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Yu YQ, Jiang MY, Zhang X, Pan QJ, Dang L, Feng RM, Ali NM, Chen W, Qiao YL. Effectiveness of high-risk human papillomavirus genotyping for cervical cancer screening. A multicentre screening cohort study in rural China. An Sist Sanit Navar 2024; 47:e1065. [PMID: 38817086 PMCID: PMC11167506 DOI: 10.23938/assn.1065] [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: 09/22/2023] [Revised: 11/11/2023] [Accepted: 12/26/2023] [Indexed: 06/01/2024]
Abstract
BACKGROUND This study aimed to assess the effectiveness of high-risk human papillomavirus (HR-HPV) primary testing for cervical cancer screening in China's rural areas. METHODS Women aged 21-64 years were recruited. Cervical cytology was diagnosed following the Bethesda 2001 classification system, HPV infection (HR-HPV, HPV-16, HPV-18, and other 12 genotypes) identified by Cobas-4800, and colposcopy and biopsy performed when required. Primary outcomes were defined as the cumulative incidence of cervical intraepithelial neoplasia grade 2/3/higher (CIN2/3+) and its relative risk at baseline and at the 36-month follow-up. RESULTS The study included 9,218 women; mean age was 45.15 years (SD: 8.74); 81% completed the follow-up. The most frequent type of cytological lesions (12.4% ) were ASCUS (8.4%) and LSIL (2.2%). HR-HPV infection (16.3%) was more prevalent in HPV-16 than in HPV-18 (3 vs 1.5%); a positive relationship with the severity of the lesions, from 29.8% in ASCUS to 89.6% in HSIL was found. At baseline, 3.5% of the patients underwent colposcopy; 20% had a positive diagnosis. At the 36-month follow-up, the cumulative incidences of CIN2+ and CIN3+ were higher in women with HR-HPV infection (16.9 vs 0.5% and 8.2 vs 0.2%). The relative risk of CIN2/3+ was lower in HR-HPV-negative women compared to those with a negative cytology at baseline (0.4; 95%CI: 0.3-0.4). CONCLUSIONS High-risk HPV-based screening may significantly reduce the risk of CIN2/3+ compared with cytology testing. This may be a new resource for public health demands in China's rural areas.
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Affiliation(s)
- Yan-Qin Yu
- Baotou Medical College/Clinical Epidemiology Research Centre of The First Affiliated Hospital of Baotou Medical College. Department of Public Health and Preventive Medicine. Baotou. China.
- National Cancer Centre /National Clinical Research Centre for Cancer/Cancer Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College. Department of Cancer Epidemiology. Beijing. China
| | - Ming-Yue Jiang
- National Cancer Centre /National Clinical Research Centre for Cancer/Cancer Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College. Department of Cancer Epidemiology. Beijing. China
| | - Xun Zhang
- National Cancer Centre /National Clinical Research Centre for Cancer/Cancer Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College. Department of Cancer Epidemiology. Beijing. China
| | - Qin-Jing Pan
- National Cancer Centre /National Clinical Research Centre for Cancer/Cancer Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College. Department of Cancer Epidemiology. Beijing. China
| | - Le Dang
- National Cancer Centre /National Clinical Research Centre for Cancer/Cancer Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College. Department of Cancer Epidemiology. Beijing. China
| | - Rui-Mei Feng
- National Cancer Centre /National Clinical Research Centre for Cancer/Cancer Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College. Department of Cancer Epidemiology. Beijing. China
| | - Nasra Mohamoud Ali
- First Affiliated Hospital of Dalian Medical University. Department of Oncology. Dalian. China.
| | - Wen Chen
- Baotou Medical College/Clinical Epidemiology Research Centre of The First Affiliated Hospital of Baotou Medical College. Department of Public Health and Preventive Medicine. Baotou. China.
| | - You-Lin Qiao
- National Cancer Centre /National Clinical Research Centre for Cancer/Cancer Hospital. Chinese Academy of Medical Sciences and Peking Union Medical College. Department of Cancer Epidemiology. Beijing. China
- School of Population Medicine and Public Health. Chinese Academy of Medical Sciences and Peking Union Medical College. Beijing. China.
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Hideshima M, Hashiguchi M, Honda A, Umezaki Y, Okuma R, Hikari T, Fukuda A, Okugawa K, Yokoyama M. Are HPV-negative lesions concerned for the introduction of primary HPV testing for cervical cancer screening in Japan? J Obstet Gynaecol Res 2023; 49:2860-2867. [PMID: 37667616 DOI: 10.1111/jog.15784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
AIM In Japan, primary human papilloma virus (HPV) testing has not been introduced for cervical cancer screening due to concerns that HPV-negative lesions may be missed and a lack of Japanese data. The purpose of this study was to evaluate the validity of primary HPV testing in Japan by analyzing cervical intraepithelial neoplasia 2 (CIN2) or more/high-risk HPV- (CIN2+/hrHPV-) cases in cervical cancer screening. METHODS Data from 35 525 cervical cancer screenings with HPV testing and cervical cytology from 2011 to 2019 in Saga City, Japan, were reviewed. The cases with low-grade squamous intraepithelial lesion (LSIL+)/hrHPV- were analyzed in detail. RESULTS The results of the 35 525 examinees were as follows: 31 123 were negative for intraepithelial lesion or malignancy (NILM)/hrHPV-, 2612 were NILM/hrHPV+, 262 were atypical squamous cells of undetermined significance (ASC-US)/hrHPV-, 213 were ASC-US/hrHPV+, 291 were LSIL+/hrHPV-, and 1024 were LSIL+/hrHPV+. Of the 256 LSIL+/hrHPV- examinees for whom histology was available, CIN2+ were CIN2 9.4% (24/256), CIN3 3.9% (10/256), cervical adenocarcinoma 0.4% (1/256), uterine corpus cancer 1.2% (3/256), and uterine sarcoma 0.4% (1/256). Overall, the rate of LSIL+/hrHPV- was 0.82% (291/35.525), 0.1% (36/35525) of which were cervical lesions with CIN2+. Only one cervical adenocarcinoma was detected, but gastric-type adenocarcinoma was not included. CONCLUSION HPV-negative CIN2+ or cervical adenocarcinoma is not a concern for the introduction of primary HPV screening in Japan. Primary HPV testing in cervical cancer screening is considered a feasible method that can be used in Japan, although an algorithm suitable for Japan and a national-level management system need to be established.
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Affiliation(s)
- Misako Hideshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Mariko Hashiguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | | | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Ryoichi Okuma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Takako Hikari
- Department of Obstetrics and Gynecology, Saga Prefectural Medical Center, Saga, Japan
| | - Asako Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Kaoru Okugawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatoshi Yokoyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, Japan
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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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Hahn EE, Munoz-Plaza C, Altman DE, Hsu C, Cannizzaro NT, Ngo-Metzger Q, Wride P, Gould MK, Mittman BS, Hodeib M, Tewari KS, Ajamian LH, Eskander RN, Tewari D, Chao CR. De-implementation and substitution of clinical care processes: stakeholder perspectives on the transition to primary human papillomavirus (HPV) testing for cervical cancer screening. Implement Sci Commun 2021; 2:108. [PMID: 34556189 PMCID: PMC8461958 DOI: 10.1186/s43058-021-00211-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/06/2021] [Indexed: 12/27/2022] Open
Abstract
Background New cervical cancer screening guidelines recommend primary human papillomavirus (HPV) testing for women age 30–65 years. Healthcare organizations are preparing to de-implement the previous recommended strategies of Pap testing or co-testing (Pap plus HPV test) and substitute primary HPV testing. However, there may be significant challenges to the replacement of this entrenched clinical practice, even with an evidence-based substitution. We sought to identify stakeholder-perceived barriers and facilitators to this substitution within a large healthcare system, Kaiser Permanente Southern California. Methods We conducted semi-structured qualitative interviews with clinician, administrative, and patient stakeholders regarding (a) acceptability and feasibility of the planned substitution; (b) perceptions of barriers and facilitators, with an emphasis on those related to the de-implementation/implementation cycle of substitution; and (c) perceived readiness to change. Our interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Using a team coding approach, we developed an initial coding structure refined during iterative analysis; the data were subsequently organized thematically into domains, key themes, and sub-themes using thematic analysis, followed by framework analysis informed by CFIR. Results We conducted 23 interviews: 5 patient and 18 clinical/administrative. Clinicians perceived that patients feel more tests equals better care, and clinicians and patients expressed fear of missed cancers (“…it’ll be more challenging convincing the patient that only one test is…good enough to detect cancer.”). Patients perceived practice changes resulting in “less care” are driven by the desire to cut costs. In contrast, clinicians/administrators viewed changing from two tests to one as acceptable and a workflow efficiency (“…It’s very easy and half the work.”). Stakeholder-recommended strategies included focusing on the increased efficacy of primary HPV testing and developing clinician talking points incorporating national guidelines to assuage “cost-cutting” fears. Conclusions Substitution to replace an entrenched clinical practice is complex. Leveraging available facilitators is key to ease the process for clinical and administrative stakeholders—e.g., emphasizing the efficiency of going from two tests to one. Identifying and addressing clinician and patient fears regarding cost-cutting and perceived poorer quality of care is critical for substitution. Multicomponent and multilevel strategies for engagement and education will be required. Trial registration ClinicalTrials.gov, #NCT04371887 Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00211-z.
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Affiliation(s)
- Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA. .,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Corrine Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA
| | - Danielle E Altman
- Center for Health Living, Kaiser Permanente Southern California, Pasadena, USA
| | - Chunyi Hsu
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA
| | - Nancy T Cannizzaro
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Patricia Wride
- Southern California Permanente Medical Group, Pasadena, USA
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Brian S Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA
| | - Melissa Hodeib
- Southern California Permanente Medical Group, Pasadena, USA
| | - Krishnansu S Tewari
- Department of Gynecologic Oncology, University of California Irvine, Irvine, CA, USA
| | - Lena H Ajamian
- Southern California Permanente Medical Group, Pasadena, USA
| | - Ramez N Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Devansu Tewari
- Southern California Permanente Medical Group, Pasadena, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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