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Hansen BT, Nygård M, Castle PE, Burger EA, Aasbø G. Sociodemographic characteristics associated with cervical cancer screening participation by send-to-all and opt-in HPV self-sampling: Who benefits? Results from a randomized controlled trial among long-term non-attending women in Norway. Int J Cancer 2024; 155:1053-1067. [PMID: 38751040 DOI: 10.1002/ijc.34989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/11/2024] [Accepted: 04/12/2024] [Indexed: 07/16/2024]
Abstract
With the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under-screened women, we randomized a random sample of 6000 women in Norway aged 35-69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in), or (iii) a self-sampling kit unsolicited (send-to-all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send-to-all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt-in arm, we observed smaller, and at times, non-significant increases within the range 0.7% (95% CI = -5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send-to-all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt-in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (-12.7%, 95% CI = -19.7% to -5.7%). Self-sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self-sampling, especially with the goal to reach long-term non-attending women.
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Affiliation(s)
- Bo T Hansen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Phil E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Interdisciplinary Health Science, University of Oslo, Oslo, Norway
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Drysdale H, Marlow LAV, Lim A, Waller J. Experiences of Self-Sampling and Future Screening Preferences in Non-Attenders Who Returned an HPV Vaginal Self-Sample in the YouScreen Study: Findings From a Cross-Sectional Questionnaire. Health Expect 2024; 27:e14118. [PMID: 38953514 PMCID: PMC11217896 DOI: 10.1111/hex.14118] [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: 01/24/2024] [Revised: 04/25/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND We assessed experiences of human papillomavirus (HPV) vaginal self-sampling and future screening preferences in an ethnically and socio-economically diverse group of women overdue for cervical screening. SETTING AND PARTICIPANTS A postal questionnaire was embedded in the YouScreen self-sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non-completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow-up test if HPV-positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self-sampling. RESULTS Most kit-completers reported high confidence in self-sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free-text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self-sampling in the future (71.3% vs. 10.4% for a clinician-taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self-tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. CONCLUSIONS Kit-completers were confident, found the test easy to complete, and trusted the self-sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self-sampling in the future, but it was not a universal preference, so offering a choice will be important. PATIENT OR PUBLIC CONTRIBUTION We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). TRIAL REGISTRATION This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934.
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Affiliation(s)
- Hannah Drysdale
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's CollegeFaculty of Life Sciences and MedicineLondonUK
| | - Laura A. V. Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's CollegeFaculty of Life Sciences and MedicineLondonUK
- Centre for Cancer Prevention, Screening and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Anita Lim
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's CollegeFaculty of Life Sciences and MedicineLondonUK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's CollegeFaculty of Life Sciences and MedicineLondonUK
- Centre for Cancer Prevention, Screening and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and DentistryQueen Mary University of LondonLondonUK
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Zhao C, An J, Li M, Li J, Zhao Y, Wang J, Xie HQ, Wei L. High-Risk Genotypes of Human Papillomavirus at Diverse Anogenital Sites among Chinese Women: Infection Features and Potential Correlation with Cervical Intraepithelial Neoplasia. Cancers (Basel) 2024; 16:2107. [PMID: 38893229 PMCID: PMC11172096 DOI: 10.3390/cancers16112107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Both cervical cancer and cervical intraepithelial neoplasia (CIN) are associated with human papillomavirus (HPV) infection at different anogenital sites, but the infection features of high-risk (HR) HPVs at these sites and their association with cervical lesions have not been well characterized. Given the limitation of cervical HPV 16/18 test in screening patients with high-grade CIN (CIN 2+), studies on whether non-16/18 HR-HPV subtype(s) have potential as additional indicator(s) to improve CIN 2+ screening are needed. METHODS The infection of 15 HR-HPVs in vulva, anus, vagina, and cervix of 499 Chinese women was analyzed, and CIN lesion-associated HR-HPV subtypes were revealed. RESULTS In addition to the well-known cervical-cancer-associated HPV 16, 52, and 58, HPV 51, 53, and 56 were also identified as high-frequency detected subtypes prevalently and consistently present at the anogenital sites studied, preferentially in multi-infection patterns. HPV 16, 52, 58, 56, and 53 were the top five prevalent subtypes in patients with CIN 2+. In addition, we found that cervical HPV 33/35/52/53/56/58 co-testing with HPV 16/18 might improve CIN 2+ screening performance. CONCLUSION This study provided a new insight into HR-HPV screening strategy based on different subtype combinations, which might be used in risk stratification clinically.
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Affiliation(s)
- Chao Zhao
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Jiahui An
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Mingzhu Li
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Jingran Li
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Yun Zhao
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
| | - Heidi Qunhui Xie
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lihui Wei
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing 100044, China
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Davies JC, Sargent A, Pinggera E, Carter S, Gilham C, Sasieni P, Crosbie EJ. Urine high-risk human papillomavirus testing as an alternative to routine cervical screening: A comparative diagnostic accuracy study of two urine collection devices using a randomised study design trial. BJOG 2024. [PMID: 38660737 DOI: 10.1111/1471-0528.17831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To evaluate the sensitivity of human papillomavirus (HPV) tested urine to detect high-grade cervical precancer (cervical intraepithelial neoplasia grade 2+ [CIN2+]) using two urine collection devices. DESIGN Randomised controlled trial. SETTING St Mary's Hospital, Manchester, UK. POPULATION Colposcopy attendees with abnormal cervical screening; a total of 480 participants were randomised. Matched urine and cervical samples were available for 235 and 230 participants using a first-void urine (FVU)-collection device and standard pot, respectively. METHODS Urine was self-collected and mixed with preservative - randomised 1:1 to FVU-collection device (Novosanis Colli-pee® 10 mL with urine conservation medium [UCM]) or standard pot. Matched clinician-collected cervical samples were taken before colposcopy. HPV testing used Roche cobas® 8800. A questionnaire evaluated urine self-sampling acceptability. MAIN OUTCOME MEASURES The primary outcome measured sensitivity of HPV-tested urine (FVU-collection device and standard pot) for CIN2+ detection. Secondary outcomes compared HPV-tested cervical and urine samples for CIN2+ and evaluated the acceptability of urine self-sampling. RESULTS Urine HPV test sensitivity for CIN2+ was higher with the FVU-collection device (90.3%, 95% CI 83.7%-94.9%, 112/124) than the standard pot (73.4%, 95% CI 64.7%-80.9%, 91/124, p = 0.0005). The relative sensitivity of FVU-device-collected urine was 0.92 (95% CI 0.87-0.97, pMcN = 0.004) compared with cervical, considering that all women were referred after a positive cervical HPV test. Urine-based sampling was acceptable to colposcopy attendees. CONCLUSIONS Testing of FVU-device-collected urine for HPV was superior to standard-pot-collected urine in colposcopy attendees and has promising sensitivity for CIN2+ detection. General population HPV testing of FVU-device-collected urine will establish its clinical performance and acceptability as an alternative to routine cervical screening.
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Affiliation(s)
- Jennifer C Davies
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alexandra Sargent
- Cytology Department, Clinical Sciences Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Elisabeth Pinggera
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Suzanne Carter
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Clare Gilham
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Emma J Crosbie
- Gynaecological Oncology Research Group, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Whittaker M, Davies JC, Sargent A, Sawyer M, Crosbie EJ. A comparison of the carbon footprint of alternative sampling approaches for cervical screening in the UK: A descriptive study. BJOG 2024; 131:699-708. [PMID: 38012840 DOI: 10.1111/1471-0528.17722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To understand whether self-sampling can reduce carbon emissions (CO2 e) from the NHS cervical screening programme (NHSCSP) by comparing the carbon footprint of three sampling strategies: routine cervical sampling, vaginal self-sampling and first-void (FV) urine collection. DESIGN Descriptive study. SETTING National Health Service (NHS), United Kingdom (UK). POPULATION OR SAMPLE Patients aged 25-64 years eligible for cervical screening in the UK. METHODS A carbon footprint analysis was undertaken for three cervical screening sampling approaches, from point of invitation to screening through to preparation for transport to the laboratory for HPV testing. A combination of primary and secondary data were used, with a bottom-up approach applied to collection of primary data. MAIN OUTCOME MEASURES We report CO2 e per sampling approach, which is the unit used to express carbon footprint and harmonise the contributions of greenhouse gases with different global warming potentials. RESULTS The total carbon footprint of routine cervical sampling is 3670 g CO2 e. By comparison, vaginal self-sampling had a total carbon footprint of 423 g CO2 e, and FV urine sampling 570 g CO2 e. The largest share of emissions for routine sampling was attributable to the carbon footprint associated with an appointment in a primary care setting, which totalled 2768 g CO2 e. CONCLUSIONS Routine cervical sampling is up to 8.7-fold more carbon-intensive than self-sampling approaches with equivalent effectiveness. We found negligible differences in the carbon footprint of alternative self-sampling methods, supporting the need for an informed choice of screening options for participants, which includes sharing information on their environmental impacts.
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Affiliation(s)
- Maya Whittaker
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jennifer C Davies
- Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alexandra Sargent
- Manchester University NHS Foundation Trust, Manchester, UK
- Cytology Department, Clinical Sciences Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Matt Sawyer
- SEE Sustainability, Leeming Bar, Northallerton, North Yorkshire, UK
| | - Emma J Crosbie
- Manchester University NHS Foundation Trust, Manchester, UK
- Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Hald SR, Tatari CR, Kirkegaard P, Tranberg M, Andersen B, Nielsen CP. "Well, that Was Pretty Clever!"-Ethnic Minority Women's Views on HPV Self-Sampling Devices for Cervical Cancer Screening: Attitudes to Brushes, First-Void Urine, and Menstrual Blood Devices. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01963-9. [PMID: 38472631 DOI: 10.1007/s40615-024-01963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Ethnic minority women are less likely to participate in cervical cancer uteri (CCU) screening compared to native women. Human Papillomavirus (HPV) self-sampling kits for CCU screening may be a potential strategy to increase participation. This study aimed to explore views and attitudes on four different types of self-sampling kits (two brushes, a first-void urine device, and a menstrual blood device) among non-Western ethnic minority women living in Denmark. METHODS The study was a social science single case study based on focus group interviews with 30 women aged 32-54 with non-Western background from a deprived area. A phenomenological approach was applied to describe the phenomenon "self-sampling" as seen from the women's lifeworlds. The interviews were transcribed verbatim and analysed using systematic text condensation. RESULTS The women expressed significant interest in the possibility of using HPV self-sampling kits as an alternative to being screened by their general practitioner. They were particularly motivated to use the non-invasive self-sampling kits for CCU screening as they were deemed suitable for addressing cultural beliefs related to their bodies and virginity. The women expressed interest in the use of the invasive self-sampling kits but were cautious, primarily due to lack of confidence in correctly performing self-sampling with a brush and due to cultural beliefs. CONCLUSION The use of non-invasive self-sampling kits, such as a first-void urine collection device and menstrual blood pad, represents a promising solution to overcome cultural barriers and promote greater equality in CCU screening participation among non-Western ethnic minority women.
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Affiliation(s)
- Signe Ruby Hald
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Camilla Rahr Tatari
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Tranberg
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Public Health Research, Central Denmark Region, Aarhus, Denmark
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Napolitano F, Angelillo S, Bianco A, Di Giuseppe G, Di Onofrio V, Licata F, Liguori G, Nobile CGA, Pavia M, Pelullo CP, Zito Marino F, Angelillo IF. Genital and Oral HPV Geno-Prevalence Measured through Urine and Saliva Samples in Young Adults in Italy. Vaccines (Basel) 2024; 12:205. [PMID: 38400188 PMCID: PMC10892725 DOI: 10.3390/vaccines12020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The aims of the study were to determine, in the urine and oral samples of young adults, the genotype-specific prevalence of Human Papilloma Virus (HPV) infection, the HPV DNA type-specific prevalence in unvaccinated and vaccinated individuals, and the determinants of HPV infection. METHODS Selected participants were asked to fill in a self-administered questionnaire and to self-collect urine and saliva samples. RESULTS Among the 1002 participants, 81 (8.1%) resulted positive for HPV DNA. The most common low-risk genotype was HPV 42 (2.2%), followed by HPV 43 (0.8%), and 40 (0.5%). The HPV 51 was the most common high-risk genotype (1.5%) followed by HPV 66 (1%) and HPV 68 (1%), and no participants were infected with HPV genotypes 18, 33, 45. Females, those who have had one or more occasional sexual partner, those who never/rarely/sometimes used condoms during their sexual activity, those with a previous diagnosis of sexually transmitted infection, and those who were not vaccinated were more likely to be tested positive for HPV infection. CONCLUSIONS The low prevalence of genital HPV infections has provided evidence of the effectiveness of HPV vaccination both in vaccinated and not yet vaccinated subjects through herd immunity and indicated its decisive role in the changing epidemiology of circulating HPV genotypes in the population.
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Affiliation(s)
- Francesco Napolitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Silvia Angelillo
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Aida Bianco
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Valeria Di Onofrio
- Department of Sciences and Technologies, University of Naples “Parthenope”, 80143 Naples, Italy
| | - Francesca Licata
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Giorgio Liguori
- Department of Medical, Movement and Wellbeing Sciences, University of Naples “Parthenope”, 80133 Naples, Italy
| | | | - Maria Pavia
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Concetta Paola Pelullo
- Department of Medical, Movement and Wellbeing Sciences, University of Naples “Parthenope”, 80133 Naples, Italy
| | - Federica Zito Marino
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Aimagambetova G, Atageldiyeva K, Marat A, Suleimenova A, Issa T, Raman S, Huang T, Ashimkhanova A, Aron S, Dongo A, Iztleuov Y, Shamkeeva S, Azizan A. Comparison of diagnostic accuracy and acceptability of self-sampling devices for human Papillomavirus detection: A systematic review. Prev Med Rep 2024; 38:102590. [PMID: 38283967 PMCID: PMC10821625 DOI: 10.1016/j.pmedr.2024.102590] [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: 09/06/2023] [Revised: 11/28/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Objective Cervical cancer screening coverage remains low in many countries worldwide. Self-sampling approach for cervical cancer screening has a good potential to improve the screening coverage. This study aims to compare different types of HPV self-sampling devices for cervical cancer screening to identify the most accurate and acceptable device(s). Methods A systematic review was performed on data extracted from all studies specific to HPV self-sampling devices by searching relevant articles in PubMed, Google Scholar, Scopus, Web of Science, ScienceDirect, Cochrane Library, and EBSCO published from 2013 to October 2023. The study was registered in PROSPERO (CRD42022375682). Results Overall, 70 papers met the eligibility criteria for this systematic review and were included in the analysis: 22 studies reported self-sampling devices diagnostic accuracy, 32 studies reported self-sampling devices acceptability and 16 studies reported both (accuracy and acceptability). The most popular self-sampling devices were Evalyn Brush, FLOQ Swab, Cervex-Brush, and Delphi Screener. Out of overall 38 studies analyzing self-sampling devices' diagnostic accuracy, 94.7% of studies reported that self-collected specimens provided sensitivity and specificity comparable with clinician-collected samples; acceptability of Evalyn Brush, FLOQ Swab, Delphi Screener, and Colli-Pee, varied between 84.2% and 100%. Conclusion The self-sampling approach has a good potential to increase cervical cancer screening coverage. Evalyn Brush, Cervex-Brush, FLOQ Swab, and Delphi Screener self-sampling devices for HPV detection were the most commonly utilized and found to be the most accurate, and patient-acceptable. HPV detection accuracy using these self-sampling devices had no significant difference compared to the sampling performed by healthcare providers.
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Affiliation(s)
- Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Kuralay Atageldiyeva
- Department of Medicine, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF “University Medical Center”, 10000 Astana, Kazakhstan
| | - Aizada Marat
- Department of Obstetrics and Gynecology #1, NJSC “Astana Medical University”, 010000, Astana, Kazakhstan
| | - Assem Suleimenova
- Kazakh National Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Torgyn Issa
- School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Sarina Raman
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Timothy Huang
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Ayimkul Ashimkhanova
- Department of Medicine, School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
- Department of Clinical Medicine, School of Medicine, Al Farabi University, Almaty, Kazakhstan
| | - Saida Aron
- School of Medicine, Nazarbayev University, 010000, Astana, Kazakhstan
| | - Andrew Dongo
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
| | - Yerbolat Iztleuov
- Medical Center, Marat Ospanov West-Kazakhstan Medical University, 030000, Aktobe, Kazakhstan
| | - Saykal Shamkeeva
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University Hospital, 04103, Leipzig, Germany
| | - Azliyati Azizan
- College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada, USA
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Effah K, Tekpor E, Amuah JE, Essel NOM, Kemawor S, Catherine Morkli EA, Lamptey–Mills E, Wormenor CM, Manu LS, Klutsey GB, Danyo S, Akakpo PK. Self-sampling and HPV DNA testing for cervical precancer screening in a cohort of nuns in Ghana: a cross-sectional cohort study. EClinicalMedicine 2023; 63:102183. [PMID: 37692077 PMCID: PMC10484965 DOI: 10.1016/j.eclinm.2023.102183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Background The need for cervical cancer screening has been emphasised in at-risk cohorts of women to reduce their risk of cervical cancer. Some women with decreased risk of acquiring human papillomavirus (HPV) infections, such as Catholic nuns, receive less attention and on occasion are missed in cervical cancer screening programmes. This study aimed to determine the high-risk HPV (hr-HPV) prevalence in such a cohort to emphasise the need for cervical precancer screening among all women. To improve compliance, we employed self-sampling. Methods This descriptive cross-sectional cohort study involved the data of 105 Catholic nuns subjected to cervical screening using self-samples in the Greater Accra, Volta, and Central regions of Ghana between June 4, 2022 and June 30, 2022. hr-HPV testing was performed on self-samples using the MA-6000 HPV DNA platform. Screen-positive nuns underwent follow-up pap smears and EVA colposcopy. In addition to descriptive analysis, univariate and multivariable nominal logistic regression was used to explore the relationship between hr-HPV positivity and selected continuous and categorical factors. Findings 105 nuns from three convents were screened with hr-HPV DNA testing (MA-6000). Twenty-five tested positive for hr-HPV (prevalence of 23.8% (95% CI, 15.7-32.0) [HPV 18 only (n = 2, 1.9%), non-HPV 16/18 genotypes (others) (n = 22, 21.0%), and mixed infection with HPV 16 and other genotype(s) (n = 1, 1.0%)]. Pap smears for all 25 hr-HPV-positives came in as negative for intraepithelial lesions or malignancy, whereas EVA mobile colposcopy showed minor abnormal findings in two (8.0%; 95% CI, 1.0-26.0), both of whom were managed conservatively. Interpretation Our findings suggest that the hr-HPV prevalence in this cohort of nuns is similar to that of the general population. To meet the World Health Organization's target for cervical cancer elimination, it is important that all women are given access to cervical cancer screening and preventative services. Further, increasing 'anonymity' and privacy among nuns through self-sampling may be crucial to expanding choice, coverage, and uptake of screening in support of their health rights. Funding None.
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Affiliation(s)
- Kofi Effah
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
- Department of Obstetrics and Gynecology, Catholic Hospital, Battor, Ghana
| | - Ethel Tekpor
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
| | - Joseph Emmanuel Amuah
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nana Owusu M. Essel
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
- Department of Emergency Medicine, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Seyram Kemawor
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
| | | | - Esther Lamptey–Mills
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | - Lawrencia Serwaa Manu
- Department of Obstetrics and Gynecology, Catholic Hospital, Battor, Ghana
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Stephen Danyo
- Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana
| | - Patrick Kafui Akakpo
- Department of Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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10
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Hou J, Zeng M, Liu C, Xie B, Li Y, Wu L, Zhu L, Li M, Zhang Z, Zhang X, Ge Y. Cervical HPV infection in Yueyang, China: a cross-sectional study of 125,604 women from 2019 to 2022. Front Public Health 2023; 11:1210253. [PMID: 37601194 PMCID: PMC10435747 DOI: 10.3389/fpubh.2023.1210253] [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: 04/22/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Human papillomavirus (HPV) infection is currently the main cause of cervical cancer and precancerous lesions in women. The aim of this study was to investigate the epidemiological characteristics of HPV genotypes among women in Yueyang city and to provide a basis for the prevention and treatment of cervical cancer in this city. Methods A cross-sectional study was conducted on 125,604 women who had received treatment from eight hospitals in Yueyang city from September 2019 to September 2022. Analysis of the prevalence of HPV in patients. Results The prevalence of HPV was 20.5% (95%CI: 20.2-20.7%), of which the high-risk type (HR-HPV) accounted for 17.5% (95%CI: 17.3-17.7%) and the low-risk type (LR-HPV) accounted for 5.0% (95%CI: 4.9-5.1%). Among the HR-HPV subtypes, the top five in prevalence, from the highest to the lowest, were HPV52 (5.1%), HPV16(2.7%), HPV58 (2.6%), HPV53 (2.4%), and HPV51 (1.7%). The main LR-HPV infection types were HPV81 (2,676 cases, OR = 2.1%; 95%CI, 2.0-2.1%). Among the infected patients, 19,203 cases (OR = 74.3%; 95%CI, 73.8-74.9%) had a single subtype, 4,673 cases (OR = 18.1%; 95%CI, 17.6-18.6%) had two subtypes, and 1957 cases (OR = 7.6%; 95%CI, 7.3-7.9%) had three or more subtypes. HPV prevalence is highest among women <25 years, 55-64 years and ≥ 65 years of age. Conclusion The prevalence of HPV in women in Yueyang city was 20.5%, with HR-HPV being dominant. As women aged <25 years, 55-64 years, and ≥ 65 years are at a relatively higher risk, more attention should be paid to them for prevention and control of HPV infections.
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Affiliation(s)
- Jinfeng Hou
- Department of Gynecology, Yueyang People’s Hospital, Hunan Normal University, Yueyang, China
| | - Min Zeng
- Department of Gynecology, Yueyang People’s Hospital, Hunan Normal University, Yueyang, China
| | - Chongmei Liu
- Department of Gynecology, Yueyang People’s Hospital, Hunan Normal University, Yueyang, China
| | - Bochao Xie
- Department of Gynecology, Yueyang People’s Hospital, Hunan Normal University, Yueyang, China
| | - Yu Li
- Department of Gynecology, Yueyang People’s Hospital, Hunan Normal University, Yueyang, China
| | - Longyun Wu
- Department of Pathology, Yueyang Central Hospital, Yueyang, China
| | - Long Zhu
- Department of Pathology, Huarong County People’s Hospital of Hunan Province, Yueyang, China
| | - Manqiu Li
- Department of Pathology, Pingjiang People’s Hospital of Hunan Province, Yueyang, China
| | - Zhihui Zhang
- Department of Pathology, Linxiang People’s Hospital of Hunan Province, Yueyang, China
| | - Xiaoyun Zhang
- Department of Gynecology, Yueyang People’s Hospital, Hunan Normal University, Yueyang, China
| | - Yangqing Ge
- Department of Gynecology, Yueyang People’s Hospital, Hunan Normal University, Yueyang, China
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11
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Jordaens S, Zwaenepoel K, Tjalma W, Deben C, Beyers K, Vankerckhoven V, Pauwels P, Vorsters A. Urine biomarkers in cancer detection: A systematic review of preanalytical parameters and applied methods. Int J Cancer 2023; 152:2186-2205. [PMID: 36647333 DOI: 10.1002/ijc.34434] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/25/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023]
Abstract
The aim of this review was to explore the status of urine sampling as a liquid biopsy for noninvasive cancer research by reviewing used preanalytical parameters and protocols. We searched two main health sciences databases, PubMed and Web of Science. From all eligible publications (2010-2022), information was extracted regarding: (a) study population characteristics, (b) cancer type, (c) urine preanalytics, (d) analyte class, (e) isolation method, (f) detection method, (g) comparator used, (h) biomarker type, (i) conclusion and (j) sensitivity and specificity. The search query identified 7835 records, of which 924 unique publications remained after screening the title, abstract and full text. Our analysis demonstrated that many publications did not report information about the preanalytical parameters of their urine samples, even though several other studies have shown the importance of standardization of sample handling. Interestingly, it was noted that urine is used for many cancer types and not just cancers originating from the urogenital tract. Many different types of relevant analytes have been shown to be found in urine. Additionally, future considerations and recommendations are discussed: (a) the heterogeneous nature of urine, (b) the need for standardized practice protocols and (c) the road toward the clinic. Urine is an emerging liquid biopsy with broad applicability in different analytes and several cancer types. However, standard practice protocols for sample handling and processing would help to elaborate the clinical utility of urine in cancer research, detection and disease monitoring.
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Affiliation(s)
- Stephanie Jordaens
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium.,Novosanis NV, Wijnegem, Belgium
| | - Karen Zwaenepoel
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium.,Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Wiebren Tjalma
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium.,Multidisciplinary Breast Clinic, Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Christophe Deben
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
| | | | - Vanessa Vankerckhoven
- Novosanis NV, Wijnegem, Belgium.,Center for Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Patrick Pauwels
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium.,Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Alex Vorsters
- Center for Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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12
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John JH, Halder A, Purwar S, Pushpalatha K, Gupta P, Dubey P. Study to determine efficacy of urinary HPV 16 & HPV 18 detection in predicting premalignant and malignant lesions of uterine cervix. Int J Gynaecol Obstet 2023; 161:79-85. [PMID: 36184575 DOI: 10.1002/ijgo.14486] [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: 08/15/2021] [Revised: 02/07/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate clinical performance and diagnostic accuracy of urinary HPV for non-invasive screening of high-grade precancerous and cancerous cervical lesions in a visual inspection under acetic acid (VIA) -positive cohort. METHOD The study included 180 women aged 35-65 years, who were VIA positive in a colposcopy clinic. All participants had the initial stream of a random urine sample tested for the presence of high-risk HPV (hrHPV) types 16 and 18 and acetowhite lesions were biopsied per protocol. Concordance analysis was conducted to assess agreement between detection of hrHPV in urine and the presence of premalignant and malignant lesions in cervix on histopathology. Measures of diagnostic accuracy were estimated to evaluate the performance of urinary HPV against histopathology (reference standard). RESULTS Substantial agreement between urinary HPV detection and histopathology was found (Cohen's κ is 0.696, P ≤ 0.001), with an agreement in 88.9% of the cases and disagreement in 11.1%. The diagnostic performance of urinary HPV in predicting the presence of a high-grade precancerous or cancerous lesion was as follows: sensitivity 67%, specificity 97%, positive predictive value 89%, and negative predictive value 88.8%. CONCLUSION HPV DNA detection from urine has good concordance with the histopathology for detection of precancerous and cancerous lesions of the cervix. Further studies on optimization of urine sampling and processing techniques are warranted.
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Affiliation(s)
- Julie Hansa John
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, India
| | - Ajay Halder
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, India
| | - Shashank Purwar
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
| | | | - Priyal Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
| | - Pankhuri Dubey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, India
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13
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Solnæs JV, Njor SH, Tranberg M. Does full HPV genotyping perform similarly well in clinician-collected cervical samples and self-collected vaginal samples when using the CLART HPV4S assay? BMC Womens Health 2023; 23:78. [PMID: 36823528 PMCID: PMC9948442 DOI: 10.1186/s12905-023-02215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Studies comparing self-collected vaginal samples with clinician-collected cervical samples with respect to high-risk human papillomavirus (HPV) detection and genotype agreement based on clinically validated full HPV genotype assays (e.g. the CLART HPV4S) are limited. This study compared the two types of samples using the CLART assay with respect to HPV detection and genotype agreement in a referral population. METHODS A total of 212 women aged 30-59 years and diagnosed with atypical squamous cells of undetermined significance (ASC-US) within the Danish cervical cancer screening programme had a cervical sample taken at their general practitioner. Afterwards, the women took a vaginal sample with the Evalyn Brush device at home. The paired samples were HPV-tested with the full genotyping CLART HPV4S assay. Histological results, i.e. cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were available for 14 women with HPV-positive clinician-collected samples. RESULTS The study found the same HPV prevalence in self-collected vaginal samples compared to clinician-collected cervical samples (19.3%, 95% CI 14.3-25.3% vs 18.4%, 95% CI 13.4-24.3%). The CLART HPV4S assay detected approximately the same number of CIN2+ cases in the self-collected vaginal samples compared to the clinician-collected cervical samples (13 vs 11 cases). Exactly the same genotypes were detected in 75% (21/28) of the HPV-positive paired samples, while at least one identical genotype was found in the remaining 25% (7/28) of the paired samples. CONCLUSIONS The CLART HPV4S assay performed similarly well in self-collected vaginal samples as in clinician-collected cervical samples with respect to both HPV detection and genotype agreement when using the Evalyn Brush and the CLART HPV4S assay in a referral population. Although further evaluation is needed, the findings suggest that full HPV genotyping based on the CLART assay can be useful when establishing HPV genotype-specific referral strategies for women tested HPV-positive by self-sampling.
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Affiliation(s)
- Jannie Villekjær Solnæs
- grid.7048.b0000 0001 1956 2722Faculty of Health, Aarhus University, Vennelyst Boulevard 4, 8000 Aarhus C, Denmark ,grid.415677.60000 0004 0646 8878University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark
| | - Sisse Helle Njor
- grid.415677.60000 0004 0646 8878University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Mette Tranberg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NØ, Denmark.
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14
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Kaoma M, Olayemi O, Mwaba MH, Sikwewa K. Utilizing first void urine for high-risk HPV testing for cervical cancer screening in HIV-positive women in Katete, Zambia. BMC Womens Health 2023; 23:62. [PMID: 36774526 PMCID: PMC9922459 DOI: 10.1186/s12905-023-02212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The World Health Organization targets to screen 70% of women worldwide twice for cervical cancer by the year 2030, first by age of 35, and again by the age of 45. However, with the current low screening coverage in many developing countries, this may not be achieved because the invasive sampling method is unacceptable to some. In Zambia, for instance, despite the availability of free cervical cancer screening through the establishment of the Cervical Cancer Prevention Programme, some women are still reluctant to go for screening. First void urine sampling is non-invasive and thus has the potential to increase screening coverage. We aimed to determine the performance of first void urine for high-risk human papillomavirus DNA detection, the prevalence of high-risk HPV, and the acceptability of first void urine sampling. MATERIALS AND METHOD A comparative cross-sectional study was conducted among 100 HIV- infected women at St Francis' Hospital in Zambia, attending the routine HIV/AIDS services and cervical cancer screening. 17 mL of first void urine sample collected by each participant was immediately mixed with 3 mL of 0.5 M EDTA preservative solution before cervical sample collection by the clinician. For testing, 2 mL of first void urine and 1 mL of the cervical sample were tested using the GeneXpert platform. An interview-based questionnaire was used to gather data on the acceptability of first void urine sampling. Data was analyzed using Stata version 17. RESULTS The mean age of the participants was 42.58 years (95% CI 40.98-44.19; SD 8.01). High-risk HPV prevalence was 34% (95% CI 24%-43.9%) in both cervical and first void urine samples. Sensitivity and specificity were 84.8% (95% CI 68.1%-94.9%) and 92.3% (83%-97.5%), respectively. There was 89.80% agreement between the samples (κ = 0.77; 95% CI 0.64-0.91). First void urine sampling was highly accepted. CONCLUSION High-risk HPV DNA can be detected in first void urine samples using the GeneXpert, with a substantial agreement with cervical samples. An affordable preservative such as Ethylenediamine tetraacetic acid can prevent DNA degradation. With optimization, first void urine sampling has the potential to increase screening coverage.
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Affiliation(s)
- Marian Kaoma
- Department of Obstetrics and Gynaecology, The Pan African University for Life and Earth Sciences Institute (Including Health and Agriculture), University of Ibadan, Ibadan, Nigeria.
| | - Oladapo Olayemi
- grid.9582.60000 0004 1794 5983Department of Obstetrics and Gynaecology, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Mwila Hilton Mwaba
- grid.442672.10000 0000 9960 5667Department of Basic Medical Sciences, Michael Chilufya Sata School of Medicine, The Copperbelt University, Ndola, Zambia
| | - Kapembwa Sikwewa
- grid.460006.4Laboratory Department, St Francis’ Hospital, Katete, Zambia
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15
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The Influence of Vaginal HPV Self-Sampling on the Efficacy of Populational Screening for Cervical Cancer-An Umbrella Review. Cancers (Basel) 2022; 14:cancers14235913. [PMID: 36497396 PMCID: PMC9740498 DOI: 10.3390/cancers14235913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Early detection of cervical cancer is a matter of great importance as the prognosis depends on the stage of the disease. The objective of the study consisted in the assessment of the impact of HPV self-sampling on the efficacy of populational screening programs aimed at early CC detection. METHODS The analysis was performed taking into account the Cochrane Collaboration guidelines for systematic reviews. The analyzed articles were searched for in the following databases: Medline (PubMed), Embase (Ovid), and Cochrane Library. RESULTS From a total of 60 citations, 16 studies were included in this review. The HPV test is highly sensitive and specific although the diagnostic accuracy of tests carried out in self-collected samples is slightly lower than that of tests carried out in samples collected by clinicians. The results of meta-analyses for HPV tests performed on self-collected samples indicate that the sensitivity for detecting CIN2+ ranges from 74% to 86% (depending on the publication and the analyzed population), and for CIN3+ from 75% to 86%. One publication showed a clearly lower sensitivity of 42% in detecting CIN3+, but the result is for a high-risk population and comes from only 1 RCT. The specificity of the assay exceeds 80% and 79.5% with regard to the detection of CIN2+ and CIN3+, respectively. As shown by the studies included in the review, both the offering of HPV self-sampling kits to patients and the mailing of such kits significantly increase the uptake of and participation in cervical cancer screening programs. In addition, self-sampling was found to be acceptable by the female subjects. CONCLUSIONS HPV self-sampling is an innovative and cost-effective way to perform screening tests. In addition, self-sampling significantly increases the willingness to participate in screening programs among female subjects.
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16
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Kim DH, Jin H, Lee KE. Analysis of HR-HPV Infection Concordance Rates in Cervical and Urine Specimens; Proposal of Additional Cervical Screening Process for Women Who Refuse Invasive Cervical Sampling. J Pers Med 2022; 12:jpm12121949. [PMID: 36556170 PMCID: PMC9784177 DOI: 10.3390/jpm12121949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to provide basic data for the clinical application of urine samples to prevent cervical cancer due to persistent HR-HPV infection in women who refuse invasive cervical sampling. Pairs of cervical swabs and urine samples were collected from 210 asymptomatic women who visited the obstetrics and gynecology department from August to December 2020, and a total of 420 samples were collected. Using the PANA RealTyper™ HPV Screening Kit as a real-time PCR method, paired cervical swabs and random urine samples were tested. A total of 19 samples (9.1%) were both HPV positive and 177 (84.3%) were both negative. The concordance between the two types of samples was 93.3%, with κ = 0.69 (moderate, 95% CI 0.54-0.84). The HPV infection rate by age was highest in both cervical swabs and urine samples in women in their 30s, followed by those in their 20s. Thus, the HPV infection rate was high in young women under 40 at 69.2% in cervical swabs and 61.8% in urine samples. Urine samples are considered a valuable screening test for women who refuse invasive Pap tests to prevent cervical cancer caused by persistent HPV infection.
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Affiliation(s)
- Dong Hyeok Kim
- Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan, Busan 46252, Republic of Korea
- Clinical Trial Specialist Program for In Vitro Diagnostics, Brain Busan 21 Plus Program, The Graduate School, Catholic University of Pusan, Busan 46252, Republic of Korea
| | - Hyunwoo Jin
- Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan, Busan 46252, Republic of Korea
- Clinical Trial Specialist Program for In Vitro Diagnostics, Brain Busan 21 Plus Program, The Graduate School, Catholic University of Pusan, Busan 46252, Republic of Korea
| | - Kyung Eun Lee
- Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan, Busan 46252, Republic of Korea
- Clinical Trial Specialist Program for In Vitro Diagnostics, Brain Busan 21 Plus Program, The Graduate School, Catholic University of Pusan, Busan 46252, Republic of Korea
- Correspondence: ; Tel.: +82-51-510-0562
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Van Keer S, Latsuzbaia A, Vanden Broeck D, De Sutter P, Donders G, Doyen J, Tjalma WAA, Weyers S, Arbyn M, Vorsters A. Analytical and clinical performance of extended HPV genotyping with BD Onclarity HPV Assay in home-collected first-void urine: A diagnostic test accuracy study. J Clin Virol 2022; 155:105271. [PMID: 36049283 DOI: 10.1016/j.jcv.2022.105271] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Urine collection is a non-invasive self-sampling method offering the prospect of reaching women un(der)-screened for cervical cancer. The VALHUDES research framework was designed to address the lack of clinical accuracy data for high-risk (hr)HPV testing using urine samples. OBJECTIVES Here, we report on the analytical and clinical accuracy of hrHPV testing on first-void urine, collected at home, using an extended HPV genotyping assay. STUDY DESIGN Paired first-void urine (Colli-Pee with UCM, Novosanis; index test) and clinician-collected cervical samples (Cervex-Brush, Rovers in PreservCyt Solution, Hologic; comparator test) were collected from 492 women aged 19 to 72 years attending colposcopy (reference test, with histology if indicated) (VALHUDES; NCT03064087). Extended HPV genotyping was performed on paired samples with the BD Onclarity HPV Assay. Cut-offs defined for cervical samples were also applied for first-void urine. RESULTS HrHPV testing in first-void urine was similarly sensitive for both CIN2+ (ratio 1.00; 95% CI: 0.93-1.07) and CIN3 (ratio 0.98; 95% CI: 0.88-1.08), and marginally less specific for <CIN2 (ratio 0.92; 95% CI: 0.84-0.996) compared to cervical samples. HPV test agreement between sample pairs expressed as Cohen's Kappa (κ) was moderate to excellent for overall hrHPV and individual genotypes (or groups) (κ=0.56-0.85). CONCLUSIONS BD Onclarity HPV Assay on first-void urine has similar clinical sensitivity and somewhat lower specificity to detect cervical precancer to testing on clinician-collected cervical samples.
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Affiliation(s)
- Severien Van Keer
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk (Antwerp), 2610 Belgium.
| | - Ardashel Latsuzbaia
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Davy Vanden Broeck
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Emiel Vloorsstraat 9, 2020 Antwerp, Belgium; National Reference Centre for HPV, Juliette Wytsmanstraat 14, Brussels, 1050 Belgium; AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Universiteitsplein 1, Wilrijk (Antwerp), 2610 Belgium; International Centre for Reproductive Health, Ghent University, Corneel Heymanslaan 10, Ghent, 9000 Belgium
| | - Philippe De Sutter
- Department Gynaecology-Oncology, UZ Brussel - VUB, Laarbeeklaan 101, Jette (Brussels), 1090 Belgium
| | - Gilbert Donders
- Department of Obstetrics and Gynaecology of the General Regional Hospital Heilig Hart, Kliniekstraat 45, Tienen 3300 Belgium; Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 33, Tienen, 3300 Belgium; Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, Edegem, 2650 Belgium
| | - Jean Doyen
- Department Gynaecology-Obstetrics, University Hospital Liège, Avenue de L'Hôpital 1, Liège, 4000 Belgium
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, Edegem, 2650 Belgium; Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk (Antwerp) 2610, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynecology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000 Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Ghent, 9000 Belgium
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk (Antwerp), 2610 Belgium
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18
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Lamsisi M, Li G, Chauleur C, Ennaji MM, Bourlet T. The potential of urine for human papillomavirus-related cervical cancer prevention. Future Virol 2022. [DOI: 10.2217/fvl-2021-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cervical cancer is one of the most preventable cancers. The introduction of human papillomavirus (HPV) vaccines and the adaptation of regular screening programs are key actions that need to be generalized globally to achieve the goal of cervical cancer elimination. However, it is still challenging to achieve satisfactory coverage rate, and many women are reluctant to participate in gynecologic examination. In this article, we review the research on the application of HPV detection in urine samples for cervical cancer screening and vaccine monitoring, as well as discuss the technical challenges and new technological advancements in urine-based tests. HPV detection in urine is an excellent noninvasive alternative that is widely accepted by women, relatively affordable, and provides the potential to reach women without the necessity for clinical visits. Thus, it is an attractive tool for both cervical cancer screening and vaccine monitoring.
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Affiliation(s)
- Maryame Lamsisi
- Team of Virology, Oncology & Medical Biotechnologies, Laboratory of Virology, Microbiology, Quality, & Biotechnologies/ETB, Faculty of Science & Techniques Mohammedia, Hassan II University of Casablanca, 20650, Mohammedia, Morocco
| | - Guorong Li
- Department of Urology/Biology Pathology Lab, North Hospital, CHU Saint-Etienne, 42000, Saint Etienne, France
| | - Celine Chauleur
- Deparment of Gynecology & Obstetrics, North Hospital, CHU Saint-Etienne, 42000, Saint Etienne, France
| | - Moulay Mustapha Ennaji
- Team of Virology, Oncology & Medical Biotechnologies, Laboratory of Virology, Microbiology, Quality, & Biotechnologies/ETB, Faculty of Science & Techniques Mohammedia, Hassan II University of Casablanca, 20650, Mohammedia, Morocco
| | - Thomas Bourlet
- Department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42000, Saint Etienne, France
- Centre International de Recherche en Infectiologie, GIMAP Team 15, Inserm, U1111, CNRS, UMR5308, University of Saint-Etienne, University of Lyon, 42000, Saint Etienne, France
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19
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Musa J, Kim K, Zheng Y, Qu Y, Joyce BT, Wang J, Nannini DR, Gursel DB, Silas O, Abdulkareem FB, Imade G, Akanmu AS, Wei JJ, Kocherginsky M, Kim KYA, Wehbe F, Achenbach CJ, Anorlu R, Simon MA, Sagay A, Ogunsola FT, Murphy RL, Hou L. Accelerated Epigenetic Age Among Women with Invasive Cervical Cancer and HIV-Infection in Nigeria. Front Public Health 2022; 10:834800. [PMID: 35570901 PMCID: PMC9099239 DOI: 10.3389/fpubh.2022.834800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Invasive cervical cancer (ICC) is a serious public health burden in Nigeria, where human immunodeficiency virus (HIV) remains highly prevalent. Previous research suggested that epigenetic age acceleration (EAA) could play a role in detection of HIV-associated ICC. However, little research has been conducted on this topic in Africa where the population is most severely affected by HIV-associated ICC. Here, we investigated the association between ICC and EAA using cervical tissues of ICC-diagnosed Nigerian women living with HIV. Methods We included 116 cervical tissue samples from three groups of Nigerian women in this study: (1) HIV+/ICC+ (n = 39); (2) HIV+/ICC- (n = 53); and (3) HIV-/ICC + (n = 24). We utilized four DNA methylation-based EAA estimators; IEAA, EEAA, GrimAA, and PhenoAA. We compared EAA measurements across the 3 HIV/ICC groups using multiple linear regression models. We also compared EAA between 26 tumor tissues and their surrounding normal tissues using paired t-tests. We additionally performed a receiver operating characteristics (ROC) curve analysis to illustrate the area under the curve (AUC) of EAA in ICC. Results We found the most striking associations between HIV/ICC status and PhenoAge acceleration (PhenoAA). Among HIV-positive women, PhenoAA was on average 13.4 years higher in women with ICC compared to cancer-free women (P = 0.005). PhenoAA was 20.7 and 7.1 years higher in tumor tissues compared to surrounding normal tissues among HIV-positive women (P = 0.009) and HIV-negative women (P = 0.284), respectively. We did not find substantial differences in PhenoAA between HIV-positive and HIV-negative women with ICC. Conclusion PhenoAA is associated with ICC in HIV-infected women in our study. Our findings suggest that PhenoAA may serve as a potential biomarker for further risk stratification of HIV-associated ICC in Nigeria and similar resource-constrained settings.
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Affiliation(s)
- Jonah Musa
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Kyeezu Kim
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yinan Zheng
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yishu Qu
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Brian T. Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jun Wang
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Drew R. Nannini
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Demirkan B. Gursel
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | | | - Godwin Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Alani S. Akanmu
- Department of Hematology and Blood Transfusion, Lagos University Teaching Hospital and College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jian-Jun Wei
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Masha Kocherginsky
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Firas Wehbe
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Division of Health and Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Chad J. Achenbach
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Melissa A. Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Atiene Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Folasade T. Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Robert L. Murphy
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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20
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Schaafsma M, van den Helder R, Bleeker MC, Rosier-van Dunné F, van der Avoort IA, Steenbergen RD, van Trommel NE. Experiences and preferences towards collecting a urine and cervicovaginal self-sample among women attending a colposcopy clinic. Prev Med Rep 2022; 26:101749. [PMID: 35256928 PMCID: PMC8897716 DOI: 10.1016/j.pmedr.2022.101749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022] Open
Abstract
In a colposcopy referral population, the majority of women consider self-collection of a urine sample and a cervicovaginal self-sample acceptable and easy to collect in a home-based setting. Urine collection is worth investigating as a potential screening method to possibly improve attendance rates in cervical cancer screening.
The effectiveness of cervical cancer screening is hampered by low attendance rates. The collection of a urine sample is hypothesized to engage non-attenders in cervical cancer screening. The aim of this prospective cohort study was to evaluate experiences of women on urine collection and cervicovaginal self-sampling in a home-based setting and preferences for future cervical cancer screening. This study included 140 women, with a median age of 40 years, who were planned for a large loop excision of the transformation zone (LLETZ) procedure. All women collected a urine sample using conventional urine cups and a cervicovaginal self-sample prior to the LLETZ in a home-based setting. Following sample collection, women filled in a questionnaire. Results showed that the instructions of urine collection and cervicovaginal self-sampling were considered clear (95%, 95%CI: 88–98; 92%, 95%CI: 83–96, respectively). Women considered urine collection compared to cervicovaginal self-sampling to be more acceptable (p < 0.001), and to provide more reliable results (p < 0.001). The three highest reported preferred sampling methods for future cervical cancer screening were: urine collection (n = 39, 28%, 95%CI: 19–39), clinician-taken cervical scrape (n = 32, 23%, 95%CI: 15–34), and equal preference for urine collection, clinician-taken cervical scrape and cervicovaginal self-sampling (n = 30, 21%, 95%CI: 14–32). In conclusion, urine collection and cervicovaginal self-sampling are acceptable sampling methods, considered easy to collect in a home-based setting, and moreover, considered trustworthy. Although these results are promising, more research is required to determine if urine collection also lowers the barrier for non-attendees and, thereby, increases the attendance rates of cervical cancer screening.
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Affiliation(s)
- Mirte Schaafsma
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
- Amsterdam University Medical Centers, Department of Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Rianne van den Helder
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
- Amsterdam University Medical Centers, Department of Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Maaike C.G. Bleeker
- Amsterdam University Medical Centers, Department of Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Fleur Rosier-van Dunné
- Tergooi Medical Center, Department of Obstetrics and Gynecology, Blaricum, the Netherlands
| | | | - Renske D.M. Steenbergen
- Amsterdam University Medical Centers, Department of Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Corresponding author.
| | - Nienke E. van Trommel
- Antoni van Leeuwenhoek/Netherlands Cancer Institute, Department of Gynecologic Oncology, Center of Gynecologic Oncology Amsterdam, Amsterdam, the Netherlands
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21
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van den Helder R, Steenbergen RDM, van Splunter AP, Mom CH, Tjiong MY, Martin I, Rosier-van Dunné FMF, van der Avoort IAM, Bleeker MCG, van Trommel NE. HPV AND DNA METHYLATION TESTING IN URINE FOR CERVICAL INTRAEPITHELIAL NEOPLASIA AND CERVICAL CANCER DETECTION. Clin Cancer Res 2022; 28:2061-2068. [PMID: 35266975 DOI: 10.1158/1078-0432.ccr-21-3710] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/28/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Biomarker detection in urine offers a potential solution to increase effectiveness of cervical cancer screening programs by attracting non-responders. In this prospective study, the presence of high-risk human papillomavirus (hrHPV DNA) and the performance of DNA methylation analysis was determined for the detection of cervical cancer and high-grade cervical intraepithelial neoplasia (CIN2/3) in urine, and compared to paired cervicovaginal self-samples and clinician-taken cervical scrapes. METHODS A total of 587 samples were included from 113 women with cervical cancer, 92 women with CIN2/3, and 64 controls. Samples were tested for hrHPV DNA and five methylation markers. Univariate and multivariate logistic regression and leave-one-out cross-validation were used to determine the methylation marker performance for CIN3 and cervical cancer (CIN3+) detection in urine. Agreement between samples was determined using Cohen's kappa statistics and the Spearman correlation coefficients. RESULTS HrHPV presence was high in all sample types, 79% to 92%. Methylation levels of all markers in urine significantly increased with increasing severity of disease. The optimal marker panel (ASCL1/LHX8) resulted in an AUC of 0.84 for CIN3+ detection in urine, corresponding to an 86% sensitivity at a 70% predefined specificity. At this threshold 96%(109/113) of cervical cancers, 68%(46/64) of CIN3 and 58%(14/24) of CIN2 were detected. Between paired samples, a strong agreement for HPV16/18 genotyping and a fair to strong correlation for methylation was found. CONCLUSION HrHPV DNA and DNA methylation testing in urine offers a promising solution to detect cervical cancer and CIN2/3 lesions, especially for women currently unreached by conventional screening methods.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nienke E van Trommel
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
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22
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Shah SK, McElfish PA. A Review of Cancer Screening Recommendations during the COVID-19 Pandemic. JMIR Cancer 2022; 8:e34392. [PMID: 35142621 PMCID: PMC8914792 DOI: 10.2196/34392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cancer screening tests are recommended to prevent cancer-associated mortality by detecting precancerous and cancerous lesions in early stages. The COVID-19 pandemic disrupted the utilization of preventive health care services. While there was a rise in the number of cancer screening tests beginning in late 2020, screenings remained 29%-36% lower than in the pre-pandemic era. OBJECTIVE The objective of this review article was to assist health care providers in identifying approaches for prioritizing patients and increasing breast, cervical, and colorectal cancer screening during the uncertainty of the COVID-19 pandemic. METHODS We used the scoping review framework to identify articles on PubMed and EBSCO databases. A total of 403 articles were identified, and 23 articles were selected for this review. Literature review ranged from January 1st, 2020 to September 30th, 2021. RESULTS The articles included two primary categories of recommendations: (1) risk stratification and triage to prioritize screenings and (2) alternative methods to conduct cancer screenings. Risk stratification and triage recommendations focused on prioritizing high-risk patients with an abnormal or suspicious result on the previous screening test, of certain age group and sex, having personal medical or family history of cancers, currently symptomatic, predisposed to hereditary cancers, and cancer-causing mutations. Other recommended strategies included: identifying areas facing most disparities, creating algorithms and using artificial intelligence to create cancer-risk scores, leveraging in-person visits to assess cancer risk, and providing the option of open access screenings where patients can schedule screenings and can be assigned a priority category by health care staff. Some recommended using telemedicine to categorize patients and determine screening-eligibility for patients with new complaints. Several articles noted the importance of implementing preventive measures such as COVID-19 screening prior to the procedures, maintaining hygiene measures, and social distancing in waiting rooms. Alternative screening methods which do not require an in-person clinic visit and can effectively screen patients for cancers included mailing self-collection sampling kits for cervical and colorectal cancers and implementing or expanding mobile screening units. CONCLUSIONS Although the COVID-19 pandemic had devastating effects on population health globally, it could be an opportunity to adapt and evolve cancer screening methods. Disruption often creates innovation, and focus on alternative methods for cancer screenings may help reach rural and under-resourced areas after the pandemic has ended. CLINICALTRIAL
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Affiliation(s)
- Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, US
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, US
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23
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Targeted Next Generation Sequencing for Human Papillomavirus Genotyping in Cervical Liquid-Based Cytology Samples. Cancers (Basel) 2022; 14:cancers14030652. [PMID: 35158920 PMCID: PMC8833452 DOI: 10.3390/cancers14030652] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Testing for Human Papillomavirus (HPV) is currently being implemented as part of cervical cancer (CC) screening in several countries. However, infections with all but one of the HPV types classified as possibly carcinogenic cannot be detected by the assays used for CC screening today. The aim of our study was to demonstrate the use of a targeted next generation sequencing (NGS) HPV panel for CC screening—both general practitioner-collected samples and self-samples. We here show that the targeted HPV panel can detect HPV with a sensitivity and specificity similar to commercial HPV assays, one of which is used for CC screening today. However, the targeted HPV panel possess several advantages compared to the screening assays, as it enables specific detection of all relevant HPV types and can identify viral integration, variants in the HPV genome, and dominant HPV types in multi-infected cases. Abstract At present, human papillomavirus (HPV) testing is replacing morphology-based cytology as the primary tool for cervical cancer screening in several countries. However, the HPV assays approved for screening lack detection for all but one of the possibly carcinogenic HPV types and do not genotype all included HPV types. This study demonstrates the use of a targeted HPV next generation sequencing (NGS) panel to detect and genotype all 25 carcinogenic, probably carcinogenic, and possibly carcinogenic HPV types as well as the low-risk types HPV6 and HPV11. The panel was validated using a cohort of 93 paired liquid-based cytology samples (general practitioner (GP)-collected cervical samples and cervico-vaginal self-samples (SS)). Overall, the targeted panel had a sensitivity (GP = 97.7%, SS = 92.1%) and specificity (GP = 98.0%, SS = 96.4%) similar to the commercial HPV assays, Cobas® 4800 HPV DNA test (Roche) and CLART® HPV4S assay (GENOMICA). Interestingly, of the samples that tested positive with the NGS panel, three (6.4%) of the GP-collected samples and four (9.1%) of the self-samples tested positive exclusively for HPV types only included in the NGS panel. Thus, targeted HPV sequencing has great potential to improve the HPV screening programs since, as shown here, it can identify additional HPV positive cases, cases with HPV integration, variants in the HPV genome, and which HPV type is dominant in multi-infected cases.
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24
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Bober P, Firment P, Sabo J. Diagnostic Test Accuracy of First-Void Urine Human Papillomaviruses for Presence Cervical HPV in Women: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413314. [PMID: 34948919 PMCID: PMC8708158 DOI: 10.3390/ijerph182413314] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 01/07/2023]
Abstract
First-void urine usually contains exfoliated cells of the debris and mucus from the female genital organs and cervix, i.e., high concentration of human papillomavirus deoxyribonucleic acid (HPV DNA). We conducted a meta-analysis of published data and determined an accuracy of HPV detection in first-void urine compared to the women’s cervix. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we carried out a comprehensive literature search. Eligible articles published from 2011 until 2021 were gathered by searching Embase, PubMed and Cochrane Library Central databases. The patient selection, index test, standard test, and patient flow were the factors involved in quality evaluation. A meta-analysis of 15 studies (3412 women) based on 5054 potential records was conducted. Pooled sensitivity for high-risk HPV detection in urine of 78% (70–84%) and specificity of 89% (81–94%) were calculated. Any HPV detection in urine of 87% (74–94%) and 91% (83–96%) were pooled sensitivity and specificity, respectively. HPV 16 and 18 had a pooled sensitivity of 77% (76–77%) and specificity of 98% (98–98%). Meta-analysis indicated variations between the pooled specificities and sensitivities. In meta-regression analysis, a heterogeneity in accuracy by using covariates (bias in patient selection, purpose, sample timing, storage temperature and HPV detection method) were not detected. Our meta-analysis demonstrates the accuracy of detection of HPV in urine for the presence of cervical HPV. Although progress is continuously made in urinary HPV detection, further studies are needed to evaluate and to improve the accuracy of the first-void urine test in order to be comparable with other screening methods.
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Affiliation(s)
- Peter Bober
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P.J. Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia;
- Correspondence:
| | - Peter Firment
- Department of Anaesthesiology and Intensive Medicine, FNsP J. A. Reimana Prešov, Jána Hollého 5898/14, 08181 Prešov, Slovakia;
| | - Ján Sabo
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P.J. Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia;
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25
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Abstract
Gynecologic cancers contribute to a significant portion of cancer morbidity and mortality among women in the United States and across the globe. This article provides a comprehensive review of current screening guidelines and novel techniques that have promise in the prevention and early detection of gynecologic cancers in the future. The authors anticipate a move toward less invasive testing modalities, use of cancer biomarkers, and the prevention and treatment of high-risk factors such as human papilloma virus infection and obesity.
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26
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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27
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Bitarafan F, Hekmat MR, Khodaeian M, Razmara E, Ashrafganjoei T, Modares Gilani M, Mohit M, Aminimoghaddam S, Cheraghi F, Khalesi R, Rajabzadeh P, Sarmadi S, Garshasbi M. Prevalence and Genotype Distribution of Human Papillomavirus Infection among 12,076 Iranian Women. Int J Infect Dis 2021; 111:295-302. [PMID: 34343706 DOI: 10.1016/j.ijid.2021.07.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) infection is one of the major health concerns of women in developing countries. This study gives an insight into the prevalence and genotype distribution of HPV infection and compares it with Pap smear results among Iranian women. METHODS In this study, 12,076 Iranian women underwent routine examination from November 2016 to November 2018 using HPV Direct Flow CHIP System for HPV DNA typing. Cytology methods were also undertaken for 5,138 samples. RESULTS Overall HPV prevalence was calculated at 38.68%. The most frequent HPV types were HPV 6, 16, 11, 62/81, 52, and 54, respectively; and, the most high-risk HPV types were HPV 16, 52, 18, 39, 31, and 51. These two groups represent about half of all HPV types detected-47% and 55%, respectively. Among individuals who underwent cytological tests, 135 individuals (2.63%) were cytologically positive. In this group, 81 individuals (60%) were HPV positive as well, 62 (76%) of whom were HR-HPV positive and among them, the most frequent type was HPV 16 (34%). CONCLUSION This study highlights the urgent need for public education and also early diagnosis using HPV screening tests to prevent cervical cancer.
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Affiliation(s)
| | | | | | - Ehsan Razmara
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Teheran, Iran
| | | | | | - Mitra Mohit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | | | | | - Raziyeh Khalesi
- Department of Medical Genetics, DeNA Laboratory, Tehran, Iran
| | | | - Soheila Sarmadi
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Garshasbi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Teheran, Iran.
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Torres-Rojas FI, Mendoza-Catalán MA, Alarcón-Romero LDC, Parra-Rojas I, Paredes-Solís S, Leyva-Vázquez MA, Cortes-Arciniega JE, Bracamontes-Benítez CJ, Illades-Aguiar B. HPV molecular detection from urine versus cervical samples: an alternative for HPV screening in indigenous populations. PeerJ 2021; 9:e11564. [PMID: 34178456 PMCID: PMC8214846 DOI: 10.7717/peerj.11564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cervical cancer (CC) is the fourth leading cause of death from neoplasms in women and is caused by the human papilloma virus (HPV). Several methods have been developed for the screening of cervical lesions and HPV; however, some socio-cultural factors prevent women from undergoing gynecological inspection, which results in a higher risk of mortality from cervical cancer in certain population groups as indigenous communities. This study aimed to compare the concordance in HPV detection from urine and cervical samples, to propose an alternative to cervical scraping, which is commonly used in the cervical cancer screening. Methodology The DNA from cervical scrapings and urine samples was extracted using the proteinase K method followed by precipitation with alcohol, phenol andchloroform; a modification of the proteinase K method was developed in the management of urine sediment. Viral genotyping was performed using INNOLipa. Results The study population consisted of 108 patients from an indigenous population at southern Mexico, 32 without squamous intraepithelial lesions (NSIL) and 76 with low squamous intraepithelial lesions (LSIL). The majority of NSIL cervical scrapes were negative for HPV (90.63%), whereas more than half of LSIL cases were high-risk HPV positive (51.32%), followed by multiple infection by HR-HPV (17.11%), and multiple infection by LR- and HR-HPV (9.21%). No statistically significant relationship between the cytological diagnosis and the HPV genotypes detected in the urine samples was observed. A concordance of 68.27% for HPV positivity from urine and cervical samples was observed. Similarly, a concordance of 64.52% was observed in the grouping of HPVs by oncogenic risk. HR-HPV was detected in 71% of the urine samples from women with LSIL diagnosis, which suggests that HR-HPV detected in a urine sample could indicate the presence or risk of developing SIL. Conclusion HR-HPV detection in urine samples could be an initial approach for women at risk of developing LSIL and who, for cultural reasons, refuse to undergo a gynecological inspection.
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Affiliation(s)
- Francisco I Torres-Rojas
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Miguel A Mendoza-Catalán
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Luz Del C Alarcón-Romero
- Laboratorio de Citopatología e Histoquímica. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Isela Parra-Rojas
- Laboratorio de Investigación en Obesidad y Diabetes, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Marco A Leyva-Vázquez
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Jair E Cortes-Arciniega
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Carlos J Bracamontes-Benítez
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Berenice Illades-Aguiar
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
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29
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Clinical and analytical evaluation of the RealTime High Risk HPV assay in Colli-Pee collected first-void urine using the VALHUDES protocol. Gynecol Oncol 2021; 162:575-583. [PMID: 34172287 DOI: 10.1016/j.ygyno.2021.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Urine self-sampling has gained increasing interest for cervical cancer screening. In contrast to analytical performance, little information is available regarding the clinical accuracy for high-risk Human Papillomavirus (hrHPV) testing on urine. METHODS VALHUDES is a diagnostic test accuracy study comparing clinical accuracy to detect high-grade cervical precancer (CIN2+) of HPV testing on self-collected compared to clinician-collected samples (NCT03064087). Disease outcome was assessed by colposcopy and histology. The Abbott RealTime High Risk HPV assay performance was evaluated on Colli-Pee collected first-void urine with cervical outcomes as comparator. RESULTS As no assay cut-off for urine has been clinically validated, we used the predefined cut-off for cervical samples (CN ≤ 32). Using this cut-off, hrHPV testing was similarly sensitive (relative sensitivity 0.95; 95% CI: 0.88-1.01) and specific (relative specificity 1.03; 95% CI: 0.95-1.13) for detection of CIN2+ compared to testing cervical samples. In the subgroup of women of 30 years and older, similar relative sensitivity (0.97; 95% CI: 0.89-1.05) and specificity (1.02; 95% CI: 0.93-1.12) was found. Additionally, an exploratory cut-off (CN ≤ 33.86) was defined which further improved sensitivity and analytical test performance. CONCLUSION HrHPV-DNA based PCR testing on home-collected first-void urine has similar accuracy for detecting CIN2+ compared to cervical samples taken by a clinician.
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30
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Tarini EZ, Özardali Hİ. Immunohistochemical expression of progesterone receptor and C-erb-B2 in cervical squamous cell carcinoma and epithelial dysplasia. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2021. [DOI: 10.25083/2559.5555/6.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. We aimed to demonstrate whether the immunohistochemical expression of C-erb-B2 and progesterone receptors are valuable in the diagnosis of intraepithelial cervical neoplasia and squamous cell carcinoma. Methods and Results. Our retrospective study, a total of 84 cases diagnosed as squamous cell carcinoma and cervical intraepithelial neoplasia during 2005-2009, at the pathology department of Harran University, was investigated and stained with immunohistochemistry. Progesterone receptor was stained positive in 5 of 21 cervical intraepithelial neoplasia I. As a result of the statistical analysis (SPSS statistic 15.0), a significant correlation was found for positive progesterone receptors. No positive staining was seen in any of the cases with CerbB2 (p>0,05). Conclusions. In this study, it was concluded that positive progesterone receptors can be used to distinguish cases of cervical intraepithelial neoplasia I from other dysplasia and carcinoma, while Cerb-B2 has not been shown to be useful in distinguishing between these lesions.
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31
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Van Keer S, van Splunter AP, Pattyn J, De Smet A, Herzog SA, Van Ostade X, Tjalma WAA, Ieven M, Van Damme P, Steenbergen RDM, Vorsters A. Triage of human papillomavirus infected women by methylation analysis in first-void urine. Sci Rep 2021; 11:7862. [PMID: 33846517 PMCID: PMC8042010 DOI: 10.1038/s41598-021-87329-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/26/2021] [Indexed: 11/28/2022] Open
Abstract
Host cell DNA methylation analysis in urine provides promising triage markers for women diagnosed with a high-risk (HR) human papillomavirus (HPV) infection. In this study, we have investigated a panel of six host cell methylation markers (GHSR, SST, ZIC1, ASCL1, LHX8, ST6GALNAC5) in cervicovaginal secretions collected within the first part of the urine void (FVU) from a referral population. Cytology, histology, and HPV DNA genotyping results on paired FVU and cervical samples were available. Urinary median methylation levels from HR-HPV (n = 93) positive women were found to increase for all markers with severity of underlying disease. Significantly elevated levels were observed for GHSR and LHX8 in relation to high-grade cervical intraepithelial neoplasia (CIN2 +; n = 33), with area under de curve values of 0.80 (95% Confidence Interval (CI) 0.59–0.92) and 0.76 (95% CI 0.58–0.89), respectively. These findings are the first to support the assertion that methylation analysis of host cell genes is feasible in FVU and holds promise as molecular, triage strategy to discern low- from high-grade cervical disease in HR-HPV positive women. Molecular testing on FVU may serve to increase cervical cancer screening attendance in hard-to-reach populations whilst reducing loss to follow-up and await further optimization and validation studies.
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Affiliation(s)
- Severien Van Keer
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Annina P van Splunter
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jade Pattyn
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Annemie De Smet
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Sereina A Herzog
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Xaveer Van Ostade
- Laboratory of Proteinscience, Proteomics & Epigenetic Signalling (PPES), Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Wilrijkstraat 10, 2650, Edegem, Belgium.,Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology (LMM), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Renske D M Steenbergen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Building S2, Universiteitsplein 1, 2610, Wilrijk, Belgium
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Urine HPV in the Context of Genital and Cervical Cancer Screening-An Update of Current Literature. Cancers (Basel) 2021; 13:cancers13071640. [PMID: 33915878 PMCID: PMC8036396 DOI: 10.3390/cancers13071640] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Despite the substantial scientific evolution in cervical cancer prevention and related infrastructures, a plethora of women still miss the opportunity to detect their precancerous lesions at a curable stage by not participating in existing screening programs. Implementing sensitive screening modalities combined with easy sampling methods with minimal pain or discomfort such as self-sampling of vaginal and urine samples is increasingly applied. Self-sampling HPV modalities aimed to address this inequity, besides facilitating HPV genotyping as well as the measurement of related biomarkers in HPV-caused lesions and genital cancer. The low costs inflicted, the non-invasive nature, and the favorable acceptability profile of urine HPV detection give the potential to become a most promising tool that could expand the possibilities in changing genital and cervical cancer prevention strategies as well as in the surveillance and management of genital precancer. Abstract Within the previous decades, following the widespread implementation of HPV-related biomarkers and computerization in liquid-based cytology, screening for lower genital tract malignancies has been optimized in several parts of the world. Many organized anogenital cancer prevention systems have reached a point at which efficacy is more a matter of population coverage and less of available infrastructures. Meanwhile, self-sampling modalities in which biologic material (vaginal secretions, urine, etc.) is obtained by the individual and not the clinician and subsequently undergoes examination for HPV biomarkers enjoy appreciating acceptance. Bygone the initial skepticism that vaginal or urine HPV represents “passenger” transient infections, extensive scientific work has been conducted to optimize high-risk HPV (hrHPV) detection from this “novel” biologic material. Nowadays, several state-of-the-art meta-analyses have illustrated that self-sampling techniques involving urine self-sampling represent a feasible alternative strategy with potentially enhanced population coverage possessing excellent performance and sensitivity. Recently published scientific work focusing on urine HPV was reviewed, and after a critical appraisal, the following points should be considered in the clinical application of hrHPV urine measurements; (i) use of first-void urine (FVU) and purpose-designed collection devices; (ii) using a preservation medium to avoid human/HPV DNA degradation during extraction and storage; (iii) using polymerase chain reaction (PCR) based assays, ideally with genotyping capabilities; (iv) processing of a sufficient volume of whole urine; and (v) the use of an analytically sensitive HPV test/recovery of cell-free HPV DNA in addition to cell-associated DNA.
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