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Fujita M, Nagashima K, Shimazu M, Suzuki M, Tauchi I, Sakuma M, Yamamoto S, Hanaoka H, Shozu M, Tsuruoka N, Kasai T, Hata A. Effectiveness of self-sampling human papillomavirus test on precancer detection and screening uptake in Japan: The ACCESS randomized controlled trial. Int J Cancer 2024; 155:905-915. [PMID: 38648390 DOI: 10.1002/ijc.34970] [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: 02/06/2024] [Revised: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
Japan is lagging in cervical cancer prevention. The effectiveness of a self-sampling human papillomavirus (HPV) test, a possible measure to overcome this situation, has not yet been evaluated. A randomized controlled trial was performed to evaluate the effectiveness of a self-sampling HPV test on detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and screening uptake. Women between 30 and 58 years old who did not participate in the cervical cancer screening program for ≥3 years were eligible and assigned to the intervention group (cytology or self-sampling HPV test) or control group (cytology). Participants assigned to the intervention group were sent a self-sampling kit according to their ordering (opt-in strategy). A total of 7337 and 7772 women were assigned to the intervention and control groups, respectively. Screening uptake in the intervention group was significantly higher than that in the control group (20.0% vs. 6.4%; risk ratio: 3.10; 95% confidence interval [CI]: 2.82, 3.42). The compliance rate with cytology triage for HPV-positive women was 46.8% (95% CI: 35.5%, 58.4%). CIN2+ was detected in five and four participants in the intervention and control groups, respectively; there was no difference for intention-to-screen analysis (risk ratio: 1.32; 95% CI: 0.36, 4.93). Self-sampling of HPV test increased screening uptake; however, no difference was observed in the detection of CIN2+, probably due to the low compliance rate for cytology triage in HPV-positive women. Efforts to increase cytology triage are essential to maximize precancer detections.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Japan
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tachikawa, Japan
| | - Minobu Shimazu
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | | | | | | | | | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Makio Shozu
- Evolution and Reproduction Biology, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
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Hon HJ, Chong PP, Choo HL, Khine PP. A Comprehensive Review of Cervical Cancer Screening Devices: The Pros and the Cons. Asian Pac J Cancer Prev 2023; 24:2207-2215. [PMID: 37505749 PMCID: PMC10676510 DOI: 10.31557/apjcp.2023.24.7.2207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE The low screening coverage and reluctance of women in participation lead to low uptake in cervical screening tests. Hence the majority of cervical cancer patients visiting the hospitals are diagnosed at advanced stage, often leading to poor survival rate. This paper aims to review and compile available cancer screening devices so that more people in this field will adopt suitable devices in cervical cancer screening routine depending on requirements which may encourage the uptake in cervical screening tests. METHODS This paper reviews devices invented for different cervical cancer screening methods, which are Pap smear test, visual inspection with acetic acid (VIA) or Lugol's iodine (VILI), and HPV (human papillomavirus)-DNA (deoxyribonucleic acid) self-test in terms of functionality, performance in solving the limitations of screening procedure and additionally where applicable, the cervical cell collection efficacy and abnormality detection accuracy. The devices are either available in the market, published in research articles or published in international patent databases. RESULT The reviewed devices either simplified the screening procedure to improve the clinical efficiency and accuracy in screening, reduced the pain and discomfort experienced by women during screening procedures, or achieved both outcomes. CONCLUSION Many devices have been invented to improve the screening procedures which may potentially improve the uptake in cervical screening tests and encourage the organization of screening campaigns to reduce cervical cancer incidence.
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Affiliation(s)
- Hui Juen Hon
- School of Engineering, Faculty of Innovation & Technology, Taylor’s University, 1, Jalan Taylors, Subang Jaya, 47500, Selangor, Malaysia.
| | - Pei Pei Chong
- School of Biosciences, Faculty of Health & Medical Sciences, Taylor’s University, 1, Jalan Taylors, Subang Jaya, 47500, Selangor, Malaysia.
- Digital Health and Innovations Impact Lab, Taylor’s University, 1, Jalan Taylors, Subang Jaya, 47500, Selangor, Malaysia.
| | - Hui Leng Choo
- School of Engineering, Faculty of Innovation & Technology, Taylor’s University, 1, Jalan Taylors, Subang Jaya, 47500, Selangor, Malaysia.
- Additive Manufacturing Cluster, Center for Smart Society 5.0, Taylor’s University, 1, Jalan Taylors, Subang Jaya, 47500, Selangor, Malaysia.
| | - Pwint Phyu Khine
- School of Medicine, Faculty of Health & Medical Sciences, Taylor’s University, 1, Jalan Taylors, Subang Jaya, 47500, Selangor, Malaysia.
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Rebolj M, Sargent A, Njor SH, Cuschieri K. Widening the offer of human papillomavirus self-sampling to all women eligible for cervical screening: Make haste slowly. Int J Cancer 2023; 153:8-19. [PMID: 36385698 PMCID: PMC10952475 DOI: 10.1002/ijc.34358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/20/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
Self-collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among underscreened women and will likely form a crucial part of the WHO's strategy to eliminate cervical cancer by 2030. In high-income countries with long-standing, organised cervical screening programmes, self-collection is increasingly becoming available as a routine offer for women regardless of their screening histories, including under- and well-screened women. For these contexts, a validated microsimulation model determined that adding self-collection to clinician collection is likely to be cost-effective on the condition that it meets specific thresholds relating to (1) uptake and (2) sensitivity for the detection of high-grade cervical intraepithelial neoplasia (CIN2+). We used these thresholds to review the 'early-adopter' programme-level evidence with a mind to determine how well and how consistently they were being met. The available evidence suggested some risk to overall programme performance in the situation where low uptake among underscreened women was accompanied by a high rate of substituting clinician sampling with self-collection among well-screened women. Risk was further compounded in a situation where the slightly reduced sensitivity of self-sampling vs clinician sampling for the detection of CIN2+ was accompanied with lack of adherence to a follow-up triage test that required a clinician sample. To support real-world programmes on their pathways toward implementation and to avoid HPV self-collection being introduced as a screening measure in good faith but with counterproductive consequences, we conclude by identifying a range of mitigations and areas worthy of research prioritisation.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Alexandra Sargent
- Cytology Department, Manchester Royal InfirmaryManchester University NHS Foundation TrustManchesterUK
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Department of Public Health ProgrammesRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian ScotlandEdinburghUK
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4
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Fujita M, Nagashima K, Shimazu M, Suzuki M, Tauchi I, Sakuma M, Yamamoto S, Hanaoka H, Shozu M, Tsuruoka N, Kasai T, Hata A. Acceptability of self-sampling human papillomavirus test for cervical cancer screening in Japan: A questionnaire survey in the ACCESS trial. PLoS One 2023; 18:e0286909. [PMID: 37289798 PMCID: PMC10249862 DOI: 10.1371/journal.pone.0286909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE In terms of medical policy for cervical cancer prevention, Japan lags far behind other industrialized countries. We initiated a randomized controlled trial to evaluate the self-sampling human papillomavirus (HPV) test as a tool to raise screening uptake and detection of pre-cancer. This study was conducted to explore the acceptability and preference of self-sampling using a subset of the data from this trial. METHODS A pre-invitation letter was sent to eligible women, aged 30-59 years who had not undergone cervical cancer screening for three or more years. After excluding those who declined to participate in this trial, the remaining women were assigned to the self-sampling and control groups. A second invitation letter was sent to the former group, and those wanting to undergo the self-sampling test ordered the kit. A self-sampling HPV kit, consent form, and a self-administered questionnaire were sent to participants who ordered the test. RESULTS Of the 7,340 participants in the self-sampling group, 1,196 (16.3%) administered the test, and 1,192 (99.7%) answered the questionnaire. Acceptability of the test was favorable; 75.3-81.3% of participants agreed with positive impressions (easy, convenient, and clarity of instruction), and 65.1-77.8% disagreed with negative impressions (painful, uncomfortable, and embarrassing). However, only 21.2% were confident in their sampling procedure. Willingness to undergo screening with a self-collected sample was significantly higher than that with a doctor-collected sample (89.3% vs. 49.1%; p<0.001). Willingness to undergo screening with a doctor-collected sample was inversely associated with age and duration without screening (both p<0.001), but that with a self-collected sample was not associated. CONCLUSIONS Among women who used the self-sampling HPV test, high acceptability was confirmed, while concerns about self-sampling procedures remained. Screening with a self-collected sample was preferred over a doctor-collected sample and the former might alleviate disparities in screening rates.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tachikawa, Tokyo, Japan
| | - Minobu Shimazu
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Misae Suzuki
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Chiba, Japan
| | - Ichiro Tauchi
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Chiba, Japan
| | - Miwa Sakuma
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Chiba, Japan
| | - Setsuko Yamamoto
- Municipal Health Center, Department of Health and Welfare, Ichihara City, Ichihara, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Makio Shozu
- Departments of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
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5
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Di Gennaro G, Licata F, Trovato A, Bianco A. Does self-sampling for human papilloma virus testing have the potential to increase cervical cancer screening? An updated meta-analysis of observational studies and randomized clinical trials. Front Public Health 2022; 10:1003461. [PMID: 36568753 PMCID: PMC9773849 DOI: 10.3389/fpubh.2022.1003461] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives A meta-analysis was conducted to examine the effectiveness of HPV self-sampling proposal on cervical cancer screening (CCS) uptake when compared with an invitation to have a clinician to collect the sample. Secondary outcomes were acceptability and preference of self-sampling compared to clinician-collected samples. Methods The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining the CCS uptake comparing self-sampling over invitation to be sampled by an healthcare professional and examining the proportion of women accepting or preferring self-sampling vs. clinician-collected sampling were included. The CCS uptake was also explored according to strategy of self-samplers' distribution, collection device type and screening status. Peters' test and Funnel Plot inspection were used to assess the publication bias. Quality of the studies was assessed through Cochrane Risk of Bias and NIH Quality Assessment tools. Results One hundred fifty-four studies were globally identified, and 482,271 women were involved. Self-sampling procedures nearly doubled the probability (RR: 1.8; 95% CI: 1.7-2.0) of CCS uptake when compared with clinician-collected samples. The opt-out (RR: 2.1; 95% CI: 1.9-2.4) and the door-to-door (RR: 1.8; 95% CI: 1.6-2.0) did not statistically significant differ (p = 1.177) in improving the CCS uptake. A higher relative uptake was shown for brushes (RR: 1.6; 95% CI: 1.5-1.7) and swabs (RR: 2.5; 95% CI: 1.9-3.1) over clinician-collected samples. A high between-studies variability in characteristics of sampled women was shown. In all meta-analyses the level of heterogeneity was consistently high (I 2 > 95%). Publication bias was unlikely. Conclusions Self-sampling has the potential to increase participation of under-screened women in the CCS, in addition to the standard invitation to have a clinician to collect the sample. For small communities door-to-door distribution could be preferred to distribute the self-sampler while; for large communities opt-out strategies should be preferred over opt-in. Since no significant difference in acceptability and preference of device type was demonstrated among women, and swabs and brushes exhibited a potential stronger effect in improving CCS, these devices could be adopted.
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Affiliation(s)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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6
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Implementation of a self-sampling HPV test for non-responders to cervical cancer screening in Japan: secondary analysis of the ACCESS trial. Sci Rep 2022; 12:14531. [PMID: 36008554 PMCID: PMC9411156 DOI: 10.1038/s41598-022-18800-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
A self-sampling human papillomavirus (HPV) test could improve the morbidity and mortality of cervical cancer in Japan. However, its effectiveness and feasibility have not been demonstrated sufficiently. Hence, we launched a randomized controlled trial, which is ongoing, and report the results of a secondary analysis. To ensure autonomous participation with a minimum selection bias, opt-out consent was obtained from women who met the inclusion criteria, and written consent was obtained from those who underwent a self-sampling test. The number of women who met the inclusion criteria was 20,555; 4283 and 1138 opted out before and after the assignment, respectively. Of the 7340 women in the self-sampling arm, 1372 (18.7%) ordered and 1196 (16.3%) underwent the test. Younger women in their 30 s and 40 s tended to undertake the test more frequently than older women in their 50 s (P for trend < 0.001). Invalid HPV test results were rare (1.3%), and neither adverse events nor serious complaints were reported. Despite adopting the opt-out procedure, more women than expected declined to participate, suggesting the need for a waiver of consent or assignment before consent to reduce selection bias. A self-sampling HPV test can be implemented in Japan and would be more accessible to young women, the predominant group affected by cervical cancer.
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7
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Avian A, Clemente N, Mauro E, Isidoro E, Di Napoli M, Dudine S, Del Fabro A, Morini S, Perin T, Giudici F, Cammisuli T, Foschi N, Mocenigo M, Montrone M, Modena C, Polenghi M, Puzzi L, Tomaic V, Valenti G, Sola R, Zanolla S, Vogrig E, Riva E, Angeletti S, Ciccozzi M, Castriciano S, Pachetti M, Petti M, Centonze S, Gerin D, Banks L, Marini B, Canzonieri V, Sopracordevole F, Zanconati F, Ippodrino R. Clinical validation of full HR-HPV genotyping HPV Selfy assay according to the international guidelines for HPV test requirements for cervical cancer screening on clinician-collected and self-collected samples. J Transl Med 2022; 20:231. [PMID: 35581584 PMCID: PMC9115952 DOI: 10.1186/s12967-022-03383-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/07/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND According to international guidelines, Human Papillomavirus (HPV) DNA tests represent a valid alternative to Pap Test for primary cervical cancer screening, provided that they guarantee balanced clinical sensitivity and specificity for cervical intraepithelial neoplasia grade 2 or more (CIN2+) lesions. The study aimed to assess whether HPV Selfy (Ulisse BioMed - Trieste, Italy), a full-genotyping HPV DNA test that detects and differentiates 14 high-risk HPV (HR-HPV) types, meets the criteria for primary cervical cancer screening described in the international guidelines, on clinician-collected as well as on self-collected samples. METHODS For each participant woman, consecutively referring to Azienda Sanitaria Universitaria Giuliano Isontina (Trieste, Italy) and CRO-National Cancer Institute (Aviano, Italy) for the cervical cancer screening program, the following samples were tested: (a) a clinician-collected cervical specimen, analyzed with the reference test (Hybrid Capture®2 test, HC2) and HPV Selfy; and (b) a self-collected vaginal sample, analyzed with HPV Selfy. Enrolled women were also asked to fulfill a questionnaire about self-sampling acceptability. As required by guidelines, a non-inferiority test was conducted to compare the clinical performance of the test under evaluation with its reference test. RESULTS HPV Selfy clinical sensitivity and specificity resulted non-inferior to those of HC2. By analysis of a total of 889 cervical liquid-based cytology samples from a screening population, of which 98 were from women with CIN2+, HPV Selfy showed relative sensitivity and specificity for CIN2+ of 0.98 and 1.00 respectively (non-inferiority score test: P = 0.01747 and P = 0.00414, respectively); the test reached adequate intra- and inter-laboratory reproducibility. Moreover, we demonstrated that the performance of HPV Selfy on self-collected vaginal samples was non-inferior to the performance obtained on clinician-collected cervical specimen (0.92 relative sensitivity and 0.97 relative specificity). Finally, through HPV Selfy genotyping, we were able to describe HPV types prevalence in the study population. CONCLUSIONS HPV Selfy fulfills all the requirements of the international Meijer's guidelines and has been clinically validated for primary cervical cancer screening purposes. Moreover, HPV Selfy has also been validated for self-sampling according to VALHUDES guidelines. Therefore, at date, HPV Selfy is the only full-genotyping test validated both for screening purposes and for self-sampling. Trial registration ASUGI Trieste n. 16008/2018; CRO Aviano n.17149/2018.
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Affiliation(s)
- Alice Avian
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy ,grid.438882.d0000 0001 0212 6916Molecular Genetics and Biotechnology PhD Study Programme, University of Nova Gorica, Nova Gorica, Slovenia
| | - Nicolò Clemente
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Elisabetta Mauro
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Erica Isidoro
- grid.413694.dAzienda Sanitaria Universitaria Giuliano Isontina UCO/SC Anatomia e Istologia Patologica, Cattinara Hospital, Trieste, Italy
| | - Michela Di Napoli
- grid.413694.dAzienda Sanitaria Universitaria Giuliano Isontina UCO/SC Anatomia e Istologia Patologica, Cattinara Hospital, Trieste, Italy
| | - Sandra Dudine
- grid.413694.dAzienda Sanitaria Universitaria Giuliano Isontina UCO/SC Anatomia e Istologia Patologica, Cattinara Hospital, Trieste, Italy
| | - Anna Del Fabro
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Stefano Morini
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Tiziana Perin
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Fabiola Giudici
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Tamara Cammisuli
- grid.418321.d0000 0004 1757 9741Anatomia Patologica, IRCCS – CRO (Istituto Nazionale Tumori - National Cancer Institute), Aviano, Italy
| | - Nicola Foschi
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Marco Mocenigo
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy ,grid.438882.d0000 0001 0212 6916Molecular Genetics and Biotechnology PhD Study Programme, University of Nova Gorica, Nova Gorica, Slovenia
| | - Michele Montrone
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Chiara Modena
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Martina Polenghi
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Luca Puzzi
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Vjekoslav Tomaic
- grid.4905.80000 0004 0635 7705Institut Ruđer Bošković, Zagreb, Croatia
| | - Giulio Valenti
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Riccardo Sola
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Shivani Zanolla
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Enea Vogrig
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Elisabetta Riva
- grid.488514.40000000417684285Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Silvia Angeletti
- grid.488514.40000000417684285Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Massimo Ciccozzi
- grid.488514.40000000417684285Policlinico Universitario Campus Biomedico, Rome, Italy
| | | | - Maria Pachetti
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy ,grid.418712.90000 0004 1760 7415Institute of Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Matteo Petti
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Sandro Centonze
- Clinical Research Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Daniela Gerin
- Cervical Cancer Screening Coordination Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Lawrence Banks
- grid.425196.d0000 0004 1759 4810International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Bruna Marini
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
| | - Vincenzo Canzonieri
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy ,grid.418321.d0000 0004 1757 9741Anatomia Patologica, IRCCS – CRO (Istituto Nazionale Tumori - National Cancer Institute), Aviano, Italy
| | - Francesco Sopracordevole
- grid.418321.d0000 0004 1757 9741Ginecologia Oncologica, IRCCS - Centro Di Riferimento Oncologico (CRO) (Istituto Nazionale Tumori – National Cancer Institute), Aviano, Italy
| | - Fabrizio Zanconati
- grid.413694.dAzienda Sanitaria Universitaria Giuliano Isontina UCO/SC Anatomia e Istologia Patologica, Cattinara Hospital, Trieste, Italy ,grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Rudy Ippodrino
- Ulisse BioMed S.P.a, Area Science Park, SS 14, km 163.5, Trieste, Italy
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8
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Veerus P, Hallik R, Jänes J, Jõers K, Paapsi K, Laidra K, Innos K. Human papillomavirus self-sampling for long-term non-attenders in cervical cancer screening: A randomised feasibility study in Estonia. J Med Screen 2021; 29:53-60. [PMID: 34694179 DOI: 10.1177/09691413211052499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Organised cervical cancer screening was started in Estonia in 2006, but participation is still low. Human papillomavirus (HPV) self-sampling has proved to increase screening uptake. This study addressed the feasibility of HPV self-sampling and the acceptance of this method among long-term screening non-attenders. METHODS A randomised intervention study was conducted in Estonia in 2020. Women born in 1958-1983 without a Pap smear in 2013-2019 were identified in the Estonian Health Insurance Fund database. From them, 12,000 women were randomly allocated to three equal-sized study groups. The opt-out group received a questionnaire and a Qvintip® sampling device by regular mail. Two opt-in groups received a questionnaire and an e-mail invitation to order a self-sampler online; one received Qvintip and the other Evalyn® Brush. Participantś background characteristics were obtained from the Population Register. The effect of covariates on participation rate was estimated with multivariate Poisson regression. Acceptance of self-sampling was analysed according to agreement with statements in the questionnaire. RESULTS The overall participation rate was 16% with significant differences between opt-out (26%) and opt-in (11%) groups. Compared to the opt-out Qvintip group, adjusted relative risks for the Qvintip and Evalyn Brush opt-in groups were 0.41 (95% confidence interval (CI) 0.37-0.45) and 0.44 (95% CI 0.40-0.49), respectively. Participation was associated with living place, citizenship, and education. Self-sampling was well accepted: 98% agreed that it was easy to use, 88% preferred it as a screening method in future. CONCLUSIONS The results show the feasibility and good acceptance of HPV self-sampling among long-term screening non-attenders in Estonia.
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Affiliation(s)
- Piret Veerus
- Department of Epidemiology and Biostatistics, 241808National Institute for Health Development, Tallinn, Estonia
| | - Reeli Hallik
- Department of Epidemiology and Biostatistics, 241808National Institute for Health Development, Tallinn, Estonia
| | - Jaak Jänes
- Department of Epidemiology and Biostatistics, 241808National Institute for Health Development, Tallinn, Estonia
| | - Kai Jõers
- 37544Tartu University Hospital United Laboratories, Tartu, Estonia
| | - Keiu Paapsi
- Department of Epidemiology and Biostatistics, 241808National Institute for Health Development, Tallinn, Estonia
| | - Kaia Laidra
- Department of Epidemiology and Biostatistics, 241808National Institute for Health Development, Tallinn, Estonia
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, 241808National Institute for Health Development, Tallinn, Estonia
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9
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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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10
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Tesfahunei HA, Ghebreyesus MS, Assefa DG, Zeleke ED, Acam J, Joseph M, Getachew E, Kajogoo VD, Bekele D, Manyazewal T. Human papillomavirus self-sampling versus standard clinician-sampling for cervical cancer screening in sub-Saharan Africa: a systematic review and meta-analysis of randomized controlled trials. Infect Agent Cancer 2021; 16:43. [PMID: 34147103 PMCID: PMC8214270 DOI: 10.1186/s13027-021-00380-5] [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: 02/18/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection remains a major health threat in sub-Saharan Africa (SSA). HPV self-sampling could help find and treat cervical cancer at an early stage. We aimed to evaluate the effectiveness of HPV self-sampling over the standard health facility-based clinician-sampling for cervical cancer screening through a systematic review and meta-analysis of available randomized controlled trials. METHOD We searched PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrial.gov, and the WHO Global Health Library for articles in SSA published as of 31 May 2020. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines for the design and reporting of the results. We included randomized control trials that compared HPV self-sampling with the standard of care. The primary endpoint was uptake of cervical cancer screening service. The secondary endpoints were linkage to care, acceptability, screening frequency, and adverse events. We used RevMan V.5.3 software for statistical analysis. We computed random-effect model to provide pooled estimates of available data and I-squared (I2) test to assess heterogeneity. RESULT Of 77 citations, we included four trials from Nigeria, Ethiopia, Kenya, and Uganda, encompassing 8200 participants with age ranging from 25 to 65 years. The pooled analysis showed significantly higher uptake of cervical cancer screening in women who used HPV self-sampling (risk ratio [RR] 1.72, 95% CI 1.58-1.87; p = 0.01), while this had a considerable heterogeneity as explained by subgroup analysis. Uptake was higher in women who were offered sampling kit at home or work (RR 2.05, 95% CI 1.80-2.33) and those who's kit was mailed to or invited to a nearby health center (RR 1.65, 95% CI 1.58-1.72, I2 = 0%) than those screened with the standard of care. There was no difference between the two groups in the rate of linkage to care of positive cases (RR 1.30, 95% CI 0.90-2.74, I2 = 91%). HPV self-sampling was acceptable and easy to use. None of the trials compared the frequency of screening or adverse events. CONCLUSION HPV self-sampling is an effective and feasible alternative to the standard health facility-based clinician-sampling for cervical cancer screening in SSA. It could improve the uptake of cervical cancer screening and harness the global strategy towards elimination of cervical cancer by 2030.
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Affiliation(s)
- Hanna Amanuel Tesfahunei
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Hager Biomedical Research Institute, Asmara, Eritrea
| | | | - Dawit Getachew Assefa
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Nursing, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Eden Dagnachew Zeleke
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Midwifery, College of Health Science, Bule-Hora University, Bule-Hora, Ethiopia
| | - Joan Acam
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Pope John’s Hospital Aber, Oyam District, Uganda
| | - Michele Joseph
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
| | - Emnet Getachew
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Arsi University, Asella, Ethiopia
| | - Violet Dismas Kajogoo
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Mafia District Hospital, Mafia Island, Tanzania
| | - Delayehu Bekele
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), P.O. Box 9086, Addis Ababa, Ethiopia
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11
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Cervical screening in high-income countries: the need for quality assurance, adjunct biomarkers and rational adaptation to HPV vaccination. Prev Med 2021; 144:106382. [PMID: 33359012 DOI: 10.1016/j.ypmed.2020.106382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
We here discuss human papillomavirus (HPV)-based screening avenues to achieve elimination of cervical cancer as a public health problem in high-income country (HIC) settings, covering both the most recent data on the performance of HPV testing, as well as the currently most robust triage methods that are known. We also provide an outlook to several other promising, yet not fully established, options for triage that have been proposed, including methylation, dual staining, machine learning, and artificial intelligence. Finally, we discuss the key issue of how to adapt screening in the presence of programmatic HPV vaccination, and how this combination can best be leveraged for comprehensive cancer control. We conclude that, for the HIC setting, evidence-based and effective cervical screening methods are readily available, but whichever method or platform is chosen, we would propose that recurring audits of performance and population attendance remain common denominators for maintaining successful disease prevention.
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12
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Foo YM, Goswami P, Grogin J, Hargan E, Thangarajah M, Dutton T, Mendel S, Bailey J. Incorporation of human papillomavirus self-sampling into the revised National Cervical Screening Program: a qualitative study of GP experiences and attitudes in rural New South Wales. Aust J Prim Health 2021; 27:284-290. [PMID: 33985644 DOI: 10.1071/py20209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/15/2021] [Indexed: 11/23/2022]
Abstract
Human papillomavirus self-sampling is part of the revised Australian National Cervical Screening Program for eligible under- or never-screened women. Although research demonstrates self-sampling as an acceptable method from the perspective of women, little is known about GP experiences and perspectives of this new screening alternative. This study sought to explore the experiences and perspectives of rural GPs towards the revised National Cervical Screening Program and the new self-sampling option. Semistructured qualitative interviews were completed with 12 GPs in central west New South Wales. The study found that GPs had limited experience facilitating self-sampling. The limited provision of education, difficulty accessing testing kits, poor availability of accredited laboratories and unclear rebate guidelines hindered their capacity to offer self-sampling. GPs reported uncertainty around patient eligibility and the quality of self-collected samples. GPs explained that self-sampling could increase cervical screening participation among some women, but because it is only available to complete in a general practice, it would not benefit those who are disengaged from health services. Despite GPs' limited experience with facilitating self-sampling to date, they were optimistic about potential increases in cervical screening rates. Clearer articulation of specific program details and the evidence underpinning the program changes would reduce clinician uncertainty regarding the practicalities of how to incorporate patient-collected sampling into their daily practice, as well as the quality of patient-collected samples compared with clinician-collected samples. GPs must also be supported at a systems level to ensure there are processes in place to enable easy access to kits, laboratories, Medicare rebates and relevant support.
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Affiliation(s)
- Yun Megan Foo
- Bathurst Rural Clinical School, Western Sydney University, PO Box 9008, Bathurst, NSW 2795, Australia
| | - Pragya Goswami
- Bathurst Rural Clinical School, Western Sydney University, PO Box 9008, Bathurst, NSW 2795, Australia
| | - James Grogin
- Bathurst Rural Clinical School, Western Sydney University, PO Box 9008, Bathurst, NSW 2795, Australia
| | - Elizabeth Hargan
- Bathurst Rural Clinical School, Western Sydney University, PO Box 9008, Bathurst, NSW 2795, Australia
| | - Meera Thangarajah
- Bathurst Rural Clinical School, Western Sydney University, PO Box 9008, Bathurst, NSW 2795, Australia
| | - Tegan Dutton
- Bathurst Rural Clinical School, Western Sydney University, PO Box 9008, Bathurst, NSW 2795, Australia; and Corresponding author.
| | - Sandra Mendel
- Bathurst Rural Clinical School, Western Sydney University, PO Box 9008, Bathurst, NSW 2795, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, Western Sydney University, PO Box 9008, Bathurst, NSW 2795, Australia
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13
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Shin HY, Lee B, Hwang SH, Lee DO, Sung NY, Park JY, Jun JK. Evaluation of satisfaction with three different cervical cancer screening modalities: clinician-collected Pap test vs. HPV test by self-sampling vs. HPV test by urine sampling. J Gynecol Oncol 2020; 30:e76. [PMID: 31328458 PMCID: PMC6658592 DOI: 10.3802/jgo.2019.30.e76] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/23/2019] [Accepted: 03/05/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Human papillomavirus testing by self-sampling and urine sampling might be alternatives to Papanicolaou test (Pap test) for cervical cancer screening (CCS), and may increase compliance and adherence thereto. The present study aimed to explore satisfaction and preferences for cervical screening modalities among Korean women. METHODS In total, 732 women aged between 20 and 69 years responded to a questionnaire designed to survey the women's perceived satisfaction for the 3 CCS modalities: clinician-collected Pap test, self-collected vaginal sampling (self-sampling) and urine sampling. RESULTS Overall satisfaction was significantly higher with both the self-sampling and urine sampling than the clinician-collected Pap test (odds ratio [OR]=2.01; 95% confidence interval [CI]=1.48-3.00 and OR=2.47; 95% CI=1.75-3.48, respectively). Psychological distress, including embarrassment, pain, anxiety, discomfort, and stress, with self-sampling and urine sampling were significantly lower than that with the Pap test. 52% of participants reported preferences for self-sampling in the next screening round. CONCLUSIONS Korean women were more likely to report satisfaction with alternative modalities (self-sampling and urine sampling) for CCS in comparison to the Pap test. This suggests that self-collected modalities may help with improving CCS uptake rates by eliminating burden related with the Pap test. However, further studies for test accuracy and cost-effective analysis of the alternative modalities should be conducted in order to apply CCS.
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Affiliation(s)
- Hye Young Shin
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Bomyee Lee
- Department of Medical Education and Medical Humanities, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sang Hyun Hwang
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Ock Lee
- Center for Uterine Cancer, National Cancer Center Hospital, National Cancer Center, Goyang, Korea
| | - Na Young Sung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Young Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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14
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Reiter PL, Shoben AB, McDonough D, Ruffin MT, Steinau M, Unger ER, Paskett ED, Katz ML. Results of a Pilot Study of a Mail-Based Human Papillomavirus Self-Testing Program for Underscreened Women From Appalachian Ohio. Sex Transm Dis 2020; 46:185-190. [PMID: 30461597 DOI: 10.1097/olq.0000000000000944] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) self-testing is an emerging cervical cancer screening strategy, yet few mail-based HPV self-testing programs have been implemented in the United States. We report the results of a pilot study of a mail-based program, the Health Outcomes through Motivation and Education Project. METHODS In 2015 to 2016, we recruited 103 women from Appalachian Ohio who were aged 30 to 65 years and had not received a Papanicolaou (Pap) test in at least 3 years. Women were mailed an HPV self-test and randomized to receive either (a) self-test instructions developed by the device manufacturer and a standard information brochure about cervical cancer (control group) or (b) self-test instructions developed by the Health Outcomes through Motivation and Education Project and a photo story information brochure about cervical cancer (intervention group). Logistic regression compared study arms on HPV self-test return and receipt of a Pap test. RESULTS Overall, 80 (78%) women returned their HPV self-test. Return was similar among the intervention and control groups (78% vs. 77%; odds ratio, 1.09; 95% confidence interval, 0.43-2.76). Among returners, 26% had an oncogenic HPV type detected in their sample. Women who returned their self-test reported high levels of satisfaction and positive experiences with the self-testing process. Few women overall received a Pap test (11%), and Pap testing was similar among the intervention and control groups (14% vs. 8%; odds ratio, 1.91; 95% confidence interval, 0.52-6.97). CONCLUSIONS Mail-based HPV self-testing programs are a potentially promising strategy for reaching underscreened women in Appalachia. Efforts are needed to better understand how to optimize the success of such programs.
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Affiliation(s)
| | | | | | - Mack T Ruffin
- Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA
| | - Martin Steinau
- Division of Global HIV and TB, Center for Global Health, and
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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15
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Polman NJ, de Haan Y, Veldhuijzen NJ, Heideman DAM, de Vet HCW, Meijer CJLM, Massuger LFAG, van Kemenade FJ, Berkhof J. Experience with HPV self-sampling and clinician-based sampling in women attending routine cervical screening in the Netherlands. Prev Med 2019; 125:5-11. [PMID: 31054907 DOI: 10.1016/j.ypmed.2019.04.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/03/2019] [Accepted: 04/28/2019] [Indexed: 01/06/2023]
Abstract
Several countries offer HPV self-sampling for screening non-attendees. It is assumed that screening attendees also prefer self-sampling to clinician-based sampling, however, little research has been conducted with respect to this. Women participating in the IMPROVE-study were randomised (1:1) to self- or clinician-collected HPV testing, and HPV-positive women were retested using the other collection method. Three different questionnaires were sent out among a subset of participating women: Q1) HPV-positive women from both study groups were asked about their experiences with self-sampling and clinician-based sampling (n = 497); Q2) HPV-negative women from the self-sampling group were asked about their experiences with self-sampling (n = 2366); and Q3) HPV-negative women in the clinician-collection group were asked about their experiences with clinician-based sampling (n = 2092). Response rates ranged from 71.6 to 79.4%. Women reported significantly lower levels of shame, nervousness, discomfort and pain during self-sampling compared to clinician-based sampling. However, trust in correct sampling was significantly higher during clinician-based sampling. The majority of women in group Q1 preferred self-sampling (76.5%) to clinician-based sampling (11.9%) in future screening, while 11.6% of women reported to have no preference for either method. To conclude, women from a regular screening population have a positive attitude towards self-sampling but express some concerns with respect to accuracy. The majority prefers self-sampling to clinician-based sampling in future screening. Based on these results, a screening approach where women can choose for either self-sampling or clinician-based sampling seems highly justifiable.
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Affiliation(s)
- Nicole J Polman
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Yanne de Haan
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nienke J Veldhuijzen
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Daniëlle A M Heideman
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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16
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Bishop E, Katz ML, Reiter PL. Acceptability of Human Papillomavirus Self-Sampling Among a National Sample of Women in the United States. Biores Open Access 2019; 8:65-73. [PMID: 31057989 PMCID: PMC6497327 DOI: 10.1089/biores.2018.0040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
As human papillomavirus (HPV) self-sampling continues to emerge as a potential cervical cancer screening strategy in the United States, it is necessary to examine women's acceptability of this screening approach. Furthermore, since several HPV self-sampling devices exist, it is important to determine if women's preferences differ by device type. We conducted an online survey in Fall 2017 with a national sample of women (n = 605) ages 21–65 years (the recommended age range for cervical cancer screening). Multivariable linear regression identified correlates of women's willingness to use an HPV self-sample at home. We used repeated measures analysis of variance to determine if preferences differed across four self-sampling devices: Evalyn® Brush (Device A), HerSwab® (Device B), Catch-All® Swab (Device C), and Qvintip® (Device D). Most women were willing to use an HPV self-sample at home (mean = 4.03 [possible range: 1–5], standard deviation = 1.09, 72.7% indicated “probably willing” or “definitely willing”). The most common concerns about self-sampling were related to test accuracy (53.1%) and obtaining the sample incorrectly (51.1%). Women were more willing to use an HPV self-sample at home if they reported greater perceived severity of cervical cancer (β = 0.16), reported an annual income less than $50,000 (β = 0.13), or were a former smoker (β = 0.11). Women were more willing to use Device A (mean = 3.72, 67.6% indicated “agree” or “strongly agree”), Device C (mean = 3.86, 73.9% indicated “agree” or “strongly agree”), and Device D (mean = 3.81, 72.1% indicated “agree” or “strongly agree”) than Device B (mean = 3.36, 49.4% indicated “agree” or “strongly agree”; all p < 0.05). Acceptability of HPV self-sampling as a cervical cancer screening strategy is generally high among women. Future efforts should consider the potential impact that device type may have on women's use of an HPV self-sample at home.
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Affiliation(s)
- Erin Bishop
- Medical Student Research Program, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Paul L Reiter
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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17
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Polman NJ, Snijders PJF, Kenter GG, Berkhof J, Meijer CJLM. HPV-based cervical screening: Rationale, expectations and future perspectives of the new Dutch screening programme. Prev Med 2019; 119:108-117. [PMID: 30594536 DOI: 10.1016/j.ypmed.2018.12.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022]
Abstract
Based on scientific data showing that HPV testing provides better protection against cervical precancer and cancer than cytology, in 2011 the Dutch Health Council advised the Minister of Welfare, Health and Sports to replace cytology by HPV testing in the Dutch population-based screening programme. After a successful evaluation of the feasibility of HPV-based screening in 2014, primary HPV testing for cervical screening was implemented in 2017. The Netherlands has been one of the first countries worldwide to implement nationwide HPV-based screening and its experience with the new programme is therefore followed with great interest. In this manuscript, we present an overview of the studies that were instrumental in the choice of HPV assay and triage strategy, the adjustment of screening starting and exit ages and intervals, and the implementation of HPV self-sampling. Finally, we review the cost-effectiveness of the proposed new screening algorithm and we explore future perspectives. The rationale behind the new Dutch HPV-based screening programme, which is based on risk management, could serve as a guidance to other countries that are planning to implement HPV-based screening in the near future.
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Affiliation(s)
- N J Polman
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - P J F Snijders
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G G Kenter
- Department of Gynecologic Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - C J L M Meijer
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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18
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Lynge E. Self-collected versus clinician-collected samples for HPV testing. Lancet Oncol 2019; 20:170-171. [PMID: 30658936 DOI: 10.1016/s1470-2045(18)30934-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, DK-4800 Nykøbing Falster, Denmark.
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19
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Chrysostomou AC, Stylianou DC, Constantinidou A, Kostrikis LG. Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:E729. [PMID: 30572620 PMCID: PMC6315375 DOI: 10.3390/v10120729] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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Affiliation(s)
- Andreas C Chrysostomou
- Department of Biological Sciences, University of Cyprus, 1 University Avenue, Aglantzia 2109, Nicosia, Cyprus.
| | - Dora C Stylianou
- Department of Biological Sciences, University of Cyprus, 1 University Avenue, Aglantzia 2109, Nicosia, Cyprus.
| | - Anastasia Constantinidou
- Medical School, University of Cyprus, Shakolas Educational Center for Clinical Medicine, Palaios dromos Lefkosias Lemesou No.215/6 2029 Aglantzia, Nicosia, Cyprus.
| | - Leondios G Kostrikis
- Department of Biological Sciences, University of Cyprus, 1 University Avenue, Aglantzia 2109, Nicosia, Cyprus.
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Acceptability, Feasibility and Uptake of HPV Self-Sampling Among Immigrant Minority Women: a Focused Literature Review. J Immigr Minor Health 2018; 21:1380-1393. [DOI: 10.1007/s10903-018-0846-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Singla AA, Komesaroff P. Self-collected Pap smears may provide an acceptable and effective method of cervical cancer screening. Health Sci Rep 2018; 1:e33. [PMID: 30623069 PMCID: PMC6266357 DOI: 10.1002/hsr2.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/11/2017] [Accepted: 02/12/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIMS The role of the Papanicolou (Pap) smear in the early detection and prevention of cervical cancer is well established. However, many women fail to undertake the test because of embarrassment or other reasons. To address this problem, we evaluated the feasibility of implementing self-sampling of cervical cytology as an alternative to clinician-collected Pap smears and compared it with the gold standard of colposcopy in terms of specificity. MATERIALS AND METHODS A prospective preliminary study of 40 women recruited from the colposcopy clinic of a tertiary referral hospital was undertaken. Participants were instructed in the technique of self-sampling and asked to collect their own Pap smears. Colposcopic examinations were performed and biopsies taken, if indicated. Clinician-collected Pap smears were performed 4 weeks later. Pairwise agreement was calculated between the outcomes of self-collected, colposcopic, and clinician-collected samples using the weighted κ statistic. RESULTS Self-collected Pap smear had a high level of acceptability among the women, all of whom were able to collect adequate tissue. The agreement of self-collected Pap smears with colposcopic assessment was no worse than that of clinician-collected Pap smears (Cohen's κ statistic 0.54 [95% CI, 0.27-0.82]; cf 0.49 [0.2-0.78], respectively). The specificity of self-collected Pap smears was almost identical to that of clinician-collected samples (specificity: 86% vs 81%, respectively). Direct comparison between patient and clinician collected Pap smears showed fair agreement (κ statistic 0.38 [0.07-0.68]). There were no adverse events in either group. CONCLUSIONS Self-collection of Pap smears is an effective and acceptable alternative to clinician-collected samples and may provide a strategy for improving compliance with cervical testing programs.
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Affiliation(s)
- Amita A. Singla
- Department of GynaecologyThe Queen Elizabeth HospitalAdelaideAustralia
- Department of Obstetrics and GynaecologyUniversity of AdelaideAdelaideAustralia
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Kellen E, Benoy I, Vanden Broeck D, Martens P, Bogers JP, Haelens A, Van Limbergen E. A randomized, controlled trial of two strategies of offering the home-based HPV self-sampling test to non- participants in the Flemish cervical cancer screening program. Int J Cancer 2018; 143:861-868. [PMID: 29569715 DOI: 10.1002/ijc.31391] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/15/2018] [Accepted: 02/22/2018] [Indexed: 01/10/2023]
Abstract
We conducted a randomized, controlled trial to evaluate different strategies of offering an HPV-self sampling program, and compared this with two control groups. All total of 35,354 women who did not participate in the Flemish cancer screening program were included in the study: 9,118 received a HPV self-collection brush (RIATOL qPCR HPV genotyping test (qPCR [E6/E7]); 9,098 were offered the opportunity to order an HPV-selfsampling brush, 8,830 received the recall letter; 8,849 received no intervention. Within 12 months after the mailing, 18.7% of the women who had received the brush, participated by returning a self-sample sample, while 10.6% women allocated to the opt- in group did so. 10.5% women who received the standard recall letter, had a PAP smear taken within a period of 12 months; while 8% women did so without receiving an intervention at all. Participation in postmenopausal women was higher than in women younger than 50 in both self-sampling arms. Screening by means of the self-sample kit increased by age, contradictory when screening is performed by a PAP smear. Of those testing hrHPV positive (9.5%), 88.9% attended for follow up cytology. The mean DNA concentration, found in the self-sampler, decreased by age, causing a higher number of inconclusive results. Our results support the efficacy of a self-sampling strategy to increase participation in the Flemish screening program. Self-sampling seems particularly acceptable to postmenopausal non-responders. Future research should focus on the performance of different self-sampling devices in post-menopausal women as low DNA concentrations exponentially increased over age.
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Affiliation(s)
- Eliane Kellen
- Centre for Cancer Detection, Flanders, Belgium.,University Hospital Leuven, Campus St. Rafael, Leuven, Belgium
| | - Ina Benoy
- AML, Sonic Healthcare, Antwerp, Belgium.,National Reference Centre for HPV, Brussels, Belgium.,AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
| | - Davy Vanden Broeck
- AML, Sonic Healthcare, Antwerp, Belgium.,National Reference Centre for HPV, Brussels, Belgium.,International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | | | - Jean-Paul Bogers
- AML, Sonic Healthcare, Antwerp, Belgium.,National Reference Centre for HPV, Brussels, Belgium.,AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium.,International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | | | - Erik Van Limbergen
- Centre for Cancer Detection, Flanders, Belgium.,University Hospital Leuven, Campus St. Rafael, Leuven, Belgium
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23
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Gupta S, Palmer C, Bik EM, Cardenas JP, Nuñez H, Kraal L, Bird SW, Bowers J, Smith A, Walton NA, Goddard AD, Almonacid DE, Zneimer S, Richman J, Apte ZS. Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs. Front Public Health 2018; 6:77. [PMID: 29686981 PMCID: PMC5900042 DOI: 10.3389/fpubh.2018.00077] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/01/2018] [Indexed: 12/23/2022] Open
Abstract
In most industrialized countries, screening programs for cervical cancer have shifted from cytology (Pap smear or ThinPrep) alone on clinician-obtained samples to the addition of screening for human papillomavirus (HPV), its main causative agent. For HPV testing, self-sampling instead of clinician-sampling has proven to be equally accurate, in particular for assays that use nucleic acid amplification techniques. In addition, HPV testing of self-collected samples in combination with a follow-up Pap smear in case of a positive result is more effective in detecting precancerous lesions than a Pap smear alone. Self-sampling for HPV testing has already been adopted by some countries, while others have started trials to evaluate its incorporation into national cervical cancer screening programs. Self-sampling may result in more individuals willing to participate in cervical cancer screening, because it removes many of the barriers that prevent women, especially those in low socioeconomic and minority populations, from participating in regular screening programs. Several studies have shown that the majority of women who have been underscreened but who tested HPV-positive in a self-obtained sample will visit a clinic for follow-up diagnosis and management. In addition, a self-collected sample can also be used for vaginal microbiome analysis, which can provide additional information about HPV infection persistence as well as vaginal health in general.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zachary S Apte
- uBiome, San Francisco, CA, United States.,University of California San Francisco, San Francisco, CA, United States
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24
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Randomised study shows that repeated self-sampling and HPV test has more than two-fold higher detection rate of women with CIN2+ histology than Pap smear cytology. Br J Cancer 2018; 118:896-904. [PMID: 29438367 PMCID: PMC5886121 DOI: 10.1038/bjc.2017.485] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/08/2022] Open
Abstract
This corrects the article DOI: 10.1038/bjc.2017.85.
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25
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Leinonen MK, Schee K, Jonassen CM, Lie AK, Nystrand CF, Rangberg A, Furre IE, Johansson MJ, Tropé A, Sjøborg KD, Castle PE, Nygård M. Safety and acceptability of human papillomavirus testing of self-collected specimens: A methodologic study of the impact of collection devices and HPV assays on sensitivity for cervical cancer and high-grade lesions. J Clin Virol 2017; 99-100:22-30. [PMID: 29289814 DOI: 10.1016/j.jcv.2017.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/08/2017] [Accepted: 12/15/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Comparative data on different self-collection methods is limited. OBJECTIVES To assess the impact of hrHPV testing of two self-collection devices for detection of cervical carcinoma and high-grade lesions. STUDY DESIGN Three hundred ten patients collected two cervicovaginal specimens using a brush (Evalyn®Brush) and a swab (FLOQSwabs™), and filled a questionnaire at home. Then, a physician at the clinic took a cervical specimen into PreservCyt® buffer for hrHPV testing and cytology. All specimens were tested using Anyplex™ II HPV28, Cobas® 4800 HPV Test and Xpert®HPV. RESULTS Performance comparison included 45 cervical carcinomas and 187 patients with premalignant lesions. Compared to the physician-specimen, hrHPV testing of Evalyn®Brush showed non-inferior sensitivity for CIN3+ (relative sensitivity of Anyplex™ 0.99; Cobas® 0.96; Xpert®HPV 0.97) while hrHPV testing of FLOQSwabs™ showed inferior sensitivity (relative sensitivity of Anyplex™ 0.91; Cobas® 0.92; Xpert®HPV 0.93). Similar results were observed for invasive carcinomas albeit that FLOQSwabs™ was statistically non-inferior to the physician-specimen. Self-collection by either Evalyn®Brush or FLOQSwabs™ was more sensitive for CIN3+ than LSIL or worse cytology. Significant decrease in sensitivity for CIN3+ were observed for FLOQSwabs™ when specimens were preprocessed for hrHPV testing after 28 days. Both devices were well accepted, but patients considered Evalyn®Brush easier and more comfortable than FLOQSwabs™. CONCLUSIONS Self-collection is comparable to current screening practice for detecting cervical carcinoma and CIN3+ but device and specimen processing effects exist. Only validated procedure including collection device, hrHPV assay and specimen preparation should be used.
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Affiliation(s)
- Maarit K Leinonen
- Department of Research, Cancer Registry of Norway, 0379 Oslo, Norway.
| | - Kristina Schee
- Department of Research, Cancer Registry of Norway, 0379 Oslo, Norway
| | - Christine M Jonassen
- Center for Laboratory Medicine, Østfold Hospital Trust, 1714 Grålum, Norway; Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, 1432 Ås, Norway
| | - A Kathrine Lie
- Center for Laboratory Medicine, Østfold Hospital Trust, 1714 Grålum, Norway
| | - Camilla F Nystrand
- Center for Laboratory Medicine, Østfold Hospital Trust, 1714 Grålum, Norway
| | - Anbjørg Rangberg
- Center for Laboratory Medicine, Østfold Hospital Trust, 1714 Grålum, Norway
| | - Ingegerd E Furre
- Department of Pathology, Oslo University Hospital, 0379 Oslo, Norway
| | | | - Ameli Tropé
- Department of Cervical Cancer Screening, Cancer Registry of Norway, 0379 Oslo, Norway; Department of Gynecologic Cancer, Division of Cancer Medicine, Oslo University Hospital, 0379 Oslo, Norway
| | - Katrine D Sjøborg
- Department of Obstetrics and Gynaecology, Østfold Hospital Trust, 1714 Grålum, Norway
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, 0379 Oslo, Norway
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Van Ostade X, Dom M, Tjalma W, Van Raemdonck G. Candidate biomarkers in the cervical vaginal fluid for the (self-)diagnosis of cervical precancer. Arch Gynecol Obstet 2017; 297:295-311. [PMID: 29143101 PMCID: PMC5778162 DOI: 10.1007/s00404-017-4587-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
Purpose Despite improvement in vaccines against human papilloma virus (HPV), the causative agent of cervical cancer, screening women for cervical precancer will remain indispensable in the coming 30–40 years. A simple test that could be performed at home or at a doctor’s practice and that informs the woman whether she is at risk would significantly help make a broader group of patients who aware that they need medical treatment. Cervical vaginal fluid (CVF) is a body fluid that is very well suited for such a test. Methods Narrative review of cervical (pre)cancer candidate biomarkers from cervicovaginal fluid, is based on a detailed review of the literature. We will also discuss the possibilities that these biomarkers create for the development of a self-test or point-of-care test for cervical (pre)cancer. Results Several DNA, DNA methylation, miRNA, and protein biomarkers were identified in the cervical vaginal fluid; however, not all of these biomarkers are suited for development of a simple diagnostic assay. Conclusions Proteins, especially alpha-actinin-4, are most suited for development of a simple assay for cervical (pre)cancer. Accuracy of the test could further be improved by combination of several proteins or by combination with a new type of biomarker, e.g., originating from the cervicovaginal microbiome or metabolome.
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Affiliation(s)
- Xaveer Van Ostade
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium. .,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium.
| | - Martin Dom
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
| | - Wiebren Tjalma
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Geert Van Raemdonck
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
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Virtanen S, Kalliala I, Nieminen P, Salonen A. Comparative analysis of vaginal microbiota sampling using 16S rRNA gene analysis. PLoS One 2017; 12:e0181477. [PMID: 28723942 PMCID: PMC5517051 DOI: 10.1371/journal.pone.0181477] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/30/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Molecular methods such as next-generation sequencing are actively being employed to characterize the vaginal microbiota in health and disease. Previous studies have focused on characterizing the biological variation in the microbiota, and less is known about how factors related to sampling contribute to the results. Our aim was to investigate the impact of a sampling device and anatomical sampling site on the quantitative and qualitative outcomes relevant for vaginal microbiota research. We sampled 10 Finnish women representing diverse clinical characteristics with flocked swabs, the Evalyn® self-sampling device, sterile plastic spatulas and a cervical brush that were used to collect samples from fornix, vaginal wall and cervix. Samples were compared on DNA and protein yield, bacterial load, and microbiota diversity and species composition based on Illumina MiSeq sequencing of the 16S rRNA gene. We quantified the relative contributions of sampling variables versus intrinsic variables in the overall microbiota variation, and evaluated the microbiota profiles using several commonly employed metrics such as alpha and beta diversity as well as abundance of major bacterial genera and species. RESULTS The total DNA yield was strongly dependent on the sampling device and to a lesser extent on the anatomical site of sampling. The sampling strategy did not affect the protein yield or the bacterial load. All tested sampling methods produced highly comparable microbiota profiles based on MiSeq sequencing. The sampling method explained only 2% (p-value = 0.89) of the overall microbiota variation, markedly surpassed by intrinsic factors such as clinical status (microscopy for bacterial vaginosis 53%, p = 0.0001), bleeding (19%, p = 0.0001), and the variation between subjects (11%, p-value 0.0001). CONCLUSIONS The results indicate that different sampling strategies yield comparable vaginal microbiota composition and diversity. Hence, past and future vaginal microbiota studies employing different sampling strategies should be comparable in the absence of other technical confounders. The Evalyn® self-sampling device performed equally well compared to samples taken by a clinician, and hence offers a good-quality microbiota sample without the need for a gynecological examination. The amount of collected sample as well as the DNA and protein yield varied across the sampling techniques, which may have practical implications for study design.
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Affiliation(s)
- Seppo Virtanen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Kalliala
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Pekka Nieminen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Salonen
- Immunobiology Research Programme, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
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28
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Tranberg M, Bech BH, Blaakær J, Jensen JS, Svanholm H, Andersen B. Study protocol of the CHOiCE trial: a three-armed, randomized, controlled trial of home-based HPV self-sampling for non-participants in an organized cervical cancer screening program. BMC Cancer 2016; 16:835. [PMID: 27809810 PMCID: PMC5094020 DOI: 10.1186/s12885-016-2859-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/11/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The effectiveness of cervical cancer screening programs is challenged by suboptimal participation and coverage. Offering cervico-vaginal self-sampling for human papillomavirus testing (HPV self-sampling) to non-participants can increase screening participation. However, the effect varies substantially among studies, especially depending on the approach used to offer HPV self-sampling. The present trial evaluates the effect on participation in an organized screening program of a HPV self-sampling kit mailed directly to the home of the woman or mailed to the woman's home on demand only, compared with the standard second reminder for regular screening. METHODS/DESIGN The CHOiCE trial is a parallel, randomized, controlled, open-label trial. It will include 9327 women aged 30-64 years who are living in the Central Denmark Region and who have not participated in cervical cancer screening after an invitation and one reminder. The women will be equally randomized into three arms: 1) Directly mailed a second reminder including a HPV self-sampling kit; 2) Mailed a second reminder offering a HPV self-sampling kit, to be ordered by e-mail, text message, phone, or through a webpage; and 3) Mailed a second reminder for a practitioner-collected sample (control group). The primary outcome will be the proportion of women in the intervention groups who participate by returning their HPV self-sampling kit or have a practitioner-collected sample compared with the proportion of women who have a practitioner-collected sample in the control group at 90 and 180 days after mail out of the second reminders. Per-protocol and intention-to-treat analyses will be performed. The secondary outcome will be the proportion of women with a positive HPV self-collected sample who attend follow-up testing at 30, 60, or 90 days after mail out of the results. DISCUSSION The CHOiCE trial will provide strong and important evidence allowing us to determine if and how HPV self-sampling can be used to increase participation in cervical cancer screening. This trial therefore has the potential to improve prevention and reduce the number of deaths caused by cervical cancer. TRIAL REGISTRATION Current Controlled Trials NCT02680262 . Registered 10 February 2016.
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Affiliation(s)
- Mette Tranberg
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.
| | - Bodil Hammer Bech
- Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Jan Blaakær
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Hans Svanholm
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.,Department of Pathology, Randers Regional Hospital, Østervangsvej 48, 8930, Randers, NØ, Denmark
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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