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Zhang Y, Du H, Wang C, Huang X, Qu X, Wu R. Feasibility and applicability of self-sampling based online cervical cancer screening: findings from the China online cervical cancer screening trial. Infect Agent Cancer 2024; 19:16. [PMID: 38664748 PMCID: PMC11046965 DOI: 10.1186/s13027-024-00583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE This study aims to evaluate the feasibility and applicability of an online cervical cancer screening program using a website as the public platform and self-collected HPV testing as the primary screening method. METHODS A website (mcareu.com) was developed to facilitate the online cervical cancer screening program by Peking University Shenzhen Hospital (PUSH). Women in Shenzhen could register for participation on the website by providing essential demographic data. Sampling kits and specimens were delivered through regular logistics. Eligible women collected vaginal samples by themselves using the provided kits and in referring of the graphic guidance. The specimens were tested for HPV at PUSH or a reference lab, and the results were accessible on the website through participants' personal accounts. Participants who tested positive for high-risk HPV were scheduled for colposcopy and biopsies. The demographic and social background data of the eligible participants were analyzed to evaluate the feasibility and applicability of the online screening approach. RESULTS A total of 1712 applicants registered for participation, with 99.9% (1710/1712) completing registration with full data. The analysis included 1560 applicants aged 30-59, with an average age of 41.1 (± 7.6) years. Among them, 83.3% (1299/1560) provided self-collected samples for testing. Age-group analysis revealed an overall sample provision rate (SPR) exceeded 80% in all age groups. A significant difference in SPR was observed only between the 30-34 and 45-49 age groups (p < 0.05), while no significant differences were found among other age groups. 99.7% of the samples were tested qualified, and there was no significant difference in sampling failure rate among age groups. Analysis of demographic and social elements showed no significant impact on the rates of sample provision among groups in most of the social elements but the medical insurance and the monthly family-incomes. CONCLUSION The findings demonstrate that online cervical cancer screening is reliable for self-registration, self-sampling, and self-ordering for specimen transportation. It is suitable for women of all ages needing to be screened, irrespective of social elements, and effectively facilitates screening for women with limited access to medical resources. Therefore, online screening holds promise as an effective approach to increase screening coverage.
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Affiliation(s)
- Yi Zhang
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China
| | - Hui Du
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China
| | - Chun Wang
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China
| | - Xia Huang
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China
| | - Xinfeng Qu
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China.
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China.
| | - Ruifang Wu
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China.
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China.
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Du H, Qu X, Wang G, Guo C, Wang Z, Min J, Liu Z, Hu Q, Luo H, Wang C, Huang X, Chen Y, Wu B, Belinson JL, Wu R. Application an internet facilitation in a community-based cervical cancer screening project. BMC Womens Health 2023; 23:641. [PMID: 38041116 PMCID: PMC10690986 DOI: 10.1186/s12905-023-02733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility of an internet-facilitated community model for cervical cancer screening using self-collected HPV testing as primary screening. METHOD A population-based cervical cancer screening program was conducted in the suburb of Shenzhen, China, from September 2014 to July 2017. Women with 25-60 years of age and no pregnancy were eligible for participation. Participants could register for screening by logging in a website by themselves or with the aids of local community workers. A unique barcode was issued to each applicant upon successful registration. After registration, women could get sampling kits from community screening site/study clinic, collect vaginal samples privately or in group, and provide their sample for Hr-HPV tests on Cobas4800 and SeqHPV assays. Testing reports were checkable through personal account for all participant and phone calls were given to all women positive of Hr-HPV. Participants positive of both or either the 2 assays were identified as the positives. The positives could return the study clinic for triage or search medical care in other clinics. Colposcopy directed or ramdom biopsies were performed on all positives who returned to the study clinics. RESULTS A total of 10,792 community women registered for screening, among whom, 10,010 provided their vaginal samples for tests. 99.5% of the participants were confirmed to have correct personal identifiable information and samples, and 98.9% of them got HPV testing results from both or either assays. No adverse event was reported. CONCLUSION When self-collected HPV testing is used as the primary testing, the internet-based data platform facilitates the screening in registration, data collection, and data tracking, and increases the screening coverage. Internet-facilitated community model is promising to cervical cancer control and applicable in regions with variety of resources.
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Affiliation(s)
- Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China
| | - Xinfeng Qu
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China
| | - Guixiang Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
| | - Chunlei Guo
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
| | | | - Juan Min
- Pinshan Renmin Hospital, Shenzhen, PR China
| | - Zhihong Liu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China
| | - Qicai Hu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China
| | - Hongxue Luo
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China
| | - Yun Chen
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
- Shenzhen Medical Women's Association, Shenzhen, PR China
| | - Bo Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China
- Shenzhen Medical Women's Association, Shenzhen, PR China
| | - J L Belinson
- Preventive Oncology International, Inc, Cleveland Heights, OH, USA
- Women Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Shenzhen, 518036, PR China.
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, PR China.
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, PR China.
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Li J, Wu R, Qu X, Huang X, Li L, Lin Z, Zhang Z, Deng J, Liu R, Zhao X, Zhang S, Lin B, An R, Zhao C, Li M, Zhao Y, Wei L. Effectiveness and feasibility of self-sampling for human papillomavirus testing for internet-based cervical cancer screening. Front Public Health 2022; 10:938272. [PMID: 36420004 PMCID: PMC9677822 DOI: 10.3389/fpubh.2022.938272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Worldwide, around 18.2% of cervical cancer occurred in China, mainly because of lower screening coverage and screening quality in regional disparities. To assess self-sampling for human papillomavirus (HPV) testing, combined with the internet, as a primary cervical cancer screening (CCS) method in low-resource settings, and to establish an internet-based self-sampling CCS-management model. Methods The women who participated registered on a CCS website. We recruited 20,136 women, aged 30-59 years, from 13 provinces in China, to perform vaginal self-sampling for HPV testing as a primary CCS, based on the internet. A questionnaire was subsequently used to investigate the acceptability of self-sampling. Results Of the 20,103 women with qualified samples, 35.80% lived in remote areas, 37.69% had never undergone CCS, 59.96% were under-screened, and the overall prevalence of a high-risk of HPV was 13.86%. Of 8,136 respondents, 95.97% of women felt that self-sampling was easy to perform, 84.61% had no discomfort when using a self-sampling brush, 62.37% women were more likely to choose self-sampling for CCS in future, and 92.53% were willing to introduce the concept to others around them. The reliability and ease of self-sampling were independent factors influencing selection of self-sampling (p < 0.05). Conclusions The Internet-facilitated self-sampling for HPV testing and management model for cervical cancer prevention is feasible and effective. It can be used as a supplement to the conventional screening, particularly in outlying areas with few medical resources, to improve the coverage of CCS. Clinical trial registration https://www.chictr.org.cn, identifier: ChiCTR2000032331.
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Affiliation(s)
- Jingran Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xinfeng Qu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ling Li
- Department of Obstetrics and Gynecology, Jiangxi Maternal and Child Health Hospital, Nanchang, China
| | - Zhixin Lin
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhijun Zhang
- Department of Obstetrics and Gynecology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jihong Deng
- Department of Obstetrics and Gynecology, Kunming City Maternal and Child Health Hospital, Kunming, China
| | - Rong Liu
- Department of Obstetrics and Gynecology, Xining First People's Hospital, Xining, China
| | - Xiaofeng Zhao
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital of Zhejiang University Medical College, Yiwu, China
| | - Songling Zhang
- Department of Obstetrics and Gynecology, The First Hospital of Jilin University, Changchun, China
| | - Bei Lin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ruifang An
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chao Zhao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Mingzhu Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Yun Zhao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Lihui Wei
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China,*Correspondence: Lihui Wei
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Yang Z, Zhang Y, Stubbe-Espejel A, Zhao Y, Liu M, Li J, Zhao Y, Tong G, Liu N, Qi L, Hutchins A, Lin S, Li Y. Vaginal microbiota and personal risk factors associated with HPV status conversion—A new approach to reduce the risk of cervical cancer? PLoS One 2022; 17:e0270521. [PMID: 35944043 PMCID: PMC9362946 DOI: 10.1371/journal.pone.0270521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/11/2022] [Indexed: 11/19/2022] Open
Abstract
Vaginal microbiota (VMB) is associated with changes in Human papilloma virus (HPV) status, which consequently influences the risk of cervical cancer. This association was often confounded by personal risk factors. This pilot research aimed to explore the relationship between vaginal microbiota, personal risk factors and their interactions with HPV status conversion to identify the vaginal microbiota that was associated with HPV clearance under heterogeneous personal risk factors. A total of 38 women participated by self-collecting a cervicovaginal mucus (CVM) sample that was sent for metagenomics sequencing. Most of the participants also filled in personal risk factors questionnaire through an eHealth platform and authorized the use of their previous HPV genotyping results stored in this eHealth platform. Based on the two HPV results, the participants were grouped into three cohorts, namely HPV negative, HPV persistent infection, and HPV status conversion. The relative abundance of VMB and personal factors were compared among these three cohorts. A correlation investigation was performed between VMB and the significant personal factors to characterize a robustness of the panel for HPV status change using R programming. At baseline, 12 participants were HPV-negative, and 22 were HPV-positive. Within one year, 18 women remained HPV-positive, 12 were HPV-negative and 4 participants showed HPV clearance. The factors in the eHealth questionnaire were systematically evaluated which identified several factors significantly associated with persistent HPV infection, including age, salary, history of reproductive tract infection, and the total number of sexual partners. Concurrent vaginal microbiome samples suggest that a candidate biomarker panel consisting of Lactobacillus gasseri, Streptococcus agalactiae, and Timona prevotella bacteria, which may be associated with HPV clearance. This pilot study indicates a stable HPV status-related vaginal microbe environment. To establish a robust biomarker panel for clinical use, larger cohorts will be recruited into follow-up studies.
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Affiliation(s)
| | - Ye Zhang
- Department of Traditional Chinese Medicine, Women & Children Health Institute Futian Shenzhen, Shenzhen, China
| | | | - Yumei Zhao
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Mengping Liu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Jianjun Li
- Department of Traditional Chinese Medicine, Women & Children Health Institute Futian Shenzhen, Shenzhen, China
| | - Yanping Zhao
- BGI-Shenzhen, Shenzhen Key Laboratory of Unknown Pathogen, Shenzhen, China
| | - Guoqing Tong
- Shouguang Hospital of Traditional Chinese Medicine, Reproduction Medicine Center Shanghai, China
| | - Na Liu
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Le Qi
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Andrew Hutchins
- Department of Biology, Southern University of Science and Technology, Xueyuan Lu, Shenzhen, China
| | - Songqing Lin
- Department of Traditional Chinese Medicine, Women & Children Health Institute Futian Shenzhen, Shenzhen, China
| | - Yantao Li
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
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Song F, Yan P, Huang X, Wang C, Du H, Qu X, Wu R. Roles of extended human papillomavirus genotyping and multiple infections in early detection of cervical precancer and cancer and HPV vaccination. BMC Cancer 2022; 22:42. [PMID: 34991494 PMCID: PMC8734293 DOI: 10.1186/s12885-021-09126-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background The aim of the study was to investigate the risk of human papillomavirus (HPV) genotyping particularly vaccine genotypes and multiple infections for cervical precancer and cancer, which might contribute to developing genotype-specific screening strategy and assessing potential effects of HPV vaccine. Methods The HPV genotypes were identified using the Seq HPV assay on self-collected samples. Hierarchical ranking of each genotype was performed according to positive predictive value (PPV) for cervical intraepithelial neoplasia 2/3 or worse (CIN2+/CIN3+). Multivariate logistic regression model was used to estimate the odds ratios (ORs) with 95% confidence interval (CI) of CIN2+ according to multiplicity of types and vaccine types. Results A total of 2811 HPV-positive women were analyzed. The five dominant HPV genotypes in high-grade lesions were 16/58/52/33/18. The overall ranking orders were HPV16/33/35/58/31/68/18/ 56/52/66/51/59/45/39 for CIN2+ and HPV16/33/31/58/45/66/52/18/35/56/51/68/59/39 for CIN3+. The risks of single infection versus co-infections with other types lower in the hierarchy having CIN2+ were not statistically significant for HPV16 (multiple infection vs. single infection: OR = 0.8, 95%CI = 0.6-1.1, P = 0.144) or other genotypes (P > 0.0036) after conservative Bonferroni correction. Whether HPV16 was present or not, the risks of single infection versus multiple infection with any number (2, ≥2, or ≥ 3) of types for CIN2+ were not significantly different. In addition, HPV31/33/45/52/58 covered by nonavalent vaccine added 27.5% of CIN2, 23.0% of CIN3, and 12.5% of cancer to the HPV16/18 genotyping. These genotype-groups were at significantly higher risks than genotypes not covered by nonavalent vaccine. Moreover, genotypes covered by nonavalent vaccine contributed to 85.2% of CIN2 lesions, 97.9% of CIN3 and 93.8% of cancers. Conclusions Partial extended genotyping such as HPV33/31/58 but not multiplicity of HPV infections could serve as a promising triage for HPV-positive self-samples. Moreover, incidence rates of cervical cancer and precancer were substantial attributable to HPV genotypes covered by current nonavalent vaccination. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09126-3.
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Affiliation(s)
- Fangbin Song
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China
| | - Peisha Yan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China. .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China.
| | - Xinfeng Qu
- Sanming Project of Medicine in Shenzhen, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, P. R. China. .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, Guangdong, P. R. China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, 518036, Guangdong, P. R. China.
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Du H, Luo H, Wang C, Qu X, Belinson JL, Wu R. The prevalence of HR-HPV infection based on self-sampling among women in China exhibited some unique epidemiologic features. J Clin Epidemiol 2021; 139:319-329. [PMID: 34161804 DOI: 10.1016/j.jclinepi.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/22/2021] [Accepted: 06/15/2021] [Indexed: 01/23/2023]
Abstract
Objective To investigate the epidemiological characteristics of high-risk human papillomavirus(HR-HPV) infection based on vaginal self-collected samples. Study Design and Setting The pooled data of 3045 self-collected samples used for the analysis derived from four previous studies on cervical cancer screening(The Chinese Multi-Center Screening Trial, CHIMUST; The Shenzhen Cervical Cancer Screening Trial-2, SHENCCAST-2; The Chinese Cervical Cancer Prevention Study, CHIPCAPS; Pingshan trial, PINGSHAN)conducted across China by our team since 2011. These cases were evaluated for HR-HPV type prevalence relative to lesion grade and age. The occurrence of cervical intraepithelial neoplasia(CIN) with specific HPV types and the influence of co-infection is explored. Results The top three most common genotypes among the HR-HPV positives were HPV-52(23.4%), HPV-16(18.0%), and HPV-58(15.50%). For women with CIN2+, the most frequent genotypes were HPV-16, 58, 52, and 18 in sequence. HPV-16 accounted for the majority of CIN2/CIN3/Ca with attribution rate of 23.86%, 44.78% and 50.00% respectively. HPV-58 accounted for 19.48%, 16.79% and 13.46% respectively. CIN2+ was found in the following types most frequently: HPV-16(31.23%), HPV-33(24.03%), HPV-58(18.41%), HPV-31(11.76%), HPV-18(7.75%), and HPV-52(7.30%). HPV-16 showed preference for co-infection with HPV-52 and HPV-58. Conclusion The prevalence of HR-HPV infection based on self-sampling among women in China exhibited some unique epidemiologic features.
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Affiliation(s)
- Hui Du
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, PR, China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen,China
| | - Hongxue Luo
- Department of Gynecology and Obstetrics, Peking University People' Hospital, Beijing, PR China
| | - Chun Wang
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, PR, China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen,China
| | - Xinfeng Qu
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen,China
| | - Jerome L Belinson
- Cleveland Clinic Lerner College of Medicine, Women' s Health Institute, Cleveland, Ohio; Preventive Oncology International, Shaker Heights, Ohio
| | - Ruifang Wu
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, PR, China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen,China.
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Song F, Belinson JL, Yan P, Huang X, Wang C, Du H, Qu X, Wu R. Evaluation of p16 INK4a immunocytology and human papillomavirus (HPV) genotyping triage after primary HPV cervical cancer screening on self-samples in China. Gynecol Oncol 2021; 162:322-330. [PMID: 34059349 DOI: 10.1016/j.ygyno.2021.05.014] [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] [Received: 04/26/2021] [Accepted: 05/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Self-sampling for human papillomavirus (HPV) testing is an effective option to increase the cervical screening coverage. How to best triage HPV-positive self-samples remains controversial. Here, we evaluated the performance of a novel p16INK4a immunocytology approach (p16) and HPV genotyping in triaging HPV-positive self-samples. METHODS A cohort of 73699 women were screened via SeqHPV assay on self-samples. HPV-positive women who met any sequential positive result of HPV16/18 or VIA or p16 were referred for colposcopy. A triage strategy was considered favorable if the NPV for CIN3+ was ≥98%, combined with an improvement of sensitivity and specificity in comparison to the comparator, being the 'ASC-US+' triage and the guideline strategy (HPV16/18+ or ASC-US+). RESULTS A total of 3510 HPV-positive women were included, 422 (12.0%) CIN2+ and 247 (7.0%) CIN3+ were identified. The positivity of p16 and ASC-US+ were 36.3% and 22.2%, respectively. p16 was more sensitive and less specific than ASC-US+ (P < 0.0001). However, when combined p16 with cytology or genotypes, two triage strategies were superior to the 'ASC-US+' strategy: p16 scored 3+; HPV16/33/58/31+ &p16+. Moreover, four strategies were favorable to the guideline strategy: ASC-US+ or p16+; LSIL+ or p16+; HPV16+ or p16+; HSIL+ or p16+ or HPV16+. These strategies achieved better balance between diseases detection and colposcopy referral. CONCLUSIONS Our findings indicate the promising utility of p16 immunocytology via adjusting the staining score or serving as an ancillary tool to liquid-based cytology or combining with genotyping for the triage of HPV-positive self-samples, which promotes the precise screening of cervical cancer.
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Affiliation(s)
- Fangbin Song
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China
| | - Jerome L Belinson
- Preventive Oncology International, Cleveland Heights, OH, USA; The Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Peisha Yan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China.
| | - Xinfeng Qu
- Sanming Project of Medicine in Shenzhen, Peking University Shenzhen Hospital, Shenzhen 518036, PR China.
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, PR China; Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, PR China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, PR China.
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8
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Reques L, Rolland C, Lallemand A, Lahmidi N, Aranda-Fernández E, Lazzarino A, Bottero J, Hamers F, Bergeron C, Haguenoer K, Launoy G, Luhmann N. Comparison of cervical cancer screening by self-sampling papillomavirus test versus pap-smear in underprivileged women in France. BMC Womens Health 2021; 21:221. [PMID: 34039341 PMCID: PMC8157706 DOI: 10.1186/s12905-021-01356-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare cervical cancer screening by pap smear (PS) versus preliminary HPV testing based on self-collected samples (SC-HPV). METHODS Interventional study among underprivileged women from 25 to 65 years old in four French cities. The control group (CG) was referred for a PS. The experimental group (EG) conducted a SC-HPV test followed by a PS in case of positivity. Differences on screening completion and cytological abnormalities were analysed by logistic and Cox regression. RESULTS 383 women were assigned to the EG and 304 to the CG. The screening completion proportion was 39.5% in the CG compared to 71.3% in the EG (HR = 2.48 (CI 95% [1.99-3.08]; p < 0.001). The proportion of cytological abnormalities was 2.0% in the CG and 2.3% in the EG (OR = 1.20 (CI 95% [0.42-3.40]; p = 0.7). The proportion of participants lost to follow-up was 60.5% in the CG and 63.2% in the EG HPV positive (p = 0.18). CONCLUSION Providing an SC-HPV-test increased the participation of underprivileged women in CCS. Nevertheless, the significant number of lost to follow-up in both groups can undermine the initial benefits of the strategy for HPV positive women. Registration: Clinicaltrials.gov: NCT03118258.
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Affiliation(s)
- Laura Reques
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France.
| | | | - Anne Lallemand
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
| | - Najat Lahmidi
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
| | | | - Antonio Lazzarino
- EPISTATA - Agency for Clinical Research and Medical Statistics, London, UK
| | - Julie Bottero
- Unité de Maladies Infectieuses et Tropicales, Groupe Hospitalo-Universitaire Paris Seine St-Denis, AP-HP, Hôpital Jean Verdier, Bondy, France
| | - Françoise Hamers
- Santé Publique France (National Public Health Agency), Saint Maurice cedex, France
| | | | - Ken Haguenoer
- U1153, INSERM, Paris, France
- Cancer Screening Department, CHRU de Tours, 37000, Tours, France
| | - Guy Launoy
- Centre François Baclesse, INSERM, Avenue du Général Harris, 14076, Caen, France
| | - Niklas Luhmann
- Médecins du Monde, 62 rue Marcadet, 75018, Paris, France
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9
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Song F, Yan P, Huang X, Wang C, Qu X, Du H, Wu R. Triaging HPV-positive, cytology-negative cervical cancer screening results with extended HPV genotyping and p16 INK4a immunostaining in China. BMC Infect Dis 2021; 21:400. [PMID: 33931022 PMCID: PMC8086315 DOI: 10.1186/s12879-021-06109-4] [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: 02/10/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Self-sampling for human papillomavirus (HPV) testing is a feasible option to improve the cervical screening coverage. However, an ideal triage method for HPV-positive self-samples does not yet exist. The aim of this study was to explore the utility of HPV genotyping and p16INK4a immunostaining (p16) in triaging HPV-positive self-samples, focusing on HPV-positive, cytology-negative (HPCN) women. Methods A total of 73,699 women were screened in a cervical screening project in China via SeqHPV assay on self-samples. HPV-positive women were called-back and collected cervical sample for p16 immunostaining and liquid-based cytology, those who met any result of HPV16/18+ or visual inspection with acetic acid (VIA) + or p16+ were referred for colposcopy, and HPCN women with adequate data on p16 and pathology were analyzed. A triage strategy was considered acceptable if the negative predictive value (NPV) for cervical intraepithelial neoplasia 3 or worse (CIN3+) was 98% or more, combined with an improvement of sensitivity and specificity for CIN2+/CIN3+ in reference to the comparator, being HPV16/18 + . Results A total of 2731 HPCN women aged 30–64 years were enrolled, 136 (5.0%) CIN2+ and 53 (1.9%) CIN3+ were detected. Five triage strategies met the criteria: p16+; HPV16/33+; ‘HPV16+ or HPV33/58/31/35+&p16+’; ‘HPV16/33+ or HPV58/31/35+&p16+’; HPV16/18/31/33/45/52/58 + & p16+. These strategies required less or similar colposcopy referrals, and less colposcopies to detected one case of CIN2+/CIN3+, achieving favorable false positive (negative) rates to the comparator. Among them, p16 staining detected 83.1% (79.2%) of underlying CIN2 + (CIN3+) in HPCN women. Moreover, three triage strategies were favorable in sensitivity and/or specificity to the ‘HPV16/33+’ strategy: p16+; ‘HPV16+ or HPV33/58/31/35 + &p16+’; HPV16/18/31/33/45/52/58 + &p16 + . Conclusions Genotyping for HPV16/33 could be utilized to optimize the management of HPCN women. Moreover, p16 immunostaining, either alone or combined with extended genotypes, is more effective than HPV genotypes alone in the triage of HPCN women. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06109-4.
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Affiliation(s)
- Fangbin Song
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China
| | - Peisha Yan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China
| | - Xia Huang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China
| | - Chun Wang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China.,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China
| | - Xinfeng Qu
- Sanming Project of Medicine in Shenzhen, Peking University Shenzhen Hospital, Shenzhen, Guangdong, 518036, P. R. China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China. .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China.
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong, 518036, P. R. China. .,Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, Guangdong, 518036, P. R. China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, Guangdong, 518036, P. R. China.
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10
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Chen R, Wu L, Ma F, Chen X, Zhu Y. The accuracy and influencing factors for preference of self-sampling in group B streptococcus screening: a cross-sectional study. J Matern Fetal Neonatal Med 2021; 35:5194-5198. [PMID: 33618588 DOI: 10.1080/14767058.2021.1875441] [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: 10/22/2022]
Abstract
OBJECTIVE Self-sampling with proper instruction in 35-37 weeks' gestation is an option to clinician sampling to prevent early-onset invasive group B streptococcal disease of infants. We aimed to assess the accuracy of self-sampling and influencing factors of preference for collection method in Chinese women. METHODS We compared the screening results of self-sampling with clinician collection in a sample of 520 women in late pregnancy. We collected their demographics, clinical information and preference for collection method. A multi-nominal logistic regression model was used to measure the association between the influencing factors and these participants' preference. RESULTS A good agreement between the two collection methods was found with a Cohen's Kappa coefficient 0.83 (95%CI = 0.71-0.95). The prevalence of GBS infection in the two methods is statistically different in this low-risk group when self-sampling presented a better outcome in terms of detecting positive cases. Self-sampling is preferable by 20.9% of the participants. No less pain during self-sampling and age older than 35 years old was statistically related to preference for clinician collection. CONCLUSION The accuracy of self-sampling is no worse than clinician collection. It could be an option for those younger than 35 years old, especially for those who report low pain threshold. Pregnant women are able to collect rectovaginal samples prior to their antenatal visit. Self-sampling followed by appropriate transportation of the sample to an advanced laboratory could eliminate the effects of local laboratory capacity. There are implications in increasing GBS screening participation in resource-limited settings.
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Affiliation(s)
- Ruirui Chen
- Department of Maternal Health, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Lijuan Wu
- Maternal-Fetal Medicine Institute, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China.,Department of Clinical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Fenglan Ma
- Department of Obstetrics, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Xuri Chen
- Department of Obstetrics, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Yuanfang Zhu
- Maternal-Fetal Medicine Institute, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China.,Department of Obstetrics, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
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11
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Du H, Duan X, Liu Y, Shi B, Zhang W, Wang C, Qu X, Li J, Zhao C, Liu J, Jiang J, Jin H, Li H, Xiao A, Bao J, Duan L, Huang X, Luo H, Bian S, Zhang L, Wei L, Belinson JL, Wu R. Evaluation of Cobas HPV and SeqHPV Assays in the Chinese Multicenter Screening Trial. J Low Genit Tract Dis 2021; 25:22-26. [PMID: 33347045 DOI: 10.1097/lgt.0000000000000577] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the Cobas 4800 Assay and the SeqHPV Assay with self (S) and direct (D) cervical samples in the Chinese Multicenter Screening Trial (CHIMUST). MATERIALS AND METHODS The CHIMUST is a large population-based multicenter clinical trial, and 10,885 women aged 30-59 years from 15 sites in 7 provinces with no cervical cancer screening for 3 years were eligible. All participating women contributed one self-collected sample (S) and 1 physician-collected endocervical sample (DL). The self-collected sample was first applied to the solid media transport card (SS), and then, the brush placed in 6 mL of ThinPrepSolution (SL). All samples were tested with Cobas 4800 and SeqHPV high-risk HPV assays. Patients human papillomavirus positive (self or direct) were recalled for colposcopy and biopsies. RESULTS A total of 10,399 women had complete data. The mean age was 43.9 years. A total of 1.4% (142/10,399) had cervical intraepithelial neoplasia (CIN) 2+ and 0.5% (54/10,339) had CIN 3+. In the liquid specimens, the overall HPV infection rates were 10.8% for Cobas and 10.9% for SeqHPV in D sample, and 13.7% for Cobas and 11.6% for SeqHPV in SL sample, respectively. The sensitivity of Cobas-DL, Cobas-SL, SeqHPV-DL, and SeqHPV-SL for CIN 2+ was 95.07%, 95.07%, 94.33%, and 96.48%, respectively. The specificity of Cobas-DL, Cobas-SL, SeqHPV-DL, and SeqHPV-SL for CIN 2+ was 90.38%, 87.35%, 90.21%, and 89.53%, respectively. There were no differences in sensitivity when applying the 2 assays to both self- and directly collected samples in liquid transport media (p > .05). CONCLUSIONS Both Cobas and SeqHPV screening assays using both self-collected and directly endocervical collected specimens demonstrate similar sensitivity for the detection of CIN 2+ and CIN 3+.
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Affiliation(s)
| | - Xianzhi Duan
- Capital Medical University Beijing Tongren Hospital, Beijing, China
| | - Yan Liu
- Fudan University Huanshan Hospital North, Shanghai, China
| | - Bin Shi
- The second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Zhang
- Wuhan University Zhongnan Hospital, Wuhan, China
| | | | - Xinfen Qu
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Jingran Li
- Peking University People's Hospital, Beijing, China
| | - Chao Zhao
- Peking University People's Hospital, Beijing, China
| | - Juan Liu
- Fudan University Huanshan Hospital North, Shanghai, China
| | - Jing Jiang
- The second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hua Jin
- Wushenqi People's Hospital, Inner Mongolia, China
| | - Hanyi Li
- Pingxiang Ganxi Cancer Hospital, Jiangxi Province, China
| | | | | | | | | | - Hongxue Luo
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuhuang Bian
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Lijie Zhang
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Lihui Wei
- Peking University People's Hospital, Beijing, China
| | - Jerome L Belinson
- Preventive Oncology International, Inc, and the Cleveland Clinic, Cleveland, OH
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12
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Zhang W, Du H, Huang X, Wang C, Duan X, Liu Y, Shi B, Zhang W, Qu X, Wei L, Schiffman M, Belinson JL, Wu R. Evaluation of an isothermal amplification HPV detection assay for primary cervical cancer screening. Infect Agent Cancer 2020; 15:65. [PMID: 33110442 PMCID: PMC7583687 DOI: 10.1186/s13027-020-00328-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022] Open
Abstract
Objective The aim of this research was to evaluate independently the performance of a new isothermal amplification assay for cervical cancer screening compared to two previously validated PCR-based assays and histologic endpoints. Methods This is a sub-study from the Chinese multi-center screening trial (CHIMUST). The self-collected and clinician-collected specimens stored in PreservCyt at − 4 °C from 6042 women with complete data were tested with the AmpFire assay. These specimens had been previously tested with Cobas and SeqHPV assays. In the primary study all patients with an abnormal test were referred to colposcopy where all had directed and/or random biopsies plus ECC. No additional patients were called back based on the AmpFire results. Results 6042/6619 women had complete data (mean age 44.1). There were 57 cases of CIN 2, 35 cases of CIN 3 and 2 cancers. The sensitivity for CIN2+ and CIN3+ were similar among the three assays (both direct and self-collected). For the specificities in all categories (CIN2+/CIN3+ and self and direct collection), isothermal amplification assay was either equal to or more specific than Cobas but consistently less specific than SeqHPV. Conclusion The AmpFire HPV assay showed similar sensitivity to Cobas and SeqHPV for CIN2+ and CIN3+ on both self and clinician-collections (P>0.05), with good specificity. The speed, low cost, and simplicity of this assay will make it particularly suited for low and middle resource settings. Its accuracy with self-collection makes it applicable for mass screening programs.
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Affiliation(s)
- Wei Zhang
- Peking University Shenzhen Hospital, Shenzhen, 518036 P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, P. R. China
| | - Hui Du
- Peking University Shenzhen Hospital, Shenzhen, 518036 P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, P. R. China
| | - Xia Huang
- Peking University Shenzhen Hospital, Shenzhen, 518036 P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, P. R. China
| | - Chun Wang
- Peking University Shenzhen Hospital, Shenzhen, 518036 P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, P. R. China
| | - Xianzhi Duan
- Capital Medical University Beijing Tongren Hospital, Beijing, P. R. China
| | - Yan Liu
- Fudan University Huanshan Hospital, Shanghai, P. R. China
| | - Bin Shi
- The second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Wei Zhang
- Wuhan University Zhongnan Hospital, Wuhan, P. R. China
| | - Xinfeng Qu
- Expert in Three Engineering Office, Shenzhen Maternal of Peking University Shenzhen Hospital, Shenzhen, 518036 China
| | - Lihui Wei
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, P. R. China
| | - M Schiffman
- National Cancer Institute, Division of Epidemiology and Genetics, Bethesda, USA
| | - J L Belinson
- Women's Health Institute, Cleveland Clinic, Cleveland, OH USA.,PPreventive Oncology International, Inc., Shaker Heights, USA
| | - Ruifang Wu
- Peking University Shenzhen Hospital, Shenzhen, 518036 P. R. China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, P. R. China
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13
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Dykens JA, Smith JS, Demment M, Marshall E, Schuh T, Peters K, Irwin T, McIntosh S, Sy A, Dye T. Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review. Cancer Causes Control 2020; 31:417-429. [PMID: 32185604 PMCID: PMC7105425 DOI: 10.1007/s10552-020-01290-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed. METHODS We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from "implementation light" to more implementation intensive. RESULTS Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demand-side (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as "Informing Scale-up" along the continuum of implementation research. CONCLUSIONS The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.
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Affiliation(s)
- J. Andrew Dykens
- University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - Jennifer S. Smith
- University of North Carolina School of Public Health, Chapel Hill, NC USA
| | - Margaret Demment
- University of Rochester Department of Obstetrics and Gynecology, Rochester, NY USA
| | - E. Marshall
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL USA
| | - Tina Schuh
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL USA
| | - Karen Peters
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL USA
| | - Tracy Irwin
- University of Washington Department of Obstetrics and Gynecology, Seattle, WA USA
| | - Scott McIntosh
- University of Rochester Department of Public Health Sciences, Rochester, NY USA
| | - Angela Sy
- University of Hawaii John A Burns School of Medicine, Honolulu, HI USA
| | - Timothy Dye
- University of Rochester Department of Obstetrics and Gynecology, Rochester, NY USA
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14
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Long H, Huang W, Zheng P, Li J, Tao S, Tang S, Abdullah AS. Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006⁻2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112378. [PMID: 30373205 PMCID: PMC6266440 DOI: 10.3390/ijerph15112378] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Background: Non-communicable diseases (NCDs) have become a dominant disease burden in China. Although China has a prevention-centered NCD strategy, the implementation effect in the community has been subjected to manpower and financial difficulties. Engaging community health workers (CHWs) in community-based interventions may be a cost-effective approach to relieve the resource shortage and improve health. This review aimed to synthesize evidence on types of NCD-related care that was provided by CHWs in China, and to identify relevant barriers and facilitators. Methods: A literature search was conducted in Medline, PubMed, ProQuest, and Google Scholar databases for English-written, peer-reviewed articles published from 1996 to 2016 that reported findings from NCD-related interventions delivered by CHWs in China. Each article was extracted independently by two researchers. Results: Twenty distinct studies met the inclusion criteria. The two most common types of CHW-led NCD-related care were diabetes and hypertension management (n = 7) and mental health care (n = 7). Thirteen studies discussed the barriers and 16 studies reported facilitators. The most common barriers included lack of support (n = 6), lack of resources (n = 4), and heavy reliance on technology (n = 4). The common facilitators included an integrated health system (n = 9), community and patient trust (n = 5), high quality training (n = 5), and CHWs’ capacity (n = 5). Fourteen studies mentioned training content, while only eight described detailed procedures and duration. Conclusions: This review suggests that trained and supervised Chinese CHWs had the capacity to provide grassroots NCDs preventive interventions. In order to increase the generalizability and sustainability of such programs, studies with robust designs are needed to explore the effectiveness of CHW-led programs, and the intervention strategies to improve the practice of CHWs in various settings.
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Affiliation(s)
- Hongfei Long
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
| | - Wenting Huang
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
| | - Pinpin Zheng
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Jiang Li
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Sha Tao
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Shenglan Tang
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA.
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA.
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA.
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Huang W, Long H, Li J, Tao S, Zheng P, Tang S, Abdullah AS. Delivery of public health services by community health workers (CHWs) in primary health care settings in China: a systematic review (1996-2016). Glob Health Res Policy 2018; 3:18. [PMID: 29992191 PMCID: PMC5989355 DOI: 10.1186/s41256-018-0072-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Community Health Workers (CHWs) have been widely used in response to the shortage of skilled health workers especially in resource limited areas. China has a long history of involving CHWs in public health intervention project. CHWs in China called village doctors who have both treatment and public health responsibilities. This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services. METHODS We searched studies published in Chinese or English, on Medline, PubMed, Cochrane, Google Scholar, and CNKI for public health services delivered by CHWs in China, during 1996-2016. The role of CHWs, training for CHWs, challenges, and facilitating factors were extracted from reviewed studies. RESULTS Guided by National Basic Public Health Service Standards, services provided by CHW covered five major areas of noncommunicable diseases (NCDs) including diabetes and/or hypertension, cancer, mental health, cardiovascular diseases, and common NCD risk factors, as well as general services including reproductive health, tuberculosis, child health, vaccination, and other services. Not many studies investigated the barriers and facilitating factors of their programs, and none reported cost-effectiveness of the intervention. Barriers challenging the sustainability of the CHWs led projects were transportation, nature of official support, quantity and quality of CHWs, training of CHWs, incentives for CHWs, and maintaining a good rapport between CHWs and target population. Facilitating factors included positive official support, integration with the existing health system, financial support, considering CHW's perspectives, and technology support. CONCLUSION CHWs appear to frequently engage in implementing diverse public health intervention programs in China. Facilitators and barriers identified are comparable to those identified in high income countries. Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.
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Affiliation(s)
- Wenting Huang
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
| | - Hongfei Long
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
| | - Jiang Li
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Sha Tao
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Pinpin Zheng
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Shenglan Tang
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
- Duke Global Health Institute, Duke University, Durham, NC 27710 USA
| | - Abu S. Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
- Duke Global Health Institute, Duke University, Durham, NC 27710 USA
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118 USA
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Ma'som M, Bhoo-Pathy N, Nasir NH, Bellinson J, Subramaniam S, Ma Y, Yap SH, Goh PP, Gravitt P, Woo YL. Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women. BMJ Open 2016; 6:e011022. [PMID: 27491667 PMCID: PMC4985871 DOI: 10.1136/bmjopen-2015-011022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women. METHOD A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, previous Pap smear experience, and attitudes towards self-administered cervicovaginal sampling were collected and analysed. Acceptability was inferred using a five-item Likert scale that included six different subjective descriptives: experience, difficulty, convenience, embarrassment, discomfort or pain, and confidence in collecting one's own sample. RESULTS Of the 839 participants, 47.9% were Malays, followed by 30.8% Indians, 18.8% Chinese and 2.5% from other ethnicities. The median age of the participants was 38 years (IQR 30-48). Some 68.2% of participants indicated a preference for self-sampling over the Pap test, with 95% indicating willingness to follow-up a positive result at the hospital. Age, ethnicity and previous Pap test experience were significant independent factors associated with preference for self-sampling. The older the individual, the less likely they were to prefer self-sampling (adjusted OR 0.94, 95% CI 0.90 to 0.98). The Chinese were less likely to prefer self-sampling (72.6%) than the Malays (85.1%) (adjusted OR 0.57, 95% CI 0.33 to 0.98, p=0.004). Participants who had never undergone a Pap smear were also more likely to prefer self-sampling (88.5%) than women who had undergone a previous Pap (80.9%) (adjusted OR 0.06, 95% CI 0.35 to 0.87). CONCLUSIONS Overall, urban Malaysian women from multiethnic backgrounds found self-sampling to be an acceptable alternative to Pap smear.
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Affiliation(s)
- Mahirah Ma'som
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- National Clinical Research Centre, Ministry of Health, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nazrila Hairizan Nasir
- Selangor State Health Department, Klinik Kesihatan Pandamaran, Ministry of Health, Kuala Lumpur, Malaysia
| | - Jerome Bellinson
- Preventive Oncology International Inc, Cleveland Heights, Ohio and The Women's Health Institute of the Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Yuntong Ma
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Siew-Hwei Yap
- University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Pik-Pin Goh
- National Clinical Research Centre, Ministry of Health, Malaysia
| | - Patti Gravitt
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
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Luo H, Du H, Maurer K, Belinson JL, Wang G, Liu Z, Zhang L, Zhou Y, Wang C, Tang J, Qu X, Wu R. An Evaluation of the Cobas4800 HPV Test on Cervico-Vaginal Specimens in Liquid versus Solid Transport Media. PLoS One 2016; 11:e0148168. [PMID: 26828360 PMCID: PMC4734716 DOI: 10.1371/journal.pone.0148168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/13/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives Determine the ability of the Cobas 4800 assay to detect high-risk human papillomavirus (HrHPV) and high-grade cervical lesions when using cervico-vaginal samples applied to liquid medium and solid media cards compared to a direct cervical sample. Methods Two cervico-vaginal specimens (pseudo self-collected) were obtained from 319 women. One was applied to an iFTA Card (FTA) then the brush placed in liquid-based medium (LSELF); the other was applied to a new solid media: POI card (POI). The clinical performance of Cobas4800 assay using the three aforementioned specimens was compared to direct collected endocervical specimens in liquid media (LDOC). Results The overall agreements of HrHPV detection were 84.2% (LSELF vs. LDOC), 81.0% (FTA vs. LDOC), and 82.3% (POI vs. LDOC). LSELF, FTA and POI identified 98.0%, 79.6%, and 97.5% positive cases of LDOC. Sensitivity to identify CIN2+ were 98.4% (LSELF), 73.8% (FTA), 95.1% (POI), and 93.4% (LDOC) respectively. FTA had 78.1% and 90.4% agreement with the LSELF samples for all HrHPV and HPV16/18 detection respectively, while POI had 91.6% for both. Conclusions Cobas4800 HPV test combined with cervico-vaginal specimens applied to both liquid media and POI solid card are accurate to detect HrHPV infection and high-grade cervical lesions as compared with direct endocervical samples in liquid media.
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Affiliation(s)
- Hongxue Luo
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
| | - Hui Du
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
| | - Kathryn Maurer
- Gynecologic Oncology Division, Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Jerome L. Belinson
- Gynecologic Oncology Division, Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Preventive Oncology International, Cleveland Heights, Ohio, United States of America
| | - Guixiang Wang
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
| | - Zhihong Liu
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
| | - Lijie Zhang
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
| | - Yanqiu Zhou
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
| | - Chun Wang
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
| | - Jinlong Tang
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
| | - Xinfeng Qu
- Preventive Oncology International, Cleveland Heights, Ohio, United States of America
| | - Ruifang Wu
- Department of obstetrics/gynaecology, Peking University Shenzhen Hospital, Shenzhen, PR China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological diseases, Shenzhen, PR China
- * E-mail:
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18
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Wu R, Qu X, Du H, Liu Z, Hu Q, Wang C, Zhang L, Zhao J, Wang G, Belinson JL. A Pilot Study to Evaluate an Internet-Based Cervical Cancer Screening Model Based on Self-Sampling. Health (London) 2016. [DOI: 10.4236/health.2016.87071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Verdoodt F, Jentschke M, Hillemanns P, Racey CS, Snijders PJF, Arbyn M. Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. Eur J Cancer 2015; 51:2375-85. [PMID: 26296294 DOI: 10.1016/j.ejca.2015.07.006] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/17/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Population coverage for cervical cancer screening is an important determinant explaining differences in the incidence of cervical cancer between countries. Offering devices for self-sampling has the potential to increase participation of hard-to-reach women. METHODS A systematic review and meta-analysis were performed to evaluate the participation after an invitation including a self-sampling device (self-sampling arm) versus an invitation to have a sample taken by a health professional (control arm), sent to under-screened women. RESULTS Sixteen randomised studies were found eligible. In an intention-to-treat analysis, the pooled participation in the self-sampling arm was 23.6% (95% confidence interval (CI)=20.2-27.3%), when self-sampling kits were sent by mail to all women, versus 10.3% (95% CI=6.2-15.2%) in the control arm (participation difference: 12.6% [95% CI=9.3-15.9]). When women had to opt-in to receive the self-sampling device, as used in three studies, the pooled participation was not higher in the self-sampling compared to the control arm (participation difference: 0.2% [95% CI=-4.5-4.9%]). CONCLUSION An increased participation was observed in the self-sampling arm compared to the control arm, if self-sampling kits were sent directly to women at their home address. However, the size of the effect varied substantially among studies. Since participation was similar in both arms when women had to opt-in, future studies are warranted to discern opt-in scenarios that are most acceptable to women.
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Affiliation(s)
- F Verdoodt
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| | - M Jentschke
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany
| | - P Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany
| | - C S Racey
- Dalla Lana School of Public Health, University of Toronto, 155 College Street , 6th Floor, Toronto, Ontario M5T3M7, Canada
| | - P J F Snijders
- Department of Pathology, VU University medical center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - M Arbyn
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium.
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Sewali B, Okuyemi KS, Askhir A, Belinson J, Vogel RI, Joseph A, Ghebre RG. Cervical cancer screening with clinic-based Pap test versus home HPV test among Somali immigrant women in Minnesota: a pilot randomized controlled trial. Cancer Med 2015; 4:620-31. [PMID: 25653188 PMCID: PMC4402076 DOI: 10.1002/cam4.429] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/23/2014] [Accepted: 12/01/2014] [Indexed: 12/28/2022] Open
Abstract
Cervical cancer is more common in the Somali immigrant population than the general population in the United States (US). There are low rates of cervical cancer screening among Somali women. This study compares cervical cancer screening test completion rates for a home human papilloma virus (HPV) test and standard clinic Pap test. Sixty-three Somali immigrant women aged 30–70 years who had not undergone cervical cancer screening within the past 3 years were randomly assigned to a home HPV test group (intervention) or a clinic Pap test group (control). Test completion rates were measured at 3 months. Univariate and multivariate logistic regression models were used to explore factors associated with test completion (intention-to-treat analysis). Participants in the HPV test group were 14 times more likely to complete the test compared to those in the Pap test group (P = 0.0002). Women who reported having friends/family members to talk about cancer screening were approximately three times more likely to complete any screening test than those who did not (P = 0.127) and participants who reported residing in the US longer were more likely to complete a screening test (P = 0.011). Future research should explore the potential of using the home-based HPV test kits as an initial approach to cervical cancer screening. Impact: The use of a self-sampling HPV kit has the potential to increase cervical cancer screening in under-served communities in the US.
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Affiliation(s)
- Barrett Sewali
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
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