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Lopez Castro R, Escudero Rivas R, Ángeles Calderón M, Iglesias Linares L, Dolores Hurtado González M, Méndez Gómez N, de la Rosa Martos B, Esther Hidalgo Carmona M, Luis López Hidalgo J. Performance of a vaginal self-collection device versus clinician collected cervical samples for the detection of high-risk human papillomavirus. Prev Med Rep 2024; 41:102705. [PMID: 38595732 PMCID: PMC11002652 DOI: 10.1016/j.pmedr.2024.102705] [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: 12/20/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Objective Screening for cervical cancer requires the participation of target women. Human papillomavirus (HPV) testing can be performed on vaginal self-samples and self-sampling can improve this participation. This study aims to validate the performance of the vaginal self-sampling device (Vitroveil®) to detect high risk human papillomavirus (hrHPV) in comparison to clinician collected samples and evaluate the degree of acceptability of the Vitroveil® device. Methods A cross-sectional observational study was carried out in a cohort of 385 participating women (median age of 44 ± 10.47 years) attending primary care centers and cervical pathology services of Granada, Spain. Two paired samples (vaginal self-sample and clinician collected cervical sample) where collected from each participant to compare the detection of HPV with the Vitro HPV Screening assay (Vitro, Granada, Spain). A questionnaire was also provided to the participants to analyze the degree of satisfaction with the device and the preference for sampling method. Results Overall concordance for hrHPV detection was substantial (ĸ 0.804). The prevalence of any hrHPV infection was higher in self-collected samples (30.6%) than in clinician-collected samples (24.3%). The participants found the self-sampling device easy to use and preferred self-collection as the collection method. Conclusion The Vitroveil® self-sampling device enables safe and accruable hrHPV testing, obtaining equivalent results to those of the clinician collected samples. High acceptability of the device has been demonstrated among women in the study. Nevertheless, additional studies are necessary to verify the efficacy and reliability of the device's performance.
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Affiliation(s)
- Rodrigo Lopez Castro
- UGC Provincial Intercentros de Anatomía Patológica de Granada, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Raquel Escudero Rivas
- Servicio de Ginecología y Obstetricia del Hospital Universitario Clínico San Cecilio de Granada, Granada, Spain
| | - María Ángeles Calderón
- Unidad de Tracto Genital Inferior, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Lucía Iglesias Linares
- Unidad de Tracto Genital Inferior, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Nadia Méndez Gómez
- Servicio de Ginecología y Obstetricia del Hospital Universitario Clínico San Cecilio de Granada, Granada, Spain
| | | | | | - Javier Luis López Hidalgo
- UGC Provincial Intercentros de Anatomía Patológica de Granada, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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Khalid FK, Ali MS. Analysis of Cervix Intraepithelial Neoplasia Prevalence in the Kurdistan Region, Iraq. Cureus 2023; 15:e45725. [PMID: 37868416 PMCID: PMC10590217 DOI: 10.7759/cureus.45725] [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: 07/06/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Cervix intraepithelial neoplasia (CIN) refers to abnormal changes in the squamous cells of the cervix, with more significant changes known as high-grade squamous intraepithelial lesions (HSIL) occurring in grades II and III. AIM The study aimed to estimate the prevalence of cervical intraepithelial neoplasia and explore potential risk factors for HSIL among women living in the Kurdistan region, Iraq. MATERIALS AND METHODS The research encompassed a sample size of 1300 female participants whose Papanicolaou (pap) smears were taken in several hospitals located within the Kurdistan region. The objective of the study was to determine the prevalence of cervical infection among these women. This was a multi-centre study conducted from January 2021 to the end of December 2021 for the determination of pap smears and the relationship between CIN and cervical cancer. Only 120 (9.23%) of those 1300 participants suffered from cervical or vaginal problems. A pap smear, also known as a pap test, is a routine screening procedure used to detect abnormal cervical cells that may indicate cervical cancer or precancerous conditions. The procedure involves collecting a sample of cells from the cervix. RESULTS The most important details in this study are the age groups and percentages of women who have undergone a pap smear. There were four women who tested positive for cervical cancer, accounting for 3.33% of the 120 participants with cervical or vaginal problems. However, there were 116 (96.67%) women who tested negative. With regard to the distribution of inflammation rates among the participants with cervical or vaginal problems, there were 114 (95%) women who suffered inflammation, whereas there were six (5%) women without inflammation. In each age group, the numbers of women with and without cervical cancer, as well as the corresponding percentages, were considered. The data suggest that the incidence of cervical cancer tends to increase with age since higher percentages were observed in older age groups. The study highlights the importance of regular screenings and age-specific cervical cancer prevention and detection strategies to ensure early diagnosis and effective medical interventions. CONCLUSION The prevalence of cervical cancer cases was relatively low, with only 0.31% of the total participants diagnosed with cervical cancer. The majority, accounting for 99.69%, did not have cervical cancer. These results highlight the importance of pap smear screenings as a valuable tool for early detection and prevention of cervical cancer. They also highlight the importance of regular screenings, especially for younger women, to detect and treat cervical abnormalities at an early stage.
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Affiliation(s)
- Fatima K Khalid
- Obstetrics and Gynecology, College of Medicine, University of Zakho, Zakho, IRQ
| | - Mahabad S Ali
- Internal Medicine, College of Medicine, Erbil Maternity Teaching Hospital, Erbil, IRQ
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Serrano B, Ibáñez R, Robles C, Peremiquel-Trillas P, de Sanjosé S, Bruni L. Worldwide use of HPV self-sampling for cervical cancer screening. Prev Med 2022; 154:106900. [PMID: 34861338 DOI: 10.1016/j.ypmed.2021.106900] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/14/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
An increasing body of evidence supports the validity of self-sampling as an alternative to clinician collection for primary Human Papillomavirus (HPV) screening. Self-sampling effectively reaches underscreened women and can be a powerful strategy in low- and high-resource settings for all target ages. This work aims to summarize the current use of HPV self-sampling worldwide. It is part of a larger project that describes cervical cancer screening programmes and produces standardized coverage estimates worldwide. A systematic review of the literature and official documents supplemented with a formal World Health Organisation country consultation was conducted. Findings show that the global use of HPV self-sampling is still limited. Only 17 (12%) of countries with identified screening programs recommend its use, nine as the primary collection method, and eight to reach underscreened populations. We identified 10 pilots evaluating the switch to self-sampling in well-established screening programs. The global use of self-sampling is likely to increase in the coming years. COVID-19's pandemic has prompted efforts to accelerate HPV self-sampling introduction globally, and it is now considered a key element in scaling up screening coverage. The information generated by the early experiences can be beneficial for decision-making in both new and existing programs.
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Affiliation(s)
- B Serrano
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain.
| | - R Ibáñez
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - C Robles
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Peremiquel-Trillas
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - S de Sanjosé
- National Cancer Institute, Rockville, MD, USA; ISGlobal, Barcelona, Spain
| | - L Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
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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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Ibáñez R, Roura E, Monfil L, Rodríguez LA, Sardà M, Crespo N, Pascual A, Martí C, Fibla M, Gutiérrez C, Lloveras B, Oliveras G, Torrent A, Català I, Bosch FX, Bruni L, de Sanjosé S. Long-term protection of HPV test in women at risk of cervical cancer. PLoS One 2020; 15:e0237988. [PMID: 32853216 PMCID: PMC7451648 DOI: 10.1371/journal.pone.0237988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To evaluate the 9-year incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and cumulative adherence to perform a next test in a cohort of women aged 40+ years with no cervical screening cytology within a window of 5 years (underscreened women), after baseline cervical cytology and HPV tests. Methods In Catalonia, Spain, co-testing with cytology and HPV test has been recommended in the Public Health system since 2006 for underscreened women. In 2007, 1,594 women with underscreened criteria were identified and followed through medical records form Pathological Department. 9-year cumulative incidence of histologically confirmed CIN2+ and cumulative adherence to perform a next test were estimated using Kaplan-Meier statistics. Results Follow-up was available for 1,009 women (63.3%) resulting in 23 women with. CIN2+ (2.3%). Of them, 4 women (17%) had both tests negative at baseline (3CIN2 and 1CIN3) with cumulative incidence of CIN2+ of 0.4% (95% CI: 0.1–1.4) at 5-years and 1.3% (95% CI: 0.4–3.7) at 9-years. During the first year, the prevalence among women with both tests positive was 27.0% (95% CI: 13.0–50.6) for CIN2+. Lost to follow-up was higher among women with both tests negative compared to those with both positive tests (38.7% vs 4.2%, p-value <0.001). 40.5% of the women HPV-/cyto- had a re-screening test during the 4 years following the baseline, increasing until 53.5% during the 6 years of follow-up. Conclusions HPV detection shows a high longitudinal predictive value at 9-year to identify women at risk to develop CIN2+. The data validate a safe extension of the 3-year screening intervals (current screening interval) to 5-year intervals in underscreened women that had negative HPV result at baseline. It is necessary to establish mechanisms to ensure screening participation and adequate follow-up for these women.
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Affiliation(s)
- Raquel Ibáñez
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Esther Roura
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red: Epidemiologıa y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Laura Monfil
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Montserrat Sardà
- Pathology Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | - Nàyade Crespo
- Sexual and Reproductive Health centre of Bages-Solsonès, Institut Català de la Salut, Manresa, Barcelona, Spain
| | - Amparo Pascual
- Sexual and Reproductive Health centre of Bages-Solsonès, Institut Català de la Salut, Manresa, Barcelona, Spain
| | - Clara Martí
- Pathology Department, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - Montserrat Fibla
- Pathology Department, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - Cristina Gutiérrez
- Clinical Laboratory ICS Tarragona, Molecular Biology Section, Hospital universitari Joan XXIII de Tarragona, IISPV Rovira i Virgili University, Tarragona, Spain
| | - Belén Lloveras
- Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Gloria Oliveras
- Pathology Department, Hospital universitari Dr, Josep Trueta de Girona, Catalan Institute of Oncology, Girona, Spain
| | - Anna Torrent
- Sexual and Reproductive Health centre of Mollet del Vallés, Institut Català de la Salut Mollet del Vallès, Barcelona, Spain
| | - Isabel Català
- Pathology Department, Hospital universitari de Bellvitge, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Xavier Bosch
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjosé
- Centro de Investigación Biomédica en Red: Epidemiologıa y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
- PATH, Seattle, Washington, United States of America
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Self-Collection for Cervical Screening Programs: From Research to Reality. Cancers (Basel) 2020; 12:cancers12041053. [PMID: 32344565 PMCID: PMC7226191 DOI: 10.3390/cancers12041053] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022] Open
Abstract
In 2018, there were an estimated 570,000 new cases of cervical cancer globally, with most of them occurring in women who either had no access to cervical screening, or had not participated in screening in regions where programs are available. Where programs are in place, a major barrier for women across many cultures has been the requirement to undergo a speculum examination. With the emergence of HPV-based primary screening, the option of self-collection (where the woman takes the sample from the vagina herself) may overcome this barrier, given that such samples when tested using a PCR-based HPV assay have similar sensitivity for the detection of cervical pre-cancers as practitioner-collected cervical specimens. Other advantages of HPV-based screening using self-collection, beyond the increase in acceptability to women, include scalability, efficiency, and high negative predictive value, allowing for long intervals between negative tests. Self-collection will be a key strategy for the successful scale up of cervical screening programs globally in response to the WHO call for all countries to work towards the elimination of cervical cancer as a public health problem. This review will examine self-collection for HPV-based cervical screening including the collection devices, assays and possible routine laboratory processes considering how they can be utilized in cervical screening programs.
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Westre B, Giske A, Guttormsen H, Wergeland Sørbye S, Skjeldestad FE. Quality control of cervical cytology using a 3-type HPV mRNA test increases screening program sensitivity of cervical intraepithelial neoplasia grade 2+ in young Norwegian women-A cohort study. PLoS One 2019; 14:e0221546. [PMID: 31689301 PMCID: PMC6830931 DOI: 10.1371/journal.pone.0221546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/11/2019] [Indexed: 12/02/2022] Open
Abstract
Within 2021, Norway intends to complete implementation of HPV DNA-based primary screening for cervical cancer for women 34–69 years, while continue cytology-based screening for women 25–33 years. Over the recent years, the incidence of cervical cancer has increased by 30% among women younger than 40 years. In this subset of women, nearly 30% were diagnosed with a normal smear, as most recent smear, prior the cancer diagnosis. This observation demands quality control of normal smears. The aim of this study was to assess increase in program sensitivity of CIN2+ after follow-up of women with false negative Pap-smears testing positive for a 3-type (-16, -18, -45) HPV mRNA test in a cohort design over one screening interval. 521 women, aged 23–39 years, and no prior history of CIN1+ or HSIL, with an ASC-US or worse smear (ASC-US+) and 1444 women with normal screening cytology comprised the study cohorts. The positivity rate for the 3-type HPV mRNA was 1.9% (28/1444). Rescreening revealed 23 women with ASC-US, two women with LSIL, two women with ASC-H, and one woman with AGUS. If the HPV mRNA-positivity rate and histology findings from samples rescreened were applied to all women with normal cytology, an estimated increase in screening sensitivity of 16.4% (95% CI:15.3–17.5) for CIN2+ and 17.3% (95% CI:16.2–18.4) for CIN3+ were achieved. By rescreening less than 2% of women with normal cytology positive for a 3-type HPV mRNA test, we achieved a significant increase in screening program sensitivity.
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Affiliation(s)
- Bjørn Westre
- Department of Pathology, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Anita Giske
- Department of Pathology, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Hilde Guttormsen
- Department of Pathology, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | | | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- * E-mail:
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Xu ML, Kim HJ, Kim SC, Ju W, Kim YH, Chang KH, Kim HJ. Serum anti-GAPDH autoantibody levels reflect the severity of cervical lesions: A potential serum biomarker for cervical cancer screening. Oncol Lett 2019; 18:255-264. [PMID: 31289495 PMCID: PMC6539791 DOI: 10.3892/ol.2019.10326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/17/2019] [Indexed: 12/22/2022] Open
Abstract
Recent studies have indicated that a certain level of autoantibodies may be essential for maintaining good health as well as preventing cancer development, and that the levels of serum autoantibodies can decline during malignant progression. The aim of the present study was to identify such an autoantibody-based biomarker for screening cervical lesions. An autoantigen reactive with healthy female sera was detected in the cytosolic fraction of HeLa cells, a cervical cancer cell line, and identified. Serum immunoglobulin (Ig)-G and IgM levels against the purified autoantigen in normal, cervical intraepithelial neoplasias (CINs) I, II and III, and cervical cancer were compared using ELISAs. The autoantigen in HeLa cells was identified to be GAPDH. The serum levels of anti-HeLa-GAPDH IgG decreased with increasing severity of cervical lesions, and similar decreases in IgM levels were revealed. Notably, the anti-HeLa-GAPDH IgG level was discovered to discriminate cervical cancer from normal samples with 80.0% sensitivity and 96.6% specificity. The serum anti-HeLa-GAPDH autoantibody level, as a single parameter, is a promising serum biomarker for screening cervical lesions.
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Affiliation(s)
- Mei Ling Xu
- Laboratory of Virology, College of Pharmacy, Chung-Ang University, Dongjak-Gu, Seoul 06974, Republic of Korea
| | - Hyoung Jin Kim
- Laboratory of Virology, College of Pharmacy, Chung-Ang University, Dongjak-Gu, Seoul 06974, Republic of Korea
| | - Seung Cheol Kim
- Department of Obstetrics and Gynecology, Ewha Woman's University College of Medicine, Yangcheon-Gu, Seoul 03760, Republic of Korea
| | - Woong Ju
- Department of Obstetrics and Gynecology, Ewha Woman's University College of Medicine, Yangcheon-Gu, Seoul 03760, Republic of Korea
| | - Yun Hwan Kim
- Department of Obstetrics and Gynecology, Ewha Woman's University College of Medicine, Yangcheon-Gu, Seoul 03760, Republic of Korea
| | - Kyu-Ho Chang
- Department of Biological Engineering, Inha University, Incheon 22212, Republic of Korea
| | - Hong-Jin Kim
- Laboratory of Virology, College of Pharmacy, Chung-Ang University, Dongjak-Gu, Seoul 06974, Republic of Korea
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Díaz Del Arco C, Jiménez Ayala B, García D, Sanabria C, Fernández Aceñero MJ. Distribution of cervical lesions in young and older women. Diagn Cytopathol 2019; 47:659-664. [PMID: 31184808 DOI: 10.1002/dc.24163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Age range for cervical screening varies widely between countries. In addition, sexual behavior has changed, life expectancy is increasing, and new insights have been gained into the pathogenesis of HPV infection. Our aim is to evaluate the distribution of cervical lesions in young and older patients. METHODS Review of all cervical smears diagnosed in a public institution (2010-2017) and a private institution (2016-2017) in Madrid, Spain. We have included all women aged younger than 30 and older than 65 years with atypical smears (n = 1573). RESULTS Women younger than 30 years were diagnosed with ASCUS, ASC-H, LSIL, and HSIL in 47%, 5.3%, 45.17%, and 2.6% of atypical cases, respectively. Women older than 65 years were diagnosed with ASCUS, ASC-H, LSIL, HSIL, and SCC in 38%, 12.39%, 16.8%, 13.27%, and 19.5% of atypical cases, respectively. Medical records of patients from the public institution were reviewed. Of note, 76.3% of young women showed negative smears at follow-up and 14.1% showed high-grade dysplasia (HGD). Mean ages for low-grade and HGD were 24.7 and 25.7 years, respectively. HGD was found in 37.9% of women with histological examination (33.5%). As for older patients, 25% of them had no Pap smears performed before age 65, and in 60% of the previously screened women, the screening program had not been used adequately. Mean age of first smear was 69.5 years. Carcinoma was subsequently detected in 20.7% of patients. CONCLUSIONS Current guidelines seem to be adequately preventing carcinoma in young women. However, screening adherence should be encouraged to detect important lesions in both age groups, especially among older women.
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Affiliation(s)
- Cristina Díaz Del Arco
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | | | - Dolores García
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Sanabria
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
| | - Mª Jesús Fernández Aceñero
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
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Acera A, Manresa JM, Rodriguez D, Rodriguez A, Bonet JM, Trapero-Bertran M, Hidalgo P, Sànchez N, de Sanjosé S. Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial. PLoS One 2017; 12:e0170371. [PMID: 28118410 PMCID: PMC5261609 DOI: 10.1371/journal.pone.0170371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/30/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage. METHODS The CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a "rescue" visit as the screening visit resulting from the study invitation. RESULTS Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50-59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women. CONCLUSIONS The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age. TRIAL REGISTRATION ClinicalTrials.gov NCT01373723.
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Affiliation(s)
- Amelia Acera
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola–Ripollet, Institut Català de la Salut, Ripollet, Spain
- Unitat de Suport a la Recerca Metropolitana Nord. Institut de Investigació en Atenció Primària (IDIAP) Jordi Gol. Sabadell, Spain
- Departament de Medicina, Universitat de Barcelona. Barcelona, Spain
- Grup de Recerca en Atenció Sexual i Reproductiva IDIAP Jordi Gol. Sabadell, Spain
| | - Josep Maria Manresa
- Unitat de Suport a la Recerca Metropolitana Nord. Institut de Investigació en Atenció Primària (IDIAP) Jordi Gol. Sabadell, Spain
- Departament de Infermeria. Universitat Autònoma de Barcelona. Bellaterra, Cerdanyola, Spain
| | - Diego Rodriguez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola–Ripollet, Institut Català de la Salut, Ripollet, Spain
| | - Ana Rodriguez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola–Ripollet, Institut Català de la Salut, Ripollet, Spain
| | - Josep Maria Bonet
- Servei d’Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain
| | - Marta Trapero-Bertran
- Center for Research in Economics and Health (CRES). University Pompeu Fabra, Barcelona, Spain
- Universidad de Castilla La Mancha. Ciudad Real, Spain
| | - Pablo Hidalgo
- Servei d’Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain
| | - Norman Sànchez
- Servei d’Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Programme | IDIBELL | Catalan Institute of Oncology, L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red en Epidemiologia y Salud Pública CIBERESP, Barcelona, Spain
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Mariani L, Igidbashian S, Sandri MT, Vici P, Landoni F. The clinical implementation of primary HPV screening. Int J Gynaecol Obstet 2017; 136:266-271. [PMID: 28099686 DOI: 10.1002/ijgo.12065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/06/2016] [Accepted: 11/17/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate, from a gynecology perspective, the transition from cytology-based HPV screening to primary HPV screening. METHODS Studies examining switching from cytology-based screening to primary HPV-DNA testing with triaging of patients with positive test results were retrieved and reviewed, with a particular focus on screening in an Italian setting. RESULTS The increased complexity of patient-management decisions when implementing HPV-based screening was a critical issue discussed in the literature. The change in strategy represents a paradigm shift in moving from a medical perspective of identifying the disease in individual patients, to a public-healthcare perspective of excluding HPV from the healthy population and identifying a small sub-group of individuals at increased risk of HPV. CONCLUSION With knowledge about HPV screening evolving rapidly, new programs and related algorithms need to be sufficiently flexible to be adjusted according to ongoing research and the validation of new assays. The establishment of a national working group (including epidemiologists, gynecologists, pathologists, and healthcare providers) will be necessary to properly implement and govern this important technical and cultural transition.
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Affiliation(s)
- Luciano Mariani
- HPV Unit, Department of Gynecologic Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Sarah Igidbashian
- Preventive Gynaecology Unit, European Institute of Oncology, Milan, Italy
| | | | - Patrizia Vici
- Department of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Landoni
- Preventive Gynaecology Unit, European Institute of Oncology, Milan, Italy
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12
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Musselwhite LW, Oliveira CM, Kwaramba T, de Paula Pantano N, Smith JS, Fregnani JH, Reis RM, Mauad E, Vazquez FDL, Longatto-Filho A. Racial/Ethnic Disparities in Cervical Cancer Screening and Outcomes. Acta Cytol 2016; 60:518-526. [PMID: 27825171 DOI: 10.1159/000452240] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/03/2016] [Indexed: 12/15/2022]
Abstract
Invasive cervical cancer disproportionately affects women without sufficient access to care, with higher rates among minority groups in higher-income countries and women in low-resource regions of the world. Many elements contribute to racial/ethnic disparities in the cervical cancer continuum - from screening and diagnosis to treatment and outcome. Sociodemographic factors, access to healthcare, income and education level, and disease stage at diagnosis are closely linked to such inequities. Despite the identification of such elements, racial/ethnic disparities persist, and are widening in several minority subgroups, particularly in older women, who are ineligible for human papillomavirus (HPV) vaccination and are underscreened. Recent studies suggest that racial/ethnic differences in HPV infection exist and may also have a role in observed differences in cervical cancer. In this review, we provide an overview of the current literature on racial disparities in cervical cancer screening, incidence, treatment and outcome to inform future strategies to reduce persistent inequities.
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13
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Poor Cervical Cancer Screening Attendance and False Negatives. A Call for Organized Screening. PLoS One 2016; 11:e0161403. [PMID: 27547971 PMCID: PMC4993473 DOI: 10.1371/journal.pone.0161403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/04/2016] [Indexed: 12/11/2022] Open
Abstract
Objective The objective of this study was to describe prior negative screening history and symptoms around the time of diagnosis of incident cervical cancer (CC) cases diagnosed between 2000 and 2010 within the Asturias public health system. Methods Records from 374 women diagnosed with CC between 2000 and 2010 from all public hospitals in Asturias were retrieved. Clinical information, FIGO stage and all previous cytological data were extracted from clinical and histopathological records. Proportional differences were assessed using chi-square tests. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Inter-observer agreement in cytology was checked by comparing concordance values using k-statistics. Results No prior screening history was recorded in 60.7% of CC cases and its absence increased with age and advanced stage. Advanced stage (e.g., ≥ II) at diagnosis was associated with age (>50 years) and adenocarcinoma (ADC) compared to younger women and those with a squamous cell carcinoma (SCC). False negative smears were identified in 27.1% of women with CC (ADC 52.6% vs. SCC 16.2%, p<0.05). Conclusions Absence of prior screening history was common among CC cases. Organized actions to reduce “under screening” and the use of highly sensitive HPV-based tests could be useful strategies in reducing the burden of CC in Asturias.
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Rasul VH, Cheraghi MA, Behboodi Moqadam Z. Influencing factors on cervical cancer screening from the Kurdish women's perspective: A qualitative study. J Med Life 2015; 8:47-54. [PMID: 28255397 PMCID: PMC5327709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022] Open
Abstract
Aim:This study was aimed to explore and describe the Kurdish women's perception of cervical cancer screening. Methods: A qualitative design based on a conventional content analysis approach. Purposive sampling was applied to 19 women chosen, who had a Pap smear or refused to have one. The study was performed in the Kurdistan Region, Iraq. Semi-structure din-depth individual interviews were carried out to collect data. Results: Four main themes including conflict, belief, and awareness about cervical cancer screening and socio-cultural factors emerged during data analysis Conclusions: Cervical cancer has a high mortality rate in the developing countries. However, only a few Kurdish women participated in the cervical cancer screening in the Kurdistan Region, Iraq. Understanding the factors associated with the women's perception of cervical cancer could guide future educational planning and clinical interventions improve the cervical cancer screening.
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Affiliation(s)
- V H Rasul
- Faculty of Nursing and Midwifery, International Campus, Tehran University of Medical Sciences, Tehran, Iran; Shaqlawa Techniqueal Institute, Erbil Polytechnique University, Kurdistan Region, Iraq
| | - M A Cheraghi
- Faculty of Nursing and Midwifery, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Z Behboodi Moqadam
- Reproductive Health, Faculty of Nursing and Midwifery, International Campus, Tehran University of Medical Sciences, Tehran, Iran
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