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Possati-Resende JC, Fritsch TZ, Souza KCB. Risk Profile of High-grade Cervical Lesions and Cervical Cancer Considering the Combination of Cytology, HPV Genotype, and Age among Women Undergoing Colposcopy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e689-e698. [PMID: 38029771 PMCID: PMC10686761 DOI: 10.1055/s-0043-1772483] [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: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE The present study aims to establish a risk profile for high-grade cervical lesions and cervical cancer (CIN2 + ) in women undergoing colposcopy at the Hospital do Câncer de Barretos, through the analysis of Human Papillomavirus (HPV) infection, cervical cytology, and patient's age. METHODS Retrospective cross-sectional study based on a computerized database of women aged ≥ 18 years old who underwent colposcopy at the Prevention Department of the Hospital do Câncer de Barretos from 2017 to 2019. RESULTS A total of 3,411 women were included, 58.0% were positive for high-risk-HPV test, with a higher prevalence of CIN2+ for HPV16 (30.3%) and other HPV (45.0%). Cytological findings that suggest invasive cervical cancer (squamous cells or adenocarcinoma), regardless of the status of HPV test, showed 100% diagnosis of CIN2 + , while atypias that suggest high-grade lesions, HSIL and ASC-H, positive for HPV test, showed in 86 and 55.2%, respectively, diagnosis of CIN2 + . ASC-H cytological results among women aged > 40 years old and negative HPV were mainly associated with benign findings. We observed that ≤ CIN1 has a higher prevalence among older women with negative HPV, while for high-grade lesions there is an increase among young women HPV16- and/or 18-positive. In cancer diagnosis, we observed a predominance of HPV 16/18 regardless of the age group. CONCLUSION The highest risks of precursor lesions and cervical cancer were found among women with positive HPV 16/18 tests and severe cytological atypia in population screening tests. In addition, cytological findings of ASC-H HPV negative in women > 40 years old usually represent benign findings in histological investigation.
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Affiliation(s)
| | - Thais Zilles Fritsch
- Research and Education Institute, Hospital do Câncer de Barretos, Barretos, SP, Brazil.
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da Silveira MF, Buffarini R, Gaspar PC, Machado HDM, Bazzo ML, Scherer A, Colusso ÁL, Travassos AGÁ, Arakaki-Sanchez D, Baia-da-Silva DC, de Oliveira EC, Zago IR, Moura MDA, de Lacerda MVG, Martins SM, Reuter T, Pinto VM, Perini W, Pereira GFM, Miranda AE. Detection of HPV DNA in vaginal samples self-collected by women living with HIV treated through the Brazilian public health system: Prevalence and analysis of risk factors. Rev Soc Bras Med Trop 2023; 56:e02772023. [PMID: 37820103 PMCID: PMC10561897 DOI: 10.1590/0037-8682-0277-2023] [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: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Women living with human immunodeficiency virus (HIV) (WLWH) are more likely to be infected with the oncogenic human papillomavirus (HPV). We assessed the prevalence of high-risk (HR) (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82), probable high-risk (pHR) (26/53/66), and low-risk (LR) (6/11/40/42/43/44/54/61/70) HPV types and their associated risk factors. METHODS This cross-sectional study of WLWH aged 18-64 years included one laboratory and eight HIV-specialty healthcare facilities in the pilot network. Descriptive statistics were used to assess sociodemographic and behavioral characteristics. Adjusted analyses were conducted to evaluate risk factors associated with HR and/or pHR HPV infection in WLWH. RESULTS From May/2021 to May/2022, 1,914 (92.5%) WLWH participated in the pilot study and had valid HPV-DNA results of self-collected vaginal samples. The median age of the participants was 45 years, 60.1% had ≥ 9 years of schooling, 80.5% were ≤ 18 years at first sexual intercourse, and 51.7% had > 4 sexual partners throughout life. The prevalence of any HPV type, HR HPV, pHR HPV, and LR HPV was 65.8%, 49.6%, 16.7%, and 40.0%, respectively. Age was inversely associated with pHR and/or HR-HPV (p < 0.001), and education level was inversely associated with HR-HPV (p = 0.003) types. Any HR or pHR was associated with being single (p = 0.029) and exchanging sex for drugs (p = 0.037). CONCLUSIONS The prevalence of HPV, especially HR HPV, among WLWH is high in Brazil, highlighting the need for HPV screening in this population. Self-collection of vaginal samples is an important strategy for increasing testing access.
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Affiliation(s)
| | - Romina Buffarini
- Universidade Federal de Pelotas, Departamento de Medicina Social, Programa de Pós-Graduação em Epidemiologia, Pelotas, RS, Brasil
| | - Pâmela Cristina Gaspar
- Ministério da Saúde, Departamento de HIV/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
| | - Hanalydia de Melo Machado
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Farmácia, Laboratório de Biologia Molecular, Microbiologia e Sorologia, Florianópolis, SC, Brasil
| | - Maria Luiza Bazzo
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Farmácia, Laboratório de Biologia Molecular, Microbiologia e Sorologia, Florianópolis, SC, Brasil
| | - Aline Scherer
- Universidade Federal de Pelotas, Hospital Escola, Empresa Brasileira de Serviços Hospitalares, Pelotas, RS, Brasil
| | - Álvaro Luis Colusso
- Secretaria do Estado de Saúde do Distrito Federal, Centro Especializado em Doenças Infecciosas do Distrito Federal, Brasília, DF, Brasil
| | | | - Denise Arakaki-Sanchez
- Secretaria do Estado de Saúde do Distrito Federal, Centro Especializado em Doenças Infecciosas do Distrito Federal, Brasília, DF, Brasil
| | | | | | | | | | | | - Simone Murta Martins
- Centro Especializado em Diagnóstico, Assistência e Pesquisa, Salvador, BA, Brasil
| | - Tânia Reuter
- Universidade Federal do Espírito Santo, Hospital Universitário Cassiano Antônio Moraes, Vitória, ES, Brasil
| | | | - Waltesia Perini
- Universidade Federal do Espírito Santo, Hospital Universitário Cassiano Antônio Moraes, Vitória, ES, Brasil
| | - Gerson Fernando Mendes Pereira
- Ministério da Saúde, Departamento de HIV/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis, Brasília, DF, Brasil
| | - Angélica Espinosa Miranda
- Ministério da Saúde, Departamento de HIV/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis, Brasília, DF, Brasil
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
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Guimarães Ribeiro A, Ferlay J, Piñeros M, Dias de Oliveira Latorre MDR, Tavares Guerreiro Fregnani JH, Bray F. Geographic variations in cancer incidence and mortality in the State of São Paulo, Brazil 2001-17. Cancer Epidemiol 2023; 85:102403. [PMID: 37390700 PMCID: PMC10432824 DOI: 10.1016/j.canep.2023.102403] [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: 03/15/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Cancer is a leading cause of morbidity and mortality in Brazil and the burden is rising. To better inform tailored cancer actions, we compare incidence and mortality profiles according to small areas in the capital and northeast region of the State of São Paulo for the leading cancer types. METHODS New cancer cases were obtained from cancer registries covering the department of Barretos (2003-2017) and the municipality of São Paulo (2001-2015). Cancer deaths for the same period were obtained from a Brazilian public government database. Age-standardized rates per 100,000 persons-years by cancer and sex are presented as thematic maps, by municipality for Barretos region, and by district for São Paulo. RESULTS Prostate and breast cancer were the leading forms of cancer incidence in Barretos, with lung cancer leading in terms of cancer mortality in both regions. The highest incidence and mortality rates were seen in municipalities from the northeast of Barretos region in both sexes, while elevated incidence rates were mainly found in São Paulo districts with high and very high socioeconomic status (SES), with mortality rates more dispersed. Breast cancer incidence rates in São Paulo were 30 % higher than Barretos, notably in high and very high SES districts, while corresponding rates of cervical cancer conveyed the opposite profile, with elevated rates in low and medium SES districts. CONCLUSIONS There is substantial diversity in the cancer profiles in the two regions, by cancer type and sex, with a clear relation between the cancer incidence and mortality patterns observed at the district level and corresponding SES in the capital.
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Affiliation(s)
- Adeylson Guimarães Ribeiro
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France; Educational and Research Institute, Barretos Cancer Hospital, Barretos, Brazil.
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | - Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | | | | | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
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One-year results of the national breast and cervical cancer screening program: Giresun province in the black sea region. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background/Aim: Increasing the survival rate of patients with breast and cervical cancers is possible by early diagnosis through screening individuals for cancer in the asymptomatic period. Especially during the COVID-19 pandemic period, the possibility of early diagnosis in breast and cervical cancers has decreased due to the decrease in cancer screening applications. The aim of cancer screening is to increase the survival of patients by detecting precancerous lesions early. The purpose of our study is to evaluate the application and results of breast and cervical cancer screening in the Black Sea region’s Giresun province.
Methods: This is a cross-sectional and descriptive study. The results of patients who were admitted to the Giresun Early Diagnosis Cancer Screening and Education Center between July 1, 2021, and June 28, 2022, were examined. The mammography report results of women aged 40–69 years who applied to the cancer screening center for breast cancer screening, and the HPV and Pap smear results of the patients aged 30–65 years who applied for cervical cancer screening, were evaluated retrospectively through the public health management system. Mammography results were evaluated with BIRADS (Breast Imaging Reporting and Dated System) scoring. The type of HPV and the cytology results from cervical swab samples were analyzed for cervical cancer screening.
Results: A total of 3567 people underwent mammography. Per the mammography results, the percentage of those with BIRADS 0 was 7.7% (n=278), the percentage of those with BIRADS 1–2 was 91% (n=3256), the percentage of those with BIRADS 4 was 0.7% (n=25), and the percentage of those with BIRADS 5 was 0.14% (n=5). HPV-DNA and cervical cytology examinations were performed for cervical cancer screening in 2326 patients. As a result of cervical cancer screening, HPV positivity was found in 6.44% (n=150) patients, and 14 different HPV types were found in the positive samples. When HPV types were examined, the two most common types were HPV type 16 (13.6%) and type 56 (11.9%). When the HPV types were examined in the positive samples, the two most common types were HPV type 16 (13.6%) and type 56 (11.9%). HPV type 18 was the least detected HPV type in patients (3.7%). When the Pap smear screening results of the 150 cases with positive screening results were examined, 3.33% were ASC-US (atypical squamous cells of undetermined significance), 22% were reported as infection, and 62.6% were normal.
Conclusion: The role of primary care physicians directing patients registered in their coverage area to cancer screening programs is especially effective in raising society’s awareness and education on the issue. As a result, it is important that primary care physicians and related specialist physicians, together with cancer early detection and screening centers, adopt a supportive stance towards these programs in order for them to be implemented effectively.
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Corrêa FM, Migowski A, de Almeida LM, Soares MA. Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination. Front Med (Lausanne) 2022; 9:945621. [PMID: 36091685 PMCID: PMC9449345 DOI: 10.3389/fmed.2022.945621] [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: 05/16/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
As a middle-income country, Brazil has one of the largest public health systems worldwide, which deals with free and universal access to health care. Regarding cervical cancer, the country possesses a large infrastructure for the screening of premalignant and malignant lesions, but yet based on old technology, having Papanicolaou as the major screening method, followed by colposcopy and treatment. Also, large disparities in access are present, which makes effectiveness of screening and treatment in different regions of the country highly unequal. In this review, we describe and evaluate the current screening, treatment and prophylactic (HPV vaccination) strategies to combat cervical cancer in Brazil, and discuss potential incorporation of more recent technologies in these areas in the country to pave its way toward cervical cancer elimination.
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Affiliation(s)
- Flávia M. Corrêa
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Arn Migowski
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Liz M. de Almeida
- Coordination of Prevention and Surveillance, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Marcelo A. Soares
- Oncovirology Program, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Department of Genetics, Universidade Federal Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Liu J, Li Y, Bo D, Wang J, Wang Y. High-risk human papillomavirus infection in pregnant women: a descriptive analysis of cohorts from two centers. J Investig Med 2022; 70:1494-1500. [PMID: 35728867 DOI: 10.1136/jim-2022-002442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
The aim was to descriptively analyze the clinical characteristics, cytopathology, and outcomes of pregnant patients with high-risk human papillomavirus (HPV) infection. Clinical data of 151,516 female patients with high-risk HPV infection were retrospectively collected. Baseline data, cervical cytology results, histopathology, HPV types, delivery mode, and follow-up outcomes were recorded for descriptive analysis. A total of 157 patients were identified as positive for high-risk HPV. There were 32 (24.2%), 6 (4.5%), and 107 (81.1%) cases of HPV-16, HPV-18, and other types, respectively. Additionally, 12 patients showed combined infection with HPV-18 or HPV-16 and other types. Cytopathological examinations showed that the most common type was low-grade squamous intraepithelial lesion (LSIL; 104 cases, 78.8%), followed by high-grade squamous intraepithelial lesion (HSIL; 17 cases, 12.8%), atypical squamous cells of undetermined significance (10 cases, 9.6%), and cervical cancer (1 case, 0.7%). Thirty-seven patients underwent colposcopic biopsy, of whom 9 (24.3%) showed normal results, while 12 (32.4%) and 13 (35.1%) patients had LSIL and HSIL, respectively. χ2 tests demonstrated that different delivery modes did not show significant difference in patients' cervical cytopathology (p>0.05). However, therapeutic methods were statistically different among patients with different cytopathological types (p<0.05). Cervical alterations in pregnancy mostly go along with high-risk HPV infection. High-risk HPV infection in pregnancy with abnormal cervical cytology should be followed closely during the pregnancy and postpartum period.
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Affiliation(s)
- Jing Liu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuhong Li
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Di Bo
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jiandong Wang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yudong Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Godoy LR, Possati-Resende JC, Guimarães YM, Pedrão PG, dos Reis R, Longatto-Filho A. Implementation of HPV Tests in Latin America: What We Learned; What Should We Have Learned, and What Can We Do Better? Cancers (Basel) 2022; 14:2612. [PMID: 35681590 PMCID: PMC9179482 DOI: 10.3390/cancers14112612] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/26/2022] [Accepted: 05/23/2022] [Indexed: 01/30/2023] Open
Abstract
Cervical cancer is caused by HPV. Although it is the fourth most common type of cancer diagnosed and the fourth cause of cancer death, cervical cancer is nearly completely preventable because of the vaccination and screening available. The present review aims to map the initiatives conducted to implement or evaluate the implementation of HPV testing in Latin American countries. We performed the review by searching on PubMed in the English language and on grey literature, as most of the information about the guidelines used was found in governmental websites in the Spanish language. We only found information in eight countries concerning HPV testing as primary screening. Only Mexico has established HPV-based screening in all territories. There are three countries with regional implementation. Two countries with pilot studies indicated results that supported implementation. Finally, there are another two countries with a national recommendation. We have learned that HPV implementation is feasible and a very promising tool for reducing cervical cancer morbidity and mortality. The costs associated with saving lives and reducing suffering due to morbidity of a preventable disease must be pragmatically evaluated by the Latin America governments, and improving outcomes must be a mandatory priority for those that are responsible for addressing an organized system of cervical cancer screening.
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Affiliation(s)
- Luani Rezende Godoy
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil; (L.R.G.); (Y.M.G.); (P.G.P.)
| | | | - Yasmin Medeiros Guimarães
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil; (L.R.G.); (Y.M.G.); (P.G.P.)
| | - Priscila Grecca Pedrão
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil; (L.R.G.); (Y.M.G.); (P.G.P.)
| | - Ricardo dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, São Paulo 14784-400, Brazil;
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil; (L.R.G.); (Y.M.G.); (P.G.P.)
- Medical Laboratory of Medical Investigation (LIM) 14, Department of Pathology, Medical School, University of São Paulo, São Paulo 01246-903, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
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Perez L, Tran K, Alvarenga-Bezerra V, Chadha D, Dotson L, Assir F, Cordioli E, Tamura Vieira Gomes M, Podgaec S, Lopes da Silva-Filho A, Ramanujam N, Moretti-Marques R. Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital. Cancer Control 2022; 29:10732748221135441. [PMID: 36433760 PMCID: PMC9703545 DOI: 10.1177/10732748221135441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/16/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Brazil has a high burden of cervical cancer, even though it is preventable, traceable and treatable. Hence, this study evaluated levels of knowledge, attitudes and practices (KAP) related to cervical cancer screening and diagnosis and acceptance of self-screening techniques among women aged 24 and greater. METHODS A cross-sectional KAP survey was administered to n = 4206 women and spanned questions relating to cervical cancer, HPV, speculum, Pap test and colposcopy. Questionnaire was disseminated through a major hospital's social media platforms, intranet and gynecologic-oncology clinics. Logistic regressions evaluated associations between sociodemographic characteristics and knowledge, attitudes, and preventative behaviors against cervical cancer. Participants indicated willingness to try DNA-HPV self-sampling and cervix self-visualization (self-colposcopy). FINDINGS Participants were mostly white individuals (70.5%) with higher education and from social classes A and B. They demonstrated superior levels of KAP than described in the literature, with over 57.8% having answered 80+% of questions correctly. KAP scores were predicted by social class, educational attainment, race, history of premalignant cervical lesions and geographic location. About 80% and 63% would be willing to try DNA-HPV self-sampling and cervix self-visualization, respectively. Interest in self-screening was associated with adequate attitude (OR = 1.85) and inadequate practice (OR = .83). INTERPRETATION Adequate KAP are fundamental for the successful implementation of a self-screening program. Participants were interested in methods that provide them with greater autonomy, control and practicality. Self-screening could address barriers for under-screened women such as shame, discomfort, distance from clinics and competing commitments, enabling Brazil to reach the WHO's cervical cancer elimination goals. It could also decrease excess medical intervention in over-screened populations by promoting shared decision-making.
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Ribeiro A, Corrêa F, Migowski A, Leal A, Martins S, Raiol T, Marques CP, Torres KL, Novetsky AP, Marcus JZ, Wentzensen N, Schiffman M, Rodriguez AC, Gage JC. Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies. Cancer Prev Res (Phila) 2021; 14:919-926. [PMID: 34607876 DOI: 10.1158/1940-6207.capr-21-0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/05/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022]
Abstract
The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil's Unified Health System (SUS) is among the world's largest public health systems offering free cytology testing, follow-up colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community's reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.
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Affiliation(s)
- Ana Ribeiro
- Department of Pharmacy, Faculty of Health Sciences, University of Brasília (UNB), Brasília, District Federal, Brazil. .,Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil
| | - Flávia Corrêa
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Arn Migowski
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Aline Leal
- General Coordination of Specialized Care, Health Care Secretariat, Ministry of Health (MS), Brasília, District Federal, Brazil
| | - Sandro Martins
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil
| | - Tainá Raiol
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil
| | - Carla P Marques
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil.,Department of Public Health, Faculty of Ceilândia, University of Brasília (UNB), Brasília, District Federal, Brazil
| | - Katia L Torres
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation (FIOCRUZ), Brasília, District Federal, Brazil.,Amazon State Oncology Control Foundation (FCECON), Manaus, Amazonas, Brazil
| | - Akiva P Novetsky
- Rutgers New Jersey Medical School (NJMS), Newark, New Jersey.,Rutgers Cancer Institute of New Jersey (CINJ), New Brunswick, New Jersey
| | - Jenna Z Marcus
- Rutgers New Jersey Medical School (NJMS), Newark, New Jersey
| | - Nicolas Wentzensen
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Mark Schiffman
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Ana Cecilia Rodriguez
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Julia C Gage
- Clinical Epidemiology Unit, Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
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Vale DB, Silva MT, Discacciati MG, Polegatto I, Teixeira JC, Zeferino LC. Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country. PLoS One 2021; 16:e0251688. [PMID: 33989331 PMCID: PMC8121350 DOI: 10.1371/journal.pone.0251688] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/01/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To report a modelling study using local health care costs and epidemiological inputs from a population-based program to access the cost-effectiveness of adopting hrHPV test. METHODS A cost-effectiveness analysis based on a microsimulation dynamic Markov model. Data and costs were based on data from the local setting and literature review. The setting was Indaiatuba, Brazil, that has adopted the hrHPV test in place of cytology since 2017. After calibrating the model, one million women were simulated in hypothetical cohorts. Three strategies were tested: cytology to women aged 25 to 64 every three years; hrHPV test to women 25-64 every five years; cytology to women 25-29 years every three years and hrHPV test to women 30-64 every five years (hybrid strategy). Outcomes were Quality-adjusted life-years (QALY) and Incremental Cost-Effectiveness Ratio (ICER). RESULTS The hrHPV testing and the hybrid strategy were the dominant strategies. Costs were lower and provided a more effective option at a negative incremental ratio of US$ 37.87 for the hybrid strategy, and negative US$ 6.16 for the HPV strategy per QALY gained. Reduction on treatment costs would influence a decrease in ICER, and an increase in the costs of the hrHPV test would increase ICER. CONCLUSIONS Using population-based data, the switch from cytology to hrHPV testing in the cervical cancer screening program of Indaiatuba is less costly and cost-effective than the old cytology program.
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Affiliation(s)
- Diama Bhadra Vale
- Obstetrics and Gynecology Department, State University of Campinas, Campinas, Brazil
- * E-mail:
| | | | | | - Ilana Polegatto
- Obstetrics and Gynecology Department, State University of Campinas, Campinas, Brazil
| | - Julio Cesar Teixeira
- Obstetrics and Gynecology Department, State University of Campinas, Campinas, Brazil
| | - Luiz Carlos Zeferino
- Obstetrics and Gynecology Department, State University of Campinas, Campinas, Brazil
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11
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Buss LF, Levi JE, Longatto-Filho A, Cohen DD, Cury L, Martins TR, Fuza LM, Villa LL, Eluf-Neto J. Attendance for diagnostic colposcopy among high-risk human papillomavirus positive women in a Brazilian feasibility study. Int J Gynaecol Obstet 2020; 152:72-77. [PMID: 33026115 DOI: 10.1002/ijgo.13362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/13/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate factors associated with colposcopy attendance in HPV-positive women in São Paulo, Brazil. METHODS We analyzed data from a prospective cohort of women positive for high-risk HPV (hr-HPV) undergoing cervical cancer screening in primary care services in São Paulo, Brazil. Non-pregnant women attending routine screening between December 2014 and March 2016 were offered an hr-HPV test, and those testing positive and aged 25 years or older were invited for colposcopy. Sociodemographic information was recorded at study enrollment. We compared variables between women who did and did not attend colposcopy within a logistic regression framework. RESULTS Of 1537 hr-HPV-positive women, 1235 (80.4%) attended for colposcopy, with a median time from primary test to colposcopy of 132 days. Younger age (P<0.001) and concurrent negative cytology results (P=0.025) were associated with lower attendance. Women registered at units providing both the primary test and colposcopy were more likely to attend than those at units making external referrals (788/862 [91.4%] versus 447/675 [66.2%], P<0.001). CONCLUSION Non-attendance for colposcopy may limit the success of future screening programs based on hr-HPV testing in Brazil. Transfer of colposcopy services to primary care is a simple and effective facilitator of attendance.
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Affiliation(s)
- Lewis F Buss
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José E Levi
- Virology Laboratory (LIM 52), Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil
| | - Adhemar Longatto-Filho
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
| | | | - Lise Cury
- Fundação Oncocentro de São Paulo, São Paulo, Brazil
| | - Toni R Martins
- Virology Laboratory (LIM 52), Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz M Fuza
- Fundação Oncocentro de São Paulo, São Paulo, Brazil
| | - Luisa L Villa
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - José Eluf-Neto
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Fundação Oncocentro de São Paulo, São Paulo, Brazil
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12
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Jin J, Yue CY. Analysis of the efficacy of liquid-based cytology combined with HPV genotypes in screening cervical lesions in women of different ages. J LAB MED 2020. [DOI: 10.1515/labmed-2019-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
To evaluate the value of liquid-based cell examination combined with human papillomavirus (HPV) genotypes in the detection of cervical intraepithelial neoplasia.
Methods
A total of 21,155 patients who had undergone cytology, HPV genotypes and colposcopy-guided biopsy were grouped into three groups. Sensitivity, specificity, positive predictive value, and negative predictive value of the test methods of the three groups were compared.
Results
In the age group of less than 50 years, the sensitivity of HPV genotype testing was significantly higher than that of liquid-based cytology. The specificity of liquid-based cytology was significantly higher in all age groups than that of HPV genotype testing. The positive predictive value of each test index was higher in the age group less than 30 years, and the negative predictive value was higher in the 30–50-year age groups. In different age groups, liquid-based cytology and HPV genotype combined method can improve the sensitivity of detection and negative predictive values.
Conclusions
The HPV test has higher sensitivity and negative predictive value, and the cytology method is relatively specific and less sensitive. The combined method has better sensitivity and negative predictive value.
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Affiliation(s)
- Jun Jin
- Department of Pathology , Fudan University Affiliated Obstetrics and Gynecology Hospital , Shanghai , P.R. China
| | - Chao-Yan Yue
- Department of Laboratory Medicine , Fudan University Affiliated Obstetrics and Gynecology Hospital , Shanghai , P.R. China
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