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Gottschlich A, Hong Q, Gondara L, Alam MS, Cook DA, Martin RE, Lee M, Melnikow J, Peacock S, Proctor L, Stuart G, Franco EL, Krajden M, Smith LW, Ogilvie GS. Evidence of Decreased Long-term Risk of Cervical Precancer after Negative Primary HPV Screens Compared with Negative Cytology Screens in a Longitudinal Cohort Study. Cancer Epidemiol Biomarkers Prev 2024; 33:904-911. [PMID: 38773687 PMCID: PMC11216858 DOI: 10.1158/1055-9965.epi-23-1587] [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: 12/12/2023] [Revised: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND The growing use of primary human papillomavirus (HPV) cervical cancer screening requires determining appropriate screening intervals to avoid overtreatment of transient disease. This study examined the long-term risk of cervical precancer after HPV screening to inform screening interval recommendations. METHODS This longitudinal cohort study (British Columbia, Canada, 2008 to 2022) recruited women and individuals with a cervix who received 1 to 2 negative HPV screens (HPV1 cohort, N = 5,546; HPV2 cohort, N = 6,624) during a randomized trial and women and individuals with a cervix with 1 to 2 normal cytology results (BCS1 cohort, N = 782,297; BCS2 cohort, N = 673,778) extracted from the provincial screening registry. All participants were followed through the registry for 14 years. Long-term risk of cervical precancer or worse [cervical intraepithelial neoplasia grade 2 or worse (CIN2+)] was compared between HPV and cytology cohorts. RESULTS Cumulative risks of CIN2+ were 3.2/1,000 [95% confidence interval (CI), 1.6-4.7] in HPV1 and 2.7/1,000 (95% CI, 1.2-4.2) in HPV2 after 8 years. This was comparable with the risk in the cytology cohorts after 3 years [BCS1: 3.3/1,000 (95% CI, 3.1-3.4); BCS2: 2.5/1,000 (95% CI, 2.4-2.6)]. The cumulative risk of CIN2+ after 10 years was low in the HPV cohorts [HPV1: 4.7/1,000 (95% CI, 2.6-6.7); HPV2: 3.9 (95% CI, 1.1-6.6)]. CONCLUSIONS Risk of CIN2+ 8 years after a negative screen in the HPV cohorts was comparable with risk after 3 years in the cytology cohorts (the benchmark for acceptable risk). IMPACT These findings suggest that primary HPV screening intervals could be extended beyond the current 5-year recommendation, potentially reducing barriers to screening.
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Affiliation(s)
- Anna Gottschlich
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
- Population Sciences and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Quan Hong
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lovedeep Gondara
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Md Saiful Alam
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Darrel A. Cook
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marette Lee
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Lily Proctor
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Cervix Screening Program, BC Cancer, Vancouver, BC, Canada
| | - Gavin Stuart
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eduardo L. Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Mel Krajden
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Laurie W. Smith
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Gina S. Ogilvie
- Women's Health Research Institute, BC Women's Hospital and Health Services, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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2
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White C, Reynolds S, Murphy K, Keegan H, Naik P, O'Brien R, Pilkington L, Sharkey Ochoa I, Glesson G, Russell N, Nuttall D, Tewari P, Wright F, O'Toole S, Sharp L, Flannelly G, O'Leary JJ, Martin CM. Performance of the HPV E6/E7 mRNA Aptima HPV assay combined with partial genotyping compared with the HPV DNA Cobas 4800 HPV test for use in primary screening: Results from the CERVIVA HPV primary screening study in Ireland. Int J Cancer 2024; 154:53-64. [PMID: 37632406 DOI: 10.1002/ijc.34685] [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: 03/06/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 08/28/2023]
Abstract
There are currently several validated HPV tests. However, longitudinal data which spans appropriate age ranges, as well as evaluation of potential screening algorithms are necessary for screening programmes choice of test. The objective of our study was to evaluate the performance of HPV mRNA and HPV DNA testing, including partial genotyping, in routine cervical screening. As part of the CERVIVA HPV Primary Screening Study, ThinPrep samples from 10 150 women were tested for HPV mRNA using the Aptima HPV assay and HPV DNA using the Cobas 4800 HPV test. HPV mRNA-positive women were further assessed with the Aptima genotyping assay for HPV 16/18/45. Baseline cytology and prospective follow-up data were collected. The performance of the two tests was examined over 42 months (to date). HPV mRNA demonstrated equivalent sensitivity to HPV DNA testing for detection of CIN2+ (93.2% [92.4-93.9] vs 92.8% [92.0-93.6], respectively) and CIN3+ (94.6% [93.8-95.3] vs 94.6% [93.8-95.3]). HPV mRNA testing had significantly higher specificity compared to HPV DNA for detection of CIN2+ (84.0% [83.5-84.5] vs 80.8% [80.2-81.4], respectively) and CIN3+ (88.44% [88.2-88.6] vs 85.62 [85.4-85.9]). The proportion of CIN2+ and CIN3+, over 3 years (42 months), in HPV-negative women was comparable for both RNA (0.20% and 0.10%) and DNA (0.22% and 0.11%). Genotyping data was comparable across both assay platforms. In the context of HPV primary screening HPV mRNA testing has potential to reduce triage tests and follow-up tests at 12 months compared to DNA testing, with no significant difference in detection of CIN2+ and CIN3+.
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Affiliation(s)
- Christine White
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
| | - Stephen Reynolds
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
| | - Katherine Murphy
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
| | - Helen Keegan
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
| | - Padma Naik
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
| | | | - Loretto Pilkington
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
| | - Imogen Sharkey Ochoa
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
| | - Grainne Glesson
- CervicalCheck, National Screening Service, Kings Inns House, Dublin 1, Ireland
| | - Noirin Russell
- CervicalCheck, National Screening Service, Kings Inns House, Dublin 1, Ireland
| | - David Nuttall
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
| | - Prerna Tewari
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Fiona Wright
- CervicalCheck, National Screening Service, Kings Inns House, Dublin 1, Ireland
| | - Sharon O'Toole
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - John J O'Leary
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Cara M Martin
- TCD CERVIVA Molecular Pathology Laboratory, Trinity College Dublin, Dublin, Ireland
- Discipline of Histopathology, St. James' University Hospital, Trinity College Dublin, Dublin, Ireland
- The Coombe Hospital, Dublin 8, Ireland
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
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3
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Hideshima M, Hashiguchi M, Honda A, Umezaki Y, Okuma R, Hikari T, Fukuda A, Okugawa K, Yokoyama M. Are HPV-negative lesions concerned for the introduction of primary HPV testing for cervical cancer screening in Japan? J Obstet Gynaecol Res 2023; 49:2860-2867. [PMID: 37667616 DOI: 10.1111/jog.15784] [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: 04/17/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
AIM In Japan, primary human papilloma virus (HPV) testing has not been introduced for cervical cancer screening due to concerns that HPV-negative lesions may be missed and a lack of Japanese data. The purpose of this study was to evaluate the validity of primary HPV testing in Japan by analyzing cervical intraepithelial neoplasia 2 (CIN2) or more/high-risk HPV- (CIN2+/hrHPV-) cases in cervical cancer screening. METHODS Data from 35 525 cervical cancer screenings with HPV testing and cervical cytology from 2011 to 2019 in Saga City, Japan, were reviewed. The cases with low-grade squamous intraepithelial lesion (LSIL+)/hrHPV- were analyzed in detail. RESULTS The results of the 35 525 examinees were as follows: 31 123 were negative for intraepithelial lesion or malignancy (NILM)/hrHPV-, 2612 were NILM/hrHPV+, 262 were atypical squamous cells of undetermined significance (ASC-US)/hrHPV-, 213 were ASC-US/hrHPV+, 291 were LSIL+/hrHPV-, and 1024 were LSIL+/hrHPV+. Of the 256 LSIL+/hrHPV- examinees for whom histology was available, CIN2+ were CIN2 9.4% (24/256), CIN3 3.9% (10/256), cervical adenocarcinoma 0.4% (1/256), uterine corpus cancer 1.2% (3/256), and uterine sarcoma 0.4% (1/256). Overall, the rate of LSIL+/hrHPV- was 0.82% (291/35.525), 0.1% (36/35525) of which were cervical lesions with CIN2+. Only one cervical adenocarcinoma was detected, but gastric-type adenocarcinoma was not included. CONCLUSION HPV-negative CIN2+ or cervical adenocarcinoma is not a concern for the introduction of primary HPV screening in Japan. Primary HPV testing in cervical cancer screening is considered a feasible method that can be used in Japan, although an algorithm suitable for Japan and a national-level management system need to be established.
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Affiliation(s)
- Misako Hideshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Mariko Hashiguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | | | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Ryoichi Okuma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Takako Hikari
- Department of Obstetrics and Gynecology, Saga Prefectural Medical Center, Saga, Japan
| | - Asako Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Kaoru Okugawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
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Lichtenfels M, Lorenzi NPC, Tacla M, Yokochi K, Frustockl F, Silva CA, Silva ALD, Termini L, Farias CB. A New Brazilian Device for Cervical Cancer Screening: Acceptability and Accuracy of Self-sampling. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:235-241. [PMID: 37339642 PMCID: PMC10281768 DOI: 10.1055/s-0043-1770134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix® - for detecting HPV-DNA. METHODS A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling. RESULTS HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling. CONCLUSION Self-sampling using the new Brazilian device SelfCervix® is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.
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Affiliation(s)
| | | | - Maricy Tacla
- Department of Gynecology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Kaori Yokochi
- Department of Gynecology, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | | | - André Luiz da Silva
- Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lara Termini
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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5
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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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6
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Joshi S, Muwonge R, Kulkarni V, Mandolkar M, Lucas E, Pujari S, Sankaranarayanan R, Basu P. Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra, India. Int J Cancer 2023; 152:249-258. [PMID: 35852007 DOI: 10.1002/ijc.34221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 03/25/2024]
Abstract
We are reporting (a) updated incidence of cervical intraepithelial neoplasia (CIN) among women who did not have colposcopic or histopathological disease at baseline and (b) disease outcomes among women treated for CIN and their follow-up HPV status; in a cohort of women living with HIV (WHIV). The median overall follow-up was 3.5 years (IQR 2.8-4.3). The incidence of any CIN and that of CIN 2 or worse disease was 16.7 and 7.0 per 1000 person-years of observation (PYO), respectively. Compared with women who were HPV negative at baseline, women who cleared HPV infection had 23.95 times increased risk of incident CIN 2 or worse lesions (95% CI 2.40-661.07). Women with persistent HPV infection had 138.18 times increased risk of CIN 2 or worse lesions (95% CI 20.30-3300.22). Complete disease regression was observed in 65.6% of the HPV positive women with high-grade CIN and were treated with thermal ablation but HPV persistence was seen in 44.8% of those with high-grade disease. Among those who did not have any disease at baseline and were also HPV negative, about 87% (95% CI 83.79-89.48) women remained HPV negative during consecutive HPV test/s with the median interval of 3.5 years. Long-term surveillance of WHIV treated for any CIN is necessary for the prevention of cervical cancer among them. Our study provides an early indication that the currently recommended screening interval of 3 to 5 years among WHIV may be extended to at least 5 years among HPV negative women. Increasing the screening interval can be cost saving and improve scalability among WHIV to support WHO's cervical cancer elimination initiative.
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Affiliation(s)
- Smita Joshi
- Prayas, Amrita Clinic, Athawale Corner, Pune, India
| | - Richard Muwonge
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | | | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Rengaswamy Sankaranarayanan
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Karkinos Healthcare, Kerala Operations, Ernakulam, India
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
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Poniewierza P, Panek G. Cervical Cancer Prophylaxis—State-of-the-Art and Perspectives. Healthcare (Basel) 2022; 10:healthcare10071325. [PMID: 35885852 PMCID: PMC9319342 DOI: 10.3390/healthcare10071325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Each year 604,127 new cases of cervical cancer (CC) are diagnosed, and 341,831 individuals die from the disease. It is the fourth most common cancer among women and the fourth most common cause of death from female cancers worldwide. The pathogenesis of CC is associated with human papillomavirus (HPV) infections and consists of several steps involving cell proliferation outside the human body’s control mechanisms. Strategies to prevent CC are based on screening and vaccination. Scope of the Review: The aim of this paper was to collect and analyze the available literature on the issue of CC prevention and the impact of the COVID-19 pandemic on its implementation. For this purpose, PubMed and Google Scholar databases were searched using keywords, such as “cervical cancer”; “HPV”; “prevention”; “prophylaxis”; “vaccination”; “screening” and “COVID-19” in different variations. Only articles published since 2018 were included in the study. Conclusions: Selected European countries have different CC prevention programs funded by national budgets. This translates into observed differences in the risk of death from CC (age-standardized rate Malta = 1.1, Poland = 5.9). COVID-19 pandemic due to disruption of CC screening may exacerbate these differences in the future. To improve the situation, new screening methods, such as p16/Ki67, HPV self-testing, and the use of artificial intelligence in colposcopic assessment, should be disseminated, as well as free HPV vaccination programs implemented in all countries. The search for new solutions is not without significance and entails ultra-sensitive screening tests for risk groups (mRNA E6/E7, SOX1/SOX14), HPV vaccines with shorter dosing schedules, and new therapeutic pathways using nanotheranostics.
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Affiliation(s)
- Patryk Poniewierza
- Medicover SP ZOO Company, Aleje Jerozolimskie 96, 00-807 Warsaw, Poland
- Correspondence:
| | - Grzegorz Panek
- Department of Oncologic Gynecology and Obstetrics, The Center of Postgraduate Medical Education, 00-416 Warsaw, Poland;
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8
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Hou D, Yang B, Li Y, Sun M. Utility of Scoring System for Screening and Early Warning of Cervical Cancer Based on Big Data Analysis. Front Public Health 2022; 10:920956. [PMID: 35795701 PMCID: PMC9251193 DOI: 10.3389/fpubh.2022.920956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the utility of the scoring system for screening and early warning of cervical cancer based on big data analysis. Methods A total of 420 women undergoing physical examination in Shenyang from January 2021 to January 2022 were screened by convenient sampling as the study subjects. All females accepted the human papilloma virus (HPV) tests and thin-prep cytology test (TCT), a Rating Questionnaire for Screening and Early Warning of Cervical Cancer was developed, and a warning threshold was derived according to the scores of the questionnaire and the goodness of fit for the results of HPV+TCT tests. The patients were graded according to the threshold, and corresponding intervention strategies for patients of different grades were developed. Results Among the 420 people undergoing physical examination, 92 (21.90%) obtained scores ≥8 points, and 328 (78.10%) obtained scores < 8 points; in diagnosing cervical cancer, the Rating Questionnaire for Screening and Early Warning of Cervical Cancer had an AUC value of 0.848, specificity of 97.22%, and sensitivity of 86.46%; after scientific intervention, HPV test results showed a significant decrease in both high-risk positive cases and low-risk positive cases (p < 0.05), and TCT results showed that there was a significant difference in the number of patients with CIN I before and after intervention (p < 0.05). Conclusion The scoring system for screening and early warning of cervical cancer based on big data analysis presents certain clinical value in the clinical screening of cervical cancer, which can further improve the screening coverage, is of great significance for the diagnosis and treatment of disease, and helps physician implement hierarchical diagnosis and treatment quickly and precisely.
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Affiliation(s)
- Dan Hou
- Department of Health Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Binjie Yang
- Department of Health Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Yangdan Li
- China Medical University, Shenyang, China
| | - Ming Sun
- Department of Health Medicine, General Hospital of Northern Theater Command, Shenyang, China
- *Correspondence: Ming Sun
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9
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Gottschlich A, Gondara L, Smith LW, Cook D, Martin RE, Lee M, Peacock S, Proctor L, Stuart G, Krajden M, Franco EL, van Niekerk D, Ogilvie G. HPV-based screening at extended intervals missed fewer cervical precancers than cytology in the HPV FOr CervicAL Cancer (HPV FOCAL) trial. Int J Cancer 2022; 151:897-905. [PMID: 35460070 PMCID: PMC9336650 DOI: 10.1002/ijc.34039] [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: 01/31/2022] [Revised: 03/15/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022]
Abstract
While cervix screening using cytology is recommended at 2-3-year intervals, given the increased sensitivity of human papillomavirus (HPV)-based screening to detect precancer, HPV-based screening is recommended every 4-5-year. As organized cervix screening programs transition from cytology to HPV-based screening with extended intervals, there is some concern that cancers will be missed between screens. Participants in HPV FOr CervicAL Cancer (HPV FOCAL) trial received cytology (Cytology Arm) at 24-month intervals or HPV-based screening (HPV Arm) at 48-month intervals, and co-testing (cytology and HPV testing) at exit. We investigated the results of the co-test to identify participants with cervical intraepithelial neoplasia grade 2 or higher (CIN2+) who would not have had their precancer detected if they had only their arm's respective primary screen. In the Cytology Arm, 25/62 (40.3%) identified CIN2+s were missed by primary screen (i.e., normal cytology/positive HPV test) and all 25 had normal cytology at the prior 24-month screen. In the HPV arm, three CIN2+s (3/49, 6.1%) were missed by primary screen (i.e., negative HPV test/abnormal cytology). One of these three misses had low-grade cytology findings and would also not have been referred to colposcopy outside of the trial. Multiple rounds of cytology did not detect some precancerous lesions detected with one round of HPV-based screening. In our population, cytology missed more CIN2+, even at shorter screening intervals, than HPV-based screening. This assuages concerns about missed detection post-implementation of an extended interval HPV-based screening program. We recommend that policymakers consider a shift from cytology to HPV-based cervix screening. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anna Gottschlich
- BC Women's Hospital and Health Service, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Lovedeep Gondara
- Department of Data and Analytics, BC Cancer Agency, Vancouver, Canada
| | - Laurie W Smith
- BC Women's Hospital and Health Service, Women's Health Research Institute, Vancouver, Canada.,BC Cancer Agency, Cancer Control Research, Vancouver, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, Canada
| | | | - Marette Lee
- University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Cancer Agency, Cervix Screening Program, Vancouver, Canada
| | - Stuart Peacock
- BC Cancer Agency, Cancer Control Research, Vancouver, Canada.,Simon Fraser University, Faculty of Health Sciences, Vancouver, Canada
| | - Lily Proctor
- BC Women's Hospital and Health Service, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Cancer Agency, Cervix Screening Program, Vancouver, Canada
| | - Gavin Stuart
- University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Mel Krajden
- University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Centre for Disease Control, Vancouver, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, Canada.,BC Cancer Agency, Cervix Screening Program, Vancouver, Canada
| | - Gina Ogilvie
- BC Women's Hospital and Health Service, Women's Health Research Institute, Vancouver, Canada.,University of British Columbia, Faculty of Medicine, Vancouver, Canada
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10
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Strang THR, Gottschlich A, Cook DA, Smith LW, Gondara L, Franco EL, van Niekerk DJ, Ogilvie GS, Krajden M. Long-term cervical precancer outcomes after a negative DNA- or RNA-based human papillomavirus test result. Am J Obstet Gynecol 2021; 225:511.e1-511.e7. [PMID: 34081897 PMCID: PMC8578173 DOI: 10.1016/j.ajog.2021.05.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical cancer, a preventable disease associated with the human papillomavirus, is responsible for significant morbidity and mortality globally. Primary human papillomavirus testing is more sensitive in detecting precancerous cervical lesions than cytologic screening and can be conducted using either DNA- or RNA-based assays. Screening programs must select the most appropriate assay from several available assays for their population. It is not yet known whether these assays perform equivalently in the long term, particularly among women with a negative human papillomavirus test result. This study aims to compare long-term safety after a negative human papillomavirus test result across both DNA- and RNA-based testing assays. OBJECTIVE This study aimed to compare long-term high-grade cervical intraepithelial neoplasia (grade 2 or higher and grade 3 or higher) outcomes of 2 DNA-based assays (Digene Hybrid Capture 2 High-Risk HPV DNA Test and cobas 4800 HPV Test) and 1 messenger RNA-based assay (Aptima HPV Assay) using data from the Human Papillomavirus For Cervical Cancer Trial-DECADEl (FOCAL-DECADE) cohort, by first comparing the positive and negative rates between the assays and then investigating the cumulative incidence of cervical intraepithelial neoplasia grade 2 and higher and grade 3 or higher detection among participants in the FOCAL DECADE cohort over follow-up according to human papillomavirus testing assays. STUDY DESIGN The FOCAL Trial was a randomized controlled trial that evaluated human papillomavirus testing for primary cervical cancer screening. The FOCAL-DECADE cohort subsequently followed FOCAL Trial participants passively through the British Columbia Cervix Screening Program Database for approximately 10 years after the FOCAL Trial study exit to examine the rates of cervical intraepithelial neoplasia grade 2 or higher and grade 3 or higher. For this study, eligible participants had baseline human papillomavirus-negative results from at least 1 assay and had 1 or more cytologic screens after baseline (9509 participants for DNA-based and 3473 participants for DNA- vs RNA-based assay comparisons). We constructed cumulative incidence curves and compared the hazard ratios for cervical intraepithelial neoplasia grade 2 or higher and grade 3 or higher detection according to the assays. RESULTS Over 10 years of follow-up, the cumulative incidence of cervical intraepithelial neoplasia grade 2 or higher and grade 3 or higher did not significantly differ between the DNA-based assays (hazard ratio, 0.95; 95% confidence interval, 0.84-1.06; P=.35 and hazard ratio, 0.82; 95% confidence interval, 0.66-1.01; P=.06 for cervical intraepithelial neoplasia grade 2 or higher and cervical intraepithelial neoplasia grade 3 or higher, respectively) or between the DNA- and RNA-based assays (hazard ratio, 0.97; 95% confidence interval, 0.87-1.06; P=.48 and hazard ratio, 0.94; 95% confidence interval, 0.79-1.13; P=.52 for cervical intraepithelial neoplasia grade 2 or higher and cervical intraepithelial neoplasia grade 3 or higher, respectively). CONCLUSION Among participants who tested negative for human papillomavirus at baseline, the long-term risk of cervical intraepithelial neoplasia grade 2 or higher and grade 3 or higher did not significantly differ regardless of whether DNA- or RNA-based human papillomavirus testing assays were used. Screening program decision makers can be confident that for women who test negative for human papillomavirus, DNA- and RNA-based assays exhibit similar cervical intraepithelial neoplasia grade 2 or higher outcomes over several years.
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Affiliation(s)
- Talia H R Strang
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Anna Gottschlich
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darrel A Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Laurie W Smith
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver, British Columbia, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Dirk J van Niekerk
- Cervix Screening Program, BC Cancer, Vancouver, British Columbia, Canada; Lower Mainland Laboratories, Vancouver, British Columbia, Canada
| | - Gina S Ogilvie
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mel Krajden
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Lower Mainland Laboratories, Vancouver, British Columbia, Canada.
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11
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Chatzistamatiou K, Tsertanidou A, Moysiadis T, Mouchtaropoulou E, Pasentsis K, Skenderi A, Stamatopoulos K, Agorastos T. Comparison of different strategies for the triage to colposcopy of women tested high-risk HPV positive on self-collected cervicovaginal samples. Gynecol Oncol 2021; 162:560-568. [PMID: 34210517 DOI: 10.1016/j.ygyno.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify the optimal strategy for the triage of women who test high-risk (hr) HPV positive on self-collected cervicovaginal samples. METHODS This is a diagnostic accuracy sub-analysis of the GRECOSELF study, which reported on HPV-DNA testing with self-sampling in Greece. More than 13,000 women, 25-60 years old, who resided in rural areas of Greece, provided a self-collected cervicovaginal sample. Samples were tested for HPV-DNA and HPV16/18 genotyping with the cobas® HPV test (Roche® Molecular Systems, Pleasanton, CA, USA). HrHPV positive women were referred for colposcopy. Prior to colposcopy a physician-collected sample was obtained for cytology. After colposcopy/biopsy, women were classified as having cervical disease or not, and treated accordingly. RESULTS Out of 1070 hrHPV positive women, 773 were subjected to colposcopy. Seventeen triage strategies, combining HPV16/18 genotyping and cytology, were investigated. The strategy referring to colposcopy women positive for HPV16 regardless of the cytology report, and women positive for other hrHPVs, in case of a subsequent atypical squamous cells of undetermined significance or worse (ASCUS+) cytology report, presented optimal trade-off; sensitivity 96.36% [(95%CI: (91.41-100.0)], positive predictive value (PPV) 27.46% [95%CI: (21.16-33.76)], and number of colposcopies required to detect one case of Cervical Intraepithelial Neoplasia grade-2 or worse (CIN2+) 3.64. CONCLUSIONS The optimal strategy for the triage to colposcopy of hrHPV positive women, detected with the cobas® HPV test on self-collected cervicovaginal samples, is referring all HPV16 positive women directly to colposcopy, and women positive for HPV18 or other hrHPVs only after an ASCUS or worse cytology report.
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Affiliation(s)
- Kimon Chatzistamatiou
- 1(st) Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
| | - Athena Tsertanidou
- 3(th) Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Theodoros Moysiadis
- Institute of Applied Biosciences, Centre for Research & Technology - Hellas, Thessaloniki, Greece; Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417 Nicosia, Cyprus
| | | | - Konstantinos Pasentsis
- Institute of Applied Biosciences, Centre for Research & Technology - Hellas, Thessaloniki, Greece
| | - Alkmini Skenderi
- Department of Cytology, Hippokratio General Hospital, Thessaloniki, Greece
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research & Technology - Hellas, Thessaloniki, Greece
| | - Theodoros Agorastos
- Department of Gynecologic Oncology, St. Luke's Hospital, Thessaloniki, Greece
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