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Mungo C, Guliam A, Chinula L, Inturrisi F, Msowoya L, Mkochi T, Jawadu S, de Sanjosé S, Schiffman M, Tang JH, Smith JS. Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi. Infect Agent Cancer 2024; 19:24. [PMID: 38760798 PMCID: PMC11100048 DOI: 10.1186/s13027-024-00585-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/03/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The World Health Organization recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi. METHODS We utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis-cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to RESULTS 315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses, of which 279 and 36 were HPV positive and HPV negative, respectively, on Xpert self-collection. Of the 315, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Of the 245 with normal pathology, 213 (87%) and 188 (77%) were HPV-positive on Xpert and ScreenFire self-collected specimens, respectively. Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50-0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens. CONCLUSION In this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.
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Affiliation(s)
- Chemtai Mungo
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Anagha Guliam
- Barnard College of Columbia University, New York City, NY, USA
| | - Lameck Chinula
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Federica Inturrisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Lizzie Msowoya
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tawonga Mkochi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Siniya Jawadu
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jennifer H Tang
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Mungo C, Guliam A, Chinula L, Inturrisi F, Msowoya L, Mkochi T, Jawadu S, de Sanjosé S, Schiffman M, Tang JH, Smith JS. Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi. medRxiv 2024:2024.02.21.24303142. [PMID: 38617305 PMCID: PMC11014639 DOI: 10.1101/2024.02.21.24303142] [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: 04/16/2024]
Abstract
Background The World Health Organization (WHO) recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries (LMICs) account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi. Methods We utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis - cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to Results 315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses. Of these, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50-0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens. Conclusion In this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.
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Affiliation(s)
- Chemtai Mungo
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill
| | | | - Lameck Chinula
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Federica Inturrisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Lizzie Msowoya
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tawonga Mkochi
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Siniya Jawadu
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jennifer H. Tang
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Jennifer S. Smith
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill
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Costas L, Frias-Gomez J, Peinado FM, Molina-Molina JM, Peremiquel-Trillas P, Paytubi S, Crous-Bou M, de Francisco J, Caño V, Benavente Y, Pelegrina B, Martínez JM, Pineda M, Brunet J, Matias-Guiu X, de Sanjosé S, Ponce J, Olea N, Alemany L, Fernández MF. Total Effective Xenoestrogen Burden in Serum Samples and Risk of Endometrial Cancer in the Spanish Screenwide Case-Control Study. Environ Health Perspect 2024; 132:27012. [PMID: 38415615 PMCID: PMC10901108 DOI: 10.1289/ehp13202] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Endometrial cancer is a hormone-dependent cancer, and estrogens play a relevant role in its etiology. However, little is known about the effects of environmental pollutants that act as xenoestrogens or that influence estrogenic activity through different pathways. OBJECTIVE We aimed to assess the relationship between the combined estrogenic activity of mixtures of xenoestrogens present in serum samples and the risk of endometrial cancer in the Screenwide case-control study. METHODS The total effective xenoestrogen burden (TEXB) attributable to organohalogenated compounds (TEXB- α ) and to endogenous hormones and more polar xenoestrogens (TEXB- β ) was assessed in serum from 156 patients with endometrial cancer (cases) and 150 controls by combining chemical extraction and separation by high-performance liquid chromatography with the E-SCREEN bioassay for estrogenicity. RESULTS Median TEXB- α and TEXB- β levels for cases (0.30 and 1.25 Eeq pM / mL , respectively) and controls (0.42 and 1.28 Eeq pM / mL , respectively) did not significantly differ (p = 0.653 and 0.933, respectively). An inverted-U risk trend across serum TEXB- α and TEXB- β levels was observed in multivariate adjusted models: Positive associations were observed for the second category of exposure in comparison to the lowest category of exposure [odds ratio ( OR ) = 2.11 (95% CI: 1.13, 3.94) for TEXB- α , and OR = 3.32 (95% CI: 1.62, 6.81) for TEXB- β ], whereas no significant associations were observed between the third category of exposure and the first [OR = 1.22 (95% CI: 0.64, 2.31) for TEXB- α , and OR = 1.58 (95% CI: 0.75, 3.33) for TEXB- β ]. In mutually adjusted models for TEXB- α and TEXB- β levels, the association of TEXB- α with endometrial cancer risk was attenuated [OR = 1.45 (95% CI: 0.61, 3.47) for the second category of exposure], as well as estimates for TEXB- β (OR = 2.68 ; 95% CI: 1.03, 6.99). Most of the individual halogenated contaminants showed no associations with both TEXB and endometrial cancer. CONCLUSIONS We evaluated serum total xenoestrogen burden in relation to endometrial cancer risk and found an inverted-U risk trend across increasing categories of exposure. The use of in vitro bioassays with human samples may lead to a paradigm shift in the way we understand the negative impact of chemical mixtures on human health effects. These results are relevant from a public health perspective and for decision-makers in charge of controlling the production and distribution of chemicals with xenoestrogenic activity. https://doi.org/10.1289/EHP13202.
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Affiliation(s)
- Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- University of Barcelona, Barcelona, Spain
| | - Francisco M. Peinado
- Centre of Biomedical Research, University of Granada, Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), Hospital Universitario San Cecilio, Granada, Spain
| | | | - Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- University of Barcelona, Barcelona, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marta Crous-Bou
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Javier de Francisco
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Anesthesiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Victor Caño
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Anesthesiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - José Manuel Martínez
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Gynecology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Marta Pineda
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer group, Molecular Mechanisms and Experimental Therapy in Oncology Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer (CIBERONC), Carlos III Institute of Health, Madrid, Spain
| | - Joan Brunet
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer group, Molecular Mechanisms and Experimental Therapy in Oncology Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer (CIBERONC), Carlos III Institute of Health, Madrid, Spain
| | - Xavier Matias-Guiu
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer (CIBERONC), Carlos III Institute of Health, Madrid, Spain
- Department of Pathology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Jordi Ponce
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Gynecology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Nicolás Olea
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centre of Biomedical Research, University of Granada, Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), Hospital Universitario San Cecilio, Granada, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mariana F. Fernández
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centre of Biomedical Research, University of Granada, Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), Hospital Universitario San Cecilio, Granada, Spain
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de Sanjosé S, Perkins RB, Campos N, Inturrisi F, Egemen D, Befano B, Rodriguez AC, Jerónimo J, Cheung LC, Desai K, Han P, Novetsky AP, Ukwuani A, Marcus J, Ahmed SR, Wentzensen N, Kalpathy-Cramer J, Schiffman M. Design of the HPV-automated visual evaluation (PAVE) study: Validating a novel cervical screening strategy. eLife 2024; 12:RP91469. [PMID: 38224340 PMCID: PMC10945624 DOI: 10.7554/elife.91469] [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] [Indexed: 01/16/2024] Open
Abstract
Background The HPV-automated visual evaluation (PAVE) Study is an extensive, multinational initiative designed to advance cervical cancer prevention in resource-constrained regions. Cervical cancer disproportionally affects regions with limited access to preventive measures. PAVE aims to assess a novel screening-triage-treatment strategy integrating self-sampled HPV testing, deep-learning-based automated visual evaluation (AVE), and targeted therapies. Methods Phase 1 efficacy involves screening up to 100,000 women aged 25-49 across nine countries, using self-collected vaginal samples for hierarchical HPV evaluation: HPV16, else HPV18/45, else HPV31/33/35/52/58, else HPV39/51/56/59/68 else negative. HPV-positive individuals undergo further evaluation, including pelvic exams, cervical imaging, and biopsies. AVE algorithms analyze images, assigning risk scores for precancer, validated against histologic high-grade precancer. Phase 1, however, does not integrate AVE results into patient management, contrasting them with local standard care.Phase 2 effectiveness focuses on deploying AVE software and HPV genotype data in real-time clinical decision-making, evaluating feasibility, acceptability, cost-effectiveness, and health communication of the PAVE strategy in practice. Results Currently, sites have commenced fieldwork, and conclusive results are pending. Conclusions The study aspires to validate a screen-triage-treat protocol utilizing innovative biomarkers to deliver an accurate, feasible, and cost-effective strategy for cervical cancer prevention in resource-limited areas. Should the study validate PAVE, its broader implementation could be recommended, potentially expanding cervical cancer prevention worldwide. Funding The consortial sites are responsible for their own study costs. Research equipment and supplies, and the NCI-affiliated staff are funded by the National Cancer Institute Intramural Research Program including supplemental funding from the Cancer Cures Moonshot Initiative. No commercial support was obtained. Brian Befano was supported by NCI/ NIH under Grant T32CA09168.
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Affiliation(s)
- Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
- ISGlobalBarcelonaSpain
| | - Rebecca B Perkins
- University Chobanian and Avedisian School of Medicine/Boston Medical CenterBostonUnited States
| | - Nicole Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public HealthBostonUnited States
| | - Federica Inturrisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Didem Egemen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Brian Befano
- Information Management Services IncCalvertonUnited States
- Department of Epidemiology, University of Washington School of Public HealthSeattleUnited States
| | - Ana Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Jose Jerónimo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Kanan Desai
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Paul Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Akiva P Novetsky
- Westchester Medical Center/New York Medical CollegeValhallaUnited States
| | - Abigail Ukwuani
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Jenna Marcus
- Feinberg School of Medicine at Northwestern UniversityChicagoUnited States
| | - Syed Rakin Ahmed
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General HospitalBostonUnited States
- Harvard Graduate Program in Biophysics, Harvard Medical School, Harvard UniversityCambridgeUnited States
- Massachusetts Institute of TechnologyCambridgeUnited States
- Geisel School of Medicine at Dartmouth, Dartmouth CollegeHanoverUnited States
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General HospitalBostonUnited States
- University of Colorado Anschutz Medical CampusAuroraUnited States
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of HealthRockvilleUnited States
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Inturrisi F, de Sanjosé S, Desai KT, Dagnall C, Egemen D, Befano B, Rodriguez AC, Jeronimo JA, Zuna RE, Hoffman A, Farhat Nozzari S, Walker JL, Perkins RB, Wentzensen N, Palefsky JM, Schiffman M. A rapid HPV typing assay to support global cervical cancer screening and risk-based management: A cross-sectional study. Int J Cancer 2024; 154:241-250. [PMID: 37772799 DOI: 10.1002/ijc.34698] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 09/30/2023]
Abstract
The World Health Organization recommends human papillomavirus (HPV) testing for cervical screening. Extended genotyping can identify the highest-risk HPV-positive women. An inexpensive, rapid, mobile isothermal amplification assay (ScreenFire HPV RS test) was recently redesigned to yield four channels ordered by cancer risk (ie, hierarchical approach): HPV16, HPV18/45, HPV31/33/35/52/58 and HPV39/51/56/59/68. Stored specimens from 2076 women (mean age 30.9) enrolled in a colposcopy clinic, with high HPV prevalence, were tested with ScreenFire. We calculated hierarchical channel positivity and non-hierarchical channel and type positivity, according to histologic diagnosis (256 cancer, 350 cervical intraepithelial neoplasia [CIN]3, 409 CIN2, 1020 < CIN2) and known virologic reference results (Linear Array and TypeSeq). Additionally, we analyzed ScreenFire time-to-positive up to 60 min by channel and histology. Overall clinical sensitivity for CIN3+ was 94.7% (95% confidence interval 92.6-96.4), similar to Linear Array (92.3, 89.7-94.3) and TypeSeq (96.0, 93.9-97.6). Sensitivity was high for all types and channels. The hierarchical approach was well in line with HPV typing and histologic diagnosis, prioritizing higher risk women having HPV16 and precancer. For HPV16, time-to-positive was shorter in women with precancer. ScreenFire showed excellent agreement with research reference typing tests and detection of CIN2+. Risk-based type results could help guide clinical management of HPV-positive women. Time-to-positive combined with genotyping might be useful. ScreenFire is rapid, mobile, relatively inexpensive and designed for implementation of HPV-based screening and management, including in lower-resource settings. Further validation in screening by self-sampling and practical effectiveness merit evaluation.
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Affiliation(s)
- Federica Inturrisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
- ISGlobal, Barcelona, Spain
| | - Kanan T Desai
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Casey Dagnall
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, Maryland, USA
| | - Didem Egemen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Brian Befano
- Information Management Services Inc., Calverton, Maryland, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Ana Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Jose A Jeronimo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Rosemary E Zuna
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amanda Hoffman
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, Maryland, USA
| | - Sepideh Farhat Nozzari
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, Maryland, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Joel M Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
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6
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Desai KT, de Sanjosé S, Schiffman M. Treatment of Cervical Precancers is the Major Remaining Challenge in Cervical Screening Research. Cancer Prev Res (Phila) 2023; 16:649-651. [PMID: 38037384 DOI: 10.1158/1940-6207.capr-23-0448] [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: 10/25/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
Deepening understanding of cervical cancer pathogenesis has yielded one-dose prophylactic human papillomavirus (HPV) vaccines and accurate HPV-based cervical screening tests. Knowing the heterogeneous carcinogenic potential of the individual high-risk HPV types permits prioritization of vaccination and screening strategies. However, "correct" (i.e., safe and effective) treatment of women found to have precancer is still undefined, forcing reliance on one or more rounds of untargeted destructive/excisional treatment. Both over-treatment and under-treatment are common results. Until safe and effective anti-HPV therapies are invented, defining optimal destructive/excisional treatment of precancer remains a fundamental and under-researched challenge, especially in resource-constrained settings. See related article by King et al., p. 681.
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7
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Peñalver-Piñol A, Benavente Y, Frias-Gomez J, Alguacil J, Santibañez M, Contreras-Llanes M, Peremiquel-Trillas P, López-Querol M, Paytubi S, Pelegrina B, Onieva I, Martínez JM, Fernandez-Gonzalez S, Francisco JD, Caño V, Brunet J, Pineda M, Ponce J, Matias-Guiu X, Bosch FX, Sanjosé SD, Alemany L, Costas L. Occupational exposure to pesticides and endometrial cancer in the Screenwide case-control study. Environ Health 2023; 22:77. [PMID: 37919733 PMCID: PMC10621144 DOI: 10.1186/s12940-023-01028-0] [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: 07/20/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Endometrial cancer is the most common gynaecological tumour in developed countries and disease burden is expected to increase over the years. Identifying modifiable risk factors may help developing strategies to reduce the expected increasing incidence of these neoplasms. OBJECTIVE This study evaluates the association between occupational exposure to pesticides and endometrial cancer using data from a recent case-control study in Spain. METHODS The analyses included data from 174 consecutive incident endometrial cancer cases and 216 hospital controls frequency-matched by age. Data were collected through structured epidemiological questionnaires and exposure to pesticides was assessed using a Spanish job-exposure matrix (MatEmESp). RESULTS Overall, 12% of controls and 18% of cases were occupationally exposed to pesticides. We observed a positive association between occupational exposure to pesticides and endometrial cancer (OR = 2.08; 95% CI = 1.13-3.88 compared to non-exposed). In general, exposures that occurred farther in the past were significantly associated with endometrial cancer. Exposure to insecticides, fungicides and herbicides were positively associated with endometrial cancer (OR = 2.08; 95% CI = 1.13-3.88, OR = 4.40; 95% CI = 1.65-13.33, and OR = 5.25; 95% CI = 1.84-17.67, respectively). The agricultural, poultry and livestock activities scenario was associated with endometrial cancer (OR = 4.16; 95% CI = 1.59-12.32), while the cleaning exposure scenario was not (OR = 1.22; 95% CI = 0.55-2.67). CONCLUSIONS Assessment of occupational exposure to pesticides assessed using a Spanish job-exposure matrix revealed a positive association with endometrial cancer. The elucidation of the role of pesticide compounds on endometrial cancer should shed a light on the aetiology of this tumour.
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Affiliation(s)
- Arnau Peñalver-Piñol
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Servei de Medicina Preventiva i Epidemiologia, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain
| | - Yolanda Benavente
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
| | - Jon Frias-Gomez
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Juan Alguacil
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
- Dept. of Sociology, Social Work and Public Health, Research Group "Preventive Medicine and Public Health", Center for Research in Health and Environment (CYSMA), Huelva, Spain
| | | | - Manuel Contreras-Llanes
- Dept. of Sociology, Social Work and Public Health, Research Group "Preventive Medicine and Public Health", Center for Research in Health and Environment (CYSMA), Huelva, Spain
- Dept. of Integrated Sciences, Center for Research in Natural Resources, Health and Environment (RENSMA), Faculty of Experimental Sciences, Research Group "Radiation Physics and Environment" (FRYMA), Campus El Carmen s/n, Huelva, 21007, Spain
| | - Paula Peremiquel-Trillas
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Marta López-Querol
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
| | - Sonia Paytubi
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
| | - Beatriz Pelegrina
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
| | - Irene Onieva
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
| | - José Manuel Martínez
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Fernandez-Gonzalez
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Javier de Francisco
- Department of Anesthesiology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Caño
- Department of Anesthesiology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Brunet
- Consortium for Biomedical Research in Cancer - CIBERONC. Carlos III Institute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
- Hereditary Cancer Program, IDIBELL, ONCOBELL Program, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, Doctor Josep Trueta Girona University Hospital, Girona, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
| | - Marta Pineda
- Consortium for Biomedical Research in Cancer - CIBERONC. Carlos III Institute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
- Hereditary Cancer Program, IDIBELL, ONCOBELL Program, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Consortium for Biomedical Research in Cancer - CIBERONC. Carlos III Institute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Bar-celona, Spain
| | - Francesc Xavier Bosch
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
- Universitat Oberta de Catalunya, Barcelona, Spain
| | | | - Laia Alemany
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain
| | - Laura Costas
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology. IDIBELL, Av Gran Vía 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP. Carlos III In-stitute of Health, Av. De Monforte de Lemos 5, Madrid, 28029, Spain.
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de Sanjosé S, Perkins RB, Campos NG, Inturrisi F, Egemen D, Befano B, Rodriguez AC, Jerónimo J, Cheung LC, Desai K, Han P, Novetsky AP, Ukwuani A, Marcus J, Ahmed SR, Wentzensen N, Kalpathy-Cramer J, Schiffman M. Design of the HPV-Automated Visual Evaluation (PAVE) Study: Validating a Novel Cervical Screening Strategy. medRxiv 2023:2023.08.30.23294826. [PMID: 37693492 PMCID: PMC10491363 DOI: 10.1101/2023.08.30.23294826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Objective To describe the HPV-Automated Visual Evaluation (PAVE) Study, an international, multi-centric study designed to evaluate a novel cervical screen-triage-treat strategy for resource-limited settings as part of a global strategy to reduce cervical cancer burden. The PAVE strategy involves: 1) screening with self-sampled HPV testing; 2) triage of HPV-positive participants with a combination of extended genotyping and visual evaluation of the cervix assisted by deep-learning-based automated visual evaluation (AVE); and 3) treatment with thermal ablation or excision (Large Loop Excision of the Transformation Zone). The PAVE study has two phases: efficacy (2023-2024) and effectiveness (planned to begin in 2024-2025). The efficacy phase aims to refine and validate the screen-triage portion of the protocol. The effectiveness phase will examine acceptability and feasibility of the PAVE strategy into clinical practice, cost-effectiveness, and health communication within the PAVE sites. Study design Phase 1 Efficacy: Around 100,000 nonpregnant women, aged 25-49 years, without prior hysterectomy, and irrespective of HIV status, are being screened at nine study sites in resource-limited settings. Eligible and consenting participants perform self-collection of vaginal specimens for HPV testing using a FLOQSwab (Copan). Swabs are transported dry and undergo testing for HPV using a newly-redesigned isothermal DNA amplification HPV test (ScreenFire HPV RS), which has been designed to provide HPV genotyping by hierarchical risk groups: HPV16, else HPV18/45, else HPV31/33/35/52/58, else HPV39/51/56/59/68. HPV-negative individuals are considered negative for precancer/cancer and do not undergo further testing. HPV-positive individuals undergo pelvic examination with collection of cervical images and targeted biopsies of all acetowhite areas or endocervical sampling in the absence of visible lesions. Accuracy of histology diagnosis is evaluated across all sites. Cervical images are used to refine a deep learning AVE algorithm that classifies images as normal, indeterminate, or precancer+. AVE classifications are validated against the histologic endpoint of high-grade precancer determined by biopsy. The combination of HPV genotype and AVE classification is used to generate a risk score that corresponds to the risk of precancer (lower, medium, high, highest). During the efficacy phase, clinicians and patients within the PAVE sites will receive HPV testing results but not AVE results or risk scores. Treatment during the efficacy phase will be performed per local standard of care: positive Visual Inspection with Acetic Acid impression, high-grade colposcopic impression or CIN2+ on colposcopic biopsy, HPV positivity, or HPV 16,18/45 positivity. Follow up of triage negative patients and post treatment will follow standard of care protocols. The sensitivity of the PAVE strategy for detection of precancer will be compared to current SOC at a given level of specificity.Phase 2 Effectiveness: The AVE software will be downloaded to the new dedicated image analysis and thermal ablation devices (Liger Iris) into which the HPV genotype information can be entered to provide risk HPV-AVE risk scores for precancer to clinicians in real time. The effectiveness phase will examine clinician use of the PAVE strategy in practice, including feasibility and acceptability for clinicians and patients, cost-effectiveness, and health communication within the PAVE sites. Conclusion The goal of the PAVE study is to validate a screen-triage-treat protocol using novel biomarkers to provide an accurate, feasible, cost-effective strategy for cervical cancer prevention in resource-limited settings. If validated, implementation of PAVE at larger scale can be encouraged. Funding The consortial sites are responsible for their own study costs. Research equipment and supplies, and the NCI-affiliated staff are funded by the National Cancer Institute Intramural Research Program including supplemental funding from the Cancer Cures Moonshot Initiative. No commercial support was obtained. Brian Befano was supported by NCI/NIH under Grant T32CA09168. Date of protocol latest review: September 24 th 2023.
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Costas L, Onieva I, Pelegrina B, Marin F, Carmona Á, López-Querol M, Frias-Gomez J, Peremiquel-Trillas P, Martínez JM, Dorca E, Brunet J, Pineda M, Ponce J, Matias-Guiu X, de Sanjosé S, Bosch FX, Alemany L, Paytubi S. Evaluation of Somatic Mutations in Urine Samples as a Noninvasive Method for the Detection and Molecular Classification of Endometrial Cancer. Clin Cancer Res 2023; 29:3681-3690. [PMID: 37439797 DOI: 10.1158/1078-0432.ccr-23-0367] [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: 02/09/2023] [Revised: 04/19/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Current diagnostic methods for endometrial cancer lack specificity, leading to many women undergoing invasive procedures. The aim of this study was to evaluate somatic mutations in urine to accurately discriminate patients with endometrial cancer from controls. EXPERIMENTAL DESIGN Overall, 72 samples were analyzed using next-generation sequencing (NGS) with molecular identifiers targeting 47 genes. We evaluated urine supernatant samples from women with endometrial cancer (n = 19) and age-matched controls (n = 20). Cell pellets from urine and plasma samples from seven cases were sequenced; further, we also evaluated paired tumor samples from all cases. Finally, immunohistochemical markers for molecular profiling were evaluated in all tumor samples. RESULTS Overall, we were able to identify mutations in DNA from urine supernatant samples in 100% of endometrial cancers. In contrast, only one control (5%) showed variants at a variant allele frequency (VAF) ≥ 2% in the urine supernatant samples. The molecular classification obtained by using tumor samples and urine samples showed good agreement. Analyses in paired samples revealed a higher number of mutations and VAF in urine supernatants than in urine cell pellets and blood samples. CONCLUSIONS Evaluation of somatic mutations using urine samples may offer a user-friendly and reliable tool for endometrial cancer detection and molecular classification. The diagnostic performance for endometrial cancer detection was very high, and cases could be molecularly classified using these noninvasive and self-collected samples. Additional multicenter evaluations using larger sample sizes are needed to validate the results and understand the potential of urine samples for the early detection and prognosis of endometrial cancer.
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Affiliation(s)
- Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Madrid, Spain
| | - Irene Onieva
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Madrid, Spain
| | - Fátima Marin
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Madrid, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain
| | | | - Marta López-Querol
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Madrid, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Madrid, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - José Manuel Martínez
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Eduard Dorca
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Brunet
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Madrid, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, Doctor Josep Trueta Girona University Hospital, Girona, Spain
| | - Marta Pineda
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Madrid, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Madrid, Spain
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Francesc Xavier Bosch
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Madrid, Spain
- Universitat Oberta de Catalunya, Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Madrid, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Madrid, Spain
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Sanchez DF, Fernández-Nestosa MJ, Alemany L, Cañete-Portillo S, Lloveras B, Clavero O, Rodríguez I, Quint W, Muñoz N, de Sanjosé S, Bosch FX, Cubilla AL. Detection of variable genotypes in common human papillomavirus-associated invasive penile squamous cell carcinomas: a study of 177 human papillomavirus-positive cases. Hum Pathol 2023; 139:65-72. [PMID: 37429448 DOI: 10.1016/j.humpath.2023.07.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
Human papillomavirus (HPV) is detected in 30-50% of invasive penile carcinomas, and it is frequently associated with basaloid and warty morphological features. Based on this heterogeneity and different clinical behaviors, we hypothesized a variation in their HPV genotypic composition. To test this, we evaluated 177 HPV-positive cases: basaloid (114), warty-basaloid (28), and warty (condylomatous) (35) invasive carcinomas. HPV DNA detection and genotyping was performed using the SPF-10/DEIA/LiPA25 system. Nineteen HPV genotypes were detected. High-risk HPVs predominated (96%), and low-risk HPVs were rarely present. Most common genotype was HPV16 followed by HPVs 33 and 35. According to the genotypes identified, 93% of the cases would be covered with current vaccination programs. There was a significant variation in the distribution of HPV16 and non-HPV16 genotypes according to histological subtype. HPV16 was significantly frequent in basaloid (87%) and was less frequent in warty carcinomas (61%). This molecular difference, along with their distinctive macro-microscopic and prognostic features, makes basaloid and warty carcinomas unique. The gradual decreasing frequency of HPV16 demonstrated in basaloid, warty-basaloid, and warty carcinomas suggest that the basaloid cell, present in those types in decreasing proportions, may be responsible for the differences.
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Affiliation(s)
- Diego F Sanchez
- Instituto de Patología e Investigación, Asunción 1228, Paraguay; Translational Oncogenomics Group, Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester M20 4GJ, UK
| | | | - Laia Alemany
- Institut Català D'Oncologia, Barcelona 08908, Spain
| | | | | | - Omar Clavero
- Institut Català D'Oncologia, Barcelona 08908, Spain
| | - Ingrid Rodríguez
- Instituto de Patología e Investigación, Asunción 1228, Paraguay; Universidad Nacional de Asunción, San Lorenzo 2111, Paraguay
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk 2288, Netherlands
| | - Nubia Muñoz
- National Cancer Institute of Colombia, Bogotá 111511-110411001, Colombia
| | - Silvia de Sanjosé
- Barcelona Institute for Global Health (ISGlobal), Barcelona 08036, Spain
| | | | - Antonio L Cubilla
- Instituto de Patología e Investigación, Asunción 1228, Paraguay; Universidad Nacional de Asunción, San Lorenzo 2111, Paraguay.
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11
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Peremiquel-Trillas P, Gómez D, Martínez JM, Fernández-González S, Frias-Gomez J, Paytubi S, Pelegrina B, Pineda M, Brunet J, Ponce J, Matias-Guiu X, Bosch X, de Sanjosé S, Bruni L, Alemany L, Costas L, Díaz M. Cost-effectiveness analysis of molecular testing in minimally invasive samples to detect endometrial cancer in women with postmenopausal bleeding. Br J Cancer 2023; 129:325-334. [PMID: 37165201 PMCID: PMC10338433 DOI: 10.1038/s41416-023-02291-1] [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: 05/12/2022] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION New approaches are being developed to early detect endometrial cancer using molecular biomarkers. These approaches offer high sensitivities and specificities, representing a promising horizon to develop early detection strategies. OBJECTIVE To evaluate the effectiveness and cost-effectiveness of introducing molecular testing to detect endometrial cancer in women with postmenopausal bleeding compared to the current strategy using the national healthcare service perspective. METHODS A Markov model was developed to assess the two early detection strategies. The model predicts the number of hysterectomies, lifetime expectancy, quality-adjusted life-years, endometrial cancer prevalence and incidence, mortality from endometrial cancer and the lifetime cost of screening, diagnosis, and treatment. Strategies were compared using the incremental cost-effectiveness ratio. RESULTS The molecular strategy reduces 1.9% of the overall number of hysterectomies and the number of undetected cancer cases by 65%. Assuming a molecular test cost of 310€, the molecular strategy has an incremental cost of -32,952€ per QALY gained, being more effective and less expensive than the current strategy. CONCLUSIONS The introduction of molecular testing to diagnose endometrial cancer in women presenting postmenopausal bleeding provides more health benefit at a lower cost, and therefore has the potential to be cost-effective.
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Affiliation(s)
- Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona. C/ Casanova, 143, 08036, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - David Gómez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Manuel Martínez
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Fernández-González
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona. C/ Casanova, 143, 08036, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Pineda
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Joan Brunet
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- Medical Oncology Department. Catalan Institute of Oncology, Doctor Josep Trueta Girona University Hospital. Av. França-Sant Ponç s/n, 17007, Girona, Spain
| | - Jordi Ponce
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Bosch
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Health Sciences, UOC - Open University of Barcelona, Barcelona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Consultant National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laia Bruni
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Mireia Díaz
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain.
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12
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Ibáñez R, Roura E, Acera A, Andújar M, Pavón MÁ, Bruni L, de Sanjosé S. HPV self-sampling among cervical cancer screening users in Spain: A randomized clinical trial of on-site training to increase the acceptability. Prev Med 2023:107571. [PMID: 37308042 DOI: 10.1016/j.ypmed.2023.107571] [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: 12/28/2022] [Revised: 05/01/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
A randomized clinical trial was conducted to compare the impact of two different instructions on vaginal self-sampling in its acceptability and willingness for future screening rounds among women attending cervical cancer screening (CCS). From November 2018 to May 2021, women aged 30-65 living in Spain attending CCS were randomized 1:1 in two arms. In the "On-site training arm (TRA)", women took a self-sample at the primary health care centre following provider's instructions. In the "No on-site training arm (NO-TRA)" women only received instructions to take self-sample at home. All women had to return a new sample collected at home one month after the baseline visit and an acceptability questionnaire. The proportion of self-samples returned, and acceptability was computed by the study arm. A total of 1158 women underwent randomization, 579 women per arm. At follow-up, women in TRA were more likely to return the home sample than women in the NO-TRA (82.4% and 75.5% respectively; p = 0.005). Over 87% of all participants favoured home-based self-sampling approach for future CCS, similar by arm. Over 80% of women in both arms chose to collect and return the self-sample at a health centre or pharmacy. Home-based self-sampling was a highly accepted strategy for CCS in Spain. Trying it first with prior on-site training at the health centre significantly increased the sample's return suggesting that a provider's supervision raised confidence and adherence. It is an option to consider when moving to self-sampling in established CCS. Preferred delivery sites most likely contextual. Registration on ClinicalTrials.gov: NCT05314907.
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Affiliation(s)
- Raquel Ibáñez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP).
| | - Esther Roura
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP)
| | - Amelia Acera
- Atenció a la Salut Sexual i Reproductiva (ASSIR), SAP Cerdanyola-Ripollet, Institut Català de la Salut, Ripollet, Barcelona, Spain
| | - Miguel Andújar
- Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Miguel Ángel Pavón
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP)
| | - Laia Bruni
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP)
| | - Silvia de Sanjosé
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP); NCI Consultant, 9609 Medical Center, Maryland, MD, United States; ISGlobal, Barcelona, Spain
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13
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Cabrera-Serrano AJ, Sánchez-Maldonado JM, ter Horst R, Macauda A, García-Martín P, Benavente Y, Landi S, Clay-Gilmour A, Niazi Y, Espinet B, Rodríguez-Sevilla JJ, Pérez EM, Maffei R, Blanco G, Giaccherini M, Cerhan JR, Marasca R, López-Nevot MÁ, Chen-Liang T, Thomsen H, Gámez I, Campa D, Moreno V, de Sanjosé S, Marcos-Gragera R, García-Álvarez M, Dierssen-Sotos T, Jerez A, Butrym A, Norman AD, Luppi M, Slager SL, Hemminki K, Li Y, Berndt SI, Casabonne D, Alcoceba M, Puiggros A, Netea MG, Försti A, Canzian F, Sainz J. Do GWAS-Identified Risk Variants for Chronic Lymphocytic Leukemia Influence Overall Patient Survival and Disease Progression? Int J Mol Sci 2023; 24:8005. [PMID: 37175717 PMCID: PMC10178669 DOI: 10.3390/ijms24098005] [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: 03/12/2023] [Revised: 04/14/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults worldwide. Although genome-wide association studies (GWAS) have uncovered the germline genetic component underlying CLL susceptibility, the potential use of GWAS-identified risk variants to predict disease progression and patient survival remains unexplored. Here, we evaluated whether 41 GWAS-identified risk variants for CLL could influence overall survival (OS) and disease progression, defined as time to first treatment (TTFT) in a cohort of 1039 CLL cases ascertained through the CRuCIAL consortium. Although this is the largest study assessing the effect of GWAS-identified susceptibility variants for CLL on OS, we only found a weak association of ten single nucleotide polymorphisms (SNPs) with OS (p < 0.05) that did not remain significant after correction for multiple testing. In line with these results, polygenic risk scores (PRSs) built with these SNPs in the CRuCIAL cohort showed a modest association with OS and a low capacity to predict patient survival, with an area under the receiver operating characteristic curve (AUROC) of 0.57. Similarly, seven SNPs were associated with TTFT (p < 0.05); however, these did not reach the multiple testing significance threshold, and the meta-analysis with previous published data did not confirm any of the associations. As expected, PRSs built with these SNPs showed reduced accuracy in prediction of disease progression (AUROC = 0.62). These results suggest that susceptibility variants for CLL do not impact overall survival and disease progression in CLL patients.
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Affiliation(s)
- Antonio José Cabrera-Serrano
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, 18016 Granada, Spain; (A.J.C.-S.); (J.M.S.-M.)
- Instituto de Investigación Biosanitaria IBs.Granada, 18012 Granada, Spain
| | - José Manuel Sánchez-Maldonado
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, 18016 Granada, Spain; (A.J.C.-S.); (J.M.S.-M.)
- Instituto de Investigación Biosanitaria IBs.Granada, 18012 Granada, Spain
| | - Rob ter Horst
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, 1090 Vienna, Austria;
| | - Angelica Macauda
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (A.M.); (F.C.)
| | | | - Yolanda Benavente
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (Y.B.); (V.M.); (S.d.S.); (D.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), University of Barcelona, 08908 Barcelona, Spain; (R.M.-G.); (T.D.-S.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Stefano Landi
- Department of Biology, University of Pisa, 56126 Pisa, Italy; (S.L.); (M.G.); (D.C.)
| | - Alyssa Clay-Gilmour
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Greenville, SC 29208, USA;
| | - Yasmeen Niazi
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), 69120 Heidelberg, Germany; (Y.N.); (A.F.)
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany
| | - Blanca Espinet
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (B.E.); (G.B.); (A.P.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | | | - Eva María Pérez
- Hospital Campus de la Salud, PTS, 18016 Granada, Spain; (P.G.-M.); (E.M.P.)
| | - Rossana Maffei
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Policlinico, 41124 Modena, Italy; (R.M.); (R.M.); (M.L.)
| | - Gonzalo Blanco
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (B.E.); (G.B.); (A.P.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Matteo Giaccherini
- Department of Biology, University of Pisa, 56126 Pisa, Italy; (S.L.); (M.G.); (D.C.)
| | - James R. Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (J.R.C.); (A.D.N.)
| | - Roberto Marasca
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Policlinico, 41124 Modena, Italy; (R.M.); (R.M.); (M.L.)
| | | | - Tzu Chen-Liang
- Hematology Department, Morales Meseguer University Hospital, 30008 Murcia, Spain; (T.C.-L.); (I.G.)
| | | | - Irene Gámez
- Hematology Department, Morales Meseguer University Hospital, 30008 Murcia, Spain; (T.C.-L.); (I.G.)
| | - Daniele Campa
- Department of Biology, University of Pisa, 56126 Pisa, Italy; (S.L.); (M.G.); (D.C.)
| | - Víctor Moreno
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (Y.B.); (V.M.); (S.d.S.); (D.C.)
- Cancer Prevention and Control Program, Unit of Biomarkers and Susceptibility, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, 08907 Barcelona, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, 08907 Barcelona, Spain
| | - Silvia de Sanjosé
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (Y.B.); (V.M.); (S.d.S.); (D.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), University of Barcelona, 08908 Barcelona, Spain; (R.M.-G.); (T.D.-S.)
| | - Rafael Marcos-Gragera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), University of Barcelona, 08908 Barcelona, Spain; (R.M.-G.); (T.D.-S.)
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), 17190 Girona, Spain
- Department of Nursing, Universitat de Girona, 17007 Girona, Spain
- Josep Carreras Leukemia Research Institute, 08916 Girona, Spain
| | - María García-Álvarez
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.G.-Á.); (M.A.)
| | - Trinidad Dierssen-Sotos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), University of Barcelona, 08908 Barcelona, Spain; (R.M.-G.); (T.D.-S.)
- Faculty of Medicine, University of Cantabria, 39011 Santander, Spain
| | - Andrés Jerez
- Department of Hematology, Experimental Hematology Unit, Vall d’Hebron Institute of Oncology (VHIO), University Hospital Vall d’Hebron, 08035 Barcelona, Spain;
| | - Aleksandra Butrym
- Department of Cancer Prevention and Therapy, Medical University of Wrocław, 50-556 Wrocław, Poland;
| | - Aaron D. Norman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (J.R.C.); (A.D.N.)
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Policlinico, 41124 Modena, Italy; (R.M.); (R.M.); (M.L.)
| | - Susan L. Slager
- Division of Computational Genomics, Mayo Clinic, Rochester, MN 85054, USA;
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kari Hemminki
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
- Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605 Pilsen, Czech Republic
| | - Yang Li
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (Y.L.); (M.G.N.)
- Centre for Individualised Infection Medicine (CiiM) & TWINCORE, Joint Ventures between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), 30625 Hannover, Germany
| | - Sonja I. Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20814, USA;
| | - Delphine Casabonne
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (Y.B.); (V.M.); (S.d.S.); (D.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), University of Barcelona, 08908 Barcelona, Spain; (R.M.-G.); (T.D.-S.)
| | - Miguel Alcoceba
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.G.-Á.); (M.A.)
| | - Anna Puiggros
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar, 08003 Barcelona, Spain; (B.E.); (G.B.); (A.P.)
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (Y.L.); (M.G.N.)
- Department for Immunology & Metabolism, Life and Medical Sciences Institute (LIMES), University of Bonn, 53115 Bonn, Germany
| | - Asta Försti
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), 69120 Heidelberg, Germany; (Y.N.); (A.F.)
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (A.M.); (F.C.)
| | - Juan Sainz
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, 18016 Granada, Spain; (A.J.C.-S.); (J.M.S.-M.)
- Instituto de Investigación Biosanitaria IBs.Granada, 18012 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), University of Barcelona, 08908 Barcelona, Spain; (R.M.-G.); (T.D.-S.)
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada (UGR), 18012 Granada, Spain
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14
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Herzog C, Marín F, Jones A, Evans I, Reisel D, Redl E, Schreiberhuber L, Paytubi S, Pelegrina B, Carmona Á, Peremiquel-Trillas P, Frias-Gomez J, Pineda M, Brunet J, Ponce J, Matias-Guiu X, de Sanjosé S, Alemany L, Olaitan A, Wong M, Jurkovic D, Crosbie EJ, Rosenthal AN, Bjørge L, Zikan M, Dostalek L, Cibula D, Sundström K, Dillner J, Costas L, Widschwendter M. A Simple Cervicovaginal Epigenetic Test for Screening and Rapid Triage of Women With Suspected Endometrial Cancer: Validation in Several Cohort and Case/Control Sets. J Clin Oncol 2022; 40:3828-3838. [PMID: 36001862 PMCID: PMC9671754 DOI: 10.1200/jco.22.00266] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Endometrial cancer (EC) incidence has been rising over the past 10 years. Delays in diagnosis reduce survival and necessitate more aggressive treatment. We aimed to develop and validate a simple, noninvasive, and reliable triage test for EC to reduce the number of invasive diagnostic procedures and improve patient survival. METHODS We developed a test to screen and triage women with suspected EC using 726 cervical smear samples from women with and without EC, and validated the test in 562 cervicovaginal samples using three different collection methods (cervical smear: n = 248; vaginal swab: n = 63; and self-collection: n = 251) and four different settings (case/control: n = 388; cohort of women presenting with postmenopausal bleeding: n = 63; a cohort of high-risk women with Lynch syndrome: n = 25; and a nested case/control setting from a screening cohort and samples taken up to 3 years before EC diagnosis: n = 86). RESULTS We describe the Women's cancer risk IDentification - quantitative polymerase chain reaction test for Endometrial Cancer (WID-qEC), a three-marker test that evaluates DNA methylation in gene regions of GYPC and ZSCAN12. In cervical, self-collected, and vaginal swab samples derived from symptomatic patients, it detected EC with sensitivities of 97.2% (95% CI, 90.2 to 99.7), 90.1% (83.6 to 94.6), and 100% (63.1 to 100), respectively, and specificities of 75.8% (63.6 to 85.5), 86.7% (79.3 to 92.2), and 89.1% (77.8 to 95.9), respectively. The WID-qEC identified 90.9% (95% CI, 70.8 to 98.9) of EC cases in samples predating diagnosis up to 1 year. Test performance was similar across menopausal status, age, stage, grade, ethnicity, and histology. CONCLUSION The WID-qEC is a noninvasive reliable test for triage of women with symptoms suggestive of ECs. Because of the potential for self-collection, it could improve early diagnosis and reduce the reliance for in-person visits.
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Affiliation(s)
- Chiara Herzog
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Innsbruck, Austria,Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Fátima Marín
- Hereditary Cancer Group, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain,Consortium for Biomedical Research in Cancer—CIBERONC, Carlos III Institute of Health, Madrid, Spain
| | - Allison Jones
- Department of Women's Cancer, University College London, London, United Kingdom
| | - Iona Evans
- Department of Women's Cancer, University College London, London, United Kingdom
| | - Daniel Reisel
- Department of Women's Cancer, University College London, London, United Kingdom
| | - Elisa Redl
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Innsbruck, Austria,Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Lena Schreiberhuber
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Innsbruck, Austria,Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Álvaro Carmona
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Pineda
- Hereditary Cancer Group, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain,Consortium for Biomedical Research in Cancer—CIBERONC, Carlos III Institute of Health, Madrid, Spain
| | - Joan Brunet
- Hereditary Cancer Group, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain,Consortium for Biomedical Research in Cancer—CIBERONC, Carlos III Institute of Health, Madrid, Spain,Hereditary Cancer Group, Catalan Institute of Oncology, IDIBGI, Girona, Spain
| | - Jordi Ponce
- Consortium for Biomedical Research in Cancer—CIBERONC, Carlos III Institute of Health, Madrid, Spain,Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Consortium for Biomedical Research in Cancer—CIBERONC, Carlos III Institute of Health, Madrid, Spain,Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain,Consortium for Biomedical Research in Epidemiology and Public Health—CIBERESP, Carlos III Institute of Health, Madrid, Spain
| | | | - Michael Wong
- University College Hospital, London, United Kingdom
| | | | - Emma J. Crosbie
- Department of Obstetrics and Gynaecology, Manchester Academic Health Science Center, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom,Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Adam N. Rosenthal
- Department of Women's Cancer, University College London, London, United Kingdom
| | - Line Bjørge
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway,Department of Clinical Science, Center for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway
| | - Michal Zikan
- Department of Gynecology and Obstetrics, Charles University in Prague, First Faculty of Medicine and Bulovka University Hospital, Czech Republic
| | - Lukas Dostalek
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Gynaecologic Oncology Center, Charles University in Prague, General University Hospital in Prague, Prague, Czech Republic
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Gynaecologic Oncology Center, Charles University in Prague, General University Hospital in Prague, Prague, Czech Republic
| | - Karin Sundström
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain,Consortium for Biomedical Research in Epidemiology and Public Health—CIBERESP, Carlos III Institute of Health, Madrid, Spain
| | - Martin Widschwendter
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Innsbruck, Austria,Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria,Department of Women's Cancer, University College London, London, United Kingdom,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden,Martin Widschwendter, MD, European Translational Oncology Prevention and Screening (EUTOPS) Institute, Milser Str 10, 6060 Hall in Tirol, Austria; e-mail:
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15
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Kelly H, Jaafar I, Chung M, Michelow P, Greene S, Strickler H, Xie X, Schiffman M, Broutet N, Mayaud P, Dalal S, Arbyn M, de Sanjosé S. Diagnostic accuracy of cervical cancer screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among women living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 53:101645. [PMID: 36187721 PMCID: PMC9520209 DOI: 10.1016/j.eclinm.2022.101645] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND We systematically reviewed the diagnostic accuracy of cervical cancer screening and triage strategies in women living with HIV (WLHIV). METHODS Cochrane Library, Embase, Global Health and Medline were searched for randomised controlled trials, prospective or cross-sectional studies published from database inception to 15 July 2022 reporting diagnostic accuracy of tests in cervical cancer screening and triage of screen-positive WLHIV. Studies were included if they reported the diagnostic accuracy of any cervical cancer screening or triage strategies for the detection of histologically-confirmed high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among WLHIV. Summary data were extracted from published reports. Authors were contacted for missing data where applicable. Sensitivity and specificity estimates for CIN2/3+ were pooled using models for meta-analysis of diagnostic accuracy data. Study quality was assessed using the QUADAS-2 tool for the quality assessment of diagnostic accuracy studies. PROSPERO registration:CRD42020189031. FINDINGS In 38 studies among 18,737 WLHIV, the majority (n=19) were conducted in sub-Saharan Africa. The pooled prevalence was 12.0% (95%CI:9.8-14.1) for CIN2+ and 6.7% (95%CI:5.0-8.4) for CIN3+. The proportion of screen-positive ranged from 3-31% (visual inspection using acetic acid[VIA]); 2-46% (high-grade squamous intraepithelial lesions, and greater [HSIL+] cytology); 20-64% (high-risk[HR]-HPV DNA). In 14 studies, sensitivity and specificity of VIA were variable limiting the reliability of pooled estimates. In 5 studies where majority had histology-confirmed CIN2+, pooled sensitivity was 56.0% (95%CI:45.4-66.1; I2=65%) for CIN2+ and 65.0% (95%CI:52.9-75.4; I2 =42%) for CIN3+; specificity for <CIN2 was 73.8% (95%CI:59.8-84.2, I2=94%). Cytology was similarly variable (sensitivity of ASCUS+ for CIN2+ range: 58-100%; specificity: 9-96%). In 28 studies, sensitivity of tests targeting 14-HR-HPV types was high (91.6%, 95%CI:88.1-94.1; I2=45% for CIN2+ and 92.5%, 95%CI:88.4-95.2; I2=32%) for CIN3+); but specificity for <CIN2 was low (62.2% (95%CI:57.9-66.4;I2=92%). Restriction to 8-HR-HPV increased specificity (65.8%; Relative specificity[RSpec] vs. 14-HR-HPV=1.17; 95%CI:1.10-1.24) with no significant change in sensitivity (CIN2+:85.5%; Relative Sensitivity[RSens]=0.94, 95%CI: 0.89-1.00; CIN3+:90%; RSens=0.96, 95%CI:0.89-1.03). VIA triage of 14-HR-HPV positive women decreased sensitivity for CIN2+ compared to HPV-DNA test alone (64.4% vs. 91.6%; RSens=0.68, 95%CI:0.62-0.75). INTERPRETATION HPV-DNA based approaches consistently showed superior sensitivity for CIN2+/CIN3+ compared to VIA or cytology. The low specificity of HPV-DNA based methods targeting up to 14-HR-HPV could be improved significantly by restricting to 8-HR-HPV with only minor losses in sensitivity, limiting requirement for triage for which optimal approaches are less clear. FUNDING World Health Organisation; National Cancer Institute; European Union's Horizon 2020 and Marie Skłodowska-Curie Actions programme.
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Affiliation(s)
- Helen Kelly
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Corresponding author at: London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Iman Jaafar
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Michael Chung
- Department of Global Health, University of Washington, Seattle, USA
| | - Pamela Michelow
- Cytology Unit, Department of Anatomical Pathology, Faculty of Health Science, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa
| | - Sharon Greene
- Department of Global Health, University of Washington, Seattle, USA
| | - Howard Strickler
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Xianhong Xie
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Mark Schiffman
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Nathalie Broutet
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Philippe Mayaud
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - 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
| | - Silvia de Sanjosé
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
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Herrick T, Thomson KA, Shin M, Gannon S, Tsu V, de Sanjosé S. Acting on the call for cervical cancer elimination: Planning tools for low- and middle- income countries to increase the coverage and effectiveness of screening and treatment. BMC Health Serv Res 2022; 22:1246. [PMID: 36241993 PMCID: PMC9563118 DOI: 10.1186/s12913-022-08423-2] [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: 08/25/2021] [Accepted: 08/04/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Accessible planning tools tailored for low-and middle-income countries can assist decision makers in comparing implementation of different cervical cancer screening approaches and treatment delivery scenarios in settings with high cervical cancer burden. Methods The Cervical Precancer Planning Tool (CPPT) was developed by PATH for users to explore and compare the accuracy of screening approaches, what treatment equipment to procure, and how best to deploy treatment equipment in a given country. The CPPT compares four screening approaches: 1) visual inspection with acetic acid (VIA), 2) HPV testing, 3) HPV testing followed by a VIA triage, and 4) HPV testing followed by an enhanced triage test. Accuracy of screening outcomes (e.g., true positives, false positives) is based on published sensitivity and specificity of tests to detect cervical precancerous lesions. The CPPT compares five scenarios for deploying ablative treatment equipment: 1) cervical precancer equipment at every location a woman is screened (single visit approach), 2) equipment only at a hospital level, 3) a single unit of equipment in each district, 4) allowing two districts to share a single unit of equipment, and 5) equipment placed at select district hospitals paired with mobile outreach. Users can customize the CPPT by adjusting pre-populated baseline values and assumptions, including population estimates, screening age range, screening frequency, HPV and HIV prevalence, supply costs, and health facility details. Results The CPPT generates data tables and graphs that compare the results of implementing each of the four screening and five treatment scenarios disaggregated by HIV status. Outputs include the number and outcomes of women screened, cost of each screening approach, provider time and cost saved by implementing self-sampling for HPV testing, number of women treated, treatment equipment needed by type, and the financial and economic costs for each equipment deployment scenario. Conclusion The CPPT provides practical information and data to compare tradeoffs of patient access and screening accuracy as well as efficient utilization of equipment, skilled personnel, and financial resources. Country decision makers can use outputs from the CPPT to guide the scale-up of cervical cancer screening and treatment while optimizing limited resources.
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Affiliation(s)
- Tara Herrick
- Market Dynamics, PATH, 2201, Westlake Ave Suite 200, Seattle, WA, 98121, USA.
| | - Kerry A Thomson
- Sexual and Reproductive Health Program, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA, 98121, USA.
| | - Michelle Shin
- Department of Global Health, University of Washington, Seattle, USA
| | - Sarah Gannon
- Market Dynamics, PATH, 2201, Westlake Ave Suite 200, Seattle, WA, 98121, USA
| | - Vivien Tsu
- Department of Global Health, University of Washington, Seattle, USA
| | - Silvia de Sanjosé
- Sexual and Reproductive Health Program, PATH, 2201 Westlake Ave, Suite 200, Seattle, WA, 98121, USA
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Bigby SM, Eva LJ, Tous S, de Sanjosé S, Bosch X, Alemany L, Chang KCT, Jones RW. Prevaccine Human Papillomavirus Status in Invasive and Intraepithelial Lesions of the Vulva in New Zealand Women. J Low Genit Tract Dis 2022; 26:323-327. [PMID: 35930419 DOI: 10.1097/lgt.0000000000000687] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The human papillomavirus (HPV) vaccine, introduced in New Zealand (NZ) in 2008, is predicted to substantially lower the incidence of HPV-associated precancers and cancers. The aim of this study is to estimate the proportion of vulvar intraepithelial neoplasia (VIN) lesions and invasive vulvar squamous cell carcinomas (SCCV) attributable to HPV in NZ women treated by the Auckland Regional Gynecological Oncology Service, covering an estimated 50% of the NZ population. MATERIALS AND METHODS Polymerase chain reaction and reverse hybridization were used to analyze retrospective histologically proven SCCV from 1990 to 2007 and VIN lesions from 2000 to 2007 for HPV content and genotype in a collaborative study with the Catalan Institute of Oncology. Immunohistochemistry for p16INK4a was performed on SCCV, which were attributed to HPV if both tested positive. RESULTS Polymerase chain reaction testing for HPV content and genotype was performed on 66 VIN lesions (all high-grade squamous intraepithelial lesions) and 189 SCCV. In addition, p16 immunohistochemistry was performed on 168 of the 189 SCCV (88.9%) tested for HPV-DNA. Overall, 61 SCCV cases (36.3%) were attributed to HPV (HPV+/p16+), and 89 SCCV cases (53%) were considered to have developed independently of HPV (HPV-/p16-). Known high-risk HPV genotypes were present in 96.8% of HPV-DNA-positive vulvar high-grade squamous intraepithelial lesions and 98.4% of HPV-attributable SCCV. Human papillomavirus 16 represented the most common genotype in both. CONCLUSIONS Overall, the HPV vaccine is likely to substantially alter the profile of SCCV in our region. The results provide a baseline assessment of the HPV status of vulvar neoplasia before the introduction of the HPV vaccine.
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Affiliation(s)
- Susan M Bigby
- Department of Histopathology, Laboratory Services, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Lois J Eva
- Department of Gynaecological Oncology, National Women's at Auckland City Hospital, Auckland, New Zealand
| | - Sara Tous
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjosé
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Alemany
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Kevin C T Chang
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Ronald W Jones
- Department of Gynaecological Oncology, National Women's at Auckland City Hospital, Auckland, New Zealand
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18
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Arbyn M, Canfell K, Poljak M, Berkhof J, de Sanjosé S, Wentzensen N. HPV mRNA testing in cervical cancer screening – Authors' reply. Lancet Oncol 2022; 23:e437. [DOI: 10.1016/s1470-2045(22)00551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
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19
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Xue Z, Angara S, Guo P, Rajaraman S, Jeronimo J, Rodriguez AC, Alfaro K, Charoenkwan K, Mungo C, Domgue JF, Wentzensen N, Desai KT, Ajenifuja KO, Wikström E, Befano B, de Sanjosé S, Schiffman M, Antani S. Image Quality Classification for Automated Visual Evaluation of Cervical Precancer. Med Image Learn Ltd Noisy Data (2022) 2022; 13559:206-217. [PMID: 36315110 PMCID: PMC9614805 DOI: 10.1007/978-3-031-16760-7_20] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Image quality control is a critical element in the process of data collection and cleaning. Both manual and automated analyses alike are adversely impacted by bad quality data. There are several factors that can degrade image quality and, correspondingly, there are many approaches to mitigate their negative impact. In this paper, we address image quality control toward our goal of improving the performance of automated visual evaluation (AVE) for cervical precancer screening. Specifically, we report efforts made toward classifying images into four quality categories ("unusable", "unsatisfactory", "limited", and "evaluable") and improving the quality classification performance by automatically identifying mislabeled and overly ambiguous images. The proposed new deep learning ensemble framework is an integration of several networks that consists of three main components: cervix detection, mislabel identification, and quality classification. We evaluated our method using a large dataset that comprises 87,420 images obtained from 14,183 patients through several cervical cancer studies conducted by different providers using different imaging devices in different geographic regions worldwide. The proposed ensemble approach achieved higher performance than the baseline approaches.
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Affiliation(s)
- Zhiyun Xue
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Sandeep Angara
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Peng Guo
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | | | - Jose Jeronimo
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | | | | | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand 50200
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Joel Fokom Domgue
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas Wentzensen
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Kanan T Desai
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | | | - Elisabeth Wikström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Brian Befano
- Information Management Services, Calverton, MD, USA
| | - Silvia de Sanjosé
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Mark Schiffman
- National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Sameer Antani
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
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20
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Peremiquel-Trillas P, Paytubi S, Pelegrina B, Frias-Gomez J, Carmona Á, Martínez JM, de Francisco J, Benavente Y, Barahona M, Briansó F, Canet-Hermida J, Caño V, Vidal A, Zanca A, Baixeras N, Rodríguez A, Fernández-Gonzalez S, Dueñas N, Càrdenas L, Aytés Á, Bianchi I, Pavón MÀ, Reventós J, Capellà G, Gómez D, Diaz M, Ponce J, Brunet J, Matias-Guiu X, Bosch FX, de Sanjosé S, Alemany L, Pineda M, Marin F, Costas L. An Integrated Approach for the Early Detection of Endometrial and Ovarian Cancers (Screenwide Study): Rationale, Study Design and Pilot Study. J Pers Med 2022; 12:jpm12071074. [PMID: 35887570 PMCID: PMC9324683 DOI: 10.3390/jpm12071074] [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: 05/30/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Screenwide is a case-control study (2017−2021) including women with incident endometrial and ovarian cancers (EC and OC), BRCA1/2 and MMR pathogenic variant carriers, and age-matched controls from three centers in Spain. Participants completed a personal interview on their sociodemographic factors, occupational exposure, medication, lifestyle, and medical history. We collected biological specimens, including blood samples, self-collected vaginal specimens, cervical pap-brush samples, uterine specimens, and, when available, tumor samples. The planned analyses included evaluation of the potential risk factors for EC/OC; evaluation of molecular biomarkers in minimally invasive samples; evaluation of the cost-effectiveness of molecular tests; and the generation of predictive scores to integrate different epidemiologic, clinical, and molecular factors. Overall, 182 EC, 69 OC, 98 BRCA pathogenic variant carriers, 104 MMR pathogenic variant carriers, and 385 controls were enrolled. The overall participation rate was 85.7%. The pilot study using 61 samples from nine EC cases and four controls showed that genetic variants at the variant allele fraction > 5% found in tumors (n = 61 variants across the nine tumors) were detected in paired endometrial aspirates, clinician-collected cervical samples, and vaginal self-samples with detection rates of 90% (55/61), 79% (48/61), and 72% (44/61) by duplex sequencing, respectively. Among the controls, only one somatic mutation was detected in a cervical sample. We enrolled more than 800 women to evaluate new early detection strategies. The preliminary data suggest that our methodological approach could be useful for the early detection of gynecological cancers.
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Affiliation(s)
- Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
- Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
| | - Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
- Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
| | - Álvaro Carmona
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
| | - José Manuel Martínez
- Department of Gynecology, IDIBELL, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08908 Barcelona, Spain; (J.M.M.); (M.B.); (S.F.-G.); (J.P.)
| | - Javier de Francisco
- Department of Anesthesiology, IDIBELL, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08908 Barcelona, Spain; (J.d.F.); (V.C.)
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
| | - Marc Barahona
- Department of Gynecology, IDIBELL, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08908 Barcelona, Spain; (J.M.M.); (M.B.); (S.F.-G.); (J.P.)
| | - Ferran Briansó
- Department of Genetics, Microbiology and Statistics, Universitat de Barcelona, 08028 Barcelona, Spain;
- Roche Diagnostics, Sant Cugat del Vallès, 08174 Barcelona, Spain
| | - Júlia Canet-Hermida
- Hereditary Cancer Group, ONCOBELL Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet, 08908 Barcelona, Spain; (J.C.-H.); (N.D.); (G.C.); (J.B.); (M.P.); (F.M.)
- Consortium for Biomedical Research in Cancer–CIBERONC, Carlos III Institute of Health, 28029 Madrid, Spain; (A.V.); (X.M.-G.)
| | - Víctor Caño
- Department of Anesthesiology, IDIBELL, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08908 Barcelona, Spain; (J.d.F.); (V.C.)
| | - August Vidal
- Consortium for Biomedical Research in Cancer–CIBERONC, Carlos III Institute of Health, 28029 Madrid, Spain; (A.V.); (X.M.-G.)
- Department of Pathology, IDIBELL, Hospitalet de Llobregat, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (A.Z.); (N.B.); (A.R.)
| | - Alba Zanca
- Department of Pathology, IDIBELL, Hospitalet de Llobregat, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (A.Z.); (N.B.); (A.R.)
| | - Núria Baixeras
- Department of Pathology, IDIBELL, Hospitalet de Llobregat, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (A.Z.); (N.B.); (A.R.)
| | - Axel Rodríguez
- Department of Pathology, IDIBELL, Hospitalet de Llobregat, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (A.Z.); (N.B.); (A.R.)
| | - Sergi Fernández-Gonzalez
- Department of Gynecology, IDIBELL, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08908 Barcelona, Spain; (J.M.M.); (M.B.); (S.F.-G.); (J.P.)
| | - Núria Dueñas
- Hereditary Cancer Group, ONCOBELL Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet, 08908 Barcelona, Spain; (J.C.-H.); (N.D.); (G.C.); (J.B.); (M.P.); (F.M.)
- Consortium for Biomedical Research in Cancer–CIBERONC, Carlos III Institute of Health, 28029 Madrid, Spain; (A.V.); (X.M.-G.)
| | - Laura Càrdenas
- Department of Gynecology and Obstetrics, Hospital Universitari Dr. Josep Trueta, 17007 Girona, Spain;
| | - Álvaro Aytés
- Program against Cancer Therapeutic Resistance (ProCURE), IDIBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Ilaria Bianchi
- ASSIR Delta, Serveis d’Atenció Primària Delta del Llobregat, Direcció d’Atenció Primària Costa de Ponent, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, 08006 Barcelona, Spain;
| | - Miquel Àngel Pavón
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
| | - Jaume Reventós
- Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, 08017 Barcelona, Spain;
| | - Gabriel Capellà
- Hereditary Cancer Group, ONCOBELL Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet, 08908 Barcelona, Spain; (J.C.-H.); (N.D.); (G.C.); (J.B.); (M.P.); (F.M.)
- Consortium for Biomedical Research in Cancer–CIBERONC, Carlos III Institute of Health, 28029 Madrid, Spain; (A.V.); (X.M.-G.)
| | - David Gómez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
| | - Mireia Diaz
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
| | - Jordi Ponce
- Department of Gynecology, IDIBELL, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08908 Barcelona, Spain; (J.M.M.); (M.B.); (S.F.-G.); (J.P.)
| | - Joan Brunet
- Hereditary Cancer Group, ONCOBELL Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet, 08908 Barcelona, Spain; (J.C.-H.); (N.D.); (G.C.); (J.B.); (M.P.); (F.M.)
- Consortium for Biomedical Research in Cancer–CIBERONC, Carlos III Institute of Health, 28029 Madrid, Spain; (A.V.); (X.M.-G.)
- Medical Oncology Department, Catalan Institute of Oncology, Doctor Josep Trueta Girona University Hospital, 17007 Girona, Spain
| | - Xavier Matias-Guiu
- Consortium for Biomedical Research in Cancer–CIBERONC, Carlos III Institute of Health, 28029 Madrid, Spain; (A.V.); (X.M.-G.)
- Department of Pathology, IDIBELL, Hospitalet de Llobregat, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (A.Z.); (N.B.); (A.R.)
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
- Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
- Consultant, National Cancer Institute, Bethesda, MA 20814, USA
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
| | - Marta Pineda
- Hereditary Cancer Group, ONCOBELL Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet, 08908 Barcelona, Spain; (J.C.-H.); (N.D.); (G.C.); (J.B.); (M.P.); (F.M.)
- Consortium for Biomedical Research in Cancer–CIBERONC, Carlos III Institute of Health, 28029 Madrid, Spain; (A.V.); (X.M.-G.)
| | - Fátima Marin
- Hereditary Cancer Group, ONCOBELL Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet, 08908 Barcelona, Spain; (J.C.-H.); (N.D.); (G.C.); (J.B.); (M.P.); (F.M.)
- Consortium for Biomedical Research in Cancer–CIBERONC, Carlos III Institute of Health, 28029 Madrid, Spain; (A.V.); (X.M.-G.)
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, l’Hospitalet de Llobregat, 08908 Barcelona, Spain; (P.P.-T.); (S.P.); (B.P.); (J.F.-G.); (Á.C.); (Y.B.); (M.À.P.); (D.G.); (M.D.); (F.X.B.); (L.A.)
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Carlos III Institute of Health, 28029 Madrid, Spain;
- Correspondence:
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21
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García-Martín P, Díez AM, Maldonado JMS, Serrano AJC, Ter Horst R, Benavente Y, Landi S, Macauda A, Clay-Gilmour A, Hernández-Mohedo F, Niazi Y, González-Sierra P, Espinet B, Rodríguez-Sevilla JJ, Maffei R, Blanco G, Giaccherini M, Puiggros A, Cerhan J, Marasca R, Cañadas-Garre M, López-Nevot MÁ, Chen-Liang T, Thomsen H, Gámez I, Moreno V, Marcos-Gragera R, García-Álvarez M, Llorca J, Jerez A, Berndt S, Butrym A, Norman AD, Casabonne D, Luppi M, Slager SL, Hemminki K, Li Y, Alcoceba M, Campa D, Canzian F, de Sanjosé S, Försti A, Netea MG, Jurado M, Sainz J. Validation and functional characterization of GWAS-identified variants for chronic lymphocytic leukemia: a CRuCIAL study. Blood Cancer J 2022; 12:79. [PMID: 35581176 PMCID: PMC9114372 DOI: 10.1038/s41408-022-00676-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
| | - Ana Moñiz Díez
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
| | - José Manuel Sánchez Maldonado
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
| | - Antonio José Cabrera Serrano
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
| | - Rob Ter Horst
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Yolanda Benavente
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Stefano Landi
- Department of Biology, University of Pisa, Pisa, Italy
| | - Angelica Macauda
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alyssa Clay-Gilmour
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Greenville, SC, USA
| | - Francisca Hernández-Mohedo
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
| | - Yasmeen Niazi
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
| | - Pedro González-Sierra
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
| | - Blanca Espinet
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | - Rossana Maffei
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Policlinico, Modena, Italy
| | - Gonzalo Blanco
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | - Anna Puiggros
- Molecular Cytogenetics Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain
- Translational Research on Hematological Neoplasms Group, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - James Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Roberto Marasca
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Policlinico, Modena, Italy
| | - Marisa Cañadas-Garre
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
| | | | - Tzu Chen-Liang
- Hematology Department, Morales Meseguer University Hospital, Murcia, Spain
| | | | - Irene Gámez
- Hematology Department, Morales Meseguer University Hospital, Murcia, Spain
| | - Víctor Moreno
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Biomarkers and Susceptibility, Cancer Prevention and Control Program, IDIBELL, Catalan Institute of Oncology; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Rafael Marcos-Gragera
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), and Universitat de Girona, Girona, Spain
- Josep Carreras Leukemia Research Institute, Girona, Spain
| | - María García-Álvarez
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Javier Llorca
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Andrés Jerez
- Hematology Department, Morales Meseguer University Hospital, Murcia, Spain
| | - Sonja Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Aaron D Norman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Delphine Casabonne
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Policlinico, Modena, Italy
| | - Susan L Slager
- Division of Computational Genomics, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kari Hemminki
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic
| | - Yang Li
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Centre for Individualised Infection Medicine (CiiM) & TWINCORE, joint ventures between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany
| | | | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Silvia de Sanjosé
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Asta Försti
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Department for Immunology & Metabolism, Life and Medical Sciences Institute (LIMES), University of Bonn, 53115, Bonn, Germany
| | - Manuel Jurado
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
| | - Juan Sainz
- Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain.
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain.
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain.
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada (UGR), Granada, Spain.
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22
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Morhason-Bello IO, Baisley K, Pavon MA, Adewole IF, Bakare RA, de Sanjosé S, Francis SC, Watson-Jones D. Oral, genital and anal human papillomavirus infections among female sex workers in Ibadan, Nigeria. PLoS One 2022; 17:e0265269. [PMID: 35353833 PMCID: PMC8967011 DOI: 10.1371/journal.pone.0265269] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background
There are limited data on the epidemiology of HPV in different anatomical sites of female sex workers (FSW). We investigated the prevalence and concordance of cervical, vulval, oral and anal HPV among FSW in Ibadan, Nigeria.
Methods
FSWs aged 18–45 years were enrolled in a cross-sectional survey. After interview and clinical examination, samples were collected from mouth, cervix, vulva and anus. HPV genotyping was done with Anyplex II 28HPV assay. Multivariable analyses were performed to explore associated risk factors and concordance of HPV infections across sites.
Results
In total, 315 FSWs participated in the study with a mean age of 30–6.5 years. The prevalence of any HPV infection was 88% in the vulva, 84% in the cervix, 75% in the anus and 24% in the oral cavity. HPV 35 was the most prevalent and concordant high-risk type in the four sites. The risk factors for HPV infection by anatomic site varied.
Conclusion
This large study showed a high prevalence and concordance of HPV infections of cervical, vulval, oral and anal HPV among FSWs in Nigeria. The potential to acquire and transmit HPV is high in this population, and we highlighted the urgency to protect young women through HPV vaccination.
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Affiliation(s)
- Imran O. Morhason-Bello
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Institute of Advance Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
| | - Miquel A. Pavon
- Infection and Cancer Laboratory, Cancer Epidemiology Research Program, ICO, Bellvitge Biomedical Research Institute (IDIBELL), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Isaac F. Adewole
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rasheed A. Bakare
- Department of Microbiology, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics (DCEG), Consultant, National Cancer Institute (NCI), National Institutes of Health (NIH), USA and Associate Researcher, ISGlobal, Barcelona, Spain
| | - Suzanna C. Francis
- International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Deborah Watson-Jones
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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23
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Lledó GM, Sellares J, Brotons C, Sans M, Antón JD, Blanco J, Bassat Q, Sarukhan A, Miró JM, de Sanjosé S. Post-acute COVID-19 syndrome: a new tsunami requiring a universal case definition. Clin Microbiol Infect 2021; 28:315-318. [PMID: 34826619 PMCID: PMC8610558 DOI: 10.1016/j.cmi.2021.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Gema M Lledó
- Department of Autoimmune Diseases, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jacobo Sellares
- Department of Pulmonary Medicine, Hospital Clínic-Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Carlos Brotons
- Sardenya Primary Health Care Centre, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Mireia Sans
- Comte Borrell Health Care Centre, CAPSBE, Metges e-Salut, COMB, International University of Catalonia, Barcelona, Catalonia, Spain
| | - Juana Díez Antón
- Molecular Virology Group, Department of Experimental and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
| | - Julià Blanco
- IrsiCaixa AIDS Research Institute, Germans Trias I Pujol Research Institute (IGTP), Can Ruti Campus, Badalona, Catalonia, Spain; University of Vic (UVic-UCC), Vic, Catalonia, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Pg. Lluís Companys 23, Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Silvia de Sanjosé
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
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24
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Desai KT, Befano B, Xue Z, Kelly H, Campos NG, Egemen D, Gage JC, Rodriguez AC, Sahasrabuddhe V, Levitz D, Pearlman P, Jeronimo J, Antani S, Schiffman M, de Sanjosé S. The development of "automated visual evaluation" for cervical cancer screening: The promise and challenges in adapting deep-learning for clinical testing. Int J Cancer 2021; 150:741-752. [PMID: 34800038 PMCID: PMC8732320 DOI: 10.1002/ijc.33879] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 07/07/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 12/22/2022]
Abstract
There is limited access to effective cervical cancer screening programs in many resource‐limited settings, resulting in continued high cervical cancer burden. Human papillomavirus (HPV) testing is increasingly recognized to be the preferable primary screening approach if affordable due to superior long‐term reassurance when negative and adaptability to self‐sampling. Visual inspection with acetic acid (VIA) is an inexpensive but subjective and inaccurate method widely used in resource‐limited settings, either for primary screening or for triage of HPV‐positive individuals. A deep learning (DL)‐based automated visual evaluation (AVE) of cervical images has been developed to help improve the accuracy and reproducibility of VIA as assistive technology. However, like any new clinical technology, rigorous evaluation and proof of clinical effectiveness are required before AVE is implemented widely. In the current article, we outline essential clinical and technical considerations involved in building a validated DL‐based AVE tool for broad use as a clinical test.
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Affiliation(s)
- Kanan T Desai
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Brian Befano
- Information Management Services Inc., Calverton, Maryland, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Zhiyun Xue
- US National Library of Medicine, Bethesda, Maryland, USA
| | - Helen Kelly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Nicole G Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Didem Egemen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Ana-Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - David Levitz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Paul Pearlman
- Center for Global Health, National Cancer Institute, Rockville, Maryland, USA
| | - Jose Jeronimo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Sameer Antani
- US National Library of Medicine, Bethesda, Maryland, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.,ISGlobal, Barcelona, Spain
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25
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Bouvard V, Wentzensen N, Mackie A, Berkhof J, Brotherton J, Giorgi-Rossi P, Kupets R, Smith R, Arrossi S, Bendahhou K, Canfell K, Chirenje ZM, Chung MH, Del Pino M, de Sanjosé S, Elfström M, Franco EL, Hamashima C, Hamers FF, Herrington CS, Murillo R, Sangrajrang S, Sankaranarayanan R, Saraiya M, Schiffman M, Zhao F, Arbyn M, Prendiville W, Indave Ruiz BI, Mosquera-Metcalfe I, Lauby-Secretan B. The IARC Perspective on Cervical Cancer Screening. N Engl J Med 2021; 385:1908-1918. [PMID: 34758259 DOI: 10.1056/nejmsr2030640] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Véronique Bouvard
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Nicolas Wentzensen
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Anne Mackie
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Johannes Berkhof
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Julia Brotherton
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Paolo Giorgi-Rossi
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Rachel Kupets
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Robert Smith
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Silvina Arrossi
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Karima Bendahhou
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Karen Canfell
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Z Mike Chirenje
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Michael H Chung
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Marta Del Pino
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Silvia de Sanjosé
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Miriam Elfström
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Eduardo L Franco
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Chisato Hamashima
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Françoise F Hamers
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - C Simon Herrington
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Raúl Murillo
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Suleeporn Sangrajrang
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Rengaswamy Sankaranarayanan
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Mona Saraiya
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Mark Schiffman
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Fanghui Zhao
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Marc Arbyn
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Walter Prendiville
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Blanca I Indave Ruiz
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Isabel Mosquera-Metcalfe
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
| | - Béatrice Lauby-Secretan
- From the International Agency for Research on Cancer, Lyon (V.B., W.P., B.I.I.R., I.M.M., B.L.-S.), and the National Public Health Agency, Saint-Maurice (F.F.H.) - both in France; the National Cancer Institute, Rockville, MD (N.W., M. Schiffman); Public Health England and Screening, London (A.M.); Amsterdam University Medical Centers, Amsterdam (J. Berkhof); VCS Foundation, Melbourne, VIC (J. Brotherton), Australia; Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy (P.G.R.); the University of Toronto, Toronto (R.K.); the American Cancer Society (R. Smith), Emory University (M.H.C.), and the Centers for Disease Control and Prevention (M. Saraiya) - all in Atlanta; the Center for the Study of the State and Society, and the National Scientific and Technical Research Council - both in Buenos Aires (S.A.); the Casablanca Cancer Registry, Casablanca, Morocco (K.B.); The Daffodil Centre, a joint venture between the Cancer Council NSW and the University of Sydney, King's Cross, NSW, Australia (K.C.); the University of Zimbabwe College of Health Sciences, Harare (Z.M.C.); Hospital Clínic de Barcelona, Barcelona (M.P.); PATH, Seattle (S. de Sanjosé); Karolinska Institutet, Stockholm (M.E.); McGill University, Montreal (E.F.); Teikyo University, and the National Cancer Center - both in Tokyo (C.H.); the University of Edinburgh, Edinburgh (C.S.H.); Hospital Universitario San Ignacio, Bogota, Colombia (R.M.); the National Cancer Institute, Bangkok, Thailand (S. Sangrajrang); Research Triangle Institute International, New Delhi, India (R. Sankaranarayanan); Chinese Academy of Medical Sciences, Beijing (F.Z.); and Sciensano, Brussels (M.A.)
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Morhason-Bello IO, Baisley K, Pavon MA, Adewole IF, Bakare R, de Sanjosé S, Francis SC, Watson-Jones D. Prevalence and genotype specific concordance of oro-genital and anal human papillomavirus infections among sexually active Nigerian women. Infect Agent Cancer 2021; 16:59. [PMID: 34496909 PMCID: PMC8424803 DOI: 10.1186/s13027-021-00398-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background Human papillomavirus (HPV) associated cancers are increasingly reported globally, including in sub-Saharan Africa (SSA). However, with the exception of cervical HPV infection, data from SSA on the epidemiology of oral and genital HPV infections are limited. This study assessed the prevalence and concordance of oro-genital and anal HPV genotype specific infections among women in the general population.
Methods We conducted a cross-sectional study in sexually active women aged 18–45 years in Ibadan, Nigeria. After a face-to-face interview and clinical examination, oral, cervical, vulvar, and anal samples were collected from participants and tested by the Anyplex II 28 HPV assay. Descriptive and multivariable analyses were used to report prevalence and risk factors associated with HPV infections. Results The prevalence of any vulva, cervical, anal, and oral HPV infections was 68.0% (210/309), 59.7% (182/305), 56.8% (172/303), and 16.1% (14/286), respectively. There was an inverse relationship between age-group and HPV prevalence of HPV in all anatomic sites except for the oral HPV infections. HPV 35 was the most prevalent high-risk HPV genotype in the vulva, cervix and oral cavity. Associated risk factors for HPV infection in each of the anatomic sites were reported. Overall, 10.0% (31/310) women had concordance of any HPV type in the four anatomic sites. Conclusion There was a high prevalence of oro-genital and anal HPV infections among sexually active Nigerian women, with concordance of HPV types in the cervix, vulva, anus and oral cavity. We advocate large longitudinal studies that will involve sampling of multiple anatomic sites and inclusion of other women in the community for better understanding of HPV epidemiology in this region. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00398-9.
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Affiliation(s)
- Imran O Morhason-Bello
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria. .,Institute of Advance Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Miquel Angel Pavon
- Infection and Cancer Laboratory, Cancer Epidemiology Research Program, ICO, Bellvitge Biomedical Research Institute (IDIBELL), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat, Gran Via de l'Hospitalet, 199-203, 08908, Barcelona, Spain
| | - Isaac F Adewole
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Rasheed Bakare
- Department of Microbiology, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Silvia de Sanjosé
- Infection and Cancer Laboratory, Cancer Epidemiology Research Program, ICO, Bellvitge Biomedical Research Institute (IDIBELL), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat, Gran Via de l'Hospitalet, 199-203, 08908, Barcelona, Spain.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA
| | - Suzanna C Francis
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
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Frias-Gomez J, Tovar E, Vidal A, Murgui L, Ibáñez R, Peremiquel-Trillas P, Paytubi S, Baixeras N, Zanca A, Ponce J, Pineda M, Brunet J, de Sanjosé S, Bosch FX, Matias-Guiu X, Alemany L, Costas L. Sensitivity of cervical cytology in endometrial cancer detection in a tertiary hospital in Spain. Cancer Med 2021; 10:6762-6766. [PMID: 34480514 PMCID: PMC8495290 DOI: 10.1002/cam4.4217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/12/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Cervical cytology is a well‐stablished cervical cancer screening method. However, due to the anatomical continuity of the genital tract, it can also detect signs of endometrial disease. Our aim was to estimate the sensitivity of cervical cytology in endometrial cancer detection and prognosis in a large population over a 30‐year period in a large academic tertiary hospital in Spain. Methodology We performed a search for women diagnosed with endometrial cancer from 1990 to 2020, who were surgically treated and had a previous cervical cytology result. Information Technologies Department databases from Bellvitge University Hospital and the Screenwide case–control study's database were used. Cervical cytology results were classified as abnormal when squamous lesions, glandular atypia or malignant cells were identified. Results Overall, we evaluated 371 women with endometrial cancer and a documented cervical cytology performed within 3 years previous to surgical treatment. Overall, the sensitivity of cervical cytology for endometrial cancer detection was 25.6%. Several clinico‐pathological characteristics, such as non‐endometrioid histology and a higher stage, were correlated with higher sensitivity. Discussion We observed a low sensitivity of cervical cytology to effectively diagnose endometrial cancer. However, recent technological advances using genomics and epigenomics may offer a promising perspective to detect endometrial cancer with high sensitivity in these cervical specimens.
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Affiliation(s)
- Jon Frias-Gomez
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain.,University of Barcelona (UB), Barcelona, Spain
| | - Eva Tovar
- Information Technologies Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - August Vidal
- Consortium for Biomedical Research in Oncology (CIBERONC), Madrid, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Lluis Murgui
- Information Technologies Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Raquel Ibáñez
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain.,University of Barcelona (UB), Barcelona, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nuria Baixeras
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Alba Zanca
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Marta Pineda
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain
| | - Joan Brunet
- Consortium for Biomedical Research in Oncology (CIBERONC), Madrid, Spain.,Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain.,Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,National Cancer Institute, Rockville, Washington, USA
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Xavier Matias-Guiu
- Consortium for Biomedical Research in Oncology (CIBERONC), Madrid, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Costas
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Arbyn M, Simon M, Peeters E, Xu L, Meijer CJLM, Berkhof J, Cuschieri K, Bonde J, Ostrbenk Vanlencak A, Zhao FH, Rezhake R, Gultekin M, Dillner J, de Sanjosé S, Canfell K, Hillemanns P, Almonte M, Wentzensen N, Poljak M. 2020 list of human papillomavirus assays suitable for primary cervical cancer screening. Clin Microbiol Infect 2021; 27:1083-1095. [PMID: 33975008 DOI: 10.1016/j.cmi.2021.04.031] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [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: 01/11/2021] [Revised: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Only clinically validated HPV assays can be accepted in cervical cancer screening. OBJECTIVES To update the list of high-risk HPV assays that fulfil the 2009 international validation criteria (Meijer-2009). DATA SOURCES PubMed/Medline, Embase, Scopus, references from selected studies; published in January 2014 to August 2020. STUDY ELIGIBILITY CRITERIA HPV test validation studies and primary screening studies, involving testing with an index HPV test and a comparator HPV test with reporting of disease outcome (occurrence of histologically confirmed cervical precancer; CIN2+). PARTICIPANTS Women participating in cervical cancer screening. INTERVENTIONS Testing with an index and a comparator HPV test of clinician-collected cervical specimens and assessment of disease outcome ( METHODS Assessment of relative clinical accuracy (including non-inferiority statistics index vs comparator assay) and test reproducibility in individual studies; random effects meta-analyses of the relative clinical sensitivity and specificity of index vs comparator tests. RESULTS Seven hrHPV DNA tests consistently fulfilled all validation criteria in multiple studies using predefined test positivity cut-offs (Abbott RealTime High Risk HPV, Anyplex II HPV HR Detection, BD Onclarity HPV Assay, Cobas 4800 HPV Test, HPV-Risk Assay, PapilloCheck HPV-Screening Test and Xpert HPV). Another assay (Alinity m HR HPV Assay) was fully validated in one validation study. The newer Cobas 6800 HPV Test, was validated in two studies against Cobas 4800. Other tests partially fulfilled the international validation criteria (Cervista HPV HR Test, EUROArray HPV, Hybribio's 14 High-Risk HPV, LMNX Genotyping Kit GP HPV, MALDI-TOF, RIATOL qPCR and a number of other in-house developed assays) since the non-inferior accuracy was reached after a posteriori cut-off optimization, inconsistent accuracy findings in different studies, and/or insufficient reproducibility assessment. The APTIMA HPV Assay targeting E6/E7 mRNA of hrHPV was fully validated in one formal validation study and showed slightly lower pooled sensitivity but higher specificity than the standard comparator tests in seven screening studies. However, the current international validation criteria relate to DNA assays. The additional requirement for longitudinal performance data required for non-DNA based HPV assays was not assessed in this review. CONCLUSIONS Eleven hrHPV DNA assays fulfil all requirements for use in cervical cancer screening using clinician-collected specimens.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium.
| | - Marie Simon
- Haute Autorité de Santé, Saint Denis, France
| | - Eliana Peeters
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Lan Xu
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chris J L M Meijer
- Department of Pathology, Amsterdam University Medical Centre, location VUMC, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anja Ostrbenk Vanlencak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Remila Rezhake
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The 3rd Affiliated Teaching Hospital of Xinjiang Medical University (Affiliated Cancer Hospital), Urumqi, China
| | - Murat Gultekin
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Ankara, Turkey
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia
| | - Peter Hillemanns
- Departments of Gynaecology and Obstetrics, Hannover Medical School, Germany
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer, Institute, Bethesda, MD, USA
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Robles C, Bruni L, Acera A, Riera JC, Prats L, Poljak M, Mlakar J, Oštrbenk Valenčak A, Eriksson T, Lehtinen M, Louvanto K, Hortlund M, Dillner J, Faber MT, Munk C, Kjaer SK, Petry KU, Denecke A, Xu L, Arbyn M, Cadman L, Cuzick J, Dalstein V, Clavel C, de Sanjosé S, Bosch FX. Determinants of Human Papillomavirus Vaccine Uptake by Adult Women Attending Cervical Cancer Screening in 9 European Countries. Am J Prev Med 2021; 60:478-487. [PMID: 33358719 DOI: 10.1016/j.amepre.2020.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/30/2020] [Revised: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Human papillomavirus-vaccinated cohorts, irrespective of age, will likely reduce their subsequent screening requirements, thus opening opportunities for global cost reduction and program sustainability. The determinants of uptake and completion of a 3-dose human papillomavirus vaccination program by adult women in a European context were estimated. STUDY DESIGN This was an intervention study. SETTING/PARTICIPANTS Study participants were women aged 25-45 years, attending opportunistic or population-based cervical cancer screening in Belgium, Denmark, Finland, France, Germany, Slovenia, Spain, Sweden, and the United Kingdom between April 2016 and May 2018. INTERVENTION Study participants completed a questionnaire on awareness and attitudes on adult female human papillomavirus vaccination and were invited to receive free human papillomavirus vaccination. MAIN OUTCOME MEASURES Main outcome measures were acceptance, uptake, and completion of vaccination schedule. Determinants of vaccine uptake were explored using multilevel logistic models in 2019. RESULTS Among 3,646 participants, 2,748 (range by country=50%-96%) accepted vaccination, and 2,151 (range=30%-93%) received the full vaccination course. The factors associated with higher vaccine acceptance were previous awareness of adult female (OR=1.22, 95% CI=1.00, 1.48) and male (OR=1.59, 95% CI=1.28, 1.97) vaccination. Women in stable relationships (OR=0.56, 95% CI=0.45, 0.69) or with higher educational level (OR=0.76, 95% CI=0.63, 0.93) were more likely to refuse vaccination. Recruitment by postal invitation versus personal invitation from a healthcare professional resulted in lower vaccine acceptance (OR=0.13, 95% CI=0.02, 0.76). Vaccination coverage of >70% of adolescent girls in national public programs was of borderline significance in predicting human papillomavirus vaccine uptake (OR=3.23, 95% CI=0.95, 10.97). The main reasons for vaccine refusal were vaccine safety concerns (range=30%-59%) and the need for more information on human papillomavirus vaccines (range=1%-72%). No safety issues were experienced by vaccinated women. CONCLUSIONS Acceptance and schedule completion were largely dependent on recruitment method, achieved coverage of national vaccination programs, and personal relationship status. Knowledge of benefits and safety reassurance may be critical to expanding vaccination target ages. Study results suggest that there are no major opinion barriers in adult women to human papillomavirus vaccination, especially when vaccination is offered face to face in healthcare settings. TRIAL REGISTRATION EudraCT Number 2014-003177-42.
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Affiliation(s)
- Claudia Robles
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Laia Bruni
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Amelia Acera
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Barcelona, Spain; Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Barcelona, Spain
| | - Joan Carles Riera
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Girones-Pla de l'Estany, Institut Catala de la Salut, Girona, Spain
| | - Laia Prats
- Centre Ginecològic Gine-3, Barcelona, Spain
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jana Mlakar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Anja Oštrbenk Valenčak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tiina Eriksson
- Department of Health Science, University of Tampere, Tampere, Finland
| | - Matti Lehtinen
- Department of Health Science, University of Tampere, Tampere, Finland
| | - Karolina Louvanto
- Department of Obstetrics and Gynecology, University of Tampere, Tampere, Finland
| | - Maria Hortlund
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mette T Faber
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karl Ulrich Petry
- Department of Gynecologic Oncology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Agnieszka Denecke
- Department of Gynecologic Oncology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Lan Xu
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Louise Cadman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Véronique Dalstein
- Centre Hospitalier Universitaire (CHU) Reims, Université de Reims Champagne-Ardenne INSERM P3Cell and UMR-S 1250, SFR CAP-SANTE, Reims, France
| | - Christine Clavel
- Centre Hospitalier Universitaire (CHU) Reims, Université de Reims Champagne-Ardenne INSERM P3Cell and UMR-S 1250, SFR CAP-SANTE, Reims, France
| | - Silvia de Sanjosé
- PATH, Seattle, Washington; Centro de Investigación Biomédica en Red en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - F Xavier Bosch
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Nicolás-Párraga S, Torres M, Alemany L, Félix A, Cruz E, de Sanjosé S, Bosch FX, Bravo IG. Human DNA decays faster with time than viral dsDNA: an analysis on HPV16 using pathology archive samples spanning 85 years. Virol J 2021; 18:65. [PMID: 33781303 PMCID: PMC8008572 DOI: 10.1186/s12985-021-01529-9] [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: 12/03/2020] [Accepted: 03/05/2021] [Indexed: 12/01/2022] Open
Abstract
Background Quality of the nucleic acids extracted from Formalin Fixed Paraffin Embedded (FFPE) samples largely depends on pre-analytic, fixation and storage conditions. We assessed the differential sensitivity of viral and human double stranded DNA (dsDNA) to degradation with storage time. Methods We randomly selected forty-four HPV16-positive invasive cervical cancer (ICC) FFPE samples collected between 1930 and 1935 and between 2000 and 2004. We evaluated through qPCR the amplification within the same sample of two targets of the HPV16 L1 gene (69 bp, 134 bp) compared with two targets of the human tubulin-β gene (65 bp, 149 bp). Results Both viral and human, short and long targets were amplified from all samples stored for 15 years. In samples archived for 85 years, we observed a significant decrease in the ability to amplify longer targets and this difference was larger in human than in viral DNA: longer fragments were nine times (CI 95% 2.6–35.2) less likely to be recovered from human DNA compared with 1.6 times (CI 95% 1.1–2.2) for viral DNA. Conclusions We conclude that human and viral DNA show a differential decay kinetics in FFPE samples. The faster degradation of human DNA should be considered when assessing viral DNA prevalence in long stored samples, as HPV DNA detection remains a key biomarker of viral-associated transformation. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-021-01529-9.
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Affiliation(s)
- Sara Nicolás-Párraga
- Infections and Cancer Laboratory, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain.
| | - Montserrat Torres
- Infections and Cancer Laboratory, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain.
| | - Laia Alemany
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ana Félix
- Pathology Unit, Portuguese Institute of Oncology Francisco Gentil (IPO Lisbon), Lisbon, Portugal
| | - Eugenia Cruz
- Pathology Unit, Portuguese Institute of Oncology Francisco Gentil (IPO Coimbra), Coimbra, Portugal
| | - Silvia de Sanjosé
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.,Sexual and Reproductive Health, PATH, Seattle, USA.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Francesc Xavier Bosch
- Infections and Cancer Unit, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.,Biomedical Research Networking Centre On Cancer (CIBERONC), Madrid, Spain.,Universitat Oberta de Catalunya, Barcelona, Spain
| | - Ignacio G Bravo
- Infections and Cancer Laboratory, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Spain.,Laboratory MIVEGEC (CNRS IRD Univ Montpellier), French National Center for Scientific Research (CNRS), Montpellier, France.,Center for Research On the Ecology and Evolution of Diseases (CREES), Montpellier, France
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31
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Baisley KJ, Whitworth HS, Changalucha J, Pinto L, Dillner J, Kapiga S, de Sanjosé S, Mayaud P, Hayes RJ, Lacey CJ, Watson-Jones D. A dose-reduction HPV vaccine immunobridging trial of two HPV vaccines among adolescent girls in Tanzania (the DoRIS trial) - Study protocol for a randomised controlled trial. Contemp Clin Trials 2021; 101:106266. [PMID: 33421649 PMCID: PMC7970022 DOI: 10.1016/j.cct.2021.106266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/10/2020] [Revised: 12/20/2020] [Accepted: 01/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infection is the primary cause of cervical cancer. In 2018, the World Health Organization (WHO) Director General announced his commitment to eliminate cervical cancer, with HPV vaccination as a priority. However, the costs of setting up a multi-dose HPV vaccination programme remain a barrier to its introduction. METHODS/DESIGN We are conducting a randomised-controlled trial of reduced dose schedules of HPV vaccine in Tanzania to establish whether a single dose produces immune responses that will be effective in preventing cervical cancer. 930 girls aged 9-14 years in Mwanza, Tanzania, were randomised to one of 6 arms, comprising 3 different dose schedules of the 2-valent (Cervarix) and 9-valent (Gardasil-9) HPV vaccines: 3 doses; 2 doses given 6 months apart; or a single dose. All participants will be followed for 36 months; those in the 1 and 2 dose arms will be followed for 60 months. Trial outcomes focus on vaccine immune responses including HPV 16/18-specific antibody levels, antibody avidity, and memory B cell responses. Results will be immunobridged to historical cohorts of girls and young women in whom efficacy has been demonstrated. DISCUSSION This is the first randomised trial of the single dose HPV vaccine schedule in the target age group. The trial will allow us to examine the quality and durability of immune responses of reduced dose schedules in a population with high burden of malaria and other infections that may affect vaccine immune responses. Initial results (24 months) are expected to be published in early 2021.
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Affiliation(s)
- Kathy J Baisley
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa.
| | - Hilary S Whitworth
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - John Changalucha
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Ligia Pinto
- Vaccine, Immunity and Cancer Program, HPV Immunology Laboratory, Leidos Biomedical Research Inc, Frederick National Laboratory, Frederick, MD, USA
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Saidi Kapiga
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Silvia de Sanjosé
- PATH, Seattle, WA, USA; National Cancer Institute, Rockville, MD, USA
| | - Philippe Mayaud
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Richard J Hayes
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Charles J Lacey
- York Biomedical Research Institute, Hull York Medical School, University of York, UK
| | - Deborah Watson-Jones
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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32
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Cocco P, Satta G, Meloni F, Pilia I, Ahmed F, Becker N, Casabonne D, de Sanjosé S, Foretova L, Maynadié M, Nieters A, Staines A, 't Mannetje A, Zucca M, Ennas MG, Campagna M, De Matteis S, Benavente Y. Occupational exposure to organic dust and risk of lymphoma subtypes in the EPILYMPH case-control study. Scand J Work Environ Health 2021; 47:42-51. [PMID: 33103203 PMCID: PMC7801142 DOI: 10.5271/sjweh.3925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to estimate the risk of lymphoma and its major subtypes in relation to occupational exposure to specific organic dusts. Methods We explored the association in 1853 cases and 1997 controls who participated in the EpiLymph case-control study, conducted in six European countries in 1998-2004. Based on expert assessment of lifetime occupational exposures, we calculated the risk of the major lymphoma subtypes associated with exposure to six specific organic dusts, namely, flour, hardwood, softwood, natural textile, synthetic textile, and leather, and two generic (any types) groups: wood and textile dusts. Risk was predicted with unconditional regression modeling, adjusted by age, gender, study center, and education. Results We observed a 2.1-fold increase in risk of follicular lymphoma associated with ever exposure to leather dust [95% confidence interval (CI) 1.01-4.20]. After excluding subjects who ever worked in a farm or had ever been exposed to solvents, risk of B-cell lymphoma was elevated in relation to ever exposure to leather dust [odd ratio (OR) 2.2, 95% CI 1.00-4.78], but it was not supported by increasing trends with the exposure metrics. Risk of Hodgkin lymphoma was elevated (OR 2.0, 95% CI 0.95-4.30) for exposure to textile dust, with consistent upward trends by cumulative exposure and three independent exposure metrics combined (P=0.023, and P=0.0068, respectively). Conclusions Future, larger studies might provide further insights into the nature of the association we observed between exposure to textile dust and risk of Hodgkin lymphoma.
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Affiliation(s)
- Pierluigi Cocco
- Department of Medical Sciences and Public Health, Occupational Medicine unit, University of Cagliari, Monserrato (Cagliari) Italy.
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33
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Bonde J, Floore A, Ejegod D, Vink FJ, Hesselink A, van de Ven PM, Valenčak AO, Pedersen H, Doorn S, Quint WG, Petry KU, Poljak M, Stanczuk G, Cuschieri K, de Sanjosé S, Bleeker M, Berkhof J, Meijer CJLM, Heideman DAM. Methylation markers FAM19A4 and miR124-2 as triage strategy for primary human papillomavirus screen positive women: A large European multicenter study. Int J Cancer 2020; 148:396-405. [PMID: 32997803 PMCID: PMC7756277 DOI: 10.1002/ijc.33320] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 04/29/2020] [Revised: 07/04/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022]
Abstract
In human papillomavirus (HPV) cervical cancer screening, cytology is used as triage to counter the low specificity of HPV testing. VALID-SCREEN is a EU-multicenter, retrospective study conducted to evaluate the clinical performance of the FAM19A4/miR124-2 methylation-based molecular triage test as a substitute or addition to cytology as reflex testing of HPV screen positive women. FAM19A4/miR124-2 methylation test (QIAsure Methylation Test) was evaluated in 2384 HPV-positive cervical screening samples, from women 29-76 years of age, derived from four EU countries. Specimens were collected in ThinPrep or SurePath media, HPV-status, concurrent cytology, and histology diagnosis were provided by the parent institutes. The control population consisted of women with no evidence of disease within 2 years of follow-up. A total of 899 histologies were retrieved; 527 showed no disease, 124 CIN2 (5.2%), 228 CIN3 (9.6%) and 20 cervical cancers (0.8%); 19 of 20 screen-detected cervical cancers were found methylation-positive (sensitivity 95%). Overall specificity of FAM19A4/miR124-2 methylation test was 78.3% (n = 2013; 95%CI: 76-80). The negative predictive value of hrHPV positive, methylation-negative outcomes were 99.9% for cervical cancer (N = 1694; 95%CI: 99.6-99.99), 96.9% for ≥CIN3 (95%CI: 96-98), and 93.0% for ≥CIN2 (95%CI: 92-94). Overall sensitivity for CIN3 using FAM19A4/miR124-2 methylation test was 77% (n = 228; 95%CI: 71-82). CIN3 sensitivity was uniform between centers independent of sample collection medias, DNA extraction methods and HPV screening tests. Being objectively reported compared to the subjectivity of cytology, equally performing across settings and screening methods, the FAM19A4/miR124-2 methylation constitute an alternative/supplement to cytology as triage method to be investigated in real-life pilot implementation.
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Affiliation(s)
- Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Ditte Ejegod
- Molecular Pathology Laboratory, Department of Pathology, Hvidovre Hospital, Hvidovre, Denmark
| | - Frederique J Vink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Helle Pedersen
- Molecular Pathology Laboratory, Department of Pathology, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Wim G Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Karl Ulrich Petry
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Germany
| | - Mario Poljak
- Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Grazyna Stanczuk
- Department of Obstetrics and Gynaecology, Western Isles Hospital, Scotland, UK
| | - Kate Cuschieri
- HPV Research Group, Division of Pathology, University of Edinburgh, Scotland, UK
| | - Silvia de Sanjosé
- Infections and Cancer Laboratory, Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - Maaike Bleeker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris J L M Meijer
- Self-screen B.V, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle A M Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Slavkovsky RC, Bansil P, Sandoval MA, Figueroa J, Rodriguez DM, Lobo JS, Jeronimo JA, de Sanjosé S. Health Outcomes at 1 Year After Thermal Ablation for Cervical Precancer Among Human Papillomavirus- and Visual Inspection With Acetic Acid-Positive Women in Honduras. JCO Glob Oncol 2020; 6:1565-1573. [PMID: 33074738 PMCID: PMC7605374 DOI: 10.1200/go.20.00400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This study aims to assess the detection of cervical intraepithelial lesions grades 2 and 3 (CIN2-3) at 1 year after treatment with thermal ablation among human papillomavirus (HPV)–positive and visual inspection with acetic acid (VIA)–positive women. METHODS All women screened and triaged for cervical cancer at four government health facilities in Honduras who were eligible for ablative treatment were enrolled and treated with thermal ablation. Women with confirmed CIN2-3 and a subset of women with CIN1/normal diagnoses at baseline were evaluated at 12 months. Follow-up procedures included HPV testing (careHPV), VIA, directed biopsy (if VIA-positive), and Papanicolaou test (if HPV positive, VIA negative). Outcomes at 1 year included histologic or cytologic assessment of CIN lesions among those with any abnormal test. RESULTS Among the 319 women treated with thermal ablation, baseline histologic diagnoses were available for 317. Two (0.6%) had invasive cancer, 36 (11.4%) had CIN3, 40 (12.6%) had CIN2, and 239 (75.4%) had CIN1/normal histology. Among the 127 women eligible for follow-up, 118 (92.9%) completed all study procedures at 1 year. Overall, 98 (83.1%) had no evidence of CIN2-3 or persistent low-grade infection, 13 (11.2%) had CIN1/atypical squamous cells of undetermined significance, six (5.1%) had CIN2/high-grade squamous intraepithelial lesion, and 1 (0.8%) had a persistent CIN3. No adverse events associated with thermal ablation at 1 year were registered. CONCLUSION A high proportion of women had no evidence of CIN2-3 at 1 year after thermal ablation treatment. Thermal ablation is an alternative to cryotherapy that may facilitate greater treatment coverage and prevent unnecessary deaths from cervical cancer.
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Affiliation(s)
| | | | - Manuel A Sandoval
- Asociación Hondureña de Planificación de Familia (ASHONPLAFA), Tegucigalpa, Honduras
| | | | - Doris M Rodriguez
- Asociación Hondureña de Planificación de Familia (ASHONPLAFA), Tegucigalpa, Honduras
| | - Jose Saul Lobo
- Asociación Hondureña de Planificación de Familia (ASHONPLAFA), Tegucigalpa, Honduras
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Andujar M, Roura E, Torres A, Vega B, Pavcovich M, Sanchez MA, Lubrano A, Trujillo JL, Almeida L, Santana M, Hurtado R, Arencibia O, Benito V, Medina N, Carballo S, Camacho MDC, Ruiz Del Pozo A, Quesada A, Salido E, de Sanjosé S, Bruni L. Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands. BMJ Open 2020; 10:e037402. [PMID: 32973061 PMCID: PMC7517562 DOI: 10.1136/bmjopen-2020-037402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/03/2022] Open
Abstract
OBJECTIVE National Spanish studies show that prevalence of cervical human papillomavirus (HPV) infection in the female population is increasingly frequent, with an overall estimate of 14% in women aged 18-65 years. The objective of this study is to know the prevalence and distribution of HPV types in the female population of the Canary Islands prior to the introduction of HPV vaccines and to investigate the associated clinical and sociodemographic factors. METHODS Based on the Primary Health Care database, a sample of adult women (aged 18-65 years) of Gran Canaria (GC) and Tenerife (TF) stratified into nine age groups was carried out between 2002 and 2007. Women were contacted by postal letter and telephone call and were visited in their primary care centre. A clinical-epidemiological survey was completed and cervical samples were taken for cytological study and HPV detection. HPV prevalence and its 95% CI were estimated, and multivariate analyses were performed using logistic regression to identify factors associated with the infection. RESULTS 6010 women participated in the study, 3847 from GC and 2163 from TF. The overall prevalence of HPV infection was 13.6% (CI 12.8%-14.5%) and 11.1% (CI 10.3%-11.9%) for high-risk types. The most frequent HPV type was 16 followed by types 51, 53, 31, 42 and 59. HPV types included in the nonavalent vaccine were detected in 54.1% of infected women. Factors associated with an increased risk of infection were: young ages (18-29 years), the number of sexual partners throughout life, not being married, being a smoker, and having had previous cervical lesions or genital warts. CONCLUSIONS It is confirmed that prevalence of HPV infection in the female population of the Canary Islands is high, but similar to that of Spain, HPV 16 being the most frequent genotype. The determinants of infection are consistent with those of other populations.
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Affiliation(s)
- Miguel Andujar
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Esther Roura
- Unit of Infections and Cancer-Information and Interventions (UNIC-I&I)-Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alejandra Torres
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Begoña Vega
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Marta Pavcovich
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Miguel Angel Sanchez
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Amina Lubrano
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Jose Luis Trujillo
- Department of Obstetrics and Gynecology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Lucia Almeida
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Milagros Santana
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Rosaura Hurtado
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Octavio Arencibia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Virginia Benito
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Norberto Medina
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Sonia Carballo
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Maria Del Carmen Camacho
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Arancha Ruiz Del Pozo
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alfoso Quesada
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Eduardo Salido
- Department of Pathology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Silvia de Sanjosé
- Reproductive Health Global Programme, PATH, Seattle, Washington, USA
- Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Laia Bruni
- Unit of Infections and Cancer-Information and Interventions (UNIC-I&I)-Cancer Epidemiology Research Program (CERP)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
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Casabonne D, Benavente Y, Seifert J, Costas L, Armesto M, Arestin M, Besson C, Hosnijeh FS, Duell EJ, Weiderpass E, Masala G, Kaaks R, Canzian F, Chirlaque MD, Perduca V, Mancini FR, Pala V, Trichopoulou A, Karakatsani A, La Vecchia C, Sánchez MJ, Tumino R, Gunter MJ, Amiano P, Panico S, Sacerdote C, Schmidt JA, Boeing H, Schulze MB, Barricarte A, Riboli E, Olsen A, Tjønneland A, Vermeulen R, Nieters A, Lawrie CH, de Sanjosé S. Serum levels of hsa-miR-16-5p, hsa-miR-29a-3p, hsa-miR-150-5p, hsa-miR-155-5p and hsa-miR-223-3p and subsequent risk of chronic lymphocytic leukemia in the EPIC study. Int J Cancer 2020; 147:1315-1324. [PMID: 32012253 DOI: 10.1002/ijc.32894] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 08/29/2019] [Revised: 11/18/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is an incurable disease accounting for almost one-third of leukemias in the Western world. Aberrant expression of microRNAs (miRNAs) is a well-established characteristic of CLL, and the robust nature of miRNAs makes them eminently suitable liquid biopsy biomarkers. Using a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC), the predictive values of five promising human miRNAs (hsa-miR-16-5p, hsa-miR-29a-3p, hsa-miR-150-5p, hsa-miR-155-5p and hsa-miR-223-3p), identified in a pilot study, were examined in serum of 224 CLL cases (diagnosed 3 months to 18 years after enrollment) and 224 matched controls using Taqman based assays. Conditional logistic regressions were applied to adjust for potential confounders. The median time from blood collection to CLL diagnosis was 10 years (p25-p75: 7-13 years). Overall, the upregulation of hsa-miR-150-5p, hsa-miR-155-5p and hsa-miR-29a-3p was associated with subsequent risk of CLL [OR1∆Ct-unit increase (95%CI) = 1.42 (1.18-1.72), 1.64 (1.31-2.04) and 1.75 (1.31-2.34) for hsa-miR-150-5p, hsa-miR-155-5p and hsa-miR-29a-3p, respectively] and the strongest associations were observed within 10 years of diagnosis. However, the predictive performance of these miRNAs was modest (area under the curve <0.62). hsa-miR-16-5p and hsa-miR-223-3p levels were unrelated to CLL risk. The findings of this first prospective study suggest that hsa-miR-29a, hsa-miR-150-5p and hsa-miR-155-5p were upregulated in early stages of CLL but were modest predictive biomarkers of CLL risk.
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MESH Headings
- Biomarkers, Tumor/blood
- Case-Control Studies
- Europe/epidemiology
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Male
- MicroRNAs/blood
- Middle Aged
- Odds Ratio
- Predictive Value of Tests
- Prospective Studies
- Up-Regulation
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Affiliation(s)
- Delphine Casabonne
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Yolanda Benavente
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Julia Seifert
- Molecular Oncology Group, Biodonostia Research Institute, San Sebastián, Spain
| | - Laura Costas
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - María Armesto
- Molecular Oncology Group, Biodonostia Research Institute, San Sebastián, Spain
| | - María Arestin
- Molecular Oncology Group, Biodonostia Research Institute, San Sebastián, Spain
| | - Caroline Besson
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
- Department of Hematology and Oncology, Hospital of Versailles, Le Chesnay, France
| | - Fatemeh S Hosnijeh
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric J Duell
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - María-Dolores Chirlaque
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Vittorio Perduca
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
- Department of Hematology and Oncology, Hospital of Versailles, Le Chesnay, France
- Laboratoire de Mathématiques Appliquées MAP5 (UMR CNRS 8145), Université Paris Descartes, Paris, France
| | - Francesca R Mancini
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Dept. of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Maria-Jose Sánchez
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Andalusian School of Public Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Universidad de Granada, Granada, Spain
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP), Ragusa, Italy
| | - Marc J Gunter
- Section of Nutrition and Metabolism, IARC, International Agency for Research on Cancer, Lyon, France
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città Della Salute e Della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Julie A Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - Aurelio Barricarte
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Elio Riboli
- School of Public Health, Imperial College London, London, United Kingdom
| | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, The Copenhagen University, Copenhagen, Denmark
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
| | - Alexandra Nieters
- Institute for Immunodeficiency (IFI) Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Charles H Lawrie
- Molecular Oncology Group, Biodonostia Research Institute, San Sebastián, Spain
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Silvia de Sanjosé
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
- Reproductive Health, PATH, Seattle, WA
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Brotons M, Monfil L, Roura E, Duarte-Salles T, Casabona J, Urbiztondo L, Cabezas C, Bosch FX, de Sanjosé S, Bruni L. Impact of a single-age cohort human papillomavirus vaccination strategy in Catalonia, Spain: Population-based analysis of anogenital warts in men and women. Prev Med 2020; 138:106166. [PMID: 32565118 DOI: 10.1016/j.ypmed.2020.106166] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/29/2020] [Accepted: 06/10/2020] [Indexed: 11/27/2022]
Abstract
Extensive multiple-age cohort human papillomavirus (HPV) vaccination has proved to be highly effective. We aimed to determine the 8-year population impact of a female single-age cohort HPV vaccination programme on the incidence of anogenital warts (AGW). In 2008, Catalonia initiated a school-based quadrivalent HPV vaccination programme targeting 11-year-old girls, achieving coverage over 80%. Data on diagnoses of AGW and genital herpes were obtained from a population-based database of electronic health records covering 74% of the population. The annual incidence rates from 2009 to 2016 were calculated, stratified by age and sex using Joinpoint regression to estimate trends and annual percentage changes (APC). Among women aged 16-19 years, the AGW incidence decreased by 61% from 2012 to 2016 (APC -19.4%; 95% CI: -30.0 to -7.3). In contrast, the incidence of genital herpes in same-aged women increased throughout the study period (APC 11.1%; 95% CI: 7.2-15.2). Among men aged 20-22 years, the increasing incidence of AGW shifted to a downward trend in 2013 (APC 2009-2013: 17.0%; 95% CI: 8.2-26.5; and APC 2013-2016: -4.5%; 95% CI: -14.6 to 6.9). A similar pattern was observed among men aged 23-25 years (APC 2009-2014: 16.0%; 95% CI: 12.0-20.2; and APC 2014-2016: -6.0%; 95% CI: -18.4 to 8.3). In contrast to AGW, among men aged 20-25 years, the incidence of genital herpes increased over this period. Our study strongly suggests that a single-cohort HPV vaccination strategy with high vaccine uptake not only provides direct benefit in the vaccinated cohorts but also extends protection through a herd effect to unvaccinated men.
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Affiliation(s)
- Maria Brotons
- Unit of Infections and Cancer - Information and Interventions, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain.
| | - Laura Monfil
- Unit of Infections and Cancer - Information and Interventions, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain.
| | - Esther Roura
- Unit of Infections and Cancer - Information and Interventions, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red en Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| | - Jordi Casabona
- Centro de Investigación Biomédica en Red en Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain; Centre for Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Badalona, Spain.
| | - Luis Urbiztondo
- Agència de Salut Pública de Catalunya, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
| | - Carmen Cabezas
- Agència de Salut Pública de Catalunya, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
| | - F Xavier Bosch
- Unit of Infections and Cancer - Information and Interventions, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Open University of Catalonia, Barcelona, Spain.
| | - Silvia de Sanjosé
- Unit of Infections and Cancer - Information and Interventions, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red en Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.
| | - Laia Bruni
- Unit of Infections and Cancer - Information and Interventions, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO) - IDIBELL, l'Hospitalet de Llobregat, Spain.
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Ibáñez R, Roura E, Monfil L, Rodríguez LA, Sardà M, Crespo N, Pascual A, Martí C, Fibla M, Gutiérrez C, Lloveras B, Oliveras G, Torrent A, Català I, Bosch FX, Bruni L, de Sanjosé S. Long-term protection of HPV test in women at risk of cervical cancer. PLoS One 2020; 15:e0237988. [PMID: 32853216 PMCID: PMC7451648 DOI: 10.1371/journal.pone.0237988] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To evaluate the 9-year incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and cumulative adherence to perform a next test in a cohort of women aged 40+ years with no cervical screening cytology within a window of 5 years (underscreened women), after baseline cervical cytology and HPV tests. Methods In Catalonia, Spain, co-testing with cytology and HPV test has been recommended in the Public Health system since 2006 for underscreened women. In 2007, 1,594 women with underscreened criteria were identified and followed through medical records form Pathological Department. 9-year cumulative incidence of histologically confirmed CIN2+ and cumulative adherence to perform a next test were estimated using Kaplan-Meier statistics. Results Follow-up was available for 1,009 women (63.3%) resulting in 23 women with. CIN2+ (2.3%). Of them, 4 women (17%) had both tests negative at baseline (3CIN2 and 1CIN3) with cumulative incidence of CIN2+ of 0.4% (95% CI: 0.1–1.4) at 5-years and 1.3% (95% CI: 0.4–3.7) at 9-years. During the first year, the prevalence among women with both tests positive was 27.0% (95% CI: 13.0–50.6) for CIN2+. Lost to follow-up was higher among women with both tests negative compared to those with both positive tests (38.7% vs 4.2%, p-value <0.001). 40.5% of the women HPV-/cyto- had a re-screening test during the 4 years following the baseline, increasing until 53.5% during the 6 years of follow-up. Conclusions HPV detection shows a high longitudinal predictive value at 9-year to identify women at risk to develop CIN2+. The data validate a safe extension of the 3-year screening intervals (current screening interval) to 5-year intervals in underscreened women that had negative HPV result at baseline. It is necessary to establish mechanisms to ensure screening participation and adequate follow-up for these women.
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Affiliation(s)
- Raquel Ibáñez
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Esther Roura
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red: Epidemiologıa y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
| | - Laura Monfil
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Montserrat Sardà
- Pathology Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | - Nàyade Crespo
- Sexual and Reproductive Health centre of Bages-Solsonès, Institut Català de la Salut, Manresa, Barcelona, Spain
| | - Amparo Pascual
- Sexual and Reproductive Health centre of Bages-Solsonès, Institut Català de la Salut, Manresa, Barcelona, Spain
| | - Clara Martí
- Pathology Department, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - Montserrat Fibla
- Pathology Department, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - Cristina Gutiérrez
- Clinical Laboratory ICS Tarragona, Molecular Biology Section, Hospital universitari Joan XXIII de Tarragona, IISPV Rovira i Virgili University, Tarragona, Spain
| | - Belén Lloveras
- Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Gloria Oliveras
- Pathology Department, Hospital universitari Dr, Josep Trueta de Girona, Catalan Institute of Oncology, Girona, Spain
| | - Anna Torrent
- Sexual and Reproductive Health centre of Mollet del Vallés, Institut Català de la Salut Mollet del Vallès, Barcelona, Spain
| | - Isabel Català
- Pathology Department, Hospital universitari de Bellvitge, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Xavier Bosch
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer—Information and Interventions; Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjosé
- Centro de Investigación Biomédica en Red: Epidemiologıa y Salud Pública (CIBERESP CB06/02/0073), Madrid, Spain
- PATH, Seattle, Washington, United States of America
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Vink FJ, Meijer CJ, Clifford GM, Poljak M, Oštrbenk A, Petry KU, Rothe B, Bonde J, Pedersen H, de Sanjosé S, Torres M, del Pino M, Quint WG, Cuschieri K, Boada EA, van Trommel NE, Lissenberg‐Witte BI, Floore AN, Hesselink AT, Steenbergen RD, Bleeker MC, Heideman DA. FAM19A4/miR124-2 methylation in invasive cervical cancer: A retrospective cross-sectional worldwide study. Int J Cancer 2020; 147:1215-1221. [PMID: 31390052 PMCID: PMC7383900 DOI: 10.1002/ijc.32614] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 12/17/2022]
Abstract
Widespread adoption of primary human papillomavirus (HPV)-based screening has encouraged the search for a triage test which retains high sensitivity for the detection of cervical cancer and precancer, but increases specificity to avoid overtreatment. Methylation analysis of FAM19A4 and miR124-2 genes has shown promise for the triage of high-risk (hr) HPV-positive women. In our study, we assessed the consistency of FAM19A4/miR124-2 methylation analysis in the detection of cervical cancer in a series of 519 invasive cervical carcinomas (n = 314 cervical scrapes, n = 205 tissue specimens) from over 25 countries, using a quantitative methylation-specific PCR (qMSP)-based assay (QIAsure Methylation Test®). Positivity rates stratified per histotype, FIGO stage, hrHPV status, hrHPV genotype, sample type and geographical region were calculated. In total, 510 of the 519 cervical carcinomas (98.3%; 95% CI: 96.7-99.2) tested FAM19A4/miR124-2 methylation-positive. Test positivity was consistent across the different subgroups based on cervical cancer histotype, FIGO stage, hrHPV status, hrHPV genotype, sample type and geographical region. In conclusion, FAM19A4/miR124-2 methylation analysis detects nearly all cervical carcinomas, including rare histotypes and hrHPV-negative carcinomas. These results indicate that a negative FAM19A4/miR124-2 methylation assay result is likely to rule out the presence of cervical cancer.
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Affiliation(s)
- Frederique J. Vink
- Cancer Center AmsterdamAmsterdam UMC, Vrije Universiteit Amsterdam, PathologyAmsterdamThe Netherlands
| | - Chris J.L.M. Meijer
- Cancer Center AmsterdamAmsterdam UMC, Vrije Universiteit Amsterdam, PathologyAmsterdamThe Netherlands
| | | | - Mario Poljak
- Institute of Microbiology and ImmunologyUniversity of LjubljanaLjubljanaSlovenia
| | - Anja Oštrbenk
- Institute of Microbiology and ImmunologyUniversity of LjubljanaLjubljanaSlovenia
| | - Karl Ulrich Petry
- Department of Gynecologic OncologyKlinikum WolfsburgWolfsburgGermany
| | - Beate Rothe
- Institute for Clinical Chemistry, Laboratory and Transfusion MedicineWolfsburgGermany
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of PathologyHvidovre HospitalHvidovreDenmark
| | - Helle Pedersen
- Molecular Pathology Laboratory, Department of PathologyHvidovre HospitalHvidovreDenmark
| | | | - Montserrat Torres
- Infections and Cancer LaboratoryCatalan Institute of Oncology (ICO)BarcelonaSpain
| | - Marta del Pino
- Faculty of Medicine, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clínic‐Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
| | | | - Kate Cuschieri
- Scottish HPV Reference LaboratoryRoyal Infirmary of EdinburghEdinburghUnited Kingdom
| | - Elia Alcañiz Boada
- HPV Research Group, Division of PathologyUniversity of EdinburghEdinburghUnited Kingdom
| | - Nienke E. van Trommel
- Department of Gynaecologic OncologyCentre of Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek/Netherlands Cancer InstituteAmsterdamThe Netherlands
| | | | | | | | - Renske D.M. Steenbergen
- Cancer Center AmsterdamAmsterdam UMC, Vrije Universiteit Amsterdam, PathologyAmsterdamThe Netherlands
| | - Maaike C.G. Bleeker
- Cancer Center AmsterdamAmsterdam UMC, Vrije Universiteit Amsterdam, PathologyAmsterdamThe Netherlands
| | - Daniëlle A.M. Heideman
- Cancer Center AmsterdamAmsterdam UMC, Vrije Universiteit Amsterdam, PathologyAmsterdamThe Netherlands
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40
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Jenkins D, Molijn A, Kazem S, Pirog EC, Alemany L, de Sanjosé S, Dinjens W, Quint W. Molecular and pathological basis of HPV-negative cervical adenocarcinoma seen in a global study. Int J Cancer 2020; 147:2526-2536. [PMID: 32474915 DOI: 10.1002/ijc.33124] [Citation(s) in RCA: 6] [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: 11/11/2019] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 01/06/2023]
Abstract
International surveys find HPV-negativity in up to 30% of cervical adenocarcinomas. We investigated the pathological diagnosis by expert consensus with immunohistochemistry and the presence of somatic mutations in recognised tumour genes in HPV-positive and negative cervical adenocarcinomas (CADC). A sample was selected of 45 paraffin-embedded cervical blocks diagnosed locally as usual cervical adenocarcinoma from a global study. These represented different diagnoses made at previous diagnostic review and HPV status. All were suitable for analysis for somatic tumour associated gene mutations. Three pathologists examined H/E slides and immunohistochemistry for p16, progesterone receptor and p53 and classified the cases. L1 genes from high-risk HPVs and low-risk HPVs were analysed by SPF10 PCR-DEIA-LiPA25 version 1 in whole tissue sections and microdissected tumour and retested by PCR for E6/E7 genes of hrHPVs if negative. Cases were analysed for microsatellite instability and next-generation sequencing mutation analysis. From the 45 cases, 20 cases of usual CADC were confirmed of which 17 (85%) were HPV-positive in tumour cells. The other 25 cases were reclassified as endometrial, serous, clear-cell and gastric-type adenocarcinomas and all were HPV-negative in tumour cells. Careful retesting for HPV DNA and IHC leads to more accurate identification of HPV-positive usual cervical adenocarcinomas. Endometrioid endometrial adenocarcinomas, other uterine adenocarcinoma with multiple somatic mutations were important in misclassification of HPV-negative cases locally managed as cervical adenocarcinoma, as was gastric-type adenocarcinoma with germline STK11 mutation in East Asia. Few consensuses confirmed HPV-negative usual cervical adenocarcinomas showed somatic tumorigenic mutations also seen in some HPV-positive usual CADC.
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Affiliation(s)
- David Jenkins
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Anco Molijn
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | | | | | - Laia Alemany
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Institut Català d'Oncologia, Barcelona, Spain
| | - Silvia de Sanjosé
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Institut Català d'Oncologia, Barcelona, Spain
| | - Winand Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
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41
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Thomson KA, Sandoval M, Bain C, Holme F, Bansil P, Figueroa J, de Sanjosé S. Recall Efforts Successfully Increase Follow-Up for Cervical Cancer Screening Among Women With Human Papillomavirus in Honduras. Glob Health Sci Pract 2020; 8:290-299. [PMID: 32606095 PMCID: PMC7326516 DOI: 10.9745/ghsp-d-19-00404] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
A reminder phone call had a substantial impact on high rates of women returning for rescreening among those at high risk of developing cervical precancer. Scaling up routine cervical screening coverage must be accompanied by efforts to retain women throughout the screening cascade and continuum of care. Scaling up coverage of routine cervical screening in low-resource settings must be accompanied by efforts to retain women throughout the screening cascade and continuum of care, including adequate follow-up of abnormal results. The Scale-Up Project implemented human papillomavirus (HPV) testing for cervical cancer screening within public-sector health facilities in Honduras between 2015 and 2019. Women who were HPV-positive but did not have visually confirmed cervical lesions upon visual inspection with acetic acid (VIA-negative) were instructed to return to the health center after 1 year for repeat HPV testing. The current evaluation assessed the effectiveness of recall strategies to prompt women to return for retesting. Clinic staff placed reminder phone calls and followed up with short message service (SMS) or home visits, if needed. We summarized number of contacts, type of contacts, and time elapsed until return to the clinic, and used log-binomial regression to identify factors associated with return to the clinic. We identified 558 women who were initially HPV-positive VIA-negative from 8 clinics as needing repeat HPV testing 1 year later. Mean age was 43.2 years. Nearly all women (98.6%) were successfully contacted and 75.1% completed repeat HPV testing. The majority of contacts (65.4%) were phone calls, and nearly half of women who returned to the clinic (42.9%) did so after 1 contact. Mean days between contact and presentation at the clinic was 10.7 (standard deviation: 14.7). Women who required 3 or more contacts were 21% less likely to return for repeat HPV testing (prevalence ratio: 0.79; 95% confidence interval=0.69,0.90; P<.001) as compared to women who received only 1 contact. Reminder phone calls were highly successful at recalling women for HPV retesting in Honduras. This low-touch intervention should be included as part of standard follow-up to retain women throughout the continuum of cervical cancer screening and treatment.
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Affiliation(s)
| | - Manuel Sandoval
- Asociación Hondureña de Planificación de Familia, Tegucigalpa, Honduras
| | - Carolyn Bain
- PATH, Sexual & Reproductive Health Program, Seattle, USA
| | | | - Pooja Bansil
- PATH, Sexual & Reproductive Health Program, Seattle, USA
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42
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Davila-Batista V, Molina AJ, Fernández-Villa T, Romaguera D, Pérez-Gómez B, Vilorio-Marqués L, Dierssen-Sotos T, Altzibar JM, Moreno V, Ardanaz E, Salcedo-Bellido I, Fernández-Tardon G, Capelo R, Salas D, Marcos-Gragera R, Huerta JM, de Sanjosé S, Sierra MÁ, Canga-Presa JM, Gómez-Acebo I, Amiano P, Pollan M, Aragones N, Castaño-Vinyals G, Kogevinas M, Martín V. The Relation of CUN-BAE Index with Body Mass Index and Waist Circumference in Adults Aged 50 to 85 Years: The MCC-Spain Study. Nutrients 2020; 12:E996. [PMID: 32260185 PMCID: PMC7231053 DOI: 10.3390/nu12040996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
Backgound: Traditional anthropometrics such as body mass index (BMI) or waist circumference (WC) do not fully capture the complex biology of body fat (BF) in the elderly. The Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index, based on BMI, is proposed as a better indicator of BF. However, its relation with BMI is not clear. The aim was to compare the agreement between CUN-BAE, BMI, and WC in those aged ≥50 years. Methods: A cross-sectional sample of 3153 Caucasian healthy adults was taken from the MCC-Spain study. The Pearson's correlation and its 95% confidence interval (CI), adiposity distribution, and Kappa Index (95%CI) were calculated. Results: The correlation of CUN-BAE with WC is 0.18 (95%CI 0.14-0.21) and that with BMI is moderate (r 0.58; 95%CI 0.55-0.60), but both increased strongly by sex. Agreement (normal weight/overweight/obesity) of CUN-BAE with BMI is 7% and with WC is 18%. Conclusions: The correlation and the degree of agreement of CUN-BAE with BMI and WC are low in individuals aged over 50, but it is higher by sex. Thus, this different criterion of obesity may have clinical applications. More studies with a gold standard are needed to evaluate the CUN-BAE in elderly adults.
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Affiliation(s)
- Veronica Davila-Batista
- Research Group on Gene-Environment Interactions and Health (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, France
| | - Antonio J. Molina
- Research Group on Gene-Environment Interactions and Health (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain
| | - Tania Fernández-Villa
- Research Group on Gene-Environment Interactions and Health (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain
| | - Dora Romaguera
- ISGlobal, 08003 Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER-OBN), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Palma (IdISPa) – Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Beatriz Pérez-Gómez
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Environmental and Cancer Epidemiology Area, National Center of Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, 28222 Madrid, Spain
| | - Laura Vilorio-Marqués
- Research Group on Gene-Environment Interactions and Health (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain
- Grupo de Investigación en Neoplasias Hematológicas, Instituto de Investigación Sanitaria Principado de Asturias (ISPA) and Fundación para la investigación Biosanitaria (FINBA), 33011 Oviedo, Spain
| | - Trinidad Dierssen-Sotos
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, 39011 Santander, Spain
| | - Jone M. Altzibar
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, Osakidetza-Basque Health Service, Directorate General, 20014 San Sebastian, Spain
| | - Victor Moreno
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Oncology Data Analytics Program, Catalan Institute of Oncology (ICO) and Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08908 Barcelona, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Inmaculada Salcedo-Bellido
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Preventive Medicine and Public Health Department, University of Granada and Instituto de Investigación Biosanitaria de Granada, Hospitales Universitarios de Granada, 18071 Granada, Spain
| | - Guillermo Fernández-Tardon
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and IUOPA, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Rocio Capelo
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigación en Recursos Naturales, Salud, y Medio Ambiente (RENSMA), University of Huelva, 21071 Huelva, Spain
| | - Dolores Salas
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), 46020 Valencia, Spain
| | - Rafael Marcos-Gragera
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Epidemiology Unit and Girona Cancer Registry (UERCG), Oncology Coordination Plan (PDO), Department of Health, Autonomous Government of Catalonia, 17071 Girona, Spain
| | - José María Huerta
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30007 Murcia, Spain
| | - Silvia de Sanjosé
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Oncology Data Analytics Program, Catalan Institute of Oncology (ICO) and Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - María Ángeles Sierra
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Environmental and Cancer Epidemiology Area, National Center of Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, 28222 Madrid, Spain
| | - José M. Canga-Presa
- Servicio de Cirugía General y Aparato Digestivo, Complejo Asistencial Universitario de León, 24001 León, Spain
| | - Ines Gómez-Acebo
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, 39011 Santander, Spain
| | - Pilar Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, Osakidetza-Basque Health Service, Directorate General, 20014 San Sebastian, Spain
| | - Marina Pollan
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Environmental and Cancer Epidemiology Area, National Center of Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, 28222 Madrid, Spain
| | - Nuria Aragones
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Epidemiology Section, Public Health Division, Department of Health of Madrid, 28035 Madrid, Spain
| | - Gemma Castaño-Vinyals
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- ISGlobal, 08003 Barcelona, Spain
- IMIM (Hospital Del Mar Medical Research Institute), 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
| | - Manolis Kogevinas
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- ISGlobal, 08003 Barcelona, Spain
- IMIM (Hospital Del Mar Medical Research Institute), 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
| | - Vicente Martín
- Research Group on Gene-Environment Interactions and Health (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, 24071 León, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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43
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Frias-Gomez J, Benavente Y, Ponce J, Brunet J, Ibáñez R, Peremiquel-Trillas P, Baixeras N, Zanca A, Piulats JM, Aytés Á, Matias-Guiu X, Bosch FX, de Sanjosé S, Alemany L, Costas L. Sensitivity of cervico-vaginal cytology in endometrial carcinoma: A systematic review and meta-analysis. Cancer Cytopathol 2020; 128:792-802. [PMID: 32202704 DOI: 10.1002/cncy.22266] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/30/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/24/2022]
Abstract
Cervico-vaginal cytology is primarily a cervical cancer screening test. The anatomical continuity of the uterine cavity with the cervix makes the Papanicolaou (Pap) test accessible to evaluate signs of disease shed from the endometrium. Our aim was to determine the sensitivity of routine Pap test in endometrial carcinoma detection and its relationship with clinico-pathologic factors. We performed a systematic review of studies reporting Pap test results prior to diagnosis of or surgery for endometrial carcinoma between 1990 and 2018 in PubMed or Web of Science. Two independent reviewers extracted data and assessed study quality using an adapted Newcastle-Ottawa Quality Assessment Scale and Quality Assessment of Diagnostic Accuracy Studies tool. We identified 45 studies including a total of 6599 women with endometrial cancer. Abnormal Pap test results prior to diagnosis of or surgery for endometrial carcinoma were observed in 45% (95% CI, 40%-50%) of study participants. This percentage was significantly higher among those of non-endometrioid histology compared with endometrioid subtypes (77% [95% CI, 66%-87%] vs 44% [95% CI, 34%-53%], respectively; P heterogeneity <.001). Several clinico-pathologic factors were related to a higher percentage of abnormal Pap test results, including high-stage, myometrial invasion >50%, high histological grade, positive peritoneal cytology, presence of lymph node metastasis, cervical involvement, and lymphovascular invasion (P heterogeneity <.05 for all variables). Routine cervical cytology can detect endometrial cancer in almost half of patients, whereas sensitivity is higher among individuals with non-endometrioid histology or more advanced cancers. This review summarizes the current clinical and prognostic value of cervical cytology in endometrial carcinoma. Recent technological developments using molecular biomarkers may improve accuracy for early cancer detection.
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Affiliation(s)
- Jon Frias-Gomez
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Jordi Ponce
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Cáncer, Madrid, Spain.,Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Raquel Ibáñez
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Nuria Baixeras
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Alba Zanca
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Piulats
- Centro de Investigación Biomédica en Red en Cáncer, Madrid, Spain.,Department of Medical Oncology, IDIBELL, Catalan Institute of Cancer, Hospitalet de Llobregat, Barcelona, Spain
| | - Álvaro Aytés
- Program Against Cancer Therapeutic Resistance, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Centro de Investigación Biomédica en Red en Cáncer, Madrid, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,PATH, Seattle, Washington
| | - Laia Alemany
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Laura Costas
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
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Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health 2020; 8:e191-e203. [PMID: 31812369 PMCID: PMC7025157 DOI: 10.1016/s2214-109x(19)30482-6] [Citation(s) in RCA: 1732] [Impact Index Per Article: 433.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of prophylactic vaccines to prevent HPV infection and HPV assays that detect nucleic acids of the virus. WHO has launched a Global Initiative to scale up preventive, screening, and treatment interventions to eliminate cervical cancer as a public health problem during the 21st century. Therefore, our study aimed to assess the existing burden of cervical cancer as a baseline from which to assess the effect of this initiative. METHODS For this worldwide analysis, we used data of cancer estimates from 185 countries from the Global Cancer Observatory 2018 database. We used a hierarchy of methods dependent on the availability and quality of the source information from population-based cancer registries to estimate incidence of cervical cancer. For estimation of cervical cancer mortality, we used the WHO mortality database. Countries were grouped in 21 subcontinents and were also categorised as high-resource or lower-resource countries, on the basis of their Human Development Index. We calculated the number of cervical cancer cases and deaths in a given country, directly age-standardised incidence and mortality rate of cervical cancer, indirectly standardised incidence ratio and mortality ratio, cumulative incidence and mortality rate, and average age at diagnosis. FINDINGS Approximately 570 000 cases of cervical cancer and 311 000 deaths from the disease occurred in 2018. Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2·1 million cases), colorectal cancer (0·8 million) and lung cancer (0·7 million). The estimated age-standardised incidence of cervical cancer was 13·1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100 000 women. Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa. The highest incidence was estimated in Eswatini, with approximately 6·5% of women developing cervical cancer before age 75 years. China and India together contributed more than a third of the global cervical burden, with 106 000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India. Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore). The global average age at death from cervical cancer was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed. INTERPRETATION Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. The global scale-up of HPV vaccination and HPV-based screening-including self-sampling-has potential to make cervical cancer a rare disease in the decades to come. Our study could help shape and monitor the initiative to eliminate cervical cancer as a major public health problem. FUNDING Belgian Foundation Against Cancer, DG Research and Innovation of the European Commission, and The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
| | | | - Laia Bruni
- Consortium for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain; Unit of Infections and Cancer, Catalonian Institute of Oncology, Barcelona, Spain
| | | | - Mona Saraiya
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Atlanta, GA, USA
| | - Jacques Ferlay
- International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
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45
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Gensthaler L, Joura EA, Alemany L, Horvat R, de Sanjosé S, Pils S. The impact of p16 ink4a positivity in invasive vulvar cancer on disease-free and disease-specific survival, a retrospective study. Arch Gynecol Obstet 2020; 301:753-759. [PMID: 31970493 PMCID: PMC7060959 DOI: 10.1007/s00404-020-05431-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/03/2020] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate HPV and p16ink4a status as prognostic factors in patients with invasive vulvar cancer. Methods Retrospective analysis of disease-free (DFS) and disease-specific survival (DSS) of patients with invasive vulvar cancer at a single tertiary care center. Histology, HPV and p16ink4a status were evaluated in the context of a global multicenter trial. Logistic regression models were performed to identify the impact of p16ink4a positivity. Results 135 patients were included in the analysis. 32 (23.7%) showed a p16ink4a expression of over 25%. Disease-free and disease-specific survival was longer in p16ink4a positive patients (23 vs. 10 months, p = 0.004, respectively, 29 vs. 21 months, p = 0.016). In multivariate analysis, p16ink4a positivity was an independent parameter for DFS (p = 0.025, HR: 2.120 (1.100–4.085)), but not for DSS (p = 0.926, HR: 1.029 (0.558–1.901), in contrast to age and tumor stage. Conclusions Age and tumor stage negatively affect survival. However, disease-free survival is significantly longer in patients with p16ink4a positive invasive vulvar cancer.
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Affiliation(s)
- Lisa Gensthaler
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Elmar A Joura
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Laia Alemany
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Reinhard Horvat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Silvia de Sanjosé
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sophie Pils
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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46
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Mena M, Taberna M, Monfil L, Arbyn M, de Sanjosé S, Bosch FX, Alemany L, Bruni L. Might Oral Human Papillomavirus (HPV) Infection in Healthy Individuals Explain Differences in HPV-Attributable Fractions in Oropharyngeal Cancer? A Systematic Review and Meta-analysis. J Infect Dis 2020; 219:1574-1585. [PMID: 30590684 PMCID: PMC6473173 DOI: 10.1093/infdis/jiy715] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 07/31/2018] [Accepted: 12/19/2018] [Indexed: 12/21/2022] Open
Abstract
Background Differences in oral human papillomavirus (HPV) prevalence and contrasts in HPV-attributable fractions (AFs) in oropharyngeal cancer (OPC) have not been evaluated in depth. Methods A systematic review was performed to identify studies in which at least 50 healthy individuals were tested for oral HPV infection. Information on sex, age, tobacco/alcohol consumption, sex practices, specimen collection, HPV detection, and population type was extracted. Prevalences were pooled using random-effects models for meta-analyses of binomial data. Correlations were assessed by the Spearman test. Results Forty-eight reports comprising 28 544 individuals fulfilled inclusion criteria. Global oral HPV prevalence was 4.9%. Estimates were highest in Europe, although regional differences were not statistically significant. HPV16 prevalence was 1.0% globally, and regional differences became statistically significant. A lifetime history of >6 sex partners showed a higher risk of oral HPV infection. The age-specific HPV distribution revealed a prevalence of ≥5% over 40 years of age and a lower prevalence at younger ages. There was no association between oral HPV prevalence and HPV-AFs or age-standardized rates (ASRs) of OPC, genital HPV in healthy women, or tobacco use. Conclusions Differences in HPV-AFs or ASRs of OPC cannot be explained by differences in the prevalence of oral HPV infection across healthy populations. Consistent research on determinants of oral HPV prevalence, acquisition, clearance, and persistence is warranted.
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Affiliation(s)
- Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona.,Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona.,Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Miren Taberna
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona.,Department of Medical Oncology, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona.,Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona.,Program of Molecular Mechanisms and Experimental Therapy in Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona.,University of Barcelona, Barcelona
| | - Laura Monfil
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona.,Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona.,Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona.,PATH Reproductive Health Global Program, Seattle, Washington
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona.,Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona.,Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona.,Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona
| | - Laia Bruni
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona.,Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona.,Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
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47
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Din L, Sheikh M, Kosaraju N, Smedby KE, Bernatsky S, Berndt S, Skibola CF, Nieters A, Wang S, McKay JD, Cocco P, Maynadié M, Foretová L, Staines A, Mack TM, de Sanjosé S, Vyse TJ, Padyukov L, Taub Z, Din M, Monnereau A, Arslan AA, Moore A, Brooks-Wilson AR, Novak AJ, Glimelius B, Birmann BM, Link BK, Stewart C, Vajdic CM, Haioun C, Magnani C, Conti D, Cox DG, Casabonne D, Albanes D, Kane E, Roman E, Muzi G, Salles G, Giles GG, Adami HO, Ghesquières H, Vivo ID, Clavel J, Cerhan JR, Spinelli JJ, Hofmann JN, Vijai J, Curtin K, Costenbader KH, Onel K, Offit K, Teras LR, Morton LM, Conde L, Miligi L, Melbye M, Ennas MG, Liebow M, Purdue MP, Glenn M, Southey MC, Rothman N, Camp NJ, Doo NW, Becker N, Pradhan N, Bracci PM, Boffetta P, Vineis P, Brennan P, Kraft P, Lan Q, Severson RK, Vermeulen RCH, Milne RL, Kaaks R, Travis RC, Weinstein S, Chanock SJ, Ansell SM, Slager SL, Zheng T, Zhang Y, Benavente Y, Madireddy L, Gourraud PA, Oksenberg JR, Cozen W, Hjalgrim H, Khankhanian P. Genetic overlap between autoimmune diseases and non-Hodgkin lymphoma subtypes. Genet Epidemiol 2019; 43:844-863. [PMID: 31407831 PMCID: PMC6763347 DOI: 10.1002/gepi.22242] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 01/21/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 01/07/2023]
Abstract
Epidemiologic studies show an increased risk of non-Hodgkin lymphoma (NHL) in patients with autoimmune disease (AD), due to a combination of shared environmental factors and/or genetic factors, or a causative cascade: chronic inflammation/antigen-stimulation in one disease leads to another. Here we assess shared genetic risk in genome-wide-association-studies (GWAS). Secondary analysis of GWAS of NHL subtypes (chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, and marginal zone lymphoma) and ADs (rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis). Shared genetic risk was assessed by (a) description of regional genetic of overlap, (b) polygenic risk score (PRS), (c)"diseasome", (d)meta-analysis. Descriptive analysis revealed few shared genetic factors between each AD and each NHL subtype. The PRS of ADs were not increased in NHL patients (nor vice versa). In the diseasome, NHLs shared more genetic etiology with ADs than solid cancers (p = .0041). A meta-analysis (combing AD with NHL) implicated genes of apoptosis and telomere length. This GWAS-based analysis four NHL subtypes and three ADs revealed few weakly-associated shared loci, explaining little total risk. This suggests common genetic variation, as assessed by GWAS in these sample sizes, may not be the primary explanation for the link between these ADs and NHLs.
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Affiliation(s)
- Lennox Din
- California Northstate University, Medicine
| | | | | | - Karin E Smedby
- Karolinska Institutet, Karolinska University Hospital, Division of Clinical Epidemiology, Dept of Medicine
| | - Sasha Bernatsky
- McGill University, Medicine
- Research Institute, McGill University Health Centre, Clinical Epidemiology
| | - Sonja Berndt
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | | | - Alexandra Nieters
- University Medical Centre Freiburg, Centre of Chronic Immunodeficiency
| | - Sophia Wang
- City of Hope and the Beckman Research Institute, Department of Population Sciences
| | | | - Pierluigi Cocco
- University of Caligari, Department of Medical Sciences and Public Health
| | - Marc Maynadié
- University of Burgundy-Franche-Comté and CHU Dijon Bourgogne, Registre des Hémopathies Malignes de Côte d’Or, INSERM U1231
| | - Lenka Foretová
- Masaryk Memorial Cancer Institute, Department of Cancer Epidemiology and Genetics
| | | | - Thomas M Mack
- University of Southern California, Norris Comprehensive Cancer Center and Hospital
| | | | | | | | | | | | - Alain Monnereau
- Center of Research in Epidemiology and Statistics, Sorbonne (CRESS), Epidemiology of childhood and adolescent cancer group, INSERM
- Institut Bergonie, Registre des Hémopathies Malignes de la Gironde
| | | | - Amy Moore
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | - Angela R Brooks-Wilson
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Agency
- Simon Fraser University, Department of Biomedical Physiology and Kinesiology
| | | | - Bengt Glimelius
- Uppsala Universitet, Department of Immunology, Genetics, and Pathology
| | - Brenda M Birmann
- Brigham and Women’s Hospital and Harvard Medical School, Channing Division of Network Medicine
| | - Brian K Link
- University of Iowa Hospitals and Clinics, Internal Medicine
| | | | - Claire M Vajdic
- University of New South Wales, Centre for Big Data Research in Health
| | - Corinne Haioun
- University Paris-Est Créteil (UPEC), Lymphoid Malignancies Unit, Henri Mondor Hospital
| | | | - David Conti
- University of Southern California, Preventive Med. Dept., Biostat
| | | | - Delphine Casabonne
- Catalan Institute of Oncology, Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL
- CIBER Epidemiología y Salud Pública
| | - Demetrius Albanes
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | - Eleanor Kane
- University of York, Department of Health Sciences
| | - Eve Roman
- University of York, Department of Health Sciences
| | - Giacomo Muzi
- Universita degli Studi di Perugia, Department of Occupational Medicine
| | - Gilles Salles
- Centre Hospitalier Universitaire de Lyon, Hematology
| | - Graham G Giles
- Cancer Council Victoria, Cancer Epidemiology & Intelligence
- University of Melbourne, Centre for Epidemiology and Biostatistics
| | - Hans-Olov Adami
- Karolinska Institutet, Department of Medical Epidmiology and Biostatistics
| | | | - Immaculata De Vivo
- Brigham and Women’s Hospital, Channing Division of Network Medicine
- Brigham Women’s Hospital and Harvard Medical School
| | | | - James R Cerhan
- Mayo Clinic, Health Sciences Research and Clinical Epidemiology
| | | | | | | | | | - Karen H Costenbader
- Brigham and Women’s Hospital, Medicine, Rheumatology, Immunology and Allergy
| | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, Department of Medicine
- Memorial Sloan Kettering Cancer Center, Department of Cancer Biology and Genetics
| | | | - Lindsay M Morton
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | | | | | - Mads Melbye
- Statens Serum Institut, Epidemiology Research
- Stanford University, Medicine
| | | | | | - Mark P Purdue
- National Cancer Institute, Division of Cancer Biology
| | | | - Melissa C Southey
- University of Melbourne, Department of Clinical Pathology, Genetic Epidemiology Laboratory
- Monash University, Precision Medicine, School of Clinical Sciences at Monash Health
| | - Nathaniel Rothman
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | - Nicola J Camp
- Huntsman Cancer Institute
- University of Utah, Internal Medicine and Biomedical Informatics
| | - Nicole Wong Doo
- University of Sydney, Concord Hospital Clinical School
- Cancer Council Australia, Centre for Epidemiology and Intelligence
| | | | | | - Paige M Bracci
- University of California San Francisco, Department of Epidemiology and Biostatistics
| | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute
| | - Paolo Vineis
- Imperial College London, Environmental Epidemiology and Public Health
| | - Paul Brennan
- International Agency for Research on Cancer (IARC)
| | - Peter Kraft
- Harvard School of Public Health, Departments of Epidemiology and Biostatistics
| | - Qing Lan
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | - Richard K Severson
- Wayne State University, Karmanos Cancer Institute, Department of Family Medicine and Public Health Sciences
| | | | - Roger L Milne
- University of Melbourne, Centre for Epidemiology and Biostatistics
- Cancer Council Australia, Epidemiology and Intelligence
| | - Rudolph Kaaks
- German Cancer Research Center, Division of Cancer Epidemiology
| | | | - Stephanie Weinstein
- National Cancer Institute, NIH, Division of Cancer Epidemiology and Genetics
| | - Stephen J Chanock
- National Cancer Research Institute, Division of Cancer Epidemiology and Genetics
| | | | | | | | - Yawei Zhang
- Yale University School of Public Health, Environmental Health Sciences
| | - Yolanda Benavente
- Institut Catala d’ Oncologia, Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, CIBER Epidemiología y Salud Pública
| | | | - Pierre-Antoine Gourraud
- Université de Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie
- Centre Hospitalier Universitaire de Nantes, Institut de Transplantation Urologie Néphrologie (ITUN)
| | | | - Wendy Cozen
- University of Southern California - Norris Comprehensive Cancer Center and Hospital, Departments of Preventive Medicine and Pathology
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48
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Butt J, Fernández de Larrea N, Tjalsma H, Roelofs R, Kato I, Martín V, Pérez-Gómez B, Moreno V, Dierssen-Sotos T, Castilla J, Fernández-Tardón G, Amiano P, Salas D, Alguacil J, Jiménez-Moleón JJ, Huerta JM, de Sanjosé S, Del Campo R, Kogevinas M, Pollán M, Pawlita M, Waterboer T, Boleij A, Aragonés N. Antibody responses to flagellin C and Streptococcus gallolyticus pilus proteins in colorectal cancer. Sci Rep 2019; 9:10847. [PMID: 31350458 PMCID: PMC6659640 DOI: 10.1038/s41598-019-47347-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/10/2019] [Indexed: 11/13/2022] Open
Abstract
Antibodies to Streptococcus gallolyticus subspecies gallolyticus (SGG) have been associated with colorectal cancer (CRC). Because SGG may correlate with impaired gut epithelia, we assessed the association of antibodies to bacterial flagellin C (FliC), a measure potentially related to this impairment, with CRC and the CRC-specific interaction with antibodies to SGG proteins. Antibodies to FliC and SGG pilus proteins Gallo2178 and Gallo2179 were measured in two independent studies, a combined study from Nijmegen and Detroit (93 CRC cases, 74 controls) and a replication data set including 576 cases and 576 controls from the Spanish multicenter multicase-control study (MCC-Spain). Logistic regression was applied to assess whether antibodies to FliC were associated with CRC and modified the association of antibodies to SGG proteins with CRC. Antibodies to FliC were associated with those to SGG Gallo2178 among CRC cases, resulting in an interaction in the association of antibodies to Gallo2178 with CRC (p = 0.007). This association was only present among individuals with high antibody responses to FliC (OR: 2.42, 95% CI: 1.45–4.06). In conclusion, our findings suggest that colorectal tumorigenesis could be accompanied by an impaired integrity of the epithelium that could result in associated increased antibody responses to bacterial proteins.
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Affiliation(s)
- Julia Butt
- Infection and Cancer Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Faculty of Biosciences, University of Heidelberg, Heidelberg, Germany.
| | - Nerea Fernández de Larrea
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Harold Tjalsma
- Independent researcher. Experimental work conducted at the Department of Laboratory Medicine, Radboud University Medical Centre (RadboudUMC), Nijmegen, The Netherlands
| | - Rian Roelofs
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud university medical centre (Radboudumc), Nijmegen, The Netherlands
| | - Ikuko Kato
- Departments of Oncology and Pathology, Wayne State University, Detroit, Michigan, USA
| | - Vicente Martín
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,The Research Group in Gene Environment and Health Interactions, University of León, León, Spain
| | - Beatriz Pérez-Gómez
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cardiovascular and Metabolic Diseases Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Victor Moreno
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Hospitalet de Llobregat, Barcelona, Spain.,Colorectal Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Trinidad Dierssen-Sotos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,University of Cantabria - IDIVAL, Santander, Spain
| | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Public Health Institute of Navarra, IdiSNA- Navarra Institute for Health Research, Pamplona, Spain
| | - Guillermo Fernández-Tardón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IUOPA, University of Oviedo, Oviedo, Spain
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Public Health Division of Gipuzkoa, BioDonostia Research institute, San Sebastian, Spain
| | - Dolores Salas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cancer and Public Health Area, FISABIO - Public Health, Valencia, Spain.,General Directorate Public Health, Valencian Community, Valencia, Spain
| | - Juan Alguacil
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Natural Resources, Health and Environment Research Center (RENSMA), University of Huelva, Huelva, Spain
| | - José Juan Jiménez-Moleón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Granada Health Research Institute (ibs.GRANADA), Granada, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - José María Huerta
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,PATH, Reproductive Health, Seattle, USA
| | - Rosa Del Campo
- Department of Microbiology, Ramón y Cajal Health Research Institute (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,ISGlobal, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain
| | - Marina Pollán
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Michael Pawlita
- Infection and Cancer Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Infection and Cancer Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annemarie Boleij
- Department of Pathology, Radboud Institute for Molecular Life Sciences (RIMLS), Radboud university medical centre (Radboudumc), Nijmegen, The Netherlands
| | - Nuria Aragonés
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
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49
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Costas L, Frias-Gomez J, Guardiola M, Benavente Y, Pineda M, Pavón MÁ, Martínez JM, Climent M, Barahona M, Canet J, Paytubi S, Salinas M, Palomero L, Bianchi I, Reventós J, Capellà G, Diaz M, Vidal A, Piulats JM, Aytés Á, Ponce J, Brunet J, Bosch FX, Matias-Guiu X, Alemany L, de Sanjosé S. New perspectives on screening and early detection of endometrial cancer. Int J Cancer 2019; 145:3194-3206. [PMID: 31199503 DOI: 10.1002/ijc.32514] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 02/15/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022]
Abstract
Due to the anatomical continuity of the uterine cavity with the cervix, genomic exploitation of material from routine Pap smears and other noninvasive sampling methods represent a unique opportunity to detect signs of disease using biological material shed from the upper genital tract. Recent research findings offer a promising perspective in the detection of endometrial cancer, but certain questions need to be addressed in order to accelerate the implementation of novel technologies in a routine screening or clinical setting. We discuss here new perspectives on detection of endometrial cancer using genomic and other biomarkers in minimally invasive sampling methods with a special focus on public health classic screening criteria, highlighting current gaps in knowledge.
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Affiliation(s)
- Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Magdalena Guardiola
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid, Spain
| | - Marta Pineda
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Miquel Á Pavón
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain
| | - José M Martínez
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Maite Climent
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Barahona
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Júlia Canet
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Salinas
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Palomero
- Program Against Cancer Therapeutic Resistance (ProCURE), IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Ilaria Bianchi
- ASSIR Delta, Direcció d'Atenció Primària Costa de Ponent, SAP Delta del Llobregat, Barcelona, Spain
| | - Jaume Reventós
- Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gabriel Capellà
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain
| | - Mireia Diaz
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain
| | - August Vidal
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Piulats
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain.,Department of Medical Oncology, IDIBELL, Catalan Institute of Cancer, Hospitalet de Llobregat, Barcelona, Spain
| | - Álvaro Aytés
- Program Against Cancer Therapeutic Resistance (ProCURE), IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain.,Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Francesc X Bosch
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain
| | - Xavier Matias-Guiu
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid, Spain.,PATH, Seattle, WA
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Costas L, Palomero L, Benavente Y, Guardiola M, Frias-Gomez J, Pavón MÁ, Climent M, Martinez JM, Barahona M, Salinas M, Pineda M, Bianchi I, Reventós J, Capellà G, Diaz M, Vidal A, Piulats JM, Ponce J, Brunet J, Bosch FX, Matias-Guiu X, Alemany L, de Sanjosé S, Aytés Á. Defining a mutational signature for endometrial cancer screening and early detection. Cancer Epidemiol 2019; 61:129-132. [PMID: 31238232 DOI: 10.1016/j.canep.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/09/2018] [Revised: 03/29/2019] [Accepted: 06/11/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The current availability of genomic information represents an opportunity to develop new strategies for early detection of cancer. New molecular tests for endometrial cancer may improve performance and failure rates of histological aspirate-based diagnosis, and provide promising perspectives for a potential screening scenario. However, the selection of relevant biomarkers to develop efficient strategies can be a challenge. MATERIALS AND METHODS We developed an algorithm to identify the largest number of patients with endometrial cancer using the minimum number of somatic mutations based on The Cancer Genome Atlas (TCGA) dataset. RESULTS The algorithm provided the number of subjects with mutations (sensitivity) for a given number of biomarkers included in the signature. For instance, by evaluating the 50 most representative point mutations, up to 81.9% of endometrial cancers can be identified in the TCGA dataset. At gene level, a 92.9% sensitivity can be obtained by interrogating five genes. DISCUSSION We developed a computational method to aid in the selection of relevant genomic biomarkers in endometrial cancer that can be adapted to other cancer types or diseases.
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Affiliation(s)
- Laura Costas
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.
| | - Luis Palomero
- Program Against Cancer Therapeutic Resistance (ProCURE), IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain
| | - Magdalena Guardiola
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Miquel Ángel Pavón
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain
| | - Maite Climent
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - José Manuel Martinez
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Barahona
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Salinas
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Pineda
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Ilaria Bianchi
- ASSIR Delta, Direcció d'Atenció Primària Costa de Ponent, SAP Delta del Llobregat, Gerència Territorial Metropolitana Sud / ICS, Barcelona, Spain
| | - Jaume Reventós
- Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gabriel Capellà
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain
| | - Mireia Diaz
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain
| | - August Vidal
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Piulats
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain; Department of Medical Oncology, IDIBELL, Catalan Institute of Cancer, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain; Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain
| | - Xavier Matias-Guiu
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain
| | | | - Álvaro Aytés
- Program Against Cancer Therapeutic Resistance (ProCURE), IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.
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