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Oštrbenk Valenčak A, Kroon KR, Fabjan D, Mlakar J, Seme K, Berkhof J, Poljak M. Clinically validated HPV assays offer comparable long-term safety in primary cervical cancer screening: A 9-year follow-up of a population-based screening cohort. Int J Cancer 2024. [PMID: 39315642 DOI: 10.1002/ijc.35200] [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: 06/26/2024] [Revised: 09/06/2024] [Accepted: 09/12/2024] [Indexed: 09/25/2024]
Abstract
Molecular testing for human papillomaviruses (HPV) is gradually replacing cytology in cervical cancer screening. In this longitudinal population-based cohort study, 4140 women 20 to 64 years old attending organized screening were tested at baseline by five different screening methods and followed for 9 years. To assess long-term safety, the cumulative risks of CIN2+/CIN3+ were estimated after a negative baseline result obtained by conventional cytology and four clinically validated HPV assays: Hybrid Capture 2 (hc2), RealTime High Risk HPV assay (RealTime), cobas 4800 HPV Test (cobas_4800), and Alinity m HR HPV (Alinity). HPV-negative women at baseline had a substantially lower risk for CIN2+ compared to those with normal baseline cytology: 0.84% (95% CI, 0.46-1.22), 0.90% (95% CI, 0.51-1.29), 0.78% (95% CI, 0.42-1.15), and 0.75% (95% CI, 0.39-1.11) for hc2, RealTime, cobas_4800, and Alinity, respectively, compared to 2.46% (95% CI, 1.88-3.03) for cytology. No differences were observed between HPV assays in longitudinal sensitivity (range: 86.21%-90.36%) and negative predictive values (range: 99.54%-99.70%) for CIN2+ in women ≥30 years, but were significantly different from cytology (p < .05). The 9-year cumulative risk of CIN2+ differed significantly between HPV genotypes, reaching 32.1% (95% CI, 14.5-46.1) for HPV16, 24.9% (95% CI, 4.7-40.8) for HPV18/45, 27.2% (95% CI, 14.6-37.8) for HPV31/33/35/52/58, and 8.1% (95% CI, 0.0-16.7) for HPV39/51/56/59. Four clinically validated HPV assays showed comparable safety and better assurance against precancerous lesions than cytology, but some important differences were identified in the performance characteristics of HPV assays impacting the referral rate. Information about the HPV genotype is valuable for guiding further clinical action in HPV-based screening programs.
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Affiliation(s)
- Anja Oštrbenk Valenčak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kelsi R Kroon
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - Danijela Fabjan
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jana Mlakar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Johannes Berkhof
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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2
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Arbyn M, Cuschieri K, Bonde J, Schuurman R, Cocuzza C, Broeck DV, Zhao FH, Rezhake R, Gultekin M, de Sanjosé S, Canfell K, Hawkes D, Saville M, Hillemanns P, Dillner J, Berkhof J, Prétet JL, Gheit T, Clifford G, Basu P, Almonte M, Wentzensen N, Poljak M. Criteria for second generation comparator tests in validation of novel HPV DNA tests for use in cervical cancer screening. J Med Virol 2024; 96:e29881. [PMID: 39221498 DOI: 10.1002/jmv.29881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
While HC2 and GP5+/6+ PCR-EIA were pivotal in test validation of new HPV assays, they represent the first generation of comparator tests based upon technologies that are not in widespread use anymore. In the current guideline, criteria for second-generation comparator tests are presented that include more detailed resolution of HPV genotypes. Second-generation comparator tests should preferentially target only the 12 genotypes classified as carcinogenic (IARC-group I), and show consistent non-inferior sensitivity for CIN2+ and CIN3+ and specificity for ≤CIN1 compared to one of the first-generations comparators, in at least three validation studies using benchmarks of 0.95 for relative sensitivity and 0.98 for relative specificity. Validation should take into account used storage media and other sample handling procedures. Meta-analyses were conducted to identify the assays that fulfill these stringent criteria. Four tests fulfilled the new criteria: (1) RealTime High-Risk HPV Test (Abbott), (2) Cobas-4800 HPV test (Roche Molecular System), (3) Onclarity HPV Assay (BD Diagnostics), and (4) Anyplex II HPV HR Detection (Seegene), each evaluated in three to six studies. Whereas the four assays target 14 carcinogenic genotypes, the first two identify separately HPV16 and 18, the third assay identifies five types separately and the fourth identifies all the types separately.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Jesper Bonde
- Department of Pathology, Molecular Pathology Laboratory, AHH-Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rob Schuurman
- Department of Medical Microbiology, University Medical Center Utrecht and Bevolkingsonderzoek Nederland and National Reference Officer HPV for the Dutch Cervical Cancer Screening Program, Utrecht, The Netherlands
| | - Clementina Cocuzza
- Department of Medicine and Surgery, Laboratory of Clinical Microbiology and Virology, University of Milano-Bicocca, Monza, Italy
| | - Davy Vanden Broeck
- Department of Molecular Diagnostics (Laboratory of the National Reference Centre for HPV), AML Sonic Healthcare Belgium, Antwerp, Belgium
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Remila Rezhake
- Cancer Research Institute, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China
| | - Murat Gultekin
- Hacettepe University Faculty of Medicine, Chair of ESGO Prevention Committee, Ankara, Turkey
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- ISGlobal, Barcelona, Spain
| | - Karen Canfell
- The Daffodil Centre, A Joint Venture with Cancer Council NSW, University of Sydney, Sydney, Australia
| | - David Hawkes
- Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
| | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Berkhof
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jean-Luc Prétet
- French National Papillomavirus Reference Center, CHU de Besancon, EA3181, Universite of Franche-Comte, Besancon, France
| | - Tarik Gheit
- International Agency for Research on Cancer, Lyon, France
| | - Gary Clifford
- International Agency for Research on Cancer, Lyon, France
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | - Maribel Almonte
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Sznurkowski JJ, Bodnar L, Szylberg Ł, Zołciak-Siwinska A, Dańska-Bidzińska A, Klasa-Mazurkiewicz D, Rychlik A, Kowalik A, Streb J, Bidziński M, Sawicki W. The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0). J Clin Med 2024; 13:4351. [PMID: 39124620 PMCID: PMC11313441 DOI: 10.3390/jcm13154351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim: To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods: Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results: (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions: These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages.
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Affiliation(s)
- Jacek J. Sznurkowski
- Profesor Sznurkowski Podmiot Leczniczy, ul. Stefana Żeromskiego 23A, 81-246 Gdynia, Poland
| | - Lubomir Bodnar
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, 08-110 Siedlce, Poland;
- Department of Clinical Oncology and Radiotherapy, Siedlce Cancer Center, 08-110 Siedlce, Poland
| | - Łukasz Szylberg
- Department of Tumor Pathology and Pathomorphology, Oncology Centre Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
- Department of Obstetrics, Gynecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland
| | - Agnieszka Zołciak-Siwinska
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Anna Dańska-Bidzińska
- Department of Gynecologic Oncology, Second Clinic of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Dagmara Klasa-Mazurkiewicz
- Department of Obstetrics and Gynecological Oncology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Agnieszka Rychlik
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holy Cross Cancer Center, 25-734 Kielce, Poland;
- Division of Medical Biology, Institute of Biology, Jan Kochanowski University, 25-406 Kielce, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Mariusz Bidziński
- Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.Z.-S.); (A.R.); (M.B.)
| | - Włodzimierz Sawicki
- Department of Obstetrics and Gynecological Oncology, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Rebolj M, Brentnall AR, Cuschieri K. Predictable changes in the accuracy of human papillomavirus tests after vaccination: review with implications for performance monitoring in cervical screening. Br J Cancer 2024; 130:1733-1743. [PMID: 38615108 PMCID: PMC11130303 DOI: 10.1038/s41416-024-02681-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024] Open
Abstract
Vaccination against human papillomavirus (HPV) is changing the performance of cytology as a cervical screening test, but its effect on HPV testing is unclear. We review the effect of HPV16/18 vaccination on the epidemiology and the detection of HPV infections and high-grade cervical lesions (CIN2+) to evaluate the likely direction of changes in HPV test accuracy. The reduction in HPV16/18 infections and cross-protection against certain non-16/18 high-risk genotypes, most notably 31, 33, and/or 45, will likely increase the test's specificity but decrease its positive predictive value (PPV) for CIN2+. Post-vaccination viral unmasking of non-16/18 genotypes due to fewer HPV16 co-infections might reduce the specificity and the PPV for CIN2+. Post-vaccination clinical unmasking exposing a higher frequency of CIN2+ related to non-16/18 high-risk genotypes is likely to increase the specificity and the PPV of HPV tests. The effect of HPV16/18 vaccination on HPV test sensitivity is difficult to predict based on these changes alone. Programmes relying on HPV detection for primary screening should monitor the frequency of false-positive and false-negative tests in vaccinated (younger) vs. unvaccinated (older) cohorts, to assess the outcomes and performance of their service.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Screening, Prevention, and Early Detection, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Adam R Brentnall
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian Scotland, Edinburgh, UK
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5
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Dombrowski C, Bourgain C, Ma Y, Meiwald A, Pinsent A, Weynand B, Turner KME, Huntington S, Adams EJ, Bogers J, Croes R, Sahebali S. An economic evaluation of two cervical screening algorithms in Belgium: HR-HPV primary compared to HR-HPV and liquid-based cytology co-testing. Eur J Cancer Prev 2024; 33:262-270. [PMID: 37933867 DOI: 10.1097/cej.0000000000000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To assess the costs and benefits of two algorithms for cervical cancer screening in Belgium (1) high-risk human papillomavirus (HR-HPV) primary screening and (2) HR-HPV and liquid-based cytology (LBC) co-testing. METHODS A decision tree was adapted from published work and parameterised using HORIZON study data and Belgian cost and population data. The theoretical model represents two different screening algorithms for a cohort of 577 846 women aged 25-64 attending routine cervical screening. Scenario analyses were used to explore the impact of including vaccinated women and alternative pricing approaches. Uncertainty analyses were conducted. RESULTS The cost per woman screened was €113.50 for HR-HPV primary screening and €101.70 for co-testing, representing a total cost of €65 588 573 and €58 775 083, respectively, for the cohort; a 10% difference. For one screening cycle, compared to HR-HPV primary, co-testing resulted in 13 173 more colposcopies, 67 731 more HR-HPV tests and 477 020 more LBC tests. Co-testing identified 2351 more CIN2+ cases per year (27% more than HR-HPV primary) and 1602 more CIN3+ cases (24% more than HR-HPV primary) than HR-HPV primary. CONCLUSION In Belgium, a co-testing algorithm could increase cervical pre-cancer detection rates compared to HR-HPV primary. Co-testing would cost less than HR-HPV primary if the cost of the HPV test and LBC were cost-neutral compared to the current cost of LBC screening but would cost more if the cost per HPV test and LBC were the same in both co-testing and HR-HPV primary strategies.
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Affiliation(s)
| | - Claire Bourgain
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
| | - Yixuan Ma
- Aquarius Population Health, London, UK
| | | | | | - Birgit Weynand
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
| | | | | | | | - Johannes Bogers
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
- University of Antwerp, Laboratory for Cell Biology and Histology, Antwerp
| | | | - Shaira Sahebali
- The Cytology Working Group of the Belgian Society of Pathology, Brussel, Belgium
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6
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Rayner M, Welp A, Stoler MH, Cantrell LA. Cervical Cancer Screening Recommendations: Now and for the Future. Healthcare (Basel) 2023; 11:2273. [PMID: 37628471 PMCID: PMC10454304 DOI: 10.3390/healthcare11162273] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Cervical cancer is the fourth most common cancer worldwide, with over 600,000 new cases annually and approximately 350,000 cancer-related deaths per year. The disease burden is disproportionately distributed, with cancer-related mortality ranging from 5.2 deaths per 100,000 individuals in highly-developed countries, to 12.4 deaths per 100,000 in less-developed countries. This article is a review of the current screening recommendations and potential future recommendations.
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Affiliation(s)
| | | | | | - Leigh A. Cantrell
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA 22908, USA
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7
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Pesola F, Rebolj M, Sasieni P. Managing an extension of screening intervals: Avoiding boom and bust in health care workloads. Int J Cancer 2023; 152:2061-2068. [PMID: 36691808 PMCID: PMC10952902 DOI: 10.1002/ijc.34441] [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: 09/28/2022] [Revised: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 01/25/2023]
Abstract
Extending screening intervals in ongoing cancer screening programmes can lead to challenging year-on-year variations in the number of screening tests. We explored how such variation could be diminished with a managed transition to the extended interval. We defined three extension scenarios: immediate extension for the entire target population; stepped transition by birth cohort; and gradual transition by reducing the number of available screening appointments. These were compared to a situation in which the interval remains unchanged in a demographic model covering a 15-year period. The model was populated with observed parameters from England, a real-world setting recommending cervical screening with 3-year intervals at age 25-49 and 5-year intervals at age 50-64. Informed by typical changes currently considered by several European programmes including the programme in England, we explored the effect on screening test numbers of an extension of the 3-year interval to 5 years for women younger than 50. All three extension scenarios resulted in similar cumulative numbers of screening tests, which were about 30% lower compared to a situation in which the interval would remain unchanged. However, the year-on-year variation in the number of screening tests varied between the scenarios. This variation was around 4-fold for the immediate scenario. In the stepped scenario, the yearly numbers could differ by around 20%, whereas in the gradual scenario they were virtually constant. A managed interval extension, transitioning different groups of the target population at different times, can substantially reduce the yearly variation in screening workload without increasing the total number of screening tests in the long term.
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Affiliation(s)
- Francesca Pesola
- Cancer Prevention Group, School of Cancer and Pharmaceutical SciencesFaculty of Life Sciences and Medicine, King's College LondonLondonUK
- Present address:
Centre for Public Health and Policy, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| | - Matejka Rebolj
- Cancer Prevention Group, School of Cancer and Pharmaceutical SciencesFaculty of Life Sciences and Medicine, King's College LondonLondonUK
| | - Peter Sasieni
- Cancer Prevention Group, School of Cancer and Pharmaceutical SciencesFaculty of Life Sciences and Medicine, King's College LondonLondonUK
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8
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Neis F, Holleczek B, Henes M, Juhasz-Böss I, Wallwiener D, Neis KJ. Proposal for a descriptive and differentiated presentation of the longitudinal impact of the new organized cancer screening guideline and HPV vaccination in Germany. Arch Gynecol Obstet 2023; 307:1125-1136. [PMID: 36053348 PMCID: PMC10023646 DOI: 10.1007/s00404-022-06747-2] [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: 05/24/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Since 01/01/2020, the cervical cancer screening in Germany has been carried out due to the organized early cancer diagnosis guideline (oKFE-RL). In 2007, HPV vaccination was initiated in Germany. The main goal of both initiatives is to further reduce the incidence of invasive cervical cancer. To assess the effect of the new screening strategy in a timely manner, monitoring of short-term changes need to be considered. Ideally, the effects of both prevention methods would be presented together in one model. MATERIALS AND METHODS Because no change in the incidence of invasive cervical cancer is initially expected, the incidence of CIN 3 is used as a surrogate parameter to assess the effects of the prevention efforts. Based on expected additional effects of vaccination and co-testing, a model-based estimation of the expected CIN 3 incidence during the evaluation of the screening program is performed using the CIN 3 incidence in the Saarland population. MODELING RESULTS The oKFE-RL provides for two groups: Primary cytodiagnosis continues until 35 years of age. Here, in the next few years, CIN 3 incidence will be reduced not by the oKFE-RL but by the increasing proportion of vaccinated women. In the group over 35 years, co-testing was introduced with a stringent algorithm. Due to the higher sensitivity of the HPV test, significantly more CIN 3 are detected in the first round of 3 years and thus, the CIN 3 incidence initially increases. As these CIN 3 are absent in the second round, significantly fewer CIN 3 cases will be detected then. These effects suggest a global decrease in CIN 3 incidence of 25.8% after 6 years. CONCLUSION Observation of the age distribution curve of CIN 3 allows both effects of prevention to be assessed in a timely manner and separately. In the future, data from epidemiologic cancer registries should be incorporated into the model to replace modeling with real data.
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Affiliation(s)
- F Neis
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany.
| | - B Holleczek
- Saarland Cancer Registry, Saarbrücken, Germany
| | - M Henes
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - I Juhasz-Böss
- Department of Obstetrics and Gynecology, University Hospital Freiburg, Freiburg, Germany
| | - D Wallwiener
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany
| | - K J Neis
- Frauenärzte am Staden, Saarbrücken, Germany
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9
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Gilham C, Sargent A, Crosbie EJ, Peto J. Long-term risks of invasive cervical cancer following HPV infection: follow-up of two screening cohorts in Manchester. Br J Cancer 2023; 128:1933-1940. [PMID: 36959379 PMCID: PMC10147679 DOI: 10.1038/s41416-023-02227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Long-term follow-up of large cohorts is needed to determine the effects of HPV and screening on CIN3 (grade 3 cervical intraepithelial neoplasia) and ICC (invasive cervical cancer). METHODS Women were recruited when attending for routine cervical screening in Greater Manchester, UK: 1987-93 for the Manchester Cohort (MC: 47,625 women) and 2001-03 for the ARTISTIC Cohort (AC: 24,496 women). Both were followed through national registration for cancer incidence and mortality to 2020. RESULTS Risk patterns following HPV infection differed for CIN3 and ICC. Risk of ICC in the MC rises for 30 years following a single positive HPV test, reaching 2.5% (95% CI: 1.3-4.5%). A similar pattern was seen in the AC, but the risks of cancer were approximately halved. CIN3 was diagnosed much sooner in the AC due to more efficient cytology. More sensitive HPV testing was able to better predict future risk. CONCLUSION The sensitivity of HPV testing and cytology influences the CIN3 detection rate. Sensitive HPV testing enables effective risk stratification. Increased risk of ICC is observed 15-30 years after HPV infection. Women testing HPV + should be followed until their infection clears. Discharging women from screening programmes whilst they remain HPV + may not be safe, even if cytology and colposcopy tests are normal.
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Affiliation(s)
- Clare Gilham
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Alexandra Sargent
- Cytology Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma J Crosbie
- Division of Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Julian Peto
- London School of Hygiene & Tropical Medicine, London, UK
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10
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Yangyanqiu W, Shuwen H. Bacterial DNA involvement in carcinogenesis. Front Cell Infect Microbiol 2022; 12:996778. [PMID: 36310856 PMCID: PMC9600336 DOI: 10.3389/fcimb.2022.996778] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/27/2022] [Indexed: 10/29/2023] Open
Abstract
The incidence of cancer is high worldwide, and biological factors such as viruses and bacteria play an important role in the occurrence of cancer. Helicobacter pylori, human papillomavirus, hepatitis B viruses and other organisms have been identified as carcinogens. Cancer is a disease driven by the accumulation of genome changes. Viruses can directly cause cancer by changing the genetic composition of the human body, such as cervical cancer caused by human papillomavirus DNA integration and liver cancer caused by hepatitis B virus DNA integration. Recently, bacterial DNA has been found around cancers such as pancreatic cancer, breast cancer and colorectal cancer, and the idea that bacterial genes can also be integrated into the human genome has become a hot topic. In the present paper, we reviewed the latest phenomenon and specific integration mechanism of bacterial DNA into the human genome. Based on these findings, we also suggest three sources of bacterial DNA in cancers: bacterial DNA around human tissues, free bacterial DNA in bacteremia or sepsis, and endogenous bacterial DNA in the human genome. Clarifying the theory that bacterial DNA integrates into the human genome can provide a new perspective for cancer prevention and treatment.
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Affiliation(s)
- Wang Yangyanqiu
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- Graduate School of Medical college of Zhejiang University, Hangzhou, China
- Key Laboratory of Multiomics Research and Clinical Transformation of Digestive Cancer, Huzhou, China
| | - Han Shuwen
- Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- Graduate School of Medical college of Zhejiang University, Hangzhou, China
- Key Laboratory of Multiomics Research and Clinical Transformation of Digestive Cancer, Huzhou, China
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Rossi PG, Rebolj M. HPV mRNA testing in cervical cancer screening. Lancet Oncol 2022; 23:e436. [PMID: 36174617 DOI: 10.1016/s1470-2045(22)00486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matejka Rebolj
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College, London SE1 9RT, UK.
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Clinical characteristics and a 2-year follow-up of unsatisfactory conventional Pap smears: a retrospective case-control study. Sci Rep 2022; 12:15393. [PMID: 36100639 PMCID: PMC9470729 DOI: 10.1038/s41598-022-19784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to conduct a 2-year follow-up of individuals having unsatisfactory reports of Pap smears and to analyze the contributing factors. This was a retrospective study at a medical center that performed about 5000-6000 Pap smears annually in Eastern Taiwan. Women who had unsatisfactory results due to scant cellularity between January 1, 2015-December 31, 2016, were included in this study. The control group comprised age-matched women with normal Pap smears at a 1:4 ratio, during the same period. The clinical characteristics and the 2-year outcomes were followed. Patients who were unavailable for follow-up assessments or who had insufficient clinical information were excluded. Student's t-test and chi-square test were used for continuous and categorical variables, respectively. Statistical significance was defined as a p-value < 0.05. A total of 887 Pap smears were included. A total of 717 and 170 women had normal Pap and unsatisfactory Pap tests, respectively. After excluding women who were unavailable for follow-up, the final analysis included 248 and 67 women with normal and unsatisfactory Pap tests, respectively. The mean age was not significantly different between the two groups (49.97 ± 10.69 and 51.61 ± 11.28 years in the unsatisfactory Pap and control groups, respectively [p > 0.05]). The percentage of menopause and vaginal discharge were significantly different between the two groups. Multivariate analysis revealed that premenopausal status, increased discharge were associated with the risk of unsatisfactory Pap tests. Of the 67 women with unsatisfactory Pap tests, all tested negative for any malignancies at a 2-year follow-up assessment. Women with increased vaginal discharge and without menopause were at an increased risk of having an unsatisfactory Pap test. Our results indicate that an unsatisfactory Pap smear due to scant cellularity might not increase the risk of intraepithelial neoplasia or cancer after 2 years. Further, large-scale studies with longer follow-up periods are required.
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Teixeira JC, Vale DB. A promising technique to improve and expand the practice of colposcopy to help the global fight against cervical cancer. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:723. [PMID: 35957735 PMCID: PMC9358523 DOI: 10.21037/atm-22-2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Julio Cesar Teixeira
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Diama Bhadra Vale
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
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Affiliation(s)
- Karen Canfell
- The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council, Sydney, NSW, Australia
| | - Megan Smith
- The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council, Sydney, NSW, Australia
| | - Marion Saville
- The Australian Centre for Prevention of Cervical Cancer, Melbourne, VIC, Australia
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Belgium
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