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Teixeira JC, Vale DB, Discacciati MG, Campos CS, Bragança JF, Zeferino LC. Cervical Cancer Screening with DNA-HPV Testing and Precancerous Lesions Detection: A Brazilian Population-based Demonstration Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:21-30. [PMID: 36878249 PMCID: PMC10021003 DOI: 10.1055/s-0043-1763493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To evaluate the rates of precancerous lesions, colposcopy referral, and positive predictive value (PPV) by age groups of a population-based screening with DNA-HPV testing. METHODS The present demonstration study compared 16,384 HPV tests performed in the first 30 months of the program with 19,992 women tested in the cytology screening. The colposcopy referral rate and PPV for CIN2+ and CIN3+ by age group and screening program were compared. The statistical analysis used the chi-squared test and odds ratio (OR) with 95% confidence interval (95%CI). RESULTS The HPV tests were 3.26% positive for HPV16-HPV18 and 9.92% positive for 12 other HPVs with a 3.7 times higher colposcopy referral rate than the cytology program, which had 1.68% abnormalities. Human Papillomavirus testing detected 103 CIN2, 89 CIN3, and one AIS, compared with 24 CIN2 and 54 CIN3 detected by cytology (p < 0.0001). The age group between 25 and 29 years old screened by HPV testing had 2.4 to 3.0 times more positivity, 13.0% colposcopy referral, twice more than women aged 30 to 39 years old (7.7%; p < 0.0001), and detected 20 CIN3 and 3 early-stage cancer versus 9 CIN3 and no cancer by cytology screening (CIN3 OR= 2.10; 95%CI: 0.91-5.25; p = 0.043). The PPV of colposcopy for CIN2+ ranged from 29.5 to 41.0% in the HPV testing program. CONCLUSION There was a significant increase in detections of cervix precancerous lesions in a short period of screening with HPV testing. In women < 30 years old, the HPV testing exhibited more positivity, high colposcopy referral rate, similar colposcopy PPV to older women, and more detection of HSIL and early-stage cervical cancer.
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Affiliation(s)
- Julio Cesar Teixeira
- Universidade Estadual de Campinas, Faculty of Medical Sciences, Department of Obstetrics and Gynecology, Campinas, SP, Brazil
| | - Diama Bhadra Vale
- Universidade Estadual de Campinas, Faculty of Medical Sciences, Department of Obstetrics and Gynecology, Campinas, SP, Brazil
| | - Michelle Garcia Discacciati
- Universidade Estadual de Campinas, Faculty of Medical Sciences, Department of Obstetrics and Gynecology, Campinas, SP, Brazil
| | - Cirbia Silva Campos
- Universidade Estadual de Campinas, Faculty of Medical Sciences, Department of Obstetrics and Gynecology, Campinas, SP, Brazil
| | - Joana Froes Bragança
- Universidade Estadual de Campinas, Faculty of Medical Sciences, Department of Obstetrics and Gynecology, Campinas, SP, Brazil
| | - Luiz Carlos Zeferino
- Universidade Estadual de Campinas, Faculty of Medical Sciences, Department of Obstetrics and Gynecology, Campinas, SP, Brazil
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Zhou Y, Shi X, Liu J, Zhang L. Correlation between human papillomavirus viral load and cervical lesions classification: A review of current research. Front Med (Lausanne) 2023; 10:1111269. [PMID: 36895724 PMCID: PMC9988912 DOI: 10.3389/fmed.2023.1111269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/26/2023] [Indexed: 02/23/2023] Open
Abstract
Cervical cancer is the fourth largest malignant tumor among women in the world. Human papillomavirus (HPV) infection can lead to cervical intraepithelial neoplasia (CIN) and cervical cancer. Active papillomavirus infection occurs when the infected basal cells replicate and fill a certain area. Persistent HPV infection can lead to squamous intraepithelial lesions, which are divided into CIN1, CIN2, and CIN3 according to how much epithelium is impacted. Different types of HPV have different possibilities of causing cervical cancer, and high-risk HPV is the main cause of cervical cancer. Research showed that viral load may be an indicator of the progression of cervical precancerous lesions, but this association does not seem to be universal. This article aims to summarize different genotypes, multiple infections, especially viral load, in cervical precancerous lesions, to guide early intervention.
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Affiliation(s)
- Yilu Zhou
- Center for Diagnosis and Treatment of Cervical Diseases, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Xiaoyu Shi
- Center for Diagnosis and Treatment of Cervical Diseases, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Jiaxin Liu
- Center for Diagnosis and Treatment of Cervical Diseases, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Lina Zhang
- Center for Diagnosis and Treatment of Cervical Diseases, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
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Valasoulis G, Michail G, Pouliakis A, Androutsopoulos G, Panayiotides IG, Kyrgiou M, Daponte A, Paraskevaidis E. Effect of Condom Use after CIN Treatment on Cervical HPV Biomarkers Positivity: Prolonged Follow Up Study. Cancers (Basel) 2022; 14:cancers14143530. [PMID: 35884589 PMCID: PMC9317636 DOI: 10.3390/cancers14143530] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Several factors contribute in the cervical healing process following local surgical treatment; in a previous work our group has documented a beneficial mid-term role of regular condom use immediately postoperatively in terms of CIN relapse prevention and expression of active viral biomarkers. Materials and Methods: Aiming to investigate whether the favorable contribution of consistent condom use could be extrapolated in the longer term, we conducted a prospective single center observational study including women scheduled to undergo conservative excisional treatment for CIN (LLETZ procedure). In all women a strong recommendation for consistent use for the first 6 months was given. For 204 women who underwent the procedure and completed successfully the two-year follow up a complete dataset of HPV biomarkers’ results obtained six months and two years postoperatively was available. Patients were asked to complete a questionnaire to assess condom use compliance. A 90% compliance rate represented the threshold for consistent use. An LBC sample was obtained and tested for HPV genotyping, E6 & E7 mRNA by NASBA technique as well as flow cytometry, and p16 at 0 (pre-treatment), 6 and 24 months. HPV DNA and other related biomarkers status at 6 and 24 months, treatment failures at 24 months and condom use compliance rates represented study outcomes. Results: Six months post-operatively we documented a reduction in the rates of HPV DNA positivity, which was detected in only 23.2% of compliant condom users in comparison to 61.9% in the non-compliant group (p < 0.001, OR: 0.19, 95%CI: 0.1−0.36). For the HPV mRNA test, either assessed with the NASBA method or with flow cytometry, reduced positivity percentages were observed in the compliant group, in particular 1.6% vs. 8% for NASBA and 7.1% vs. 16.4% using flow cytometry, although these differences were not statistically significant (p = 0.1039 and 0.0791, respectively). Finally, reduced p16 positivity rates were documented in the compliant group. At the two year follow up, a more pronounced difference in HPV DNA positivity rates was observed, specifically only 13% positivity among the compliant women compared with 71% of the non-compliant (p < 0.0001); this illustrates a further decreasing trend compared with the 6th month in the compliant group as opposed to an increasing tendency in the non-compliant group, respectively (difference: 9.0%, 95% CI: 0% to 20.6%, p = 0.1523). At that time, 80% of the failed treatments were HPV mRNA positive compared to 10% positivity for the cases treated successfully (OR: 34, 95%CI: 6.8−173, p < 0.0001), a finding indicative that HPV mRNA E6 & E7 positivity accurately predicts treatment failure; p16 positivity was also observed at higher rates in cases with treatment failure. Conclusions: Consistent condom use following conservative excisional CIN treatment appears to significantly reduce rates of CIN recurrence and biomarkers of HPV expression. Additional HPV vaccination at the time of treatment could further enhance the positive effect of consistent condom use.
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Affiliation(s)
- George Valasoulis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece;
- Hellenic National Public Health Organization-ECDC, 15123 Athens, Greece
- Correspondence: ; Tel.: +30-6946-308-060
| | - Georgios Michail
- Department of Obstetrics & Gynaecology, University Hospital of Patras, 26504 Patras, Greece; (G.M.); (G.A.)
| | - Abraham Pouliakis
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (I.G.P.)
| | - Georgios Androutsopoulos
- Department of Obstetrics & Gynaecology, University Hospital of Patras, 26504 Patras, Greece; (G.M.); (G.A.)
| | - Ioannis. G. Panayiotides
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (I.G.P.)
| | - Maria Kyrgiou
- West London Gynaecological Cancer Centre, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction-Surgery and Cancer, Imperial College London, London W12 0NN, UK
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece;
| | - Evangelos Paraskevaidis
- Department of Obstetrics & Gynaecology, University Hospital of Ioannina, 45500 Ioannina, Greece;
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4
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Torres M, Silva-Klug A, Ferrer E, Saumoy M, Trenti L, Tous S, Esteban A, Baixeras N, Catala I, Vidal A, G Bravo I, Podzamczer D, de Sanjose S. Detecting anal human papillomavirus infection in men who have sex with men living with HIV: implications of assay variability. Sex Transm Infect 2022; 99:187-190. [PMID: 35545433 PMCID: PMC10176368 DOI: 10.1136/sextrans-2021-055303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/15/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Incidence of anal cancer (AC) caused by persistent human papillomavirus (HPV) infection has risen in the last years in men who have sex with men (MSM) living with HIV. There is consensus that this population should be screened for anal precancerous lesions, but the role of HPV DNA testing in AC screening programmes is still under debate. OBJECTIVES This study employed two molecular test to detect anal HPV DNA and compared assay performance and prognostic value for the diagnosis of histology proven high-grade intraepithelial anal lesions. METHODS MSM living with HIV attended their regular check-up visits consisting of detection of anal HPV infection, anal cytology, digital anorectal examination and high resolution anoscopy. HPV DNA was detected using Hybrid Capture 2 High-Risk test (HC2, total assay) and LINEAR ARRAY HPV Genotyping Test (LA, type-specific assay) RESULTS: Among 274 participant, prevalence of HPV DNA was 48.5% by HC2 and 89.4% by LA. HPV16 (30.6%) and HPV6 (19.6%) were the most common genotypes identified. Prevalence of multiple HPV infections was 56.2%. Agreement between HPV DNA assays was 75.2% (κ=0.51; 95% CI 0.42 to 0.60). Total HPV detection demonstrated high sensitivity (90%; 95% CI 68.3 to 98.8) and moderate specificity (58.4%; 95% CI 50.2 to 66.3), while type-specific HPV16/18 genotyping provided an increase in specificity and showed the highest area under the curve (0.81; 95% CI 0.74 to 0.89) and Youden's index (0.63). CONCLUSIONS Both methodologies identified a high prevalence of anal HPV infection and multiple HPV infections in MSM living with HIV, showing a moderate overall agreement between them. Either total HPV detection or type-specific HPV16/18 detection together with a threshold ≥atypical squamous cells of undetermined significance for abnormal cytology showed an acceptable diagnostic accuracy.
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Affiliation(s)
- Montserrat Torres
- Infection and Cancer Laboratory, Cancer Epidemiology Research Program, Institut Catala d' Oncologia-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Silva-Klug
- HIV and STD Unit (Infectious Disease Service), Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Ferrer
- HIV and STD Unit (Infectious Disease Service), Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Saumoy
- HIV and STD Unit (Infectious Disease Service), Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Loris Trenti
- General Surgery Department, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sara Tous
- Infection and Cancer Unit. Cancer Epidemiology Research Program, Institut Catala d' Oncologia-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,CIBERESP, Madrid, Comunidad de Madrid, Spain
| | - Ana Esteban
- Infection and Cancer Laboratory, Cancer Epidemiology Research Program, Institut Catala d' Oncologia-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Baixeras
- Pathology Unit, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
| | - Isabel Catala
- Pathology Unit, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
| | - August Vidal
- Pathology Unit, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
| | - Ignacio G Bravo
- Laboratory MIVEGEC (CNRS IRD Univ Montpellier), Centre National de la Recherche Scientifique, Montpellier, France
| | - Daniel Podzamczer
- HIV and STD Unit (Infectious Disease Service), Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia de Sanjose
- Infection and Cancer Unit. Cancer Epidemiology Research Program, Institut Catala d' Oncologia-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,CIBERESP, Madrid, Comunidad de Madrid, Spain.,Consultant, National Cancer Institute, Rockville, Maryland, USA
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5
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Clinical performance of DNA and RNA based HPV tests for Test of Cure (TOC) post treatment for cervical intraepithelial neoplasia (CIN) - a retrospective study. J Clin Virol 2022; 150-151:105165. [DOI: 10.1016/j.jcv.2022.105165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022]
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Ji L, Liu LY, Cho M, Karaaslan MA, Renneckar S. Revisiting the Molar Mass and Conformation of Derivatized Fractionated Softwood Kraft Lignin. Biomacromolecules 2021; 23:708-719. [PMID: 34968020 DOI: 10.1021/acs.biomac.1c01101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The limited utilization of reliable tools and standards for determination of the softwood kraft lignin molar mass and the corresponding molecular conformation hampers elucidation of the structure-property relationships of lignin. At issue, conventional size exclusion chromatography (SEC) is unable to robustly measure the molar mass because of a lack of calibration standards with a similar structure to lignin. In the present work, the determination of the absolute molar mass of acetylated technical lignin was revisited utilizing SEC combined with multi-angle light scattering with a band pass filter to suppress the fluorescence. Fractionated lignin isolated using sequential techniques of solvent and membrane methods was used to enhance the clarity of light-scattering profiles by narrowing the molar mass distribution of lignin fractions. Further information on the molecular conformation of derivatized samples was studied utilizing a differential viscometer, and chemical structures were identified by NMR spectroscopy analysis. Through the help of fractionation, intrinsic viscosity values were determined for the different fractions as a function of molecular weight cut-off membranes. The derivatized acetone-soluble lignin was found to possess a lower molecular weight and an extremely compact structure relative to the derivatized acetone-insoluble fraction based on a significantly lower "α" value in the Mark-Houwink-Sakurada plot (0.15 acetone-soluble vs 0.33 acetone-insoluble). The differences in geometry were supported by the linkage analysis from NMR showing the acetone-soluble part containing fewer native linkages. In both of these examples, kraft lignin behaved like a solid sphere, limiting the ability to provide entanglements between molecular chains. From this standpoint, macroscopic properties of lignin are justified with this knowledge of a dense and extremely compact structure.
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Affiliation(s)
- Lun Ji
- Advanced Renewable Materials Lab, Department of Wood Science, University of British Columbia, 2424 Main Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Li-Yang Liu
- Advanced Renewable Materials Lab, Department of Wood Science, University of British Columbia, 2424 Main Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Mijung Cho
- Advanced Renewable Materials Lab, Department of Wood Science, University of British Columbia, 2424 Main Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Muzaffer A Karaaslan
- Advanced Renewable Materials Lab, Department of Wood Science, University of British Columbia, 2424 Main Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Scott Renneckar
- Advanced Renewable Materials Lab, Department of Wood Science, University of British Columbia, 2424 Main Mall, Vancouver, British Columbia V6T 1Z4, Canada
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Zuo T, Levi AW, Lin Q, Abi-Raad R, Adeniran AJ, Cai G. High-Risk Human Papillomavirus Testing, Genotyping, and Histopathologic Follow-up in Women With Abnormal Glandular Cells on Papanicolaou Tests. Am J Clin Pathol 2021; 156:569-576. [PMID: 33728437 DOI: 10.1093/ajcp/aqaa265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study examined the association of high-risk human papillomavirus (hrHPV) status and HPV genotype with histopathologic follow-ups in women with an atypical glandular cell (AGC) interpretation. METHODS Cases with AGC interpretation on a Papanicolaou (Pap) test were retrieved along with hrHPV testing, genotyping, and histologic follow-up results if available. RESULTS A total of 561 AGC cases were identified, with histologic follow-up available for 471 cases (84%). The follow-up diagnoses included benign or reactive changes (60% of cases), low-grade cervical intraepithelial neoplasia (18%), high-grade cervical intraepithelial neoplasia (CIN2-3; 7%), cervical carcinoma (5%), and other malignancies (10%). Tests for hrHPV were positive in 128 of 426 (30%) cases, including HPV16 (30%), HPV18 (14%) and other HPV subtypes (56%). A positive hrHPV result significantly increased the risk of developing CIN2-3 or cervical carcinoma (odds ratio, 24.6; 95% CI, 9.9-58.9) and HPV16 or HPV18 further increased the risk (odds ratio, 49.5; 95% CI, 17.7-123.7). CONCLUSIONS Our data demonstrate that in women with an AGC Pap interpretation, a positive hrHPV result, especially type 16 or 18, is associated with an increased risk of developing cervical CIN2-3 or higher lesions, suggesting potential implications of hrHPV testing for the management of patients with an AGC result on a Pap test.
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Affiliation(s)
- Tao Zuo
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Angelique W Levi
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Qiongqiong Lin
- Department of Pathology, Wenzhou Medical University Second Affiliated Hospital, Wenzhou, Zhejiang, China
| | - Rita Abi-Raad
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
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Baumann A, Henriques J, Selmani Z, Meurisse A, Lepiller Q, Vernerey D, Valmary-Degano S, Paget-Bailly S, Riethmuller D, Ramanah R, Mougin C, Prétet JL. HPV16 Load Is a Potential Biomarker to Predict Risk of High-Grade Cervical Lesions in High-Risk HPV-Infected Women: A Large Longitudinal French Hospital-Based Cohort Study. Cancers (Basel) 2021; 13:cancers13164149. [PMID: 34439304 PMCID: PMC8394477 DOI: 10.3390/cancers13164149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary This study aimed at assessing HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 885 women positive for hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 135 developed a high-grade lesion during the follow-up. Considering an HPV16 viral load cut-off set at 3.2 log10 GE/103 cells a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97 p ≤ 0.0001) has been identified. Moreover, a composite score based on HPV16 load, cytology and hrHPV detection allowed for CIN2+ risk stratification. To conclude, HPV16 load is a relevant biomarker to identify women at high risk for developing precancerous lesions of the cervix. Abstract High-risk HPV (hrHPV) testing has been implemented as a primary screening tool for cervical cancer in numerous countries. However, there is still a need for relevant triage strategies to manage hrHPV positive women to avoid excessive referral to colposcopy. The objective of this study was to assess, in women infected by hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 2102 women positive for hrHPV, 885 had no lesion or mild cytological abnormalities at baseline and had at least one follow-up (FU) visit. HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 15% developed a high-grade lesion during the FU. An HPV16 viral load cut-off set at 3.2 log10GE/103 cells permitted to identify a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97; p ≤ 0.0001). No specific HPV18 viral load threshold could have been defined in regard to the present study. In multivariate analysis, HPV16 load (absence/log10GE/103 cells < 3.2 vs. ≥3.2), RLU/PC 239 (1–100 pg/mL vs. >100 pg/mL) and cytology (normal vs abnormal) were independently associated with a significant increased risk of high-grade lesion development and were used to construct the prognostic score. In conclusion, HPV16 load is a relevant biomarker to identify women at high risk for developing cervical precancerous lesions.
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Affiliation(s)
- Antoine Baumann
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- Pathology Department, CHU de Besançon, 25000 Besançon, France;
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Zohair Selmani
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Aurélia Meurisse
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Quentin Lepiller
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Séverine Valmary-Degano
- Pathology Department, CHU de Besançon, 25000 Besançon, France;
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Sophie Paget-Bailly
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Didier Riethmuller
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
- Gynecology Department, CHU de Besançon, 25000 Besançon, France;
| | - Rajeev Ramanah
- Gynecology Department, CHU de Besançon, 25000 Besançon, France;
| | - Christiane Mougin
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jean-Luc Prétet
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
- Correspondence: ; Tel.: +33-(03)-70-63-20-49
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9
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Shin MB, Liu G, Mugo N, Garcia PJ, Rao DW, Bayer CJ, Eckert LO, Pinder LF, Wasserheit JN, Barnabas RV. A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities. Front Public Health 2021; 9:670032. [PMID: 34277540 PMCID: PMC8281011 DOI: 10.3389/fpubh.2021.670032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.
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Affiliation(s)
- Michelle B. Shin
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Gui Liu
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, United States
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patricia J. Garcia
- Department of Global Health, University of Washington, Seattle, WA, United States
- School of Public Health, Cayetano Heredia University, Lima, Peru
| | - Darcy W. Rao
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Cara J. Bayer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Linda O. Eckert
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Leeya F. Pinder
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Judith N. Wasserheit
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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10
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Dong B, Zou H, Mao X, Su Y, Gao H, Xie F, Lv Y, Chen Y, Kang Y, Xue H, Pan D, Sun P. Effect of introducing human papillomavirus genotyping into real-world screening on cervical cancer screening in China: a retrospective population-based cohort study. Ther Adv Med Oncol 2021; 13:17588359211010939. [PMID: 33995595 PMCID: PMC8107662 DOI: 10.1177/17588359211010939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background: China’s Fujian Cervical Pilot Project (FCPP) transitioned cervical cancer screening from high-risk human papillomavirus (HR-HPV) nongenotyping to genotyping. We investigated the clinical impact of this introduction, comparing performance indicators between HR-HPV genotyping combined with cytology screening (HR-HPV genotyping period) and the previous HR-HPV nongenotyping combined with cytology screening (HR-HPV nongenotyping period). Methods: A retrospective population-based cohort study was performed using data from the FCPP for China. We obtained data for the HR-HPV nongenotyping period from 1 January 2012 to 31 December 2013, and for the HR-HPV genotyping period from 1 January 2014 to 31 December 2016. Propensity score matching was used to match women from the two periods. Multivariable Cox regression was used to assess factors associated with cervical intraepithelial neoplasia of grade 2 or worse (CIN2+). The primary outcome was the incidence of CIN2+ in women aged ⩾25 years. Performance was assessed and included consistency, reach, effectiveness, adoption, implementation and cost. Results: Compared with HR-HPV nongenotyping period, in the HR-HPV genotyping period, more CIN2+ cases were identified at the initial screening (3.06% versus 2.32%; p < 0.001); the rate of colposcopy referral was higher (10.87% versus 6.64%; p < 0.001); and the hazard ratio of CIN2+ diagnosis was 1.64 (95% confidence interval, 1.43–1.88; p < 0.001) after controlling for health insurance status and age. The total costs of the first round of screening (US$66,609 versus US$65,226; p = 0.293) were similar during the two periods. Higher screening coverage (25.95% versus 25.19%; p = 0.007), higher compliance with age recommendations (92.70% versus 91.69%; p = 0.001), lower over-screening (4.92% versus 10.15%; p < 0.001), and reduced unqualified samples (cytology: 1.48% versus 1.73%, p = 0.099; HR-HPV: 0.57% versus 1.34%, p < 0.001) were observed in the HR-HPV genotyping period. Conclusions: Introduction of an HR-HPV genotyping assay in China could detect more CIN2+ lesions at earlier stages and improve programmatic indicators. Evidence suggests that the introduction of HR-HPV genotyping is likely to accelerate the elimination of cervical cancer in China.
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Affiliation(s)
- Binhua Dong
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, P.R. China
| | - Xiaodan Mao
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Yingying Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, Fujian, P.R. China
| | - Hangjing Gao
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Fang Xie
- Department of Obstetrics and Gynecology, Mindong Hospital of Fujian Medical University, Fuan, Fujian, P.R. China
| | - Yuchun Lv
- Department of Obstetrics and Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, P.R. China
| | - Yaojia Chen
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Yafang Kang
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Huifeng Xue
- Fujian Provincial Cervical Disease Diagnosis and Treatment Health Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Diling Pan
- Department of Pathology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, 18 Daoshan Road, Fuzhou, Fujian 350001, P.R. China
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11
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Costa AF, Pogere A, Pasinato APBF, Bello EJM, Onofre ASC, Onofre FBDM. DNA ploidy measurement and human papillomavirus in abnormal cervical cytology. Cytopathology 2020; 32:180-186. [PMID: 33217061 DOI: 10.1111/cyt.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the efficacy of high-risk human papillomavirus (HR-HPV) and DNA image cytometry (DNA-ICM) status for identifying high-grade cervical intraepithelial neoplasia or worse (≥CIN2). METHODS This cross-sectional study was performed in women undergoing follow-up procedure after a previous abnormal cervical cytology. Cervical cells were collected for HPV detection and DNA ploidy measurement. Biopsy samples were taken for histological confirmation. Sensitivity and specificity values for ≥CIN2 detection with HR-HPV and DNA-ICM were determined. RESULTS HR-HPV was present in 74.5% of the women. The most frequent HPV infection was HPV 16, followed by HPV 31, 33 and 58. Aneuploidy was observed in 60.6% of all cases. Referral cytology revealed 78.0% sensitivity and 68.6% specificity for detecting a ≥CIN2 lesion. The HR-HPV test alone showed 92.7% sensitivity, albeit it was not statistically different from DNA-ICM (88.1%, P > .05). Positivity for HPV or DNA-ICM resulted in 100% sensitivity. Higher specificity was observed for the combination of HR-HPV and DNA-ICM (88.6%), with no difference from DNA-ICM alone (85.7%, P > .05). CONCLUSION DNA-ICM or HR-HPV positivity identified all cases of ≥CIN2 in women undergoing follow-up procedure after a previous abnormal cervical cytology. Routine cervical cancer screening could be improved by the incorporation of DNA-ICM as a complementary method to primary screening to identify which women need closer follow-up.
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Affiliation(s)
- Ane Francyne Costa
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Adriane Pogere
- Department of Obstetrics and Gynecology, Polydoro Ernani of Sao Thiago University Hospital of the Federal University of Santa Catarina, Florianópolis, Brazil
| | - Ana Paula Beltrame Farina Pasinato
- Department of Pathology, Polydoro Ernani of Sao Thiago University Hospital of the Federal University of Santa Catarina, Florianópolis, Brazil
| | - Edson Jose Monteiro Bello
- Department of Virology, Central Laboratory of Public Health of Distrito Federal (LACEN-DF), Brasília, Brazil
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12
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Bhatla N, Singhal S. Primary HPV screening for cervical cancer. Best Pract Res Clin Obstet Gynaecol 2020; 65:98-108. [PMID: 32291178 DOI: 10.1016/j.bpobgyn.2020.02.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/24/2022]
Abstract
Cytology-based cervical screening had unequivocal success in reducing the incidence and mortality of cervical cancer in the last century. The recognition of the role of human papillomavirus (HPV) as a necessary cause of cervical cancer led to the development of HPV testing. Gradually, there has been a shift from reflex HPV testing for mild cytological abnormalities, to co-testing with cytology and HPV, and lately to primary HPV screening, based on evidence from well-designed large randomized controlled trials and meta-analyses. Advantages of primary HPV screening include higher sensitivity to detect pre-neoplastic lesions, better re-assurance with a negative test, and safe prolongation of screening intervals. However, clinicians and policy makers must ensure the availability of clinically validated HPV assays and triage protocols of screen positive cases prior to implementation of primary HPV screening. This is likely to reduce potential harm from over-treatment as well as extra burden on the health care system.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
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13
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Arrossi S, Paolino M, Laudi R, Gago J, Campanera A, Marín O, Falcón C, Serra V, Herrero R, Thouyaret L. Programmatic human papillomavirus testing in cervical cancer prevention in the Jujuy Demonstration Project in Argentina: a population-based, before-and-after retrospective cohort study. Lancet Glob Health 2019; 7:e772-e783. [PMID: 31097279 DOI: 10.1016/s2214-109x(19)30048-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) testing for cervical cancer prevention was introduced in Argentina through the Jujuy Demonstration Project (2011-14). The programme tested women aged 30 years and older attending the public health system with clinician-collected HPV tests. HPV self-collection was introduced as a programmatic strategy in 2014. We aimed to evaluate the effectiveness of programmatic HPV testing to detect cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) in comparison with cytology-based screening. METHODS We did a population-based, before-and-after retrospective cohort study using data from the National Cervical Cancer Prevention Program for the Jujuy province in northwest Argentina. We obtained data for the cytology-based screening period from Jan 1, 2010, until Dec 31, 2011, and for the HPV-based screening period from Jan 1, 2012, until Dec 31, 2014. The primary outcome was detection of histologically diagnosed CIN2+ among women aged 30 years and older. To assess the outcomes in all individuals included in the study, we used multivariable logistic regression and propensity score matching. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was used for the before-and-after analysis of programmatic dimensions. FINDINGS Of the 29 631 women who underwent cytology-based screening in 2010-11, CIN2+ was detected in 236 (0·8%) individuals. Of the 49 565 women HPV tested in 2012-14 (clinician-collected tests, n=44 700; self-collection tests, n=4865), 693 (1·4%; 658 clinician-collected tests; 35 self-collection tests) were found to have CIN2+ after the first round of screening. Compared with cytology-based screening, the odds ratio of being diagnosed with a CIN2+ lesion was 2·34 (95% CI 2·01-2·73; p<0·0010) with clinician-collected tests, and 1·08 (0·74-1·52; p=0·68) when screened with self-collection tests, after controlling for age and health insurance status. Screening coverage was similar in both periods (52·7% vs 53·2%); improvements of programmatic indicators were observed in the HPV testing period in relation to laboratory centralisation, lower overscreening (6·6% vs 0·0%), higher adherance to age recommendations (79·3% vs 98·8%), and a decrease of inadequate samples (3·6% vs 0·2%). INTERPRETATION HPV testing in middle-income settings increases detection of CIN2+ lesions and allows for improvement of programmatic indicators. Evidence suggests that the introduction of HPV testing will accelerate the reduction of cervical cancer burden. FUNDING Argentinian National Cancer Institute and National Council of Scientific and Technologic Research.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Rosa Laudi
- Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Juan Gago
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina; Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
| | - Alicia Campanera
- Ministerio de Salud de la Provincia de Jujuy, San Salvador de Jujuy, Argentina
| | - Oscar Marín
- Hospital Pablo Soria, San Salvador de Jujuy, Argentina
| | | | - Verónica Serra
- Ministerio de Salud de la Provincia de Jujuy, San Salvador de Jujuy, Argentina
| | | | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino, Instituto Nacional del Cáncer, Buenos Aires, Argentina
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Cuschieri K, Schuurman R, Coughlan S. Ensuring quality in cervical screening programmes based on molecular human papillomavirus testing. Cytopathology 2019; 30:273-280. [PMID: 30657615 DOI: 10.1111/cyt.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/10/2018] [Accepted: 01/11/2019] [Indexed: 01/13/2023]
Abstract
The increased use of human papillomavirus testing within cervical screening programmes necessarily brings about changes to the laboratory services required to support them. A crucial element of such services is to demonstrate initial and ongoing quality of the test (and associated processes). In this review, we outline some of the quality considerations and challenges with an emphasis on the laboratory including assay and platform validation, internal quality control selection and strengths and weaknesses of external quality assurance schemes. The influence and role of key external entities, including regulatory agencies, guideline groups, programme commissioners and commercial providers, are also discussed.
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Affiliation(s)
- Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, Scotland.,HPV Research Group, University of Edinburgh, Edinburgh, Scotland
| | - Rob Schuurman
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Suzie Coughlan
- National Virus Reference Laboratory, University College Dublin, Belfield, Ireland
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Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:v10120729. [PMID: 30572620 PMCID: PMC6315375 DOI: 10.3390/v10120729] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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