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Hansen BT, Nygård M, Castle PE, Burger EA, Aasbø G. Sociodemographic characteristics associated with cervical cancer screening participation by send-to-all and opt-in HPV self-sampling: Who benefits? Results from a randomized controlled trial among long-term non-attending women in Norway. Int J Cancer 2024; 155:1053-1067. [PMID: 38751040 DOI: 10.1002/ijc.34989] [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: 11/14/2023] [Revised: 03/11/2024] [Accepted: 04/12/2024] [Indexed: 07/16/2024]
Abstract
With the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under-screened women, we randomized a random sample of 6000 women in Norway aged 35-69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in), or (iii) a self-sampling kit unsolicited (send-to-all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send-to-all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt-in arm, we observed smaller, and at times, non-significant increases within the range 0.7% (95% CI = -5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send-to-all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt-in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (-12.7%, 95% CI = -19.7% to -5.7%). Self-sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self-sampling, especially with the goal to reach long-term non-attending women.
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Affiliation(s)
- Bo T Hansen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Phil E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Interdisciplinary Health Science, University of Oslo, Oslo, Norway
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Li X, Xie H, Fu Y, Zhang X, Dong X, Ji Y, Lu W, Wang X. Epidemiology Characteristics and Potential Cervical Cancer Screening Value of Vulvar Human Papillomavirus in Chinese Women: A Multicenter Cross-Sectional Study. Arch Pathol Lab Med 2024; 148:1035-1040. [PMID: 38059501 DOI: 10.5858/arpa.2023-0255-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 12/08/2023]
Abstract
CONTEXT.— Noninvasive self-sampling is a convenient option that may be highly accepted by women for home-based detection, which could increase the screening rate for cervical cancer (CC) and reduce its incidence and mortality. OBJECTIVE.— To compare the distribution of high-risk human papillomavirus (hr-HPV) between the vulva and cervix and to explore the clinical value of vulvar HPV detection in CC screening. DESIGN.— The study was nested within a clinical trial on a recombinant HPV 9-valent vaccine for women ages 20 to 45 years. Women with paired vulvar and cervical specimens were included and underwent cytology and HPV detection. The consistency of HPV detection between vulvar and cervical specimens was evaluated using Cohen κ statistics. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to evaluate the diagnostic accuracy of primary CC screening. The primary end points were cervical intraepithelial neoplasia (CIN) grade 2/3 or worse (CIN2+/3+). RESULTS.— A total of 7999 women were enrolled, and 83/33 cases were diagnosed as CIN2+/CIN3+. The HPV-positive rate in vulvar specimens (1785 of 7999; 22.32%) was higher than that in cervical specimens (1390 of 7999; 17.38%), and there were no significant differences in the distribution of hr-HPV genotypes between the vulva and cervix in patients with CIN2+/CIN3+. Vulva-based HPV primary screening showed sensitivity, specificity, PPV, and NPV comparable to those for cervix-based HPV primary CC screening in the detection of CIN3+. CONCLUSIONS.— The distribution of vulvar and cervical HPV was similar in patients with CIN2+/CIN3+. Vulva-based HPV primary CC screening had acceptable diagnostic efficacy and might be used as a modality for primary CC screening.
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Affiliation(s)
- Xiao Li
- From the Departments of Gynecologic Oncology (Li, Dong, Lu, Wang) and Pathology (Zhang), the Clinical Research Center (Xie), and the Centre for Diagnosis & Treatment of Cervical Diseases (Fu), Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- the Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China (Li, Lu)
- the Cancer Research Institute of Zhejiang University, Hangzhou, China (Li)
| | - Hongyu Xie
- From the Departments of Gynecologic Oncology (Li, Dong, Lu, Wang) and Pathology (Zhang), the Clinical Research Center (Xie), and the Centre for Diagnosis & Treatment of Cervical Diseases (Fu), Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- the Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Hangzhou, China (Xie)
| | - Yunfeng Fu
- From the Departments of Gynecologic Oncology (Li, Dong, Lu, Wang) and Pathology (Zhang), the Clinical Research Center (Xie), and the Centre for Diagnosis & Treatment of Cervical Diseases (Fu), Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaofei Zhang
- From the Departments of Gynecologic Oncology (Li, Dong, Lu, Wang) and Pathology (Zhang), the Clinical Research Center (Xie), and the Centre for Diagnosis & Treatment of Cervical Diseases (Fu), Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaohui Dong
- From the Departments of Gynecologic Oncology (Li, Dong, Lu, Wang) and Pathology (Zhang), the Clinical Research Center (Xie), and the Centre for Diagnosis & Treatment of Cervical Diseases (Fu), Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ying Ji
- the Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China (Ji)
- Bovax Biotechnology Co Ltd, Shanghai, China (Ji)
| | - Weiguo Lu
- From the Departments of Gynecologic Oncology (Li, Dong, Lu, Wang) and Pathology (Zhang), the Clinical Research Center (Xie), and the Centre for Diagnosis & Treatment of Cervical Diseases (Fu), Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- the Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China (Li, Lu)
| | - Xinyu Wang
- From the Departments of Gynecologic Oncology (Li, Dong, Lu, Wang) and Pathology (Zhang), the Clinical Research Center (Xie), and the Centre for Diagnosis & Treatment of Cervical Diseases (Fu), Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- the Department of Obstetrics and Gynecology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Wang)
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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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Nakamura K, Kigure K, Nishimura T, Yamashita S. Questionnaire survey on cervical cancer screening and HPV awareness among patients at a local cancer center in Japan. BMC Womens Health 2024; 24:402. [PMID: 39014425 PMCID: PMC11251239 DOI: 10.1186/s12905-024-03256-z] [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: 06/19/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The incidence of cervical intraepithelial neoplasia is increasing in Japan. Although human papillomavirus (HPV) vaccination and cancer screening are crucial in preventing cancer-related mortality, the cervical cancer screening rate in Japan was only approximately 43.6% in 2022. This study aimed to conduct an epidemiological analysis of cervical cancer by collecting data from individual patients. METHODS A questionnaire survey was administered to patients who visited our hospital between January 2017 and July 2023 owing to abnormal cervical cytological findings or a cancer diagnosis. Patients answered questions regarding their history of cervical cancer screening as well as their knowledge of HPV and cervical cancer. RESULTS During the study period, 471 patients participated in the survey, with 35 declining to participate. Patients with Stage 1b1-4b primarily sought medical attention due to self-reported symptoms (P < 0.001); however, they were less likely to have undergone cervical cancer screening (P < 0.001). Additionally, older patients were less likely to be aware of the association of HPV with cervical and other cancers. Notably, 28 of the 129 patients with stage 1b1-4b cancer underwent cervical cancer screening within 2 years. The tumor location within the endocervical canal emerged as a significant factor contributing to the difficulty for an accurate diagnosis of precancerous or cervical cancer during cervical screening. Furthermore, non- squamous cell carcinoma (SCC) histology was another possible factor. CONCLUSIONS Our findings suggest the need to widely disseminate information regarding the significance of cancer screening to increase cancer screening rates. Moreover, establishing strategies for improving the accuracy of detecting lesions during screening for non-SCC and endocervical canal tumors is crucial.
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Affiliation(s)
- Kazuto Nakamura
- Department of Gynecology, Gunma Prefectural Cancer Center, 617-1 Takabayashi-nishi, Ota, Japan.
| | - Keiko Kigure
- Department of Gynecology, Gunma Prefectural Cancer Center, 617-1 Takabayashi-nishi, Ota, Japan
| | - Toshio Nishimura
- Department of Gynecology, Gunma Prefectural Cancer Center, 617-1 Takabayashi-nishi, Ota, Japan
| | - Soichi Yamashita
- Department of Gynecology, Gunma Prefectural Cancer Center, 617-1 Takabayashi-nishi, Ota, Japan
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Kim H, Kim KY, Kim D, Hwang JH. Implementation rate and related factors of confirmatory tests following an abnormal Pap smear: a nationwide study from the National Health Insurance. J Gynecol Oncol 2024; 35:e26. [PMID: 38130135 PMCID: PMC11107272 DOI: 10.3802/jgo.2024.35.e26] [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: 07/18/2023] [Revised: 09/17/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE This study aims to investigate the implementation rate and influencing factors of confirmatory tests for women with abnormal cervical cytology results in the Korean nationwide cervical cancer screening program. METHODS The National Health Insurance Service (NHIS) database was utilized to identify all Korean women who have participated in the Korean nationwide cervical cancer screening program from January 2011 and December 2021 using the NHIS database. Multiple logistic regression analysis was performed to estimate the multivariate odds ratio and evaluate the patients' characteristics. RESULTS The rate of abnormal Papanicolaou (Pap) smears showed an initial increase from 2011 to 2015 and subsequently reached a plateau after 2016. When examining specific subcategories, cases of atypical squamous cells of undetermined significance (ASC-US) increased from 28,546 cases (1.1%) in 2011 to 62,850 cases (1.7%) in 2021. In contrast, cases of HSIL and SCC declined from 3,535 cases (0.14%) to 2,763 cases (0.07%) and from 383 cases (0.01%) to 179 cases (0.005%), respectively. Furthermore, the implementation rate of confirmatory tests for women with abnormal cytology increased from 8,865 cases (21.0%) in 2011 to 39,045 cases (51.2%) in 2021. Regarding the specific subcategory of ASC-US, the number of confirmatory tests exhibited a substantial increase from 4,101 cases (14.4%) in 2011 to 30,482 cases (48.5%) in 2021. For SCC, there was no significant change, with 216 cases (56.4%) in 2011 and 102 cases (57.0%) in 2021. The implementation rate of confirmatory tests was found to be significantly associated with results of abnormal Pap smear, age, and residence. Notably, economic status did not emerge as a significant factor affecting the likelihood of undergoing confirmatory tests. CONCLUSIONS The severity of abnormal Pap smear results is a reliable indicator of the probability of undergoing a confirmatory test. Additional endeavors are required to improve the implementation rate among women who have received abnormal Pap smear results.
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Affiliation(s)
- Hyeongsu Kim
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kyeong Yeon Kim
- Department of Occupational and Environmental Medicine Center, Korea Medical Institute, Seoul, Korea
| | - Dasom Kim
- Home Visit Healthcare Team, Expert Group on Health Promotion for Seoul Metropolitan Government, Konkuk University, Seoul, Korea
| | - Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
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Sláma J, Dvořák V, Trnková M, Skřivánek A, Hrabcová K, Ovesná P, Nováčková M. Is phased implementation of HPV testing and triage with dual staining the way to transform organized cytology screening? Eur J Cancer Prev 2024; 33:168-176. [PMID: 37751376 PMCID: PMC10833184 DOI: 10.1097/cej.0000000000000844] [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: 08/05/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The substantial material and legislative investments in establishing and maintaining cytological screening in the Czech Republic represent barriers to a direct transition to primary HPV screening. Therefore, the LIBUSE project was implemented to test the efficacy of phasing in HPV DNA testing as a co-test to cytology in routine screening of women >30 years of age. METHODS Women aged 30 to 60 years who underwent regular annual Pap smears were co-tested for HPV DNA with selective 16/18 genotyping at 3-year intervals. All HPV 16/18-positive cases and/or cases with a severe abnormality in cytology were sent for colposcopy; HPV non-16/18-positive cases and LSILs were graded using p16/Ki67 dual-stain cytology, and positive cases were sent for colposcopy. RESULTS Overall, 2409 patients were included. After the first combined screening (year 'zero') visit, 7.4% of women were HPV-positive and 2.0% were HPV16/18-positive; only 8 women had severe Pap smear abnormalities. Triage by dual staining was positive in 21.9% of cases (28/128). Biopsy confirmed 34 high-grade precancer lesions. At the second combined visit (year 'three'), the frequency of HPV infection (5.3% vs. 7.4%) frequency of HPV16/18 (1.1% vs. 2.0%), referrals for colposcopy (35 vs. 83), and biopsy verified high-grade lesions (5 vs. 34) were significantly lower (all P ≤ 0.001). CONCLUSION The addition of HPV DNA testing with selective genotyping of HPV16/18 to existing cytology screening significantly increased the safety of the program. The gradual introduction of HPV testing was well received by healthcare professionals and patients, and can facilitate transformation of the cytology-based screening. ClinicalTrials.gov Identifier: NCT05578833.
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Affiliation(s)
- Jiří Sláma
- Department of Obstetrics, Gynecology and Neonatology, General University Hospital, 1 Medical Faculty, Charles University, Prague
| | | | | | | | | | - Petra Ovesná
- Institute of Biostatistics and Analyses, Brno, Czech Republic
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Bønløkke S, Blaakær J, Steiniche T, Iachina M. Social factors and age play a significant role in cervical cancer and advanced-stage disease among Danish women. BMC Cancer 2024; 24:259. [PMID: 38395802 PMCID: PMC10893677 DOI: 10.1186/s12885-024-11994-4] [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: 02/01/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND For cervical cancer (CC), the implementation of preventive strategies has the potential to make cervical cancer occurrence and death largely avoidable. To better understand the factors possibly responsible for cervical cancer, we aimed to examine possible differences in age and social parameters as well as screening status between women with low- or high-stage cervical cancer and matched controls. METHODS Through the Danish Cancer Registry (DCR), women diagnosed with cervical cancer in Denmark between 1987 and 2016 were included. These were age- and residence-matched in a 1:5 ratio with controls from the general female population. The study population was sub grouped into a low-stage subpopulation with women with early-stage cervical cancer and matched controls and a high-stage subpopulation with women with late-stage cervical cancer and matched controls. Age and social parameters were compared within the subpopulations as well as between low- and high-stage cases. For part of the study population, screening attendance was examined to compare differences in adherence. RESULTS Overall, we found that the risk of cervical cancer is significantly increased in socially disadvantaged women and not least non-attenders in screening. Interestingly, the high-stage subpopulation was significantly older than the low-stage subpopulation (p < 0.001), and when examining the impact of age further, we found that for cervical cancer cases, the risk of having low-stage disease decreases significantly with increasing age, whereas the risk of having high-stage disease increases significantly with increasing age. In the screening cohort, significantly less cases than controls were attenders in screening with the most pronounced differences seen in the old subpopulation (women aged 50-64 years) and in the high-stage subpopulation (p-values all < 0.001). Interestingly, when examining the risk of CC for attenders and non-attenders, we demonstrated that many social parameters continue to influence the risk of cervical cancer, even in women attending screening. CONCLUSIONS Older women, socially disadvantaged women, and non-attenders in screening are particularly vulnerable in terms of developing cervical cancer, especially high-stage disease. Therefore, improvements in the participating rate in screening as well as a revision of the current screening guidelines are needed.
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Affiliation(s)
- Sara Bønløkke
- Department of Clinical Medicine - Department of Pathology, Aarhus University, Aarhus N, Denmark.
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
| | - Jan Blaakær
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Torben Steiniche
- Department of Clinical Medicine - Department of Pathology, Aarhus University, Aarhus N, Denmark
- Department of Pathology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Maria Iachina
- Department of Clinical Epidemiology, Odense University Hospital, Odense C, Denmark
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Wang J, Edvardsson H, Strander B, Andrae B, Sparén P, Dillner J. Long-term follow-up of cervical cancer incidence after normal cytological findings. Int J Cancer 2024; 154:448-453. [PMID: 37694922 DOI: 10.1002/ijc.34723] [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: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023]
Abstract
An increase in cervical cancer incidence in Sweden from 2014 to 2015 has been attributed to an increase in false-negative cytological findings before cancer diagnoses. Years later, we performed a long-term follow-up to investigate whether the problem persisted. At each calendar year from 2016 to 2020, we identified women with prior normal cervical screening results through linkage to the Swedish National Cervical Screening Registry. We reported their incidence rates (IRs) of invasive cervical cancer in consecutive years and compared the IRs over time. For the years 2016 to 2020, there was no overall change in cervical cancer incidence after two normal cytology in the last two screening intervals. However, there was a further 62% increase among women 50 to 60 years of age with normal cytology in the past two screening intervals. The incidence rate of cervical cancer was high among nonscreened women and low among HPV-screened women with negative results, with no trends over time. Our results imply that the previously reported decrease in sensitivity of cervical cytology is persisting. Although primary cytology screening is no longer used, cytology is used in triaging among HPV-positive women. Our findings suggest that improved triaging is needed, for example, improved quality assurance and/or use of alternative triage tests.
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Affiliation(s)
- Jiangrong Wang
- Division of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Edvardsson
- Department of Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Strander
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regional Cancer Centre West Region Västra Götaland, Gothenburg, Sweden
| | - Bengt Andrae
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Division of Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Center for Cervical Cancer Elimination, Department of Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden
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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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Herweijer E, Wang J, Hu K, Valdimarsdóttir UA, Adami HO, Sparén P, Sundström K, Fang F. Overall and Cervical Cancer Survival in Patients With and Without Mental Disorders. JAMA Netw Open 2023; 6:e2336213. [PMID: 37773493 PMCID: PMC10542737 DOI: 10.1001/jamanetworkopen.2023.36213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/17/2023] [Indexed: 10/01/2023] Open
Abstract
Importance Individuals with a mental disorder experience substantial health disparity and are less likely to participate in cervical screening and human papillomavirus vaccination. Additionally, this population may benefit less from tertiary cancer prevention. Objective To compare clinical characteristics and survival patterns between patients with cervical cancer with and without a preexisting diagnosis of a mental disorder at the time of cervical cancer diagnosis. Design, Setting, and Participants This cohort study obtained data from Swedish population-based (Swedish Cancer Register, Swedish Cause of Death Register, Swedish Total Population Register, Swedish Patient Register, and Swedish Longitudinal Integration Database for Health Insurance and Labor Market Studies) and quality registries (Swedish Quality Register of Gynecologic Cancer and Swedish National Cervical Screening Register) on patients with cervical cancer. Patients who were included in the analysis were identified using the Swedish Cancer Register and were diagnosed with cervical cancer between 1978 and 2018. The Swedish Patient Register was used to identify patients with mental disorders using codes from the International Classification of Diseases, Eighth Revision and Ninth Revision and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Because data on clinical characteristics at the time of cancer diagnosis were available for only for part of the study population, 2 patient groups were created: those with cervical cancer diagnosed from 2002 to 2016 and all patients diagnosed with cervical cancer (1978-2018). Data analyses were carried out between March and September 2022. Exposure Clinical diagnoses of a mental disorder, including substance abuse, psychotic disorders, depression, anxiety, stress-related disorders, attention-deficit/hyperactivity disorder, autism, and intellectual disability, prior to cervical cancer. Main Outcomes and Measures Death due to any cause or due to cervical cancer as ascertained from the Swedish Cause of Death Register. Results The sample included 20 177 females (mean [SD] age, 53.4 [17.7] years) diagnosed with cervical cancer from 1978 to 2018. In a subgroup of 6725 females (mean [SD] age, 52.2 [18.0] years) with cervical cancer diagnosed from 2002 to 2016, 893 (13.3%) had a preexisting diagnosis of a mental disorder. Compared with patients with no preexisting mental disorder diagnosis, those with a preexisting mental disorder had a higher risk of death due to any cause (hazard ratio [HR], 1.32; 95% CI, 1.17-1.48) and due to cervical cancer (HR, 1.23; 95% CI, 1.07-1.42). These risks were lower after adjustment for cancer characteristics at the time of cancer diagnosis (death due to any cause: HR, 1.19 [95% CI, 1.06-1.34] and death due to cervical cancer: HR, 1.12 [95% CI, 0.97-1.30]). Risk of death was higher for patients with substance abuse, psychotic disorders, or mental disorders requiring inpatient care. Among patients with cervical cancer diagnosed from 1978 to 2018, the estimated 5-year survival improved continuously during the study period regardless of preexisting diagnosis of a mental disorder status. For example, in 2018, the estimated 5-year overall survival proportion was 0.66 (95% CI, 0.60-0.71) and 0.74 (95% CI, 0.72-0.76) for patients with and without a preexisting diagnosis of a mental disorder, respectively. Conclusions and Relevance Findings of this cohort study suggest that patients with cervical cancer and a preexisting diagnosis of a mental disorder have worse overall and cervical cancer-specific survival than patients without a preexisting mental disorder diagnosis, which may be partly attributable to cancer and sociodemographic characteristics at diagnosis. Hence, individuals with mental disorders deserve special attention in the tertiary prevention of cervical cancer.
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Affiliation(s)
- Eva Herweijer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiangrong Wang
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kejia Hu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A. Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Zhang B, Wang S, Yang X, Chen M, Ren W, Bao Y, Qiao Y. Knowledge, willingness, uptake and barriers of cervical cancer screening services among Chinese adult females: a national cross-sectional survey based on a large e-commerce platform. BMC Womens Health 2023; 23:435. [PMID: 37592252 PMCID: PMC10436426 DOI: 10.1186/s12905-023-02554-2] [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: 02/27/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Improving the coverage rate of cervical cancer screening is a challenge mission for cervical cancer elimination. This study attempted to assess the knowledge, willingness, and uptake of cervical cancer screening services among Chinese females and determined associated factors. METHODS This is a cross-sectional online survey conducted in China from March to April 2022. Information on demographic characteristics, knowledge, willingness, and uptake of cervical cancer screening was collected through a large e-commerce platform. Women aged 18-65 were included in the analysis. Logistic regression analysis was employed to detect the possible factors associated with knowledge, willingness, and screening participation. RESULTS A total of 4518 women (37.83 ± 9.14 years) were included in the final analysis, of whom 87.16% (n = 3938) lived in urban areas. About 93.40% (n = 4220) of the respondents reported hearing of cervical cancer screening. The median score of knowledge about cervical cancer was 16 out of 26. Over 84% (n = 3799) of the respondents were willing to receive regular cervical cancer screening. Nearly 40% (n = 1785) had never received cervical cancer screening. Among the screened women, 21.26% (n = 581), 35.24% (n = 1151), and 42.37% (n = 1158) were screened through a national cervical cancer screening program, employee physical examination, and self-paid physical examination, respectively. Knowledge was positively associated with willingness and screening participation. Age, marital status, occupation, monthly household income, and HPV vaccination history could influence screening participation (all p < 0.05). CONCLUSIONS Though women had high-level awareness and strong participation willingness in cervical cancer screening, the overall screening coverage among Chinese women was still low. Besides, the knowledge about cervical cancer was still limited. Comprehensive health education should be enhanced by utilizing social media platforms and medical workers. It is also important to promote national free cervical cancer screening with high-performance screening methods.
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Affiliation(s)
- Bo Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sumeng Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiyu Yang
- The High School Affiliated to Renmin University of China, Beijing, China
| | - Mingyang Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenhui Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yanping Bao
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Present Address: School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China.
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Firtina Tuncer S, Tuncer HA. Cervical Cancer Screening in Women Aged Older Than 65 Years. J Low Genit Tract Dis 2023; 27:207-211. [PMID: 37097226 DOI: 10.1097/lgt.0000000000000742] [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: 04/26/2023]
Abstract
OBJECTIVES Considerable debate exists among guidelines regarding when cervical cancer screening can be safely stopped. The authors aimed to compare the efficiency of human papillomavirus (HPV) test, cytology, and previous screening history for the diagnosis of cervical intraepithelial neoplasia (CIN) 2+ lesions in women aged older than 65 years. MATERIALS AND METHODS This is a retrospective cohort study. Multiple logistic regressions were used to compare the efficiency of the HPV test, cytology, and previous screening history for the diagnosis of histologically proven CIN 2+ lesions. RESULTS A total of 5,427 women were included in the study. A total of 2,143 women were tested with HPV and 52 (2.4%) of them were HPV-positive. Abnormal cytology was detected in 359 (6.6%) women. Most of the women (70.4%) had inadequate screening in the previous 10 years. According to regression analysis, an HPV-positive test increases the risk of probability of CIN 2+ 136.111 times [95% CI for odds ratio (OR) = 41.212-449.538] compared with an HPV-negative test ( p < .001). Abnormal cytology increases the probability of CIN 2+ 13.072 times (95% CI for OR = 3.878-44.062) compared with normal cytology ( p < .001). Inadequate or positive previous screening increases the likelihood of CIN 2+ 9.705 times (95% CI for OR = 1.603-58.756) compared with adequate and negative previous screening ( p = .013). CONCLUSIONS Adequate previous screening is a valuable strategy, and abnormal cytology is an important screening test in women aged older than 65 years. However, the HPV test is the most determinant parameter for CIN 2+ risk in elderly women.
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Affiliation(s)
- Serap Firtina Tuncer
- Department of Obstetrics and Gynecology, Antalya Education & Research Hospital, Antalya, Turkey
| | - Hasan Aykut Tuncer
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, Akdeniz University School of Medicine Hospital, Antalya, Turkey
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Aasbø G, Hansen BT, Waller J, Nygård M, Solbrække KN. Unpacking the Lay Epidemiology of Cervical Cancer: A Focus Group Study on the Perceptions of Cervical Cancer and Its Prevention among Women Late for Screening in Norway. Healthcare (Basel) 2023; 11:healthcare11101441. [PMID: 37239727 DOI: 10.3390/healthcare11101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Nonattendance for cervical cancer screening is often understood in terms of a lack of 'appropriate' or 'correct' knowledge about the risks and prevention of the disease. Few studies have explored how lay persons-the users themselves-interpret and contextualise scientific knowledge about cervical cancer. In this study, we address the following research question: How is the epidemiology of cervical cancer and its prevention discussed among women who are late for cervical cancer screening in Norway? We completed nine focus group interviews (FGIs) with 41 women who had postponed cervical screening. The analyses were both inductive and explorative, aiming to unpack the complexity of lay understandings of cervical cancer. Interactive associations expressed in the FGIs reflected multiple understandings of aetiology and risk factors, screening, and interpretations of responsibility for acquiring cervical cancer. The term 'candidacy' was employed to provide an enhanced understanding of lay reasoning about the explanations and predictions of cervical cancer, as reflected in the FGIs. Both interpretations of biomedical concepts and cultural values were used to negotiate acceptable and nuanced interpretations of candidacy for cervical cancer. Uncertainties about risk factors for acquiring cervical cancer was an important aspect of such negotiations. The study's findings provide an in-depth understanding of the contexts in which screening may be rendered less relevant or significant for maintaining health. Lay epidemiology should not be considered inappropriate knowledge but rather as a productive component when understanding health behaviours, such as screening attendance.
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Affiliation(s)
- Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
- Department of Interdisciplinary Health Science, Institute of Health and Society, University of Oslo, 0318 Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London WC2R 2LS, UK
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Kari N Solbrække
- Department of Interdisciplinary Health Science, Institute of Health and Society, University of Oslo, 0318 Oslo, Norway
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Blomberg K, Hälleberg-Nyman M. Experiences of human papillomavirus self-sampling by women >60 years old: A qualitative study. Health Expect 2023; 26:818-826. [PMID: 36633121 PMCID: PMC10010077 DOI: 10.1111/hex.13707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) self-sampling has shown to be acceptable and feasible across cultures and effective in reaching women who do not participate in regular cervical cancer screening. However, most of these studies have included younger women. There is a lack of knowledge of how older women reason about HPV self-sampling. OBJECTIVE The aim of this study was to describe how women (>60 years old) experience the offering of self-sampling of HPV, compared to having a sample collected by a healthcare professional. DESIGN AND PARTICIPANTS The study had a qualitative explorative design. Four focus group discussions were conducted with women 60-69 years old (n = 22). Data were analysed using principles of interpretive description. RESULTS Five themes were identified: self-sampling-convenient and without pain, lack of knowledge, worries related to HPV self-sampling, need for information and taking a societal perspective. CONCLUSION Women aged >60 years found that HPV self-sampling was convenient and easy to perform. Further, they stressed the importance of being able to remain in the screening programme in advanced age and that self-sampling could be a possible solution. This study also revealed a lack of knowledge among women in this age group regarding HPV infection, how the disease is transmitted and its relation to cervical cancer. PUBLIC CONTRIBUTION Women who had performed HPV self-sampling participated in the focus group discussion.
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Affiliation(s)
- Karin Blomberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Hälleberg-Nyman
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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15
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Costa S, Verberckmoes B, Castle PE, Arbyn M. Offering HPV self-sampling kits: an updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening. Br J Cancer 2023; 128:805-813. [PMID: 36517552 PMCID: PMC9977737 DOI: 10.1038/s41416-022-02094-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) testing on self-samples represents a great opportunity to increase cervical cancer screening uptake among under-screened women. METHODS A systematic review and meta-analysis on randomised controlled trials (RCTs) were performed to update the evidence on the efficacy of strategies for offering self-sampling kits for HPV testing compared to conventional invitations and to compare different self-sampling invitation scenarios. Four experimental invitational scenarios were considered. Women in the control group were invited for screening according to existing practice: collection of a cervical specimen by a healthcare professional. Random-effects models were used to pool proportions, relative participation rates and absolute participation differences. RESULTS Thirty-three trials were included. In the intention-to-treat analysis, all self-sampling invitation scenarios were more effective in reaching under-screened women compared to controls. Pooled participation difference (PD) and 95% confidence interval (CI) for experimental vs. control was 13.2% (95% CI = 11.0-15.3%) for mail-to-all, 4.4% (95% CI = 1.2-7.6%) for opt-in, 39.1% (95% CI = 8.4-69.9%) for community mobilisation & outreach and 28.1% (23.5-32.7%) for offer at healthcare service. PD for the comparison opt-in vs. mail-to-all, assessed in nine trials, was -8.2% (95% CI = -10.8 to -5.7%). DISCUSSION Overall, screening participation was higher among women invited for self-sampling compared to control, regardless of the invitation strategy used. Opt-in strategies were less effective than send-to-all strategies.
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Affiliation(s)
- Stefanie Costa
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Bo Verberckmoes
- International Centre for Reproductive Health, Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Ding T, Li L, Duan R, Chen Y, Yang B, Xi M. Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia. Int J Gynaecol Obstet 2023; 160:538-547. [PMID: 35810389 PMCID: PMC10087663 DOI: 10.1002/ijgo.14340] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/04/2022] [Accepted: 07/07/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the risk factors of recurrent high-grade cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after loop electrosurgical excision procedure (LEEP). METHODS This retrospective study included patients with histopathologically confirmed CIN2/3 who underwent LEEP in 2015-2020. Cox regression analysis was used to evaluate the risk factors of recurrence. RESULTS Recurrent CIN2+ was found in 268 patients after LEEP (268/4369, recurrence rate, 6.1%). High-risk (hr-) HPV infection (hazard ratio [HR] 12.09, 95% confidence interval [CI] 7.78-18.79), margin status (HR 6.48, 95% CI 4.75-8.84), baseline diagnosis (HR 1.45, 95% CI 1.08-1.95), smoking (HR 3.17, 95% CI 2.27-4.43), and immunosuppression (HR 1.96, 95% CI 1.33-2.91) were significant independent risk factors of recurrence. HPV16 (HR 3.61, 95% CI 2.43-5.37), HPV33 (HR 2.62, 95% CI 1.12-6.12), and HPV52 (HR 1.61, 95% CI 1.02-2.55) infection showed a higher risk of recurrence. High-risk HPV had the highest accuracy (sensitivity 88.5%; negative predictive values 98.7%) in predicting recurrence compared with liquid-based cytology test and margins. CONCLUSION Given that positive margins present a higher risk, wide excision may be required to avoid residual lesions. More attention should be paid to the correlation between recurrence and hr-HPV genotypes. After treatment for high-grade CIN, HPV-based testing is recommended at 6 months. Timely identification of high-risk factors enables risk stratification, and enables individual management or individual follow-up and recall strategies.
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Affiliation(s)
- Ting Ding
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lin Li
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ruiqi Duan
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yun Chen
- Department of Information Management, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bowen Yang
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Mingrong Xi
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Knauss T, Hansen BT, Pedersen K, Aasbø G, Kunst N, Burger EA. The cost-effectiveness of opt-in and send-to-all HPV self-sampling among long-term non-attenders to cervical cancer screening in Norway: The Equalscreen randomized controlled trial. Gynecol Oncol 2023; 168:39-47. [PMID: 36371904 DOI: 10.1016/j.ygyno.2022.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We assessed the cost-effectiveness of mailing a human papillomavirus self-sampling (HPV-ss) kit, directly or via invitation to order, compared with mailing reminder letters among long-term non-attenders in Norway. METHODS We conducted a secondary analysis using the Equalscreen study data with 6000 women aged 35-69 years who had not screened in 10+ years. Participants were equally randomized into three arms: reminder letter (control); invitation to order HPV-ss kit (opt-in); directly mailed HPV-ss kit (send-to-all). Cost-effectiveness (2020 Great British Pounds (GBP)) was estimated using incremental cost-effectiveness ratios (ICERs) per additional screened woman, and per additional cervical intraepithelial neoplasia grade 2 or worse (CIN2+) from extended and direct healthcare perspectives. RESULTS Participation, CIN2+ detection, and total screening costs were highest in the send-to-all arm, followed by the opt-in and control arms. Non-histological physician appointments contributed to 67% of the total costs in the control arm and ≤ 31% in the self-sampling arms. From an expanded healthcare perspective, the ICERs were 135 GBP and 169 GBP per additional screened woman, and 2864 GBP and 4165 GBP per additional CIN2+ detected for the opt-in and send-to-all, respectively. CONCLUSIONS Opt-in and send-to-all self-sampling were more effective and, depending on willingness-to-pay, may be considered cost-effective alternatives to improve screening attendance in Norway.
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Affiliation(s)
- Tara Knauss
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, P.O. box 5313 Majorstuen, NO-0304 Oslo, Norway; Department of Infection Control and Vaccine, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
| | - Kine Pedersen
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway
| | - Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, P.O. box 5313 Majorstuen, NO-0304 Oslo, Norway; Department of Interdisciplinary Health Science, Institute of Health and Society, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway
| | - Natalia Kunst
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway; Public Health Modeling Unit, Yale University School of Public Health, P.O. Box 208034, 60 College Street, New Haven, CT 06520-0834, USA; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, Harkness Office Building, 367 Cedar Street, New Haven, CT 06520-8023, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089 Blindern, 0317 Oslo, Norway; Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA, USA.
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Gómez-Vargas V, Ortiz-Ortiz KJ, Almodóvar-Rivera I, Torres-Cintrón CR, Deshmukh AA, Ortiz AP. Screening History and Survival Among Women With Cervical Cancer in Puerto Rico. J Low Genit Tract Dis 2023; 27:19-23. [PMID: 36349996 DOI: 10.1097/lgt.0000000000000709] [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: 11/11/2022]
Abstract
OBJECTIVES Cervical cancer incidence is rising in Puerto Rico (PR). Screening for cervical cancer could prevent the occurrence of the disease or lead to its early detection, translating to survival benefits. In this study, we evaluated the association of cervical cancer screening status with tumor diagnosis and survival among Hispanic women living in PR. METHODS We analyzed data for 506 incident cases of primary cervical cancer diagnosed from the period 2011-2014, identified through the PR Central Cancer Registry. We ascertained screening status 3 years before cervical cancer diagnosis using data from the period 2008-2014 from the PR Central Cancer Registry-Health Insurance Linkage Database. Patients were followed until 2019. Our outcomes of interest were stage at diagnosis and survival. RESULTS Most women (78.86%) were covered by public insurance (Medicare and/or Medicaid), and 69.57% underwent screening 3 years before their diagnosis. The proportion of cases diagnosed with localized stage was significantly greater among the screened group compared with those unscreened (43.5% vs 33.1%, p < .0001). Multivariate analysis showed that women insured through Medicaid were less likely to have been screened when compared with women with private insurance (odds ratio = 0.29; 95% CI = 0.16-0.52). Five-year survival was significantly greater among screened (72%) than unscreened (54%) women (p log-rank < 0.05). The multivariate Cox proportional hazards model showed that women who received screening had a 39% (hazard ratio [HR] = 0.61; 95% CI = 0.43-0.87) lower risk of death compared with unscreened women. CONCLUSION Our findings exemplify survival benefits among women who underwent cervical cancer screening in PR. Interventions to improve screening uptake and adherence are a public health priority.
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Affiliation(s)
| | | | - Israel Almodóvar-Rivera
- Department of Mathematical Sciences, University of Puerto Rico at Mayagüez, Mayagüez, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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Hassine A, Antoni G, Fender M, Slama K, Léandri FX, Fanon JL, Auvray C, Jaffar Bandjee MC, Traversier N, Fagour L, Rochaix L, Fiorina C, Pourette D, Opigez E, Dumont A, Bardou M, Study Group R. Combined incentive actions, focusing on primary care professionals, to improve cervical cancer screening in women living in socioeconomically disadvantaged geographical areas: a study protocol of a hybrid cluster randomised effectiveness and implementation trial- RESISTE. BMJ Open 2022; 12:e065952. [PMID: 36418118 PMCID: PMC9684961 DOI: 10.1136/bmjopen-2022-065952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cervical cancer (CC) causes thousands of deaths each year. Nearly 100% of cases are caused by oncogenic strains of human papillomavirus (HPV). In most industrialised countries, CC screening (CCS) is based on the detection of HPV infections. For many reasons including lower adherence to CCS, underserved women are more likely to develop CC, and die from it. We aim to demonstrate that the use of incentives could improve screening rates among this population. METHODS AND ANALYSIS Our cluster randomised, controlled trial will include 10 000 women aged 30-65 years eligible for CCS, living in deprived areas in four French departments, two mainlands and two overseas, and who did not perform physician-based HPV testing within the framework of the nationally organised screening programme. HPV self-sampling kit (HPVss) will be mailed to them. Two interventions are combined in a factorial analysis design ending in four arms: the possibility to receive or not a financial incentive of €20 and to send back the self-sampling by mail or to give it to a health professional, family doctor, gynaecologist, midwife or pharmacist. The main outcome is the proportion of women returning the HPVss, or doing a physician-based HPV or pap-smear test the year after receiving the HPVss. 12-month follow-up data will be collected through the French National Health Insurance database. We expect to increase the return rate of HPV self-samples by at least 10% (from 20% to 30%) compared with the postal return without economic incentive. ETHICS AND DISSEMINATION Ethics approval was first obtained on 2 April 2020, then on July 29 2022. The ethics committee classified the study as interventional with low risk, thus no formal consent is required for inclusion. The use of health insurance data was approved by the Commission Nationale Informatique et Libertés on 14 September 2021 (ref No 920276). An independent data security and monitoring committee was established. The main trial results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04312178.
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Affiliation(s)
- Amir Hassine
- CIC-P INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Guillemette Antoni
- Centre for Research in Epidemiology and Population Health INSERM UMR 1018, CESP, Villejuif, France
| | - Muriel Fender
- Regional Center for the Coordination of Cancer Screening Grand Est Region, Strasbourg, France
| | - Katia Slama
- Regional Screening for the Coordination of Cancer Screening, Réunion, France
| | - François-Xavier Léandri
- Regional Center for the Coordination Screening of Cancer Screening PACA Region, Marseille, France
| | - Jean-Luc Fanon
- Regional Centre for the Coordination of Cancer Screening Martinique Island, Martinique, France
| | | | | | | | - Laurence Fagour
- Laboratory of Virology, CHU de Martinique, Fort-de-France, Martinique
| | - Lise Rochaix
- Chaire de Recherche Hospinnomics, Paris School of Economics, Paris, France
| | - Camilla Fiorina
- Chaire de Recherche Hospinnomics, Paris School of Economics, Paris, France
| | | | | | | | - Marc Bardou
- CIC-P INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Resiste Study Group
- Regional Center for the Coordination of Cancer Screening Grand Est Region, Strasbourg, France
- Regional Screening for the Coordination of Cancer Screening, Réunion, France
- Regional Center for the Coordination Screening of Cancer Screening PACA Region, Marseille, France
- Regional Centre for the Coordination of Cancer Screening Martinique Island, Martinique, France
- CEPED, Research Institute for Development, Paris, France
- DRCI, CHU Félix Guyon, Saint-Denis, Réunion
- Centre Hospitalier Universitaire de Dijon, Dijon, France
- DRCI, Pierre Zobda-Quitman Hospital, Martinique, France
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20
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Pankakoski M, Sarkeala T, Anttila A, Heinävaara S. Effectiveness of Cervical Testing in and outside a Screening Program-A Case-Control Study. Cancers (Basel) 2022; 14:5193. [PMID: 36358612 PMCID: PMC9653595 DOI: 10.3390/cancers14215193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 04/29/2024] Open
Abstract
In many countries with organized cervical cancer screening, opportunistic Pap and human papillomavirus (HPV) tests are common. However, little is known about their effectiveness. We examined the effect of testing in and outside the Finnish screening program on the risk of cervical cancer. We conducted a case-control study that involved 1677 cases with invasive cervical cancer that were diagnosed between 2010 and 2019. Five- and three-year test intervals were analyzed across all ages, by age group and by cancer morphology subtype. Conditional logistic regression was used, adjusting for socioeconomic variables. Women undergoing any kind of cervical test had a significantly lowered risk of cervical cancer (adjusted OR = 0.43, 95% CI = 0.38-0.48, tests in five-year intervals). The results were similar, regardless of whether the test had been taken in the screening program or outside of it, or whether the interval was five years or three years. Testing of women at ages 35-64 showed the strongest effects, but moderate preventive effects were seen until age 79. No significant effect was seen below age 30. Tests in and outside the program were effective at the screening target age. However, participation in the program should be encouraged for optimal cost-effectiveness. Preventive effects were also seen above the program target ages.
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Affiliation(s)
- Maiju Pankakoski
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00014 Helsinki, Finland
| | - Tytti Sarkeala
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Ahti Anttila
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00014 Helsinki, Finland
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21
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Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Cervical Cancer Screening in Gynecological Practices in Germany. Cancers (Basel) 2022; 14:cancers14194820. [PMID: 36230743 PMCID: PMC9562656 DOI: 10.3390/cancers14194820] [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: 08/22/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: the aim of this cross-sectional study was to analyze the impact of the COVID-19 pandemic on Cervical Cancer Screening (CCS) in gynecological practices in Germany. Methods: The basis of the analysis was the Uniform Evaluation Standard (EBM) of the Statutory Health Insurance Scheme. This cross-sectional study included all women aged ≥20 years with at least one CCS (clinical and cytological examination) in 223 gynecological practices in Germany during the period 2018−2021. The number of patients with CCS per practice was shown for each year. The average number of patients per year was compared between the pre-pandemic time period (2018, 2019) and the pandemic time period (2020, 2021) using Wilcoxon tests. Analyses were conducted separately for clinical investigations and cytological investigations and were also stratified by age group (20−34, 35−50, >50 years). Results: CCS in gynecological practices significantly decreased in Germany between the pre-pandemic time period of 2018−2019 and the pandemic years of 2020−2021. This decrease was observed in all age groups but was stronger in women aged 20−34 (−25.6%) and weaker in women aged >50 (−15.2%). Conclusions: We found a statistically and clinically relevant decrease of patients receiving CCS in gynecological practices in Germany. This finding is even more exceptional because the new screening algorithm with direct invitations for each patient started in 2020 and was supposed to lead to a higher number of patients in its first years. However, the observed decline in the detection of cervical precancer lesions may lead to increased cervical cancer burden. Risk-based screening strategies and further measures are necessary to adapt to the ongoing COVID-19 pandemic and return to pre-pandemic CCS numbers.
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22
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Inturrisi F, Rozendaal L, Veldhuijzen NJ, Heideman DAM, Meijer CJLM, Berkhof J. Risk of cervical precancer among HPV-negative women in the Netherlands and its association with previous HPV and cytology results: A follow-up analysis of a randomized screening study. PLoS Med 2022; 19:e1004115. [PMID: 36306283 PMCID: PMC9616214 DOI: 10.1371/journal.pmed.1004115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-based screening programs still use one-size-fits-all protocols but efficiency and efficacy of programs may be improved by stratifying women based on previous screening results. METHODS AND FINDINGS We studied the association between cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) and previous screening results in the Population-Based Screening Study Amsterdam (POBASCAM) trial, performed in the Netherlands in the setting of regular screening, where women aged from 29 to 61 years old were invited to cytology and HPV co-testing at enrolment in year 1999/2002 and at the next round in 2003/2007. We selected 18,448 women (9,293 from the intervention group and 9,155 from the control group) who tested HPV-negative in 2003/2007 and did not have cervical intraepithelial neoplasia grade 2 or worse (CIN2+) or hysterectomy after enrolment. Follow-up was collected until 14 years after the 2003/2007 screen, covering 4 rounds of screening. Risk of CIN3+ and CIN2+ among women with an HPV-negative test, irrespective of previous round results and stratified according to previous round HPV and cytology results, were calculated by the Kaplan-Meier method. During 14 years of follow-up, 62 CIN3+ cases (24 in the intervention group and 38 in the control group) were detected. HPV-negative women had a 14-year CIN3+ risk of 0.48% (95% confidence interval 0.37 to 0.62) and CIN2+ risk of 1.17% (0.99 to 1.38). The CIN3+ risk among HPV-negative women was increased in women with a previous positive HPV test (2.36%, 1.20 to 4.63; p < 0.001) or co-test (1.68%, 0.87 to 3.20; p < 0.001) and, equivalently, decreased in women with a previous negative HPV test (0.43%, 0.33 to 0.57) or a negative co-test (0.43%, 0.33 to 0.57). The CIN3+ risk was not influenced by the previous cytology result. The CIN3+ risk among HPV-negative women was increased after both a previous HPV16-positive test (3.90%, 1.47 to 10.12; p < 0.001) and a previous HPV16-negative/HPVother-positive test (1.91%, 0.76 to 4.74; p = 0.002). For endpoint CIN2+ (147 cases), findings were similar except that the CIN2+ risk was increased after previous abnormal cytology (4.06%, 2.30 to 7.12; p < 0.001). The presented risk estimates were calculated by tracking histological results through the Dutch nationwide pathology archive (PALGA) and were not adjusted for non-compliance with the colposcopy referral advice. CONCLUSIONS HPV-negative women had an increased long-term risk of CIN3+ when the HPV test in the previous screening round was positive. This supports the implementation of risk-based intervals that depend on HPV results in the current and previous screening round. TRIAL REGISTRATION POBASCAM trial, trial registration number ISRCTN20781131.
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Affiliation(s)
- Federica Inturrisi
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
- * E-mail: (FI); (JB)
| | - Lawrence Rozendaal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, Amsterdam, the Netherlands
| | - Nienke J. Veldhuijzen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Daniëlle A. M. Heideman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Chris J. L. M. Meijer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
- * E-mail: (FI); (JB)
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23
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HPV self-sampling among long-term non-attenders to cervical cancer screening in Norway: a pragmatic randomised controlled trial. Br J Cancer 2022; 127:1816-1826. [PMID: 35995936 DOI: 10.1038/s41416-022-01954-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Cervical cancer screening participation is suboptimal in most settings. We assessed whether human papillomavirus (HPV) self-sampling may increase screening participation among long-term non-attenders in Norway. METHODS A pragmatic randomised controlled trial with participation as the primary outcome was initiated in the national cervical screening programme in March 2019. A random sample of 6000 women aged 35-69 years who had not attended screening for at least 10 years were randomised 1:1:1 to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in) for HPV testing or (iii) a self-sampling kit unsolicited (send-to-all) for HPV testing. RESULTS Total participation was 4.8%, 17.0% and 27.7% among control, opt-in and send-to-all (P < 0.0001; participation difference (%) send-to-all vs. control: 22.9 (95%CI: 20.7, 25.2); opt-in vs. control: 12.3 (95%CI: 10.3, 14.2); send-to-all vs. opt-in: 10.7 (95% CI: 8.0, 13.3)). High-risk HPV was detected in 11.5% of self-samples and 9.2% of clinician-collected samples (P = 0.40). Most women (92.5%) who returned a positive self-sample attended the clinic for triage testing. Of the 933 women screened, 33 (3.5%) had CIN2 + (1.1%, 3.7%, 3.8% among control, opt-in, and send-to-all, respectively), and 11 (1.2%) had cervical cancer (0%, 1.2%, 1.3% among control, opt-in, send-to-all, respectively). CONCLUSION Opt-in and send-to-all self-sampling increased screening participation among long-term, higher-risk non-attenders. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT03873376.
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24
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Hermansson RS, Olovsson M, Gustavsson I, Gyllensten U, Lindkvist O, Lindberg JH, Lillsunde-Larsson G, Lindström AK. Incidence of oncogenic HPV and HPV-related dysplasia five years after a negative HPV test by self-sampling in elderly women. Infect Agent Cancer 2022; 17:42. [PMID: 35922825 PMCID: PMC9351123 DOI: 10.1186/s13027-022-00453-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Cervical cancer prevention for older women can be challenging since there are no specific guidelines for this group. This study aimed to determine the incidence of oncogenic HPV and HPV-related dysplasia in elderly women 5 years after being HPV negative. METHODS Invited women participated five years earlier in a study where self-sampling for HPV testing was applied, at this time, they were all HPV negative. The women were now, five years later invited to perform self-sampling for HPV testing. Women with a positive result performed a repeat HPV test. Those with a positive repeat HPV test were examined by colposcopy, biopsy and cytology. RESULTS Of the 804 invited women, 634 (76.9%) agreed to participate in the study and a self-sampling kit was sent to them. Of these, 99.6% (632/634) sent a sample to the HPV laboratory. The participation rate in each age group was 93.3% at age 65, 74.0% at age 70, 80.7% at age 75 and 64.6% at age 80. Overall 18 women (2.8%, 95% CI 3.2 to 6.0) were HPV positive in the first test and 8 (1.3%, 95% CI 0.6 to 2.6) in the second test. Sampling for the second test was done on average 5.4 months after the first test. Fifty per cent (4/8) of the women with a positive repeat test had dysplasia in histology. CONCLUSION The incidence of HPV in previously HPV-negative elderly women was low. Among women who were HPV positive in a repeat test, there was a high prevalence of low grade dysplasia.
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Affiliation(s)
- Ruth S Hermansson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Olga Lindkvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Gabriella Lillsunde-Larsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Annika K Lindström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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25
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Sundqvist A, Moberg L, Dickman PW, Högberg T, Borgfeldt C. Time Trends for Incidence and Net Survival of Cervical Cancer in Sweden 1960-2014-A Nationwide Population-Based Study. Cancer Epidemiol Biomarkers Prev 2022; 31:1572-1581. [PMID: 35654420 PMCID: PMC9344906 DOI: 10.1158/1055-9965.epi-21-1323] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim was to investigate time trends for incidence and long-term net survival in the morphologic subtypes and stages of cervical cancer in Sweden during the period 1960 to 2014. METHODS Women with invasive cervical cancer were identified through the Swedish Cancer Registry. Incidence and net survival were calculated according to morphology, age at diagnosis, and FIGO stage at diagnosis. RESULTS In total, 29,579 cases of invasive cervical cancer between 1960 and 2014 were included. The age-standardized incidence for squamous cell carcinoma (SCC) decreased until 2000; thereafter, the incidence rate stagnated, and a small increase was found in 2014. The incidence of adenocarcinoma continuously increased. The age-standardized 5-year net survival increased. However, decreasing net survival with increasing age was found. A higher stage at diagnosis showed a worse net survival. SCC and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. CONCLUSIONS Age-standardized 5-year net survival improved between 1960 and 2014. A positive trend for short- and long-term net survival was seen for women ages 18 to 64 years but long-term net survival for women ≥75 years decreased. In this study, age and FIGO stage at diagnosis were found to be important prognostic factors in determining net survival. The morphologies, SCC, and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. IMPACT This study demonstrates longitudinal data on cervical cancer in Sweden for over 50 years with sub analyses on morphology, age, and stage at diagnosis.
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Affiliation(s)
- Avalon Sundqvist
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden
| | - Louise Moberg
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Thomas Högberg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden
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26
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Nõmm O, Veerus P, Orumaa M, Innos K. Effect of Pap-smear and sociodemographic factors on cervical cancer risk in Estonia: A population-based case-control study. Cancer Epidemiol 2022; 80:102231. [PMID: 35901623 DOI: 10.1016/j.canep.2022.102231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Like many Eastern-European countries, Estonia struggles with ineffective cervical cancer (CC) screening. Despite a long-term organised screening programme and high overall Pap-smear coverage, CC incidence and mortality remain very high. The aim of the study was to examine the reasons for high CC incidence in Estonia by analysing the effect of Pap-smears and sociodemographic factors on CC risk. METHODS In this population-based case-control study, women aged ≥ 25 years with an in situ/invasive CC diagnosed in Estonia in 2011-2017 were defined as cases. Using a density sampling scheme, controls were randomly selected from general population. To estimate CC risk associated with having no Pap-smears during seven years before diagnosis (cases) or index date (controls), place of residence, interruption in health insurance, and several sociodemographic factors, multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Individual-level data from three population-based registries were used. RESULTS Among 1439 cases and 4317 controls, proportion of women with no Pap-smears was 53% and 35%, respectively. Women with no Pap-smears were at higher risk for CC (OR=2.35; 95% CI: 1.85-2.98). CC risk was increased among women who were younger, living in more remote regions, lower-educated, or divorced/widowed. Interruption in health insurance was associated with a 23% risk increase. Regional differences in CC risk were observed among screened women. CONCLUSION To reduce the risk of CC in Estonia, efforts are necessary to increase screening coverage among high-risk women and ensure the quality of CC screening programme. Screening approaches and communication should be tailored to the needs of different population groups. Further studies are warranted to identify the reasons for regional differences in CC risk.
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Affiliation(s)
- Oskar Nõmm
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Piret Veerus
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Madleen Orumaa
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
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27
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Ejegod DM, Pedersen H, Pedersen BT, Serizawa R, Bonde J. Operational experiences from the general implementation of HPV self-sampling to Danish screening non-attenders. Prev Med 2022; 160:107096. [PMID: 35594924 DOI: 10.1016/j.ypmed.2022.107096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/25/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022]
Abstract
The Danish cervical cancer screening program is a cost-free cancer prevention program for all Danish resident women aged 23-64 years. The coverage is 73%, but screening attendance is slowly declining. Notwithstanding, almost half of all newly diagnosed cervical cancers are found amongst screening non-attenders. To increase screening attendance, the Capital Region of Denmark implemented HPV self-sampling as an alternative offer to women not attending the regular screening offer. This was an opt-in offer to 57,717 screening non-attending women in 2017-2018. They received an invitation letter and could opt-in by letter, phone, e-mail, or website. Invitation and return-of-kit reminders were used in the set-up. HPV positive women were recommended to go to their General Practitioner (GP) for a follow-up sample. HPV negative women returned to the ordinary screening program. Of all invited women, 15,501 opted-in (27%). The purpose designed website was the most frequent used method of response, 63% opted in by the HPV-self sampling website. Use of invitation and return-of-kit reminders generated 8.6% and 6.1% additional responses and participation, respectively, underlining the importance of timely communication. Overall, 17% returned the HPV self-sampling kit for analysis. In addition, 14% had a regular clinician collected screening sample after receiving the invitation for self-sampling, leading to a total screening of 31% of the invited women. HPV prevalence was 15% and 92% of the women positive for HPV adhered to the recommended follow-up.
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Affiliation(s)
- Ditte Møller Ejegod
- Department of Pathology, Copenhagen University Hospital AHH-Hvidovre, Hvidovre, Denmark
| | - Helle Pedersen
- Department of Pathology, Copenhagen University Hospital AHH-Hvidovre, Hvidovre, Denmark
| | | | - Reza Serizawa
- Department of Pathology, Copenhagen University Hospital AHH-Hvidovre, Hvidovre, Denmark
| | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital AHH-Hvidovre, Hvidovre, Denmark.
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28
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Baasland I, Vie GÅ, Romundstad PR, Lönnberg S. Cervical cancer mortality in Norway according to screening attendance and age. Acta Obstet Gynecol Scand 2022; 101:952-959. [PMID: 35689441 DOI: 10.1111/aogs.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/25/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The association between cervical cancer screening and reduction of cervical cancer has been dealt with in much research. However, little has been published on the association between screening and cervical cancer mortality. We assessed cervical cancer deaths according to screening history, histopathology, and age among women in, under, and above screening age. MATERIAL AND METHODS In this nationwide, registry-based case-control study from Norway, we included 817 cervical cancer deaths in women diagnosed with cervical cancer in the period 1998-2009. We matched each case with 10 population-based controls free from cervical cancer, obtained by density-based sampling. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between screening attendance and cervical cancer mortality were estimated using conditional logistic regression models. RESULTS Of all fatal cervical cancers, 35% were diagnosed among women over screening age and altogether, 83% were either in age groups not covered by the screening program or in non-attenders of screening age. The estimated risk reduction associated with a cytology test in the preceding 3.5 years was 80% in screening age 25-69 years (OR 0.20; 95% CI 0.16-0.24) with the largest reduction in squamous cell carcinomas (84%) but also a substantial estimated risk reduction of 65% for adenocarcinomas. The associated risk reduction was strongest in women aged 45-69 years, with ORs in the range 0.09-0.18, compared with ORs 0.42-1.35 in women aged 25-39 years. CONCLUSIONS To reduce the mortality of cervical cancer, screening programs should focus on increasing adherence to the program, as half of all the fatal cases were in the non-attender group. Further assessments regarding the potential preventive impact of extending screening to women over the current screening age should be considered.
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Affiliation(s)
- Ingrid Baasland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Gunnhild Å Vie
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål R Romundstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stefan Lönnberg
- Cancer Registry of Norway, Oslo, Norway.,Finnish Cancer Registry, Helsinki, Finland
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29
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Women with obesity participate less in cervical cancer screening and are more likely to have unsatisfactory smears: Results from a nationwide Danish cohort study. Prev Med 2022; 159:107072. [PMID: 35460722 DOI: 10.1016/j.ypmed.2022.107072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022]
Abstract
Some studies found an association between obesity and increased cervical cancer risk, but potential mechanisms are unknown. In this nationwide register-based cohort study, we investigated the association between overweight/obesity and cervical cancer screening participation and risk of unsatisfactory smears. The study population was identified in the Danish Medical Birth Registry. We included 342,526 women aged 23-49 years with pre-pregnancy body mass index (BMI) registered during 2004-2013. Screening participation and unsatisfactory smears during up to four years after child birth were identified in a nationwide pathology register. We used absolute risk regression to estimate the relative absolute risk (RAR) with 95% confidence intervals (CIs) of screening participation according to BMI, adjusted for age, calendar year, sociodemographic characteristics, parity and previous high-grade cervical intraepithelial neoplasia. Among those who were screened (n = 295,482), we used log-binomial regression to investigate the relative risk (RR) of an unsatisfactory smear according to BMI, adjusted for age, year, parity, oral contraceptive use and pathology department. A lower proportion of obese women (79.3%) than women of normal weight (85.8%) were screened, and obese women had lower adjusted probability of being screened than women of normal weight (RARadjusted = 0.94, 95% CI, 0.93-0.95). A higher proportion of obese women (2.4%) than women of normal weight (1.7%) had an unsatisfactory smear, and this association remained after adjustments (RRadjusted = 1.28, 95% CI, 1.19-1.38). In conclusion, women with obesity were less likely to participate in cervical cancer screening and more likely to have an unsatisfactory smear than women of normal weight.
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30
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Sakamoto J, Saito M, Zhang S, Takakura M, Takagi H, Sasagawa T. Determination of human papillomavirus type in archival tissue specimens of invasive cervical cancer using molecular mapping and E6/E7-based polymerase chain reaction. PLoS One 2022; 17:e0265996. [PMID: 35381047 PMCID: PMC8982890 DOI: 10.1371/journal.pone.0265996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
In our previous study, an L1-based human papillomavirus (HPV) test using liquid-based cytology revealed that some invasive cervical cancers (ICC) exhibited multiple HPV types or harbored no HPV DNA. Here, molecular mapping of formalin-fixed paraffin-embedded cancer tissue specimens from the same patients were conducted to confirm these observations. Among 377 ICC cases, 73 eligible specimens (9 positive for multiple HPV types, 16 negative for HPV, and 48 positive for a single HPV type from the previous study) were reexamined by manual microdissection of cancer lesions, then subjected to HPV genotyping using the uniplex E6/E7 polymerase-chain-reaction method to detect all high-risk and potentially high-risk HPV types. The HPV typing results were confirmed in 52 of 73 cancer cases; among the 21 remaining cases, 15 were discordant and 6 were partially concordant. In total, 8 of 16 (50%) HPV-negative samples became positive; 6 were positive for HPV16 and 2 were positive for HPV67. Moreover, two samples previously positive for HPV6 and HPV53 were negative for HPV. All nine cancers with multiple HPV types were found to harbor only a single HPV type. In total, 63 cancer tissues exhibited a single HPV type. HPV16 and HPV18 were detected in squamous cell carcinoma (SCC) and adenocarcinoma (ADC). Alpha-5 (HPV82), -6 (HPV56), and -9 (HPV31/52/67) HPV types were detected in SCC, whereas Alpha-7 (HPV59/68) types were detected in ADC and adenosquamous carcinoma (ADSCC). These findings suggested that the different HPV types induced different histological cancers. Furthermore, all SCCs and 10 of 11 usual-type ADCs were positive for high-risk HPV types, supporting the use of HPV screening for the detection of these cancers and associated premalignant lesions. HPV16 is likely to remain undetected in some cervical cancer tissues because of low viral-copy-numbers. Putative high-risk HPV types (e.g., HPV67 and HPV82) might be high risk in Japan.
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Affiliation(s)
- Jinichi Sakamoto
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Mayumi Saito
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Shitai Zhang
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Masahiro Takakura
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Hiroaki Takagi
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
- * E-mail:
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Tiiti TA, Bogers J, Lebelo RL. Knowledge of Human Papillomavirus and Cervical Cancer among Women Attending Gynecology Clinics in Pretoria, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074210. [PMID: 35409892 PMCID: PMC8998542 DOI: 10.3390/ijerph19074210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 12/04/2022]
Abstract
Background: Cervical cancer is mainly caused by human papillomavirus (HPV). Worldwide, knowledge of HPV and cervical cancer among women is reported to be inadequate. The study aimed to assess the knowledge and awareness of HPV and cervical cancer among women attending gynecology clinics at a tertiary hospital in Pretoria, South Africa. The study also intended to identify socio-demographic factors influencing women’s knowledge about HPV and cervical cancer risk factors. Methods: This was a clinic-based analytic cross-sectional study conducted among women aged 18 years and older. Participants were enrolled in the clinic waiting rooms while waiting to be attended to by the clinician. A self-administered questionnaire to assess knowledge of HPV, cervical cancer, and risk factors for developing cervical cancer was distributed to the participants. Results: A total of 527 women aged ≥18 years and older were randomly enrolled with a 99.8% response rate. Less than half (47.1%) of the participants had been previously screened for cervical cancer using a Papanicolaou (Pap) test. Few (18.8%) women correctly mentioned cervical cancer risk factors. Unemployed women were less likely to have correct knowledge of cervical cancer causes/risk factors (OR: 0.63; 95% CI 0.40–0.97) compared to employed women. Divorced/separated/widowed women were more likely to have good HPV knowledge compared to single participants (OR: 2.74; 95% CI 1.46–5.15). Conclusion: From this study, it is evident that cervical cancer screening is very low, and women lack knowledge of HPV and cervical cancer disease symptoms and its risk factors. There is a need for policies to prioritize providing accurate information to the public to reduce cervical cancer morbidity and mortality.
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Affiliation(s)
- Teboho Amelia Tiiti
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium;
| | - Johannes Bogers
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium;
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, 2020 Antwerpen, Belgium
- Department of Anatomical Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Ramokone Lisbeth Lebelo
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- National Health Laboratory Service, Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Correspondence: ; Tel.: +27-1521-3038
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Sackey ENS, Pemmaraju M, Griffin MR, Castilho JL. Impact of prior underinsurance on cervical cancer screening among Davidson County, Tennessee, women diagnosed with invasive cervical cancer, 2008-2018. BMC Womens Health 2022; 22:68. [PMID: 35279162 PMCID: PMC8918308 DOI: 10.1186/s12905-022-01638-9] [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: 09/10/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We sought to investigate the association between insurance coverage history and cervical cancer screening among Davidson County, Tennessee, women diagnosed with incident cervical cancer. METHODS We reviewed medical records of women diagnosed with invasive cervical cancer from 2008 through 2018 identified via the state's cancer registry and by active surveillance of diagnostic pathology reports for the HPV-IMPACT project. Per 2012 United States Preventive Services Task Force recommended cervical cancer screening guidelines, women were characterized into three screening history categories: "no screening", "no follow-up" and "test/screening failure". Multivariable logistic regression measured the association of prior inadequate insurance (underinsurance) and screening history ("no screening/no follow-up" compared to "test/screening failure"). RESULTS Of 212 women, most (77%) had not undergone recommended cervical cancer screening or follow-up prior to cancer diagnosis. Overall, 28% of women had history of underinsurance in 5 years prior to diagnosis. In adjusted analyses, underinsured women were more likely to have a "no screening/no follow-up" prior to cancer diagnosis (aOR 4.26; 95% CI 1.15-15.80) compared to "test/screening failure" history. Non-white race (aOR 2.73; 95% CI 0.98-7.61), older age (aOR 1.03 per year; 95% CI 1.00-1.07), and history of smoking (aOR 4.07; 95% CI 1.54-10.74) were also associated with increased likelihood of "no screening/no follow-up". CONCLUSIONS Previous underinsurance was independently associated with non-adherence to cervical cancer screening and follow-up guidelines among women with incident cervical cancer. Further study of factors contributing to inadequate cervical cancer screening and interventions to increase cervical cancer screening in high-risk populations is needed.
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Affiliation(s)
- Emmanuel N S Sackey
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Manideepthi Pemmaraju
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica L Castilho
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Partanen VM, Heinävaara S, Anttila A, Hakkarainen J, Lönnberg S. Setting the record straight-Correcting uterine cancer incidence and mortality in the Nordic countries by reallocation of unspecified cases. Acta Obstet Gynecol Scand 2022; 101:323-333. [PMID: 35040121 DOI: 10.1111/aogs.14314] [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: 07/07/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The incidence of and mortality from cancers of the cervix uteri and corpus uteri are underestimated if the presence of uterine cancers, where the exact topography (site of origin) is not specified, is omitted. In this paper we present the corrected figures on mortality from and incidence of cervix and corpus uteri cancers in the Nordic countries by reallocating unspecified uterine cancer deaths and cases to originate either from the corpus uteri or cervix uteri. To further validate the accuracy of reallocation, we also analyzed how well the reallocation captures the changes occurring as the result of a transition in cause of death coding in Norway that took place in 2005. MATERIAL AND METHODS This study uses data available in the NORDCAN database, which contains aggregated cancer data from all the Nordic countries for the years 1960-2016. The unspecified uterine cancer cases and deaths were reallocated to either cervix uteri or corpus uteri based on the estimated probability that follows the distribution of cases and deaths with verified topography. The estimated proportions of cases and deaths for both cancers were calculated for each combination of age group, year, and country as a proportion of cases (and deaths, respectively) with known topography. Annual age-standardized rates were calculated by direct age-adjustment. RESULTS The proportions of unspecified uterine cancers were higher in the mortality data than in incidence data, with mean values for 1960-2016 ranging between 5.1% and 26.6% and between 0.2% and 6.8% by country, respectively. In the Nordic countries combined, the reallocation increased the number of cases by 4% and deaths by approximately 20% for both cancers. Finland was the only Nordic country where the mortality rate did not increase substantially after reallocation. CONCLUSIONS The reallocation procedure had a significant impact on mortality from cancers of the cervix and corpus uteri for countries where the proportion of cancer deaths coded as uterus, not otherwise specified, is substantial. More effort to validate cause of death data with incidence data from cancer registries is warranted to avoid erroneous conclusions of temporal trends based on uncorrected cancer burden.
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Affiliation(s)
| | | | | | - Jenni Hakkarainen
- Finnish Cancer Registry, Helsinki, Finland.,Faculty of Medicine and Health Technology (MET), Tampere University, Tampere, Finland.,Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland
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He W, Sparén P, Fang F, Sengpiel V, Strander B, Czene K. Pregnancy Outcomes in Women With a Prior Cervical Intraepithelial Neoplasia Grade 3 Diagnosis : A Nationwide Population-Based Cohort Study With Sibling Comparison Design. Ann Intern Med 2022; 175:210-218. [PMID: 35130050 DOI: 10.7326/m21-2793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Treatment of cervical intraepithelial neoplasia grade 3 (CIN 3) removes or destroys part of the cervix and might subsequently influence pregnancy outcomes. OBJECTIVE To investigate pregnancy outcomes in women diagnosed with CIN 3. DESIGN Population- and sibling-matched cohort study. SETTING Sweden, 1973 to 2018. PARTICIPANTS The general population comparison included 78 450 singletons born to women diagnosed with CIN 3 and 784 500 matched singletons born to women in the general population who had no CIN 3 diagnosis; the sibling comparison included 23 199 singletons born to women diagnosed with CIN 3 and 28 135 singletons born to their sisters without a CIN 3 diagnosis. MEASUREMENTS Preterm birth, including spontaneous or iatrogenic preterm birth; infection-related outcomes, including chorioamnionitis and infant sepsis; and early neonatal death, defined as death during the first week after birth. RESULTS Compared with the matched general population, women previously diagnosed with CIN 3 were more likely to have a preterm birth, especially extremely preterm (22 to 28 weeks; odds ratio [OR], 3.00 [95% CI, 2.69 to 3.34]) or spontaneous preterm (OR, 2.12 [CI, 2.05 to 2.20]); infection-related outcomes, including chorioamnionitis (OR, 3.23 [CI, 2.89 to 3.62]) and infant sepsis (OR, 1.72 [CI, 1.60 to 1.86]); or early neonatal death (OR, 1.83 [CI, 1.61 to 2.09]). Sibling comparison analyses rendered largely similar results. Over time, the risk difference attenuated for all outcomes and disappeared for early neonatal death. LIMITATION Lack of data on CIN 3 treatment and spontaneous abortion. CONCLUSION History of CIN 3 is associated with adverse pregnancy outcomes even after accounting for familial factors. Decreasing risk estimates over time suggest that adverse pregnancy outcomes among women diagnosed with CIN 3 may be minimized by improving treatment methods. PRIMARY FUNDING SOURCE The Swedish Research Council, the Swedish Cancer Society, and the Swedish Research Council for Health, Working Life and Welfare.
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Affiliation(s)
- Wei He
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China, Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (W.H.)
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (P.S., K.C.)
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (F.F.)
| | - Verena Sengpiel
- Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg and Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (V.S.)
| | - Björn Strander
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and Regional Cancer Center West, Gothenburg, Sweden (B.S.)
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (P.S., K.C.)
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Alfonzo E, Holmberg E, Milsom I, Strander B. Colposcopic assessment by Swedescore, evaluation of effectiveness in the Swedish screening programme: a cross-sectional study. BJOG 2021; 129:1261-1267. [PMID: 34894043 DOI: 10.1111/1471-0528.17054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and performance of Swedescore in the Swedish screening programme. DESIGN Cross-sectional register study. SETTING AND POPULATION All Swedish women aged over 18 years with a colposcopic assessment linked to a biopsy in the Swedish National Cervical Screening Registry, 2015-20. METHODS Colposcopies with Swedescore were compared with the histopathological diagnosis of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). The respective influence of cytology and human papillomavirus (HPV) testing, at referral for colposcopy and concurrently with colposcopy, were investigated in regression models. MAIN OUTCOME MEASURES CIN2+. RESULTS A total of 11 317 colposcopic assessments with Swedescore were included. Odds ratios for CIN2+ increased for every step in the Swedescore scale. At Swedescore ≥0-1, the proportion of CIN2+ was 9.8%. At Swedescore ≥8, the specificity was 93.3% and the positive predictive value was 60.1%, Area under the receiver operating characteristics curve (AUC) was 0.71. If the smear had been abnormal at referral, a normal colposcopy (Swedescore 0-1) was still associated with a CIN2+ risk of more than 5%. In the regression model, cytology and HPV had higher odds ratio for CIN2+ than colposcopy; the combination resulted in an AUC of 0.88. CONCLUSIONS Swedescore works well in a routine clinical setting but colposcopy assessed with Swedescore was inferior to that reported in previous clinical studies. No safe cutoff level was identified for refraining from biopsy. See-and-treat at Swedescore 8-10 is feasible only if referral cytology showed high-grade squamous intraepithelial lesion. TWEETABLE ABSTRACT No safe cutoff level for refraining from biopsy nor for see-and-treat with Swedescore.
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Affiliation(s)
- Emilia Alfonzo
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Holmberg
- Regional Cancer Centre West, Gothenburg, Sweden.,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Strander
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Centre West, Gothenburg, Sweden
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Castanon A, Kamineni A, Elfström KM, Lim AWW, Sasieni P. Exposure Definition in Case-Control Studies of Cervical Cancer Screening: A Systematic Literature Review. Cancer Epidemiol Biomarkers Prev 2021; 30:2154-2166. [PMID: 34526301 PMCID: PMC8643309 DOI: 10.1158/1055-9965.epi-21-0376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 01/07/2023] Open
Abstract
The first step in evaluating the effectiveness of cervical screening is defining exposure to screening. Our aim was to describe the spectrum of screening exposure definitions used in studies of the effectiveness of cervical screening. This systematic review included case-control studies in a population-based screening setting. Outcome was incidence of cervical cancer. Three electronic databases were searched from January 1, 2012 to December 6, 2018. Articles prior to 2012 were identified from a previous review. The qualitative synthesis focused on describing screening exposure definitions reported in the literature and the methodologic differences that could have an impact on the association between screening and cervical cancer. Forty-one case-control studies were included. Six screening exposure definitions were identified. Cervical cancer risk on average decreased by 66% when screening exposure was defined as ever tested, by 77% by time since last negative test, and by 79% after two or more previous tests. Methodologic differences included composition of the reference group and whether diagnostic and/or symptomatic tests were excluded from the analysis. Consensus guidelines to standardize exposure definitions are needed to ensure evaluations of cervical cancer screening can accurately measure the impact of transitioning from cytology to human papillomavirus-based screening and to allow comparisons between programs.
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Affiliation(s)
- Alejandra Castanon
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, United Kingdom.
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - K Miriam Elfström
- Institutionen för Laboratoriemedicin, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anita W W Lim
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, United Kingdom
| | - Peter Sasieni
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, Innovation Hub, Guys Cancer Centre, Guys Hospital, Great Maze Pond, London, United Kingdom
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Sahlgren H, Sparén P, Elfgren K, Miriam Elfström K. Feasibility of sending a direct send HPV self-sampling kit to long-term non-attenders in an organized cervical screening program. Eur J Obstet Gynecol Reprod Biol 2021; 268:68-73. [PMID: 34875556 DOI: 10.1016/j.ejogrb.2021.11.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Non-participation in screening is a main risk factor for cervical cancer. Human-papillomavirus (HPV) self-sampling may be an alternative to repeated invitations for non-attenders. Several studies have concluded that participation among non-attenders increases significantly when offering self-sampling kits for HPV. However, participation rates are highly variable between settings, and therefore pilots to determine optimal implementation strategy have been recommended before routine roll out. MATERIALS AND METHODS All women who had not participated in the organized screening program for at least 10 years aged 33-62 in one Swedish county were identified through screening registers. HPV self-sampling kits were sent to all eligible women. Participation was defined as returning a self-sample kit or attending routine screening within 6 months. Women who did not submit the kit within 8 weeks were randomized to receive a written reminder. HPV-positive women were referred directly to colposcopy without prior triage. Biopsies for histopathologic confirmation were used as gold standard. RESULTS Among eligible women, 150/741 (20.2%) returned the self-sample kit or attended routine screening. A randomized written reminder was sent out to 319/591 non-responders and another 11 women returned the kit. In total, 23/147 (16.3%) of returned kits were HPV positive. Out of the 23 HPV-positive women, 17 (74%) attended colposcopy; 10/17 (59%) had a histopathological high-grade squamous intraepithelial lesions (HSIL) or cervical cancer. The most common HPV type was HPV 52, and 2 out of 3 women with HPV 16 had a histopathologically confirmed cancer. CONCLUSION The direct send kit strategy and referral of all HPV-positive women to colposcopy without prior triage appears to be feasible if resources are available and should be prioritized given the high prevalence of HSIL lesions and cancer among non-attenders. A written reminder might further increase attendance.
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Affiliation(s)
- Hanna Sahlgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Regional Cancer Center, Uppsala, Sweden.
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Kristina Elfgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention, Sweden
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Center for Cervical Cancer Prevention, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Andersson S, Megyessi D, Belkić K, Alder S, Östensson E, Mints M. Age, margin status, high-risk human papillomavirus and cytology independently predict recurrent high-grade cervical intraepithelial neoplasia up to 6 years after treatment. Oncol Lett 2021; 22:684. [PMID: 34434283 PMCID: PMC8335741 DOI: 10.3892/ol.2021.12945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
The present study aimed to identify the factors that independently contribute to disease recurrence among women first-time treated for high-grade cervical intraepithelial neoplasia (CIN) during 4–6 years of follow-up. Overall, 529 of 530 eligible patients participated; these patients all attended a 1st follow-up appointment ~6 months post-conization, at which time high-risk human-papillomavirus (HPV) testing, liquid-based cytology and colposcopy were performed. Full data on margin excision status, other aspects of initial treatment and comorbidity were obtained. At least one subsequent follow-up was attended by 88% of patients. A total of 22 recurrent cases were detected during follow-up. Detected recurrence was the outcome of focus for multiple logistic regression analysis, with odds ratios (OR) and 95% confidence intervals (CI) computed. Four significant independent risk factors were identified: Age 45 years or above (OR=3.5, 95% CI=1.3–9.9), one or both unclear or uncertain margins (OR=5.3, 95% CI=2.0–14.2), positive HPV at 1st follow-up (OR=5.8, 95% CI=2.0–16.8), and abnormal cytology at 1st follow-up (OR=3.9, 95% CI=1.4–11.0). Bivariate analysis revealed that persistent HPV positivity was associated with recurrence (P<0.01). These findings indicated that incomplete excision of the CIN lesion may warrant more intensive subsequent screening, regardless of early post-conization HPV findings. Although early post-conization positive HPV was a powerful, independent predictor of recurrent high-grade CIN, over one-third of the patients with detected recurrence had a negative early post-conization HPV finding. These patients returned for routine screening, at which time, in most cases, HPV status was positive, thus indicating the need for repeated HPV evaluation. Especially during the on-going pandemic, home vaginal self-sampling is recommended. Particular attention is required for women aged ≥45 years. In addition, although not statistically significant, relevant comorbidities, especially autoimmune conditions, warrant consideration in clinical decision-making. Women who have been treated for high-grade CIN are at risk for recurrent disease and progression to cervical cancer; therefore, they require careful, individualized follow-up to avoid these adverse consequences.
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Affiliation(s)
- Sonia Andersson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - David Megyessi
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Karen Belkić
- Department of Oncology-Pathology, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Community/Global Health, Claremont Graduate University, Claremont, CA 91711, USA.,Institute for Health Promotion & Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Susanna Alder
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Ellinor Östensson
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, SE-17176 Stockholm, Sweden.,School of Medical Sciences, Faculty of Medicine-Health, Örebrö University, SE-70182 Örebrö, Sweden
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Abstract
OBJECTIVES The aims of the study were to identify whether obese women are less appropriately screened for cervical cancer before diagnosis and to explore related cancer outcomes. METHODS We retrospectively reviewed all cervical cancer patients at a single institution between 1986 and 2016 and collected demographic information including age, cancer stage, body mass index (BMI), screening information, and cancer outcomes. Morbid obesity was defined as BMI of 40 kg/m or greater, obesity as BMI of 30 to less than 40 kg/m, and nonobese as BMI of less than 30 kg/m. χ, Fisher exact, and Wilcoxon rank sum tests were used to compare variables between BMI categories. Cox regression models were used to evaluate recurrence-free survival and overall survival (OS). RESULTS A total of 1,080 patients were reviewed, of whom 311 (29.4%) were obese and 107 (10.1%) morbidly obese. A significant association between BMI and cytology screening was evidenced with morbidly obese women having the highest incorrect rate (64.4%), followed by obese (51.5%) and nonobese women (46.0%, p < .01). There was no significant difference in presence of symptoms at presentation (p = .12) or stage (p = .06) between BMI categories. In multivariable analysis of cancer outcomes, higher BMI was associated with worse OS (p < .01) with a hazard ratio of 1.25 (95% CI = 0.92-1.69) for obese women and hazard ratio 2.27 (95% CI = 1.56-3.31) for morbidly obese women relative to normal weight but recurrence-free survival did not differ between BMI groups (p = .07). CONCLUSIONS Our study strengthens evidence that obese and morbidly obese women have disproportionate inappropriate screening before cervical cancer diagnosis, and morbidly obese women have worse OS than their counterparts.
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Hellsten C, Ernstson A, Bodelsson G, Forslund O, Borgfeldt C. Equal prevalence of severe cervical dysplasia by HPV self-sampling and by midwife-collected samples for primary HPV screening: a randomised controlled trial. Eur J Cancer Prev 2021; 30:334-340. [PMID: 34010238 DOI: 10.1097/cej.0000000000000693] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES HPV self-sampling is an option for cervical screening. The aim of this randomised study was to investigate the compliance, prevalence of HPV, and prevalence of severe dysplasia in a vaginal self-sampling group in comparison to cervical samples collected by midwives (control arm). The hypothesis was that there would be no difference between vaginal self-sampling and cervical sampling to find high-grade cervical dysplasia or cancer. METHODS Vaginal HPV self-sampling kits were sent by regular mail to 14 765 randomly selected women aged 30-64 years old in the screening programme. HPV-positive women were invited for a follow-up examination by their midwife in which they provided a cervical sample for cytological and HPV co-testing. The control arm consisted of 14 839 women who met the same inclusion criteria and were invited to have cervical sampling by midwives for primary HPV screening. All HPV samples were analysed by the Aptima HPV assay (Hologic Inc.). MAIN RESULTS The participation rate was 33.5% in the self-sampling arm and 47.5% in the cervical sampling arm, (P < 0.0001). HPV was detected in 17.1% (95% confidence interval (CI), 16.1-18.23%) in the self-sampling arm and 4.5% (95% CI, 4.0-5.0%) in the cervical sampling arm. Histological, severe dysplasia was observed among 0.48% (95% CI, 0.3-0.72%) and 0.47% (95% CI, 0.3-0.66%) of the self-sampling and the cervical sampling groups, respectively. CONCLUSION The self-sampling approach detects a similar proportion of severe dysplasia as regular screening. Thus, our study indicates that self-sampling could replace primary HPV screening of cervical samples.
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Affiliation(s)
- Caroline Hellsten
- Department of Obstetrics & Gynaecology, Skåne University Hospital, Lund University, Lund
| | - Avalon Ernstson
- Department of Obstetrics & Gynaecology, Skåne University Hospital, Lund University, Lund
| | - Gunilla Bodelsson
- Department of Clinical Genetics and Pathology, Office for Medical Services, Region Skåne
| | - Ola Forslund
- Department of Medical Microbiology, Laboratory Medicine Region Skåne, Lund University, Lund, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics & Gynaecology, Skåne University Hospital, Lund University, Lund
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Klischke L, von Ehr J, Kohls F, Kampers J, Hülse F, Schmitz M, Hennig A, Dörk T, Hillemanns P, Jentschke M. Performance of a six-methylation-marker assay on self-collected cervical samples - A feasibility study. J Virol Methods 2021; 295:114219. [PMID: 34175345 DOI: 10.1016/j.jviromet.2021.114219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In high-income countries, a high proportion of cervical cancers is diagnosed in screening non-attendees. One approach to improve screening coverage is to offer self-sampling for human papillomavirus (HPV) testing. However, especially young women are often HPV positive without having a precancerous lesion in need of treatment. To improve the rather low specificity of HPV testing additional markers such as DNA-methylation can be used. The aim of this feasibility study was to examine the performance of the methylation marker assay GynTect®, comprising six methylation markers, on dry self-collected cervico-vaginal samples compared to physician-taken samples. METHODS We recruited 89 patients from our colposcopy clinic of whom 87 qualified for the study. The women took a self-sample with the Evalyn-Brush. Afterwards the planned colposcopy was performed and smears for cytology and reference HPV testing were taken as well as a biopsy in cases of abnormalities. Physician-taken and self-collected samples were tested for HPV DNA and were analyzed with GynTect®. RESULTS We obtained 95.5 % valid results for the self-collected samples which was very close to the physician-taken samples. Only about half of the self-collected samples were GynTect® positive in comparison to the physician-taken samples. GynTect® scores were significantly lower for self-collected than for physician-taken samples (p = 0.001, paired t-test). The overall concordance for GynTect® results was moderate (kappa 0.394; p < 0.001). For HPV testing we obtained a good concordance (kappa 0.586; p < 0.001). The GynTect® results for the self-collected samples showed a sensitivity for the detection of cervical intraepithelial neoplasia 2 or worse (CIN2+) of 26.1 % (95 %-CI: 0.13-0.46) and a specificity of 95.6 % (95 %-CI: 0.85-0.99), in comparison to a sensitivity of 45.5 % (95 %-CI: 0.27-0.65) and a specificity of 78.3 % (95 %-CI: 0.64-0.88) for the physician-taken samples. CONCLUSIONS GynTect® methylation marker testing has a satisfactory amount of valid results on self-collected samples. However, the results of the self-collected samples differed clearly in comparison to the reference samples. To justify an application in screening, a larger study with more cases of high-grade cervical dysplasia and HPV positive patients will be needed.
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Affiliation(s)
- Lara Klischke
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Julia von Ehr
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fabian Kohls
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johanna Kampers
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Anne Hennig
- Oncgnostics GmbH, Winzerlaer Str. 2, 07745, Jena, Germany
| | - Thilo Dörk
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Yordanov A, Kostov S, Slavchev S, Strashilov S, Konsoulova A, Calleja-Agius J, Di Fiore R, Suleiman S, Kubelac P, Vlad C, Achimas-Cadariu P, Vasileva-Slaveva M. Adenosquamous Carcinoma of the Uterine Cervix - Impact of Histology on Clinical Management. Cancer Manag Res 2021; 13:4979-4986. [PMID: 34188551 PMCID: PMC8236277 DOI: 10.2147/cmar.s311326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/12/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Historically, the incidence rate of cervical cancer (CC) in Eastern Europe and particularly in Bulgaria has constantly been higher than that in the other European countries. Adenosquamous carcinoma (ASC) is a rare histological subtype of CC with incidence rate of less than 6 per 100,000. We aimed to analyze the epidemiology and prognosis of all Bulgarian patients with ASC, registered at the Bulgarian National Cancer Registry (BNCR), and to compare patients’ characteristics and outcomes with those of patients, treated at a large specialized institution – the Department of Gynecologic Oncology, University Hospital in Pleven, Bulgaria. Materials and Methods This is a retrospective study of all cases of ASC, registered at the BNCR for a 10-year period of time. The Kaplan–Meier analysis with Log rank test was used to estimate the significant differences. Results The incidence rate of ASC was calculated as 3.2% of all CC registered in BNCR and 4.97% of all stage I patients, treated in our department. The 5-year overall survival (OS) rate of all patients with ASC tumors from the registry was 50.5%. A total of 171 (48.4%) of the patients had T1 tumors and a 5-year OS of 67.1%. Lymph node status was a significant prognostic factor for OS (p=0.001). Thirty-one patients with T1 tumors and ASC histology were treated in our department for the same period of time. Lymph node metastases were found in 10 of them (32.2%). The 5-year observed OS in ASC group was 74.19%. Conclusion The histological subtype of cancer of the uterine cervix has an impact on prognosis and should not be simply considered as a descriptive characteristic but a poor prognostic feature and should be an integral part of the decision-making in clinical management of patients.
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Affiliation(s)
- Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, Pleven, 5800, Bulgaria
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna "Prof. Dr. Paraskev Stoyanov", Varna, 9002, Bulgaria
| | - Stanislav Slavchev
- Department of Gynecology, Medical University Varna "Prof. Dr. Paraskev Stoyanov", Varna, 9002, Bulgaria
| | - Strahil Strashilov
- Department of plastic and reconstructive surgery, MU-Pleven, Pleven, 5800, Bulgaria
| | - Assia Konsoulova
- Department of Medical Oncology, Complex Oncological Center Burgas, Burgas, 8000, Bulgaria
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2080, Malta
| | - Riccardo Di Fiore
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2080, Malta.,Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA, 19122, USA
| | - Sherif Suleiman
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2080, Malta
| | - Paul Kubelac
- Department of Medical Oncology, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, 400015, Romania.,Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 400012, Romania
| | - Catalin Vlad
- Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 400012, Romania.,Department of Surgery, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj Napoca, 400015, Romania
| | - Patriciu Achimas-Cadariu
- Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 400012, Romania.,Department of Surgery, The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj Napoca, 400015, Romania
| | - Mariela Vasileva-Slaveva
- Department of surgery, University Hospital Acibadem City Clinic, Sofia, Bulgaria.,Women for Oncology - Bulgaria Society, Bulgaria
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Macios A, Didkowska J, Wojciechowska U, Komerska K, Glińska P, Kamiński MF, Nowakowski A. Risk factors of cervical cancer after a negative cytological diagnosis in Polish cervical cancer screening programme. Cancer Med 2021; 10:3449-3460. [PMID: 33934537 PMCID: PMC8124104 DOI: 10.1002/cam4.3857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/24/2022] Open
Abstract
Risk factors of cervical cancer (CC) development are well investigated, however, those influencing the risk of a potential false negative cytology preceding diagnosis of an invasive CC are not. We have aimed to explore these factors according to the data from Organised Cervical Cancer Screening Programme (OCCSP) in Poland. A total of 2.36 million of Pap tests sampled in 2010–2012 within OCCSP were merged with the Polish National Cancer Registry to identify CC cases after abnormal cytology and after normal cytology within 3 years of screening. Of 1460 invasive CCs, 1025 were preceded by abnormal and 399 by normal cytology result. Multivariate logistic analysis indicated that the presence of microorganisms in the Pap (OR = 2.18, 95% CI 1.65–2.87), evaluation by smaller (below 9000 slides processed per year) laboratories (OR = 1.60, 95% CI 1.22–2.09) and non‐squamous histology of cancer increased the odds for a potential false negative result (OR = 3.39, 95% CI 2.37–4.85 for adenocarcinoma, OR = 1.99, 95% CI 1.11–3.55 for other types of carcinoma), whereas cervical ectropion, other macroscopic changes on the cervix and smoking decrease the odds for a potential false negative Pap test result preceding CC (OR = 0.61, 95% CI 0.45–0.82, OR = 0.41, 95% CI 0.25–0.67, OR = 0.60, 95% CI 0.46–0.78, respectively). Proper triage of women with microscopic signs of microorganisms in the Pap smear should be reconsidered and cytology should be assessed in laboratories processing over 9000 slides annually to decrease the odds for negative Pap test result in 2 years before CC diagnosis. Information on macroscopic changes on the cervix provided to cytomorphologist may reduce the risk of a potential false negative cytology result.
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Affiliation(s)
- Anna Macios
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Joanna Didkowska
- Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Urszula Wojciechowska
- Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarzyna Komerska
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Patrycja Glińska
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michał F Kamiński
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Andrzej Nowakowski
- Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Mancebo G, Miralpeix E, Solé-Sedeño JM, Tió G, Rodrigo-Calvo T, Lloveras B, Alameda F. Influence of age on treatment and prognosis of invasive cervical cancer. Eur J Obstet Gynecol Reprod Biol 2021; 262:68-72. [PMID: 33991774 DOI: 10.1016/j.ejogrb.2021.04.040] [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: 11/05/2020] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Invasive cervical cancer is considered a young women's disease, however up to 20 % of cases develop cervical cancer at advanced ages. The aim was to characterize invasive cervical cancer in women aged 65 and older assessing age-specific survival differences. STUDY DESIGN A retrospective study including cervical cancer patients was conducted at Hospital del Mar Barcelona from July-2007 to December-2016. Women were stratified: <65 or ≥65years. Clinical and pathological data were collected. Multivariate analysis was used to compare outcomes. Adjusted hazard ratios with 95 % confidence intervals for disease-free survival, and overall survival were estimated using Cox proportional hazards models. RESULTS 124 patients with invasive cervical cancer (n = 87 < 65years and n = 37 ≥ 65years) were included. At diagnosis, 48.3 % of <65years patients were diagnosed at advanced stages, while 64.9 % in ≥65years (p = 0.018). Standard treatment was given to 83.9 % of patients in <65years group compared to 62.2 % in ≥65years (p = 0.015). Disease-free survival and overall survival showed no significant differences between groups. Age ≥65 did not predict worse disease-free survival (HR: 0.3 95 %CI, 0.04-3.1, p = 0.347) or overall survival (HR: 0.82 95 %CI, 0.3-2.3, p = 0.729). CONCLUSION Invasive cervical cancer was diagnosed at advanced stages and was treated less frequently with radical intention in patients ≥65years; overall survival and disease-free survival were similar to those cervical cancer diagnosed at younger ages.
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Affiliation(s)
- Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Ester Miralpeix
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep-Maria Solé-Sedeño
- Department of Obstetrics and Gynecology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gisela Tió
- Department of Obstetrics and Gynecology, Hospital Universitari Josep Trueta, Girona, Spain
| | - Teresa Rodrigo-Calvo
- Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Belen Lloveras
- Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Alameda
- Department of Pathology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Associations of treated and untreated human papillomavirus infection with preterm delivery and neonatal mortality: A Swedish population-based study. PLoS Med 2021; 18:e1003641. [PMID: 33970907 PMCID: PMC8143418 DOI: 10.1371/journal.pmed.1003641] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/24/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Treatment of cervical intraepithelial neoplasia (CIN) is associated with an increased risk of preterm delivery (PTD) although the exact pathomechanism is not yet understood. Women with untreated CIN also seem to have an increased risk of PTD. It is unclear whether this is attributable to human papillomavirus (HPV) infection or other factors. We aimed to investigate whether HPV infection shortly before or during pregnancy, as well as previous treatment for CIN, is associated with an increased risk of PTD and other adverse obstetric and neonatal outcomes. METHODS AND FINDINGS This was a retrospective population-based register study of women with singleton deliveries registered in the Swedish Medical Birth Register 1999-2016 (n = 1,044,023). The study population had a mean age of 30.2 years (SD 5.2) and a mean body mass index of 25.4 kg/m2 (SD 3.0), and 44% of the women were nulliparous before delivery. Study groups were defined based on cervical HPV tests, cytology, and histology, as registered in the Swedish National Cervical Screening Registry. Women with a history of exclusively normal cytology (n = 338,109) were compared to women with positive HPV tests (n = 2,550) or abnormal cytology (n = 11,727) within 6 months prior to conception or during the pregnancy, women treated for CIN3 before delivery (n = 23,185), and women with CIN2+ diagnosed after delivery (n = 33,760). Study groups were compared concerning obstetric and neonatal outcomes by logistic regression, and comparisons were adjusted for socioeconomic and health-related confounders. HPV infection was associated with PTD (adjusted odds ratio [aOR] 1.19, 95% CI 1.01-1.42, p = 0.042), preterm prelabor rupture of membranes (pPROM) (aOR 1.52, 95% CI 1.18-1.96, p < 0.001), prelabor rupture of membranes (PROM) (aOR 1.24, 95% CI 1.08-1.42, p = 0.002), and neonatal mortality (aOR 2.69, 95% CI 1.25-5.78, p = 0.011). Treatment for CIN was associated with PTD (aOR 1.85, 95% CI 1.76-1.95, p < 0.001), spontaneous PTD (aOR 2.06, 95% CI 1.95-2.17, p < 0.001), pPROM (aOR 2.36, 95% CI 2.19-2.54, p < 0.001), PROM (aOR 1.11, 95% CI 1.05-1.17, p < 0.001), intrauterine fetal death (aOR 1.35, 95% CI 1.05-1.72, p = 0.019), chorioamnionitis (aOR 2.75, 95% CI 2.33-3.23, p < 0.001), intrapartum fever (aOR 1.24, 95% CI 1.07-1.44, p = 0.003), neonatal sepsis (aOR 1.55, 95% CI 1.37-1.75, p < 0.001), and neonatal mortality (aOR 1.79, 95% CI 1.30-2.45, p < 0.001). Women with CIN2+ diagnosed within 3 years after delivery had increased PTD risk (aOR 1.18, 95% CI 1.10-1.27, p < 0.001). Limitations of the study include the retrospective design and the fact that because HPV test results only became available in 2007, abnormal cytology was used as a proxy for HPV infection. CONCLUSIONS In this study, we found that HPV infection shortly before or during pregnancy was associated with PTD, pPROM, PROM, and neonatal mortality. Previous treatment for CIN was associated with even greater risks for PTD and pPROM and was also associated with PROM, neonatal mortality, and maternal and neonatal infectious complications.
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Castanon A, Rebolj M, Pesola F, Sasieni P. Recovery strategies following COVID-19 disruption to cervical cancer screening and their impact on excess diagnoses. Br J Cancer 2021; 124:1361-1365. [PMID: 33558708 PMCID: PMC8039040 DOI: 10.1038/s41416-021-01275-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/13/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted cervical cancer screening services. Assuming increases to screening capacity are unrealistic, we propose two recovery strategies: one extends the screening interval by 6 months for all and the other extends the interval by 36/60 months, but only for women who have already missed being screened. METHODS Using routine statistics from England we estimate the number of women affected by delays to screening. We used published research to estimate the proportion of screening age women with high-grade cervical intraepithelial neoplasia and progression rates to cancer. Under two recovery scenarios, we estimate the impact of COVID-19 on cervical cancer over one screening cycle (3 years at ages 25-49 and 5 years at ages 50-64 years). The duration of disruption in both scenarios is 6 months. In the first scenario, 10.7 million women have their screening interval extended by 6 months. In the second, 1.5 million women (those due to be screened during the disruption) miss one screening cycle, but most women have no delay. RESULTS Both scenarios result in similar numbers of excess cervical cancers: 630 vs. 632 (both 4.3 per 100,000 women in the population). However, the scenario in which some women miss one screening cycle creates inequalities-they would have much higher rates of excess cancer: 41.5 per 100,000 delayed for screened women compared to those with a 6-month delay (5.9 per 100,000). CONCLUSION To ensure equity for those affected by COVID-19 related screening delays additional screening capacity will need to be paired with prioritising the screening of overdue women.
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Affiliation(s)
- Alejandra Castanon
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, UK.
| | - Matejka Rebolj
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, UK
| | - Francesca Pesola
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, UK
| | - Peter Sasieni
- King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London, UK
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Jodry D, Blemur D, Nguyen ML, Kuhn T, Easley K, Wang H, Ramaswamy M, Birdsong G, Kohut A, Manobianco B, Flowers L. Criminal Justice Involvement and Abnormal Cervical Cancer Screening Results Among Women in an Urban Safety Net Hospital. J Low Genit Tract Dis 2021; 25:81-85. [PMID: 33631779 DOI: 10.1097/lgt.0000000000000589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to elucidate the risk factors underlying abnormal cytology-based cervical cancer screening (Pap testing) in justice-involved women (JIW) compared with non-JIW in an urban safety net hospital. METHODS Retrospective chart review of women with a history of correctional involvement who received care at Grady Health System between 2010 and 2018 and had a Pap test was performed (n = 191). An age-matched cohort of women with no correctional involvement and had a Pap test at Grady served as the control (n = 394). Variables of interest were age, HIV, smoking, race, mental health history, and history of incarceration. Outcomes of interests were rate of abnormal Pap tests and follow-up. χ2 and logistic regression models evaluated associations between the variables of interest and outcomes. RESULTS Rates of abnormal Pap tests were significantly higher in JIW (35.6%) than controls (18.5%, p < .0001). Compared with controls, JIW were significantly more likely to have high-grade cervical cytology (odds ratio [OR] = 3.89, p < .0005) and be lost to gynecologic follow-up (OR = 8.75, p < .0001) and a history of severe mental illness (29.5% vs 4.3%, p < .0001). Those with abnormal Pap tests were likely to be HIV-positive (OR = 20.7, p < .001) and have a history of incarceration (OR = 2.33, p < .001). Predictors of high-grade Pap test were smoking history (OR = 0.16, p = .014), HIV-positive (OR = 3.66, p = .025), and history of incarceration (OR = 3.96, p < .0005). CONCLUSIONS Justice-involved women represent a high-risk subpopulation with significantly increased rates of high-grade cytology and lost to follow-up. This underscores the need for attention to screening programs and follow-up interventions for JIW.
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Affiliation(s)
- Dominique Jodry
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | | | - Minh Ly Nguyen
- Department of Infectious Disease, Emory University School of Medicine, Atlanta, GA
| | - Theresa Kuhn
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA
| | - Heqiong Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - George Birdsong
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Adrian Kohut
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Brittany Manobianco
- Department of Gynecology and Obstetrics, University of South Florida Morsani College of Medicine, Tampa, FL
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Ernstson A, Forslund O, Borgfeldt C. Promotion of Cervical Screening among Long-term Non-attendees by Human Papillomavirus Self-sampling. J Cancer Prev 2021; 26:25-31. [PMID: 33842403 PMCID: PMC8020173 DOI: 10.15430/jcp.2021.26.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 01/06/2023] Open
Abstract
Cervical cancer is preventable through gynecological screening. To promote participation among non-attending women, self-collected vaginal samples for detection of high-risk human papillomavirus (hr-HPV) is an option. The aims of this study were to investigate the response of self-collected vaginal samples for hr-HPV testing among long-term non-attendees, to explore the attendance at follow-up among HPV-positive women, and to analyze the prevalence of hr-HPV and severe cervical dysplasia or cancer among the responders. A vaginal self-sampling kit was sent to 19,766 women aged 30-70 years who had not provided a cervical screening sample for ≥ 7 years in Skåne, Sweden. The self-sample was analyzed by the Aptima HPV mRNA assay (Hologic). Women testing positive for HPV were invited for follow-up. The response was 18.5% (3,646/19,757). The prevalence of HPV mRNA was 11.3% (412/3,636). Among HPV-positive women, 85.7% (353/412) attended follow-up, and of these, 44.8% (158/353) had HPV in the cervical sample. The HPV mRNA test of self-samples showed a positive predictive value of 9.3% ([33/353], 95% CI = 6.5-12.9) for detection of cytologically severe dysplasia. Histologically severe dysplasia or cancer was detected in 0.88% ([32/3,636], 95% CI = 0.6-1.2) among responders, including two cervical- and one vaginal cancer. In conclusion, almost one fifth of the long-term non-attendees participated in self-collected vaginal hr-HPV sampling. The prevalence of histologically confirmed high grade squamous intraepithelial lesion or cervical cancer was not increased significantly compared to regularly screened women in Sweden. The relatively high HPV prevalence among the self-samples indicates the importance of diagnostic follow-up with cervical HPV testing and reflex-cytology of HPV-positive cases.
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Affiliation(s)
- Avalon Ernstson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ola Forslund
- Department of Medical Microbiology, Laboratory Medicine Region Skåne, Lund University, Lund, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
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Cervical screening in high-income countries: the need for quality assurance, adjunct biomarkers and rational adaptation to HPV vaccination. Prev Med 2021; 144:106382. [PMID: 33359012 DOI: 10.1016/j.ypmed.2020.106382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
We here discuss human papillomavirus (HPV)-based screening avenues to achieve elimination of cervical cancer as a public health problem in high-income country (HIC) settings, covering both the most recent data on the performance of HPV testing, as well as the currently most robust triage methods that are known. We also provide an outlook to several other promising, yet not fully established, options for triage that have been proposed, including methylation, dual staining, machine learning, and artificial intelligence. Finally, we discuss the key issue of how to adapt screening in the presence of programmatic HPV vaccination, and how this combination can best be leveraged for comprehensive cancer control. We conclude that, for the HIC setting, evidence-based and effective cervical screening methods are readily available, but whichever method or platform is chosen, we would propose that recurring audits of performance and population attendance remain common denominators for maintaining successful disease prevention.
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