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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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de Waard J, Bhattacharya A, de Boer MT, van Hemel BM, Esajas MD, Vermeulen KM, de Bock GH, Schuuring E, Wisman GBA. Methylation Analysis to Detect CIN3+ in High-Risk Human Papillomavirus-Positive Self-Samples From the Population-Based Cervical Cancer Screening Program. Mod Pathol 2024; 37:100528. [PMID: 38810730 DOI: 10.1016/j.modpat.2024.100528] [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: 10/23/2023] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
Since 2017, a self-sampling device has been introduced to the Dutch population-based screening program to enable higher participation rates. However, routine triage cytology cannot be performed on self-sampling material. Methylation is an alternative triage method that can be performed directly on DNA extracted from self-samples. Recently, we tested a set of 15 published cervical intraepithelial neoplasia grade 3 or worse (CIN3+)-specific methylation markers and found a panel of 3 markers with a sensitivity of 82% and a specificity of 74%. In this study, we determined the sensitivity and specificity of 2 commercial assays using quantitative methylation-specific PCR. DNA from the same cohort of high-risk human papillomavirus-positive self-sampled material obtained through the population-based screening program in the North of the Netherlands from women with CIN2 or less (
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Affiliation(s)
- Jolien de Waard
- Department of Gynecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Arkajyoti Bhattacharya
- Department of Medical Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martine T de Boer
- Department of Gynecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martha D Esajas
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G Bea A Wisman
- Department of Gynecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Malagón T, Franco EL, Tejada R, Vaccarella S. Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination. Nat Rev Clin Oncol 2024; 21:522-538. [PMID: 38760499 DOI: 10.1038/s41571-024-00904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/19/2024]
Abstract
Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.
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Affiliation(s)
- Talía Malagón
- Department of Oncology, McGill University, Montréal, Quebec, Canada.
- St Mary's Research Centre, Montréal West Island CIUSSS, Montréal, Quebec, Canada.
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada.
| | - Eduardo L Franco
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Romina Tejada
- Department of Oncology, McGill University, Montréal, Quebec, Canada
- Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montréal, Quebec, Canada
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Gottschlich A, Hong Q, Gondara L, Alam MS, Cook DA, Martin RE, Lee M, Melnikow J, Peacock S, Proctor L, Stuart G, Franco EL, Krajden M, Smith LW, Ogilvie GS. Evidence of Decreased Long-term Risk of Cervical Precancer after Negative Primary HPV Screens Compared with Negative Cytology Screens in a Longitudinal Cohort Study. Cancer Epidemiol Biomarkers Prev 2024; 33:904-911. [PMID: 38773687 PMCID: PMC11216858 DOI: 10.1158/1055-9965.epi-23-1587] [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: 12/12/2023] [Revised: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND The growing use of primary human papillomavirus (HPV) cervical cancer screening requires determining appropriate screening intervals to avoid overtreatment of transient disease. This study examined the long-term risk of cervical precancer after HPV screening to inform screening interval recommendations. METHODS This longitudinal cohort study (British Columbia, Canada, 2008 to 2022) recruited women and individuals with a cervix who received 1 to 2 negative HPV screens (HPV1 cohort, N = 5,546; HPV2 cohort, N = 6,624) during a randomized trial and women and individuals with a cervix with 1 to 2 normal cytology results (BCS1 cohort, N = 782,297; BCS2 cohort, N = 673,778) extracted from the provincial screening registry. All participants were followed through the registry for 14 years. Long-term risk of cervical precancer or worse [cervical intraepithelial neoplasia grade 2 or worse (CIN2+)] was compared between HPV and cytology cohorts. RESULTS Cumulative risks of CIN2+ were 3.2/1,000 [95% confidence interval (CI), 1.6-4.7] in HPV1 and 2.7/1,000 (95% CI, 1.2-4.2) in HPV2 after 8 years. This was comparable with the risk in the cytology cohorts after 3 years [BCS1: 3.3/1,000 (95% CI, 3.1-3.4); BCS2: 2.5/1,000 (95% CI, 2.4-2.6)]. The cumulative risk of CIN2+ after 10 years was low in the HPV cohorts [HPV1: 4.7/1,000 (95% CI, 2.6-6.7); HPV2: 3.9 (95% CI, 1.1-6.6)]. CONCLUSIONS Risk of CIN2+ 8 years after a negative screen in the HPV cohorts was comparable with risk after 3 years in the cytology cohorts (the benchmark for acceptable risk). IMPACT These findings suggest that primary HPV screening intervals could be extended beyond the current 5-year recommendation, potentially reducing barriers to screening.
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Affiliation(s)
- Anna Gottschlich
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
- Population Sciences and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Quan Hong
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lovedeep Gondara
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Md Saiful Alam
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Darrel A. Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marette Lee
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Lily Proctor
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Gavin Stuart
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mel Krajden
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Laurie W. Smith
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Gina S. Ogilvie
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Zhao X, Zhang R, Song S, Wang Y, Mu X. Analysis of the clinical characteristics and surgical methods of high-grade squamous intraepithelial lesions of the cervix in postmenopausal women: A retrospective case study. Medicine (Baltimore) 2024; 103:e38657. [PMID: 38905358 PMCID: PMC11191910 DOI: 10.1097/md.0000000000038657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/31/2024] [Indexed: 06/23/2024] Open
Abstract
The purpose of this study was to thoroughly evaluate the clinical features and surgical options for high-grade squamous intraepithelial lesions (HSIL) in postmenopausal women. A total of 308 patients diagnosed with HSIL through colposcopic cervical biopsy and endocervical curettage were included. Their clinical characteristics, surgical treatments, and postoperative pathology were analyzed. Key findings include: 1. Patients with positive preoperative thinprep cytologic test (TCT) results and postoperative pathology indicating HSIL or squamous cell carcinoma (≥HSIL) were significantly more frequent than those with negative preoperative TCT results (P < .05). 2. Univariate analysis indicated significant impacts of TCT, human papillomavirus (HPV) type, transformation zone (TZ) location, and surgical technique on postoperative pathology (P < .05). 3. Logistic regression analysis confirmed significant influences of TCT, HPV type, TZ location, and surgical method on postoperative pathology outcomes (P < .05), showing that each unit increase in TZ raised the probability of ≥HSIL in postoperative pathology by 49.7%. In surgical comparisons, cold knife conization (CKC) and extrafascial hysterectomy resulted in 8.379 and 4.427 times higher probabilities of ≥HSIL in postoperative pathology, respectively, compared to loop electrosurgical excision procedure (LEEP). 4. Surgical methods significantly influenced margin results (P < .05). After LEEP, 17.5% of cases had positive margins, compared to 9.4% after CKC, and 3.7% after extrafascial hysterectomy, indicating the highest rate of positive surgical margins occurred with LEEP. 1. Combined TCT and HPV screening is crucial for cervical cancer prevention, early detection, and management in postmenopausal women. Women with positive results for both TCT and HPV should undergo colposcopic cervical biopsy and endocervical curettage. 2. For patients with TZ3, CKC is the recommended surgical option. 3. CKC is the preferred treatment for postmenopausal women with HSIL, as it effectively diagnoses and treats the lesion, showing superior outcomes in managing postmenopausal HSIL.
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Affiliation(s)
- Xiaofeng Zhao
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Rong Zhang
- Maternal and Child Health Hospital of Inner Mongolia, Hohhot, China
| | - Shufang Song
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yu Wang
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiaojie Mu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Patterson EJ, Bounds AD, Wagner SK, Kadri-Langford R, Taylor R, Daly D. Oculomics: A Crusade Against the Four Horsemen of Chronic Disease. Ophthalmol Ther 2024; 13:1427-1451. [PMID: 38630354 PMCID: PMC11109082 DOI: 10.1007/s40123-024-00942-x] [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: 02/02/2024] [Accepted: 03/25/2024] [Indexed: 05/22/2024] Open
Abstract
Chronic, non-communicable diseases present a major barrier to living a long and healthy life. In many cases, early diagnosis can facilitate prevention, monitoring, and treatment efforts, improving patient outcomes. There is therefore a critical need to make screening techniques as accessible, unintimidating, and cost-effective as possible. The association between ocular biomarkers and systemic health and disease (oculomics) presents an attractive opportunity for detection of systemic diseases, as ophthalmic techniques are often relatively low-cost, fast, and non-invasive. In this review, we highlight the key associations between structural biomarkers in the eye and the four globally leading causes of morbidity and mortality: cardiovascular disease, cancer, neurodegenerative disease, and metabolic disease. We observe that neurodegenerative disease is a particularly promising target for oculomics, with biomarkers detected in multiple ocular structures. Cardiovascular disease biomarkers are present in the choroid, retinal vasculature, and retinal nerve fiber layer, and metabolic disease biomarkers are present in the eyelid, tear fluid, lens, and retinal vasculature. In contrast, only the tear fluid emerged as a promising ocular target for the detection of cancer. The retina is a rich source of oculomics data, the analysis of which has been enhanced by artificial intelligence-based tools. Although not all biomarkers are disease-specific, limiting their current diagnostic utility, future oculomics research will likely benefit from combining data from various structures to improve specificity, as well as active design, development, and optimization of instruments that target specific disease signatures, thus facilitating differential diagnoses.
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Affiliation(s)
| | | | - Siegfried K Wagner
- Moorfields Eye Hospital NHS Trust, 162 City Road, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | | | - Robin Taylor
- Occuity, The Blade, Abbey Square, Reading, Berkshire, RG1 3BE, UK
| | - Dan Daly
- Occuity, The Blade, Abbey Square, Reading, Berkshire, RG1 3BE, UK
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Han Q, Guo H, Wu Z, Shi J, Zhang X. Efficacy and Safety of 5-Aminolevulinic Acid Photodynamic Therapy for Treating Cervical and Vaginal Intraepithelial Neoplasia. Pharmaceutics 2024; 16:627. [PMID: 38794289 PMCID: PMC11126115 DOI: 10.3390/pharmaceutics16050627] [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: 03/27/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Persistent HPV infections may cause cervical and vaginal intraepithelial neoplasia (CIN and VaIN). Traditional methods might destroy the structure and function of the cervix. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a non-invasive targeted therapy. This study aims to evaluate the efficacy and safety of ALA-PDT for CIN and VaIN and the clearance of HPV. A retrospective study of 303 patients who confirmed CIN or VaIN and received ALA-PDT was conducted. All the patients were followed up at six and twelve months after treatment and then annually thereafter. The effect was evaluated through HPV genotyping, a cytology test, and colposcopy-directed biopsy if necessary. After ALA-PDT, the remission rates for CIN 2, CIN 3, VaIN 2, and VaIN 3 were 90.6%, 88.5%, 87.3%, and 77.8%. For CIN 1, the remission rate at the six-month follow-up was 93.1%. The total HPV clearance rates were 72.5% at the six-month follow-up and 85.7% at the 12-month follow-up. The most common adverse event was vaginal discharge. No severe adverse effect was observed. ALA-PDT is an effective and safe treatment for all grades of CIN and VaIN and is helpful in clearing HPV with minimal side effects. This treatment may not influence fertility and delivery.
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Affiliation(s)
- Qin Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; (H.G.)
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Hongyan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; (H.G.)
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Zhangxin Wu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; (H.G.)
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Jiaxin Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; (H.G.)
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Xue Zhang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; (H.G.)
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
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Liu S, Zhang W, Wang W, Zheng J. Topical delivery of drugs in the treatment of high-grade cervical squamous intraepithelial lesions: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 296:131-139. [PMID: 38432019 DOI: 10.1016/j.ejogrb.2024.02.036] [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: 01/10/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The present study aims to evaluate the efficacy and effect of localized delivery of drugs in the treatment of high-grade squamous intraepithelial lesion (HSIL) based on a meta-analysis. STUDY DESIGN Databases including Cochrane Library, PubMed, Embase, Scopus, CNKI, and Wanfang were searched from their inception till August 2022. Randomized controlled trials (RCTs) that compared the efficacy of drugs and surgery in the treatment of HSIL were collected. A meta-analysis was performed using the software of Review Manager (version 5.4.1). RESULTS Eight RCTs involving 523 patients were included in the meta-analysis. For HSIL, the rate of cervical lesions histological regression was 69.85 % in the surgery group and 59.88 % in the drug group, there was no significant difference between the two groups [OR = 0.45, 95 % CI (0.07, 3.03), P = 0.41]. The histological regression rate of cervical lesions in the placebo group was 37.76 %, and the difference between the drug group and the placebo group was statistically significant [OR = 4.94, 95 % CI (2.65, 9.20), P < 0.00001]. CONCLUSION A total of four drugs were involved in the eight RCTS included in this study, which were imiquimod, 5-fluorouracil (5-FU), cidofovir and interferon. The results showed that although drug administration was effective in the histological regression of HSIL, the efficacy was less than about 10% of surgical treatment. Considering the recurrence of the disease after surgery and the problems of abortion, premature delivery and premature rupture of membranes after cervical conization in reproductive women, drug therapy can be used as a supplement to surgery or conservative treatment to promote the histological regression of cervical lesions in patients with HSIL.
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Affiliation(s)
- Shixuan Liu
- Chenggong Hospital (the 73th Group Military Hospital of People's Liberation Army) Affiliated to Xiamen University, China
| | - Wenlei Zhang
- Chenggong Hospital (the 73th Group Military Hospital of People's Liberation Army) Affiliated to Xiamen University, China
| | - Wenyan Wang
- Chenggong Hospital (the 73th Group Military Hospital of People's Liberation Army) Affiliated to Xiamen University, China
| | - Jianlan Zheng
- Chenggong Hospital (the 73th Group Military Hospital of People's Liberation Army) Affiliated to Xiamen University, China.
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Liu Y, Wu R, Li C, Wei L, Li R. Successful pregnancy and delivery after HiPorfin photodynamic therapy for cervical high-grade squamous intraepithelial lesion. Photodiagnosis Photodyn Ther 2024; 46:104062. [PMID: 38527659 DOI: 10.1016/j.pdpdt.2024.104062] [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: 02/17/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE The study analyzed HiPorfin-Photodynamic therapy (PDT) for young women with cervial high-grade squamous intraepithelial lesion (HSIL) and evaluated the impact of PDT on their pregnancy and delivery. METHODS Retrospective analysis of 4 patients (21-33 years old) were treated with HiPorfin® (2 mg/kg) PDT in 2019-2022. 1 patient suffered from cervical intraepithelial neoplasia (CIN)Ⅱ and 3 patients from CIN Ⅲ. 630 nm laser light irradiated the cervical surface and endocervical canal with light dose of 150 J/cm2 and 100-120 J/cm2 respectively. RESULTS The median observation time period was 40.5 months. Cure rate, HPV eradication rate and negative conversion rate of cytology were all 100.0 % at 3, 6 and 12 months. All cervical canal lesions completely turned negative. No recurrence occurred during the long-term follow-up period. None of patients suffered from infertility. Three patients delivered vaginally and one delivered by C-section to healthy infants at term. CONCLUSION HiPorfin® PDT for cervical HSIL was proved to be a safe method without adverse effects on female fertility and allowing these women to have healthy, full-term children.
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Affiliation(s)
- Yu Liu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lihui Wei
- Director of Sanming Project of Medicine of Department of Obstetrics and Gynecology of Peking University Shenzhen Hospital, Shenzhen, China; Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
| | - Ruizhen Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, China.
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Liu Y, Wu R, Li C, Wei L, Li R. Photodynamic therapy with HiPorfin for cervical squamous intraepithelial lesion at childbearing age. Photodiagnosis Photodyn Ther 2024; 46:104018. [PMID: 38401818 DOI: 10.1016/j.pdpdt.2024.104018] [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: 01/16/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To evaluate the clinical efficacy and safety of HiPorfin® photodynamic therapy (PDT) in the treatment of young women at reproductive age with high-grade squamous intraepithelial lesion (HSIL) of the cervix. METHODS Prospective study of 41 patients aged 28.8 ± 4.6 years old with cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ at Peking University Shenzhen Hospital from March 2019 to January 2023. HiPorfin® (2 mg/kg) was infused intravenously, and 48-72 h later, 630-nm laser irradiation was performed in cervical canal and cervical surface with an irradiation dose of 100-120 J/cm2 and 150 J/cm2 respectively. RESULTS All 41 patients with no recurrence had been observed at least 12 months follow-up period after PDT. The number of nulliparous women was 30 (30/41, 73.2 %). CIN Ⅱ were 22 cases (22/41,53.7 %) and CIN Ⅲ were 19 cases (19/41,46.3 %). Complete response (CR) was in 95.5 % (21/22) patients with CIN Ⅱ and 78.9 % (15/19) patients with CIN Ⅲ at 6 months follow-up. Meanwhile, CR rate was 100.0 % (22/22) and 84.2 % (16/19) in CIN Ⅱ and CIN Ⅲ group respectively at 12 months. Pre-treatment, all patients (41/41,100 %) were Human papilloma virus (HPV) positive. HPV eradication rate was 63.4 % (26/41), 73.2 % (30/41) and 92.7 % (38/41) at 3, 6 and 12 months after PDT respectively. Before treatment, cytology ≥ atypical squamous cells of undetermined significance (ASCUS) was 78.0 % (32/41). Negative conversion ratio of cytology was 75.0 % (24/32), 90.6 % (29/32) and 100.0 % (32/32) at 3, 6 and 12 months after PDT respectively. There were no serious adverse effects in patients during and after PDT. CONCLUSION HiPorfin-PDT is a promising and organ-saving approach for cervical HSIL, which also eradicates HPV infection effectively and can be a beacon of hope for the young women with fertility preservation requirement.
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Affiliation(s)
- Yu Liu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, PR China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, PR China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, PR China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, PR China
| | - Lihui Wei
- Director of Sanming Project of Medicine of Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, PR China; Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, PR China.
| | - Ruizhen Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, PR China; Institute of Obstetrics and Gynecology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Peking University Shenzhen Hospital, Shenzhen, PR China.
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Papoutsis D, Underwood M, Parry-Smith W, Tzavara C. Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia and its association with high-grade histopathological recurrence after cervical excision in women with negative excision margins: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:939-948. [PMID: 37821642 PMCID: PMC10867046 DOI: 10.1007/s00404-023-07242-y] [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: 06/27/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for disease recurrence after cervical treatment. OBJECTIVES To provide a systematic review and meta-analysis on whether endocervical crypt involvement by high-grade CIN on the excised cervical specimen is associated with high-grade histopathological recurrence during the follow-up of women after cervical excisional treatment. SEARCH STRATEGY We searched the Medline, Scopus, Central, and Clinical Trials.gov databases from inception till May 2023. SELECTION CRITERIA Studies that reported on women with a single cervical treatment with any method of excision for CIN2 or CIN3 lesion, negative excision margins, and whose recurrence was defined histopathologically were included. DATA COLLECTION AND ANALYSIS Two reviewers independently evaluated study eligibility. We used the fixed effects model for meta-analysis. MAIN RESULTS There were 4 eligible studies included in the present systematic review that evaluated 1088 women treated with either large loop excision of the transformation zone (LLETZ) or with cold knife conization (CKC). We found no significant association of endocervical crypt involvement by CIN2-3 with high-grade histopathological recurrence at follow-up after cervical excision (OR 1.93; 95% CI 0.51-3.35). The subgroup analysis of women with LLETZ cervical excision showed again no significant association with high-grade histopathological recurrence at follow-up (OR 2.00; 95% CI 0.26-3.74). CONCLUSION Endocervical crypt involvement by high-grade CIN does not seem to be a risk factor for high-grade histopathological recurrence after cervical excision with negative excision margins.
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Affiliation(s)
- Dimitrios Papoutsis
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK.
- School of Health Sciences, University of Western Macedonia, 50100, Ptolemaida, Kozani, PC, Greece.
| | - Martyn Underwood
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - William Parry-Smith
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Cao D, Yang Z, Dong S, Li Y, Mao Z, Lu Q, Xu P, Shao M, Pan L, Han X, Yuan J, Fan Q, Chen L, Wang Y, Zhu W, Yu W, Wang Y. PCDHGB7 hypermethylation-based Cervical cancer Methylation (CerMe) detection for the triage of high-risk human papillomavirus-positive women: a prospective cohort study. BMC Med 2024; 22:55. [PMID: 38317152 PMCID: PMC10845746 DOI: 10.1186/s12916-024-03267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Implementation of high-risk human papillomavirus (hrHPV) screening has greatly reduced the incidence and mortality of cervical cancer. However, a triage strategy that is effective, noninvasive, and independent from the subjective interpretation of pathologists is urgently required to decrease unnecessary colposcopy referrals in hrHPV-positive women. METHODS A total of 3251 hrHPV-positive women aged 30-82 years (median = 41 years) from International Peace Maternity and Child Health Hospital were included in the training set (n = 2116) and the validation set (n = 1135) to establish Cervical cancer Methylation (CerMe) detection. The performance of CerMe as a triage for hrHPV-positive women was evaluated. RESULTS CerMe detection efficiently distinguished cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) from cervical intraepithelial neoplasia grade 1 or normal (CIN1 -) women with excellent sensitivity of 82.4% (95% CI = 72.6 ~ 89.8%) and specificity of 91.1% (95% CI = 89.2 ~ 92.7%). Importantly, CerMe showed improved specificity (92.1% vs. 74.9%) in other 12 hrHPV type-positive women as well as superior sensitivity (80.8% vs. 61.5%) and specificity (88.9% vs. 75.3%) in HPV16/18 type-positive women compared with cytology testing. CerMe performed well in the triage of hrHPV-positive women with ASC-US (sensitivity = 74.4%, specificity = 87.5%) or LSIL cytology (sensitivity = 84.4%, specificity = 83.9%). CONCLUSIONS PCDHGB7 hypermethylation-based CerMe detection can be used as a triage strategy for hrHPV-positive women to reduce unnecessary over-referrals. TRIAL REGISTRATION ChiCTR2100048972. Registered on 19 July 2021.
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Affiliation(s)
- Dan Cao
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Zhicong Yang
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shihua Dong
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuhong Li
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Zhanrui Mao
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi Lu
- Department of Obstetrics and Gynecology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Peng Xu
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Minfang Shao
- Department of Obstetrics and Gynecology, 2nd Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Pan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Xu Han
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jiangjing Yuan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Qiong Fan
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Lei Chen
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yanzhong Wang
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK.
| | - Weipei Zhu
- Department of Obstetrics and Gynecology, 2nd Affiliated Hospital of Soochow University, Suzhou, China.
| | - Wenqiang Yu
- Shanghai Public Health Clinical Center and Department of General Surgery, Huashan Hospital, Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yudong Wang
- Department of Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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Grimes DR. Impact of human papillomavirus age-related prevalence and vaccination levels on interpretation of cervical screening modalities: a modelling study. BMJ Open 2024; 14:e078551. [PMID: 38309749 PMCID: PMC10840029 DOI: 10.1136/bmjopen-2023-078551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE Cervical screening is a life-saving intervention, which reduces the incidence of and mortality from cervical cancer in the population. Human papillomavirus (HPV) based screening modalities hold unique promise in improving screening accuracy. HPV prevalence varies markedly by age, as does resultant cervical intraepithelial neoplasia (CIN), with higher rates recorded in younger women. With the advent of effective vaccination for HPV drastically reducing prevalence of both HPV and CIN, it is critical to model how the accuracy of different screening approaches varies with age cohort and vaccination status. This work establishes a model for the age-specific prevalence of HPV factoring in vaccine coverage and predicts how the accuracy of common screening modalities is affected by age profile and vaccine uptake. DESIGN Modelling study of HPV infection rates by age, ascertained from European cohorts prior to the introduction of vaccination. Reductions in HPV due to vaccination were estimated from the bounds predicted from multiple modelling studies, yielding a model for age-varying HPV and CIN grades 2 and above (CIN2+) prevalence. SETTING Performance of both conventional liquid-based cytology (LBC) screening and HPV screening with LBC reflex (HPV reflex) was estimated under different simulated age cohorts and vaccination levels. PARTICIPANTS Simulated populations of varying age and vaccination status. RESULTS HPV-reflex modalities consistently result in much lower incidence of false positives than LBC testing, with an accuracy that improves even as HPV and CIN2+ rates decline. CONCLUSIONS HPV-reflex tests outperform LBC tests across all age profiles, resulting in greater test accuracy. This improvement is especially pronounced as HPV infection rates fall and suggests HPV-reflex modalities are robust to future changes in the epidemiology of HPV.
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Affiliation(s)
- David Robert Grimes
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Physical Sciences, Dublin City University, Dublin, Ireland
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14
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Hellsten C, Holmberg A, Astrom J, Forslund O, Borgfeldt C. Cervical cancer in Region Skåne, Sweden 2017-2020 after the implementation of primary HPV screening: A quality assurance audit. Acta Obstet Gynecol Scand 2024; 103:129-137. [PMID: 37817563 PMCID: PMC10755128 DOI: 10.1111/aogs.14691] [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: 06/12/2023] [Revised: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Primary human papilloma virus (HPV) screening to detect cervical cancer and dysplastic lesions was implemented in Region Skåne 2017 for women aged 30-70. The aim of this study was to characterize the screening history of women diagnosed with cervical cancer to evaluate the performance of the screening program, as well as to assess the cancer treatments given and shortcomings in the follow-up of women with cervical dysplasia. MATERIAL AND METHODS We performed a quality assurance audit. The data was collected from the National Cervical Cancer Prevention Registry, Region Skåne Labmedicin database and the Melior Journal system in 2017-2020. RESULTS We identified 247 women diagnosed with invasive cervical cancer in Region Skåne in 2017-2020. Of these, 35 (14.2%) had a screening history over at least two screening rounds before diagnosis. There were 25 (10.1%) women diagnosed with cervical cancer in between screening intervals, i.e., interval cancer. The most common screening history in women with cervical cancer was irregular screening (143, 57.9%), followed by women being above screening age (44, 17.8%). HPV was detected in 96% of the cases, either in cervical cytology or in the tumor tissue. The screening program detected the disease in 96 (38.9%) of the patients, 149 (60.3%) were diagnosed through symptoms and two (0.80%) as a result of incidental findings. CONCLUSIONS The most powerful tool in the prevention of cervical cancer is screening program attendance. Prolongation with HPV screening among elderly women will also reduce the incidence of cervical cancer. Today, such cancers are usually discovered when symptoms appear.
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Affiliation(s)
- Caroline Hellsten
- Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Science LundLund UniversityLundSweden
| | - Anna Holmberg
- Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Science LundLund UniversityLundSweden
| | - Jennica Astrom
- Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Science LundLund UniversityLundSweden
| | - Ola Forslund
- Department of Laboratory MedicineLund UniversityLundSweden
- Clinical Microbiology, Infection Prevention and Control, Office for Medical ServicesRegion SkåneSweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Department of Clinical Science LundLund UniversityLundSweden
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Wang J, Li M, Zhao L, Zhou B, Chen H, Duan F, Wang G. Whole genome sequencing in high-grade cervical intraepithelial neoplasia patients from different ethnic groups in China. Medicine (Baltimore) 2023; 102:e35953. [PMID: 37960754 PMCID: PMC10637475 DOI: 10.1097/md.0000000000035953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
Cervical cancer (CC) is the fourth most common cancer in women worldwide. It develops through precancerous lesions (cervical intraepithelial neoplasia (CIN), graded from low-grade (CIN1) to high-grade (CIN2-3)). It is well established that precancerous and cancerous cervical lesions are caused by a persistent infection with high-risk types of the human papilloma virus (hrHPV). To have a deeper understanding of the pathogenesis of CIN and CC, we systematically analyzed the landscape of genomic alterations and HPV integration profiles in high-grade CIN2/3. We performed deep whole genome sequencing on exfoliated cervical cells and matched peripheral blood samples from a cohort of 51 Chinese patients (of whom 35 were HPV+) with high-grade CIN from 3 ethnic groups and constructed strict integrated workflow of genomic analysis. In addition, the HPV types and integration breakpoints in the exfoliated cervical cells from these patients were examined. Genomic analysis identified 6 significantly mutated genes (SMGs), including CDKN2A, PIK3CB, FAM20A, RABEP1, TMPRSS2 and SS18L1, in 51 CIN2/3 samples. As none of them had previously been identified as SMGs in the Cancer Genome Atlas cervical squamous cell carcinoma and endocervical adenocarcinoma (TCGA-CESC) cohort, future studies with larger sample size of CINs may be needed to validate our findings. Mutational signature analysis showed that mutational signatures of CINs were dramatically different from CCs, highlighting their different mutational processes and etiologies. Moreover, non-silent somatic mutations were detected in all of the CIN2/3 samples, and 88% of these mutations occurred in genes that also mutated in CCs of TCGA cohort. CIN2 samples had significantly less non-silent mutations than CIN3 samples (P = .0006). Gene ontology and pathway level analysis revealed that functions of mutated genes were significantly associated with tumorigenesis, thus these genes may be involved in the development and progression of CC. HPV integration breakpoints occurred in 28.6% of the CIN2/3 samples with HPV infection. Integrations of common high risk HPV types in CCs, including HPV16, 52, 58 and 68, also occurred in the CIN samples. Our results lay the groundwork for a deeper understanding of the molecular mechanisms underlying the pathogenesis of CC and pave the way for new tools for screening, diagnosis and treatment of cervical precancerous and cancerous lesions.
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Affiliation(s)
- Jingjing Wang
- The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China
- Second Department of Production, Handan Central Hospital, Handan, Hebei Province, China
| | - Menghuan Li
- The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China
- Department of Gynecology, People’s Hospital of Pingyu County, Zhumadian City, Henan Province, China
| | - Lixian Zhao
- The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China
| | - Bingjie Zhou
- The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China
- Maternity and Obstetrics Department of Fangshan District Maternity and Child Health Hospital of Beijing, Fangshan District of Beijing, China
| | - Huaqiu Chen
- The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China
- Department of Laboratory, Xichang People’s Hospital, Sichuan Province, China
| | - Fuhui Duan
- The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China
| | - Guangming Wang
- The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China
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Nasreen S, Lone AR, Manzoor A, Dar SA, Banday SZ, Nuzhatu N, Rasool MT, Andleeb A, Wani SQ, Fatima K, Sofi MA, Hussain S, Dar NA. Carcinoma cervix: A single institute experience from Kashmir, Northern India. J Cancer Res Ther 2023; 19:1407-1411. [PMID: 37787316 DOI: 10.4103/jcrt.jcrt_203_22] [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: 10/04/2023]
Abstract
Background Carcinoma cervix is the fourth most commonly diagnosed cancer worldwide, with an estimated 604,000 new cases and 342,000 deaths worldwide in 2020. Carcinoma cervix is an uncommon malignancy in Kashmir. In this retrospective study, we have tried to find clinicopathological characteristics of carcinoma cervix along with the survival rates at our tertiary care hospital. Materials and Methods Case records of cervical cancer patients registered from January 1, 2015, to January 1, 2019, were retrieved. A total of 138 patients was registered. 22 had undergone surgery, and out of these 17 had received postoperative radiotherapy. 109 patients were treated with definitive chemoradiation and 13 with palliative radiotherapy. Descriptive statistics were used to summarize patient and treatment-related variables, and Kaplan-Meier analysis was performed for survival analysis. Results A total of 138 cases that were registered from 2015 to 2019 were included in this study. The median age at the presentation was 56 years. Most of the patients had a performance status of 1 (98 patients (71.01)). Most of the patients 110 (79.71%) were married before 20 years of age, only 1 patient was unmarried, and 85 (61.59) patients were multiparous in our study group. Only 14 (10.14%) patients in our study group had a history of oral contraceptive use and most of them were non-smokers [124 (89.80%)]. Multiple marriages were present in 8 (5.79%) patients only. The most common presenting symptom was bleeding per vagina (78.26%), and the maximum number of patients fall in the post-menopausal group (67.39%). 116 patients had squamous cell carcinoma histology while 10 patients had adenocarcinoma histology. Most of the patients had stage II and stage III disease (85 patients). At last, follow up out of 138 patients 75 (54.35) were alive. 3 year disease-free survival was 54.34% and 3-year overall survival was 72.46%. Conclusion Carcinoma cervix is an uncommon malignancy in Kashmir because of different socio-cultural and religious practices but the response to treatment, toxicity profile, and survival are similar to the rest of the world.
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Affiliation(s)
- Shahida Nasreen
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Aabid R Lone
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Arshad Manzoor
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Showket A Dar
- Department of Anesthesia and Critical Care Noora Hospital, Srinagar UT, Srinagar, Jammu and Kashmir, India
| | - Saquib Z Banday
- Department of Medical Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Nazia Nuzhatu
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Malik T Rasool
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Asifa Andleeb
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Shaqul Q Wani
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Kaneez Fatima
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Mushtaq A Sofi
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Shaiba Hussain
- Department of Radiation Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
| | - Nazir Ahmad Dar
- Department of Medical Oncology, Sheri Kashmir Institute of Medical Sciences SKIMS Soura UT, Srinagar, Jammu and Kashmir, India
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de Waard J, Bhattacharya A, de Boer MT, van Hemel BM, Esajas MD, Vermeulen KM, de Bock GH, Schuuring E, Wisman GBA. Identification of a methylation panel as an alternative triage to detect CIN3+ in hrHPV-positive self-samples from the population-based cervical cancer screening programme. Clin Epigenetics 2023; 15:103. [PMID: 37322534 PMCID: PMC10273737 DOI: 10.1186/s13148-023-01517-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The Dutch population-based cervical cancer screening programme (PBS) consists of primary high-risk human papilloma virus (hrHPV) testing with cytology as triage test. In addition to cervical scraping by a general practitioner (GP), women are offered self-sampling to increase participation. Because cytological examination on self-sampled material is not feasible, collection of cervical samples from hrHPV-positive women by a GP is required. This study aims to design a methylation marker panel to detect CIN3 or worse (CIN3+) in hrHPV-positive self-samples from the Dutch PBS as an alternative triage test for cytology. METHODS Fifteen individual host DNA methylation markers with high sensitivity and specificity for CIN3+ were selected from literature and analysed using quantitative methylation-specific PCR (QMSP) on DNA from hrHPV-positive self-samples from 208 women with CIN2 or less (< CIN2) and 96 women with CIN3+. Diagnostic performance was determined by area under the curve (AUC) of receiver operating characteristic (ROC) analysis. Self-samples were divided into a train and test set. Hierarchical clustering analysis to identify input methylation markers, followed by model-based recursive partitioning and robustness analysis to construct a predictive model, was applied to design the best marker panel. RESULTS QMSP analysis of the 15 individual methylation markers showed discriminative DNA methylation levels between < CIN2 and CIN3+ for all markers (p < 0.05). The diagnostic performance analysis for CIN3+ showed an AUC of ≥ 0.7 (p < 0.001) for nine markers. Hierarchical clustering analysis resulted in seven clusters with methylation markers with similar methylation patterns (Spearman correlation> 0.5). Decision tree modeling revealed the best and most robust panel to contain ANKRD18CP, LHX8 and EPB41L3 with an AUC of 0.83 in the training set and 0.84 in the test set. Sensitivity to detect CIN3+ was 82% in the training set and 84% in the test set, with a specificity of 74% and 71%, respectively. Furthermore, all cancer cases (n = 5) were identified. CONCLUSION The combination of ANKRD18CP, LHX8 and EPB41L3 revealed good diagnostic performance in real-life self-sampled material. This panel shows clinical applicability to replace cytology in women using self-sampling in the Dutch PBS programme and avoids the extra GP visit after a hrHPV-positive self-sampling test.
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Affiliation(s)
- J de Waard
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, PO-Box 30001, 9700 RB, Groningen, The Netherlands
| | - A Bhattacharya
- Department of Medical Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M T de Boer
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, PO-Box 30001, 9700 RB, Groningen, The Netherlands
| | - B M van Hemel
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M D Esajas
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - K M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Schuuring
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G B A Wisman
- Department of Gynaecologic Oncology, Cancer Research Center Groningen, University of Groningen, University Medical Center Groningen, PO-Box 30001, 9700 RB, Groningen, The Netherlands.
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Chen LY, Drayson M, Bunce C, Ramasamy K. Monoclonal gammopathy of increasing significance: time to screen? Haematologica 2023; 108:1476-1486. [PMID: 36373250 PMCID: PMC10233333 DOI: 10.3324/haematol.2022.281802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
Monoclonal gammopathy (MG) is a frequently detected clonal B-cell or plasma-cell disorder. Importantly, every multiple myeloma (MM) case is preceded by MG. Although clinical algorithms now allow earlier treatment of patients with biomarkers of malignancy before MM-induced tissue damage (CRAB) occurs, most patients are still diagnosed late. It is important to revisit how MG should be managed in clinical practice and whether screening is required. As the prevalence of MG and other medical co-morbidities both rise with increasing age, the degree of contribution of MG to disease states other than malignant progression is often unclear. This can lead to monitoring lapses and under recognition of the organ dysfunction that can occur with monoclonal gammopathy of clinical significance (MGCS). Therefore, models of progression to MM and/or MGCS require further refinement. While MG is currently detected incidentally, a case for screening has been made with ongoing studies in this area. Screening has the potential benefit of earlier detection and prevention of both MGCS and delayed MM presentations, but important drawbacks include the psychosocial impact on individuals and resource burden on healthcare services. MG terminology should transition alongside our increasing understanding of the condition and genomic characterization that have already begun to revise the MG nomenclature. The biology of MG has been poorly understood and is often inferred from the biology of MM, which is unhelpful. We review the literature and case for MG screening in this paper. In particular, we highlight areas that require focus to establish screening for MG.
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Affiliation(s)
- Lucia Y Chen
- Oxford University Hospitals NHS Foundation Trust
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Ashique S, Hussain A, Fatima N, Altamimi MA. HPV pathogenesis, various types of vaccines, safety concern, prophylactic and therapeutic applications to control cervical cancer, and future perspective. Virusdisease 2023:1-19. [PMID: 37363362 PMCID: PMC10208188 DOI: 10.1007/s13337-023-00824-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
Over 98% of cervical cancers (CC) are caused by regular infections with "high risk" genotype of the human papilloma virus (HPV). However, this is not always the causative factor. Therefore, production of HPV vaccinations represents a significant chance to minimize the risk of CC. Phase III studies for a number of preventative HPV vaccines based on L1-virus-like particle (VLPs) have just been completed and the preliminary results are very convincing. However, there are a lot of practical concerns that need to be resolved before the use of these vaccinations. These vaccines were challenged with obvious queries such as protection time, subject receiving vaccines, time of vaccination, and how to include them into ongoing screening programs. Although these vaccines were 90% effective at preventing HPV infection as these offered only modest advantages for the removal of pre-existing infections. New advancements in the creation of therapeutic vaccinations have been explored for further improvement and post-vaccination surveillance. Therapeutic vaccines attempted to boost cell-mediated immunities and these are detrimental to the infected cell as opposed to neutralizing antibodies (different from prophylactic vaccines).
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Affiliation(s)
- Sumel Ashique
- Department of Pharmaceutics, School of Pharmacy, Bharat Institute of Technology (BIT), Meerut, Uttar Pradesh 250103 India
| | - Afzal Hussain
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi Arabia
| | - Neda Fatima
- Department of Pharmacology, Sai College of Pharmacy, Mau, Uttar Pradesh 275102 India
| | - Mohammad A. Altamimi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451 Saudi Arabia
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Gilham C, Sargent A, Crosbie EJ, Peto J. Long-term risks of invasive cervical cancer following HPV infection: follow-up of two screening cohorts in Manchester. Br J Cancer 2023; 128:1933-1940. [PMID: 36959379 PMCID: PMC10147679 DOI: 10.1038/s41416-023-02227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Long-term follow-up of large cohorts is needed to determine the effects of HPV and screening on CIN3 (grade 3 cervical intraepithelial neoplasia) and ICC (invasive cervical cancer). METHODS Women were recruited when attending for routine cervical screening in Greater Manchester, UK: 1987-93 for the Manchester Cohort (MC: 47,625 women) and 2001-03 for the ARTISTIC Cohort (AC: 24,496 women). Both were followed through national registration for cancer incidence and mortality to 2020. RESULTS Risk patterns following HPV infection differed for CIN3 and ICC. Risk of ICC in the MC rises for 30 years following a single positive HPV test, reaching 2.5% (95% CI: 1.3-4.5%). A similar pattern was seen in the AC, but the risks of cancer were approximately halved. CIN3 was diagnosed much sooner in the AC due to more efficient cytology. More sensitive HPV testing was able to better predict future risk. CONCLUSION The sensitivity of HPV testing and cytology influences the CIN3 detection rate. Sensitive HPV testing enables effective risk stratification. Increased risk of ICC is observed 15-30 years after HPV infection. Women testing HPV + should be followed until their infection clears. Discharging women from screening programmes whilst they remain HPV + may not be safe, even if cytology and colposcopy tests are normal.
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Affiliation(s)
- Clare Gilham
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Alexandra Sargent
- Cytology Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma J Crosbie
- Division of Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Julian Peto
- London School of Hygiene & Tropical Medicine, London, UK
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21
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Saini T, Bansal B, Dey P. Digital cytology: Current status and future prospects. Diagn Cytopathol 2023; 51:211-218. [PMID: 36594526 DOI: 10.1002/dc.25099] [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: 06/19/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023]
Abstract
AIMS In this paper, we reviewed the basic principle and the currentstatus of digital cytopathology. MATERIALS AND METHODS We reviewed the published papers on digitalcytology and analysed its future prospects. RESULTS Virtualcytology using digital platform is being increasingly used to render diagnosisrather than conventional glass slide microscopy. Whole slide imaging (WSI)offers the prospect of true virtual microscopy and in the near future, may evenreplace glass slides in routine practice. It may be pivotal in diagnosing andtraining pathology graduates faster and more accurately. CONCLUSION The digital cytopathology is a promising field and may have great impact indiagnosis, research and teaching.
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Affiliation(s)
- Tarunpreet Saini
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Baneet Bansal
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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22
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Singini MG, Singh E, Bradshaw D, Ramaliba T, Chen WC, Motlhale M, Kamiza AB, Babb de Villiers C, Muchengeti M, Mathew CG, Newton R, Bender N, Waterboer T, Sitas F. Usefulness of high-risk HPV early oncoprotein (E6 and E7) serological markers in the detection of cervical cancer: A systematic review and meta-analysis. J Med Virol 2023; 95:e27900. [PMID: 35641882 PMCID: PMC10952611 DOI: 10.1002/jmv.27900] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 01/11/2023]
Abstract
We reviewed the literature on the importance of selected anti-high-risk human papillomavirus (HR-HPV) antibodies (namely, 16/18 and early oncoproteins E6 and E7) as potential serological markers for early detection of individuals at high risk of cervical cancer. We searched for studies in PubMed and Embase databases published from 2010 to 2020 on antibodies against HR-HPV E6 and E7 early proteins and cervical cancer. Pooled sensitivity and specificity for HPV16 and HPV18 antibodies were calculated using a bivariate hierarchical random-effects model. A total of 69 articles were identified; we included three studies with 1550 participants. For the three HPV16/18 E6 and E7 antibody tests, enzyme-linked immunosorbent assay-based assays had a sensitivity of 18% for detecting CIN2+ (95% confidence interval [CI]: 15-21) and a specificity of 96% (95% CI: 92-98), for slot-blot, sensitivity was 28.9% (95% CI: 23.3-35.1) and specificity was 72% (95% CI: 66.6-77.0) for detecting CIN2+, and for multiplex HPV serology assay based on a glutathione S-transferase, sensitivity was 16% (95% CI: 8.45-28.6) and specificity was 98% (95% CI: 97-99) for detecting invasive cervical cancer. HR-HPV16/18 E6 and E7 serological markers showed high specificity, but sensitivity was suboptimal for the detection of cervical cancer in either population screening settings or as point-of-care screening tests.
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Affiliation(s)
- Mwiza Gideon Singini
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Elvira Singh
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Debbie Bradshaw
- Burden of Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Thendo Ramaliba
- Burden of Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Wenlong Carl Chen
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Melitah Motlhale
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Abram Bunya Kamiza
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Mazvita Muchengeti
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- South African DSI‐NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA)Stellenbosch UniversityStellenboschSouth Africa
| | - Christopher G. Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Medical and Molecular GeneticsFaculty of Life Sciences and Medicine, King's College LondonLondonUK
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research UnitEntebbeUganda
- University of YorkYorkUK
| | - Noemi Bender
- Division of Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Tim Waterboer
- Division of Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Freddy Sitas
- Burden of Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
- Centre for Primary Health Care and Equity, School of Population HealthUniversity of New South Wales SydneyNew South WalesSydneyAustralia
- Menzies Centre of Health Policy, School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
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Krishnamoorthy Y, Rajaa S, Giriyappa DK. Global pattern and trend of cervical cancer incidence from 1993 to 2012: Joinpoint regression and age-period-cohort analysis. Indian J Cancer 2022; 59:521-531. [PMID: 34380829 DOI: 10.4103/ijc.ijc_1043_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Cervical cancer ranks fourth in global cancer incidence and mortality among women. A comparison of the global trends in cervical cancer would help us to identify high focus regions and serves an opportunity to evaluate the impact of the screening programs. Hence, the current study was done to assess the global trend in the incidence of cervical cancer from 1993 to 2012 among individuals aged between 30 and 79 years. Methods This secondary data analysis was conducted using the World Health Organization (WHO) Cancer Incidence data of five continents plus database (America, Asia, Europe, and Oceania) on the incidence of cervical cancer. Joinpoint regression was performed to determine the average annual percent change (AAPC) in cervical cancer incidence. We performed an age-period-cohort analysis to obtain age, period, and cohort-specific deviations and rate ratio (RR). Results Out of the four regions studied, all the regions showed a declining trend in cervical cancer incidence. The maximum decline was found in Oceania (AAPC = -3.3%) followed by America (AAPC = -2.0%). There was a consistent rise in cervical cancer incidence across the age groups in all the four continents with the maximum burden among the elderly. All the regions showed a steady decline in the rate of cervical cancer through the periods 1998-2002 to 2007-2012. There was also a steady decline in cervical cancer incidence across the cohorts from 1923-1927 to 1978-1982 in all the regions except America. Conclusion To summarize, cervical cancer incidence showed a declining trend globally, with the maximum decline in the Oceania region from 1993 to 2012.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sathish Rajaa
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dinesh K Giriyappa
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Prusty S, Patnaik S, Dash SK. SKCV: Stratified K-fold cross-validation on ML classifiers for predicting cervical cancer. FRONTIERS IN NANOTECHNOLOGY 2022. [DOI: 10.3389/fnano.2022.972421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer is the unregulated development of abnormal cells in the human body system. Cervical cancer, also known as cervix cancer, develops on the cervix’s surface. This causes an overabundance of cells to build up, eventually forming a lump or tumour. As a result, early detection is essential to determine what effective treatment we can take to overcome it. Therefore, the novel Machine Learning (ML) techniques come to a place that predicts cervical cancer before it becomes too serious. Furthermore, four common diagnosis testing namely, Hinselmann, Schiller, Cytology, and Biopsy have been compared and predicted with four common ML models, namely Support Vector Machine (SVM), Random Forest (RF), K-Nearest Neighbors (K-NNs), and Extreme Gradient Boosting (XGB). Additionally, to enhance the better performance of ML models, the Stratified k-fold cross-validation (SKCV) method has been implemented over here. The findings of the experiments demonstrate that utilizing an RF classifier for analyzing the cervical cancer risk, could be a good alternative for assisting clinical specialists in classifying this disease in advance.
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Shiraz A, Egawa N, Pelt DM, Crawford R, Nicholas AK, Romashova V, Sasieni P, Griffin H, Doorbar J. Cervical cell lift: A novel triage method for the spatial mapping and grading of precancerous cervical lesions. EBioMedicine 2022; 82:104157. [PMID: 35863292 PMCID: PMC9301573 DOI: 10.1016/j.ebiom.2022.104157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Primary HPV screening, due to its low specificity, requires an additional liquid-based cytology (LBC) triage test. However, even with LBC triage there has been a near doubling in the number of patients referred for colposcopy in recent years, the majority having low-grade disease. METHODS To counter this, a triage test that generates a spatial map of the cervical surface at a molecular level has been developed which removes the subjectivity associated with LBC by facilitating identification of lesions in their entirety. 50 patients attending colposcopy were recruited to participate in a pilot study to evaluate the test. For each patient, cells were lifted from the cervix onto a membrane (cervical cell lift, CCL) and immunostained with a biomarker of precancerous cells, generating molecular maps of the cervical surface. These maps were analysed to detect high-grade lesions, and the results compared to the final histological diagnosis. FINDINGS We demonstrated that spatial molecular mapping of the cervix has a sensitivity of 90% (95% CI 69-98) (positive predictive value 81% (95% CI 60-92)) for the detection of high-grade disease, and that AI-based analysis could aid disease detection through automated flagging of biomarker-positive cells. INTERPRETATION Spatial molecular mapping of the CCL improved the rate of detection of high-grade disease in comparison to LBC, suggesting that this method has the potential to decisively identify patients with clinically relevant disease that requires excisional treatment. FUNDING CRUK Early Detection Project award, Jordan-Singer BSCCP award, Addenbrooke's Charitable Trust, UK-MRC, Janssen Pharmaceuticals/Advanced Sterilisation Products, and NWO.
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Affiliation(s)
- Aslam Shiraz
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK; Department of Gynae-Oncology, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Nagayasu Egawa
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Daniël M Pelt
- Leiden Institute of Advanced Computer Science (LIACS), Leiden University, Niels Bohrweg 1, 2333 CA Leiden, the Netherlands
| | - Robin Crawford
- Department of Gynae-Oncology, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Adeline K Nicholas
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Veronika Romashova
- Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, Puddicombe Way, Cambridge, CB2 0AW, UK
| | - Peter Sasieni
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - Heather Griffin
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - John Doorbar
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK.
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Lu H, Li L, Cheng Y, Yang Z, Cao X, Zhang H, Qiao D, Wang L, Chen T. Timely Estimates of 5-Year Relative Survival for Patients With Cervical Cancer: A Period Analysis Using Cancer Registry Data From Taizhou, Eastern China. Front Public Health 2022; 10:926058. [PMID: 35958852 PMCID: PMC9358018 DOI: 10.3389/fpubh.2022.926058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives While timely assessment of long-term survival for patients with cervical cancer is essential for the evaluation of early detection and screening programs for cervical cancer, those data are extremely scarce in China. We aimed to timely and accurately assess long-term survival for patients with cervical cancer in eastern China, using cancer registry data from Taizhou, eastern China. Methods Patients diagnosed with cervical cancer during 2004-2018 from four cancer registries with high-quality data from Taizhou, eastern China were included. A period analysis was used to calculate the 5-year relative survival (RS) overall and on stratification by sex, age at diagnosis, and region. Additionally, the projected 5-year relative survival (RS) of patients with cervical cancer during 2019-2023 was evaluated, using a model-based period analysis. Results Overall 5-year RS for patients with cervical cancer during 2014-2018 reached 90.9%. When stratified by age at diagnosis, we found a clear age gradient for 5-year RS, declining from 95.6% for age <45 years to 68.7% for age >74 years, while urban areas had higher 5-year RS compared to rural areas (92.9 vs. 88.6%). We found a clear increasing trend of 5-year RS during 2004-2018 overall and on stratification by region and age at diagnosis. The projected overall 5-year RS is expected to reach 94.2% for the period 2019-2023. Conclusions We found that, for the first time in China, using period analysis, the most up-to-date (during 2014-2018) 5-year RS for patients with cervical cancer reached 90.9%. Our data have important implications for the timely evaluation of early detection and screening programs for patients with cervical cancer in eastern China.
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Affiliation(s)
- Hongsheng Lu
- Department of Pathology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Lu Li
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yongran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Zhaohui Yang
- Department of Pathology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Xuequan Cao
- Department of Pathology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Hui Zhang
- Department of Pathology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Dongju Qiao
- Department of Non-communicable Chronic Disease Control and Prevention, Taizhou Municipal Center for Disease Control and Prevention, Taizhou, China
| | - Liangyou Wang
- Department of Non-communicable Chronic Disease Control and Prevention, Taizhou Municipal Center for Disease Control and Prevention, Taizhou, China
| | - Tianhui Chen
- Department of Cancer Prevention/Zhejiang Cancer Institute, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- Department of Preventative Medicine, School of Medicine, Ningbo University, Ningbo, China
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Taylor J, Nailer E, Cohen CR, Redman CWE, Sherman SM. HPV vaccination and cervical screening: the knowledge and attitudes of mothers of adolescent girls. Psychol Health 2022:1-18. [PMID: 35653227 DOI: 10.1080/08870446.2022.2081327] [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: 05/03/2019] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Mothers play a significant role in decision making about human papillomavirus (HPV) vaccination for their daughters and about cervical screening attendance for themselves. This study had three objectives, to explore: (1) mothers' knowledge and attitudes about HPV and HPV vaccination, (2) their knowledge and attitudes about cervical cancer and screening, and (3) whether their daughter's HPV vaccination invitation was an opportunity to nudge mothers to attend screening. DESIGN 138 women from North Staffordshire completed a cross-sectional survey and 15 took part in follow-up focus groups. RESULTS Despite high self-reported engagement with both the cervical screening and HPV vaccination programmes, relatively low levels of knowledge and some uncertainty were evident. There was mixed opinion about the potential of using the vaccination invite as an opportunity to nudge mothers to attend cervical screening. CONCLUSION Even amongst women who do engage positively with the programmes, knowledge is not as complete and certain as it could be. Further research is needed with women who are less likely to accept the vaccination for their daughters. Women need to be better informed, which may go some way to reversing the decline in screening and maintaining high levels of vaccination.
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Affiliation(s)
- Jennifer Taylor
- School of Psychology, Keele University, Keele, UK
- School of Life Sciences & Education, Staffordshire University, Stoke-on-Trent, UK
| | - Emma Nailer
- School of Psychology, Keele University, Keele, UK
| | | | - Charles W E Redman
- Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke on Trent, UK
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Meira KC, Magnago C, Mendonça AB, Duarte SFS, de Freitas PHO, dos Santos J, de Souza DLB, Simões TC. Inequalities in Temporal Effects on Cervical Cancer Mortality in States in Different Geographic Regions of Brazil: An Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5591. [PMID: 35564986 PMCID: PMC9105639 DOI: 10.3390/ijerph19095591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 02/01/2023]
Abstract
Cervical cancer is a public health issue with high disease burden and mortality in Brazil. The objectives of the present study were, firstly, to analyze age, period, and cohort effects on cervical cancer mortality in women 20 years old or older from 1980 to 2019 in the North, South, and Southeast Regions of Brazil; and secondly, to evaluate whether the implementation of a national screening program and the expansion of access to public health services impacted the examined period and reduced the risk of death compared with previous years and among younger cohorts. The effects were estimated by applying Poisson regression models with estimable functions. The highest mortality rate per 100,000 women was found in Amazonas (24.13), and the lowest in São Paulo (10.56). A positive gradient was obtained for death rates as women's age increased. The states in the most developed regions (South and Southeast) showed a reduction in the risk of death in the period that followed the implementation of the screening program and in the cohort from the 1960s onwards. The North Region showed a decreased risk of death only in Amapá (2000-2004) and Tocantins (1995-2004; 2010-2019). The findings indicate that health inequities remain in Brazil and suggest that the health system has limitations in terms of decreasing mortality associated with this type of cancer in regions of lower socioeconomic development.
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Affiliation(s)
- Karina Cardoso Meira
- Health School, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
| | - Carinne Magnago
- School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil;
| | - Angelo Braga Mendonça
- Brazilian National Cancer Institute, Rio de Janeiro 20230-130, Brazil; (A.B.M.); (J.d.S.)
| | - Stephane Fernanda Soares Duarte
- Department of Demography and Actuarial Sciences, Federal University of Rio Grande Norte, Natal 59078-970, Brazil; (S.F.S.D.); (P.H.O.d.F.)
| | - Pedro Henrique Oliveira de Freitas
- Department of Demography and Actuarial Sciences, Federal University of Rio Grande Norte, Natal 59078-970, Brazil; (S.F.S.D.); (P.H.O.d.F.)
| | - Juliano dos Santos
- Brazilian National Cancer Institute, Rio de Janeiro 20230-130, Brazil; (A.B.M.); (J.d.S.)
| | | | - Taynãna César Simões
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte 30190-002, Brazil;
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Zhang L, Tan W, Yang H, Zhang S, Dai Y. Detection of Host Cell Gene/HPV DNA Methylation Markers: A Promising Triage Approach for Cervical Cancer. Front Oncol 2022; 12:831949. [PMID: 35402283 PMCID: PMC8990922 DOI: 10.3389/fonc.2022.831949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer is the most prevalent gynecologic malignancy, especially in women of low- and middle-income countries (LMICs). With a better understanding of the etiology and pathogenesis of cervical cancer, it has been well accepted that this type of cancer can be prevented and treated via early screening. Due to its higher sensitivity than cytology to identify precursor lesions of cervical cancer, detection of high-risk human papillomavirus (HR-HPV) DNA has been implemented as the primary screening approach. However, a high referral rate for colposcopy after HR-HPV DNA detection due to its low specificity in HR-HPV screening often leads to overtreatment and thus increases the healthcare burden. Emerging evidence has demonstrated that detection of host cell gene and/or HPV DNA methylation represents a promising approach for the early triage of cervical cancer in HR-HPV-positive women owing to its convenience and comparable performance to cytology, particularly in LMICs with limited healthcare resources. While numerous potential markers involving DNA methylation of host cell genes and the HPV genome have been identified thus far, it is crucial to define which genes or panels involving host and/or HPV are feasible and appropriate for large-scale screening and triage. An ideal approach for screening and triage of CIN/ICC requires high sensitivity and adequate specificity and is suitable for self-sampling and inexpensive to allow population-based screening, particularly in LMICs. In this review, we summarize the markers of host cell gene/HR-HPV DNA methylation and discuss their triage performance and feasibility for high-grade precancerous cervical intraepithelial neoplasia or worse (CIN2+ and CIN3+) in HR-HPV-positive women.
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Affiliation(s)
- Lingyi Zhang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China.,Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Wenxi Tan
- Department of Gynecology and Obstetrics, The Second Hospital of Jilin University, Changchun, China
| | - Hongmei Yang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China.,Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Songling Zhang
- Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Changchun, China
| | - Yun Dai
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
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Schaafsma M, van den Helder R, Bleeker MC, Rosier-van Dunné F, van der Avoort IA, Steenbergen RD, van Trommel NE. Experiences and preferences towards collecting a urine and cervicovaginal self-sample among women attending a colposcopy clinic. Prev Med Rep 2022; 26:101749. [PMID: 35256928 PMCID: PMC8897716 DOI: 10.1016/j.pmedr.2022.101749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022] Open
Abstract
In a colposcopy referral population, the majority of women consider self-collection of a urine sample and a cervicovaginal self-sample acceptable and easy to collect in a home-based setting. Urine collection is worth investigating as a potential screening method to possibly improve attendance rates in cervical cancer screening.
The effectiveness of cervical cancer screening is hampered by low attendance rates. The collection of a urine sample is hypothesized to engage non-attenders in cervical cancer screening. The aim of this prospective cohort study was to evaluate experiences of women on urine collection and cervicovaginal self-sampling in a home-based setting and preferences for future cervical cancer screening. This study included 140 women, with a median age of 40 years, who were planned for a large loop excision of the transformation zone (LLETZ) procedure. All women collected a urine sample using conventional urine cups and a cervicovaginal self-sample prior to the LLETZ in a home-based setting. Following sample collection, women filled in a questionnaire. Results showed that the instructions of urine collection and cervicovaginal self-sampling were considered clear (95%, 95%CI: 88–98; 92%, 95%CI: 83–96, respectively). Women considered urine collection compared to cervicovaginal self-sampling to be more acceptable (p < 0.001), and to provide more reliable results (p < 0.001). The three highest reported preferred sampling methods for future cervical cancer screening were: urine collection (n = 39, 28%, 95%CI: 19–39), clinician-taken cervical scrape (n = 32, 23%, 95%CI: 15–34), and equal preference for urine collection, clinician-taken cervical scrape and cervicovaginal self-sampling (n = 30, 21%, 95%CI: 14–32). In conclusion, urine collection and cervicovaginal self-sampling are acceptable sampling methods, considered easy to collect in a home-based setting, and moreover, considered trustworthy. Although these results are promising, more research is required to determine if urine collection also lowers the barrier for non-attendees and, thereby, increases the attendance rates of cervical cancer screening.
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Affiliation(s)
- Mirte Schaafsma
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
- Amsterdam University Medical Centers, Department of Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Rianne van den Helder
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
- Amsterdam University Medical Centers, Department of Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Maaike C.G. Bleeker
- Amsterdam University Medical Centers, Department of Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Fleur Rosier-van Dunné
- Tergooi Medical Center, Department of Obstetrics and Gynecology, Blaricum, the Netherlands
| | | | - Renske D.M. Steenbergen
- Amsterdam University Medical Centers, Department of Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Corresponding author.
| | - Nienke E. van Trommel
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
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Liu Y, Yin Y, Zhang Y, Lin L, Zhao M, Chen Q. Diagnostic Management of Oncogenic HPV Cervical Infections: The Field Experience in Wuxi, China. Front Med (Lausanne) 2022; 9:825228. [PMID: 35402444 PMCID: PMC8984024 DOI: 10.3389/fmed.2022.825228] [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: 11/30/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction A liquid-based cytology test was introduced for cervical cancer screening in the 2000s worldwide. However, the concordance of diagnostic findings between the liquid-based cytology test and cervical biopsy has not been fully investigated, especially the overall failure rate on the diagnosis of cervical cancer and high-grade squamous intraepithelial lesion (HSIL) by cytology testing. The aim of this retrospective study was to investigate the concordance between ThinPrep cytology and histology test in the diagnosis of cervical cancer and HSIL in HPV-positive women. Methods ThinPrep cytology test was performed in 2,472 HPV-positive women. Out of 2,472 HPV-positive women, the cervical biopsy was concurrently performed in 1,533 women. Data on the HPV type and the diagnostic findings of the ThinPrep cytology test and cervical biopsy were collected from our hospital electronic database. The concordance of diagnostic findings between cytology and histology was compared. Results The rate of agreement in the diagnosis of the low-grade squamous intraepithelial lesion (LSIL) or HSIL between cervical biopsy and ThinPrep cytology test was 58 or 49%. The overall false negative rate in the diagnosis of cervical cancer and HSIL by ThinPrep cytology test was 6%. However, when considering the total number of HPV-positive women diagnosed with cervical cancer (n = 36) and HSIL (n = 117) by cervical biopsy, we found that a significant number of HPV-positive women with cervical cancer (n = 12, 33%), or women with HSIL (n = 77, 66%) were failed to be diagnosed by the ThinPrep cytology test. These HPV-positive women were either diagnosed with cervical infection or ASCUS, or LSIL. Discussion Our data demonstrated that in order to ensure an accurate diagnosis, an immediate cervical biopsy in women with cervical infection or ASCUS or LSIL should be strongly recommended in clinical practice.
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Affiliation(s)
- Yang Liu
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Yongxiang Yin
- Department of Pathology, Wuxi Maternity and Child Health Hospital Affiliated Nanjing Medical University, Wuxi, China
| | - Yi Zhang
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Luling Lin
- Liggins Institutes, The University of Auckland, Auckland, New Zealand
| | - Min Zhao
- Department of Gynaecological Cancer, Wuxi Maternity and Child Health Hospital Affiliated Nanjing Medical University, Wuxi, China
| | - Qi Chen
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
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Gupta R, Kumar N, Sood N, Sharda A, Kumar D, Gupta S. Knowledge, Practice, and Skills in Cytology-Based Cervical Cancer Screening: Impact Assessment of Training Workshop for the Pathologists. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:58-64. [PMID: 32514726 DOI: 10.1007/s13187-020-01785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is a paucity of trained cytopathologists in low-resource settings for effective cervical cancer screening. There has been no documented report of the impact of a dedicated training program in cervical cytology on pathologists' knowledge and skill in this field. The present study aimed to evaluate the efficacy of the regularly conducted training workshops on the attending pathologists' knowledge, practice, and skills in cervicovaginal smear reporting. Our institute, a premier cancer research institute, has conducted 10 cytology-based cervical cancer screening workshops for pathologists with pre- and post-training evaluation using sets of digital images and a questionnaire (knowledge score). Additionally, feedback on diagnostic skills was taken at a 1-month and 6-month interval post-workshop using a separate set of digital images of cervical lesions. A Google form-based questionnaire was designed to seek the participants' feedback on the perceived improvement in knowledge and skills. All the data thus collected were analyzed to assess the efficacy of these workshops in imparting the desired knowledge and skills. A total of 350 participants were enrolled in these workshops. The average knowledge score improved from 10.56 (± 3.23) in the pre-training questionnaire to 21.17 (± 2.41) in the post-training evaluation, making a 100.5% increase (P < 0.001). Similarly, the diagnostic accuracy on digital images was enhanced from 8.6 (± 2.12) to 19.5 (± 4.28) immediately post-training and was maintained at 17.6 (± 3.87) at 1-month and 16.4 (± 4.26) at a 6-month interval (P < 0.001). The majority of the participants reported fair to a marked improvement in their knowledge, practice, and confidence in reporting cervical cytology in the response to form-based questionnaire. One-fifth of the responders also acknowledged the assistance of the knowledge gained during the workshop in refinement or initiation of cervical cytology at their set-up. Our experience of conducting these regular workshops demonstrates the utility of such training programs in human resource development in the field of cervical cytology for enhancement of cervical cancer screening in resource-constrained settings.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, 201301, India
| | - Neeta Kumar
- Department of Pathology, Faculty of Dentistry, Jamia Millia Islamia (Central University), New Delhi, India
| | - Neelam Sood
- Department of Pathology, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi, India
| | - Akhileshwar Sharda
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, 201301, India
| | - Dinesh Kumar
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, 201301, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, I-7, Sector-39, Noida, 201301, India.
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Lewis S, Mphande M, Chibwana F, Gumbo T, Banda BA, Sigauke H, Moses A, Gupta S, Hoffman RM, Moucheraud C. Association of HIV status and treatment characteristics with VIA screening outcomes in Malawi: A retrospective analysis. PLoS One 2022; 17:e0262904. [PMID: 35077501 PMCID: PMC8789172 DOI: 10.1371/journal.pone.0262904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although evidence from high-resource settings indicates that women with HIV are at higher risk of acquiring high-risk HPV and developing cervical cancer, data from cervical cancer "screen and treat" programs using visual inspection with acetic acid (VIA) in lower-income countries have found mixed evidence about the association between HIV status and screening outcomes. Moreover, there is limited evidence regarding the effect of HIV-related characteristics (e.g., viral suppression, treatment factors) on screening outcomes in these high HIV burden settings. METHODS This study aimed to evaluate the relationship between HIV status, HIV treatment, and viral suppression with cervical cancer screening outcomes. Data from a "screen and treat" program based at a large, free antiretroviral therapy (ART) clinic in Lilongwe, Malawi was retrospectively analyzed to determine rates of abnormal VIA results and suspected cancer, and coverage of same-day treatment. Multivariate logistic regression assessed associations between screening outcomes and HIV status, and among women living with HIV, viremia, ART treatment duration and BMI. RESULTS Of 1405 women receiving first-time VIA screening between 2017-2019, 13 (0.9%) had suspected cancer and 68 (4.8%) had pre-cancerous lesions, of whom 50 (73.5%) received same-day lesion treatment. There was no significant association found between HIV status and screening outcomes. Among HIV+ women, abnormal VIA was positively associated with viral load ≥ 1000 copies/mL (aOR 3.02, 95% CI: 1.22, 7.49) and negatively associated with ART treatment duration (aOR 0.88 per additional year, 95% CI: 0.80, 0.98). CONCLUSION In this population of women living with HIV with high rates of ART coverage and viral suppression, HIV status was not significantly associated with abnormal cervical cancer screening results. We hypothesize that ART treatment and viral suppression may mitigate the elevated risk of cervical cancer for women living with HIV, and we encourage further study on this relationship in high HIV burden settings.
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Affiliation(s)
- Samuel Lewis
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States of America
| | | | | | - Temwa Gumbo
- Partners in Hope Medical Center, Lilongwe, Malawi
| | | | | | - Agnes Moses
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Sundeep Gupta
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States of America
- Partners in Hope Medical Center, Lilongwe, Malawi
| | - Risa M. Hoffman
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Corrina Moucheraud
- Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, United States of America
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Chargari C, Arbyn M, Leary A, Abu-Rustum NR, Basu P, Bray F, Chopra S, Nout R, Tanderup K, Viswanathan AN, Zacharopoulou C, Soria JC, Deutsch E, Gouy S, Morice P. Increasing global accessibility to high-level treatments for cervical cancers. Gynecol Oncol 2022; 164:231-241. [PMID: 34716024 PMCID: PMC9496636 DOI: 10.1016/j.ygyno.2021.10.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023]
Abstract
Human papillomaviruses (HPV)-related gynecological cancers are a major health care issue, and a leading cause of cancer death in low- and middle-income countries (LMIC). In 2020, the World Health Organization launched a program aimed at cervical cancer elimination, by screening and vaccination strategies. Offering the best possible care to women diagnosed with invasive cancer is a complementary objective. Treatment of cervical cancer as per modern standards is complex and multimodal, mainly relying on surgery, external-beam radiotherapy (+/-chemotherapy) and brachytherapy. In parallel with the pivotal role of multidisciplinary discussion, international societies provide guidance to define the most effective and least toxic anti-cancer strategy, homogenize treatment protocols and provide benchmark quality indicators as a basis for accreditation processes. The challenge is to offer the appropriate diagnostic workup and treatment upfront and to avoid non- evidence-based treatment that consumes resources, impairs quality of life (QoL), and compromises oncological outcome. Various strategies may be applied for improving treatment quality: development of surgical mentorship, companion-training programs and international cooperation. The lack of radiotherapy/brachytherapy facilities is a major concern in LMIC. Reinforcing international support in terms of education, training, research and development and technical cooperation with national projects is required to increase access to minimum requirements but also introduce modern techniques, upgrade radiotherapy/brachytherapy services, and expand access to modern systemic treatments. In countries with robust economies, compliance to standards should also be increased. Integrative cancer care and multidisciplinary approaches are needed to tackle the dual challenge of increasing cure rates while minimizing QoL impairment. Appropriate dimensioning of the resources to avoid harmful treatment delays and access to expert referral centers is also a priority.
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Affiliation(s)
- C Chargari
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | - M Arbyn
- Unit Cancer Epidemiology - Belgian Cancer Centre, Brussels, Belgium
| | - A Leary
- Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - N R Abu-Rustum
- Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, United States; European Society of Gynecological Oncology, Geneva, Switzerland
| | - P Basu
- Early Detection, Prevention & Infection Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - F Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, UK
| | - S Chopra
- Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Homi Bhabha National Institute, Maharashtra, India
| | - R Nout
- Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - K Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD, United States
| | - C Zacharopoulou
- European Parliament, Committee on the Environment, Public Health and Food Safety, France
| | - J C Soria
- Governance, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - E Deutsch
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - S Gouy
- Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - P Morice
- Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; European Society of Gynecological Oncology, Geneva, Switzerland; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
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Li CS, Hung CJ, Peng SC, Ho YL. Impact of Gender and Age on Claim Rates of Dread Disease and Cancer Insurance Policies in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:216. [PMID: 35010476 PMCID: PMC8750668 DOI: 10.3390/ijerph19010216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
In this paper, the impact of both gender and age on the claim rates of dread disease and cancer insurance policies were examined using unique data taken from Taiwan's private health insurance policies issued by non-life insurers during the 2012 to 2015 policy years. Those aged 30-39 served as the reference group. For the total number of dread disease policies, male insureds had a higher non-cancer claim probability than female insureds, while an age under 20 was associated with much lower claim rates for dread disease policies than for ages over 50. The claim rate for dread disease policies increased rapidly beginning at age 40 for both cancerous and non-cancerous diseases amongst male insureds. Amongst female insureds, those under 20 had much lower claim rates for dread disease policies. Only those aged 50-59 had a higher claim rate for non-cancerous diseases. For the total number of cancer insurance policies, male insureds had lower claim rates than female insureds, with an upward trend being associated with age. For male (female) insureds aged over 40 (20), the claim rates of cancer increased with age.
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Affiliation(s)
- Chu-Shiu Li
- Department of Risk Management and Insurance, National Kaohsiung University of Science & Technology, Kaohsiung 824, Taiwan;
| | - Chih-Jen Hung
- Ph.D. Program of Business, College of Business, Feng Chia University, Taichung 40724, Taiwan
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Sheng-Chang Peng
- Department of Risk Management and Insurance, Ming Chuan University, Taipei 111, Taiwan;
| | - Ya-Lee Ho
- Department of Business Administration, Feng Chia University, Taichung 40724, Taiwan;
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Bober P, Firment P, Sabo J. Diagnostic Test Accuracy of First-Void Urine Human Papillomaviruses for Presence Cervical HPV in Women: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413314. [PMID: 34948919 PMCID: PMC8708158 DOI: 10.3390/ijerph182413314] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 01/07/2023]
Abstract
First-void urine usually contains exfoliated cells of the debris and mucus from the female genital organs and cervix, i.e., high concentration of human papillomavirus deoxyribonucleic acid (HPV DNA). We conducted a meta-analysis of published data and determined an accuracy of HPV detection in first-void urine compared to the women’s cervix. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we carried out a comprehensive literature search. Eligible articles published from 2011 until 2021 were gathered by searching Embase, PubMed and Cochrane Library Central databases. The patient selection, index test, standard test, and patient flow were the factors involved in quality evaluation. A meta-analysis of 15 studies (3412 women) based on 5054 potential records was conducted. Pooled sensitivity for high-risk HPV detection in urine of 78% (70–84%) and specificity of 89% (81–94%) were calculated. Any HPV detection in urine of 87% (74–94%) and 91% (83–96%) were pooled sensitivity and specificity, respectively. HPV 16 and 18 had a pooled sensitivity of 77% (76–77%) and specificity of 98% (98–98%). Meta-analysis indicated variations between the pooled specificities and sensitivities. In meta-regression analysis, a heterogeneity in accuracy by using covariates (bias in patient selection, purpose, sample timing, storage temperature and HPV detection method) were not detected. Our meta-analysis demonstrates the accuracy of detection of HPV in urine for the presence of cervical HPV. Although progress is continuously made in urinary HPV detection, further studies are needed to evaluate and to improve the accuracy of the first-void urine test in order to be comparable with other screening methods.
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Affiliation(s)
- Peter Bober
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P.J. Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia;
- Correspondence:
| | - Peter Firment
- Department of Anaesthesiology and Intensive Medicine, FNsP J. A. Reimana Prešov, Jána Hollého 5898/14, 08181 Prešov, Slovakia;
| | - Ján Sabo
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P.J. Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia;
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Al Sekri E, Al Musalhi A, Al Abri K, Al Kindi H, Al Salmani AA. Prevalence of Cytological Abnormalities in Papanicolaou Smears and Risk Factors for Cervical Cancer Among Women in Muscat, Oman. Sultan Qaboos Univ Med J 2021; 21:598-603. [PMID: 34888080 PMCID: PMC8631215 DOI: 10.18295/squmj.4.2021.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women. Methods A cross-sectional study was conducted from March to September 2019 at the gynaecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21 and 65 years were included. Data regarding the participants' sociodemographic characteristics and known risk factors were collected using a self-reported sheet. Pap smears were performed and the results were reported by a cytotechnologist and histopathologist. Results A total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( P = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity (P >0.050 each). Conclusion The prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. The findings of this study also highlighted the need for a future vaccination program against HPV infections.
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Affiliation(s)
| | | | | | | | - Asma A Al Salmani
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, Muscat, Oman
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Hanley SJB, Fujita H, Aoyama-Kikawa S, Kasamo M, Torigoe T, Matsuno Y, Noriaki S. Evaluation of partial genotyping with HPV16/18 for triage of HPV positive, cytology negative women in the COMPACT study. J Gynecol Oncol 2021; 32:e86. [PMID: 34708593 PMCID: PMC8550923 DOI: 10.3802/jgo.2021.32.e86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/15/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
Objective While cytology-based screening programs have significantly reduced mortality and morbidity from cervical cancer, the global consensus is that primary human papillomavirus (HPV) testing increases detection of high-grade cervical intraepithelial neoplasia (CIN) and invasive cancer. However, the optimal triage strategy for HPV+ women to avoid over-referral to colposcopy may be setting specific. We compared absolute and relative risk (RR) of >CIN2/3 within 12 months of a negative cytologic result in women HPV16/18+ compared to those with a 12-other high-risk HPV (hrHPV) genotype to identify women at greatest risk of high-grade disease and permit less aggressive management of women with other hrHPV infections. Methods Participants were 14,160 women aged 25–69 years with negative cytology participating in the COMparison of HPV genotyping And Cytology Triage (COMPACT) study. Women who were HPV16/18+ were referred to colposcopy. Those with a 12-other hrHPV type underwent repeat cytology after 6 months and those with >abnormal squamous cells of undetermined significance went to colposcopy. Results Absolute risk of >CIN2 in HPV16/18+ women was 19.5% (95% CI=12.4%–29.4%). In women 25–29 years and HPV16+ it was 40.0% (95% CI=11.8%–76.9%). Absolute risk of >CIN3 in women HPV16/18+ was 11.0% (95% CI=5.9%–19.6%). For women 30–39 years and HPV16+ it was 23.1% (95% CI=5.0%–53.8%). Overall risk of >CIN2, >CIN3 in women with a 12-other hrHPV HPV type was 5.6% (95% CI=3.1%–10.0%) and 3.4% (95% CI=1.6%–7.2%) respectively. RR of >CIN2, >CIN3 in HPV16/18+ vs. 12-other hrHPV was 3.5 (95% CI=1.7–7.3) and 3.3 (95% CI=1.2–8.8), respectively. Conclusion Primary HPV screening with HPV16/18 partial genotyping is a promising strategy to identify women at current/future risk of >CIN2 in Japan without over-referral to colposcopy. Trial Registration UMIN Clinical Trials Registry Identifier: UMIN000013203
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Affiliation(s)
- Sharon J B Hanley
- Department of Obstetrics and Gynecology, Hokkaido University Faculty of Medicine, Sapporo, Japan.,Hokkaido Center for Environmental and Health Sciences, Sapporo, Japan.
| | | | | | | | | | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Sakuragi Noriaki
- Department of Obstetrics and Gynecology, Hokkaido University Faculty of Medicine, Sapporo, Japan.,Women's Healthcare Center, Otaru General Hospital, Otaru, Japan
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Cho HW, Shim SR, Lee JK, Hong JH. Accuracy of human papillomavirus tests on self-collected urine versus clinician-collected samples for the detection of cervical precancer: a systematic review and meta-analysis. J Gynecol Oncol 2021; 33:e4. [PMID: 34783207 PMCID: PMC8728664 DOI: 10.3802/jgo.2022.33.e4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The human papillomavirus (HPV) test is an effective screening tool to prevent cervical cancer. Urinary sampling for HPV detection improves the accessibility and participation of screening services and reduces the cost and burden on physicians. The clinical accuracy of urinary HPV test has yet to be determined via meta-analysis. This study assessed the clinical accuracy of these tests to detect cervical intraepithelial neoplasia (CIN) 2 or worse. Methods Relevant studies were identified using the PubMed, Embase, and Cochrane databases. Research eligibility was based on the clinical accuracy of HPV test on clinician-collected samples as a comparator test, and urine as an index test. The reference standard was the presence of CIN2 or worse. The pooled absolute, relative sensitivity, and specificity of the urinary HPV test versus clinician-collected samples were assessed using a bivariate model. Results The pooled sensitivity of urinary HPV test was significantly lower than that of clinician-collected samples (ratio=0.84, 95% confidence interval [CI]=0.78–0.91). However, some polymerase chain reaction (PCR)-based HPV test such as GP5+/6+ (relative sensitivity=0.98, 95% CI=0.91–1.05), SPF10 (relative sensitivity=0.98, 85% CI=0.88–1.08) and non GP5+/6+ PCR (relative sensitivity=1.00, 95% CI=0.88–1.14) showed similar sensitivity in both the urine and clinician-collected samples. Conclusion Our findings indicate that HPV test with some PCR-based assay on urine versus clinician-collected samples demonstrate similar clinical accuracy to detect CIN2 or worse. It suggests that urinary HPV test may present itself as a decent alternative screening tool for the detection of cervical pre-cancer. Trial Registration PROSPERO identifier: CRD42021227901 Some polymerase chain reaction-based human papillomavirus (HPV) tests showed similar accuracy in urine and cervical samples. Signal amplification or messenger RNA HPV test on urine is less sensitive than cervical test. High-risk HPV assays is the only significant factor to affect test accuracy. Urinary HPV test may be an alternative option for cervical cancer screening.
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Affiliation(s)
- Hyun-Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Leung SOA, Vitonis AF, Feldman S. Loop Electrosurgical Excision Procedure in Managing Persistent Low-Grade Abnormality or Human Papillomavirus Positivity. J Low Genit Tract Dis 2021; 25:281-286. [PMID: 34284456 DOI: 10.1097/lgt.0000000000000619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to estimate the rate and to identify predictors of high-grade abnormalities among women with persistent low-grade abnormalities or high-risk human papillomavirus (hrHPV) positivity for at least 2 years stratified by presence (high risk) or absence (low risk) of previous high-grade results or HPV 16/18. MATERIALS AND METHODS A retrospective cohort study of patients who underwent a loop electrosurgical excision procedure (LEEP) for persistent low-grade or hrHPV positivity was performed. Patients were stratified based on whether they had a history of high-grade and/or HPV 16/18 positivity. Rates of high-grade or worse abnormalities on LEEP were compared using Fisher exact tests. Logistic regression was used to evaluate the associations between patient characteristics and high-grade results on the LEEP. RESULTS Three hundred eleven LEEPs were performed for persistent low-grade or hrHPV positivity. The rates of occult high grade were 12% and 22% among the low- and high-risk groups, respectively. Compared with those 45 years and older, the adjusted odds of high grade was 3.79 (95% CI = 1.19-12.1) for women aged 25-29 years. The odds of high grade was higher among current versus never smokers (6.40; 95% CI = 2.01-20.4) and those with a history of high-grade abnormality (2.23; 95% CI = 1.12-4.43). At 2 years, approximately half had an abnormal cytology and/or hrHPV positivity result independent of whether high grade was identified on their LEEP specimen. CONCLUSIONS Patients with persistent low-grade abnormalities or persistent hrHPV should be counseled on the risks and benefits of a LEEP given that 12%-22% have a risk of occult high grade, especially if they have a history of high-grade dysplasia.
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Affiliation(s)
- Shuk On Annie Leung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGill University Health Centre, McGill University, Montreal, QC
| | - Allison F Vitonis
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
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Dieleman M, de Waard J, Wisman GBA, Schuuring E, Esajas MD, Vermeulen KM, de Bock GH. Preferences and Experiences Regarding the Use of the Self-Sampling Device in hrHPV Screening for Cervical Cancer. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:245-253. [PMID: 34558035 PMCID: PMC8866331 DOI: 10.1007/s40271-021-00550-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND To improve participation in the Dutch cervical cancer screening, a self-sampling device (SSD) was introduced in 2017 into the Dutch population-based screening programme (PBS) for the early detection of cervical cancer. The aim of this study was to gather potential preferences and experiences that might influence a woman's decision to use the SSD in the Dutch PBS. METHODS A scoping review was performed in the PubMed database. Studies that assessed preferences and experiences of women regarding the SSD were included, and preferences and experiences were extracted. In addition, in a qualitative study, the list of potential preferences and experiences specific for the Dutch PBS was extended based on semi-structured interviews with SSD users as well as non-SSD users who recently participated in the PBS, analysed in a structured manner by translating full sentences to key words. RESULTS Ninety-eight studies were included in the scoping review and 16 interviews were performed. Frequently mentioned reasons for using the SSD, in both the interviews and the literature, were practicality and comfort. Frequently mentioned reasons for not using the SSD were fear of not performing the SSD procedure correctly and doubts on whether the results of the high-risk human papillomavirus (hrHPV) test will be reliable. A new positive experience elicited in the interviews was accessibility. Negative preferences and experiences were not being aware the SSD was an option, and the inconvenience that after an hrHPV-positive test result of the SSD, an additional smear test at the GP is necessary. CONCLUSION Several preferences and experiences play a role in the choice whether or not to use the SSD. Based on the currently found preferences and experiences, an app will be developed in order to assess which of these are the most important for women participating in the Dutch population-based cervical screening programme.
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Affiliation(s)
- Marjolein Dieleman
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Huispostcode FA40, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Jolien de Waard
- Department of Gynaecologic Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - G Bea A Wisman
- Department of Gynaecologic Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ed Schuuring
- Department of Pathology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Martha D Esajas
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Huispostcode FA40, PO BOX 30 001, 9700 RB, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Huispostcode FA40, PO BOX 30 001, 9700 RB, Groningen, The Netherlands.
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Robust whole slide image analysis for cervical cancer screening using deep learning. Nat Commun 2021; 12:5639. [PMID: 34561435 PMCID: PMC8463673 DOI: 10.1038/s41467-021-25296-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/03/2021] [Indexed: 01/20/2023] Open
Abstract
Computer-assisted diagnosis is key for scaling up cervical cancer screening. However, current recognition algorithms perform poorly on whole slide image (WSI) analysis, fail to generalize for diverse staining and imaging, and show sub-optimal clinical-level verification. Here, we develop a progressive lesion cell recognition method combining low- and high-resolution WSIs to recommend lesion cells and a recurrent neural network-based WSI classification model to evaluate the lesion degree of WSIs. We train and validate our WSI analysis system on 3,545 patient-wise WSIs with 79,911 annotations from multiple hospitals and several imaging instruments. On multi-center independent test sets of 1,170 patient-wise WSIs, we achieve 93.5% Specificity and 95.1% Sensitivity for classifying slides, comparing favourably to the average performance of three independent cytopathologists, and obtain 88.5% true positive rate for highlighting the top 10 lesion cells on 447 positive slides. After deployment, our system recognizes a one giga-pixel WSI in about 1.5 min. Computer-assisted diagnosis is key for scaling up cervical cancer screening, but current algorithms perform poorly on whole slide image analysis and generalization. Here, the authors present a WSI classification and top lesion cell recommendation system using deep learning, and achieve comparable results with cytologists.
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Staley H, Shiraz A, Shreeve N, Bryant A, Martin-Hirsch PP, Gajjar K. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2021; 9:CD002834. [PMID: 34694000 PMCID: PMC8543674 DOI: 10.1002/14651858.cd002834.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND This is an update of the Cochrane review published in Issue 5, 2011. Worldwide, cervical cancer is the fourth commonest cancer affecting women. High-risk human papillomavirus (HPV) infection is causative in 99.7% of cases. Other risk factors include smoking, multiple sexual partners, the presence of other sexually transmitted diseases and immunosuppression. Primary prevention strategies for cervical cancer focus on reducing HPV infection via vaccination and data suggest that this has the potential to prevent nearly 90% of cases in those vaccinated prior to HPV exposure. However, not all countries can afford vaccination programmes and, worryingly, uptake in many countries has been extremely poor. Secondary prevention, through screening programmes, will remain critical to reducing cervical cancer, especially in unvaccinated women or those vaccinated later in adolescence. This includes screening for the detection of pre-cancerous cells, as well as high-risk HPV. In the UK, since the introduction of the Cervical Screening Programme in 1988, the associated mortality rate from cervical cancer has fallen. However, worldwide, there is great variation between countries in both coverage and uptake of screening. In some countries, national screening programmes are available whereas in others, screening is provided on an opportunistic basis. Additionally, there are differences within countries in uptake dependent on ethnic origin, age, education and socioeconomic status. Thus, understanding and incorporating these factors in screening programmes can increase the uptake of screening. This, together with vaccination, can lead to cervical cancer becoming a rare disease. OBJECTIVES To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical screening. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 6, 2020. MEDLINE, Embase and LILACS databases up to June 2020. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical screening. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. Where possible, the data were synthesised in a meta-analysis using standard Cochrane methodology. MAIN RESULTS Comprehensive literature searches identified 2597 records; of these, 70 met our inclusion criteria, of which 69 trials (257,899 participants) were entered into a meta-analysis. The studies assessed the effectiveness of invitational and educational interventions, lay health worker involvement, counselling and risk factor assessment. Clinical and statistical heterogeneity between trials limited statistical pooling of data. Overall, there was moderate-certainty evidence to suggest that invitations appear to be an effective method of increasing uptake compared to control (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.49 to 1.96; 141,391 participants; 24 studies). Additional analyses, ranging from low to moderate-certainty evidence, suggested that invitations that were personalised, i.e. personal invitation, GP invitation letter or letter with a fixed appointment, appeared to be more successful. More specifically, there was very low-certainty evidence to support the use of GP invitation letters as compared to other authority sources' invitation letters within two RCTs, one RCT assessing 86 participants (RR 1.69 95% CI 0.75 to 3.82) and another, showing a modest benefit, included over 4000 participants (RR 1.13, 95 % CI 1.05 to 1.21). Low-certainty evidence favoured personalised invitations (telephone call, face-to-face or targeted letters) as compared to standard invitation letters (RR 1.32, 95 % CI 1.11 to 1.21; 27,663 participants; 5 studies). There was moderate-certainty evidence to support a letter with a fixed appointment to attend, as compared to a letter with an open invitation to make an appointment (RR 1.61, 95 % CI 1.48 to 1.75; 5742 participants; 5 studies). Low-certainty evidence supported the use of educational materials (RR 1.35, 95% CI 1.18 to 1.54; 63,415 participants; 13 studies) and lay health worker involvement (RR 2.30, 95% CI 1.44 to 3.65; 4330 participants; 11 studies). Other less widely reported interventions included counselling, risk factor assessment, access to a health promotion nurse, photo comic book, intensive recruitment and message framing. It was difficult to deduce any meaningful conclusions from these interventions due to sparse data and low-certainty evidence. However, having access to a health promotion nurse and attempts at intensive recruitment may have increased uptake. One trial reported an economic outcome and randomised 3124 participants within a national screening programme to either receive the standard screening invitation, which would incur a fee, or an invitation offering screening free of charge. No difference in the uptake at 90 days was found (574/1562 intervention versus 612/1562 control, (RR 0.94, 95% CI: 0.86 to 1.03). The use of HPV self-testing as an alternative to conventional screening may also be effective at increasing uptake and this will be covered in a subsequent review. Secondary outcomes, including cost data, were incompletely documented. The majority of cluster-RCTs did not account for clustering or adequately report the number of clusters in the trial in order to estimate the design effect, so we did not selectively adjust the trials. It is unlikely that reporting of these trials would impact the overall conclusions and robustness of the results. Of the meta-analyses that could be performed, there was considerable statistical heterogeneity, and this should be borne in mind when interpreting these findings. Given this and the low to moderate evidence, further research may change these findings. The risk of bias in the majority of trials was unclear, and a number of trials suffered from methodological problems and inadequate reporting. We downgraded the certainty of evidence because of an unclear or high risk of bias with regards to allocation concealment, blinding, incomplete outcome data and other biases. AUTHORS' CONCLUSIONS There is moderate-certainty evidence to support the use of invitation letters to increase the uptake of cervical screening. Low-certainty evidence showed lay health worker involvement amongst ethnic minority populations may increase screening coverage, and there was also support for educational interventions, but it is unclear what format is most effective. The majority of the studies were from developed countries and so the relevance of low- and middle-income countries (LMICs), is unclear. Overall, the low-certainty evidence that was identified makes it difficult to infer as to which interventions were best, with exception of invitational interventions, where there appeared to be more reliable evidence.
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Affiliation(s)
- Helen Staley
- Obstetrics & Gynaecology, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Norman Shreeve
- Obstetrics & Gynaecology, University of Cambridge Clinical School, Cambridge, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Pierre Pl Martin-Hirsch
- Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Preston, UK
| | - Ketankumar Gajjar
- Department of Gynaecological Oncology, 1st Floor Maternity Unit, City Hospital Campus, Nottingham, UK
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Salciccioli I, Zhou CD, Okonji EC, Shalhoub J, Salciccioli JD, Marshall D. European trends in cervical cancer mortality in relation to national screening programs, 1985-2014. Cancer Epidemiol 2021; 74:102002. [PMID: 34371420 DOI: 10.1016/j.canep.2021.102002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cervical cancer is the fourth leading oncological cause of death in women. Variable trends in cervical cancer mortality have been observed across Europe, despite the widespread adoption of screening programs. This variability has previously been attributed to heterogeneity in the quality of screening programs. METHODS Age-standardized cervical cancer death rates for European countries between 1985 and 2014 were analyzed using Joinpoint regression. Countries were dichotomized based on year of implementation and population invitational coverage of national population-based cervical cancer screening programs. National cervical cancer mortality trends during the study period were compared based on this classification. RESULTS Decreasing trends in mortality were observed in all European countries with the specific exceptions of Bulgaria, Greece and Latvia. The highest rates of cervical cancer mortality throughout the study period were in Romania (16.0-14.9/100,000) and the lowest rates in Italy (1.4-1.2/100,000). The greatest percentage decline in mortality was observed in the United Kingdom and the greatest absolute reduction in mortality was seen in Hungary. European countries which implemented a national population-based cervical cancer screening program prior to 2009 demonstrated greater improvements in cervical cancer mortality outcomes compared to those that did not (p = 0.016). CONCLUSION Cervical cancer mortality is improving in most European countries; however, substantial variation remains. Trends in mortality were associated with the time of implementation of national population-based cervical screening programs.
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Affiliation(s)
| | | | | | | | - Justin D Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Dominic Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
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Gong J, Jiang J, Qu J, Li J, Chen X, Ruan Z, Lu G, He Y, He X, Sun R. Association between the rs3733846 in the flanking region of miR-143/145 and risk of cervical squamous cell carcinoma. Biomark Med 2021; 15:891-897. [PMID: 34229450 DOI: 10.2217/bmm-2020-0865] [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: 12/10/2020] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate the effect of rs3733846 in the flanking region of miR-143/145 on susceptibility to cervical squamous cell carcinoma (CSCC). Materials & methods: We collected venous blood samples from 242 CSCC patients and 250 healthy controls. The rs3733846 polymorphism was genotyped by SnaPshot and Sanger sequencing. The expression of miR-143/145 in CSCC tissues was detected by quantitative real-time PCR. Results: The rs3733846 AG genotype was associated with a decreased risk of CSCC in genetic model (AGvs.AA: adjusted odds ratio [OR]: 0.44; 95% CI: 0.30-0.66; p < 0.001). Patients with the rs3733846 AG/GG genotypes had a reduced risk of developing poorly differential status (OR: 0.57; 95% CI: 0.33-0.98; p < 0.04) and lymph node metastasis (OR: 0.49; 95% CI: 0.26-0.92; p < 0.03). Conclusion: The rs3733846 in the flanking region of miR-143/145 was related to the susceptibility of CSCC.
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Affiliation(s)
- Jianyu Gong
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Jike Jiang
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Jianwen Qu
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Ju Li
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Xin Chen
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Zhiguo Ruan
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Gangxu Lu
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Yuxiao He
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Xiaoshan He
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
| | - Ruifen Sun
- School of Basic Medicine, Yunnan University of Chinese Medicine, Yunnan, Kunming, China
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Altová A, Kulhánová I, Brůha L, Lustigová M. Breast and cervical cancer screening attendance among Czech women. Cent Eur J Public Health 2021; 29:90-95. [PMID: 34245547 DOI: 10.21101/cejph.a6623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the variation in breast and cervical cancer screening attendance among Czech women by age and in regions in 2009-2017. METHODS The data from the health insurance company that covers around 50% of the Czech population were used to calculate age-specific attendance rates and standardized attendance rates by year and region. RESULTS In 2017, the attendance of all eligible women was 52% in breast cancer screening and 46% in cervical cancer screening. There were differences in attendance among groups of women. Women aged 45-49 had attendance rates in both screenings around 60%, while 39% of women aged 75-79 attended breast cancer screening, and 23% attended cervical cancer screening. In regions, attendance ranged from 38% to 70% in breast cancer screening and from 32% to 55% in cervical cancer screening. CONCLUSIONS We identified the age-specific differences and regional variation in both breast and cervical cancer screening attendance among Czech women. Those with lower attendance may have a higher risk of dying from breast and cervical cancers. Mitigating this risk should be a priority of public health policies.
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Affiliation(s)
- Anna Altová
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czech Republic
| | - Ivana Kulhánová
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czech Republic.,Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Lukáš Brůha
- Department of Applied Geoinformatics and Cartography, Faculty of Science, Charles University, Prague, Czech Republic
| | - Michala Lustigová
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic.,National Institute of Public Health, Prague, Czech Republic
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Anyasi HI, Foss AM. A comparative analysis of cervical cancer prevention between Nigeria and Nordic countries that have experienced a decline in cervical cancer incidence. Int Health 2021; 13:307-317. [PMID: 33000170 PMCID: PMC8253993 DOI: 10.1093/inthealth/ihaa062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A modelling analysis carried out in 2014 suggested that, without cervical cancer screening programmes, the incidence of cervical cancer in Denmark, Finland, Norway and Sweden would have been as high as that in some low- and middle-income countries. We compare programme strategies between Nigeria and these Nordic countries and develop translatable recommendations. METHODS A literature review using a systematic approach through Medline, Popline, Global Health, CINAHL PLUS, Cochrane Library, EMBASE, Google Scholar, Africa Wide and WHO databases was conducted. RESULTS Fifteen journal articles and two grey literature reports met our criteria. Six descriptive studies from Nigeria noted that services in Nigeria were mainly provided in urban secondary/tertiary facilities and that uptake was low even where screening was free. Trials in Nigeria and Sweden noted that subsidies and free programmes alone did not improve uptake; a Danish trial demonstrated that reminders and invitations issued by general practitioners improved participation. CONCLUSION Free screening programmes are important but should also consider incentivisation of treatment when needed and demand creation among health workers. Additionally, effective monitoring and evaluation of programme data are key to improving and maintaining quality. More broadly, we suggest that Nigeria can build success through stakeholder-led implementation of well-defined policies with national consensus to ensure coordination and sustainability.
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Affiliation(s)
- Helen I Anyasi
- Prevention Unit, SIDHAS Project, FHI360, No. 8, Yedseram Street, Maitama| P.M.B. 44, Abuja, Nigeria
| | - Anna M Foss
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
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Shin MB, Liu G, Mugo N, Garcia PJ, Rao DW, Bayer CJ, Eckert LO, Pinder LF, Wasserheit JN, Barnabas RV. A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities. Front Public Health 2021; 9:670032. [PMID: 34277540 PMCID: PMC8281011 DOI: 10.3389/fpubh.2021.670032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.
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Affiliation(s)
- Michelle B. Shin
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Gui Liu
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patricia J. Garcia
- Department of Global Health, University of Washington, Seattle, WA, United States
- School of Public Health, Cayetano Heredia University, Lima, Peru
| | - Darcy W. Rao
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Cara J. Bayer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Linda O. Eckert
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Leeya F. Pinder
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Judith N. Wasserheit
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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Santaclara V, Torres-Moreno D, Bernal-Mañas CM, Isaac MA, Ortiz-Reina S, Conesa-Zamora P. Relationship between polymorphisms in the FAS/FASL death receptor system and progression of low-grade precursor lesions infected with high-risk human papilloma virus. Hum Immunol 2021; 82:621-624. [PMID: 34127318 DOI: 10.1016/j.humimm.2021.06.002] [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: 03/05/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
Squamous intraepithelial lesions (SIL) and cervical cancer are primary due to suboptimal immune response against human papillomavirus (HPV). The FASL/FAS system is a trigger of extrinsic pathway apoptosis. The distribution of polymorphisms rs1800682 (-670 A > G) FAS and rs763110 (-844C > T) FASL was studied in cervical smears from 372 females (182 with stable or regressed low-grade SIL (LSIL) (groupI) and a group of 190 high-grade SIL (HSIL) (groupII). No significant differences were observed for rs1800682 in FAS between the study groups. In contrast, rs763110 CC genotype of FASL was found in 35.7% of group I females, and in 50.5% of group II (p = 0.0027; OR = 1.83 (95% CI = 1.21-2.79)). When only females infected with high-risk HPV were analysed, these differences were even higher (p = 0.0024; OR = 2.21 (95% CI = 1.30-3.75)). CC genotype in FASL seems to be associated with increased risk of LSIL to HSIL progression suggesting a role in HPV tolerance, persistent infection, and HSIL development.
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Affiliation(s)
| | | | | | - María Alejandra Isaac
- Pathology Department, Santa Lucía University Hospital (HGUSL), Spain; Facultad de Ciencias de la Salud, Catholic University of Murcia (UCAM), Murcia, Spain
| | | | - Pablo Conesa-Zamora
- Facultad de Ciencias de la Salud, Catholic University of Murcia (UCAM), Murcia, Spain; Clinical Analysis Department, HGUSL, Cartagena, Spain; Molecular Pathology and Pharmacogenetic Group. Institute for Biohealth Research from Murcia (IMIB), HGUSL, Cartagena, Spain.
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Grimes DR, Corry EMA, Malagón T, O’Riain C, Franco EL, Brennan DJ. Modeling Cervical Cancer Screening Strategies With Varying Levels of Human Papillomavirus Vaccination. JAMA Netw Open 2021; 4:e2115321. [PMID: 34190993 PMCID: PMC8246311 DOI: 10.1001/jamanetworkopen.2021.15321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Cervical cancer screening is a lifesaving intervention, with an array of approaches, including liquid-based cytology (LBC), molecular testing for human papillomavirus (HPV) infection, and combinations via parallel cotesting or sequential triage. Maximizing screening efficacy while minimizing overtreatment is vital, especially when considering how the HPV vaccine will affect the interpretation of results. OBJECTIVES To estimate the likely outcomes of different screening modalities and to model how the increasing uptake of the HPV vaccine could affect the interpretation of screening results. DESIGN, SETTING, AND PARTICIPANTS This decision analytic model established a simple Markov model to compare the outcomes of different cervical cancer screening modalities on a simulated population of women (aged ≥25 years), considering different levels of HPV vaccination. MAIN OUTCOMES AND MEASURES The number of cases of cervical intraepithelial neoplasia (CIN) grade 2 and 3 detected and missed, the number of false positives, and the number of tests required to achieve a given level of accuracy. Positive and negative predictive values of different modalities were simulated under varying levels of HPV vaccination and therefore HPV prevalence. RESULTS In a simulated population of 1000 women aged 25 years and older with an HPV prevalence of 2%, HPV-based modalities outperformed LBC-based approaches, detecting 19% more true positives (HPV test sensitivity, 89.9% [95% CI, 88.6%-91.1%]; LBC test sensitivity, 75.5% [95% CI, 66.6%-82.7%]). While cotesting markedly reduced missed cases, detecting 29% more true positives than LBC alone (19.5 [95% CI, 19.3-19.7] per 1000 women screened vs 15.1 [95% CI, 13.3-16.5] per 1000 women screened), it unacceptably increased excess colposcopy referral by 94% (184.4 [95% CI, 181.8-188.0] false positives per 1000 women screened vs 95.1 [95% CI, 93.1-97.0] false positives per 1000 women screened). By contrast, triage testing with reflex screening substantially reduced false positives by a factor of approximately 10 (eg, HPV with LBC triage, 9.6 [95% CI, 9.3-10.0] per 1000 women screened). Over a lifetime of screening, reflex approaches with appropriate test intervals maximized therapeutic efficacy; as HPV vaccination rates increased, HPV-based screening approaches resulted in fewer unnecessary colposcopies than LBC approaches (HPV testing, 80% vaccine coverage: 44.1 [95% CI, 40-45.9] excess colposcopies; LBC testing, 80% vaccine coverage: 96.9 [95% CI, 96.8-97.0] excess colposcopies). CONCLUSIONS AND RELEVANCE In this decision analytic model, the effectiveness of cervical cancer screening was dependent on the prevalence of cervical dysplasia and/or HPV infection or vaccination in a population as well as the sensitivity and specificity of various modalities. Although screening is lifesaving, overtesting or modalities inappropriate to the target population may cause significant harm, including overtreatment.
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Affiliation(s)
- David Robert Grimes
- School of Physical Sciences, Dublin City University, Glasnevin, Dublin, Ireland
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Edward M. A. Corry
- Department of Gynaecological Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Ciaran O’Riain
- Department of Histopathology, St James’s Hospital, Dublin, Ireland
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada
| | - Donal J. Brennan
- Department of Gynaecological Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
- Systems Biology Ireland, University College Dublin School of Medicine, Belfield, Dublin, Ireland
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