1
|
Muraki I, Sobue T, Yamagishi K, Tsugane S, Sawada N, Iso H. Validity of self-reported participation in cancer screenings and health checkups in Japan. J Epidemiol 2024:JE20240090. [PMID: 38910128 DOI: 10.2188/jea.je20240090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND The participation rate for screening is regarded as a useful indicator for preventing cancer and cardio-metabolic disease. However, the validity of self-reported screening participation has not yet been thoroughly evaluated in Japan. We aimed to examine its validity using the municipal screening records among the Japanese population. METHODS We included 3,060 men and 3,860 women insured by the National Health Insurance for residents aged <75 years or the Medical Care System for the Elderly aged ≥75 years in the Chikusei area of the Japan Public Health Center-based Prospective Study for the Next Generation. They were asked about their participation in cancer screenings and health checkups during the previous year. We compared their responses to the municipal records and calculated the sensitivity and specificity of self-reported screening participation. RESULTS The sensitivity and specificity of self-reported participation were 0.49 and 0.86 for lung cancer screening; 0.67 and 0.85 for colorectal cancer screening; 0.77 and 0.79 for stomach cancer screening; and 0.86 and 0.65 for health checkup, respectively. Among women, the sensitivity and specificity were 0.83 and 0.81 for breast cancer and 0.85 and 0.90 for cervical cancer, respectively. CONCLUSION Self-reported cancer screening participation for colorectal, stomach, breast, and cervical cancers had moderate-high sensitivity and specificity. Self-reported participation, especially for lung cancer screening and health checkups, should be carefully interpreted when assessing the performance of preventive measures.
Collapse
Affiliation(s)
- Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Tomotaka Sobue
- Environmental Medicine, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Kazumasa Yamagishi
- Department of Public Health, Graduate School of Medicine, Juntendo University
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba
| | - Shoichiro Tsugane
- International University of Health and Welfare Graduate School of Public Health
- Division of Cohort Research, National Cancer Center Institute for Cancer Control
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control
| | - Hiroyasu Iso
- Institute for Global Health Policy Research Center, Bureau of International Health Cooperation, National Center for Global Health and Medicine
| |
Collapse
|
2
|
Ouh YT, Kim HY, Yi KW, Lee NW, Kim HJ, Min KJ. Enhancing Cervical Cancer Screening: Review of p16/Ki-67 Dual Staining as a Promising Triage Strategy. Diagnostics (Basel) 2024; 14:451. [PMID: 38396493 PMCID: PMC10888225 DOI: 10.3390/diagnostics14040451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Cervical cancer, primarily caused by high-risk human papillomavirus (HR-HPV) types 16 and 18, is a major global health concern. Persistent HR-HPV infection can progress from reversible precancerous lesions to invasive cervical cancer, which is driven by the oncogenic activity of human papillomavirus (HPV) genes, particularly E6 and E7. Traditional screening methods, including cytology and HPV testing, have limited sensitivity and specificity. This review explores the application of p16/Ki-67 dual-staining cytology for cervical cancer screening. This advanced immunocytochemical method allows for simultaneously detecting p16 and Ki-67 proteins within cervical epithelial cells, offering a more specific approach for triaging HPV-positive women. Dual staining and traditional methods are compared, demonstrating their high sensitivity and negative predictive value but low specificity. The increased sensitivity of dual staining results in higher detection rates of CIN2+ lesions, which is crucial for preventing cervical cancer progression. However, its low specificity may lead to increased false-positive results and unnecessary biopsies. The implications of integrating dual staining into contemporary screening strategies, particularly considering the evolving landscape of HPV vaccination and changes in HPV genotype prevalence, are also discussed. New guidelines and further research are necessary to elucidate the long-term effects of integrating dual staining into screening protocols.
Collapse
Affiliation(s)
| | | | | | | | | | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan-si 15355, Gyeonggi-do, Republic of Korea; (Y.-T.O.); (H.Y.K.); (K.W.Y.); (N.-W.L.); (H.-J.K.)
| |
Collapse
|
3
|
Sroczynski G, Hallsson LR, Mühlberger N, Jahn B, Rehms R, Hoffmann S, Crispin A, Lindoerfer D, Mansmann U, Siebert U. Long-term benefits and harms of early colorectal cancer screening in German individuals with familial cancer risk. Int J Cancer 2024; 154:516-529. [PMID: 37795630 DOI: 10.1002/ijc.34747] [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: 05/08/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 10/06/2023]
Abstract
Individuals with a family history of colorectal cancer (CRC) may benefit from early screening with colonoscopy or immunologic fecal occult blood testing (iFOBT). We systematically evaluated the benefit-harm trade-offs of various screening strategies differing by screening test (colonoscopy or iFOBT), interval (iFOBT: annual/biennial; colonoscopy: 10-yearly) and age at start (30, 35, 40, 45, 50 and 55 years) and end of screening (65, 70 and 75 years) offered to individuals identified with familial CRC risk in Germany. A Markov-state-transition model was developed and used to estimate health benefits (CRC-related deaths avoided, life-years gained [LYG]), potential harms (eg, associated with additional colonoscopies) and incremental harm-benefit ratios (IHBR) for each strategy. Both benefits and harms increased with earlier start and shorter intervals of screening. When screening started before age 50, 32-36 CRC-related deaths per 1000 persons were avoided with colonoscopy and 29-34 with iFOBT screening, compared to 29-31 (colonoscopy) and 28-30 (iFOBT) CRC-related deaths per 1000 persons when starting age 50 or older, respectively. For iFOBT screening, the IHBRs expressed as additional colonoscopies per LYG were one (biennial, age 45-65 vs no screening), four (biennial, age 35-65), six (biennial, age 30-70) and 34 (annual, age 30-54; biennial, age 55-75). Corresponding IHBRs for 10-yearly colonoscopy were four (age 55-65), 10 (age 45-65), 15 (age 35-65) and 29 (age 30-70). Offering screening with colonoscopy or iFOBT to individuals with familial CRC risk before age 50 is expected to be beneficial. Depending on the accepted IHBR threshold, 10-yearly colonoscopy or alternatively biennial iFOBT from age 30 to 70 should be recommended for this target group.
Collapse
Affiliation(s)
- Gaby Sroczynski
- Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Lára R Hallsson
- Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Nikolai Mühlberger
- Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Beate Jahn
- Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Raphael Rehms
- Department of Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians Universität, Munich, Germany
| | - Sabine Hoffmann
- Department of Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians Universität, Munich, Germany
| | - Alexander Crispin
- Department of Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians Universität, Munich, Germany
| | - Doris Lindoerfer
- Department of Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians Universität, Munich, Germany
- Chronobiology and Health, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ulrich Mansmann
- Department of Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians Universität, Munich, Germany
| | - Uwe Siebert
- Department of Public Health, Health Services Research, and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Health Policy & Management, Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
De Prez V, Jolidon V, Cullati S, Burton-Jeangros C, Bracke P. Cervical cancer (over-)screening in Europe: Balancing organised and opportunistic programmes. Scand J Public Health 2023; 51:1239-1247. [PMID: 36016469 DOI: 10.1177/14034948221118215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Cervical cancer (CC) over-screening has been understudied in Europe, yet is relevant for approaching inequalities in screening uptake. Focusing on countries' screening strategies (opportunistic systems versus organised programmes), we assess in which contexts CC over-screening is more prevalent, and which women are more likely to have engaged in cervical cancer screening (CCS) within the past year. METHODS A two-level (multilevel) design among screening women (N = 80,761) nested in 31 European countries was used to analyse data from the second wave (2013-2015) of the European Health Interview Survey. We focused on over-screening, defined as screening more frequently than the three-yearly screening interval prescribed in the European guidelines - that is, having screened within the past year. RESULTS Higher levels of over-screening were observed in opportunistic systems compared to systems with organised programmes. In opportunistic systems, women with a higher socioeconomic position had a higher likelihood of being screened within the past year than their socioeconomic counterparts. Moreover, these differences diminished under organised programmes. CONCLUSIONS Contexts with organised CCS programmes are more efficiently reducing over-screening, and enforcing the European guidelines. We suggest that the physician-patient relationship is an essential pathway for explaining socioeconomic differences in CC (over-)screening and for future interventions.
Collapse
Affiliation(s)
| | - Vladimir Jolidon
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Switzerland
| | - Stéphane Cullati
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Switzerland
- Population Health Laboratory, Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Switzerland
| | - Claudine Burton-Jeangros
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Switzerland
| | - Piet Bracke
- Department of Sociology, Ghent University, Belgium
| |
Collapse
|
5
|
Sørbye SW, Falang BM, Botha MH, Snyman LC, van der Merwe H, Visser C, Richter K, Dreyer G. Enhancing Cervical Cancer Prevention in South African Women: Primary HPV mRNA Screening with Different Genotype Combinations. Cancers (Basel) 2023; 15:5453. [PMID: 38001713 PMCID: PMC10670851 DOI: 10.3390/cancers15225453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Cervical cancer prevention in regions with limited access to screening and HPV vaccination necessitates innovative approaches. This study explored the potential of a test-and-treat strategy using mRNA HPV tests to impact cervical cancer prevention in a high-prevalence HIV population. METHODS A cervical screening study was conducted at three South African hospitals involving 710 under-screened, non-pregnant women (25 to 65 years) without known cervical diseases. Cytology, HPV testing, colposcopy, and biopsies were performed concurrently. Histopathologists determined final histological diagnoses based on biopsy and LLETZ histology. mRNA-HPV-genotyping for 3 (16, 18, 45) to 8 (16, 18, 31, 33, 35, 45, 52, 58) high-risk types was performed on leftover liquid-based cytology material. The preventive potential of the test-and-treat approach was estimated based on published data, reporting the causative HPV types in cervical cancer tissue from South African women. Treatment was provided as needed. RESULTS The HPV positivity rate more than doubled from 3-type (15.2%; 95% CI: 12.6-17.8) to 8-type mRNA (31.5%; 95% CI: 28.8-34.9) combinations, significantly higher among HIV-positive women. CIN3+ prevalence among HIV-positive women (26.4%) was double that of HIV-negative women (12.9%) (p < 0.01). The 6-type combination showed the best balance of sensitivity, specificity and treatment group size, and effectiveness to prevent cervical cancer. A 4-type combination (16, 18, 35, 45) could potentially prevent 77.6% (95% CI: 71.2-84.0) of cervical cancer burden by treating 20% and detecting 41.1% of CIN3 cases in the study group. Similarly, a 6-type combination (16, 18, 31, 33, 35, 45), treating 25% and including 62% of CIN3 cases, might prevent 85% of cervical cancer cases (95% CI: 79.6-90.6) among HIV-positive and negative women. CONCLUSION Employing mRNA HPV tests within a test-and-treat approach holds huge promise for targeted cervical cancer prevention in under-screened populations. Testing for mRNA of the 6 highest-risk HPV types in this population and treating them all is projected to effectively prevent progression from CIN3 to invasive cervical cancer while reducing overtreatment in resource-constrained settings.
Collapse
Affiliation(s)
| | | | - Matthys H. Botha
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (M.H.B.); (H.v.d.M.)
| | - Leon Cornelius Snyman
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa; (L.C.S.); (C.V.); (G.D.)
| | - Haynes van der Merwe
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; (M.H.B.); (H.v.d.M.)
| | - Cathy Visser
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa; (L.C.S.); (C.V.); (G.D.)
| | - Karin Richter
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa;
| | - Greta Dreyer
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa; (L.C.S.); (C.V.); (G.D.)
| |
Collapse
|
6
|
Senevirathna P, Pires DEV, Capurro D. Data-driven overdiagnosis definitions: A scoping review. J Biomed Inform 2023; 147:104506. [PMID: 37769829 DOI: 10.1016/j.jbi.2023.104506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Adequate methods to promptly translate digital health innovations for improved patient care are essential. Advances in Artificial Intelligence (AI) and Machine Learning (ML) have been sources of digital innovation and hold the promise to revolutionize the way we treat, manage and diagnose patients. Understanding the benefits but also the potential adverse effects of digital health innovations, particularly when these are made available or applied on healthier segments of the population is essential. One of such adverse effects is overdiagnosis. OBJECTIVE to comprehensively analyze quantification strategies and data-driven definitions for overdiagnosis reported in the literature. METHODS we conducted a scoping systematic review of manuscripts describing quantitative methods to estimate the proportion of overdiagnosed patients. RESULTS we identified 46 studies that met our inclusion criteria. They covered a variety of clinical conditions, primarily breast and prostate cancer. Methods to quantify overdiagnosis included both prospective and retrospective methods including randomized clinical trials, and simulations. CONCLUSION a variety of methods to quantify overdiagnosis have been published, producing widely diverging results. A standard method to quantify overdiagnosis is needed to allow its mitigation during the rapidly increasing development of new digital diagnostic tools.
Collapse
Affiliation(s)
- Prabodi Senevirathna
- School of Computing and Information Systems, The University of Melbourne, Melbourne, 3053, Victoria, Australia
| | - Douglas E V Pires
- School of Computing and Information Systems, The University of Melbourne, Melbourne, 3053, Victoria, Australia; Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, 3053, Victoria, Australia.
| | - Daniel Capurro
- School of Computing and Information Systems, The University of Melbourne, Melbourne, 3053, Victoria, Australia; Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, 3053, Victoria, Australia; Department of General Medicine, Royal Melbourne Hospital, Melbourne, 3053, Victoria, Australia.
| |
Collapse
|
7
|
Hallsson LR, Sroczynski G, Engel J, Siebert U. Decision-analytic evaluation of the comparative effectiveness and cost-effectiveness of strategies to prevent breast and ovarian cancer in German women with BRCA-1/2 mutations. BMC Cancer 2023; 23:590. [PMID: 37365514 DOI: 10.1186/s12885-023-10956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/13/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Women with inherited mutations in the BRCA1 or BRCA2 genes have increased lifetime risks for developing breast and/or ovarian cancer and may develop these cancers around the age of 30 years. Therefore, prevention of breast and ovarian cancer in these women may need to start relatively early in life. In this study we systematically evaluate the long-term effectiveness and cost effectiveness of different prevention strategies for breast and ovarian cancer in women with BRCA-1/2 mutation in Germany. METHODS A decision-analytic Markov model simulating lifetime breast and ovarian cancer development in BRCA-1/2 carriers was developed. Different strategies including intensified surveillance (IS), prophylactic bilateral mastectomy (PBM), and prophylactic bilateral salpingo-oophorectomy (PBSO) alone or in combination at different ages were evaluated. German clinical, epidemiological, and economic (in 2022 Euro) data were used. Outcomes included cancer incidences, mortality, life years (LYs), quality-adjusted life years (QALYs), and discounted incremental cost-effectiveness ratios (ICER). We adopted the German health-care system perspective and discounted costs and health effects with 3% annually. RESULTS All intervention strategies are more effective and less costly than IS alone. Prevention with PBM plus PBSO at age 30 maximizes life expectancy with 6.3 LYs gained, whereas PBM at age 30 with delayed PBSO at age 35 improves quality of life with 11.1 QALYs gained, when compared to IS alone. A further delay of PBSO was associated with lower effectiveness. Both strategies are cost effective with ICERs significantly below 10,000 EUR/LYG or QALY. CONCLUSION Based on our results, PBM at age 30 plus PBSO between age 30 and 40 prolongs life and is cost effective in women with BRCA-1/2 mutations in Germany. Serial preventive surgeries with delayed PBSO potentially improve quality of life for women. However, delaying PBM and/or PBSO further may lead to increased mortality and reduced QALYs.
Collapse
Affiliation(s)
- Lára R Hallsson
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, Hall in Tirol, A-6060, Austria
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
- IBE-Institute for Medical Informatics, Biometry and Epidemiology, LMU-Ludwig-Maximilians- University, Munich, Germany
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, Hall in Tirol, A-6060, Austria
| | - Jutta Engel
- MCR-Munich Cancer Registry, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians Universität (LMU), Munich, Germany
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, Hall in Tirol, A-6060, Austria.
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Institute for Technology Assessment, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
8
|
Sørbye SW, Falang BM, Antonsen M. Performance of a 7-Type HPV mRNA Test in Triage of HPV DNA Primary Screen Positive Women Compared to Liquid-Based Cytology. JOURNAL OF MOLECULAR PATHOLOGY 2023. [DOI: 10.3390/jmp4020008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: A plethora of data supports HPV-based screening to be the preferred strategy for cervical cancer prevention. The shift to a more sensitive first-line test brings the need of effective triage up for discussion. Currently, most algorithms apply cytology as a triage of HPV-DNA positive women. This study compared the performance of a 7-type HPV-mRNA test to cytology. Methods: From 1 January 2019 until 31 December 2021, cervical samples from 58,029 women were examined at the University Hospital of North Norway. A total of 30.5% (17,684/58,029) fulfilled the criteria for HPV-DNA primary screening. All positive samples were triaged by cytology and followed-up according to national guidelines through 2022. Additionally, a 7-type HPV-mRNA test was applied. The study endpoint was a histologically confirmed high-grade lesion (CIN2+). Results: A total of 5.6% (990/17,684) had positive HPV-DNA test, 97.2% (962/990) with valid HPV-mRNA results. A total of 55.5% (534/962) had abnormal cytology (ASC-US+), and 35.1% (338/962) had a positive HPV-mRNA test. A total of 13.9% (134/962) had CIN2+. The sensitivity (CIN2+) of cytology versus the HPV-mRNA test was 76.1% (102/134) versus 73.1% (98/134), p = 0.67. The specificity was 47.8% (396/828) versus 71.0% (588/624), p < 0.001. PPV was 19.1% (102/534) and 29.0% (98/338), p < 0.001, respectively. The number of colposcopies per CIN2+ detected by cytology and HPV-mRNA test was 5.2 and 3.1. Conclusion: The 7-type HPV mRNA test was significantly more specific than cervical cytology in a triage of HPV-DNA positive women. Using this biomarker as the threshold for colposcopy may better balance the benefits and harms of screening.
Collapse
|
9
|
On the role of data, statistics and decisions in a pandemic. ASTA ADVANCES IN STATISTICAL ANALYSIS 2022; 106:349-382. [PMID: 35432617 PMCID: PMC8988552 DOI: 10.1007/s10182-022-00439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/09/2022] [Indexed: 12/03/2022]
Abstract
A pandemic poses particular challenges to decision-making because of the need to continuously adapt decisions to rapidly changing evidence and available data. For example, which countermeasures are appropriate at a particular stage of the pandemic? How can the severity of the pandemic be measured? What is the effect of vaccination in the population and which groups should be vaccinated first? The process of decision-making starts with data collection and modeling and continues to the dissemination of results and the subsequent decisions taken. The goal of this paper is to give an overview of this process and to provide recommendations for the different steps from a statistical perspective. In particular, we discuss a range of modeling techniques including mathematical, statistical and decision-analytic models along with their applications in the COVID-19 context. With this overview, we aim to foster the understanding of the goals of these modeling approaches and the specific data requirements that are essential for the interpretation of results and for successful interdisciplinary collaborations. A special focus is on the role played by data in these different models, and we incorporate into the discussion the importance of statistical literacy and of effective dissemination and communication of findings.
Collapse
|
10
|
Poniewierza P, Panek G. Cervical Cancer Prophylaxis—State-of-the-Art and Perspectives. Healthcare (Basel) 2022; 10:healthcare10071325. [PMID: 35885852 PMCID: PMC9319342 DOI: 10.3390/healthcare10071325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Each year 604,127 new cases of cervical cancer (CC) are diagnosed, and 341,831 individuals die from the disease. It is the fourth most common cancer among women and the fourth most common cause of death from female cancers worldwide. The pathogenesis of CC is associated with human papillomavirus (HPV) infections and consists of several steps involving cell proliferation outside the human body’s control mechanisms. Strategies to prevent CC are based on screening and vaccination. Scope of the Review: The aim of this paper was to collect and analyze the available literature on the issue of CC prevention and the impact of the COVID-19 pandemic on its implementation. For this purpose, PubMed and Google Scholar databases were searched using keywords, such as “cervical cancer”; “HPV”; “prevention”; “prophylaxis”; “vaccination”; “screening” and “COVID-19” in different variations. Only articles published since 2018 were included in the study. Conclusions: Selected European countries have different CC prevention programs funded by national budgets. This translates into observed differences in the risk of death from CC (age-standardized rate Malta = 1.1, Poland = 5.9). COVID-19 pandemic due to disruption of CC screening may exacerbate these differences in the future. To improve the situation, new screening methods, such as p16/Ki67, HPV self-testing, and the use of artificial intelligence in colposcopic assessment, should be disseminated, as well as free HPV vaccination programs implemented in all countries. The search for new solutions is not without significance and entails ultra-sensitive screening tests for risk groups (mRNA E6/E7, SOX1/SOX14), HPV vaccines with shorter dosing schedules, and new therapeutic pathways using nanotheranostics.
Collapse
Affiliation(s)
- Patryk Poniewierza
- Medicover SP ZOO Company, Aleje Jerozolimskie 96, 00-807 Warsaw, Poland
- Correspondence:
| | - Grzegorz Panek
- Department of Oncologic Gynecology and Obstetrics, The Center of Postgraduate Medical Education, 00-416 Warsaw, Poland;
| |
Collapse
|
11
|
Christley S, Ostmeyer J, Quirk L, Zhang W, Sirak B, Giuliano AR, Zhang S, Monson N, Tiro J, Lucas E, Cowell LG. T Cell Receptor Repertoires Acquired via Routine Pap Testing May Help Refine Cervical Cancer and Precancer Risk Estimates. Front Immunol 2021; 12:624230. [PMID: 33868241 PMCID: PMC8050337 DOI: 10.3389/fimmu.2021.624230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is the fourth most common cancer and fourth leading cause of cancer death among women worldwide. In low Human Development Index settings, it ranks second. Screening and surveillance involve the cytology-based Papanicolaou (Pap) test and testing for high-risk human papillomavirus (hrHPV). The Pap test has low sensitivity to detect precursor lesions, while a single hrHPV test cannot distinguish a persistent infection from one that the immune system will naturally clear. Furthermore, among women who are hrHPV-positive and progress to high-grade cervical lesions, testing cannot identify the ~20% who would progress to cancer if not treated. Thus, reliable detection and treatment of cancers and precancers requires routine screening followed by frequent surveillance among those with past abnormal or positive results. The consequence is overtreatment, with its associated risks and complications, in screened populations and an increased risk of cancer in under-screened populations. Methods to improve cervical cancer risk assessment, particularly assays to predict regression of precursor lesions or clearance of hrHPV infection, would benefit both populations. Here we show that women who have lower risk results on follow-up testing relative to index testing have evidence of enhanced T cell clonal expansion in the index cervical cytology sample compared to women who persist with higher risk results from index to follow-up. We further show that a machine learning classifier based on the index sample T cells predicts this transition to lower risk with 95% accuracy (19/20) by leave-one-out cross-validation. Using T cell receptor deep sequencing and machine learning, we identified a biophysicochemical motif in the complementarity-determining region 3 of T cell receptor β chains whose presence predicts this transition. While these results must still be tested on an independent cohort in a prospective study, they suggest that this approach could improve cervical cancer screening by helping distinguish women likely to spontaneously regress from those at elevated risk of progression to cancer. The advancement of such a strategy could reduce surveillance frequency and overtreatment in screened populations and improve the delivery of screening to under-screened populations.
Collapse
Affiliation(s)
- Scott Christley
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jared Ostmeyer
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Lisa Quirk
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Wei Zhang
- Department of Neurology and Neurotherapeutics, Department of Immunology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Bradley Sirak
- Center for Immunization and Infection Research, Moffitt Cancer Center, Tampa, FL, United States
| | - Anna R Giuliano
- Center for Immunization and Infection Research, Moffitt Cancer Center, Tampa, FL, United States
| | - Song Zhang
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Nancy Monson
- Department of Neurology and Neurotherapeutics, Department of Immunology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jasmin Tiro
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Elena Lucas
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, United States.,Department of Pathology, Parkland Health and Hospital System, Dallas, TX, United States
| | - Lindsay G Cowell
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States.,Department of Neurology and Neurotherapeutics, Department of Immunology, UT Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
12
|
Human Papilloma Virus: Current Knowledge and Focus on Oral Health. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6631757. [PMID: 33623784 PMCID: PMC7875628 DOI: 10.1155/2021/6631757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022]
Abstract
The human papilloma virus (HPV) is responsible for different pathological manifestations in humans. This agent gives rise to lesions of different types and in different areas of the organism, including the oral cavity. The aim of this study is to show which are the main diseases for which HPV is responsible and to bring to light some of the interceptive and therapeutic strategies. The analysis was conducted by consulting the major scientific databases with the aim of obtaining information on the characteristics of oral HPV and its management; furthermore, the literature was supported by some clinical cases proposed by the authors. The role of dentistry is essential in the early diagnosis of this type of pathologies and above all in knowing how to direct patients towards a path that can lead to patient management, especially in the event that these lesions have a malignant potential. Enhancing the knowledge and role of dentistry can lead to early diagnosis of this type of injury, intercepting a pathology that could have multiorgan implications.
Collapse
|