1
|
Sahasrabuddhe VV. Cervical Cancer: Precursors and Prevention. Hematol Oncol Clin North Am 2024; 38:771-781. [PMID: 38760198 DOI: 10.1016/j.hoc.2024.03.005] [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: 05/19/2024]
Abstract
Cervical cancer, caused due to oncogenic types of human papillomavirus (HPV), is a leading preventable cause of cancer morbidity and mortality globally. Chronic, persistent HPV infection-induced cervical precursor lesions, if left undetected and untreated, can progress to invasive cancer. Cervical cancer screening approaches have evolved from cytology (Papanicolaou test) to highly sensitive HPV-based molecular methods and personalized, risk-stratified, management guidelines. Innovations like self-collection of samples to increase screening access, innovative triage methods to optimize management of screen positives, and scalable and efficacious precancer treatment approaches will be key to further enhance the utility of prevention interventions.
Collapse
Affiliation(s)
- Vikrant V Sahasrabuddhe
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 5E-338, Rockville, MD, USA.
| |
Collapse
|
2
|
Janowski EM, Hall E, Jin R, Horton B, Walker K, Mistro M, Showalter T, Romano K. Impact of baseline lymphopenia on outcomes of definitive treatment for locally advanced cervical cancer. Gynecol Oncol Rep 2024; 54:101448. [PMID: 39040940 PMCID: PMC11261294 DOI: 10.1016/j.gore.2024.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/24/2024] Open
Abstract
Objectives The purpose of this study is to evaluate the association between lymphopenia and survival in women with locally advanced cervical cancer (LACC) treated with definitive chemoradiation (CRT). Methods We retrospectively reviewed patients with LACC treated at a single institution from 2004 to 2021. Patient and treatment characteristics were recorded along with baseline absolute lymphocyte counts (ALC). Overall survival (OS), progression free survival (PFS), and local control (LC) were calculated from start of treatment to date of last follow-up. Cox regression and competing risks regression model were performed to evaluate whether baseline ALC was associated with OS, PFS, or LC. Results 246 patients met study inclusion criteria with stage IB - IV disease with a median follow up of 2.8 years (range 0.2-13.4 years). 5-year OS, PFS, and LC were 68.4 % (95 % CI 61.7-75.9), 57.2 % (95 % CI 50.4-64.8), and 79.0 % (95 % CI 73.0-84.4), respectively. Baseline lymphopenia (ALC < 1000 cells/mm3) was present in 12.5 % of patients. OS was improved in the patients without lymphopenia, with a 5-year OS of 69.0 % (95 % CI 61.6-77.3) versus 63.0 % (95 % CI 47.6-83.3)in the lymphopenia group (p = 0.233), though this did not meet statistical significance. PFS also trended towards improvement in patients without baseline lymphopenia, with a 5-year PFS of 58.5 % (95 % CI 51.2-66.8) versus 48.5 % (95 % CI 32.8-71.7), p = 0.220. No significant difference was found for LC in the patients without lymphopenia, p = 0.745. Conclusions In this single institution experience of LACC treated with definitive CRT, we found that baseline lymphopenia trends toward inferior OS and PFS.
Collapse
Affiliation(s)
| | - Emilee Hall
- University of Virginia, School of Medicine, USA
| | - Ruyun Jin
- University of Virginia, Department of Public Health Sciences, Division of Biostatistics, USA
| | - Bethany Horton
- University of Virginia, Department of Public Health Sciences, Division of Biostatistics, USA
| | - Kristin Walker
- University of Virginia, Department of Radiation Oncology, USA
| | - Matthew Mistro
- University of Virginia, Department of Radiation Oncology, USA
| | | | - Kara Romano
- University of Virginia, Department of Radiation Oncology, USA
| |
Collapse
|
3
|
Qin J, Scarinci I, Lu E, Senkomago V, Ngoc Nguyen DT, Abonales L, Soin K, Edilyong J, Reichhardt M, Marfel M, Simms K, Canfell K, Maxwell K, Saraiya M, Palafox N. Building Capacity for Cervical Cancer Prevention in U.S.-Affiliated Pacific Islands: The Pacific Against Cervical Cancer Project. J Womens Health (Larchmt) 2024; 33:839-847. [PMID: 38864276 DOI: 10.1089/jwh.2024.0284] [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: 06/13/2024] Open
Abstract
The U.S.-affiliated Pacific Islands (USAPI) have higher cervical cancer incidence and mortality rates and lower screening coverage compared with the United States. This is likely because of economic, geographical, health care delivery, and cultural barriers for women living in these resource-constrained, isolated regions. The most recent U.S. and World Health Organization cervical cancer screening guidelines recommended primary human papillomavirus (HPV) testing as one screening option or the preferred screening modality. Primary HPV screening-based strategies offer several advantages over current screening methods in the USAPI. However, adoption of this newer screening modality has been slow in the United States and not yet incorporated into USAPI screening programs. The U.S. Centers for Disease Control and Prevention and partners initiated the Pacific Against Cervical Cancer (PACe) project in 2019 to evaluate the feasibility, acceptability, and cost-effectiveness of primary HPV testing-based strategies in Guam and in Yap, Federated States of Micronesia. This report provides an overview of the PACe project and outlines the approaches we took in implementing primary HPV testing as a new cervical cancer screening strategy (including the option of self-sampling in Yap), encompassing four core components: (1) community engagement and education, (2) medical and laboratory capacity building, (3) health information and system improvement, and (4) modeling and cost-effectiveness analysis. The PACe project provides examples of systematic implementation and resource appropriate technologies to the USAPI, with broader implications for never screened and under-screened populations in the United States and Pacific as they face similar barriers to accessing cervical cancer screening services.
Collapse
Affiliation(s)
- Jin Qin
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isabel Scarinci
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Enriquito Lu
- Family Planning and Reproductive Health Unit, Jhpiego, Johns Hopkins University, Baltimore, Maryland, USA
| | - Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Diep Thi Ngoc Nguyen
- The Daffodil Centre, a joint venture between Cancer Council New South Wales and the University of Sydney, Sydney, Australia
| | - Lesley Abonales
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - Komal Soin
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - James Edilyong
- Yap State Department of Health Services, Colonia, Micronesia (the Federated States of)
| | - Martina Reichhardt
- Yap State Department of Health Services, Colonia, Micronesia (the Federated States of)
| | - Maria Marfel
- Yap State Department of Health Services, Colonia, Micronesia (the Federated States of)
| | - Kate Simms
- The Daffodil Centre, a joint venture between Cancer Council New South Wales and the University of Sydney, Sydney, Australia
| | - Karen Canfell
- The Daffodil Centre, a joint venture between Cancer Council New South Wales and the University of Sydney, Sydney, Australia
| | - Kathryn Maxwell
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neal Palafox
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| |
Collapse
|
4
|
Schreiberhuber L, Barrett JE, Wang J, Redl E, Herzog C, Vavourakis CD, Sundström K, Dillner J, Widschwendter M. Cervical cancer screening using DNA methylation triage in a real-world population. Nat Med 2024:10.1038/s41591-024-03014-6. [PMID: 38834848 DOI: 10.1038/s41591-024-03014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/23/2024] [Indexed: 06/06/2024]
Abstract
Cervical cancer (CC) screening in women comprises human papillomavirus (HPV) testing followed by cytology triage of positive cases. Drawbacks, including cytology's low reproducibility and requirement for short screening intervals, raise the need for alternative triage methods. Here we used an innovative triage technique, the WID-qCIN test, to assess the DNA methylation of human genes DPP6, RALYL and GSX1 in a real-life cohort of 28,017 women aged ≥30 years who attended CC screening in Stockholm between January and March 2017. In the analysis of all 2,377 HPV-positive samples, a combination of WID-qCIN (with a predefined threshold) and HPV16 and/or HPV18 (HPV16/18) detected 93.4% of cervical intraepithelial neoplasia grade 3 and 100% of invasive CCs. The WID-qCIN/HPV16/18 combination predicted 69.4% of incident cervical intraepithelial neoplasia grade 2 or worse compared with 18.2% predicted by cytology. Cytology or WID-qCIN/HPV16/18 triage would require 4.1 and 2.4 colposcopy referrals to detect one cervical intraepithelial neoplasia grade 2 or worse, respectively, during the 6 year period. These findings support the use of WID-qCIN/HPV16/18 as an improved triage strategy for HPV-positive women.
Collapse
Affiliation(s)
- Lena Schreiberhuber
- European Translational Oncology Prevention and Screening Institute, Hall in Tirol, Austria
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - James E Barrett
- European Translational Oncology Prevention and Screening Institute, Hall in Tirol, Austria
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Jiangrong Wang
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Redl
- European Translational Oncology Prevention and Screening Institute, Hall in Tirol, Austria
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Chiara Herzog
- European Translational Oncology Prevention and Screening Institute, Hall in Tirol, Austria
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Charlotte D Vavourakis
- European Translational Oncology Prevention and Screening Institute, Hall in Tirol, Austria
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Karin Sundström
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Widschwendter
- European Translational Oncology Prevention and Screening Institute, Hall in Tirol, Austria.
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria.
- General Hospital Hall, Tirol Kliniken, Hall in Tirol, Austria.
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK.
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
5
|
Mwenda V, McGrath CJ. Choosing the Appropriate HPV Testing and Treatment Algorithm: What Works for Different Contexts? Cancer Epidemiol Biomarkers Prev 2024; 33:763-765. [PMID: 38826081 DOI: 10.1158/1055-9965.epi-23-1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/29/2024] [Accepted: 04/01/2024] [Indexed: 06/04/2024] Open
Abstract
Cervical cancer can be eliminated, and the global community intends to achieve this goal in the next century. For this to successfully occur, concerted efforts to implement and scale-up available, evidence-based strategies including human papillomavirus vaccination, screening and treatment of precancerous lesions, and early detection and treatment for invasive cancers is paramount. While the World Health Organization has offered technical guidance and recommendations on implementation, several questions remain unanswered and require urgent high-quality research to inform policy and practice. We discuss the findings from the Cervical Cancer Screening and Treatment Algorithms pilot study in the context of the evidence synthesis conducted for the second edition of the World Health Organization guidelines for screening and treatment of cervical precancer lesions for cervical cancer prevention. Policymakers at the national level must consider the weight of evidence with country-level resources to make decisions on screening, triage, and treatment approaches. See related article by Sebitloane et al., p. 779.
Collapse
Affiliation(s)
- Valerian Mwenda
- Division of Cancer and Non-communicable Diseases, Ministry of Health, Nairobi, Kenya
| | | |
Collapse
|
6
|
Dicu-Andreescu IG, Marincaș MA, Simionescu AA, Dicu-Andreescu I, Prunoiu VM, Ionescu SO, Neicu ȘA, Radu GM, Brătucu E, Simion L. Abdominal Parietal Metastasis from Cervical Cancer: A Review of One of the Most Uncommon Sites of Recurrence Including a Report of a New Case. Life (Basel) 2024; 14:667. [PMID: 38929651 PMCID: PMC11204997 DOI: 10.3390/life14060667] [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: 04/09/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Cervical cancer is the fourth most common cancer in women, the highest mortality being found in low- and middle-income countries. Abdominal parietal metastases in cervical cancer are a very rare entity, with an incidence of 0.1-1.3%, and represent an unfavorable prognostic factor with the survival rate falling to 17%. Here, we present a review of cases of abdominal parietal metastasis in recent decades, including a new case of a 4.5 cm abdominal parietal metastasis at the site of the scar of the former drain tube 28 months after diagnosis of stage IIB cervical cancer (adenosquamous carcinoma), treated by external radiotherapy with concurrent chemotherapy and intracavitary brachytherapy and subsequent surgery (type B radical hysterectomy). The tumor was resected within oncological limits with the histopathological result of adenosquamous carcinoma. The case study highlights the importance of early detection and appropriate treatment of metastases in patients with cervical cancer. The discussion explores the potential pathways for parietal metastasis and the impact of incomplete surgical procedures on the development of metastases. The conclusion emphasizes the poor prognosis associated with this type of metastasis in cervical cancer patients and the potential benefits of surgical resection associated with systemic therapy in improving survival rates.
Collapse
Affiliation(s)
- Irinel-Gabriel Dicu-Andreescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Marian-Augustin Marincaș
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Anca-Angela Simionescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Ioana Dicu-Andreescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
| | - Virgiliu-Mihail Prunoiu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Sânziana-Octavia Ionescu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Ștefania-Ariana Neicu
- Department of Pathological Anatomy, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Gabriela-Mădălina Radu
- Department of Pathological Anatomy, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Eugen Brătucu
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Laurențiu Simion
- Clinical Department No 10, General Surgery, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (I.-G.D.-A.)
- Department of Oncological Surgery, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| |
Collapse
|
7
|
Yang ST, Wang PH, Liu HH, Chang WH, Chou FW, Lee WL. Cervical cancer: Part I human papilloma virus vaccination in Taiwan. Taiwan J Obstet Gynecol 2024; 63:320-328. [PMID: 38802194 DOI: 10.1016/j.tjog.2024.04.005] [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] [Accepted: 04/09/2024] [Indexed: 05/29/2024] Open
Abstract
A significant decline in both incidence and prevalence of cervical cancers after widespread-introducing cervical screening strategy by Papanicolau test (Pap test) has been found in the world, but cervical cancer is still one of the most common female cancers, reporting the fourth prevalence and also one of the leading causes to result in main women-associated morbidity and mortality, particularly for those women living in low- and middle-income countries. Cervical cancer is one of the most important health concerns directly destroying the global health-care system, partly because of not only increasing the disability either secondary to diseases themselves of victims or mediated by treatment-related adverse events to the survivors but also acting as a leading cause of death of diseased patients worldwide, alarming the urgent need to do something to minimize the catastrophic diseases-related heavy socioeconomic burden. It is fortunate that cervical cancer is a preventable disease, based on its strong association with human papillomavirus (HPV) infection (more than 95%), particularly for those high-risk HPV (HR-HPV) and its high possibility by detecting HPV infection before the development of cervical cancer as well as an effective prevention by HPV vaccination. That is why WHO (World Health Organization) considers cervical cancer as a public problem and attempts to accelerate the elimination of cervical cancer program by three-pillar approach (90:70:90% targets), including (1) 90% of girls are fully vaccinated with HPV vaccine by 15 years of age; (2) 70% of women are screened with a high-performance test by 35 and 45 years of age and precancerous lesions are treated early; and (3) 90% of women identified with cervical diseases receive appropriate and adequate treatment. Herein, this review focuses on the HPV vaccination as Part I, including global recommendations and Taiwan government's policy for HPV vaccination.
Collapse
Affiliation(s)
- Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Hung-Hsien Liu
- Department of Medical Imaging and Intervention, Tucheng Hospital, New Taipei City, Taiwan
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Wei Chou
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Ling Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan.
| |
Collapse
|
8
|
Vale DB, Teixeira JC. Implementing plans for global elimination of cervical cancer. Nat Med 2023; 29:3004-3005. [PMID: 38087117 DOI: 10.1038/s41591-023-02577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Diama Bhadra Vale
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
| | - Julio Cesar Teixeira
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| |
Collapse
|