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Katki HA, Prorok PC, Castle PE, Minasian LM, Pinsky PF. Increasing power in screening trials by testing control-arm specimens: Application to multicancer detection screening. J Natl Cancer Inst 2024:djae083. [PMID: 38603624 DOI: 10.1093/jnci/djae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Cancer screening trials have required large sample-sizes and long time-horizons to demonstrate cancer mortality reductions, the primary goal of cancer screening. We examine assumptions and potential power gains from exploiting information from testing control-arm specimens, which we call the "Intended Effect" (IE) analysis that we explain in detail herein. The IE analysis is particularly suited to tests that can be conducted on stored specimens in the control-arm, such as stored blood for multicancer detection (MCD) tests. METHODS We simulated hypothetical MCD screening trials to compare power and sample-size for the standard vs IE analysis. Under two assumptions that we detail herein, we projected the IE analysis for 3 existing screening trials (National Lung Screening Trial (NLST), Minnesota Colon Cancer Control Study (MINN-FOBT-A), and Prostate, Lung, Colorectal, Ovarian Cancer Screening Trial-colorectal component (PLCO-CRC)). RESULTS Compared to the standard analysis for the 3 existing trials, the IE design could have reduced cancer-specific mortality p-values 5-fold (NLST), 33-fold (MINN-FOBT-A), or 14,160-fold (PLCO-CRC), or alternately, reduced sample-size (90% power) by 26% (NLST), 48% (MINN-FOBT-A), or 59% (PLCO-CRC). For potential MCD trial designs requiring 100,000 subjects per-arm to achieve 90% power for multi-cancer mortality for the standard analysis, the IE analysis achieves 90% power for only 37,500-50,000 per arm, depending on assumptions concerning control-arm test-positives. CONCLUSIONS Testing stored specimens in the control arm of screening trials to conduct the IE analysis could substantially increase power to reduce sample-size or accelerate trials, and provide particularly strong power gains for MCD tests.
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Affiliation(s)
- Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Philip C Prorok
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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2
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O’Connor L, Bailey-Whyte M, Bhattacharya M, Butera G, Hardell KNL, Seidenberg AB, Castle PE, Loomans-Kropp HA. Association of metformin use and cancer incidence: a systematic review and meta-analysis. J Natl Cancer Inst 2024; 116:518-529. [PMID: 38291943 PMCID: PMC10995851 DOI: 10.1093/jnci/djae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Metformin is among the most widely used antidiabetics medications because of its minimal toxicity, favorable safety profile, availability, and low cost. In addition to its role in diabetes management, metformin may reduce cancer risk. METHODS We conducted a comprehensive systematic review and meta-analysis to investigate the association between metformin use and cancer risk, with evaluation by specific cancer type when possible. Applicable studies were identified in PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus from inception through March 7, 2023, with metformin use categorized as "ever" or "yes" and a cancer diagnosis as the outcome. Article quality was evaluated using National Heart, Lung, and Blood Institute guidelines, and publication bias was evaluated using the Egger test, Begg test, and funnel plots. Pooled relative risk (RR) estimates were calculated using random-effects models, and sensitivity analysis was completed through leave-one-out cross-validation. RESULTS We included 166 studies with cancer incidence information in the meta-analysis. Reduced risk for overall cancer was observed in case-control studies (RR = 0.55, 95% confidence interval [CI] = 0.30 to 0.80) and prospective cohort studies (RR = 0.65, 95% CI = 0.37 to 0.93). Metformin use was associated with reduced gastrointestinal (RR = 0.79, 95% CI = 0.73 to 0.85), urologic (RR = 0.88, 95% CI = 0.78 to 0.99), and hematologic (RR = 0.87, 95% CI = 0.75 to 0.99) cancer risk. Statistically significant publication bias was observed within the studies (Egger P < .001). CONCLUSIONS Metformin may be associated with a decreased risk of many cancer types, but high heterogeneity and risk of publication bias limit confidence in these results. Additional studies in populations without diabetes are needed to better understand the utility of metformin in cancer prevention.
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Affiliation(s)
- Lauren O’Connor
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | | | - Manami Bhattacharya
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Gisela Butera
- Division of Library Services, Office of Research Services, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn N Lewis Hardell
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Andrew B Seidenberg
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Holli A Loomans-Kropp
- Divison of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Cancer Control Program, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, USA
- Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
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Castle PE, Faupel-Badger JM, Umar A, Rebbeck TR. A Proposed Framework and Lexicon for Cancer Prevention. Cancer Discov 2024; 14:594-599. [PMID: 38571411 DOI: 10.1158/2159-8290.cd-23-1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
SUMMARY Cancer prevention is central to efforts to control the burden of cancer. We propose a new terminology framework to help guide these efforts and promote a key equity principle: "equal care for equal risk."
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Affiliation(s)
- Philip E Castle
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, Maryland
| | | | - Asad Umar
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland
| | - Timothy R Rebbeck
- Division of Population Science, Dana-Farber Cancer Institute; Zhu Family Center for Global Cancer Prevention and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
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4
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Sei S, Srivastava S, Kelly HR, Miller MS, Leitner WW, Shoemaker RH, Szabo E, Castle PE. NCI Resources for Cancer Immunoprevention Research. Cancer Immunol Res 2024; 12:387-392. [PMID: 38562082 DOI: 10.1158/2326-6066.cir-23-0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/29/2023] [Accepted: 01/31/2024] [Indexed: 02/03/2024]
Abstract
Cancer prevention and early detection, the first two of the eight primary goals of the National Cancer Plan released in April 2023, are at the forefront of the nation's strategic efforts to reduce cancer incidence and mortality. The Division of Cancer Prevention (DCP) of the NCI is the federal government's principal component devoted to promoting and supporting innovative cancer prevention research. Recent advances in tumor immunology, cancer immunotherapy, and vaccinology strongly suggest that the host immune system can be effectively harnessed to elicit protective immunity against the development of cancer, that is, cancer immunoprevention. Cancer immunoprevention may be most effective if the intervention is given before or early in the carcinogenic process while the immune system remains relatively uncompromised. DCP has increased the emphasis on immunoprevention research in recent years and continues to expand program resources and interagency collaborations designed to facilitate research in the immunoprevention field. These resources support a wide array of basic, translational, and clinical research activities, including discovery, development, and validation of biomarkers for cancer risk assessment and early detection (Early Detection Research Network), elucidation of biological and pathophysiological mechanistic determinants of precancer growth and its control (Translational and Basic Science Research in Early Lesions), spatiotemporal multiomics characterization of precancerous lesions (Human Tumor Atlas Network/Pre-Cancer Atlas), discovery of immunoprevention pathways and immune targets (Cancer Immunoprevention Network), and preclinical and clinical development of novel agents for immunoprevention and interception (Cancer Prevention-Interception Targeted Agent Discovery Program, PREVENT Cancer Preclinical Drug Development Program, and Cancer Prevention Clinical Trials Network).
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Affiliation(s)
- Shizuko Sei
- Division of Cancer Prevention, NCI, NIH, Bethesda, Maryland
| | | | - Halonna R Kelly
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | - Wolfgang W Leitner
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | - Eva Szabo
- Division of Cancer Prevention, NCI, NIH, Bethesda, Maryland
| | - Philip E Castle
- Division of Cancer Prevention, NCI, NIH, Bethesda, Maryland
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
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Rubinstein WS, Patriotis C, Dickherber A, Han PKJ, Katki HA, LeeVan E, Pinsky PF, Prorok PC, Skarlupka AL, Temkin SM, Castle PE, Minasian LM. Cancer screening with multicancer detection tests: A translational science review. CA Cancer J Clin 2024. [PMID: 38517462 DOI: 10.3322/caac.21833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/23/2024] Open
Abstract
Multicancer detection (MCD) tests use a single, easily obtainable biospecimen, such as blood, to screen for more than one cancer concurrently. MCD tests can potentially be used to improve early cancer detection, including cancers that currently lack effective screening methods. However, these tests have unknown and unquantified benefits and harms. MCD tests differ from conventional cancer screening tests in that the organ responsible for a positive test is unknown, and a broad diagnostic workup may be necessary to confirm the location and type of underlying cancer. Among two prospective studies involving greater than 16,000 individuals, MCD tests identified those who had some cancers without currently recommended screening tests, including pancreas, ovary, liver, uterus, small intestine, oropharyngeal, bone, thyroid, and hematologic malignancies, at early stages. Reported MCD test sensitivities range from 27% to 95% but differ by organ and are lower for early stage cancers, for which treatment toxicity would be lowest and the potential for cure might be highest. False reassurance from a negative MCD result may reduce screening adherence, risking a loss in proven public health benefits from standard-of-care screening. Prospective clinical trials are needed to address uncertainties about MCD accuracy to detect different cancers in asymptomatic individuals, whether these tests can detect cancer sufficiently early for effective treatment and mortality reduction, the degree to which these tests may contribute to cancer overdiagnosis and overtreatment, whether MCD tests work equally well across all populations, and the appropriate diagnostic evaluation and follow-up for patients with a positive test.
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Affiliation(s)
- Wendy S Rubinstein
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Christos Patriotis
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Anthony Dickherber
- Center for Strategic Scientific Initiatives, US National Cancer Institute, Rockville, Maryland, USA
| | - Paul K J Han
- Division of Cancer Control and Population Sciences, US National Cancer Institute, Rockville, Maryland, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, Maryland, USA
| | - Elyse LeeVan
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Paul F Pinsky
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Philip C Prorok
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Amanda L Skarlupka
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
| | - Sarah M Temkin
- National Institutes of Health Office of Research on Women's Health, Bethesda, Maryland, USA
| | - Philip E Castle
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
- Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, Maryland, USA
| | - Lori M Minasian
- Division of Cancer Prevention, US National Cancer Institute, Rockville, Maryland, USA
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6
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Stanton SE, Castle PE, Finn OJ, Sei S, Emens LA. Advances and challenges in cancer immunoprevention and immune interception. J Immunother Cancer 2024; 12:e007815. [PMID: 38519057 PMCID: PMC10961508 DOI: 10.1136/jitc-2023-007815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 03/24/2024] Open
Abstract
Invasive cancers typically evade immune surveillance through profound local and systemic immunosuppression, preventing their elimination or control. Targeting immune interventions to prevent or intercept premalignant lesions, before significant immune dysregulation has occurred, may be a more successful strategy. The field of cancer immune interception and prevention is nascent, and the scientific community has been slow to embrace this potentially most rational approach to reducing the global burden of cancer. This may change due to recent promising advances in cancer immunoprevention including the use of vaccines for the prevention of viral cancers, the use of cancer-associated antigen vaccines in the setting of precancers, and the development of cancer-preventative vaccines for high-risk individuals who are healthy but carry cancer-associated heritable genetic mutations. Furthermore, there is increasing recognition of the importance of cancer prevention and interception by national cancer organizations. The National Cancer Institute (NCI) recently released the National Cancer Plan, which includes cancer prevention among the top priorities of the institute. The NCI's Division of Cancer Prevention has been introducing new funding opportunities for scientists with an interest in the field of cancer prevention: The Cancer Prevention-Interception Targeted Agent Discovery Program and The Cancer Immunoprevention Network. Moreover, the Human Tumor Atlas Network is spearheading the development of a precancer atlas to better understand the biology of pre-invasive changes, including the tissue microenvironment and the underlying genetics that drive carcinogenesis. These data will inform the development of novel immunoprevention/immuno-interception strategies. International cancer foundations have also started recognizing immunoprevention and immune interception with the American Association for Cancer Research, Cancer Research UK and the Society for Immunotherapy of Cancer each implementing programming focused on this area. This review will present recent advances, opportunities, and challenges in the emerging field of cancer immune prevention and immune interception.
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Affiliation(s)
- Sasha E Stanton
- Cancer Immunoprevention Laboratory, Earle A Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Olivera J Finn
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shizuko Sei
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
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7
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Befano B, Wentzensen N, Lorey T, Poitras N, Cheung LC, Schiffman M, Clarke MA, Cohen C, Kinney W, Locke A, Castle PE. Calendar-period trends in cervical precancer and cancer diagnoses since the introduction of human papillomavirus and cytology co-testing into routine cervical cancer screening at Kaiser Permanente Northern California. Gynecol Oncol 2024; 184:89-95. [PMID: 38301311 DOI: 10.1016/j.ygyno.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/10/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES The longer-term impact of introducing human papillomavirus (HPV) testing into routine cervical cancer screening on precancer and cancer rates by histologic type has not been well described. Calendar trends in diagnoses were examined using data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in 2003 for women aged ≥30 years. METHODS We examined trends in cervical precancer (cervical intraepithelial neoplasia grade 3 [CIN3] and adenocarcinoma in situ [AIS]) and cancer (squamous cell carcinoma [SCC] and adenocarcinoma [ADC]) diagnoses per 1000 screened during 2003-2018. We examined ratios of squamous vs. glandular diagnoses (SCC:ADC and CIN3:AIS). RESULTS CIN3 and AIS diagnoses increased approximately 2% and 3% annually, respectively (ptrend < 0.001 for both). While SCC diagnoses decreased by 5% per annually (ptrend < 0.001), ADC diagnoses did not change. These patterns were generally observed within each age group (30-39, 40-49, and 50-64 years). ADC diagnoses per 1000 screened did not change even among those who underwent co-testing starting in 2003-2006. SCC:ADC decreased from approximately 2.5:1 in 2003-2006 to 1.3:1 in 2015-2018 while the CIN3:AIS remained relatively constant, ∼10:1. CONCLUSIONS Since its introduction at KPNC, co-testing increased the detection of CIN3 over time, which likely caused a subsequent reduction of SCC. However, there has been no observed decrease in ADC. One possible explanation for lack of effectiveness against ADC is the underdiagnosis of AIS. Novel strategies to identify and treat women at high risk of ADC need to be developed and clinically validated.
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Affiliation(s)
- Brian Befano
- Information Management Services, Calverton, MD, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Thomas Lorey
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | - Nancy Poitras
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Camryn Cohen
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | | | | | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA; Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, MD, USA.
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8
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Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, Huh WK, Kim JJ, Moscicki AB, Nayar R, Saraiya M, Sawaya GF, Wentzensen N, Schiffman M. 2019 ASCCP Risk-Based Management Consensus Guidelines: Updates Through 2023. J Low Genit Tract Dis 2024; 28:3-6. [PMID: 38117563 PMCID: PMC10755815 DOI: 10.1097/lgt.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
ABSTRACT This Research Letter summarizes all updates to the 2019 Guidelines through September 2023, including: endorsement of the 2021 Opportunistic Infections guidelines for HIV+ or immunosuppressed patients; clarification of use of human papillomavirus testing alone for patients undergoing observation for cervical intraepithelial neoplasia 2; revision of unsatisfactory cytology management; clarification that 2012 guidelines should be followed for patients aged 25 years and older screened with cytology only; management of patients for whom colposcopy was recommended but not completed; clarification that after treatment for cervical intraepithelial neoplasia 2+, 3 negative human papillomavirus tests or cotests at 6, 18, and 30 months are recommended before the patient can return to a 3-year testing interval; and clarification of postcolposcopy management of minimally abnormal results.
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Affiliation(s)
| | | | - Philip E. Castle
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - David Chelmow
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Mark H. Einstein
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Francisco Garcia
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Warner K. Huh
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Jane J. Kim
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Anna-Barbara Moscicki
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Ritu Nayar
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Mona Saraiya
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - George F. Sawaya
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Nicolas Wentzensen
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Mark Schiffman
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - 2019 ASCCP Risk-Based Management Consensus Guidelines Committee
- Boston University School of Medicine/ Boston Medical Center, Boston, MA; University of Pittsburgh/ Magee-Women’s Hospital, Pittsburgh, PA; Albert Einstein College of Medicine, New York, NY; Virginia Commonwealth University School of Medicine, Richmond, VA; Rutgers, New Jersey Medical School, Newark, NJ; Pima County Health & Community Services, Tucson, AZ; UAB School of Medicine, Birmingham, AL; Harvard T.H. Chan School of Public Health Boston, MA; University of California, Los Angeles, CA; Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL; Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; University of California, San Francisco; San Francisco, California; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
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9
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Gradissimo A, Clarke MA, Xue X, Castle PE, Raine-Bennett TR, Schiffman M, Wentzensen N, Strickler HD, Burk RD. A novel human papillomavirus and host DNA methylation score and detection of cervical adenocarcinoma. J Natl Cancer Inst 2023; 115:1535-1543. [PMID: 37467068 PMCID: PMC10699843 DOI: 10.1093/jnci/djad134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The widespread introduction of Pap testing in the 1960s was followed by substantial reductions in the incidence of cervical squamous cell cancer (SCC). However, the incidence of cervical adenocarcinoma (ADC) did not decrease, likely because of low Pap test sensitivity for ADC and adenocarcinoma in situ (AIS). This study assessed a novel human papillomavirus (HPV) and host DNA Methylation Score for AIS and ADC screening. METHODS We measured methylation levels at CpG sites in the L2/L1 open reading frames of HPV16, HPV18, and HPV45-as well as 2 human loci, DCC and HS3ST2. Specifically, we tested exfoliated cervicovaginal cells from women in the HPV Persistence and Progression (PaP) cohort who were positive for 1 of HPV16, 18, or 45, including: 1) 176 with AIS/ADC, 2) 353 with cervical intraepithelial neoplasia-3 (CIN3) or SCC, and 3) controls who either cleared (HPV-Clearers; n = 579) or had persistent HPV16, 18, or 45 infection (HPV-Persisters; n = 292). CpG site-specific methylation percentages were measured using our reported next-generation methods. The Methylation Score was the average methylation percentage across all 35 CpG sites tested. RESULTS Each individual CpG site had higher methylation percentages in exfoliated cervicovaginal cells collected from patients with AIS/ADC, and as well as those with CIN3/SCC, relative to either control group (weakest P = .004). The Methylation Score for AIS/ADC had a sensitivity of 74% and specificity of 89%. The multivariate odds ratio (OR) between the Methylation Score (4th vs 1st quartile) for AIS/ADC was ORq4-q1 = 49.01 (PBenjamini-Hochberg = 4.64E-12), using HPV-Clearers as controls. CIN3/SCC had similar, albeit weaker, associations with the Methylation Score. CONCLUSIONS HPV16/18/45-infected women with Methylation Scores in the highest quartile had very high odds of AIS/ADC, suggesting they may warrant careful histologic evaluation of the cervical transition zone (eg, conization or loop electrosurgical excision procedure [LEEP]).
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Affiliation(s)
- Ana Gradissimo
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Immunology, Memorial Sloan Kettering Cancer Center, Manhattan, NY, USA
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Xiaonan Xue
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Howard D Strickler
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert D Burk
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Departments of Microbiology & Immunology, Gynecology & Women’s Health, Albert Einstein College of Medicine, Bronx, NY, USA
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10
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Salcedo MP, Lathrop E, Osman N, Neves A, Rangeiro R, Mariano AAN, Nkundabatware JC, Tivir G, Carrilho C, Monteiro ECS, Burny R, Thomas JP, Carns J, Andrade V, Mavume C, Paulo Mugolo R, Atif H, Hoover H, Chivambo E, Chissano M, Oliveira C, Milan J, Varon ML, Fellman BM, Baker E, Jeronimo J, Castle PE, Richards-Kortum R, Schmeler KM, Lorenzoni C. The Mulher Study: cervical cancer screening with primary HPV testing in Mozambique. Int J Gynecol Cancer 2023; 33:1869-1874. [PMID: 37907263 DOI: 10.1136/ijgc-2023-004958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE To evaluate cervical cancer screening with primary human papillomavirus (HPV) testing in Mozambique, a country with one of the highest burdens of cervical cancer globally. METHODS Women aged 30-49 years were prospectively enrolled and offered primary HPV testing using either self-collected or provider-collected specimens. Patients who tested positive for HPV underwent visual assessment for treatment using visual inspection with acetic acid to determine eligibility for thermal ablation. If ineligible, they were referred for excision with a loop electrosurgical excision procedure, for cold knife conization, or for cervical biopsy if malignancy was suspected. RESULTS Between January 2020 and January 2023, 9014 patients underwent cervical cancer screening. Median age was 37 years (range 30-49) and 4122 women (45.7%) were patients living with HIV. Most (n=8792, 97.5%) chose self-collection. The HPV positivity rate was 31.1% overall and 39.5% among patients living with HIV. Of the 2805 HPV-positive patients, 2588 (92.3%) returned for all steps of their diagnostic work-up and treatment, including ablation (n=2383, 92.1%), loop electrosurgical excision procedure (n=169, 6.5%), and cold knife conization (n=5, 0.2%). Thirty-one patients (1.2%) were diagnosed with cancer and referred to gynecologic oncology. CONCLUSION It is feasible to perform cervical cancer screening with primary HPV testing and follow-up in low-resource settings. Participants preferred self-collection, and the majority of screen-positive patients completed all steps of their diagnostic work-up and treatment. Our findings provide important information for further implementation and scale-up of cervical cancer screening and treatment services as part of the WHO global strategy for the elimination of cervical cancer.
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Affiliation(s)
- Mila Pontremoli Salcedo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eva Lathrop
- Population Services International, Washington, District of Columbia, USA
| | | | - Andrea Neves
- Hospital Geral e Centro de Saúde José Macamo, Maputo, Mozambique
| | | | | | | | | | | | | | | | - Joseph P Thomas
- Oncology Care & Research IS, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Celda Mavume
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | | | - Hira Atif
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique
| | - Hannah Hoover
- Population Services International, Washington, District of Columbia, USA
| | | | | | | | - Jessica Milan
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Lopez Varon
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan M Fellman
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ellen Baker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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Chang MM, Ma A, Novak EN, Barra M, Kundrod KA, Montealegre JR, Scheurer ME, Castle PE, Schmeler K, Richards-Kortum R. A novel tailed primer nucleic acid test for detection of HPV 16, 18 and 45 DNA at the point of care. Sci Rep 2023; 13:20397. [PMID: 37989845 PMCID: PMC10663460 DOI: 10.1038/s41598-023-47582-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
Cervical cancer is a leading cause of death for women in low-resource settings despite being preventable through human papillomavirus (HPV) vaccination, early detection, and treatment of precancerous lesions. The World Health Organization recommends high-risk HPV (hrHPV) as the preferred cervical cancer screening strategy, which is difficult to implement in low-resource settings due to high costs, reliance on centralized laboratory infrastructure, and long sample-to-answer times. To help meet the need for rapid, low-cost, and decentralized cervical cancer screening, we developed tailed primer isothermal amplification and lateral flow detection assays for HPV16, HPV18, and HPV45 DNA. We translated these assays into a self-contained cartridge to achieve multiplexed detection of three hrHPV genotypes in a disposable cartridge. The developed test achieves clinically relevant limits of detection of 50-500 copies per reaction with extracted genomic DNA from HPV-positive cells. Finally, we performed sample-to-answer testing with direct lysates of HPV-negative and HPV-positive cell lines and demonstrated consistent detection of HPV16, HPV18, and HPV45 with 5000-50,000 cells/mL in < 35 min. With additional optimization to improve cartridge reliability, incorporation of additional hrHPV types, and validation with clinical samples, the assay could serve as a point-of-care HPV DNA test that improves access to cervical cancer screening in low-resource settings.
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Affiliation(s)
- Megan M Chang
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Ariel Ma
- Department of Bioengineering, Rice University, Houston, TX, USA
| | | | - Maria Barra
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Kathryn A Kundrod
- Department of Bioengineering, Rice University, Houston, TX, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jane Richards Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Pediatrics Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Michael E Scheurer
- Department of Pediatrics Hematology/Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Kathleen Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Knudsen AB, Trentham-Dietz A, Kim JJ, Mandelblatt JS, Meza R, Zauber AG, Castle PE, Feuer EJ. Estimated US Cancer Deaths Prevented With Increased Use of Lung, Colorectal, Breast, and Cervical Cancer Screening. JAMA Netw Open 2023; 6:e2344698. [PMID: 37991759 PMCID: PMC10665973 DOI: 10.1001/jamanetworkopen.2023.44698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
Importance Increased use of recommended screening could help achieve the Cancer Moonshot goal of reducing US cancer deaths. Objective To estimate the number of cancer deaths that could be prevented with a 10-percentage point increase in the use of US Preventive Services Task Force (USPSTF)-recommended screening. Design, Setting, and Participants This decision analytical model study is an extension of previous studies conducted for the USPSTF from 2018 to 2023. This study simulated contemporary cohorts of US adults eligible for lung, colorectal, breast, and cervical cancer screening. Exposures Annual low-dose computed lung tomography among eligible adults aged 50 to 80 years; colonoscopy every 10 years among adults aged 45 to 75 years; biennial mammography among female adults aged 40 to 74 years; and triennial cervical cytology screening among female adults aged 21 to 29 years, followed by human papillomavirus testing every 5 years from ages 30 to 65 years. Main Outcomes and Measures Estimated number of cancer deaths prevented with a 10-percentage point increase in screening use, assuming screening commences at the USPSTF-recommended starting age and continues throughout the lifetime. Outcomes were presented 2 ways: (1) per 100 000 and (2) among US adults in 2021; and they were expressed among the target population at the age of screening initiation. For lung cancer, estimates were among those who will also meet the smoking eligibility criteria during their lifetime. Harms from increased uptake were also reported. Results A 10-percentage point increase in screening use at the age that USPSTF recommended screening commences was estimated to prevent 226 lung cancer deaths (range across models within the cancer site, 133-332 deaths), 283 (range, 263-313) colorectal cancer deaths, 82 (range, 61-106) breast cancer deaths, and 81 (1 model; no range available) cervical cancer deaths over the lifetimes of 100 000 persons eligible for screening. These rates corresponded with an estimated 1010 (range, 590-1480) lung cancer deaths prevented, 11 070 (range, 10 280-12 250) colorectal cancer deaths prevented, 1790 (range, 1330-2310) breast cancer deaths prevented, and 1710 (no range available) cervical cancer deaths prevented over the lifetimes of eligible US residents at the recommended age to initiate screening in 2021. Increased uptake was also estimated to generate harms, including 100 000 (range, 45 000-159 000) false-positive lung scans, 6000 (range, 6000-7000) colonoscopy complications, 300 000 (range, 295 000-302 000) false-positive mammograms, and 348 000 (no range available) colposcopies over the lifetime. Conclusions and Relevance In this decision analytical model study, a 10-percentage point increase in uptake of USPSTF-recommended lung, colorectal, breast, and cervical cancer screening at the recommended starting age was estimated to yield important reductions in cancer deaths. Achieving these reductions is predicated on ensuring equitable access to screening.
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Affiliation(s)
- Amy B. Knudsen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Jane J. Kim
- Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jeanne S. Mandelblatt
- Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip E. Castle
- Division of Cancer Prevention and Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Eric J. Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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13
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Batman S, Rangeiro R, Monteiro E, Changule D, Daud S, Ribeiro M, Tsambe E, Bila C, Osman N, Carrilho C, Neves A, Atif H, De Jesus C, Mariano A, Moretti-Marques R, Vieira M, Fontes-Cintra G, Lopes A, Batware JC, Luis E, Grover S, Baker E, Fellman B, Montealegre J, Castle PE, Jeronimo J, Chiao E, Lorenzoni C, Schmeler K, Salcedo MP. Expanding Cervical Cancer Screening in Mozambique: Challenges Associated With Diagnosing and Treating Cervical Cancer. JCO Glob Oncol 2023; 9:e2300139. [PMID: 37824802 PMCID: PMC10664858 DOI: 10.1200/go.23.00139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/26/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023] Open
Abstract
PURPOSE Mozambique has one of the highest burdens of cervical cancer globally. Treatment options are few as most women present with advanced disease, and there are limited trained health professionals and health care resources. The objective of this study was to describe the outcomes of women diagnosed with invasive cancer as part of the Mozambican women undergoing cervical cancer screening with human papillomavirus (HPV) testing in conjunction with family planning services (MULHER) study. MATERIALS AND METHODS Women age 30-49 years were prospectively enrolled in the MULHER study and offered screening with primary HPV testing followed by treatment of screen-positive women with thermal ablation or excision as appropriate. Women with cervical examination findings suspicious for cancer were referred to one of the three gynecologic oncologists in the country. RESULTS Between January 2020 and January 2023, 9,014 women underwent cervical cancer screening and 30 women were diagnosed with cervical cancer. In this cohort, four patients (13.3%) had early-stage disease, 18 (60.0%) had locally advanced disease, one (3.3%) had distant metastatic disease, and seven (23.3%) did not have staging information available. Five patients (16.6%) died without receiving oncologic treatment, and seven patients (23.3%) are still awaiting treatment. Of the remaining 18 patients, three (17.6%) underwent surgery and four (23.5%) received radiotherapy. Eleven (36.7%) patients received only chemotherapy. CONCLUSION As cervical screening programs are implemented in low-resource settings, there will likely be an increase in the number of women diagnosed with invasive cervical cancer. Our results in Mozambique demonstrate the need to increase access to advanced surgery, radiation, and palliative care services.
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Affiliation(s)
- Samantha Batman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Siro Daud
- Maputo Central Hospital, Maputo, Mozambique
| | | | | | - Celso Bila
- Maputo Central Hospital, Maputo, Mozambique
| | | | | | - Andrea Neves
- Jose Macamo General Hospital, Maputo, Mozambique
| | - Hira Atif
- Maputo Central Hospital, Maputo, Mozambique
| | | | | | | | | | | | - Andre Lopes
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | - Ellen Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bryan Fellman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Elizabeth Chiao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Mila P. Salcedo
- The University of Texas MD Anderson Cancer Center, Houston, TX
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14
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Kundrod KA, Jeronimo J, Vetter B, Maza M, Murenzi G, Phoolcharoen N, Castle PE. Toward 70% cervical cancer screening coverage: Technical challenges and opportunities to increase access to human papillomavirus (HPV) testing. PLOS Glob Public Health 2023; 3:e0001982. [PMID: 37585432 PMCID: PMC10431663 DOI: 10.1371/journal.pgph.0001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The World Health Organization (WHO) has called for the elimination of cervical cancer as a public health problem. Cervical cancer screening through human papillomavirus (HPV) testing is a core component of the strategy for elimination, with a set target of screening 70% of women twice in their lifetimes. In this review, we discuss technical barriers and opportunities to increase HPV screening globally.
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Affiliation(s)
- Kathryn A. Kundrod
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Jose Jeronimo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Beatrice Vetter
- FIND, the Global Alliance for Diagnostics, Geneva, Switzerland
| | - Mauricio Maza
- Department of Noncommunicable Diseases and Mental Health, Unit of Noncommunicable Diseases, Violence and Injury Prevention, Pan American Health Organization, Washington, DC, United States of America
| | - Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Research for Development Rwanda and Rwanda Military Hospital, Kigali, Rwanda
| | - Natacha Phoolcharoen
- Faculty of Medicine, Department of Obstetrics and Gynecology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, United States of America
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15
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Cuzick J, Adcock R, Kinney W, Castle PE, Robertson M, McDonald RM, Stoler MH, Du R, Wheeler CM. Impact of HPV testing in opportunistic cervical screening: Support for primary HPV screening in the United States. Int J Cancer 2023; 153:83-93. [PMID: 36946690 PMCID: PMC10639031 DOI: 10.1002/ijc.34519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
Human papillomavirus (HPV) testing for cervical screening increases diagnosis of precancer and reduces the incidence of cervical cancer more than cytology alone. However, real-world evidence from diverse practice settings is lacking for the United States (U.S.) to support clinician adoption of primary HPV screening. Using a population-based registry, which captures all cervical cytology (with or without HPV testing) and all cervical biopsies, we conducted a real-world evidence study of screening in women aged 30 to 64 years across the entire state of New Mexico. Negative cytology was used to distinguish cotests from reflex HPV tests. A total of 264 198 cervical screening tests (with exclusions based on clinical history) were recorded as the first screening test between 2014 and 2017. Diagnoses of cervical intraepithelial neoplasia grades 2 or 3 or greater (CIN2+, CIN3+) from 2014 to 2019 were the main outcomes. Of cytology-negative screens, 165 595 (67.1%) were cotests and 4.8% of these led to biopsy within 2 years vs 3.2% in the cytology-only group. Among cytology-negative, HPV tested women, 347 of 398 (87.2%) CIN2+ cases were diagnosed in HPV-positive women, as were 147 of 164 (89.6%) CIN3+ cases. Only 29/921 (3.2%) CIN3+ and 67/1964 (3.4%) CIN2+ cases were diagnosed in HPV-negative, cytology-positive women with biopsies. Under U.S. opportunistic screening, across a diversity of health care delivery practices, and in a population suffering multiple disparities, we show adding HPV testing to cytology substantially increased the yield of CIN2+ and CIN3+. CIN3+ was rarely diagnosed in HPV-negative women with abnormal cytology, supporting U.S. primary HPV-only screening.
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Affiliation(s)
- Jack Cuzick
- Centre for Prevention, Diagnosis and Detection, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rachael Adcock
- Centre for Prevention, Diagnosis and Detection, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Center for HPV Prevention, UNM Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | | | - Philip E. Castle
- Division of Cancer Prevention and Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Michael Robertson
- Center for HPV Prevention, UNM Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Ruth M. McDonald
- Center for HPV Prevention, UNM Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Mark H. Stoler
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ruofei Du
- Center for HPV Prevention, UNM Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Cosette M. Wheeler
- Center for HPV Prevention, UNM Comprehensive Cancer Center, Albuquerque, New Mexico, USA
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16
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Kundrod KA, Barra M, Wilkinson A, Smith CA, Natoli ME, Chang MM, Coole JB, Santhanaraj A, Lorenzoni C, Mavume C, Atif H, Montealegre JR, Scheurer ME, Castle PE, Schmeler KM, Richards-Kortum RR. An integrated isothermal nucleic acid amplification test to detect HPV16 and HPV18 DNA in resource-limited settings. Sci Transl Med 2023; 15:eabn4768. [PMID: 37343083 PMCID: PMC10566637 DOI: 10.1126/scitranslmed.abn4768] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/01/2023] [Indexed: 06/23/2023]
Abstract
High-risk human papillomavirus (HPV) DNA testing is widely acknowledged as the most sensitive cervical cancer screening method but has limited availability in resource-limited settings, where the burden of cervical cancer is highest. Recently, HPV DNA tests have been developed for use in resource-limited settings, but they remain too costly for widespread use and require instruments that are often limited to centralized laboratories. To help meet the global need for low-cost cervical cancer screening, we developed a prototype, sample-to-answer, point-of-care test for HPV16 and HPV18 DNA. Our test relies on isothermal DNA amplification and lateral flow detection, two technologies that reduce the need for complex instrumentation. We integrated all test components into a low-cost, manufacturable platform, and performance of the integrated test was evaluated with synthetic samples, provider-collected clinical samples in a high-resource setting in the United States, and self-collected clinical samples in a low-resource setting in Mozambique. We demonstrated a clinically relevant limit of detection of 1000 HPV16 or HPV18 DNA copies per test. The test requires six user steps, yields results in 45 min, and can be performed using a benchtop instrument and minicentrifuge by minimally trained personnel. The projected per-test cost is <$5, and the projected instrumentation cost is <$1000. These results show the feasibility of a sample-to-answer, point-of-care HPV DNA test. With the inclusion of other HPV types, this test has the potential to fill a critical gap for decentralized and globally accessible cervical cancer screening.
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Affiliation(s)
- Kathryn A Kundrod
- Department of Bioengineering, Rice University, Houston, TX, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Maria Barra
- Department of Bioengineering, Rice University, Houston, TX, USA
| | | | - Chelsey A Smith
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Mary E Natoli
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Megan M Chang
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Jackson B Coole
- Department of Bioengineering, Rice University, Houston, TX, USA
| | | | - Cesaltina Lorenzoni
- Ministério da Saúde de Moçambique (MISAU), Hospital Central de Maputo, Hospital Geral de Mavalane, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Celda Mavume
- Ministério da Saúde de Moçambique (MISAU), Hospital Central de Maputo, Hospital Geral de Mavalane, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Hira Atif
- Ministério da Saúde de Moçambique (MISAU), Hospital Central de Maputo, Hospital Geral de Mavalane, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | | | - Michael E Scheurer
- Department of Pediatrics-Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Schiffman M, Mirabello L, Egemen D, Befano B, Xiao Y, Wentzensen N, Raine-Bennett T, Nayar R, Cheung LC, Rositch A, Beaty T, Perkins RB, de Sanjose S, Lorey T, Castle PE, Burk RD. The combined finding of HPV 16, 18, or 45 and cytologic Atypical Glandular Cells (AGC) indicates a greatly elevated risk of in situ and invasive cervical adenocarcinoma. Gynecol Oncol 2023; 174:253-261. [PMID: 37243996 DOI: 10.1016/j.ygyno.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Cervical screening has not effectively controlled cervical adenocarcinoma (AC). Human papillomavirus (HPV) testing is recommended for cervical screening but the optimal management of HPV-positive individuals to prevent AC remains a question. Cytology and HPV typing are two triage options to predict the risk of AC. We combined two potential biomarkers (atypical glandular cell, AGC, cytology and HPV-types 16, 18, or 45) to assess their joint effect on detecting AC. METHODS Kaiser Permanente Northern California (KPNC) used triennial co-testing with cytology and HPV testing (positive/negative) for routine cervical screening between 2003 and 2020. HPV typing of a sample of residual HPV test specimens was performed on a separate cohort selected from KPNC (Persistence and Progression, PaP, cohort). We compared risk of prevalent and incident histologic AC/AIS (adenocarcinoma in situ) associated with preceding combinations of cytologic results and HPV typing. Risk of squamous cell cancer (SCC)/cervical intraepithelial neoplasia grade 3 (CIN3) (SCC/CIN3) was also included for comparison. RESULTS Among HPV-positive individuals in PaP cohort, 99% of prevalent AC and 96% of AIS were linked to HPV-types 16, 18, or 45 (denoted HPV 16/18/45). Although rare (0.09% of screening population), the concurrent detection of HPV 16/18/45 with AGC cytology predicted a highly elevated relative risk of underlying histologic AC/AIS; the absolute risk of diagnosing AC/AIS was 12% and odds ratio (OR) was 1341 (95%CI:495-3630) compared to patients with other high-risk HPV types and normal cytology. Cumulatively (allowing non-concurrent results), approximately one-third of the AC/AIS cases ever had HPV 16/18/45 and AGC cytology (OR = 1785; 95%CI:872-3656). AGC was not as strongly associated with SCC/CIN3. CONCLUSION Detection of HPV 16/18/45 positivity elevates risk of adenocarcinoma, particularly if AGC cytology is also found.
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Affiliation(s)
- Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Didem Egemen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Brian Befano
- Information Management Services Inc, Calverton, MD, USA
| | - Yanzi Xiao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Tina Raine-Bennett
- Women's Health Research Institute, Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ritu Nayar
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Anne Rositch
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Terri Beaty
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca B Perkins
- Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Silvia de Sanjose
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; ISGlobal, Barcelona, Spain
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Robert D Burk
- Departments of Pediatrics, Microbiology & Immunology, Epidemiology & Population Health, and Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Etzioni R, Castle PE. Shopping for New Cancer Screening Tests. J Clin Oncol 2023; 41:2471-2473. [PMID: 36862969 PMCID: PMC10414693 DOI: 10.1200/jco.23.00240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 03/04/2023] Open
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Castle PE. Prophylactic human papillomavirus vaccination for prevention of oropharyngeal cancer in older men: is the juice worth the squeeze? J Natl Cancer Inst 2023; 115:349-351. [PMID: 36782371 PMCID: PMC10086616 DOI: 10.1093/jnci/djad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
- Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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20
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Minasian LM, Pinsky P, Katki HA, Dickherber T, Han PKJ, Harris L, Patriotis C, Srivastava S, Weil CJ, Prorok PC, Castle PE. Study design considerations for trials to evaluate multicancer early detection assays for clinical utility. J Natl Cancer Inst 2023; 115:250-257. [PMID: 36458902 PMCID: PMC9996206 DOI: 10.1093/jnci/djac218] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/08/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Blood-based assays using various technologies and biomarkers are in commercial development for the purpose of detecting multiple cancer types concurrently at an early stage of disease. These multicancer early detection (MCED) assays have the potential to improve the detection of cancers, particularly those for which no current screening modality exists. However, the unknown clinical benefits and harms of using MCED assays for cancer screening necessitate the development and implementation of a randomized controlled trial (RCT) to ascertain their clinical effectiveness. This was the consensus of experts at a National Cancer Institute-hosted workshop to discuss initial design concepts for such a trial. Using these assays to screen simultaneously for multiple cancers poses novel uncertainties for patient care compared with conventional screening tests for single cancers, such as establishing the diagnostic workup to confirm the presence of cancer at any organ site; clarifying appropriate follow-up for a positive assay for which there is no definitive diagnosis; identifying potential harms such as overdiagnosis of indolent disease; determining clinically effective and efficient strategies for disseminating MCED screening in real-world practice; and understanding the ethical implications, such as potentially alleviating or exacerbating existing health disparities. These assays present new and complex challenges for designing an RCT. Issues that emerged from the meeting centered around the need for a flexibly designed, clinical utility RCT to rigorously capture the evidence required to fully understand the net benefit of this promising technology. Specific topic areas were endpoints, screening protocols, recruitment, diagnostic pathway, pilot phase, data elements, specimen collection, and ethical considerations.
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Affiliation(s)
- Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Paul Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Bethesda, MD, USA
| | - Tony Dickherber
- Center for Scientific Strategic Initiatives, National Cancer Institute, Bethesda, MD, USA
| | - Paul K J Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Lyndsay Harris
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Christos Patriotis
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Sudhir Srivastava
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Carol J Weil
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Philip C Prorok
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
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21
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Doubeni CA, Castle PE. Multicancer Early Detection: A Promise Yet to Be Proven. Am Fam Physician 2023; 107:224-225A. [PMID: 36920808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Chyke A Doubeni
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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22
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Landy R, Wang VL, Baldwin DR, Pinsky PF, Cheung LC, Castle PE, Skarzynski M, Robbins HA, Katki HA. Recalibration of a Deep Learning Model for Low-Dose Computed Tomographic Images to Inform Lung Cancer Screening Intervals. JAMA Netw Open 2023; 6:e233273. [PMID: 36929398 PMCID: PMC10020880 DOI: 10.1001/jamanetworkopen.2023.3273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/31/2023] [Indexed: 03/18/2023] Open
Abstract
Importance Annual low-dose computed tomographic (LDCT) screening reduces lung cancer mortality, but harms could be reduced and cost-effectiveness improved by reusing the LDCT image in conjunction with deep learning or statistical models to identify low-risk individuals for biennial screening. Objective To identify low-risk individuals in the National Lung Screening Trial (NLST) and estimate, had they been assigned a biennial screening, how many lung cancers would have been delayed 1 year in diagnosis. Design, Setting, and Participants This diagnostic study included participants with a presumed nonmalignant lung nodule in the NLST between January 1, 2002, and December 31, 2004, with follow-up completed on December 31, 2009. Data were analyzed for this study from September 11, 2019, to March 15, 2022. Exposures An externally validated deep learning algorithm that predicts malignancy in current lung nodules using LDCT images (Lung Cancer Prediction Convolutional Neural Network [LCP-CNN]; Optellum Ltd) was recalibrated to predict 1-year lung cancer detection by LDCT for presumed nonmalignant nodules. Individuals with presumed nonmalignant lung nodules were hypothetically assigned annual vs biennial screening based on the recalibrated LCP-CNN model, Lung Cancer Risk Assessment Tool (LCRAT + CT [a statistical model combining individual risk factors and LDCT image features]), and the American College of Radiology recommendations for lung nodules, version 1.1 (Lung-RADS). Main Outcomes and Measures Primary outcomes included model prediction performance, the absolute risk of a 1-year delay in cancer diagnosis, and the proportion of people without lung cancer assigned a biennial screening interval vs the proportion of cancer diagnoses delayed. Results The study included 10 831 LDCT images from patients with presumed nonmalignant lung nodules (58.7% men; mean [SD] age, 61.9 [5.0] years), of whom 195 were diagnosed with lung cancer from the subsequent screen. The recalibrated LCP-CNN had substantially higher area under the curve (0.87) than LCRAT + CT (0.79) or Lung-RADS (0.69) to predict 1-year lung cancer risk (P < .001). If 66% of screens with nodules were assigned to biennial screening, the absolute risk of a 1-year delay in cancer diagnosis would have been lower for recalibrated LCP-CNN (0.28%) than LCRAT + CT (0.60%; P = .001) or Lung-RADS (0.97%; P < .001). To delay only 10% of cancer diagnoses at 1 year, more people would have been safely assigned biennial screening under LCP-CNN than LCRAT + CT (66.4% vs 40.3%; P < .001). Conclusions and Relevance In this diagnostic study evaluating models of lung cancer risk, a recalibrated deep learning algorithm was most predictive of 1-year lung cancer risk and had least risk of 1-year delay in cancer diagnosis among people assigned biennial screening. Deep learning algorithms could prioritize people for workup of suspicious nodules and decrease screening intensity for people with low-risk nodules, which may be vital for implementation in health care systems.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Vivian L. Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - David R. Baldwin
- School of Medicine, Nottingham University Hospitals and the University of Nottingham, Nottingham, United Kingdom
| | - Paul F. Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Martin Skarzynski
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Hilary A. Robbins
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Hormuzd A. Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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23
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Costa S, Verberckmoes B, Castle PE, Arbyn M. Offering HPV self-sampling kits: an updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening. Br J Cancer 2023; 128:805-813. [PMID: 36517552 PMCID: PMC9977737 DOI: 10.1038/s41416-022-02094-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) testing on self-samples represents a great opportunity to increase cervical cancer screening uptake among under-screened women. METHODS A systematic review and meta-analysis on randomised controlled trials (RCTs) were performed to update the evidence on the efficacy of strategies for offering self-sampling kits for HPV testing compared to conventional invitations and to compare different self-sampling invitation scenarios. Four experimental invitational scenarios were considered. Women in the control group were invited for screening according to existing practice: collection of a cervical specimen by a healthcare professional. Random-effects models were used to pool proportions, relative participation rates and absolute participation differences. RESULTS Thirty-three trials were included. In the intention-to-treat analysis, all self-sampling invitation scenarios were more effective in reaching under-screened women compared to controls. Pooled participation difference (PD) and 95% confidence interval (CI) for experimental vs. control was 13.2% (95% CI = 11.0-15.3%) for mail-to-all, 4.4% (95% CI = 1.2-7.6%) for opt-in, 39.1% (95% CI = 8.4-69.9%) for community mobilisation & outreach and 28.1% (23.5-32.7%) for offer at healthcare service. PD for the comparison opt-in vs. mail-to-all, assessed in nine trials, was -8.2% (95% CI = -10.8 to -5.7%). DISCUSSION Overall, screening participation was higher among women invited for self-sampling compared to control, regardless of the invitation strategy used. Opt-in strategies were less effective than send-to-all strategies.
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Affiliation(s)
- Stefanie Costa
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Bo Verberckmoes
- International Centre for Reproductive Health, Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Cohen CM, Wentzensen N, Castle PE, Schiffman M, Zuna R, Arend RC, Clarke MA. Racial and Ethnic Disparities in Cervical Cancer Incidence, Survival, and Mortality by Histologic Subtype. J Clin Oncol 2023; 41:1059-1068. [PMID: 36455190 PMCID: PMC9928618 DOI: 10.1200/jco.22.01424] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/26/2022] [Accepted: 10/27/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE We conducted an integrated population-based analysis of histologic subtype-specific cervical cancer incidence, survival, and incidence-based mortality by race and ethnicity, with correction for hysterectomy prevalence. METHODS Using the SEER 21 and 18 registries, we selected primary cases of malignant cervical cancer diagnosed among women ≥ 15 years. We evaluated age-adjusted incidence rates among cases diagnosed between 2000 and 2018 (SEER21) and incidence-based mortality rates among deaths from 2005 to 2018 (SEER18), per 100,000 person-years. Rates were stratified by histologic subtype and race/ethnicity (incidence and mortality), and stage, age at diagnosis, and county-level measures of social determinants of health (incidence only). Incidence and mortality rates were corrected for hysterectomy using data from the Behavioral Risk Factor Surveillance System. We estimated 5-year relative survival by histologic subtype and stratified by stage at diagnosis. RESULTS Incidence rates of cervical squamous cell carcinoma were highest in Black and Hispanic women, while incidence rates of cervical adenocarcinoma (ADC) were highest among Hispanic and White women, particularly for localized ADC. County-level income and education variables were inversely associated with squamous cell carcinoma incidence rates in all racial and ethnic groups but had less influence on ADC incidence rates. Black women had the highest overall mortality rates and lowest 5-year relative survival, irrespective of subtype and stage. Disparities in survival were particularly pronounced for Black women with regional and distant ADC, compared with other racial/ethnic groups. CONCLUSION Although Black women are less likely to be diagnosed with ADC compared with all other racial/ethnic groups, they experience the highest mortality rates for this subtype, likely attributed to the poor survival observed for Black women with regional and distant ADC.
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Affiliation(s)
- Camryn M. Cohen
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Philip E. Castle
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD
| | - Mark Schiffman
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Rosemary Zuna
- Department of Pathology, College of Medicine, University of Oklahoma, Oklahoma City, OK
| | - Rebecca C. Arend
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Megan A. Clarke
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
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25
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Arbyn M, Costa S, Latsuzbaia A, Kellen E, Girogi Rossi P, Cocuzza CE, Basu P, Castle PE. HPV-based Cervical Cancer Screening on Self-samples in the Netherlands: Challenges to Reach Women and Test Performance Questions. Cancer Epidemiol Biomarkers Prev 2023; 32:159-163. [PMID: 36744312 DOI: 10.1158/1055-9965.epi-22-1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 02/07/2023] Open
Abstract
In 2017, cervical cancer screening in the Netherlands switched from cytology to human papillomavirus (HPV) testing using the validated PCR-based cobas 4800. Women could order and subsequently received a free self-sampling kit (Evalyn Brush) at their home address instead of clinician sampling. In the laboratory, the shipped brush was placed into 20 mL of PreservCyt fluid, before testing. In the first 2 years of the new program, only 7% of screening tests were performed on a self-sample. Those who chose self-sampling versus clinician sampling were more likely to have never been screened previously and differed also with respect to sociodemographic factors. Subsequent more active promotion and increasing the ease to obtain kits increased the proportion opting for self-sampling (16% in 2020). HPV positivity and detection rate of precancer (CIN3+) were lower in the self-sampling compared with the clinician-sampling group (adjusted ORs of 0.65 and 0.86, respectively). Although population differences may partially explain these results, self-samples may have been too dilute, thereby reducing the analytic and clinical sensitivity. The Dutch findings demonstrate the importance of optimizing outreach, specimen handling and testing protocols for self-samples to effectively screen the target population and reach in particular the women at highest risk for cervical cancer. See related article by Aitken et al., p. 183.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stefanie Costa
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Ardashel Latsuzbaia
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | | | - Paolo Girogi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Partha Basu
- International Agency for Research in Cancer, Lyon, France
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, NCI, Rockville, Maryland
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Velentzis LS, Hawkes D, Caruana M, Brotherton JML, Smith MA, Roeske L, Karim KA, Garland SM, Wrede CD, Tan J, Wheeler C, Castle PE, Saville M, Canfell K. Exploring monitoring strategies for population surveillance of HPV vaccine impact using primary HPV screening. Tumour Virus Res 2023; 15:200255. [PMID: 36736490 PMCID: PMC9925607 DOI: 10.1016/j.tvr.2023.200255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
Australia's cervical screening program transitioned from cytology to HPV-testing with genotyping for HPV16/18 in Dec'2017. We investigated whether program data could be used to monitor HPV vaccination program impact (commenced in 2007) on HPV16/18 prevalence and compared estimates with pre-vaccination benchmark prevalence. Pre-vaccination samples (2005-2008) (n = 1933; WHINURS), from 25 to 64-year-old women had been previously analysed with Linear Array (LA). Post-vaccination samples (2013-2014) (n = 2989; Compass pilot), from 25 to 64-year-old women, were analysed by cobas 4800 (cobas), and by LA for historical comparability. Age standardised pre-vaccination HPV16/18 prevalence was 4.85% (95%CI:3.81-5.89) by LA; post-vaccination estimates were 1.67% (95%CI:1.21-2.13%) by LA, 1.49% (95%CI:1.05-1.93%) by cobas, and 1.63% (95%CI:1.17-2.08%) for cobas and LA testing of non-16/18 cobas positives (cobas/LA). Age-standardised pre-vaccination oncogenic HPV prevalence was 15.70% (95%CI:13.79-17.60%) by LA; post-vaccination estimates were 9.06% (95%CI:8.02-10.09%) by LA, 8.47% (95%CI:7.47-9.47%) by cobas and cobas/LA. Standardised rate ratios between post-vs. pre-vaccination rates were significantly different for HPV16/18, non-16/18 HPV and oncogenic HPV: 0.34 (95%CI:0.23-0.50), 0.68 (95%CI:0.55-0.84) and 0.58 (95%CI:0.48-0.69), respectively. Additional strategies (LA for all cobas positives; combined cobas and LA results on all samples) had similar results. If a single method is applied consistently, it will provide important data on relative changes in HPV prevalence following vaccination.
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Affiliation(s)
- Louiza S. Velentzis
- The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia,Corresponding author. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia
| | - David Hawkes
- Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia,Department of Biochemistry and Pharmacology, University of Melbourne, Victoria, Australia,Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Julia ML. Brotherton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia,Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Megan A. Smith
- The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Lara Roeske
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - Khurram A. Karim
- Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia
| | - Suzanne M. Garland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia,Centre Women's Infectious Diseases Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - C. David Wrede
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia,Department of Oncology & Dysplasia, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Jeffery Tan
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia,Department of Oncology & Dysplasia, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Cosette Wheeler
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - Philip E. Castle
- Division of Cancer Prevention, National Cancer Institute, NIH, Rockville, MD, USA,Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, 265 Faraday Street, Carlton South, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a Joint venture with Cancer Council NSW, Sydney, NSW, Australia
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Smith CA, Chang MM, Kundrod KA, Novak EN, Parra SG, López L, Mavume C, Lorenzoni C, Maza M, Salcedo MP, Carns JL, Baker E, Montealegre J, Scheurer M, Castle PE, Schmeler KM, Richards-Kortum RR. A low-cost, paper-based hybrid capture assay to detect high-risk HPV DNA for cervical cancer screening in low-resource settings. Lab Chip 2023; 23:451-465. [PMID: 36562325 PMCID: PMC9890501 DOI: 10.1039/d2lc00885h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Cervical cancer is a leading cause of cancer death for women in low-resource settings. The World Health Organization recommends that cervical cancer screening programs incorporate HPV DNA testing, but available tests are expensive, require laboratory infrastructure, and cannot be performed at the point-of-care. We developed a two-dimensional paper network (2DPN), hybrid-capture, signal amplification assay and a point-of-care sample preparation protocol to detect high-risk HPV DNA from exfoliated cervical cells within an hour. The test does not require expensive equipment and has an estimated cost of <$3 per test without the need for batching. We evaluated performance of the paper HPV DNA assay with short synthetic and genomic HPV DNA targets, HPV positive and negative cellular samples, and two sets of clinical samples. The first set of clinical samples consisted of 16 biobanked, provider-collected cervical samples from a study in El Salvador previously tested with careHPV and subsequently tested in a controlled laboratory environment. The paper HPV DNA test correctly identified eight of eight HPV-negative clinical samples and seven of eight HPV-positive clinical samples. We then performed a field evaluation of the paper HPV DNA test in a hospital laboratory in Mozambique. Cellular controls generated expected results throughout field testing with fully lyophilized sample preparation and 2DPN reagents. When evaluated with 16 residual self-collected cervicovaginal samples previously tested by the GeneXpert HPV assay ("Xpert"), the accuracy of the HPV DNA paper test in the field was reduced compared to testing in the controlled laboratory environment, with positive results obtained for all eight HPV-positive samples as well as seven of eight HPV-negative samples. Further evaluation showed reduction in performance was likely due in part to increased concentration of exfoliated cells in the self-collected clinical samples from Mozambique compared with provider-collected samples from El Salvador. Finally, a formal usability assessment was conducted with users in El Salvador and Mozambique; the assay was rated as acceptable to perform after minimal training. With additional optimization for higher cell concentrations and inclusion of an internal cellular control, the paper HPV DNA assay offers promise as a low-cost, point-of-care cervical cancer screening test in low-resource settings.
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Affiliation(s)
- Chelsey A Smith
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | - Megan M Chang
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | | | - Emilie N Novak
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | - Sonia G Parra
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | - Leticia López
- Basic Health International, San Salvador, El Salvador
| | | | - Cesaltina Lorenzoni
- Hospital Central de Maputo, Maputo, Mozambique
- Ministerio da Saude de Moçambique (MISAU), Maputo, Mozambique
| | - Mauricio Maza
- Basic Health International, San Salvador, El Salvador
| | - Mila P Salcedo
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer L Carns
- Department of Bioengineering, Rice University, Houston, TX, USA.
| | - Ellen Baker
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jane Montealegre
- Department of Pediatrics-Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Michael Scheurer
- Department of Pediatrics-Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Castle PE, Wentzensen N. Clarifying the Equivocal Diagnosis of Cervical Intraepithelial Neoplasia 2: Still a Work in Progress. J Clin Oncol 2023; 41:419-420. [PMID: 36126232 PMCID: PMC9839263 DOI: 10.1200/jco.22.01268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Philip E. Castle
- Philip E. Castle, PhD, MPH, Division of Cancer Prevention, US National Cancer Institute, Rockville, MD, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD; and Nicolas Wentzensen, MD, PhD, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD
| | - Nicolas Wentzensen
- Philip E. Castle, PhD, MPH, Division of Cancer Prevention, US National Cancer Institute, Rockville, MD, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD; and Nicolas Wentzensen, MD, PhD, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD
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29
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Salcedo MP, Gowen R, Rodriguez AM, Fisher-Hoch S, Daheri M, Guerra L, Toscano PA, Gasca M, Morales J, Reyna-Rodriguez FE, Cavazos B, Marin E, Perez C, Guerra M, Milbourne A, Varon ML, Reininger B, Fernandez ME, Ogburn T, Castle PE, McCormick J, Baker E, Hawk E, Schmeler KM. Addressing high cervical cancer rates in the Rio Grande Valley along the Texas-Mexico border: a community-based initiative focused on education, patient navigation, and medical provider training/telementoring. Perspect Public Health 2023; 143:22-28. [PMID: 34130548 DOI: 10.1177/1757913921994610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS Cervical cancer incidence and mortality rates are approximately 55% higher in the Rio Grande Valley (RGV) along the Texas-Mexico border compared with the average rates in the US. Our aim was to improve cervical cancer prevention efforts in the RGV through a comprehensive multilevel intervention initiative focused on community education, patient navigation, and training of local providers. METHODS We initiated a program in the RGV which consisted of (1) community education, (2) patient navigation, and (3) a training/mentoring program for local medical providers including hands-on training courses coupled with telementoring using Project ECHO® (Extension for Community Health Outcomes). We assessed the number of women undergoing cervical cancer screening, diagnosis, and treatment at three participating clinics caring for underserved women in the region. RESULTS From November 2014 to October 2018, 14,846 women underwent cervical cancer screening. A total of 2030 (13.7%) women underwent colposcopy for abnormal results (179% increase over baseline) and 453 women underwent loop electrosurgical excision procedures (LEEPs) for treatment of cervical dysplasia. Invasive cancer was diagnosed in 39 women who were navigated to a gynecologic oncologist for treatment. Seven local medical providers were trained to perform colposcopy and/or LEEP. Project ECHO telementoring videoconferences were held every 2 weeks for a total 101 sessions with an average of 22 participants per session and a total of 180 patient cases presented and discussed. CONCLUSIONS Our program led to a large number of women undergoing diagnosis and treatment of cervical dysplasia in the RGV. If sustained, we anticipate these efforts will decrease cervical cancer rates in the region. The program is currently being expanded to additional underserved areas of Texas and globally to low- and middle-income countries.
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Affiliation(s)
- M P Salcedo
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Federal University of Health Sciences of Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - R Gowen
- Su Clínica, Brownsville, TX, USA
| | - A M Rodriguez
- The University of Texas Medical Branch, Galveston, TX, USA
| | - S Fisher-Hoch
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M Daheri
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - L Guerra
- Su Clínica, Brownsville, TX, USA
| | - P A Toscano
- UTHealth McGovern Medical School, Houston, TX, USA
| | - M Gasca
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - J Morales
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | | | | | - E Marin
- Su Clínica, Brownsville, TX, USA
| | - C Perez
- Su Clínica, Brownsville, TX, USA
| | - M Guerra
- The University of Texas Medical Branch, Galveston, TX, USA
| | - A Milbourne
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M L Varon
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Reininger
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M E Fernandez
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - T Ogburn
- The University of Texas Rio Grande Valley Medical School, Edinburg, TX, USA
| | - P E Castle
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - J McCormick
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Hawk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Unit 1362, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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30
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Zary N, Campbell S, Støer NC, Castle PE, Sen S, Tropé A, Adedimeji A, Nygård M. Impact of the Mobile Game FightHPV on Cervical Cancer Screening Attendance: Retrospective Cohort Study. JMIR Serious Games 2022; 10:e36197. [PMID: 36512401 PMCID: PMC9795393 DOI: 10.2196/36197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/16/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The wide availability of mobile phones has made it easy to disseminate health-related information and make it accessible. With gamification, mobile apps can nudge people to make informed health choices, including attending cervical cancer screening. OBJECTIVE This matched retrospective cohort study examined the association between exposure to the FightHPV mobile app gamified educational content and having a cervical exam in the following year. METHODS Women aged 20 to 69 years who signed an electronic consent form after downloading the FightHPV app in 2017 (intervention group) were matched 1:6 with women of the same age and with the same screening history (reference group) in 2015. To estimate the impact of exposure to the FightHPV app, we estimated cumulative incidence and hazard ratios (HRs) with 95% CIs. We used data from the Norwegian Cervical Cancer Screening Program database and Statistics Norway to determine screening participation and outcomes, respectively. RESULTS We matched 3860 women in the control group to 658 women in the intervention group; 6 months after enrollment, 29.6% (195/658) of the women in the intervention group and 15.21% (587/3860) of those in the reference group underwent a cervical exam (P<.01). Women exposed to the FightHPV app were 2 times more likely to attend screening (adjusted HR 2.3, 95% CI 2.0-2.7), during which they were 13 times more likely to be diagnosed with high-grade abnormality (adjusted HR 12.7, 95% CI 5.0-32.5) than the women in the reference group. CONCLUSIONS Exposure to the FightHPV app significantly increased cervical cancer screening attendance across the various analyses and improved detection of women with high risk for cervical cancer. For the first time, we demonstrated the effectiveness of gamification combined with mobile technology in cancer prevention by empowering women to make active health-related decisions. Gamification can significantly improve the understanding of complicated scientific concepts behind interventions and increase the acceptance of proposed cancer control measures.
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Affiliation(s)
| | | | - Nathalie C Støer
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Norwegian Research Centre for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | | | - Ameli Tropé
- Section for Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, United States
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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31
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Murangwa A, Desai KT, Gage JC, Murenzi G, Tuyisenge P, Kanyabwisha F, Musafili A, Kubwimana G, Mutesa L, Anastos K, Kim HY, Castle PE. Agreement between Xpert and AmpFire tests for high-risk human papillomavirus among HIV-positive women in Rwanda. Afr J Lab Med 2022; 11:1827. [PMID: 36353194 PMCID: PMC9639372 DOI: 10.4102/ajlm.v11i1.1827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/26/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND High-risk human papillomavirus (hrHPV) may cause more than 99% of cervical cancers worldwide. Little is known about performance differences in tests for hrHPV. OBJECTIVE This study analysed agreement for detection of hrHPV between the established, clinically validated Xpert HPV assay and the novel isothermal amplification-based AmpFire HPV genotyping assay. METHODS This study was nested in a larger project on cervical cancer screening among approximately 5000 women living with HIV in Kigali, Rwanda. This sub-study included 298 participants who underwent initial screening for cervical cancer using the Xpert HPV assay and visual inspection with acetic acid in 2017 and tested positive by either or both. Participants were rescreened using colposcopy, and cervical samples were collected between June 2018 and June 2019. Samples were then tested for HPV using the Xpert HPV assay and AmpFire HPV genotyping assay. Agreement between results from both tests was analysed using an exact version of McNemar test and chi-square test. RESULTS Overall agreement and kappa value for detection of hrHPV by Xpert and AmpFire were 89% and 0.77 (95% confidence interval: 0.70-0.85). AmpFire was marginally more likely to diagnose hrHPV-positive than Xpert (p = 0.05), due primarily to the extra positivity for HPV16 (p < 0.001). CONCLUSION Overall, there was good to excellent agreement between the Xpert and AmpFire when testing hrHPV types among women living with HIV. AmpFire was more likely to test extra cases of HPV16, the most carcinogenic HPV type, but the clinical meaning of detecting additional HPV16 infections remains unknown.
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Affiliation(s)
| | - Kanan T. Desai
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, United States
| | - Julia C. Gage
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, United States
| | | | | | | | - Aimable Musafili
- Department of Paediatrics and Child Health, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gallican Kubwimana
- Rwanda Military Hospital, Kigali, Rwanda
- Research for Development (RD Rwanda), Kigali, Rwanda
| | - Leon Mutesa
- Research for Development (RD Rwanda), Kigali, Rwanda
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Health Systems, Bronx, New York, United States
| | - Hae-Young Kim
- Department of Public Health, New York Medical College, Valhalla, New York, United States
| | - Philip E. Castle
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, United States
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland, United States
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32
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Hughes SM, Levy CN, Katz R, Lokken EM, Anahtar MN, Hall MB, Bradley F, Castle PE, Cortez V, Doncel GF, Fichorova R, Fidel PL, Fowke KR, Francis SC, Ghosh M, Hwang LY, Jais M, Jespers V, Joag V, Kaul R, Kyongo J, Lahey T, Li H, Makinde J, McKinnon LR, Moscicki AB, Novak RM, Patel MV, Sriprasert I, Thurman AR, Yegorov S, Mugo NR, Roxby AC, Micks E, Hladik F. Changes in concentrations of cervicovaginal immune mediators across the menstrual cycle: a systematic review and meta-analysis of individual patient data. BMC Med 2022; 20:353. [PMID: 36195867 PMCID: PMC9533580 DOI: 10.1186/s12916-022-02532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/16/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hormonal changes during the menstrual cycle play a key role in shaping immunity in the cervicovaginal tract. Cervicovaginal fluid contains cytokines, chemokines, immunoglobulins, and other immune mediators. Many studies have shown that the concentrations of these immune mediators change throughout the menstrual cycle, but the studies have often shown inconsistent results. Our understanding of immunological correlates of the menstrual cycle remains limited and could be improved by meta-analysis of the available evidence. METHODS We performed a systematic review and meta-analysis of cervicovaginal immune mediator concentrations throughout the menstrual cycle using individual participant data. Study eligibility included strict definitions of the cycle phase (by progesterone or days since the last menstrual period) and no use of hormonal contraception or intrauterine devices. We performed random-effects meta-analyses using inverse-variance pooling to estimate concentration differences between the follicular and luteal phases. In addition, we performed a new laboratory study, measuring select immune mediators in cervicovaginal lavage samples. RESULTS We screened 1570 abstracts and identified 71 eligible studies. We analyzed data from 31 studies, encompassing 39,589 concentration measurements of 77 immune mediators made on 2112 samples from 871 participants. Meta-analyses were performed on 53 immune mediators. Antibodies, CC-type chemokines, MMPs, IL-6, IL-16, IL-1RA, G-CSF, GNLY, and ICAM1 were lower in the luteal phase than the follicular phase. Only IL-1α, HBD-2, and HBD-3 were elevated in the luteal phase. There was minimal change between the phases for CXCL8, 9, and 10, interferons, TNF, SLPI, elafin, lysozyme, lactoferrin, and interleukins 1β, 2, 10, 12, 13, and 17A. The GRADE strength of evidence was moderate to high for all immune mediators listed here. CONCLUSIONS Despite the variability of cervicovaginal immune mediator measurements, our meta-analyses show clear and consistent changes during the menstrual cycle. Many immune mediators were lower in the luteal phase, including chemokines, antibodies, matrix metalloproteinases, and several interleukins. Only interleukin-1α and beta-defensins were higher in the luteal phase. These cyclical differences may have consequences for immunity, susceptibility to infection, and fertility. Our study emphasizes the need to control for the effect of the menstrual cycle on immune mediators in future studies.
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Affiliation(s)
- Sean M Hughes
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Claire N Levy
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Erica M Lokken
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Melis N Anahtar
- Ragon Institute of MIT and Harvard, Massachusetts General Hospital, Boston, MA, USA
| | | | - Frideborg Bradley
- Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Valerie Cortez
- Department of Molecular, Cell & Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | | | - Raina Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul L Fidel
- Louisiana State University Health, New Orleans, LA, USA
| | - Keith R Fowke
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Mimi Ghosh
- Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Loris Y Hwang
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mariel Jais
- Office of Laboratory Safety, The George Washington University, Washington, DC, USA
| | | | - Vineet Joag
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Kyongo
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Timothy Lahey
- University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Huiying Li
- Department of Molecular and Medical Pharmacology, Crump Institute for Molecular Imaging, University of California, Los Angeles, Los Angeles, CA, USA
| | - Julia Makinde
- IAVI Human Immunology Laboratory, Imperial College, London, England, UK
- IAVI, New York, NY, USA
| | - Lyle R McKinnon
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - Anna-Barbara Moscicki
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Mickey V Patel
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Intira Sriprasert
- Department of OB/GYN, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Sergey Yegorov
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nelly Rwamba Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Alison C Roxby
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutch, Seattle, WA, USA
| | - Elizabeth Micks
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
| | - Florian Hladik
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
- Department of Medicine, University of Washington, Seattle, WA, USA.
- Vaccine and Infectious Disease Division, Fred Hutch, Seattle, WA, USA.
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Jackson SS, Marks MA, Katki HA, Cook MB, Hyun N, Freedman ND, Kahle LL, Castle PE, Graubard BI, Chaturvedi AK. Sex disparities in the incidence of 21 cancer types: Quantification of the contribution of risk factors. Cancer 2022; 128:3531-3540. [PMID: 35934938 DOI: 10.1002/cncr.34390] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/25/2022] [Accepted: 02/10/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cancer incidence is higher in men than in women at most shared anatomic sites for currently unknown reasons. The authors quantified the extent to which behaviors (smoking and alcohol use), anthropometrics (body mass index and height), lifestyles (physical activity, diet, medications), and medical history collectively explain the male predominance of risk at 21 shared cancer sites. METHODS Prospective cohort analyses (n = 171,274 male and n = 122,826 female participants; age range, 50-71 years) in the National Institutes of Health-AARP Diet and Health Study (1995-2011). Cancer-specific Cox regression models were used to estimate male-to-female hazard ratios (HRs). The degree to which risk factors explained the observed male-female risk disparity was quantified using the Peters-Belson method. RESULTS There were 26,693 incident cancers (17,951 in men and 8742 in women). Incidence was significantly lower in men than in women only for thyroid and gallbladder cancers. At most other anatomic sites, the risks were higher in men than in women (adjusted HR range, 1.3-10.8), with the strongest increases for bladder cancer (HR, 3.33; 95% confidence interval [CI], 2.93-3.79), gastric cardia cancer (HR, 3.49; 95% CI, 2.26-5.37), larynx cancer (HR, 3.53; 95% CI, 2.46-5.06), and esophageal adenocarcinoma (HR, 10.80; 95% CI, 7.33-15.90). Risk factors explained a statistically significant (nonzero) proportion of the observed male excess for esophageal adenocarcinoma and cancers of liver, other biliary tract, bladder, skin, colon, rectum, and lung. However, only a modest proportion of the male excess was explained by risk factors (ranging from 50% for lung cancer to 11% for esophageal adenocarcinoma). CONCLUSIONS Men have a higher risk of cancer than women at most shared anatomic sites. Such male predominance is largely unexplained by risk factors, underscoring a role for sex-related biologic factors.
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Affiliation(s)
- Sarah S Jackson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Morgan A Marks
- Pharmacoepidemiology Department, Merck & Company Inc., Kenilworth, New Jersey, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Michael B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Noorie Hyun
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Lisa L Kahle
- Information Management Services Inc., Calverton, Maryland, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.,Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, USA
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Adebamowo SN, Befano B, Cheung LC, Rodriguez AC, Demarco M, Rydzak G, Chen X, Porras C, Herrero R, Kim JJ, Castle PE, Wentzensen N, Kreimer AR, Schiffman M, Campos NG. Different human papillomavirus types share early natural history transitions in immunocompetent women. Int J Cancer 2022; 151:920-929. [PMID: 35603904 PMCID: PMC9329241 DOI: 10.1002/ijc.34128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/07/2022]
Abstract
Necessary stages of cervical carcinogenesis include acquisition of a carcinogenic human papillomavirus (HPV) type, persistence associated with the development of precancerous lesions, and invasion. Using prospective data from immunocompetent women in the Guanacaste HPV Natural History Study (NHS), the ASCUS-LSIL Triage Study (ALTS) and the Costa Rica HPV Vaccine Trial (CVT), we compared the early natural history of HPV types to inform transition probabilities for health decision models. We excluded women with evidence of high-grade cervical abnormalities at any point during follow-up and restricted the analysis to incident infections in all women and prevalent infections in young women (aged <30 years). We used survival approaches accounting for interval-censoring to estimate the time to clearance distribution for 20 529 HPV infections (64% were incident and 51% were carcinogenic). Time to clearance was similar across HPV types and risk classes (HPV16, HPV18/45, HPV31/33/35/52/58, HPV 39/51/56/59 and noncarcinogenic HPV types); and by age group (18-29, 30-44 and 45-54 years), among carcinogenic and noncarcinogenic infections. Similar time to clearance across HPV types suggests that relative prevalence can predict relative incidence. We confirmed that there was a uniform linear association between incident and prevalent infections for all HPV types within each study cohort. In the absence of progression to precancer, we observed similar time to clearance for incident infections across HPV types and risk classes. A singular clearance function for incident HPV infections has important implications for the refinement of microsimulation models used to evaluate the cost-effectiveness of novel prevention technologies.
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Affiliation(s)
- Sally N. Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center; University of Maryland School of Medicine, Baltimore, MD, United States
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Brian Befano
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Information Management Services Inc, Information Management, Calverton, NY, United States
| | - Li C. Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Ana Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Maria Demarco
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Greg Rydzak
- Information Management Services Inc, Information Management, Calverton, NY, United States
| | - Xiaojian Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Carolina Porras
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, San José, Costa Rica
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Jane J. Kim
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Aimée R. Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Nicole G. Campos
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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35
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Nygård M, Engesæter B, Castle PE, Berland JM, Eide ML, Iversen OE, Jonassen CM, Christiansen IK, Vintermyr OK, Tropé A. Randomized Implementation of a Primary Human Papillomavirus Testing-based Cervical Cancer Screening Protocol for Women 34 to 69 Years in Norway. Cancer Epidemiol Biomarkers Prev 2022; 31:1812-1822. [PMID: 35793700 PMCID: PMC9437559 DOI: 10.1158/1055-9965.epi-22-0340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/30/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cervical cancer screening programs are facing a programmatic shift where screening protocol based on human papillomavirus testing (HPV-Screening protocol) is replacing the liquid-based cytology (LBC-Screening protocol). For safe technology transfer within the nationwide screening programme in Norway, HPV-Screening protocol was implemented randomized to compare the real-world effectiveness of HPV-Screening protocol and LBC-Screening protocol at the first screening round. METHODS Among 302,295 women ages 34 to 69 years scheduled to attend screening from February 2015 to June 2017, 157,447 attended. A total of 77,207 were randomly allocated to the HPV-Screening protocol and 80,240 were allocated to the LBC-Screening protocol. All women were followed up for 18 months. RESULTS The HPV-Screening protocol resulted in a relative increase of 60% in the detection of cervical intraepithelial neoplasia (CIN) grade 2 or worse [risk ratio (RR) = 1.6, 95% confidence interval (CI) = 1.5-1.7], 40% in CIN grade 3 or worse (RR = 1.4, 95% CI = 1.3-1.6), 40% in cancer (RR = 1.4, 95% CI = 1.0-2.1), and 60% in colposcopy referrals (RR = 1.6, 95% CI = 1.5-1.6) compared with LBC-Screening. The performance of both protocols was age dependent, being more effective in women ages under 50 years. CONCLUSIONS The HPV-Screening protocol was well accepted by women in Norway and detected more CIN2, CIN3, and cancers compared with the LBC-Screening protocol. IMPACT A randomized implementation of the HPV-Screening protocol with real-world assessment enabled a gradual, quality assured, and safe technology transition. HPV-based screening protocol may further be improved by using HPV genotyping and age-specific referral algorithms.
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Affiliation(s)
- Mari Nygård
- The Cancer Registry of Norway, Oslo, Norway.,Corresponding Author: Mari Nygård, Research Department, The Cancer Registry of Norway, Postbox 5313 Majorstuen, Oslo 0304, Norway. Phone: 47-9518-1886; E-mail:
| | | | - Philip E. Castle
- Division of Cancer Prevention, NCI, NIH, Rockville, Maryland.,Division of Cancer Epidemiology and Genetics, NCI, NIH, Rockville, Maryland
| | | | - Maj Liv Eide
- Trondheim University Hospital, Trondheim, Norway
| | - Ole Erik Iversen
- Institute of Clinical Science, University of Bergen, Bergen, Norway.,Haukeland University Hospital, Bergen, Norway
| | | | | | - Olav Karsten Vintermyr
- Haukeland University Hospital, Bergen, Norway.,The Gades Laboratory for Pathology, University of Bergen, Bergen, Norway
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36
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Castle PE, Befano B, Schiffman M, Wentzensen N, Lorey T, Poitras N, Hyer M, Cheung LC. A comparison of high-grade cervical abnormality risks in women living with and without human immunodeficiency virus undergoing routine cervical-cancer screening. Prev Med 2022; 162:107157. [PMID: 35810936 PMCID: PMC9388588 DOI: 10.1016/j.ypmed.2022.107157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/16/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
As the US moves increasingly towards using human papillomavirus (HPV) testing with or without concurrent cytology for cervical cancer screening, it is unknown what the corresponding risks are following a screening result for women living with HIV (WLWH), which will dictate the optimal clinical follow-up. Therefore, using medical records data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in women aged 30-64 years in 2003, we compared risks of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnoses (CIN2+) in women not known to have HIV (HIV[-] women) (n = 67,488) frequency matched 111:1 on age and year of the first co-test to the 608 WLWH (n = 608). WLWH were more likely to test HPV positive (20.2% vs. 6.5%, p < 0.001) and have non-normal cytology (14.1% vs. 4.1%, p < 0.001) than HIV[-] women. Five-year CIN2+ risks for all WLWH and HIV[-] women were 3.5% (95%CI = 2.0-5.0%) and 1.6% (95%CI = 1.5-1.8%) (p = 0.01), respectively. Five-year CIN2+ risks for WLWH with positive HPV and non-normal cytology, positive HPV and normal cytology, negative HPV and non-normal cytology, and negative HPV and normal cytology were 24.9% (95%CI = 13.4-36.4%), 3.0% (95%CI = 0.0-7.4%), 3.6 (95%CI = 0.0-9.8%) and 0.3% (95%CI = 0.0-0.8%), respectively. Corresponding 5-year CIN2+ risks for HIV[-] women were 26.6% (95%CI = 24.6-28.7%), 8.5% (95%CI = 7.2-9.9%), 1.9% (95%CI = 1.0-2.8%), and 0.5% (95%CI = 0.4-0.6%), respectively. Thus, in this healthcare setting, the main cause in overall CIN2+ risk differences between WLWH and HIV[-] women was the former was more likely to screen positive and once the screening result is known, it may be reasonable to manage both populations similarly.
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Affiliation(s)
- Philip E Castle
- Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA.
| | - Brian Befano
- Information Management Services, Calverton, MD, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Thomas Lorey
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | - Nancy Poitras
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | | | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
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37
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Murenzi G, Shumbusho F, Hansen N, Munyaneza A, Gage JC, Muhoza B, Kanyabwisha F, Pierz A, Tuyisenge P, Anastos K, Castle PE. Long-term human papillomavirus vaccination effectiveness and immunity in Rwandan women living with and without HIV: a study protocol. BMJ Open 2022; 12:e061650. [PMID: 36008069 PMCID: PMC9422845 DOI: 10.1136/bmjopen-2022-061650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Prophylactic human papillomavirus (HPV) vaccines have been shown to be highly effective in protecting women against cervical infections, high-grade abnormalities and cancer caused by the targeted HPV types. However, the evidence for their effectiveness in women living with HIV (WLWH) is less clear. METHODS WLWH and HIV-negative women who likely did (birth cohorts 1996 and later) and WLWH and HIV(-) negative who likely did not (birth cohorts before 1996) receive HPV vaccination (n=3028; 757 participants for each of the four groups). Between groups, we will compare cervicovaginal, anal and oral prevalent and 6-12 month persistent HPV6/11/16/18 infections as measured using a modified AmpFire HPV genotyping assay that tests for 15 high-risk or intermediate-risk HPV genotypes, HPV6 and HPV11. We will also compare the HPV immune response in HPV-vaccinated WLWH to HPV-vaccinated HIV-negative women using an anti-HPV16 and anti-HPV18 ELISA. Vaccination status will be confirmed through national vaccination records. ANALYSIS We will calculate point prevalence and prevalence of 6-12 month persisting infections by individual HPV-type specific infections and groups of infections for each anatomic site and for each group of women. Results will be stratified by age at vaccination, age at enrolment and the number of doses (3 vs 2) as well as other factors possibly associated with HPV prevalence. Differences in endpoints between groups, overall and between subgroups, will be tested for statistical significance (p<0.05) using Fisher's exact or Pearson χ2 test. Differences in geometric mean titres and seropositivity will be tested for statistical significance using the Mann-Whitney and Fisher's exact tests, respectively. ETHICS AND DISSEMINATION The study was approved by the Albert Einstein College of Medicine Institutional Review Board and the Rwanda National Ethics Committee. Results will be disseminated through publication in peer-reviewed journals.
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Affiliation(s)
- Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Fabienne Shumbusho
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Natasha Hansen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Athanase Munyaneza
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Benjamin Muhoza
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Faustin Kanyabwisha
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Amanda Pierz
- Department of Community Health and Health Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Patrick Tuyisenge
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
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Crawford DR, Sinha S, Nair NU, Ryan BM, Barnholtz-Sloan J, Mount SM, Erez A, Adalpe K, Castle PE, Rajagopal PS, Day CP, Schäffer AA, Ruppin E. Abstract 27: Sex biases in cancer and autoimmune disease incidence are strongly positively correlated with mitochondrial gene expression across human tissues. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancer occurs more frequently in men while autoimmune diseases (AIDs) occur more frequently in women. To explore whether these sex biases have a common basis, we collected 170 AID incidence studies from many countries for tissues that have both a cancer type and an AID that arise from that tissue. Analyzing a total of 182 country-specific, tissue-matched cancer-AID incidence rate sex bias data pairs, we find that the sex biases observed in the incidence of AIDs and cancers that occur in the same tissue are positively correlated across human tissues. Second, we find that the sex bias in the expression of the 37 genes encoded in the mitochondrial genome stands out as the common key factor whose levels across human tissues are most strongly and positively associated with these incidence rate sex biases.
Citation Format: David Robert Crawford, Sanju Sinha, Nishanth U. Nair, Bríd M. Ryan, Jill Barnholtz-Sloan, Stephen M. Mount, Ayelet Erez, Kenneth Adalpe, Philip E. Castle, Padma S. Rajagopal, Chi-Ping Day, Alejandro A. Schäffer, Eytan Ruppin. Sex biases in cancer and autoimmune disease incidence are strongly positively correlated with mitochondrial gene expression across human tissues [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 27.
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Affiliation(s)
| | - Sanju Sinha
- 1National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nishanth U. Nair
- 1National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bríd M. Ryan
- 1National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Ayelet Erez
- 3Weizmann Institute of Science, Rehovot, Israel
| | - Kenneth Adalpe
- 1National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Philip E. Castle
- 1National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Chi-Ping Day
- 1National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Eytan Ruppin
- 1National Cancer Institute, National Institutes of Health, Bethesda, MD
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Fernandez ME, Savas LS, Atkinson JS, Ricks KB, Ibekwe LN, Jackson I, Castle PE, Jobe D, Vernon SW. Evaluation of a 2-1-1 Telephone Navigation Program to Increase Cancer Control Behaviors: Results From a Randomized Controlled Trial. Am J Health Promot 2022; 36:1083-1093. [PMID: 35514063 DOI: 10.1177/08901171211041276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the effectiveness of a telephone navigation intervention for increasing use of cancer control services among underserved 2-1-1 callers. DESIGN Randomized controlled trial. SETTING 2-1-1 call centers in Houston and Weslaco, Texas (located in the Rio Grande Valley near the Mexican border). PARTICIPANTS 2-1-1 callers in need of Pap test, mammography, colorectal cancer screening, smoking cessation counseling, and/or HPV vaccination for a daughter (n = 1,554). A majority were low-income and described themselves as Black or Hispanic. INTERVENTION Participants were randomly assigned to receive either a cancer control referral for the needed service(s) with telephone navigation from a trained cancer control navigator (n = 995) or a referral only (n = 559). MEASURES Uptake of each individual service and any needed service. ANALYSIS Assessed uptake in both groups using bivariate chi-square analyses and multivariable logistic regression analyses, adjusted for sociodemographic covariates. Both per-protocol and intent-to-treat approaches were used. RESULTS Both interventions increased cancer control behaviors. Referral with navigation intervention resulted in significantly greater completion of any needed service (OR = 1.38; p = .042), Pap test (OR = 1.56; p = .023), and smoking cessation counseling (OR = 2.66; p = .044), than referral-only condition. Other outcomes showed the same trend although the difference was not statistically significant: mammography (OR = 1.53; p = .106); colorectal cancer screening (OR = 1.80; p = .095); and HPV vaccination of a daughter (OR = 1.61; p = .331). CONCLUSION Adding cancer control referrals and navigation to an informational service like the 2-1-1 program can increase overall participation in cancer control services.
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Affiliation(s)
- Maria E Fernandez
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - John S Atkinson
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Katherine Ball Ricks
- Cecil G. Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, USA
| | - Lynn N Ibekwe
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Inimfon Jackson
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.,Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD, USA
| | - David Jobe
- 2-1-1 Texas/United Way HELPLINE, United Way of Greater Houston, Houston, TX, USA
| | - Sally W Vernon
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Sahasrabuddhe VV, Castle PE, Schiffman M, Wentzensen N, Heckman-Stoddard B, Arbyn M. Reply to: Comments on 'Meta-analysis of agreement/concordance statistics in studies comparing self- versus clinician-collected samples for HPV testing in cervical cancer screening'. Int J Cancer 2022; 151:484-487. [PMID: 35377490 DOI: 10.1002/ijc.34013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Philip E Castle
- Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, Maryland, USA.,Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
| | | | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Brenes D, Barberan CJ, Hunt B, Parra SG, Salcedo MP, Possati-Resende JC, Cremer ML, Castle PE, Fregnani JHTG, Maza M, Schmeler KM, Baraniuk R, Richards-Kortum R. Multi-task network for automated analysis of high-resolution endomicroscopy images to detect cervical precancer and cancer. Comput Med Imaging Graph 2022; 97:102052. [PMID: 35299096 PMCID: PMC9250128 DOI: 10.1016/j.compmedimag.2022.102052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
Abstract
Cervical cancer is a public health emergency in low- and middle-income countries where resource limitations hamper standard-of-care prevention strategies. The high-resolution endomicroscope (HRME) is a low-cost, point-of-care device with which care providers can image the nuclear morphology of cervical lesions. Here, we propose a deep learning framework to diagnose cervical intraepithelial neoplasia grade 2 or more severe from HRME images. The proposed multi-task convolutional neural network uses nuclear segmentation to learn a diagnostically relevant representation. Nuclear segmentation was trained via proxy labels to circumvent the need for expensive, manually annotated nuclear masks. A dataset of images from over 1600 patients was used to train, validate, and test our algorithm; data from 20% of patients were reserved for testing. An external evaluation set with images from 508 patients was used to further validate our findings. The proposed method consistently outperformed other state-of-the art architectures achieving a test per patient area under the receiver operating characteristic curve (AUC-ROC) of 0.87. Performance was comparable to expert colposcopy with a test sensitivity and specificity of 0.94 (p = 0.3) and 0.58 (p = 1.0), respectively. Patients with recurrent human papillomavirus (HPV) infections are at a higher risk of developing cervical cancer. Thus, we sought to incorporate HPV DNA test results as a feature to inform prediction. We found that incorporating patient HPV status improved test specificity to 0.71 at a sensitivity of 0.94.
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Affiliation(s)
| | | | - Brady Hunt
- Rice University, Houston, TX 77005, USA.
| | | | - Mila P Salcedo
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | | | | - Mauricio Maza
- Basic Health International, San Savlador, El Salvador.
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42
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Demarco M, Egemen D, Hyun N, Chen X, Moscicki AB, Cheung L, Carter-Pokras O, Hammer A, Gage JC, Clarke MA, Castle PE, Befano B, Chen J, Dallal C, He X, Desai K, Lorey T, Poitras N, Raine-Bennett TR, Perkins RB, Wentzensen N, Schiffman M. Contribution of Etiologic Cofactors to CIN3+ Risk Among Women With Human Papillomavirus-Positive Screening Test Results. J Low Genit Tract Dis 2022; 26:127-134. [PMID: 35249974 PMCID: PMC8940696 DOI: 10.1097/lgt.0000000000000667] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The US screening and management guidelines for cervical cancer are based on the absolute risk of precancer estimated from large clinical cohorts and trials. Given the widespread transition toward screening with human papillomavirus (HPV) testing, it is important to assess which additional factors to include in clinical risk assessment to optimize management of HPV-infected women. MATERIALS AND METHODS We analyzed data from HPV-infected women, ages 30-65 years, in the National Cancer Institute-Kaiser Permanente Northern California Persistence and Progression study. We estimated the influence of HPV risk group, cytology result, and selected cofactors on immediate risk of cervical intraepithelial neoplasia grade 3 or higher (CIN 3+) among 16,094 HPV-positive women. Cofactors considered included, age, race/ethnicity, income, smoking, and hormonal contraceptive use. RESULTS Human papillomavirus risk group and cytology test result were strongly correlated with CIN 3+ risk. After considering cytology and HPV risk group, other cofactors (age, race/ethnicity, income, smoking, and hormonal contraceptive use) had minimal impact on CIN 3+ risk and did not change recommended management based on accepted risk thresholds. We had insufficient data to assess the impact of long-duration heavy smoking, parity, history of sexually transmitted infection, or immunosuppression. CONCLUSIONS In our study at the Kaiser Permanente Northern California, the risk of CIN 3+ was determined mainly by HPV risk group and cytology results, with other cofactors having limited impact in adjusted analyses. This supports the use of HPV and cytology results in risk-based management guidelines.
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Affiliation(s)
- Maria Demarco
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Didem Egemen
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Noorie Hyun
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Xiaojian Chen
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | | | - Li Cheung
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Olivia Carter-Pokras
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | | | - Julia C. Gage
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Megan A. Clarke
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Philip E. Castle
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Brian Befano
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Jie Chen
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Cher Dallal
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Xin He
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Kanan Desai
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Thomas Lorey
- Kaiser Permanente Northern California, San Francisco, CA
| | - Nancy Poitras
- Kaiser Permanente Northern California, San Francisco, CA
| | | | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
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43
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Mango VL, Olasehinde O, Omisore AD, Wuraola FO, Famurewa OC, Sevilimedu V, Knapp GC, Steinberg E, Akinmaye PR, Adewoyin BD, Romanoff A, Castle PE, Alatise O, Kingham TP. The iBreastExam versus clinical breast examination for breast evaluation in high risk and symptomatic Nigerian women: a prospective study. Lancet Glob Health 2022; 10:e555-e563. [PMID: 35303464 PMCID: PMC9102465 DOI: 10.1016/s2214-109x(22)00030-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The iBreastExam electronically palpates the breast to identify possible abnormalities. We assessed the iBreastExam performance compared with clinical breast examination for breast lesion detection in high risk and symptomatic Nigerian women. METHODS This prospective study was done at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Nigeria. Participants were Nigerian women aged 40 years or older who were symptomatic and presented with breast cancer symptoms or those at high risk with a first-degree relative who had a history of breast cancer. Participants underwent four breast examinations: clinical breast examination (by an experienced surgeon), the iBreastExam (performed by recent nursing school graduates, who finished nursing school within the previous year), ultrasound, and mammography. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the iBreastExam and clinical breast examination for detecting any breast lesion and suspicious breast lesions were calculated, using mammography and ultrasound as the reference standard. FINDINGS Between June 19 and Dec 5, 2019, 424 Nigerian women were enrolled (151 [36%] at high risk of breast cancer and 273 [64%] symptomatic women). The median age of participants was 46 years (IQR 42-52). 419 (99%) women had a breast imaging-reporting and data system (BI-RADS) assessment and were included in the analysis. For any breast finding, the iBreastExam showed significantly better sensitivity than clinical breast examination (63%, 95% CI 57-69 vs 31%, 25-37; p<0·0001), and clinical breast examination showed significantly better specificity (94%, 90-97 vs 59%, 52-66; p<0·0001). For suspicious breast findings, the iBreastExam showed similar sensitivity to clinical breast examination (86%, 95% CI 70-95 vs 83%, 67-94; p=0·65), and clinical breast examination showed significantly better specificity (50%, 45-55 vs 86%, 83-90; p<0·0001). The iBreastExam and clinical breast examination showed similar NPVs for any breast finding (56%, 49-63 vs 52%, 46-57; p=0·080) and suspicious findings (98%, 94-99 vs 98%, 96-99; p=0·42), whereas the PPV was significantly higher for clinical breast examination in any breast finding (87%, 77-93 vs 66%, 59-72; p<0·0001) and suspicious findings (37%, 26-48 vs 14%, 10-19; p=0·0020). Of 15 biopsy-confirmed cancers, clinical breast examination and the iBreastExam detected an ipsilateral breast abnormality in 13 (87%) women and missed the same two cancers (both <2 cm). INTERPRETATION The iBreastExam by nurses showed a high sensitivity and NPV, but lower specificity than surgeon's clinical breast examination for identifying suspicious breast lesions. In locations with few experienced practitioners, the iBreastExam might provide a high sensitivity breast evaluation tool. Further research into improved specificity with device updates and cost feasibility in low-resource settings is warranted. FUNDING Prevent Cancer Foundation Global Community Grant Award with additional support from the P30 Cancer Center Support Grant (P30 CA008748).
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Affiliation(s)
- Victoria L Mango
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Adeleye D Omisore
- Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | | | | | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gregory C Knapp
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Evan Steinberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Anya Romanoff
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Olusegun Alatise
- Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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44
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Smith MA, Sherrah M, Sultana F, Castle PE, Arbyn M, Gertig D, Caruana M, Wrede CD, Saville M, Canfell K. National experience in the first two years of primary human papillomavirus (HPV) cervical screening in an HPV vaccinated population in Australia: observational study. BMJ 2022; 376:e068582. [PMID: 35354610 PMCID: PMC8965648 DOI: 10.1136/bmj-2021-068582] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review the first two years of the primary human papillomavirus (HPV) cervical screening programme in an HPV vaccinated population. DESIGN Observational study. SETTING Australia. PARTICIPANTS 3 745 318 women with a primary HPV test between 1 December 2017 and 31 December 2019; most women aged <40 years had previously been offered vaccination against HPV16 and HPV18. INTERVENTIONS Primary HPV screening with referral if HPV16 or HPV18 (HPV16/18) positive and triage with liquid based cytology testing (threshold atypical squamous cells-cannot exclude high grade squamous intraepithelial lesion) for women who were positive for high risk HPV types other than 16/18. A 12 month follow-up HPV test was recommended in triaged women with a negative or low grade cytology result, with referral if they tested positive for any high risk HPV type at follow-up. MAIN OUTCOME MEASURES Proportion of women who had attended for their first HPV screening test, tested positive, and were referred for colposcopy; and short term risk of detecting cervical intraepithelial neoplasia (CIN) grade 2 or worse, CIN grade 3 or worse, or cancer. RESULTS 54.6% (n=3 507 281) of an estimated 6 428 677 eligible women aged 25-69 had undergone their first HPV test by the end of 2019. Among those attending for routine screening, positivity for HPV16/18 and for HPV types not 16/18 was, respectively, 2.0% and 6.6% in women aged 25-69 (n=3 045 844) and 2.2% and 13.3% in highly vaccinated cohorts of women aged 25-34 (n=768 362). Colposcopy referral (ages 25-69 years) was 3.5%, increasing to an estimated 6.2% after accounting for women who had not yet had a 12 month repeat test. Cervical cancer was detected in 0.98% (456/46 330) of women positive for HPV16/18 at baseline, including 0.32% (89/28 003) of women with HPV16/18 and negative cytology. Women with HPV types not 16/18 and negative or low grade cytology at both baseline and 12 months were at low risk of serious disease (3.4% CIN grade 3 or worse; 0.02% cancer; n=20 019) but estimated to account for 62.0% of referrals for this screening algorithm. CONCLUSIONS Colposcopy referral thresholds need to consider underlying cancer risk; on this basis, women with HPV16/18 in the first round of HPV screening were found to be at higher risk regardless of cytology result, even in a previously well screened population. Women with HPV types not 16/18 and negative or low grade cytology showed a low risk of serious abnormalities but constitute most referrals and could be managed safely with two rounds of repeat HPV testing rather than one. HPV16/18 driven referrals were low in HPV vaccinated cohorts.
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Affiliation(s)
- Megan A Smith
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - Maddison Sherrah
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - Farhana Sultana
- National Cancer Screening Register, Telstra Health, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Philip E Castle
- Division of Cancer Prevention, and Senior Investigator, Division of Cancer Epidemiology and Genetics, US National Cancer Institute, NIH, Rockville, MD, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Dorota Gertig
- National Cancer Screening Register, Telstra Health, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
| | - C David Wrede
- Oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - Marion Saville
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
- Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC, Australia
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney NSW 2011 Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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45
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Cohen CM, Wentzensen N, Lahrmann B, Tokugawa D, Poitras N, Bartels L, Krauthoff A, Keil A, Miranda F, Castle PE, Lorey T, Hare B, Darragh TM, Grabe N, Clarke MA. Automated evaluation of p16/Ki-67 dual stain cytology as a biomarker for detection of anal precancer in MSM living with HIV. Clin Infect Dis 2022; 75:1565-1572. [PMID: 35325073 DOI: 10.1093/cid/ciac211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-related biomarkers such as p16/Ki-67 "dual stain" (DS) cytology have shown promising clinical performance for anal cancer screening. Here, we assessed the performance of automated evaluation of DS cytology to detect anal precancer in men who have sex with men (MSM) living with human immunodeficiency virus (HIV). METHODS We conducted a cross-sectional analysis of 320 MSM with HIV undergoing anal cancer screening and high-resolution anoscopy (HRA) between 2009-2010. We evaluated the performance of automated DS based on a deep-learning classifier compared to manual DS evaluation to detect anal intraepithelial neoplasia (AIN) grades 2 and 3 (AIN2+) and AIN3. We evaluated different DS-positive cell thresholds quantified by the automated approach and modeled its performance compared to other screening strategies in a hypothetical population of MSM with HIV. RESULTS Automated DS had significantly higher specificity (50.9% vs. 42.2%, p=0.0004) and similar sensitivity (93.2% vs. 92.1%) for detection of AIN2+ compared to manual DS cytology. HPV testing with automated DS triage was significantly more specific (56.5% vs. 50.9%, p=0.0003) with the same sensitivity (93.2%) compared to automated DS alone. In a modeled analysis assuming a 20% AIN2+ prevalence, automated DS detected the most precancers compared to manual DS and anal cytology (186,184, and 162, respectively) and had the lowest HRA referral per AIN2+ detected (3.1,3.5, and 3.3, respectively). CONCLUSIONS Compared to manual evaluation, automated DS cytology detects the same number of precancers with lower HRA referral.
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Affiliation(s)
- Camryn M Cohen
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, USA
| | - Bernd Lahrmann
- Steinbeis Transfer Center for Medical Systems Biology (STCMED), Heidelberg, Germany
| | - Diane Tokugawa
- Kaiser Permanante The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | - Nancy Poitras
- Kaiser Permanante The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | - Liam Bartels
- Steinbeis Transfer Center for Medical Systems Biology (STCMED), Heidelberg, Germany.,Hamamatsu Tissue Imaging and Analysis Center (TIGA), BIOQUANT, University Heidelberg, Heidelberg, Germany.,National Center of Tumor Diseases, Medical Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexandra Krauthoff
- Steinbeis Transfer Center for Medical Systems Biology (STCMED), Heidelberg, Germany.,Hamamatsu Tissue Imaging and Analysis Center (TIGA), BIOQUANT, University Heidelberg, Heidelberg, Germany.,National Center of Tumor Diseases, Medical Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Keil
- Steinbeis Transfer Center for Medical Systems Biology (STCMED), Heidelberg, Germany
| | - Felipe Miranda
- Steinbeis Transfer Center for Medical Systems Biology (STCMED), Heidelberg, Germany
| | - Philip E Castle
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, USA.,Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Thomas Lorey
- Kaiser Permanante The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | - Brad Hare
- The Permanante Medical Group, San Francisco, CA, USA
| | - Teresa M Darragh
- University of California at San Francisco, San Francisco, CA, USA
| | - Niels Grabe
- Steinbeis Transfer Center for Medical Systems Biology (STCMED), Heidelberg, Germany.,Hamamatsu Tissue Imaging and Analysis Center (TIGA), BIOQUANT, University Heidelberg, Heidelberg, Germany.,National Center of Tumor Diseases, Medical Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Megan A Clarke
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, USA
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Arbyn M, Latsuzbaia A, Castle PE, Sahasrabuddhe VV, Broeck DV. HPV testing of self-samples: Influence of collection and sample handling procedures on clinical accuracy to detect cervical precancer. Lancet Reg Health Eur 2022; 14:100332. [PMID: 35243475 PMCID: PMC8857649 DOI: 10.1016/j.lanepe.2022.100332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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47
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Arbyn M, Castle PE, Schiffman M, Wentzensen N, Heckman-Stoddard B, Sahasrabuddhe VV. Meta-analysis of agreement/concordance statistics in studies comparing self- versus clinician-collected samples for HPV testing in cervical cancer screening. Int J Cancer 2022; 151:308-312. [PMID: 35179777 DOI: 10.1002/ijc.33967] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/02/2022] [Accepted: 01/18/2022] [Indexed: 11/12/2022]
Abstract
We conducted a meta-analysis of test agreement/concordance between human papillomavirus (HPV) testing in self-collected versus clinician-collected samples in 26 studies (10,071 participants) updating a previous meta-analysis on accuracy for cervical precancer. Pooled overall agreement was 88.7% (95%CI: 86.3%-90.9%), positive agreement was 84.6% (95%CI: 79.9%-88.7%), negative agreement was 91.7% (95%CI: 89.1%-94.0%), and kappa was 0.72 (95%CI: 0.66-0.78). Subgroup meta-analyses suggested higher overall agreement for target amplification-based DNA assays (90.4%) compared to signal amplification-based DNA assays (86.7%) (p=0.175) or RNA assays (82.3%) (p<0.001). HPV test agreement/concordance targets may provide criteria to extend existing validations towards alternative sampling approaches and devices/storage media. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Philip E Castle
- Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, Maryland, USA.,Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, Maryland, USA
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48
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Mix J, Saraiya M, Hallowell BD, Befano B, Cheung LC, Unger ER, Gargano JW, Markowitz LE, Castle PE, Raine-Bennett T, Walker J, Zuna R, Schiffman M, Wentzensen N, Gage JC. Cervical Precancers and Cancers Attributed to HPV Types by Race and Ethnicity: Implications for Vaccination, Screening, and Management. J Natl Cancer Inst 2022; 114:845-853. [PMID: 35176161 DOI: 10.1093/jnci/djac034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/02/2021] [Accepted: 02/02/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Racial and ethnic variations in attribution of cervical precancer and cancer to HPV types may result in different HPV vaccine protection, screening test coverage, and clinical management. METHODS Pooling data from seven U.S. studies, we calculated the proportional attribution of precancers and cancers to HPV types using HPV DNA typing from diagnosis. All statistical tests were 2-sided. RESULTS For all racial and ethnic groups, most cervical intraepithelial neoplasia grade 3 (CIN3) (n = 5,526) and squamous cell carcinoma (SCC) cases (n = 1,138) were attributed to types targeted by the 9-valent vaccine. A higher proportion of CIN3s were attributed to non-vaccine HPV types among non-Hispanic Black women (15.8%) compared with non-Hispanic Asian or Pacific Islander (9.7%, P=.002), non-Hispanic White (9.2%, P<.001), and Hispanic women (11.3%, P=.004). The proportion of SCCs attributed to 9-valent types was similar by race and ethnicity (90.4%-93.8%, P = .80). A higher proportion of CIN3s were attributed to non-vaccine HPV35 among non-Hispanic Black (9.0%) compared with non-Hispanic Asian or Pacific Islander (2.2%), non-Hispanic White (2.5%), and Hispanic women (3.0%, all P<.001). Compared with CIN3, the proportion of SCCs attributed to HPV35 among Non-Hispanic Black women (3.2%) was lower and closer to other groups (0.3%-2.1%, P = .70). CONCLUSION The 9-valent HPV vaccine will prevent nearly all cervical precancers and invasive cancers among major racial and ethnic groups in the United States. Adding HPV35 to vaccines could prevent a small percentage of CIN3s and SCCs, with greater potential impact for CIN3s among Black women. HPV screening tests target high-risk HPV types, including HPV35. Future genotyping triage strategies could consider the importance of HPV35 and other HPV16 related types.
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Affiliation(s)
- Jacqueline Mix
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Benjamin D Hallowell
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Brian Befano
- Information Management Services, Calverton, MD, United States
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Elizabeth R Unger
- Divison of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Julia W Gargano
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lauri E Markowitz
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.,Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
| | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Joan Walker
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rosemary Zuna
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
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49
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Butler EN, Umar A, Heckman-Stoddard BM, Kundrod KA, Signorello LB, Castle PE. Redefining precision cancer prevention to promote health equity. Trends Cancer 2022; 8:295-302. [PMID: 35181273 DOI: 10.1016/j.trecan.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/15/2022]
Abstract
Precision cancer prevention as it is currently envisioned is a targeted, molecular-based approach to intercept carcinogenesis before cancer develops or before it becomes untreatable. Unfortunately, due to systemic biases, current precision cancer prevention interventions might not be effective in all populations, especially in minoritized communities. In addition, not all cancer risk is attributable to genetic or even biological factors, but includes social determinants of health (SDH). Here, we propose a broader framework for precision cancer prevention, anchored in optimizing the benefits to harms for all people. We propose that precision cancer prevention considers not only what is being delivered, but also for whom, where, and how, with a goal of achieving cancer prevention health equity.
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Affiliation(s)
- Eboneé N Butler
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Asad Umar
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Brandy M Heckman-Stoddard
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Kathryn A Kundrod
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Lisa B Signorello
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
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Gage JC, Raine-Bennett T, Schiffman M, Clarke MA, Cheung LC, Poitras NE, Varnado NE, Katki HA, Castle PE, Befano B, Chandra M, Rydzak G, Lorey T, Wentzensen N. The Improving Risk Informed HPV Screening (IRIS) Study: Design and Baseline Characteristics. Cancer Epidemiol Biomarkers Prev 2021; 31:486-492. [PMID: 34789470 DOI: 10.1158/1055-9965.epi-21-0865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/21/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical cancer screening with high-risk HPV (HrHPV) testing is being introduced. Most HrHPV infections are transient, requiring triage tests to identify individuals at highest risk for progression to cervical cancer. Head-to-head comparisons of available strategies for screening and triage are needed. Endometrial and ovarian cancers could be amenable to similar testing. METHODS Between 2016-2021 discard cervical cancer screening specimens from women ages 25-65 undergoing screening at Kaiser Permanente Northern California were collected. Specimens were aliquoted, stabilized, and stored frozen. HPV, cytology and histopathology results as well as demographic and co-factor information were obtained from electronic medical records. Follow-up collection of specimens was conducted for 2 years and EMR-based data collection was planned five years. RESULTS Collection of enrollment and follow-up specimens are complet and EMR-based follow-up data collection is ongoing. At baseline, specimens were collected from 54,971 HPV-positive, 10,219 HPV-negative/Pap-positive and 12,751 HPV-negative/Pap-negative women. Clinical history prior to baseline was available for 72.6% of individuals, of which 53.9% were undergoing routine screening, 8.6% recently had an abnormal screen, 30.3% had previous colposcopy, and 7.2% had previous treatment. As of November 2020, 55.6% had one or more colposcopies, yielding 5,515 CIN2, 2,735 CIN3 and 147 cancer histopathology diagnoses. CONCLUSIONS This robust population-based cohort study represents all stages of cervical cancer screening, management, and post-treatment follow-up. IMPACT The IRIS study is a unique and highly relevant resource allowing for natural history studies and rigorous evaluation of candidate HrHPV screening and triage markers, while permitting studies of biomarkers associated with other gynecological cancers.
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Affiliation(s)
- Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS
| | | | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS
| | | | | | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | | | - Malini Chandra
- Division of Research, Kaiser Permanente Northern California
| | | | - Thomas Lorey
- Division of Research, Kaiser Permanente Northern California
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS
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