (I 2 > 95%). Publication bias was unlikely. Conclusions Self-sampling has the potential to increase participation of under-screened women in the CCS, in addition to the standard invitation to have a clinician to collect the sample. For small communities door-to-door distribution could be preferred to distribute the self-sampler while; for large communities opt-out strategies should be preferred over opt-in. Since no significant difference in acceptability and preference of device type was demonstrated among women, and swabs and brushes exhibited a potential stronger effect in improving CCS, these devices could be adopted.
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Affiliation(s)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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Ebisch RMF, Rijstenberg LL, Soltani GG, van der Horst J, Vedder JEM, Hermsen M, Bosgraaf RP, Massuger LFAG, Meijer CJLM, Heideman DAM, van Kemenade FJ, Melchers WJG, Bekkers RLM, Siebers AG, Bulten J. Adjunctive use of p16 immunohistochemistry for optimizing management of CIN lesions in a high-risk human papillomavirus-positive population. Acta Obstet Gynecol Scand 2022; 101:1328-1336. [PMID: 36177908 PMCID: PMC9812205 DOI: 10.1111/aogs.14459] [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: 05/09/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Immunostaining with p16INK4a (p16), a tumor-suppressor surrogate protein biomarker for high-risk human papillomavirus (hrHPV) oncogenic activity, may complement standard hematoxylin and eosin (H&E) histology review, and provide more objective criteria to support the cervical intraepithelial neoplasia (CIN) diagnosis. With this study we assessed the impact of p16 immunohistochemistry on CIN grading in an hrHPV-based screening setting. MATERIAL AND METHODS In this post-hoc analysis, 326 histology follow-up samples from a group of hrHPV-positive women were stained with p16 immunohistochemistry. All H&E samples were centrally revised. The pathologists reported their level of confidence in classifying the CIN lesion. RESULTS Combining H&E and p16 staining resulted in a change of diagnosis in 27.3% (n = 89) of cases compared with the revised H&E samples, with a decrease of 34.5% (n = 18) in CIN1 and 22.7% (n = 15) in CIN2 classifications, and an increase of 18.3% (n = 19) in no CIN and 20.7% (n = 19) in CIN3 diagnoses. The level of confidence in CIN grading by the pathologist increased with adjunctive use of p16 immunohistochemistry to standard H&E. CONCLUSIONS This study shows that adjunctive use of p16 immunohistochemistry to H&E morphology reduces the number of CIN1 and CIN2 classifications with a proportional increase in no CIN and CIN3 diagnoses, compared with standard H&E-based CIN diagnosis alone. The pathologists felt more confident in classifying the material with H&E and p16 immunohistochemistry than by using H&E alone, particularly during assessment of small biopsies. Adjunctive use of p16 immunohistochemistry to standard H&E assessment of CIN would be valuable for the diagnostic accuracy, thereby optimizing CIN management and possibly decreasing overtreatment.
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Affiliation(s)
- Renée M. F. Ebisch
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands,Department of Obstetrics and GynecologyCatharina Hospital EindhovenEindhovenThe Netherlands
| | | | - Gilda Ghazi Soltani
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Judith E. M. Vedder
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Meyke Hermsen
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Remko P. Bosgraaf
- Department of Obstetrics and GynecologyCatharina Hospital EindhovenEindhovenThe Netherlands
| | - Leon F. A. G. Massuger
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Chris J. L. M. Meijer
- Amsterdam UMCVrije Universiteit Amsterdam, Pathology, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Daniëlle A. M. Heideman
- Amsterdam UMCVrije Universiteit Amsterdam, Pathology, Cancer Center AmsterdamAmsterdamThe Netherlands
| | | | - Willem J. G. Melchers
- Department of Medical MicrobiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Ruud L. M. Bekkers
- Department of Obstetrics and GynecologyCatharina Hospital EindhovenEindhovenThe Netherlands,GROW, School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Albert G. Siebers
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Johan Bulten
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
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Implementation of a self-sampling HPV test for non-responders to cervical cancer screening in Japan: secondary analysis of the ACCESS trial. Sci Rep 2022; 12:14531. [PMID: 36008554 PMCID: PMC9411156 DOI: 10.1038/s41598-022-18800-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
A self-sampling human papillomavirus (HPV) test could improve the morbidity and mortality of cervical cancer in Japan. However, its effectiveness and feasibility have not been demonstrated sufficiently. Hence, we launched a randomized controlled trial, which is ongoing, and report the results of a secondary analysis. To ensure autonomous participation with a minimum selection bias, opt-out consent was obtained from women who met the inclusion criteria, and written consent was obtained from those who underwent a self-sampling test. The number of women who met the inclusion criteria was 20,555; 4283 and 1138 opted out before and after the assignment, respectively. Of the 7340 women in the self-sampling arm, 1372 (18.7%) ordered and 1196 (16.3%) underwent the test. Younger women in their 30 s and 40 s tended to undertake the test more frequently than older women in their 50 s (P for trend < 0.001). Invalid HPV test results were rare (1.3%), and neither adverse events nor serious complaints were reported. Despite adopting the opt-out procedure, more women than expected declined to participate, suggesting the need for a waiver of consent or assignment before consent to reduce selection bias. A self-sampling HPV test can be implemented in Japan and would be more accessible to young women, the predominant group affected by cervical cancer.
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Williams J, Kostiuk M, Biron VL. Molecular Detection Methods in HPV-Related Cancers. Front Oncol 2022; 12:864820. [PMID: 35574396 PMCID: PMC9092940 DOI: 10.3389/fonc.2022.864820] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Human papillomavirus (HPV) is responsible for most cervical cancers and some head and neck cancers, including oropharyngeal squamous cell carcinoma and sinonasal carcinoma. Cervical cancer is commonly diagnosed by liquid-based cytology, followed by HPV testing using commercially available DNA polymerase chain reaction (PCR), p16 immunohistochemistry (IHC), or DNA/RNA in situ hybridization. HPV in head and neck cancers is commonly diagnosed by p16 IHC or by RT-qPCR of HPV-16 E6 and E7 oncoproteins. Droplet digital PCR has been reported as an ultrasensitive and highly precise method of nucleic acid quantification for biomarker analysis and has been used to detect oncogenic HPV in oropharyngeal and cervical cancers.
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Affiliation(s)
- Jordana Williams
- Division of Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Morris Kostiuk
- Division of Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vincent L Biron
- Division of Otolaryngology-Head and Neck Surgery Research Laboratory of Alberta, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Stanczuk GA, Currie H, Forson W, Baxter G, Lawrence J, Wilson A, Palmer T, Arbyn M, Cuschieri K. Self-sampling as the principal modality for population based cervical screening: Five-year follow-up of the PaVDaG study. Int J Cancer 2022; 150:1350-1356. [PMID: 34850395 PMCID: PMC9300001 DOI: 10.1002/ijc.33888] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 01/21/2023]
Abstract
Self-sampling provides a powerful means to engage women in cervical screening. In the original Papillomavirus Dumfries and Galloway study (PaVDaG), we demonstrated cross-sectional similarity of high-risk human papillomavirus (Hr-HPV) testing on self-taken vaginal vs clinician-taken samples for the detection of cervical intraepithelial neoplasia 2 or worse (CIN2+). Few data exist on the longitudinal performance of self-sampling; we present longitudinal outcomes of PaVDaG. Routinely screened women provided a self-taken and a clinician-collected sample. Ninety-one percent of 5136 women from the original cohort completed a further screening round. Sensitivity, specificity, positive predictive value and complement of the negative predictive value of the Hr-HPV test on self-samples for detection of CIN2+ and CIN3+ up-to 5 years after testing were determined. Additionally, clinical accuracy of Hr-HPV testing on vaginal and clinician-collected samples was assessed. A total of 183 CIN2+ and 102 CIN3+ lesions were diagnosed during follow-up. Risk of CIN2+ and CIN3+ following an Hr-HPV negative self-sample was 0.6% and 0.2%, respectively, for up to 5 years after testing. The relative sensitivity for CIN3+ and specificity for ≤CIN1 of Hr-HPV testing on self-taken specimens was slightly lower vs clinician-collected samples: 0.95 (95% CI: 0.90-0.99; PMcN = .0625) and 0.98 (95% CI: 0.95-1.00; PMcN = <.0000), respectively. The low risk of CIN2+ in women with Hr-HPV-self-sample(s) suggests, that the 3 to 5-year recall interval implemented in several cervical screening settings, based on clinician-taken samples, may be safe for self-samples. Future assessment will show if "universal" 5-year screening is appropriate for programs based on self-sampling.
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Affiliation(s)
- Grazyna A. Stanczuk
- Department of Research and DevelopmentDumfries and Galloway Royal InfirmaryDumfriesUK
- Global Health AcademyUniversity of EdinburghEdinburghUK
| | - Heather Currie
- Department of Obstetrics and GynaecologyDumfries and Galloway Royal InfirmaryDumfriesUK
| | - William Forson
- Department of Obstetrics and GynaecologyDumfries and Galloway Royal InfirmaryDumfriesUK
| | | | - James Lawrence
- Department of Research and DevelopmentDumfries and Galloway Royal InfirmaryDumfriesUK
| | - Allan Wilson
- Department of PathologyMonklands HospitalAirdrieUK
| | - Timothy Palmer
- Department of PathologyUniversity of EdinburghEdinburghUK
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, SciensanoBrusselsBelgium
- Department of Human Structure and RepairFaculty of Medicine and Health Sciences, University GhentGhentBelgium
| | - Kate Cuschieri
- Scottish HPV Reference LaboratoryRoyal Infirmary of EdinburghEdinburghUK
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Stoltzfus KC, Popalis ML, Reiter PL, Moss JL. Perspectives on self-sampling for cancer screening among rural and urban women: Multilevel factors related to acceptability. J Rural Health 2022; 38:391-397. [PMID: 34002407 PMCID: PMC8599503 DOI: 10.1111/jrh.12590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Self-sampling tests may be used to overcome barriers to screening that are more prevalent in rural populations compared to urban populations. This study aims to qualitatively examine the attitudes toward established and novel self-sampling tests for cervical and colorectal cancer among women, comparing themes from rural versus urban areas. METHODS We recruited women (ages 45-65) from 28 counties in Pennsylvania. Four focus groups were conducted with women from metropolitan counties, and 7 focus groups were conducted with women from nonmetropolitan counties. A brief survey was conducted prior to the focus group regarding general health and willingness to complete self-sampling tests for cervical and colorectal cancer. FINDINGS We identified 3 themes about the potential for self-sampling for cancer screening: advantages and disadvantages of self-sampling compared to traditional testing, impact of self-sampling on patient interactions with their health care providers/clinics, and implications for improving/worsening access to quality health care services. We detected differences in responses from rural versus urban participants in the potential impact of self-sampling for cancer screening. CONCLUSIONS There are several barriers and facilitators at the individual, interpersonal, and organizational levels that influence the feasibility of implementing self-sampling for cancer screening in routine clinical practice. Rural participants face unique barriers to cancer screening across all levels. These findings can be used to guide interventions aimed at increasing the use of self-sampling methods.
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Affiliation(s)
- Kelsey C Stoltzfus
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Madyson L Popalis
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Paul L Reiter
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer L Moss
- Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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11
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Lorenzi NPC, Termini L, Ferreira-Filho ES, Nunes RAL, Silva GAF, Lepique AP, Longatto-Filho A, Tacla M, Baracat EC, Villa LL, Soares-Júnior JM. A positive HPV test with positive p16/Ki-67 double staining in self-sampled vaginal material is an accurate tool to detect women at risk for cervical cancer. Cancer Cytopathol 2022; 130:41-54. [PMID: 34375039 DOI: 10.1002/cncy.22498] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The development of efficient strategies for managing high-risk human papillomavirus (HR-HPV)-positive women is a major challenge when human papillomavirus-based primary screening is being performed. The objectives of this study were to evaluate the comparative effectiveness of HR-HPV testing based on self-collection (SC) and HR-HPV testing based on collection by a health professional (HP) and to assess the potential usefulness of HR-HPV testing combined with testing with the biomarkers p16/Ki-67, α-mannosidase, and superoxide dismutase 2 (SOD2). METHODS This was a cross-sectional study of 232 women admitted for colposcopy because of an abnormal Papanicolaou smear. The collected material underwent liquid-based cytology, HR-HPV detection, and immunocytochemical testing (p16/Ki-67, α-mannosidase, and SOD2). The gold standard was the histopathological result; the positive reference was CIN2+. RESULTS The overall accuracy of HR-HPV testing was 76.6%; the results for the SC group (78.1%) and the HP group (75.2%) were similar. The positive predictive values (HP, 76.5%; SC, 80.0%), the negative predictive values (HP, 66.7%; SC, 64.3%), the positive likelihood values (HP, 1.35; SC, 1.36), and the negative likelihood values (HP, 0.21; SC, 0.19) were also similar. p16/Ki-67 showed higher sensitivity than the other 2 biomarkers: 78.1% versus 45.8% for α-mannosidase and 44.5% for SOD2. The specificities of the biomarkers were equivalent: 71.4% for p16/Ki-67, 77.8% for α-mannosidase, and 71.2% for SOD2. In the HP group, accuracy also leaned more heavily toward the final score (using α-mannosidase and SOD2) without statistical significance (80.8% vs 77.9%). The contrast with the SC group yielded the same level of accuracy. CONCLUSIONS SC, when associated with testing with biomarkers, is as accurate as collection by HPs in the detection of women at risk for cervical cancer.
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Affiliation(s)
- Noely P C Lorenzi
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Ginecologia, Hospital Universitario, Universidade de São Paulo, São Paulo, Brazil
| | - Lara Termini
- Center for Translational Investigation in Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edson S Ferreira-Filho
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Divisao de Clínica Ginecologica, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafaella A L Nunes
- Center for Translational Investigation in Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriela A F Silva
- Center for Translational Investigation in Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana P Lepique
- Instituto de Ciencias Biomedicas, Universidade de São Paulo, São Paulo, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital/Pio XII Foundation, São Paulo, Brazil
- Medical Laboratory of Medical Investigation 14, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Research Institute of Life and Health Sciences, University of Minho, Braga, Portugal
- 8ICVS/3B's-Associated Laboratory to the Government of Portugal, Braga/Guimaraes, Portugal
| | - Maricy Tacla
- Divisao de Clínica Ginecologica, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edmund C Baracat
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Divisao de Clínica Ginecologica, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luisa L Villa
- Center for Translational Investigation in Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José M Soares-Júnior
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Divisao de Clínica Ginecologica, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Aarnio R, Isacson I, Sanner K, Gustavsson I, Gyllensten U, Olovsson M. Comparison of vaginal self-sampling and cervical sampling by medical professionals for the detection of HPV and CIN2+: A randomized study. Int J Cancer 2021; 148:3051-3059. [PMID: 33497465 DOI: 10.1002/ijc.33482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 11/06/2022]
Abstract
Primary screening with human papillomavirus (HPV) test is more effective in reducing cervical cancer incidence than cytology and it also offers the opportunity to self-sample. We conducted a randomized study to compare vaginal self-sampling with cervical sampling by medical professionals for HPV testing concerning prevalence of HPV and detection of cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) or grade 3 or worse (CIN3+) in primary screening. In total, 11 951 women aged 30-60 years were randomized into two groups, 5961 for self-sampling (SS arm) and 5990 for sampling by medical professionals (SMP arm). Sampling was performed with a RoversViba-brush in the SS arm and a cytobrush in the SMP arm. All samples were applied to an indicating FTA elute card and analyzed for HPV using a clinically validated real-time PCR test (hpVIR). All HPV-positive women performed repeated sampling about 6 months later using the same procedure as used initially. All HPV-positive women in the second sampling were referred to colposcopy. The prevalence of HPV in the first test did not differ between the SS arm (6.8%, 167/2466) and the SMP arm (7.8%, 118/1519) (P = .255). The prevalence of CIN2+ per 1000 screened women was 17 (43/2466 × 1000) (95%CI 13-24) in the SS arm and 21 (32/1519 × 1000) (95%CI 15-30) in the SMP arm. For CIN3+, the prevalence per 1000 screened women was 14 (35/2466 × 1000) (95%CI 10-20) in the SS arm and 15 (23/1519 × 1000) (95%CI 10-23) in the SMP arm. In conclusion, self-sampling and sampling by medical professionals showed the same prevalence of HPV and detection rate of CIN2+ and CIN3+ in histology.
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Affiliation(s)
- Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isabella Isacson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Krishnamurthy A, Ramshankar V. Current Status and Future Perspectives of Molecular Prevention Strategies for Cervical Cancers. Indian J Surg Oncol 2020; 11:752-761. [PMID: 33299288 DOI: 10.1007/s13193-019-00910-z] [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: 02/17/2019] [Accepted: 03/07/2019] [Indexed: 01/22/2023] Open
Abstract
Cervical cancer continues to be a global health problem; despite the potential for prevention through organised screening programmes that can detect and treat pre-cancerous lesions and also more recently, the availability of HPV (Human Papilloma Virus) vaccines. While routine screening with Pap smear testing has reduced the burden of cervical cancer in the high-income countries, the implementation of organised Pap-based screening programmes has not been found feasible in low-resource settings due to a lack of health care delivery infrastructure and limited health budgets. The well-established causal relationship between cervical cancer development and high-risk-HPV (HR-HPV) infection and the subsequent appreciation of the greater sensitivity of HPV testing over Pap smear cytology eventually lead to HPV testing being incorporated in the primary cervical cancer prevention programmes. An organised cervical cancer screening programme incorporating HR-HPV testing and HPV vaccine administration are currently considered to be the two major interventions for a comprehensive cervical cancer control programme worldwide. However, there are concerns that the requirement of a sophisticated infrastructure with its associated costs may make cervical cancer screening using molecular prevention by HPV testing impracticable to be implemented, especially in resource-poor, low-income countries. Visual Inspection with Acetic acid (VIA) represents one of the alternative methods for cervical cancer screening proposed for the countries with low- to middle-income resources and has gained popularity in India following the successful completion of two randomised controlled trials, but this method but has low sensitivity to detect cervical pre-cancers. More recently, the cost-effectiveness analysis of many studies including randomised controlled trials, even from the low-resource settings, has found that HPV testing is followed by treatment for HPV-positive women to be an effective and cost-effective screening strategy as compared to other screening methods including VIA. The incorporation of self-sampling and HPV testing by partial genotyping has the potential to significantly add to the effectiveness and the cost-effectiveness. The current status and future perspectives of molecular prevention strategies for cervical cancer prevention is further discussed.
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Affiliation(s)
- Arvind Krishnamurthy
- Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Rd, Adyar, Chennai, 600036 India
| | - Vijayalakshmi Ramshankar
- Department of Preventive Oncology (Research), Cancer Institute (WIA), 38, Sardar Patel Rd, Adyar, Chennai, 600036 India
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Rutty Phiri C, Sturt AS, Webb EL, Chola N, Hayes R, Shanaube K, Ayles H, Hansingo I, Bustinduy AL. Acceptability and feasibility of genital self-sampling for the diagnosis of female genital schistosomiasis: a cross-sectional study in Zambia. Wellcome Open Res 2020; 5:61. [PMID: 33154978 PMCID: PMC7610177 DOI: 10.12688/wellcomeopenres.15482.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Female genital schistosomiasis (FGS) is a neglected and disabling gynaecological disorder that is difficult to diagnose and is part of the wider spectrum of urogenital disease caused by the waterborne parasite
Schistosoma haematobium. Over 90% of human schistosomiasis cases are found in sub-Saharan Africa with 3.8 million people infected with schistosomes in Zambia. Reported FGS prevalence ranges from 33-75% of those with urinary schistosomiasis in endemic areas, suggesting a potentially high FGS burden in Zambia alone. The Bilharzia and HIV (BILHIV) study evaluated home self-sampling genital collection methods for the diagnosis of FGS. Methods: Eligible participants included non-pregnant, sexually active women aged 18-31 who were previously recruited for the HPTN 071 (PopART) trial in Livingstone, Zambia. Household demographic and symptom questionnaires were administered by community workers. Participants were offered vaginal and cervical self-swabs and a urine cup. Cervicovaginal lavage (CVL) was performed in clinic by midwives. Information was collected from participants on the acceptability and feasibility of genital self-sampling. Results: From January-August 2018, 603 women were enrolled, and 87.3% (527/603) completed clinic follow up. A high proportion of participants indicated that self-collection of specimens was “easy” or “very easy” on a 5-point Likert scale. A high proportion of women would be willing to self-collect all three specimens again in future: vaginal swab 96.7% (583/603), cervical swab 96.5% (582/603), and urine 96.2% (580/603). Overall, 90.0% (543/603) preferred to self-collect samples at home, compared with sampling in the clinic Home-based self-sampling was preferred over provider-based sampling in the clinic due to greater privacy 65.0% (353/543), convenience 51.4% (279/543) and lack of needed transportation 17.7% (96/543). Conclusions: Home based genital self-sampling for FGS diagnosis is highly acceptable. This scalable method may inform future efforts for community-based diagnosis of FGS
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Affiliation(s)
| | - Amy S Sturt
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | - Helen Ayles
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Isaiah Hansingo
- Gynecology Department, Livingstone Central Hospital, Livingstone, Zambia
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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16
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Rutty Phiri C, Sturt AS, Webb EL, Chola N, Hayes R, Shanaube K, Ayles H, Hansingo I, Bustinduy AL. Acceptability and feasibility of genital self-sampling for the diagnosis of female genital schistosomiasis: a cross-sectional study in Zambia. Wellcome Open Res 2020; 5:61. [DOI: 10.12688/wellcomeopenres.15482.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Female genital schistosomiasis (FGS) is a neglected and disabling gynaecological disorder that is difficult to diagnose and is part of the wider spectrum of urogenital disease caused by the waterborne parasite Schistosoma haematobium. Over 90% of human schistosomiasis cases are found in sub-Saharan Africa with 3.8 million people infected with schistosomes in Zambia. Reported FGS prevalence ranges from 33-75% of those with urinary schistosomiasis in endemic areas, suggesting a potentially high FGS burden in Zambia alone. The Bilharzia and HIV (BILHIV) study evaluated home self-sampling genital collection methods for the diagnosis of FGS. Methods: Eligible participants included non-pregnant, sexually active women aged 18-31 who were previously recruited for the HPTN 071 (PopART) trial in Livingstone, Zambia. Household demographic and symptom questionnaires were administered by community workers. Participants were offered vaginal and cervical self-swabs and a urine cup. Cervicovaginal lavage (CVL) was performed in clinic by midwives. Information was collected from participants on the acceptability and feasibility of genital self-sampling. Results: From January-August 2018, 603 women were enrolled, and 87.3% (527/603) completed clinic follow up. A high proportion of participants indicated that self-collection of specimens was “easy” or “very easy” on a 5-point Likert scale. A high proportion of women would be willing to self-collect all three specimens again in future: vaginal swab 96.7% (583/603), cervical swab 96.5% (582/603), and urine 96.2% (580/603). Home-based self-sampling was preferred over provider-based sampling in the clinic due to greater privacy 58.5% (353/603), convenience 46.3% (279/603) and need for transportation 15.9% (96/603). Conclusions: Home based genital self-sampling for FGS diagnosis is highly acceptable. This scalable method may inform future efforts for community-based diagnosis of FGS.
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Aitken CA, van Agt HME, Siebers AG, van Kemenade FJ, Niesters HGM, Melchers WJG, Vedder JEM, Schuurman R, van den Brule AJC, van der Linden HC, Hinrichs JWJ, Molijn A, Hoogduin KJ, van Hemel BM, de Kok IMCM. Introduction of primary screening using high-risk HPV DNA detection in the Dutch cervical cancer screening programme: a population-based cohort study. BMC Med 2019; 17:228. [PMID: 31829241 PMCID: PMC6907114 DOI: 10.1186/s12916-019-1460-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In January 2017, the Dutch cervical cancer screening programme transitioned from cytomorphological to primary high-risk HPV (hrHPV) DNA screening, including the introduction of self-sampling, for women aged between 30 and 60 years. The Netherlands was the first country to switch to hrHPV screening at the national level. We investigated the health impact of this transition by comparing performance indicators from the new hrHPV-based programme with the previous cytology-based programme. METHODS We obtained data from the Dutch nationwide network and registry of histo- and cytopathology (PALGA) for 454,573 women eligible for screening in 2017 who participated in the hrHPV-based programme between 1 January 2017 and 30 June 2018 (maximum follow-up of almost 21 months) and for 483,146 women eligible for screening in 2015 who participated in the cytology-based programme between 1 January 2015 and 31 March 2016 (maximum follow-up of 40 months). We compared indicators of participation (participation rate), referral (screen positivity; referral rate) and detection (cervical intraepithelial neoplasia (CIN) detection; number of referrals per detected CIN lesion). RESULTS Participation in the hrHPV-based programme was significantly lower than that in the cytology-based programme (61% vs 64%). Screen positivity and direct referral rates were significantly higher in the hrHPV-based programme (positivity rate: 5% vs 9%; referral rate: 1% vs 3%). CIN2+ detection increased from 11 to 14 per 1000 women screened. Overall, approximately 2.2 times more clinical irrelevant findings (i.e. ≤CIN1) were found in the hrHPV-based programme, compared with approximately 1·3 times more clinically relevant findings (i.e. CIN2+); this difference was mostly due to a national policy change recommending colposcopy, rather than observation, of hrHPV-positive, ASC-US/LSIL results in the hrHPV-based programme. CONCLUSIONS This is the first time that comprehensive results of nationwide implementation of hrHPV-based screening have been reported using high-quality data with a long follow-up. We have shown that both benefits and potential harms are higher in one screening round of a well-implemented hrHPV-based screening programme than in an established cytology-based programme. Lower participation in the new hrHPV programme may be due to factors such as invitation policy changes and the phased roll-out of the new programme. Our findings add further to evidence from trials and modelling studies on the effectiveness of hrHPV-based screening.
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Affiliation(s)
- Clare A. Aitken
- Department of Public Health, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CN Rotterdam, the Netherlands
| | - Heleen M. E. van Agt
- Department of Public Health, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CN Rotterdam, the Netherlands
| | - Albert G. Siebers
- PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, De Bouw 123, 3991 SZ Houten, the Netherlands
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Folkert J. van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CN Rotterdam, the Netherlands
| | - Hubert G. M. Niesters
- Division of Clinical Virology, Department of Medical Microbiology, The University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Judith E. M. Vedder
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Rob Schuurman
- Facilitaire Samenwerking Bevolkingsonderzoeken, Godebaldkwartier 435, 3511 DT Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | | | - Hans C. van der Linden
- Jeroen Bosch Hospital, Pathologie-DNA, Henri Dunantstraat 1, 5223 GZ ‘s-Hertogenbosch, the Netherlands
| | - John W. J. Hinrichs
- Symbiant Pathology Expert Centre Hoorn (Westfriesgasthuis), Maelsonstraat 3, 1624 NP Hoorn, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Anco Molijn
- NMDL-LCPL, Visseringlaan 25, 2288 ER Rijswijk, the Netherlands
| | | | - Bettien M. van Hemel
- Department of Pathology and Medical Biology, the University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Inge M. C. M. de Kok
- Department of Public Health, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CN Rotterdam, the Netherlands
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Brewer N, Bartholomew K, Maxwell A, Grant J, McPherson G, Wihongi H, Bromhead C, Scott N, Crengle S, Cunningham C, Douwes J, Potter JD. Comparison of two invitation-based methods for human papillomavirus (HPV) self-sampling with usual care among un- and under-screened Māori, Pacific and Asian women: study protocol for a randomised controlled community trial to examine the effect of self-sampling on participation in cervical-cancer screening. BMC Cancer 2019; 19:1198. [PMID: 31815615 PMCID: PMC6902319 DOI: 10.1186/s12885-019-6401-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/22/2019] [Indexed: 01/25/2023] Open
Abstract
Background Māori, Pacific and Asian women in New Zealand have lower cervical-cancer screening rates than European women, and there are persistent inequities in cervical cancer outcomes for Māori and Pacific women. Innovative ways to address access barriers are required. New Zealand is transitioning to screening with human papillomavirus (HPV) DNA testing, which could allow women themselves, rather than a clinician, to take the sample. Internationally, self-sampling has been found to increase screening participation rates. The aim of this open-label community-based randomised controlled trial is to investigate whether self-sampling increases screening participation among un- and under-screened Māori, Pacific and Asian women in New Zealand. Methods/design We aim to invite at least 3550 un- or under-screened (≥5 years overdue) Māori, Pacific and Asian women (1050, 1250, 1250 respectively), aged 30–69 years, for screening. The three study arms are: usual care in which women are invited to attend a clinic for a standard clinician-collected cytology test; clinic-based self-sampling in which women are invited to take a self-sample at their usual general practice; and mail-out self-sampling in which women are mailed a kit and invited to take a self-sample at home. Women will be randomised 3:3:1 to the clinic and mail-out self-sampling groups, and usual care. There is also a nested sub-study in which non-responding women in all allocation groups, when they subsequently present to the clinic for other reasons, are offered clinic or home-kit self-sampling. The primary outcome will be the proportion of women who participate (by taking a self-sample or cytology test). Discussion This trial is the first to evaluate the effectiveness of mailed self-sampling in New Zealand and will be one of the first internationally to evaluate the effectiveness of opportunistic in-clinic invitations for self-sampling. The trial will provide robust evidence on the impact on participation proportions from different invitation approaches for HPV self-sampling in New Zealand un- and under-screened Māori, Pacific and Asian women. Trial registration ANZCTR Identifier: ACTRN12618000367246 (date registered 12/3/2018) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371741&isReview=true; UTN: U1111–1189-0531.
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Affiliation(s)
- Naomi Brewer
- Centre for Public Health Research, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand.
| | - Karen Bartholomew
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand
| | - Anna Maxwell
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand
| | - Jane Grant
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand
| | | | - Helen Wihongi
- Waitematā District Health Board (DHB) and Auckland DHB, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand
| | - Collette Bromhead
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Nina Scott
- University of Auckland, Waikato District Health Board, Hamilton, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Chris Cunningham
- Research Centre for Māori Health and Development, Massey University, Wellington, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - John D Potter
- Centre for Public Health Research, Massey University, Wellington, New Zealand
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19
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Advances in Precision Health and Emerging Diagnostics for Women. J Clin Med 2019; 8:jcm8101525. [PMID: 31547515 PMCID: PMC6832724 DOI: 10.3390/jcm8101525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 12/29/2022] Open
Abstract
During the Dutch winter famine of 1944–1945, an interesting observation was made about the offspring born during this time—They had an increased risk of developing metabolic syndrome and other chronic diseases. Subsequent research has confirmed this finding as well as noting that health outcomes for many diseases are different, and often worse, for women. These findings, combined with the lack of enrollment of women in clinical trials and/or analysis of sex-specific differences are important factors which need to be addressed. In fact, Women’s health research and sex differences have historically been overlooked or lumped together and assumed equivalent to those of men. Hence, a focus on women’s health and disease prevention is critical to improve the lives of women in the 21st Century. In this review, we point out the critical differences biologically and socially that present both challenges and opportunities for development of novel platforms for precision health. The technologic and scientific advances specific to women’s precision health have the potential to improve the health and wellbeing for all females across the world.
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20
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Bishop E, Katz ML, Reiter PL. Acceptability of Human Papillomavirus Self-Sampling Among a National Sample of Women in the United States. Biores Open Access 2019; 8:65-73. [PMID: 31057989 PMCID: PMC6497327 DOI: 10.1089/biores.2018.0040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
As human papillomavirus (HPV) self-sampling continues to emerge as a potential cervical cancer screening strategy in the United States, it is necessary to examine women's acceptability of this screening approach. Furthermore, since several HPV self-sampling devices exist, it is important to determine if women's preferences differ by device type. We conducted an online survey in Fall 2017 with a national sample of women (n = 605) ages 21–65 years (the recommended age range for cervical cancer screening). Multivariable linear regression identified correlates of women's willingness to use an HPV self-sample at home. We used repeated measures analysis of variance to determine if preferences differed across four self-sampling devices: Evalyn® Brush (Device A), HerSwab® (Device B), Catch-All® Swab (Device C), and Qvintip® (Device D). Most women were willing to use an HPV self-sample at home (mean = 4.03 [possible range: 1–5], standard deviation = 1.09, 72.7% indicated “probably willing” or “definitely willing”). The most common concerns about self-sampling were related to test accuracy (53.1%) and obtaining the sample incorrectly (51.1%). Women were more willing to use an HPV self-sample at home if they reported greater perceived severity of cervical cancer (β = 0.16), reported an annual income less than $50,000 (β = 0.13), or were a former smoker (β = 0.11). Women were more willing to use Device A (mean = 3.72, 67.6% indicated “agree” or “strongly agree”), Device C (mean = 3.86, 73.9% indicated “agree” or “strongly agree”), and Device D (mean = 3.81, 72.1% indicated “agree” or “strongly agree”) than Device B (mean = 3.36, 49.4% indicated “agree” or “strongly agree”; all p < 0.05). Acceptability of HPV self-sampling as a cervical cancer screening strategy is generally high among women. Future efforts should consider the potential impact that device type may have on women's use of an HPV self-sample at home.
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Affiliation(s)
- Erin Bishop
- Medical Student Research Program, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Paul L Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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21
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Snoek BC, Verlaat W, Babion I, Novianti PW, van de Wiel MA, Wilting SM, van Trommel NE, Bleeker MCG, Massuger LFAG, Melchers WJG, Sie D, Heideman DAM, Snijders PJF, Meijer CJLM, Steenbergen RDM. Genome-wide microRNA analysis of HPV-positive self-samples yields novel triage markers for early detection of cervical cancer. Int J Cancer 2018; 144:372-379. [PMID: 30192375 PMCID: PMC6518875 DOI: 10.1002/ijc.31855] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/20/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
Abstract
Offering self‐sampling for HPV testing improves the effectiveness of current cervical screening programs by increasing population coverage. Molecular markers directly applicable on self‐samples are needed to stratify HPV‐positive women at risk of cervical cancer (so‐called triage) and to avoid over‐referral and overtreatment. Deregulated microRNAs (miRNAs) have been implicated in the development of cervical cancer, and represent potential triage markers. However, it is unknown whether deregulated miRNA expression is reflected in self‐samples. Our study is the first to establish genome‐wide miRNA profiles in HPV‐positive self‐samples to identify miRNAs that can predict the presence of CIN3 and cervical cancer in self‐samples. Small RNA sequencing (sRNA‐Seq) was conducted to determine genome‐wide miRNA expression profiles in 74 HPV‐positive self‐samples of women with and without cervical precancer (CIN3). The optimal miRNA marker panel for CIN3 detection was determined by GRridge, a penalized method on logistic regression. Six miRNAs were validated by qPCR in 191 independent HPV‐positive self‐samples. Classification of sRNA‐Seq data yielded a 9‐miRNA marker panel with a combined area under the curve (AUC) of 0.89 for CIN3 detection. Validation by qPCR resulted in a combined AUC of 0.78 for CIN3+ detection. Our study shows that deregulated miRNA expression associated with CIN3 and cervical cancer development can be detected by sRNA‐Seq in HPV‐positive self‐samples. Validation by qPCR indicates that miRNA expression analysis offers a promising novel molecular triage strategy for CIN3 and cervical cancer detection applicable to self‐samples. What's new? MicroRNAs (miRNAs) are suspected of playing a role in cervical cancer development. They are also potential markers for the identification of human papillomavirus (HPV)‐infected women who are at risk of cervical cancer. Here, using small RNA sequencing of HPV‐positive self‐samples from women with and without cervical precancer (CIN3), the authors identify a miRNA signature consisting of multiple miRNAs that is strongly predictive of CIN3. Validation of this signature by qPCR revealed a good clinical performance for CIN3+ detection. The findings suggest that miRNA analysis is an effective means of CIN3+ prediction in HPV‐positive self‐samples obtained for cervical cancer screening.
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Affiliation(s)
- Barbara C Snoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Wina Verlaat
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Iris Babion
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Putri W Novianti
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam, Netherlands
| | - Mark A van de Wiel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Mathematics, Amsterdam, Netherlands
| | - Saskia M Wilting
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands.,Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Nienke E van Trommel
- Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Maaike C G Bleeker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Daoud Sie
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Daniëlle A M Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Peter J F Snijders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Chris J L M Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Renske D M Steenbergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, Netherlands
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22
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van Leeuwen RW, Oštrbenk A, Poljak M, van der Zee AGJ, Schuuring E, Wisman GBA. DNA methylation markers as a triage test for identification of cervical lesions in a high risk human papillomavirus positive screening cohort. Int J Cancer 2018; 144:746-754. [PMID: 30259973 PMCID: PMC6587981 DOI: 10.1002/ijc.31897] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/03/2018] [Accepted: 08/23/2018] [Indexed: 12/20/2022]
Abstract
Objective triage strategies are required to prevent unnecessary referrals for colposcopy in population‐based screening programs using primary high‐risk human papillomavirus (hrHPV) testing. We have identified several DNA methylation markers with high sensitivity and specificity for detection of high‐grade cervical intraepithelial neoplasia or worse (CIN2+) in women referred for colposcopy. Our study assessed diagnostic potential of these methylation markers in a hrHPV‐positive screening cohort. All six markers (JAM3, EPB41L3, C13orf18, ANKRD18CP, ZSCAN1 and SOX1) showed similar association across histology in the hrHPV‐positive cohort when compared to the Dutch cohort (each p > 0.15). Sensitivity for CIN2+ was higher using methylation panel C13orf18/EPB41L3/JAM3 compared to the other 2 panels (80% vs. 60% (ANKRD18CP/C13orf18/JAM3) and 63% (SOX1/ZSCAN1), p = 0.01). For CIN3+ all three methylation panels showed comparable sensitivity ranging from 68% (13/19) to 95% (18/19). Specificity of SOX1/ZSCAN1 panel (84%, 167/200) was considerably higher compared to ANKRD18CP/C13orf18/JAM3 (68%, 136/200, p = 2 × 10−5) and C13orf18/EPB41L3/JAM3 (66%, 132/200, p = 2 × 10−7). High negative predictive value (NPV) (91–95% and 96–99%) was observed for CIN2+ and CIN3+, for all three methylation panels, while positive predictive value (PPV) varied from 25 to 40% for CIN2+ and 15–27% for CIN3+. Interestingly, 118/235 samples were negative for all six markers (including 106 controls (89.8%), 6 CIN1 (5.1%), 5 CIN2 (4.2%) and 1 CIN3 (0.8%)). Methylation results from both independent cohorts were comparable as well as high sensitivity for detection of cervical cancer and its high‐grade precursors in hrHPV‐positive population. Our study therefore validates these methylation marker panels as triage test either in hrHPV‐based or abnormal cytology‐based screening programs. What's new? In cervical cancer screening, HPV testing provides greater sensitivity than cytology, but its lower specificity leads to some unnecessary treatment referrals. DNA methylation assays could potentially provide better specificity for identifying CIN2+ in women carrying high risk HPV. These authors investigated six previously identified CIN2+ methylation markers. They tested three different combinations of markers, and found high levels of sensitivity and specificity, making these markers potentially useful as part of a population‐based screening program.
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Affiliation(s)
- Robert W van Leeuwen
- Department of Gynaecologic Oncology, Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Anja Oštrbenk
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ate G J van der Zee
- Department of Gynaecologic Oncology, Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology, Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - G Bea A Wisman
- Department of Gynaecologic Oncology, Cancer Research Centre Groningen, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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23
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Ebisch RMF, Ketelaars PJW, van der Sanden WMH, Schmeink CE, Lenselink CH, Siebers AG, Massuger LFAG, Melchers WJG, Bekkers RLM. Screening for persistent high-risk HPV infections may be a valuable screening method for young women; A retrospective cohort study. PLoS One 2018; 13:e0206219. [PMID: 30356297 PMCID: PMC6200272 DOI: 10.1371/journal.pone.0206219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Screening of young women is often discouraged because of the high risk of unnecessary diagnostics or overtreatment. Multiple countries therefore use cytology instead of high risk human papillomavirus (hrHPV)-testing as screening method for young women because of the limited specificity of hrHPV-testing. The objective of this study was to investigate how hrHPV screening before the age of 30, can be used to reduce the future prevalence of high-grade cervical lesions in young women. Methods We retrospectively analyzed follow-up data from a cohort study on HPV prevalence in unscreened Dutch women aged 18–29 years. Women performed multiple self-collected cervico-vaginal samples for HPV detection and genotyping. At least one valid cervical pathology result was obtained from 1,018 women. Women were categorized as hrHPV negative, cleared- or persistent hrHPV infection. Anonymized follow-up data for each group was obtained. Composite outcome measures were defined as; normal, low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL). The association between prior hrHPV status and cytology and histology outcome was analyzed. Results After exclusion, a pathology result was registered for 962 women. The prevalence of HSIL was 19.3% in women with a persistent HPV infection at a younger age. This is significantly higher (p<0,001) compared with the HSIL prevalence of 1.5% in HPV-negative women, and 3.1% (n = 8) in women who cleared the hrHPV infection in the past. Conclusion Women with a persistent hrHPV infection in their 20s, show an increased prevalence of HSIL lesions in their early 30s. Screening for persistent hrHPV infections, instead of cytology screening before the age of 30, can be used to reduce the future prevalence of cervical cancer in young women.
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Affiliation(s)
- Renée M. F. Ebisch
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
- * E-mail:
| | - Pleun J. W. Ketelaars
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Channa E. Schmeink
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Albert G. Siebers
- Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - Leon F. A. G. Massuger
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology, Radboud university medical center, Nijmegen, the Netherlands
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, the Netherlands
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24
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Krings A, Dückelmann AM, Moser L, Gollrad J, Wiegerinck M, Schweizer J, Kaufmann AM. Performance of OncoE6 cervical test with collection methods enabling self-sampling. BMC WOMENS HEALTH 2018; 18:68. [PMID: 29783960 PMCID: PMC5963066 DOI: 10.1186/s12905-018-0559-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The paradigm shift from cytological screening to Human Papillomavirus (HPV)-based screening for cervical cancer allows the introduction of new technologies in sample collection and diagnostics. The OncoE6™ Cervical Test (OncoE6 Test) is a rapid, easy-to-use lateral flow method detecting HPV16/18 E6 oncoproteins that has proven to detect high-grade cervical lesions with high specificity. If compatible with self-collection samples, this technology might allow for decentralized screening of hard-to-reach populations. METHODS For technical validation, cervicovaginal lavages were collected from 20 patients with confirmed HPV16+ or HPV18+ invasive cervical cancer. Cervical smears were collected by polyester-tipped swabs and cytobrushes. All samples were applied to the OncoE6 Test and cytobrush samples additionally genotyped. RESULTS Lavage, swab, and cytobrush revealed concordant outcome in 18/20 samples. HPV types corresponded with the HPV genotyping by GP5+/6+ PCR analyses. Due to a rare mutation found in the E6 antibody binding site one sample was not detected, another sample had very low cellularity. CONCLUSIONS Overall, vaginal lavages are technically adequate for the OncoE6 Test. Combining self-sampling with oncoprotein rapid testing to detect women with highest risk for severe dysplasia or cancer may allow for secondary cancer prevention in settings where other screening modalities were unsuccessful to date.
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Affiliation(s)
- Amrei Krings
- Clinic for Gynecology CCM/CBF, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna M Dückelmann
- Clinic for Gynecology CCM/CBF, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lutz Moser
- Department of Radiooncology, CBF, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Gollrad
- Department of Radiooncology, CBF, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | | | - Andreas M Kaufmann
- Clinic for Gynecology CCM/CBF, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. .,Gynäkologische Tumorimmunologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30 Room # 4503, 12200, Berlin, Germany.
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25
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Verlaat W, Snoek BC, Heideman DAM, Wilting SM, Snijders PJF, Novianti PW, van Splunter AP, Peeters CFW, van Trommel NE, Massuger LFAG, Bekkers RLM, Melchers WJG, van Kemenade FJ, Berkhof J, van de Wiel MA, Meijer CJLM, Steenbergen RDM. Identification and Validation of a 3-Gene Methylation Classifier for HPV-Based Cervical Screening on Self-Samples. Clin Cancer Res 2018; 24:3456-3464. [PMID: 29632006 DOI: 10.1158/1078-0432.ccr-17-3615] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/22/2018] [Accepted: 04/02/2018] [Indexed: 01/09/2023]
Abstract
Purpose: Offering self-sampling of cervico-vaginal material for high-risk human papillomavirus (hrHPV) testing is an effective method to increase the coverage in cervical screening programs. Molecular triage directly on hrHPV-positive self-samples for colposcopy referral opens the way to full molecular cervical screening. Here, we set out to identify a DNA methylation classifier for detection of cervical precancer (CIN3) and cancer, applicable to lavage and brush self-samples.Experimental Design: We determined genome-wide DNA methylation profiles of 72 hrHPV-positive self-samples, using the Infinium Methylation 450K Array. The selected DNA methylation markers were evaluated by multiplex quantitative methylation-specific PCR (qMSP) in both hrHPV-positive lavage (n = 245) and brush (n = 246) self-samples from screening cohorts. Subsequently, logistic regression analysis was performed to build a DNA methylation classifier for CIN3 detection applicable to self-samples of both devices. For validation, an independent set of hrHPV-positive lavage (n = 199) and brush (n = 287) self-samples was analyzed.Results: Genome-wide DNA methylation profiling revealed 12 DNA methylation markers for CIN3 detection. Multiplex qMSP analysis of these markers in large series of lavage and brush self-samples yielded a 3-gene methylation classifier (ASCL1, LHX8, and ST6GALNAC5). This classifier showed a very good clinical performance for CIN3 detection in both lavage (AUC = 0.88; sensitivity = 74%; specificity = 79%) and brush (AUC = 0.90; sensitivity = 88%; specificity = 81%) self-samples in the validation set. Importantly, all self-samples from women with cervical cancer scored DNA methylation-positive.Conclusions: By genome-wide DNA methylation profiling on self-samples, we identified a highly effective 3-gene methylation classifier for direct triage on hrHPV-positive self-samples, which is superior to currently available methods. Clin Cancer Res; 24(14); 3456-64. ©2018 AACR.
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Affiliation(s)
- Wina Verlaat
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Barbara C Snoek
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Daniëlle A M Heideman
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Saskia M Wilting
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter J F Snijders
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Putri W Novianti
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Annina P van Splunter
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Carel F W Peeters
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Nienke E van Trommel
- Department of Gynecology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Mark A van de Wiel
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Renske D M Steenbergen
- Cancer Center Amsterdam, Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.
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26
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Van Ostade X, Dom M, Tjalma W, Van Raemdonck G. Candidate biomarkers in the cervical vaginal fluid for the (self-)diagnosis of cervical precancer. Arch Gynecol Obstet 2017; 297:295-311. [PMID: 29143101 PMCID: PMC5778162 DOI: 10.1007/s00404-017-4587-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
Purpose Despite improvement in vaccines against human papilloma virus (HPV), the causative agent of cervical cancer, screening women for cervical precancer will remain indispensable in the coming 30–40 years. A simple test that could be performed at home or at a doctor’s practice and that informs the woman whether she is at risk would significantly help make a broader group of patients who aware that they need medical treatment. Cervical vaginal fluid (CVF) is a body fluid that is very well suited for such a test. Methods Narrative review of cervical (pre)cancer candidate biomarkers from cervicovaginal fluid, is based on a detailed review of the literature. We will also discuss the possibilities that these biomarkers create for the development of a self-test or point-of-care test for cervical (pre)cancer. Results Several DNA, DNA methylation, miRNA, and protein biomarkers were identified in the cervical vaginal fluid; however, not all of these biomarkers are suited for development of a simple diagnostic assay. Conclusions Proteins, especially alpha-actinin-4, are most suited for development of a simple assay for cervical (pre)cancer. Accuracy of the test could further be improved by combination of several proteins or by combination with a new type of biomarker, e.g., originating from the cervicovaginal microbiome or metabolome.
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Affiliation(s)
- Xaveer Van Ostade
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium. .,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium.
| | - Martin Dom
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
| | - Wiebren Tjalma
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Geert Van Raemdonck
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
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Tian Y, Yuan Wu NY, Liou YL, Yeh CT, Cao L, Kang YN, Wang HJ, Li Y, Chu TY, Li W, Liu X, Zhang Y, Zhou H, Zhang Y. Utility of gene methylation analysis, cytological examination, and HPV-16/18 genotyping in triage of high-risk human papilloma virus-positive women. Oncotarget 2017; 8:62274-62285. [PMID: 28977944 PMCID: PMC5617504 DOI: 10.18632/oncotarget.19459] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 05/11/2017] [Indexed: 01/23/2023] Open
Abstract
In 2015, the American Society for Colposcopy and Cervical Pathology and the Society of Gynecologic Oncology issued interim guidance for the use of a human papillomavirus (HPV) test for primary screening, suggesting triage of women positive for high-risk human papillomavirus (hrHPV) by HPV-16/18 genotyping and cytology for women positive for non-16/18 hrHPV. The design of the present study was based on this interim guidance and analysis of the methylation status of specific candidate genes, which has been proposed as a tool to reduce unnecessary referral following primary HPV screening for cervical cancer. We performed a hospital-based case-control study including 312 hrHPV-positive women. hrHPV genotyping was performed by nested multiplex PCR assay with type-specific primers.Residual cervical cells from liquid-based cytology were used for extraction of genomic DNA for assessment of the methylation status of PAX1, ZNF582, SOX1, and NKX6-1 and HPV genotyping. Combined with HPV-16/18 genotyping, both a dual methylation test for PAX1/ZNF582 and testing for ZNF582 methylation demonstrated 100% association of methylation with pathology results, indicating carcinoma in situ or squamous cell carcinoma. The sensitivity and specificity of the dual methylation test for PAX1/ZNF582 as a reflex test for identification of CIN3+ lesions were 78.85% and 73.55% (odds ratio = 10.37, 95% confidence interval = 4.76-22.58), respectively. This strategy could reduce the number of patients referred for colposcopic examination by 31.3% compared with cytology, and thus provide a feasible follow-up solution in regions where colposcopy is not readily available. This strategy could also prevent unnecessary anxiety in women with hrHPV infection.
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Affiliation(s)
- Yan Tian
- Department of Obstetrics & Gynecology, Xiangya Hospital, Hunan, P. R. China
| | - Na-Yi Yuan Wu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, P. R. China
- Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, P. R. China
| | - Yu-Ligh Liou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, P. R. China
- Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, P. R. China
- iStat Biomedical Co. Ltd., Taipei, Taiwan
| | | | - Lanqin Cao
- Department of Obstetrics & Gynecology, Xiangya Hospital, Hunan, P. R. China
| | - Ya-Nan Kang
- Department of Obstetrics & Gynecology, Xiangya Hospital, Hunan, P. R. China
| | | | - Yichen Li
- iStat Biomedical Co. Ltd., Taipei, Taiwan
| | - Tang-Yuan Chu
- Department of Obstetrics & Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Wei Li
- Department of Obstetrics and Gynecology, ShengJing Hospital of China Medical University, Liaoning, P. R. China
| | - Xiang Liu
- Department of Pharmacy, Xiangtan Central Hospital, Xiangtan, P. R. China
| | - Yi Zhang
- Department of Obstetrics & Gynecology, Xiangya Hospital, Hunan, P. R. China
| | - Honghao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, P. R. China
- Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, P. R. China
| | - Yu Zhang
- Department of Obstetrics & Gynecology, Xiangya Hospital, Hunan, P. R. China
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28
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Evaluation of p16/Ki-67 dual-stained cytology as triage test for high-risk human papillomavirus-positive women. Mod Pathol 2017; 30:1021-1031. [PMID: 28304400 DOI: 10.1038/modpathol.2017.16] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 12/16/2022]
Abstract
The aim of this study was to evaluate the clinical utility of p16/Ki-67 dual staining, for the identification of CIN in high-risk HPV-positive women from a non-responder screening cohort. P16/Ki-67 dual staining, Pap cytology, and HPV16/18 genotyping were performed on physician-taken liquid-based samples from 495 women who tested high-risk HPV positive on self-sampled material (PROHTECT-3B study). Different triage strategies involving p16/Ki-67 dual staining were evaluated for sensitivity, specificity, and predictive value for ≥CIN2 and ≥CIN3, and compared to Pap cytology with a threshold of atypical cells of undetermined significance. Centrally revised histology or an adjusted endpoint with combined high-risk HPV negative and cytology negative follow-up at 6 months was used as gold standard. Pap cytology (threshold atypical cells of undetermined significance) triage of high-risk HPV-positive samples showed a sensitivity of 93% (95% confidence interval: 85-98) with a specificity of 49% (95% confidence interval: 41-56) for ≥CIN3. Three triage strategies with p16/Ki-67 showed a significantly increased specificity with similar sensitivity. P16/Ki-67 triage of all high-risk HPV-positive samples had a sensitivity of 92% (95% confidence interval: 84-97) and a specificity of 61% (95% confidence interval: 54-69) for ≥CIN3. Applying p16/Ki-67 triage to only high-risk HPV-positive women with low-grade Pap cytology showed a similar sensitivity of 92% (95% confidence interval: 84-97), with a specificity for ≥CIN3 of 64% (95% confidence interval: 56-71). For high-risk HPV-positive women with low-grade and normal Pap cytology, triage with p16/Ki-67 showed a sensitivity of 96% (95% confidence interval: 89-99), and a specificity of 58% (95% confidence interval: 50-65). HPV16/18 genotyping combined with Pap cytology showed a sensitivity and specificity for ≥CIN3 similar to Pap cytology with an atypical cells of undetermined significance threshold. Because the quality of Pap cytology worldwide varies, and differences in sensitivity and specificity are limited between the three selected strategies, p16/Ki-67 triage of all high-risk HPV-positive samples would be the most reliable strategy in triage of high-risk HPV-positive women with an increased specificity and similar sensitivity compared with Pap cytology triage.
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Viviano M, Catarino R, Jeannot E, Boulvain M, Malinverno MU, Vassilakos P, Petignat P. Self-sampling to improve cervical cancer screening coverage in Switzerland: a randomised controlled trial. Br J Cancer 2017; 116:1382-1388. [PMID: 28427086 PMCID: PMC5520090 DOI: 10.1038/bjc.2017.111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/17/2017] [Accepted: 03/30/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate whether self-sampling can increase screening attendance of women who do not attend regular screening in Switzerland. METHODS Participants were proactively recruited in Geneva between September 2011 and November 2015. Women (25-69 years) who had not undergone CC screening in the last 3 years were considered eligible. Through a 1 : 1 ratio randomisation, enrolled participants were invited to either undergo liquid-based cytology, which was performed by a health-care provider (control group, CG) or to take a self-sample for HPV-testing, which was mailed to their home (intervention group, IG). RESULTS A total of 331 and 336 women were randomised in the CG and in the IG, respectively. Overall, 7.3% (95% CI: 4.9-10.6) women in the CG and 5.7% (95% CI: 3.6-8.7) women in the IG did not undergo the initial screening (P=0.400). There were 1.95% (95% CI: 0.8-4.3) women in the CG and 5.05% (95% CI: 3.1-8.1) women in the IG with a positive screen who did not attend triage and colposcopy (P=0.036). CONCLUSIONS The participation in CC screening in women offered self-sampling was not higher than among those offered specimen collection by a clinician. Compliance with further follow-up for women with a positive HPV test on the self-sample requires further attention.
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Affiliation(s)
- Manuela Viviano
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
| | - Rosa Catarino
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
| | - Emilien Jeannot
- Institute of Global Health-Faculty of Medicine, Chemin de Mines 9, Geneva 1202, Switzerland.,School of Health Sciences, University of Applied Sciences and Arts of Western Switzerland, Avenue de Champel 47, Geneva 1206, Switzerland
| | - Michel Boulvain
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
| | - Manuela Undurraga Malinverno
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Route de Ferney 150, Geneva 1211, Switzerland
| | - Patrick Petignat
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1205, Switzerland
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Lam JUH, Rebolj M, Møller Ejegod D, Pedersen H, Rygaard C, Lynge E, Thirstrup Thomsen L, Krüger Kjaer S, Bonde J. Human papillomavirus self-sampling for screening nonattenders: Opt-in pilot implementation with electronic communication platforms. Int J Cancer 2017; 140:2212-2219. [PMID: 28195317 PMCID: PMC5516138 DOI: 10.1002/ijc.30647] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/23/2017] [Accepted: 02/01/2017] [Indexed: 01/23/2023]
Abstract
In organized cervical screening programs, typically 25% of the invited women do not attend. The Copenhagen Self‐sampling Initiative (CSi) aimed to gain experiences on participation among screening nonattenders in the Capital Region of Denmark. Here, we report on the effectiveness of different communication platforms used in the pilot with suggestions for strategies prior to a full‐implementation. Moreover, an innovative approach using self‐sampling brushes with unique radio frequency identification chips allowed for unprecedented levels patient identification safety. Nonattenders from the capital region of Denmark were identified via the organized national invitation module. Screening history was obtained via the nationwide pathology registry. Twenty‐four thousand women were invited, and as an alternative to the regular communication platforms (letter and phone), women could request a home test via a mobile‐friendly webpage. Instruction material and video‐animation in several languages were made available online. Chi‐square test was used to test differences. Out of all invited, 31.7% requested a home test, and 20% returned it to the laboratory. In addition, 10% were screened at the physician after receiving the invitation. Stratified by screening history, long‐term unscreened women were less likely to participate than intermittently screened women (28% vs. 16%, p < 0.001). Of all contacts received, 64% (63–65) came via letter, and 31% (95CI: 30–32%) via webpage/mobile‐app. Self‐sampling was well‐accepted among nonattenders. Adopting modern technology‐based platforms into the current organized screening program would serve as a convenient communication method between health authority and citizens, allowing easy access for the citizen and reducing the work load in administrating self‐sampling approaches. What's new? Our implementation study is the first to evaluate opt‐in self‐sampling for 24,000 screening nonattenders, which can be basis for future routine implementation. Women could respond through a variety of communication channels (regular mail, phone and custom‐made web/mobile‐app). Our study utilized self‐sampling brushes with a novel RFID‐chip for secure patient‐identification, eliminating inconveniences for the women to fill out forms on returning the brush and loss of brushes due to missing identification.
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Affiliation(s)
- Janni Uyen Hoa Lam
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Matejka Rebolj
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Helle Pedersen
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Carsten Rygaard
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Susanne Krüger Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.,Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
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31
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Tranberg M, Bech BH, Blaakær J, Jensen JS, Svanholm H, Andersen B. Study protocol of the CHOiCE trial: a three-armed, randomized, controlled trial of home-based HPV self-sampling for non-participants in an organized cervical cancer screening program. BMC Cancer 2016; 16:835. [PMID: 27809810 PMCID: PMC5094020 DOI: 10.1186/s12885-016-2859-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/11/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The effectiveness of cervical cancer screening programs is challenged by suboptimal participation and coverage. Offering cervico-vaginal self-sampling for human papillomavirus testing (HPV self-sampling) to non-participants can increase screening participation. However, the effect varies substantially among studies, especially depending on the approach used to offer HPV self-sampling. The present trial evaluates the effect on participation in an organized screening program of a HPV self-sampling kit mailed directly to the home of the woman or mailed to the woman's home on demand only, compared with the standard second reminder for regular screening. METHODS/DESIGN The CHOiCE trial is a parallel, randomized, controlled, open-label trial. It will include 9327 women aged 30-64 years who are living in the Central Denmark Region and who have not participated in cervical cancer screening after an invitation and one reminder. The women will be equally randomized into three arms: 1) Directly mailed a second reminder including a HPV self-sampling kit; 2) Mailed a second reminder offering a HPV self-sampling kit, to be ordered by e-mail, text message, phone, or through a webpage; and 3) Mailed a second reminder for a practitioner-collected sample (control group). The primary outcome will be the proportion of women in the intervention groups who participate by returning their HPV self-sampling kit or have a practitioner-collected sample compared with the proportion of women who have a practitioner-collected sample in the control group at 90 and 180 days after mail out of the second reminders. Per-protocol and intention-to-treat analyses will be performed. The secondary outcome will be the proportion of women with a positive HPV self-collected sample who attend follow-up testing at 30, 60, or 90 days after mail out of the results. DISCUSSION The CHOiCE trial will provide strong and important evidence allowing us to determine if and how HPV self-sampling can be used to increase participation in cervical cancer screening. This trial therefore has the potential to improve prevention and reduce the number of deaths caused by cervical cancer. TRIAL REGISTRATION Current Controlled Trials NCT02680262 . Registered 10 February 2016.
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Affiliation(s)
- Mette Tranberg
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.
| | - Bodil Hammer Bech
- Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Jan Blaakær
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Hans Svanholm
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.,Department of Pathology, Randers Regional Hospital, Østervangsvej 48, 8930, Randers, NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Ma'som M, Bhoo-Pathy N, Nasir NH, Bellinson J, Subramaniam S, Ma Y, Yap SH, Goh PP, Gravitt P, Woo YL. Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women. BMJ Open 2016; 6:e011022. [PMID: 27491667 PMCID: PMC4985871 DOI: 10.1136/bmjopen-2015-011022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women. METHOD A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, previous Pap smear experience, and attitudes towards self-administered cervicovaginal sampling were collected and analysed. Acceptability was inferred using a five-item Likert scale that included six different subjective descriptives: experience, difficulty, convenience, embarrassment, discomfort or pain, and confidence in collecting one's own sample. RESULTS Of the 839 participants, 47.9% were Malays, followed by 30.8% Indians, 18.8% Chinese and 2.5% from other ethnicities. The median age of the participants was 38 years (IQR 30-48). Some 68.2% of participants indicated a preference for self-sampling over the Pap test, with 95% indicating willingness to follow-up a positive result at the hospital. Age, ethnicity and previous Pap test experience were significant independent factors associated with preference for self-sampling. The older the individual, the less likely they were to prefer self-sampling (adjusted OR 0.94, 95% CI 0.90 to 0.98). The Chinese were less likely to prefer self-sampling (72.6%) than the Malays (85.1%) (adjusted OR 0.57, 95% CI 0.33 to 0.98, p=0.004). Participants who had never undergone a Pap smear were also more likely to prefer self-sampling (88.5%) than women who had undergone a previous Pap (80.9%) (adjusted OR 0.06, 95% CI 0.35 to 0.87). CONCLUSIONS Overall, urban Malaysian women from multiethnic backgrounds found self-sampling to be an acceptable alternative to Pap smear.
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Affiliation(s)
- Mahirah Ma'som
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- National Clinical Research Centre, Ministry of Health, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nazrila Hairizan Nasir
- Selangor State Health Department, Klinik Kesihatan Pandamaran, Ministry of Health, Kuala Lumpur, Malaysia
| | - Jerome Bellinson
- Preventive Oncology International Inc, Cleveland Heights, Ohio and The Women's Health Institute of the Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Yuntong Ma
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Siew-Hwei Yap
- University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Pik-Pin Goh
- National Clinical Research Centre, Ministry of Health, Malaysia
| | - Patti Gravitt
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
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Karjalainen L, Anttila A, Nieminen P, Luostarinen T, Virtanen A. Self-sampling in cervical cancer screening: comparison of a brush-based and a lavage-based cervicovaginal self-sampling device. BMC Cancer 2016; 16:221. [PMID: 26979237 PMCID: PMC4791879 DOI: 10.1186/s12885-016-2246-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High coverage and attendance is essential for cervical cancer screening success. We investigated whether the previous positive experiences on increasing screening attendance by self-sampling in Finland are sampler device dependent. METHODS All women identified to cervical cancer screening in 2013 in 28 Finnish municipalities were randomised to receive a lavage- (n = 6030) or a brush type of self-sampling device (n = 6045) in case of non-attendance after two invitation letters. Seven hundred seventy non-attending women in the lavage device group and 734 in the brush group received the self-sampling offer. Women's experiences were enquired with an enclosed questionnaire. RESULTS Total attendance in the lavage group increased from 71.0 to 77.7% by reminder letters and further to 80.5% by self-sampling. Respective increase in the brush group was from 72.2 to 78.6% and then to 81.5%. The participation by self-sampling was 21.7% (95% CI 18.8-24.6) in the lavage group and 23.8% (95% CI 20.8-26.9) in the brush group. Women's self-sampling experiences were mainly positive and the sampler devices were equally well accepted by the women. CONCLUSION Our study shows that the lavage device and brush device perform similarly in terms of uptake by non-attending women and user comfort. If self-sampling is integrated to the routine screening program in Finland, either of the devices can be chosen without the fear of losing participants due to a less acceptable device.
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Affiliation(s)
- Liisa Karjalainen
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland.
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Jorvi Hospital, Turuntie 150, Espoo, Finland
| | - Tapio Luostarinen
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland
| | - Anni Virtanen
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland
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34
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De Strooper LMA, Verhoef VMJ, Berkhof J, Hesselink AT, de Bruin HME, van Kemenade FJ, Bosgraaf RP, Bekkers RLM, Massuger LFAG, Melchers WJG, Steenbergen RDM, Snijders PJF, Meijer CJLM, Heideman DAM. Validation of the FAM19A4/mir124-2 DNA methylation test for both lavage- and brush-based self-samples to detect cervical (pre)cancer in HPV-positive women. Gynecol Oncol 2016; 141:341-347. [PMID: 26921784 PMCID: PMC4851217 DOI: 10.1016/j.ygyno.2016.02.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/09/2016] [Accepted: 02/13/2016] [Indexed: 12/20/2022]
Abstract
Objectives DNA methylation analysis of cancer-related genes is a promising tool for HPV-positive women to identify those with cervical (pre)cancer (CIN3+) in need of treatment. However, clinical performance of methylation markers can be influenced by the sample type utilized. We describe a multiplex quantitative methylation-specific PCR that targets FAM19A4 and mir124-2 loci, to detect CIN3+ using both HPV-positive lavage- and brush self-samples. Methods We determined methylation thresholds for clinical classification using HPV-positive training sets comprising lavage self-samples of 182 women (including 40 with CIN3+) and brush self-samples of 224 women (including 61 with CIN3+). Subsequently, independent HPV-positive validation sets of 389 lavage self-samples (including 78 with CIN3+), and 254 brush self-samples (including 72 with CIN3+) were tested using the preset thresholds. Furthermore, the clinical performance of combined methylation analysis and HPV16/18 genotyping was determined. Results Training set analysis revealed similar FAM19A4 and mir124-2 thresholds for both self-sample types to yield highest CIN3+ sensitivity at 70% specificity. Validation set analysis resulted in a CIN3+ sensitivity of 70.5% (95%CI: 60.4–80.6) at a specificity of 67.8% (95%CI: 62.7–73.0) for lavage self-samples, and a CIN3+ sensitivity of 69.4% (95%CI: 58.8–80.1) at a 76.4% (95%CI: 70.2–82.6) specificity for brush self-samples. In combination with HPV16/18 genotyping, CIN3+ sensitivity and specificity were 88.5% (95%CI: 81.4–95.6) and 46.0% (95%CI: 40.4–51.5) for lavage self-samples, and 84.7% (95%CI: 76.4–93.0) and 54.9% (95%CI: 47.7–62.2) for brush self-samples. Conclusions FAM19A4/mir124-2 methylation analysis performs equally well in HPV-positive lavage- and brush self-samples to identify women with CIN3+. In combination with HPV16/18 genotyping, significantly higher CIN3+ sensitivities are obtained, at decreased specificity. FAM19A4/mir124-2 triage of HPV-positive self-samples is a feasible and promising tool FAM19A4/mir124-2 analysis identifies HPV-positive women at risk of cervical cancer. FAM19A4/mir124-2 analysis performs equally well in lavage and brush self-samples. Further validation of HPV self-sampling with FAM19A4/mir124-2 triage is warranted
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Affiliation(s)
- Lise M A De Strooper
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Viola M J Verhoef
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | | | - Helena M E de Bruin
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Remko P Bosgraaf
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
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Sultana F, Mullins R, English DR, Simpson JA, Drennan KT, Heley S, Wrede CD, Brotherton JML, Saville M, Gertig DM. Women's experience with home-based self-sampling for human papillomavirus testing. BMC Cancer 2015; 15:849. [PMID: 26536865 PMCID: PMC4634718 DOI: 10.1186/s12885-015-1804-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/16/2015] [Indexed: 12/15/2022] Open
Abstract
Background Increasing cervical screening coverage by reaching inadequately screened groups is essential for improving the effectiveness of cervical screening programs. Offering HPV self-sampling to women who are never or under-screened can improve screening participation, however participation varies widely between settings. Information on women’s experience with self-sampling and preferences for future self-sampling screening is essential for programs to optimize participation. Methods The survey was conducted as part of a larger trial (“iPap”) investigating the effect of HPV self-sampling on participation of never and under-screened women in Victoria, Australia. Questionnaires were mailed to a) most women who participated in the self-sampling to document their experience with and preference for self-sampling in future, and b) a sample of the women who did not participate asking reasons for non-participation and suggestions for enabling participation. Reasons for not having a previous Pap test were also explored. Results About half the women who collected a self sample for the iPap trial returned the subsequent questionnaire (746/1521). Common reasons for not having cervical screening were that having Pap test performed by a doctor was embarrassing (18 %), not having the time (14 %), or that a Pap test was painful and uncomfortable (11 %). Most (94 %) found the home-based self-sampling less embarrassing, less uncomfortable (90 %) and more convenient (98 %) compared with their last Pap test experience (if they had one); however, many were unsure about the test accuracy (57 %). Women who self-sampled thought the instructions were clear (98 %), it was easy to use the swab (95 %), and were generally confident that they did the test correctly (81 %). Most preferred to take the self-sample at home in the future (88 %) because it was simple and did not require a doctor’s appointment. Few women (126/1946, 7 %) who did not return a self-sample in the iPap trial returned the questionnaire. Their main reason for not screening was having had a hysterectomy. Conclusions Home-based self-sampling can overcome emotional and practical barriers to Pap test and increase participation in cervical screening despite some women’s concerns about test accuracy. Mailing to eligible women and assuring women about test accuracy could further optimize participation in screening. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1804-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farhana Sultana
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Robyn Mullins
- Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Vic, 3004, Australia.
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. .,Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Vic, 3004, Australia.
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Kelly T Drennan
- Victorian Cervical Cytology Registry, PO Box 161, Carlton South, Vic, 3053, Australia.
| | - Stella Heley
- VCS Pathology, 265 Faraday Street, Carlton, Vic, 3053, Australia.
| | - C David Wrede
- Royal Women's Hospital, Locked Bag 300, Cnr Flemington Road and Grattan Street, Parkville, VIC, 3052, Australia. .,Department of Obstetrics & Gyneacology, University of Melbourne, Melbourne, Australia.
| | - Julia M L Brotherton
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. .,VCS Inc, 265 Faraday Street, Carlton, Vic, 3053, Australia. .,National HPV Vaccination Program Register, Victorian Cytology Service, PO Box 310, East Melbourne, Vic, 3002, Australia.
| | - Marion Saville
- VCS Inc, 265 Faraday Street, Carlton, Vic, 3053, Australia. .,VCS Pathology, 265 Faraday Street, Carlton, Vic, 3053, Australia.
| | - Dorota M Gertig
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. .,Victorian Cervical Cytology Registry, PO Box 161, Carlton South, Vic, 3053, Australia. .,VCS Inc, 265 Faraday Street, Carlton, Vic, 3053, Australia.
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Concordance analysis of methylation biomarkers detection in self-collected and physician-collected samples in cervical neoplasm. BMC Cancer 2015; 15:418. [PMID: 25985991 PMCID: PMC4448302 DOI: 10.1186/s12885-015-1411-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/30/2015] [Indexed: 01/09/2023] Open
Abstract
Background Non-attendance at gynecological clinics is a major limitation of cervical cancer screening and self-collection of samples may improve this situation. Although HPV testing of self-collected vaginal samples is acceptable, the specificity is inadequate. The current focus is increasing self-collection of vaginal samples to minimize clinic visits. In this study, we analyzed the concordance and clinical performance of DNA methylation biomarker (PAX1, SOX1, and ZNF582) detection in self-collected vaginal samples and physician-collected cervical samples for the identification of cervical neoplasm. Methods We enrolled 136 cases with paired methylation data identified from abnormal Pap smears (n = 126) and normal controls (n = 10) regardless of HPV status at gynecological clinics. The study group comprised 37 cervical intraepithelial neoplasm I (CIN1), 23 cervical intraepithelial neoplasm II (CIN2), 16 cervical intraepithelial neoplasm III (CIN3), 30 carcinoma in situ (CIS), 13 squamous cell carcinomas (SCCs) and seven adenocarcinomas (ACs)/adenosquamous carcinomas (ASCs). PAX1, SOX1 and ZNF582 methylation in study samples was assessed by real-time quantitative methylation-specific polymerase chain reaction analysis. We generated methylation index cutoff values for the detection of CIN3+ in physician-collected cervical samples for analysis of the self-collected group. Concordance between the physician-collected and self-collected groups was evaluated by Cohen’s Kappa. Sensitivity, specificity and area under curve (AUC) were calculated for detection of CIN3+ lesions. Finally, we produced an optimal cutoff value with the best sensitivity from the self-collected groups. Results We generated a methylation index cutoff value from physician-collected samples for detection of CIN3+. There were no significant differences in sensitivity, specificity of PAX1, SOX1 and ZNF582 between the self-collected and physician-collected groups. The methylation status of all three genes in the normal control samples, and the CIN 1, CIN2, CIN3, CIS, ACs/ASCs and SCC samples showed reasonable to good concordance between the two groups (κ = 0.443, 0.427, and 0.609 for PAX1, SOX1, and ZNF582, respectively). In determining the optimal cutoff values from the self-collected group, ZNF582 showed the highest sensitivity (0.77; 95%CI, 0.65–0.87) using a cutoff value of 0.0204. Conclusions Methylation biomarker analysis of the three genes for detection of CIN3+ lesions shows reasonable to good concordance between the self-collected and physician-collected samples. Therefore, self-collection of samples could be adopted to decrease non-attendance and improve cervical screening.
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Giorgi Rossi P, Fortunato C, Barbarino P, Boveri S, Caroli S, Del Mistro A, Ferro A, Giammaria C, Manfredi M, Moretto T, Pasquini A, Sideri M, Tufi MC, Cogo C, Altobelli E. Self-sampling to increase participation in cervical cancer screening: an RCT comparing home mailing, distribution in pharmacies, and recall letter. Br J Cancer 2015; 112:667-75. [PMID: 25633037 PMCID: PMC4333501 DOI: 10.1038/bjc.2015.11] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/19/2014] [Accepted: 12/25/2014] [Indexed: 01/23/2023] Open
Abstract
Background: We performed a multicentre randomised controlled trial to evaluate the effect on participation in organised screening programmes of a self-sampling device mailed home or picked up at a pharmacy compared with the standard recall letter. Methods: Women aged 30–64 non-responding to screening invitation were eligible. Response rate to first invitation ranged from 30% to 60% between centres. The control was the standard reminder letter to undergo the test used by the programme (Pap test in three centres and HPV DNA test in three other centres). Home mailing of the self-sampler was preceded by a letter with a leaflet about HPV. The analysis was intention-to-treat. Results: In all, 14 041 women were randomised and recruited: 5012 in the control arm, 4516 to receive the self-sampler at home, and 4513 to pick up the self-sampler at a pharmacy. Participation was 11.9% in the control, 21.6% (relative participation: 1.75; 95% CI 1.60–1.93) in home, and 12.0% (relative participation: 0.96; 95% CI 0.86–1.07) in the pharmacy arms, respectively. The heterogeneity between centres was high (excess heterogeneity of that expected due to chance, i.e., I2, 94.9% and 94.1% for home and pharmacy arm, respectively). The estimated impact on the overall coverage was +4.3% for home mail self-sampling compared with +2.2% for standard reminder. Conclusions: Home mailing of self-sampler proved to be an effective way to increase participation in screening programmes, even in those with HPV as primary testing. Picking up at pharmacies showed effects varying from centre to centre.
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Affiliation(s)
- P Giorgi Rossi
- 1] Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, via Amendola 2, Reggio Emilia 42122, Italy [2] IRCCS-Arcispedale S. Maria Nuova, 42122 Reggio Emilia, Italy
| | - C Fortunato
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Viale San Salvatore, Edificio Delta 6, 67100 L'Aquila, Italy
| | - P Barbarino
- UOC Screening e prevenzione ASL Roma G, 00019 Tivoli (Rome), Italy
| | - S Boveri
- Preventive Gynaecology Unit, European Institute of Oncology, 20141 Milano, Italy
| | - S Caroli
- 1] Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, via Amendola 2, Reggio Emilia 42122, Italy [2] IRCCS-Arcispedale S. Maria Nuova, 42122 Reggio Emilia, Italy
| | - A Del Mistro
- Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - A Ferro
- Dipartimento di Prevenzione Azienda ULSS 17, 35042 Este-Monselice (PD), Italy
| | - C Giammaria
- UOC Ginecologia e Ostetricia, Screening Oncologici Regionali Ospedale Cardarelli, 86100 Campobasso (CB), Italy
| | - M Manfredi
- Programma Screening Oncologici AUSL di Bologna, 40068 San Lazzaro di Savena (BO), Italy
| | - T Moretto
- Dipartimento di Prevenzione Azienda ULSS 7 Pieve di Soligo - Conegliano, 31053 Pieve di Soligo (TV), Italy
| | - A Pasquini
- Programma Screening Oncologici AUSL di Bologna, 40068 San Lazzaro di Savena (BO), Italy
| | - M Sideri
- Preventive Gynaecology Unit, European Institute of Oncology, 20141 Milano, Italy
| | - M C Tufi
- UOC Screening e prevenzione ASL Roma G, 00019 Tivoli (Rome), Italy
| | - C Cogo
- Registro tumori del Veneto, 35131 Padova, Italy
| | - E Altobelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Viale San Salvatore, Edificio Delta 6, 67100 L'Aquila, Italy
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Virtanen A, Nieminen P, Niironen M, Luostarinen T, Anttila A. Self-sampling experiences among non-attendees to cervical screening. Gynecol Oncol 2014; 135:487-94. [DOI: 10.1016/j.ygyno.2014.09.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 12/19/2022]
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Verhoef VMJ, Heideman DAM, van Kemenade FJ, Rozendaal L, Bosgraaf RP, Hesselink AT, Bekkers RLM, Massuger LFAG, Steenbergen RDM, Snijders PJF, Berkhof J, Meijer CJLM. Methylation marker analysis and HPV16/18 genotyping in high-risk HPV positive self-sampled specimens to identify women with high grade CIN or cervical cancer. Gynecol Oncol 2014; 135:58-63. [PMID: 25111387 DOI: 10.1016/j.ygyno.2014.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/24/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Methylation marker analysis using bi-marker panel MAL/miR-124-2 is a promising triage test for identifying cervical (pre)cancer in high-risk human papillomavirus (hrHPV) positive women. Bi-marker panel MAL/miR-124-2 can be applied directly on self-sampled cervico-vaginal material and its sensitivity is non-inferior to that of cytology, yet at the cost of more colposcopy referrals. Our objective was to increase specificity of MAL/miR-124-2 methylation analysis by varying the assay thresholds and adding HPV16/18 genotyping. METHODS 1019 hrHPV-positive women were selected from a randomized controlled self-sampling trial (PROHTECT-3; 33-63 years, n=46,001) and nine triage strategies with methylation testing of MAL/miR-124-2 and HPV16/18 genotyping were evaluated. The methylation assay threshold was set at four different predefined levels which correspond with clinical specificities for end-point cervical intra-epithelial grade 3 or worse (CIN3+) of 50%, 60%, 70%, and 80%. RESULTS The CIN3+ sensitivity of methylation analysis decreased (73.5 to 44.9%) while specificity increased (47.2 to 83.4%) when increasing the assay threshold. CIN3+ sensitivity and specificity of HPV16/18 genotyping were 68.0% and 65.6%, respectively. Combined methylation analysis at threshold-80 and HPV16/18 genotyping yielded similar CIN3+ sensitivity as that of methylation only at threshold-50 (77.6%) with an increased specificity (54.8%). CONCLUSIONS Combined triage by MAL/miR-124-2 methylation analysis with threshold-80 and HPV16/18 genotyping reaches high CIN3+ sensitivity with increased specificity to identify women with cervical (pre)cancer among HPV self-sample positive women. The combined strategy is attractive as it is fully molecular and identifies women at the highest risk of cervical (pre)cancer because of strongly elevated methylation levels and/or HPV16/18 positivity.
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Affiliation(s)
- Viola M J Verhoef
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Daniëlle A M Heideman
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Lawrence Rozendaal
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Remko P Bosgraaf
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Albertus T Hesselink
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Renske D M Steenbergen
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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DNA methylation analysis in self-sampled brush material as a triage test in hrHPV-positive women. Br J Cancer 2014; 111:1095-101. [PMID: 25032730 PMCID: PMC4453842 DOI: 10.1038/bjc.2014.392] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Primary high-risk human papillomavirus (hrHPV) testing in cervical cancer screening shows relatively low specificity, which makes triage testing necessary. In this study, DNA methylation analysis was compared with cytology for triage testing in hrHPV-positive women. Moreover, feasibility of DNA methylation analysis directly on brush-based self-sampled specimens was assessed. METHODS Non-responding women from population-based screening were invited to self-collect a cervico-vaginal specimen for hrHPV testing; hrHPV-positive women were referred to a physician for triage liquid-based cytology. DNA methylation analysis was performed on 128 hrHPV-positive physician-collected triage samples and 50 matched brush self-samples with QMSP for C13ORF18, EPB41L3, JAM3 and TERT. RESULTS In physician-taken triage material, DNA methylation analysis of JAM3 showed the highest combined specificity (88%) and sensitivity (82%) for detection of CIN3+, whereas cytology showed a specificity of 48% and a sensitivity of 91%. Out of 39 women with abnormal cytology and normal histology (false-positive by cytology), 87% were negative for JAM3 and 90% for C13ORF18 methylation. Agreement between DNA methylation analysis performed directly on the matched self-sampled material and physician-taken samples was 88% for JAM3 (κ=0.75, P<0.001) and 90% for C13ORF18 (κ=0.77; P<0.001). CONCLUSIONS DNA methylation analysis as a triage test in hrHPV-positive women is an attractive alternative to cytology. Furthermore, DNA methylation is feasible directly on brush-based self-samplers and showed good correlation with matched physician-taken samples. Direct molecular triage on self-collected specimens could optimise the screening program, especially for non-responders, as this would eliminate the need for an additional physician-taken scraping for triage testing.
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