1
|
Pankakoski M, Anttila A, Sarkeala T, Heinävaara S. Effectiveness of cervical cancer screening at age 65 - A register-based cohort study. PLoS One 2019; 14:e0214486. [PMID: 30913262 PMCID: PMC6435141 DOI: 10.1371/journal.pone.0214486] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
Most cervical cancer deaths in Finland occur after the termination of the national screening program, targeted at women aged 30 to 64 years. The purpose of this study was to examine the effectiveness of screening at age 65 in reducing cervical cancer mortality. A register-based cohort study was performed with a follow-up period between 1991 and 2014. Mortality risk ratios for incident cervical cancer cases diagnosed at age 65 or older were compared between women invited and not invited for screening. The background risk difference between the studied areas was accounted for by using a reference cohort. The relative risk of death for women invited for cervical cancer screening at the age of 65 was 0.52 (95% CI: 0.29-0.94). The relative risks for women not attending and attending to screening with respect to the uninvited were 1.28 (CI: 0.65-2.50) and 0.28 (CI: 0.13-0.59), respectively. Inviting 65-year-old women for screening has been effective in reducing cervical cancer mortality.
Collapse
Affiliation(s)
- Maiju Pankakoski
- Finnish Cancer Registry, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- * E-mail:
| | | | | | - Sirpa Heinävaara
- Finnish Cancer Registry, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
2
|
Sabol I, Milutin Gašperov N, Matovina M, Božinović K, Grubišić G, Fistonić I, Belci D, Alemany L, Džebro S, Dominis M, Šekerija M, Tous S, de Sanjosé S, Grce M. Cervical HPV type-specific pre-vaccination prevalence and age distribution in Croatia. PLoS One 2017; 12:e0180480. [PMID: 28692681 PMCID: PMC5503252 DOI: 10.1371/journal.pone.0180480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
The main etiological factor of precancerous lesion and invasive cervical cancer are oncogenic human papillomaviruses types (HPVs). The objective of this study was to establish the distribution of the most common HPVs in different cervical lesions and cancer prior to the implementation of organized population-based cervical screening and HPV vaccination in Croatia. In this study, 4,432 cervical specimens, collected through a 16-year period, were tested for the presence of HPV-DNA by polymerase chain reaction (PCR) with three sets of broad-spectrum primers and type-specific primers for most common low-risk (LR) types (HPV-6, 11) and the most common high-risk (HR) types (HPV-16, 18, 31, 33, 45, 52, 58). Additional 35 archival formalin-fixed, paraffin embedded tissue of cervical cancer specimens were analyzed using LiPA25 assay. The highest age-specific HPV-prevalence was in the group 18-24 years, which decreased continuously with age (P<0.0001) regardless of the cytological diagnosis. The prevalence of HR-HPV types significantly increased (P<0.0001) with the severity of cervical lesions. HPV-16 was the most common type found with a prevalence (with or without another HPV-type) of 6.9% in normal cytology, 15.5% in atypical squamous cells of undetermined significance, 14.4% in low-grade squamous intraepithelial lesions, 33.3% in high-grade squamous intraepithelial lesions, and 60.9% in cervical cancer specimens (P<0.0001). This study provides comprehensive and extensive data on the distribution of the most common HPV types among Croatian women, which will enable to predict and to monitor the impact of HPV-vaccination and to design effective screening strategies in Croatia.
Collapse
Affiliation(s)
- Ivan Sabol
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | | | - Mihaela Matovina
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Ksenija Božinović
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Goran Grubišić
- University Hospital Sisters of Mercy, Clinic of Obstetrics and Gynaecology, Zagreb, Croatia
| | - Ivan Fistonić
- Obstetrics, Gynecology and Menopause Clinic, Zagreb, Croatia
| | - Dragan Belci
- Department of Gynecology and Obstetrics, General Hospital Pula, Pula, Croatia
| | - Laia Alemany
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Sonja Džebro
- Department of Pathology and Cytology, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb, Croatia
| | - Mara Dominis
- Department of Pathology and Cytology, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb, Croatia
| | - Mario Šekerija
- Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia
- School of Medicine, Andrija Štampar School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Sara Tous
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Program, Unit of Infections and Cancer, Catalan Institute of Oncology, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Magdalena Grce
- Department of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| |
Collapse
|
3
|
Abstract
We conducted a systematic review summarizing data on incidence of high- and low-grade lesions in women with normal baseline cervical cytology, stratified by age (<30 and ⩾30 years), and baseline human papillomavirus (HPV) infection. Incidence of high- and low-grade lesions in women aged ⩾30 years with a baseline HPV infection increased over follow-up time (5-127 months), although incidence generally remained <10%. Without baseline HPV infection, incidence of high-grade lesions remained low over follow-up time (<5% over 5-122 months). Incidence of high-grade lesions in women aged ⩾30 years with baseline HPV infection appeared similar to that in women aged <30 years. In some women aged <30 years, high-grade lesions can develop relatively shortly after initial HPV infection. We observed an increase in low-grade lesions over time in women aged ⩾30 years with baseline HPV infection, potentially indicative of an HPV infection that is potentially progressing to higher grade lesions.
Collapse
|
4
|
Banik U, Bhattacharjee P, Ahamad SU, Rahman Z. Pattern of epithelial cell abnormality in Pap smear: A clinicopathological and demographic correlation. Cytojournal 2011; 8:8. [PMID: 21713015 PMCID: PMC3119384 DOI: 10.4103/1742-6413.80527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 03/05/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In the low resource settings of a developing country, a conventional Papanicolaou (Pap) test is the mainstay screening system for cervical cancer. In order to counsel women and to organize a public health system for cervical cancer screening by Pap smear examination, it is imperative to know the pattern of premalignant and malignant lesions. This study was undertaken to find out the prevalence of an abnormal Pap smear, in a tertiary hospital of a developing country, and to carry out a clinicopathological and demographical analysis for establishing the pattern of epithelial cell abnormality in a Pap smear. MATERIALS AND METHODS A cross-sectional descriptive study was carried out in a total of 1699 patients who underwent Pap smear examination. The prevalence of epithelial cell abnormality in the Pap smear was calculated in proportions / percentages. Specimen adequacy and reporting was assessed according to the revised Bethesda system. RESULTS Among the total of 1699 patients who had their Pap smear done, 139 (8.18%) revealed epithelial cell abnormality. Altogether 26 smears revealed high-grade lesions and malignancy, most of which were found to be in women belonging to the 30 - 39 and ≥ 45 age group. A total of 75 (53.96%) women were in the 20 - 44 age group and 64 (46.04%) were in the ≥ 45 age group. A bimodal age distribution was detected in the epithelial cell abnormality, with the bulk being diagnosed in patients aged 45 or above. Overall one-third of the patients with an abnormal Pap smear result showed healthy cervix in per vaginal examination. CONCLUSIONS A raised prevalence of epithelial cell abnormality reflects the lack of awareness about cervical cancer screening. Women aged 45 or above harbor the bulk of premalignant and malignant lesions in the Pap smear, signifying that these women are among the under users of cytological screening.
Collapse
Affiliation(s)
- Urmila Banik
- Department of Pathology, Chittagong Medical College, Chittagong - 4000, Bangladesh
| | | | | | | |
Collapse
|