1
|
Befano B, Wentzensen N, Lorey T, Poitras N, Cheung LC, Schiffman M, Clarke MA, Cohen C, Kinney W, Locke A, Castle PE. Calendar-period trends in cervical precancer and cancer diagnoses since the introduction of human papillomavirus and cytology co-testing into routine cervical cancer screening at Kaiser Permanente Northern California. Gynecol Oncol 2024; 184:89-95. [PMID: 38301311 DOI: 10.1016/j.ygyno.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/10/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES The longer-term impact of introducing human papillomavirus (HPV) testing into routine cervical cancer screening on precancer and cancer rates by histologic type has not been well described. Calendar trends in diagnoses were examined using data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in 2003 for women aged ≥30 years. METHODS We examined trends in cervical precancer (cervical intraepithelial neoplasia grade 3 [CIN3] and adenocarcinoma in situ [AIS]) and cancer (squamous cell carcinoma [SCC] and adenocarcinoma [ADC]) diagnoses per 1000 screened during 2003-2018. We examined ratios of squamous vs. glandular diagnoses (SCC:ADC and CIN3:AIS). RESULTS CIN3 and AIS diagnoses increased approximately 2% and 3% annually, respectively (ptrend < 0.001 for both). While SCC diagnoses decreased by 5% per annually (ptrend < 0.001), ADC diagnoses did not change. These patterns were generally observed within each age group (30-39, 40-49, and 50-64 years). ADC diagnoses per 1000 screened did not change even among those who underwent co-testing starting in 2003-2006. SCC:ADC decreased from approximately 2.5:1 in 2003-2006 to 1.3:1 in 2015-2018 while the CIN3:AIS remained relatively constant, ∼10:1. CONCLUSIONS Since its introduction at KPNC, co-testing increased the detection of CIN3 over time, which likely caused a subsequent reduction of SCC. However, there has been no observed decrease in ADC. One possible explanation for lack of effectiveness against ADC is the underdiagnosis of AIS. Novel strategies to identify and treat women at high risk of ADC need to be developed and clinically validated.
Collapse
Affiliation(s)
- Brian Befano
- Information Management Services, Calverton, MD, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Thomas Lorey
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | - Nancy Poitras
- Kaiser Permanante, The Permanante Medical Group Regional Laboratory, Berkeley, CA, USA
| | - Li C Cheung
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | - Camryn Cohen
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA
| | | | | | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Rockville, MD, USA; Division of Cancer Prevention, U.S. National Cancer Institute, Rockville, MD, USA.
| |
Collapse
|
2
|
Bai H, Liu Y, Gao L, Wang T, Zhang X, Hu J, Ding L, Zhang Y, Wang Q, Wang L, Li J, Zhang Z, Wang Y, Shen C, Ying B, Niu X, Hu W. A portable all-in-one microfluidic device with real-time colorimetric LAMP for HPV16 and HPV18 DNA point-of-care testing. Biosens Bioelectron 2024; 248:115968. [PMID: 38150799 DOI: 10.1016/j.bios.2023.115968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023]
Abstract
Screening for high-risk human papillomavirus (HPV) infection is one of the most important preventative measures for cervical cancer. However, fast, convenient, and low-cost HPV detection remains challenging, especially in resource-limited settings. Here, we report a portable all-in-one device (PAD) for point-of-care testing (POCT) for HPV16 and HPV18 DNA in cervical swabs. The PAD was engineered to integrate modules for extraction-free sample lysis, loop-mediated isothermal amplification (LAMP) with lyophilized reagent beads, and real-time colorimetric signal sensing into a single miniaturized device, considerably shortening the sample-to-result time to 15 min. The precision liquid handling in the completely sealed microfluidic chip is achieved by a uniquely designed pressure-balanced automatic liquid flow mechanism, thereby eliminating the need for manual manipulation of liquids and thus the risk of biohazards. The PAD employs an improved real-time colorimetric LAMP (rcLAMP) assay with a limit of detection (LOD) of 1 copy/μL, enabled by enhanced assay chemistry to maximize the reaction kinetics. To validate this device for clinical application, we tested 206 clinical cervical swab samples and obtained a sensitivity of 92.1% and a specificity of 99.0%. This custom PAD enabled by microfluidic and electronic engineering techniques can be configured for the simultaneous detection of HPV16 and HPV18 or other pathogens in point-of-care applications.
Collapse
Affiliation(s)
- Hao Bai
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China; Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuqing Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Metabolomics and Gynecological Disease Research, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Linbo Gao
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Tao Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Metabolomics and Gynecological Disease Research, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoli Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Metabolomics and Gynecological Disease Research, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Jie Hu
- Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, 610041, China; Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lisha Ding
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Metabolomics and Gynecological Disease Research, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Yueting Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Qian Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Metabolomics and Gynecological Disease Research, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Lei Wang
- One-Chip Biotechnology Co. Ltd, Chengdu, 610041, China
| | - Jianlong Li
- One-Chip Biotechnology Co. Ltd, Chengdu, 610041, China
| | - Zhifeng Zhang
- One-Chip Biotechnology Co. Ltd, Chengdu, 610041, China
| | - Yang Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology, School of Engineering Medicine, Beihang University, Beijing, 100083, China
| | - Chenlan Shen
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Binwu Ying
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China; Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Xiaoyu Niu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Metabolomics and Gynecological Disease Research, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
| | - Wenchuang Hu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China; Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, 610041, China; Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
3
|
Kim JY, Hong J, Yoon J, Park J, Kim TH. Regularity of cervical cancer screening in Korea: analysis using national public data for 12 years. J Gynecol Oncol 2024; 35:e18. [PMID: 37921602 PMCID: PMC10948977 DOI: 10.3802/jgo.2024.35.e18] [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: 05/08/2023] [Revised: 09/04/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To assess the frequency of regular uptake of national cervical cancer screening (CCS) program and identify associated factors among Korean women. METHODS This study is a fundamental investigation that employs openly accessible public data of Korea through secondary data analysis. A cohort of 4,663 women from the 2007-2012 Korean National Health and Nutrition Examination Survey, was followed up for up to 12 years (2007-2018) to obtain the frequency of national CCS. Compliance level with CCS was categorized, and an ordinal logistic regression model was employed to investigate the contributing factors. RESULTS The regular uptake of CCS in South Korea was low at 18.9%. The trend of regular screening showed significant association with various factors, including age (40-59 years), household income (100%-150% bracket), occupation (service workers), place of residence (small to medium sized cities), education level (middle school graduates), marital status (married), and possession of private insurance. Moreover, individuals with a history of non-cervical cancer or carcinoma in situ of the cervix, a family history of cervical cancer, or a higher frequency of general check-ups demonstrated a stronger adherence to regular CCS uptake. CONCLUSION Our findings revealed that regular participation in CCS in Korea was lower than anticipated, with factors such as socioeconomic status, personal history of gynecologic issue, and frequency of general health check-ups playing influential roles. However, further research, including an exploration of unexamined psychological barriers to screening, is necessary to gain a better understanding the reasons behind the reduced rates of regular CCS among Korean women.
Collapse
Affiliation(s)
- Jong-Yeup Kim
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea
| | - Jeeyoung Hong
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea
| | - Juhee Yoon
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Jinsol Park
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Hyun Kim
- Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea.
| |
Collapse
|
4
|
Adhikari A, Kashyap B, Acharya S, Sharma S, Gurung S, Yadav RK, Budhathoki P. Knowledge and practice regarding cancer screening in Nepal: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:382-391. [PMID: 38222683 PMCID: PMC10783334 DOI: 10.1097/ms9.0000000000001529] [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: 09/07/2023] [Accepted: 11/10/2023] [Indexed: 01/16/2024] Open
Abstract
Background Cancer screening utilization can aid in the early diagnosis and treatment of cancer. However, the current scenario of the knowledge and practice regarding cancer screening remains unclear as the authors do not have sufficient studies. Hence, the authors conducted this systematic review and meta-analysis to assess the situation of cancer screening utilization and knowledge. Methods A systematic literature review was conducted to identify all studies on knowledge and practice regarding cancer screening in the Nepalese population. Data extraction and analysis were done with SPSS and CMA-3. Results The authors identified a total of 5238 studies after database searching, and 19 studies were included in a narrative synthesis. Lack of awareness and knowledge was the major barrier in cervical, breast, and testicular cancer screening. In cervical cancer screening, the most common reason for screening was the advice of health personnel in 85% of respondents, and the barrier was lack of awareness in 49.33% of participants. Conclusion The knowledge and practice of cancer screening is lacking in Nepal, as shown by our review. More educational and awareness programs, easy access to screening services, and elimination of sociocultural barriers are necessary to increase the utilization of screening services.
Collapse
|
5
|
Bin C, Zhong H, Mo J, Wang Z, Li M, Wei S. Comparative Efficacy and Safety of Chinese Patent Medicines for Cervical High-risk Human Papillomavirus Infection: A Bayesian Network Meta-analysis. J Cancer 2023; 14:2373-2385. [PMID: 37576405 PMCID: PMC10414044 DOI: 10.7150/jca.86043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Background: Many Chinese patent medicines have been reported to show anti-tumor cell effects on cervical cancer. To estimate the comparative effectiveness and safety of Chinese patent medicines for cervical high-risk human papillomavirus (HR-HPV) infection. Methods: Randomized controlled trials (RCTs) of Chinese patent medicines for HR-HPV infection were searched in eight databases until 31 August 2022, and two review authors independently extracted data and assessed the risk of bias. Outcomes concerning efficacy were evaluated as odds ratio (OR) and 95% credible intervals (CrI) utilizing R 4.1.2 and Stata 16.1. The protocol was registered on the International Prospective Register of Systematic Reviews (CRD42022351120). Results: We ultimately identified 60 RCTs that involved 5,951 participants and 8 interventions. Chinese patent medicines combined with recombinant human interferon (rhIFN) have better treatment effects than rhIFN alone. The results showed that Baofukang suppository (BFK) combined with rhIFN is greater for the rate of HR-HPV clearance follow-up at 6 months (SUCRA = 78.16%). Kushen gel (KS) combined with rhIFN ranked first for the rate of HR-HPV clearance after treatment (SUCRA = 90.77%). Furthermore, KS + rhIFN is most likely to be the best intervention for improving the clinical effectiveness rate (SUCRA = 87.39%). Adverse reactions were not statistically significant in BFK + rhIFN versus BFK, BFK + rhIFN versus rhIFN, and BFK versus rhIFN. Conclusion: The combination of Chinese patent medicines with rhIFN may demonstrate a higher efficacy than rhIFN alone in clearing the virus and improving cervical symptoms. Weighing with the clinical comprehensive efficacy, BFK + rhIFN and KS + rhIFN maybe the optimal treatments for cervical HR-HPV infection. However, more high-quality randomized controlled trials are needed in the future to further confirm the efficacy and safety of proprietary Chinese medicines for cervical HR-HPV infection.
Collapse
Affiliation(s)
- Chengli Bin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hanzhi Zhong
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Mo
- Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhenyi Wang
- Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Maoya Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shaobin Wei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
6
|
Herrera DJ, van de Veerdonk W, Berhe NM, Talboom S, van Loo M, Alejos AR, Ferrari A, Van Hal G. Mixed-Method Systematic Review and Meta-Analysis of Shared Decision-Making Tools for Cancer Screening. Cancers (Basel) 2023; 15:3867. [PMID: 37568683 PMCID: PMC10417450 DOI: 10.3390/cancers15153867] [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: 06/01/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
This review aimed to synthesize evidence on the effectiveness of shared decision-making (SDM) tools for cancer screening and explored the preferences of vulnerable people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analysis revealed that SDM tools were more effective for improving knowledge, reducing decisional conflict, and increasing screening intentions among vulnerable populations compared to non-vulnerable populations. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes measured over a six-month period. Insights from the qualitative findings revealed the complexities of clinicians' and vulnerable populations' preferences for an SDM tool in cancer screening. Vulnerable populations highly preferred SDM tools with relevant information, culturally tailored content, and appropriate communication strategies. Clinicians, on the other hand, highly preferred tools that can be easily integrated into their medical systems for efficient use and can effectively guide their practice for cancer screening while considering patients' values. Considering the complexities of patients' and clinicians' preferences in SDM tool characteristics, fostering collaboration between patients and clinicians during the creation of an SDM tool for cancer screening is essential. This collaboration may ensure effective communication about the specific tool characteristics that best support the needs and preferences of both parties.
Collapse
Affiliation(s)
- Deborah Jael Herrera
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| | - Wessel van de Veerdonk
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Neamin M Berhe
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Société Générale de Surveillance (SGS), 2800 Mechelen, Belgium
| | - Sarah Talboom
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Marlon van Loo
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Andrea Ruiz Alejos
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| | - Allegra Ferrari
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16123 Genoa, Italy
| | - Guido Van Hal
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| |
Collapse
|
7
|
Martinez-Gutierrez J, Chima S, Boyd L, Sherwani A, Drosdowsky A, Karnchanachari N, Luong V, Reece JC, Emery J. Failure to follow up abnormal test results associated with cervical cancer in primary and ambulatory care: a systematic review. BMC Cancer 2023; 23:653. [PMID: 37438686 DOI: 10.1186/s12885-023-11082-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/17/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Cervical cancer is a preventable and treatable form of cancer yet continues to be the fourth most common cancer among women globally. Primary care is the first point of contact most patients have with health services and is where most cancer prevention and early detection occur. Inadequate follow-up of abnormal test results for cervical abnormalities in primary care can lead to suboptimal patient outcomes including higher mortality and decreased quality of life. AIMS To explore the magnitude of and factors associated with, inadequate follow-up of test results for cervical abnormalities in primary and ambulatory care. METHODS MEDLINE, Embase, Cochrane Library and CINAHL were searched for peer-reviewed literature from 2000-2022, excluding case-studies, grey literature, and systematic reviews. Studies were included if they reported on patients aged ≥ 18 years with no previous cancer diagnosis, in a primary care/ambulatory setting. Risk of bias was assessed using the Joanna Briggs Institute Critical appraisal checklists, appropriate to the study design. A segregated methodology was used to perform a narrative synthesis, maintaining the distinction between quantitative and qualitative research. RESULTS We included 27 publications reporting on 26 studies in our review; all were conducted in high-income countries. They included 265,041 participants from a variety of ambulatory settings such as family medicine, primary care, women's services, and colposcopy clinics. Rates of inadequate follow-up ranged from 4 to 75%. Studies reported 41 different factors associated with inadequate follow-up. Personal factors associated with inadequate follow-up included younger age, lower education, and socioeconomic status. Psychological factors were reported by only 3/26 studies and 2/3 found no significant association. System protective factors included the presence of a regular primary care provider and direct notification of abnormal test results. DISCUSSION This review describes inadequate follow-up of abnormal cervical abnormalities in primary care. Prevalence varied and the evidence about causal factors is unclear. Most interventions evaluated were effective in decreasing inadequate follow-up. Examples of effective interventions were appointment reminders via telephone, direct notification of laboratory results, and HPV self-sampling. Even though rates of cervical cancer have decreased over the years, there is a lack of information on factors affecting follow-up in primary care and ambulatory settings, particularly in low and middle-income countries. This information is crucial if we are to achieve WHO's interim targets by 2030, and hope to avert 62 million cervical cancer deaths by 2120. TRIAL REGISTRATION PROSPERO ID CRD42021250136.
Collapse
Affiliation(s)
- Javiera Martinez-Gutierrez
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia.
- Department of Family Medicine. Pontificia, Universidad Católica de Chile, Santiago, Chile.
| | - Sophie Chima
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Lucy Boyd
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
- Melbourne School of Population and Global Health, Centre for Health Policy, The University of Melbourne, Melbourne, Australia
| | - Asma Sherwani
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Allison Drosdowsky
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Vivien Luong
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Jeanette C Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| |
Collapse
|
8
|
Prudden HJ, Achilles SL, Schocken C, Broutet N, Canfell K, Akaba H, Basu P, Bhatla N, Chirenje ZM, Delany-Moretlwe S, Denny L, Gamage DG, Herrero R, Hutubessy R, Villa LL, Murillo R, Schiller JT, Stanley M, Temmerman M, Zhao F, Ogilvie G, Kaslow DC, Dull P, Gottlieb SL. Understanding the public health value and defining preferred product characteristics for therapeutic human papillomavirus (HPV) vaccines: World Health Organization consultations, October 2021-March 2022. Vaccine 2022; 40:5843-5855. [PMID: 36008233 DOI: 10.1016/j.vaccine.2022.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
The World Health Organization (WHO) global strategy to eliminate cervical cancer (CxCa) could result in >62 million lives saved by 2120 if strategy targets are reached and maintained: 90% of adolescent girls receiving prophylactic human papillomavirus (HPV) vaccine, 70% of women receiving twice-lifetime cervical cancer screening, and 90% of cervical pre-cancer lesions and invasive CxCa treated. However, the cost and complexity of CxCa screening and treatment approaches has hampered scale-up, particularly in low- and middle-income countries (LMICs), and new approaches are needed. Therapeutic HPV vaccines (TxV), which could clear persistent high-risk HPV infection and/or cause regression of pre-cancerous lesions, are in early clinical development and might offer one such approach. During October 2021 to March 2022, WHO, in collaboration with the Bill and Melinda Gates Foundation, convened a series of global expert consultations to lay the groundwork for understanding the potential value of TxV in the context of current CxCa prevention efforts and for defining WHO preferred product characteristics (PPCs) for TxV. WHO PPCs describe preferences for vaccine attributes that would help optimize vaccine value and use in meeting the global public health need. This paper reports on the main discussion points and findings from the expert consultations. Experts identified several ways in which TxV might address challenges in current CxCa prevention programmes, but emphasized that the potential value of TxV will depend on their degree of efficacy and how quickly they can be developed and implemented relative to ongoing scale-up of existing interventions. Consultation participants also discussed potential use-cases for TxV, important PPC considerations (e.g., vaccine indications, target populations, and delivery strategies), and critical modelling needs for predicting TxV impact and cost-effectiveness.
Collapse
Affiliation(s)
| | | | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Australia
| | | | - Partha Basu
- International Agency for Research on Cancer, France
| | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Lynette Denny
- University of Cape Town, SA MRC Gynaecology Cancer Research, South Africa
| | | | | | | | | | | | | | | | | | - Fanghui Zhao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Gina Ogilvie
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Canada
| | | | | | | | | |
Collapse
|
9
|
Audiger C, Bovagnet T, Bardes J, Abihsera G, Nicolet J, Deghaye M, Bochaton A, Menvielle G. Social Inequalities in Participation in Cervical Cancer Screening in a Metropolitan Area Implementing a Pilot Organised Screening Programme (Paris Region, France). Int J Public Health 2022; 67:1604562. [PMID: 35859669 PMCID: PMC9289096 DOI: 10.3389/ijph.2022.1604562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: We aimed to examine social inequalities in participation in cervical cancer screening (CCS) in a metropolitan area by implementing a pilot organised screening programme. The pilot programme consisted of sending invitations to women who did not perform a pap smear within the past 3 years, managing interventions to reach vulnerable women, training healthcare professionals, and organising follow-ups of abnormal pap smears. Methods: We studied participation in CCS between January 2014 and December 2016 among 241,257 women aged 25-63 years old. To assess relative inequalities, Odds Ratios were computed using multilevel logistic regression. To assess absolute inequalities, the CCS coverage and the rate difference were calculated. Inequalities were computed by age and neighbourhood characteristics (social deprivation and proportion of single women). Results: Disparities in participation in CCS were observed by age and social deprivation. For overall screening compared to opportunistic screening, disparities by age were larger (OR25-35_vs._55-64 = 2.13 [2.08-2.19] compared to 2.02 [1.96-2.07]), but disparities by social deprivation were decreased (OR10%_most_vs._10%_least_deprived = 2.09 [1.90-2.30] compared to 2.22 [2.02-2.44]). Conclusion: Disparities in CCS participation remain despite the organised programme. To reduce these inequalities, free screening should be proposed and evaluated.
Collapse
Affiliation(s)
- Céline Audiger
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Thomas Bovagnet
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Julia Bardes
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Gaëlle Abihsera
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Jérôme Nicolet
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Michel Deghaye
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Audrey Bochaton
- Université Paris Nanterre, UMR CNRS 7533 LADYSS, Nanterre, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| |
Collapse
|
10
|
Castle PE, Einstein MH, Sahasrabuddhe VV. Cervical cancer prevention and control in women living with human immunodeficiency virus. CA Cancer J Clin 2021; 71:505-526. [PMID: 34499351 PMCID: PMC10054840 DOI: 10.3322/caac.21696] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Despite being highly preventable, cervical cancer is the fourth most common cancer and cause of cancer death in women globally. In low-income countries, cervical cancer is often the leading cause of cancer-related morbidity and mortality. Women living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are at a particularly high risk of cervical cancer because of an impaired immune response to human papillomavirus, the obligate cause of virtually all cervical cancers. Globally, approximately 1 in 20 cervical cancers is attributable to HIV; in sub-Saharan Africa, approximately 1 in 5 cervical cancers is due to HIV. Here, the authors provide a critical appraisal of the evidence to date on the impact of HIV disease on cervical cancer risk, describe key methodologic issues, and frame the key outstanding research questions, especially as they apply to ongoing global efforts for prevention and control of cervical cancer. Expanded efforts to integrate HIV care with cervical cancer prevention and control, and vice versa, could assist the global effort to eliminate cervical cancer as a public health problem.
Collapse
Affiliation(s)
- Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Mark H Einstein
- Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vikrant V Sahasrabuddhe
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| |
Collapse
|
11
|
Castanon A, Sheikh S, Pearmain P, Sasieni P. Impact of changes to cervical screening guidelines on age and interval at which women are tested: Population-based study. J Med Screen 2021; 28:325-332. [PMID: 32862772 PMCID: PMC8366121 DOI: 10.1177/0969141320953446] [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: 06/10/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND English cervical screening programme guidelines changed between 2009 and 2012. We explore the impact on the age and intervals at which women receive a cytology test. METHODS Eligible women were controls from a population-based case-control study in England. Tests taken between 1980 and 2017 were extracted from the call/recall database. Using the Kaplan-Meier estimator by birth cohort and age at (or time since) last test, we explore proportions tested since or prior to a given age, years since previous test, and interval following a negative test. RESULTS Screening histories from 46,037 women were included. Proportion tested by age 26 has increased from 55% among birth cohorts 1978-1979 to 67% among those born 1990-1991, despite more recent cohorts only having received one invitation (instead of two) prior to age 26. The proportion of women tested at aged 28 with a test three years earlier increased by 20% (from 36% in 1997-2006 to 56% in 2012-2017) whereas the proportion tested at ages 23-27 without a prior test increased from 34% to 80%. The age at last test prior to exiting the programme has decreased: among those born 1928-1931 86% had a test aged 60-65, but only 71% of those born 1947-1951. CONCLUSION Clear programme guidance alongside quality assurance has improved the cervical screening programme by standardising the age and intervals at which women are screened.
Collapse
Affiliation(s)
- Alejandra Castanon
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Shama Sheikh
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Philippa Pearmain
- Public Health England Screening, Screening Quality Assurance Service, Birmingham, UK
| | - Peter Sasieni
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| |
Collapse
|
12
|
de Almeida JR, Bratman SV, Hansen AR. Screening for Nasopharyngeal Cancer in High-Risk Populations: A Small Price to Pay for Early Disease Identification? J Natl Cancer Inst 2021; 113:803-804. [PMID: 33351096 PMCID: PMC8491804 DOI: 10.1093/jnci/djaa199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- John R de Almeida
- Department of Otolaryngology Head and Neck Surgery,
Surgical Oncology, Princess Margaret Cancer Center, University of
Toronto, Toronto, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, Princess Margaret
Cancer Center, Toronto, Canada
| | - Aaron R Hansen
- Department of Medical Oncology, Princess Margaret
Cancer Center, Toronto, Canada
| |
Collapse
|
13
|
Miao D, Fader AN. Surgical Clinical Trials in Gynecology: Rare, Challenging but Desperately Needed. J Minim Invasive Gynecol 2020; 28:379-383. [PMID: 33253959 DOI: 10.1016/j.jmig.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Diana Miao
- Department of Gynecology and Obstetrics, Kelly Gynecologic Oncology Service, Johns Hopkins School of Medicine, Baltimore, Maryland (all authors)
| | - Amanda N Fader
- Department of Gynecology and Obstetrics, Kelly Gynecologic Oncology Service, Johns Hopkins School of Medicine, Baltimore, Maryland (all authors)..
| |
Collapse
|
14
|
Response to the letter commenting on 'Effect of organised cervical cancer screening on cervical cancer mortality in Europe: a systematic review'. Eur J Cancer 2020; 138:232-233. [PMID: 32811688 DOI: 10.1016/j.ejca.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/22/2022]
|
15
|
Silva SR, Gaskins JT, Nichols MR, Metzinger DS, Todd SL, Eldredge-Hindy HB. Cervical cancer incidence and mortality rates in Kentucky. Gynecol Oncol 2020; 158:446-451. [DOI: 10.1016/j.ygyno.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
|
16
|
de Kok IMCM, Burger EA, Naber SK, Canfell K, Killen J, Simms K, Kulasingam S, Groene E, Sy S, Kim JJ, van Ballegooijen M. The Impact of Different Screening Model Structures on Cervical Cancer Incidence and Mortality Predictions: The Maximum Clinical Incidence Reduction (MCLIR) Methodology. Med Decis Making 2020; 40:474-482. [PMID: 32486894 PMCID: PMC7322998 DOI: 10.1177/0272989x20924007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. To interpret cervical cancer screening model results, we need to understand the influence of model structure and assumptions on cancer incidence and mortality predictions. Cervical cancer cases and deaths following screening can be attributed to 1) (precancerous or cancerous) disease that occurred after screening, 2) disease that was present but not screen detected, or 3) disease that was screen detected but not successfully treated. We examined the relative contributions of each of these using 4 Cancer Intervention and Surveillance Modeling Network (CISNET) models. Methods. The maximum clinical incidence reduction (MCLIR) method compares changes in the number of clinically detected cervical cancers and mortality among 4 scenarios: 1) no screening, 2) one-time perfect screening at age 45 that detects all existing disease and delivers perfect (i.e., 100% effective) treatment of all screen-detected disease, 3) one-time realistic-sensitivity cytological screening and perfect treatment of all screen-detected disease, and 4) one-time realistic-sensitivity cytological screening and realistic-effectiveness treatment of all screen-detected disease. Results. Predicted incidence reductions ranged from 55% to 74%, and mortality reduction ranged from 56% to 62% within 15 years of follow-up for scenario 4 across models. The proportion of deaths due to disease not detected by screening differed across the models (21%–35%), as did the failure of treatment (8%–16%) and disease occurring after screening (from 1%–6%). Conclusions. The MCLIR approach aids in the interpretation of variability across model results. We showed that the reasons why screening failed to prevent cancers and deaths differed between the models. This likely reflects uncertainty about unobservable model inputs and structures; the impact of this uncertainty on policy conclusions should be examined via comparing findings from different well-calibrated and validated model platforms.
Collapse
Affiliation(s)
- Inge M C M de Kok
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Emily A Burger
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Steffie K Naber
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - James Killen
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Kate Simms
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | | | - Emily Groene
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Stephen Sy
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jane J Kim
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Marjolein van Ballegooijen
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| |
Collapse
|
17
|
Connolly D, Hughes X, Berner A. Barriers and facilitators to cervical cancer screening among transgender men and non-binary people with a cervix: A systematic narrative review. Prev Med 2020; 135:106071. [PMID: 32243938 DOI: 10.1016/j.ypmed.2020.106071] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022]
Abstract
Cervical cancer mortality in the United Kingdom (UK) has decreased over the last decade, largely due to uptake of cervical cancer screening. However, only those with a female gender marker on their health records are invited, creating a significant barrier to gender minorities accessing screening. We undertook a systematic review to synthesise published literature on cervical cancer screening among eligible gender minorities, aiming to identify barriers and facilitators that might inform changes in UK policy and clinical practice. We conducted a broad search across Medline, Embase, PsycInfo and Global Health databases to 3rd January 2020 and included any original, peer-reviewed research, published in the English language that reported on cervical cancer screening among gender minorities assigned female at birth (AFAB). Twenty-seven studies were critically appraised and included in the final synthesis, which identified significant disparities in cervical cancer screening uptake between gender minorities AFAB and cis women. It revealed a lack of knowledge surrounding the relationship between gender minority status and cervical cancer risk among both service users and providers and highlighted significant barriers to access for gender minorities AFAB. Cervical cancer screening was not universally associated with dysphoria among gender minorities AFAB and we recommend that providers explore patients' preferences around screening, while avoiding assumptions. Providers should be proficient in examination techniques that maximise patient autonomy and minimise gender dysphoria or pain. Self-swabs for high-risk HPV may provide a more acceptable, evidence-based, alternative to Pap smears but there remains a need for further UK-specific research, to inform changes in policy.
Collapse
Affiliation(s)
- Dean Connolly
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK; Newham University Hospital, Barts Health NHS Trust, Glen Rd, London E13 8SL, UK.
| | - Xan Hughes
- St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Alison Berner
- Gender Identity Clinic, The Tavistock and Portman NHS Foundation Trust, 179-183 Fulham Palace Road, London W6 8QZ, UK; Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BE, UK
| |
Collapse
|
18
|
Austin RM, Zhao C. What Constitutes Optimal Cervical Screening for Young Women Ages 21 to 29 Years? Am J Clin Pathol 2020; 153:712-714. [PMID: 32221525 DOI: 10.1093/ajcp/aqaa025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Marshall Austin
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Chenquan Zhao
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
19
|
González-Espinoza D, Ponce Camus K, Meneses Pérez I, Molina Cruz C. Cytohistological correlation in patients with atypical glandular cells on Papanicolaou test in a Chilean population. Diagn Cytopathol 2020; 48:852-856. [PMID: 32239660 DOI: 10.1002/dc.24421] [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: 10/30/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/10/2022]
Abstract
The standard screening test for detecting cervical lesions and cancers is a Papanicolaou (Pap) smear. While squamous cell abnormalities remain the most common positive Pap test result, cytologic findings of glandular cell abnormalities have become more frequent in recent decades. The 2014 Bethesda System for reporting cervical cytology includes the classification "atypical glandular cells" (AGC). AGC have morphological abnormalities that fall outside the range of reactive changes, but are insufficient for a diagnosis of invasive adenocarcinoma. In several histologic follow-up studies, most AGC cases were found to represent a benign condition. In the current study, we evaluate the significance of AGC cytology findings by analyzing the histologic follow-up results of a large number of patients with AGC. Most patients with AGC in this study were found to have a significant lesion on follow-up (63.9%), with negative histologic results in only 36.1% of patients. Among patients with significant lesions, the most common result was low-grade squamous intraepithelial lesion (26.6%), followed by high-grade squamous intraepithelial lesion (23.2%). This provides further evidence to support the Chilean Clinical Guidelines for Cervical Cancer, which recommends diagnostic follow-up studies in all women with AGC to minimize the chance of undetected serious cervical disease.
Collapse
Affiliation(s)
| | - Katherine Ponce Camus
- Preventive Oncology Center, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ives Meneses Pérez
- Preventive Oncology Center, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carla Molina Cruz
- Preventive Oncology Center, Faculty of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
20
|
Rebolj M, Parmar D, Maroni R, Blyuss O, Duffy SW. Concurrent participation in screening for cervical, breast, and bowel cancer in England. J Med Screen 2020; 27:9-17. [PMID: 31525303 DOI: 10.1177/0969141319871977] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Objectives To determine how many women participate in all three recommended cancer screening programmes (breast, cervical, and bowel). During their early 60s, English women receive an invitation from all the three programmes. Methods For 3060 women aged 60–65 included in an England-wide breast screening case–control study, we investigated the number of screening programmes they participated in during the last invitation round. Additionally, using the Fingertips database curated by Public Health England, we explored area-level correlations between participation in the three cancer screening programmes and various population characteristics for all 7014 English general practices with complete data. Results Of the 3060 women, 1086 (35%) participated in all three programmes, 1142 (37%) in two, 526 (17%) in one, and 306 (10%) in none. Participation in all three did not appear to be a random event (p < 0.001). General practices from areas with less deprivation, with more patients who are carers or have chronic illnesses themselves, and with more patients satisfied with the provided service were significantly more likely to attain high coverage rates in all programmes. Conclusions Only a minority of English women is concurrently protected through all recommended cancer screening programmes. Future studies should consider why most women participate in some but not all recommended screening.
Collapse
Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Oleg Blyuss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Paediatrics, Sechenov University, Moscow, Russia
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
21
|
Han M, Li J, Austin M, Varma KR, Zhang H, Zhao C. Human Papillomavirus (HPV) 16 and 18/45 Genotyping-Directed Follow-up of Women With Messenger RNA HPV-Positive, Cytology-Negative Cervical Screening Test Results. Am J Clin Pathol 2020; 153:243-250. [PMID: 31603212 DOI: 10.1093/ajcp/aqz156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES In this study, we sought to correlate genotype test results for human papillomavirus (HPV) types 16, 18, and 45 with histopathologic follow-up diagnoses in patients with messenger RNA (mRNA) high-risk HPV-positive, cytology-negative results. METHODS We identified 1,157 patients with mRNA HPV-positive, cytology-negative cervical screening test results between June 2015 and June 2018. Reflex HPV 16/18/45 genotype results were documented in 1,018 women aged 30 years or older, 318 of whom had follow-up within 18 months. RESULTS Histopathologic findings of cervical intraepithelial neoplasia 2 or worse (CIN2+) were diagnosed in 14 of 122 (11.5%) patients positive for HPV 16/18/45 vs in seven of 196 (3.6%) HPV 16/18/45-negative patients. Three patients with high-risk HPV-positive, cytology-negative cervical screening test results were diagnosed with stage I cervical adenocarcinomas following early colposcopic referral and biopsy after HPV 16/18/45-positive genotype results. CONCLUSIONS Immediate reflex HPV 16/18/45 genotyping of mRNA HPV-positive, cytology-negative patients led to early colposcopic referral and histopathologic diagnoses of three difficult-to-detect, low-stage, cervical adenocarcinomas and significantly increased overall early detection of CIN2+ lesions.
Collapse
Affiliation(s)
- Min Han
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Marshall Austin
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kavita R Varma
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Huina Zhang
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
22
|
Wiley DJ, Hsu HK, Ganser MA, Brook J, Elashoff DA, Moran MG, Young SA, Joste NE, Mitsuyasu R, Darragh TM, Morris DH, Martínez-Maza OM, Detels R, Rao JY, Bolan RK, Shigeno ET, Rodriguez E. Comparison of nylon-flocked swab and Dacron swab cytology for anal HSIL detection in transgender women and gay, bisexual, and other men who have sex with men. Cancer Cytopathol 2019; 127:247-257. [PMID: 30913381 PMCID: PMC7108036 DOI: 10.1002/cncy.22114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/22/2019] [Accepted: 02/04/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND An anal histological high-grade squamous intraepithelial lesion (hHSIL) is an anal cancer precursor. Experts recommend Dacron swab anal cytology as a primary screen for anal hHSILs, especially among human immunodeficiency virus-infected and -uninfected men who have sex with men (MSM). Studies have shown that Dacron cytology inaccurately predicts anal hHSILs and results in unnecessary diagnostic procedures. Nylon-flocked (NF) swabs have been shown to trap pathogens and cells well. Thus, this study compared test characteristics of anal cytology using NF and Dacron swab collection protocols to predict anal hHSILs. METHODS A single-visit, randomized clinical trial compared NF and Dacron swab anal cytology specimens to predict high-resolution anoscopy and biopsy-diagnosed anal hHSILs. Data for 326 gay men, bisexual men, other MSM, and male-to-female transgender women contributed descriptive and tabular statistics with which unadjusted and fully adjusted logistic regression models were constructed. The models estimated the odds of hHSILs, test accuracy (area under the curve [AUC]) and sensitivity, and specificity as well as the positive and negative predictive values of abnormal NF and Dacron cytology for predicting hHSILs. RESULTS In the fully adjusted model, the sensitivities for NF and Dacron cytology were nearly equal (48% vs 47%), but the specificity was higher with NF cytology (76% vs 69%). Comparisons of the areas under receiver operating characteristic curves showed that NF cytology alone predicted hHSILs better than the covariate model (AUC, 0.69 vs 0.63; P = .02), but NF and Dacron cytology comparisons showed no statistically significant differences (AUC, 0.69 vs 0.67; P = .3). CONCLUSIONS NF cytology and Dacron cytology provide modest sensitivity, but NF cytology has higher specificity and accuracy, and this is important for lowering the costs of population-based screening.
Collapse
Affiliation(s)
- Dorothy J Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, California
| | - Hilary K Hsu
- School of Nursing, University of California Los Angeles, Los Angeles, California
| | - Martha A Ganser
- School of Nursing, University of California Los Angeles, Los Angeles, California
| | - Jenny Brook
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - David A Elashoff
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Matthew G Moran
- School of Nursing, University of California Los Angeles, Los Angeles, California
- Desert AIDS Project, Palm Springs, California
| | - Stephen A Young
- Tricore Reference Laboratories, University of New Mexico, Albuquerque, New Mexico
| | - Nancy E Joste
- Tricore Reference Laboratories, University of New Mexico, Albuquerque, New Mexico
| | - Ronald Mitsuyasu
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Teresa M Darragh
- Department of Pathology, University of California San Francisco, San Francisco, California
| | | | - Otoniel M Martínez-Maza
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Jonathan and Karen Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Roger Detels
- Jonathan and Karen Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Jian Yu Rao
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Eric T Shigeno
- School of Nursing, University of California Los Angeles, Los Angeles, California
| | - Ernesto Rodriguez
- School of Nursing, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
23
|
Polman NJ, Veldhuijzen NJ, Heideman DAM, Snijders PJF, Meijer CJLM, Berkhof J. Management of HPV-positive women in cervical screening using results from two consecutive screening rounds. Int J Cancer 2019; 144:2339-2346. [PMID: 30565673 DOI: 10.1002/ijc.32004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/21/2018] [Accepted: 10/31/2018] [Indexed: 11/11/2022]
Abstract
We studied whether triage of human papillomavirus (HPV)-positive women participating in an HPV-based screening programme can be improved by including the HPV result at the previous screen in the triage algorithm. We analyzed data of a subgroup of 366 women from the POBASCAM trial, screened by cytology and HPV cotesting. Women were included if they tested HPV-positive in the second HPV-based screening round. We evaluated the clinical performance of 16 strategies, consisting of cytology, HPV genotyping, and/or previous screen HPV result. The clinical endpoint was cervical precancer or cancer (CIN3+). The current Dutch triage testing policy for HPV-positive women is to refer women for colposcopy if they have abnormal cytology at baseline or after 6-18 months. In the second HPV-based screening round, this strategy yielded a negative predictive value (NPV) of 95.8% (95% confidence interval: 91.9-98.2) and colposcopy referral rate of 37.6% (32.3-43.2%). Replacing repeat cytology by the previous screen HPV result yielded a similar NPV (96.9%, 93.3-98.9) and colposcopy referral rate (38.8%, 33.4-44.4). A higher NPV (99.2%, 96.3-100%) at the cost of a higher colposcopy referral rate (49.2%, 43.6-54.8) was achieved when cytology was combined with HPV16/18 genotyping. The other 13 triage strategies yielded a lower NPV, a higher colposcopy referral rate or performed similarly but required additional testing. HPV-positive women in the second HPV-based screening round can be suitably managed by cytology, HPV16/18 genotyping and the HPV result at the previous screen, obviating the need for repeat testing of HPV-positive, cytology negative women.
Collapse
Affiliation(s)
- Nicole J Polman
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nienke J Veldhuijzen
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle A M Heideman
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter J F Snijders
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris J L M Meijer
- Cancer Center Amsterdam, Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Excess Cost of Cervical Cancer Screening Beyond Recommended Screening Ages or After Hysterectomy in a Single Institution. J Low Genit Tract Dis 2018; 22:184-188. [PMID: 29733302 DOI: 10.1097/lgt.0000000000000400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the excess cost of guideline nonadherent cervical cancer screening in women beyond the recommended screening ages or posthysterectomy in a single healthcare system. MATERIALS AND METHODS All Pap tests performed between September 1, 2012, and August 31, 2014, in women younger than 21 years, older than 65 years, or after hysterectomy, were coded as guideline adherent or nonadherent per the 2012 America Society of Colposcopy and Clinical Pathology guidelines. We assumed management of abnormal results per the 2013 America Society of Colposcopy and Clinical Pathology management guidelines. Costs were obtained from a literature review and Center for Medicare and Medicaid Services data and applied to nonadherent screening and subsequent diagnostic tests. RESULTS During this period, 1,398 guideline nonadherent Pap tests were performed (257 in women <21 years, 536 in women >65 years, and 605 after hysterectomy), with 88 abnormal results: 35 (13.5%) in women younger than 21 years, 14 (2.6%) in women older than 65 years, and 39 (6.5%) in women after hysterectomy. The excess cost for initial screening, diagnostic tests, and follow-up was US $35,337 for 2 years in women younger than 21 years, US $54,378 for 5 years in women older than 65 years, and US $77,340 for 5 years in women after hysterectomy, resulting in a total excess cost of US $166,100 for 5 years. Of the 1,398 women who underwent guideline nonadherent screening, there were only 2 (0.1%) diagnoses of high-grade dysplasia (VaIN3). CONCLUSIONS Guideline nonadherent cervical cancer screening in women beyond the recommended screening ages and posthysterectomy resulted in costs exceeding US $160,000 for screening, diagnostic tests, and follow-up with minimal improvement in detection of high-grade dysplasia.
Collapse
|
25
|
Cervical cancer screening and subsequent procedures in women under the age of 25 years between 2007 and 2013 in France: a nationwide French healthcare database study. Eur J Cancer Prev 2018; 27:479-485. [DOI: 10.1097/cej.0000000000000360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
26
|
Cobo-Cuenca AI, Rodríguez-Borrego MA, Hidalgo-Lópezosa P, Rodríguez-Muñoz PM, Martins M, Carmona-Torres JM. Prevalence and determinants in cytology testing for cervical cancer screening in Spain (2006-14). Eur J Public Health 2018; 28:410-415. [PMID: 29444273 DOI: 10.1093/eurpub/cky015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Cervical cancer has decreased in developed countries thanks to cytology screening programmes. The aims of this study were To analyse the frequency and evolution of performing cytology tests and to determine the variables that influence their use. Methods Cross-sectional study of non-institutionalized women who participated in the national health survey (2006, 2011/12) and the European Health Survey in Spain (2009, 2014). Study variables: cytology-testing, time since last cytology-test, reason for performing the test, age, nationality, marital status, social status, education level and place of residence. Results The study evaluated 53 628 women in Spain over 15 years old, with a mean age of 52.68 (SD ± 19.12). About 94.1% were Spanish, 49.2% were married and 77.2% lived with a partner. In 2014, 72% had a cytology test, a number that increased significantly. Women aged 25-65 were 5.13 times more likely to undergo a cytology test than those aged 15-24 years old (odds ratio (OR): 5.13; P < 0.001); women with university educations were 9.23 times more likely to undergo a cytology test than those without university educations (P > 0.001); those of social classes I and II (high) were 1.2 more likely to undergo a cytology test than those of low social class (P = 0.026); and Spanish women were 1.74 times more likely to undergo a cytology test than foreigners living in Spain (P < 0.001). Conclusion Frequency of cytology testing has increased in the last few years. Screening for cervical cancer is associated with higher social status, education level, age, and not being foreign.
Collapse
Affiliation(s)
- Ana I Cobo-Cuenca
- E.U. de Enfermería y Fisioterapia de Toledo, Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba, Spain
| | - María-Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba, Spain.,Facultad de Medicina y Enfermería, Departamento de Enfermería, Universidad de Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Spain
| | - Pedro Hidalgo-Lópezosa
- Instituto Maimónides de Investigación Biomédica de Córdoba, Spain.,Facultad de Medicina y Enfermería, Departamento de Enfermería, Universidad de Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Spain
| | - Pedro M Rodríguez-Muñoz
- Instituto Maimónides de Investigación Biomédica de Córdoba, Spain.,Facultad de Medicina y Enfermería, Departamento de Enfermería, Universidad de Córdoba, Spain.,Hospital Universitario Reina Sofía de Córdoba, Spain
| | | | - Juan M Carmona-Torres
- E.U. de Enfermería y Fisioterapia de Toledo, Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba, Spain
| |
Collapse
|
27
|
de Vries E, Arroyave I, Pardo C. Re-emergence of educational inequalities in cervical cancer mortality, Colombia 1998–2015. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
28
|
Primary Health Care and Cervical Cancer Mortality Rates in Brazil: A Longitudinal Ecological Study. J Ambul Care Manage 2018; 40 Suppl 2 Supplement, The Brazilian National Program for Improving Primary Care Access and Quality (PMAQ):S24-S34. [PMID: 28252500 PMCID: PMC5338880 DOI: 10.1097/jac.0000000000000185] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has contributed to reducing cervical cancer mortality rates in Brazil; however, the full potential of preventive care has yet to be realized.
Collapse
|
29
|
Abstract
In the absence of organized cervical cancer screening (CCS) programs, gynecologists remain principal actors in obtaining a Pap smear, followed by general practitioners (GPs). In France, with the growing scarcity of gynecologists and social inequalities in access to opportunistic screening, GPs are valuable resources for women's gynecologic follow-up. We aimed to investigate the characteristics of GPs who do not perform CCS, analyzing the effect of GPs' sex and their evolution over time. On the basis of data from three cross-sectional surveys conducted among representative samples of French GPs in 1998, 2002, and 2009 (n=5199), we constructed univariate and multivariate logistic mixed models (level 2: county, level 1: GP) with random intercept stratified on GPs' sex to investigate the characteristics of the GPs associated with no practice of CCS ever. Almost one-third of all GPs did not perform CCS ever and it increased with time. Male GPs were always more likely not to perform it (odds ratio=0.50, 95% confidence interval=0.42-0.59). The percentage of GPs not performing CCS increased more markedly among male than among female GPs, and increased more among the youngest age group. Increasingly fewer GPs engage in CCS when the growing scarcity of medical gynecologists calls for more participation. Female GPs remain significantly more active in CCS than male GPs. The participation in CCS is determined differently according to the practitioner's sex.
Collapse
|
30
|
Effect of Cervical Cancer Screening Programs on Preterm Birth: A Decision and Cost-Effectiveness Analysis. Obstet Gynecol 2017; 130:1207-1217. [PMID: 29112652 DOI: 10.1097/aog.0000000000002366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effect of age at initiation and interval of cervical cancer screening in women of reproductive age on the risk of future preterm birth and subsequent adverse neonatal outcome relative to maternal life-years gained and cost of both screening and preterm birth. METHODS In this decision and cost-effectiveness analysis, we compared eight cytology-based screening programs varying in age of onset (21, 24, 25, 27, or 30 years) and screening interval (3 or 5 years) in a fictive cohort of 100,000 women. We used the microsimulation screening analysis model to estimate number of cervical intraepithelial neoplasia diagnoses, large loop excisions of the transformation zone (LLETZs), life-years gained, cervical cancer cases, deaths, and costs of screening and treatment. We used the number of LLETZs to calculate additional preterm births, subsequent neonatal morbidity, mortality, and associated costs. RESULTS The number of LLETZs per 100,000 women varied from 9,612 for the most intensive screening (every 3 years from age 21 years) to 4,646 for the least intensive screening (every 5 years from age 30 years). Compared with the least intensive program, the most intensive program increased maternal life-years gained by 9% (10,728 compared with 9,839), decreased cervical cancer cases by 67% (52 compared with 158), and cervical cancer deaths by 75% (four compared with 16) at the expense of 250% (158 compared with 45) more preterm births and 320% (four compared with one) more neonatal deaths while increasing total costs by $55 million ($77 compared with $23 million). The number of maternal life-years gained per additional preterm birth varied from 68 to 258 with subsequent total costs per maternal life-years gained of $7,212 and $2,329. CONCLUSION Cervical cancer screening every 3 years and subsequent treatment in women aged younger than 30 years yield limited life-years but may have substantial perinatal adverse effects. Consequently, women who plan to have children may benefit from a more cautious screening approach, taking into account their risk for both cancer and preterm birth.
Collapse
|
31
|
Habbema D, Weinmann S, Arbyn M, Kamineni A, Williams AE, M C M de Kok I, van Kemenade F, Field TS, van Rosmalen J, Brown ML. Harms of cervical cancer screening in the United States and the Netherlands. Int J Cancer 2017; 140:1215-1222. [PMID: 27864938 PMCID: PMC5423652 DOI: 10.1002/ijc.30524] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/09/2016] [Accepted: 11/03/2016] [Indexed: 11/06/2022]
Abstract
We studied harms related to cervical cancer screening and management of screen-positive women in the United States (US) and the Netherlands. We utilized data from four US integrated health care systems (SEARCH), the US National Health Interview Survey, New Mexico state, the Netherlands national histopathology registry, and included studies on adverse health effects of cervical screening. We compared the number of Papanicolaou (Pap) smear tests, abnormal test results, punch biopsies, treatments, health problems (anxiety, pain, bleeding and discharge) and preterm births associated with excisional treatments. Results were age-standardized to the 2007 US population. Based on SEARCH, an estimated 36 million Pap tests were performed in 2007 for 91 million US women aged 21-65 years, leading to 2.3 million abnormal Pap tests, 1.5 million punch biopsies, 0.3 million treatments for precancerous lesions, 5 thousand preterm births and over 8 million health problems. Under the Netherlands screening practice, fewer Pap tests (58%), abnormal test results (64%), punch biopsies (75%), treatment procedures (40%), preterm births (60%) and health problems (63%) would have occurred. The SEARCH data did not differ much from other US data for 2007 or from more recent data up to 2013. Thus compared to the less intensive screening practice in the Netherlands, US practice of cervical cancer screening may have resulted in two- to threefold higher harms, while the effects on cervical cancer incidence and mortality are similar. The results are also of high relevance in making recommendations for HPV screening. Systematic collection of harms data is needed for monitoring and for better incorporation of harms in making screening recommendations.
Collapse
Affiliation(s)
- Dik Habbema
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam
| | - Sheila Weinmann
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Brussels
| | | | - Andrew E Williams
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam
| | | | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam
| | | |
Collapse
|
32
|
Constantinou P, Sicsic J, Franc C. Effect of pay-for-performance on cervical cancer screening participation in France. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2016; 17:10.1007/s10754-016-9207-3. [PMID: 28005224 DOI: 10.1007/s10754-016-9207-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/04/2016] [Indexed: 06/06/2023]
Abstract
Pay-for-performance (P4P) has been increasingly used across different healthcare settings to incentivize the provision of targeted services. In this study, we investigated the effect of a nationwide P4P scheme for general practitioners implemented in 2012 in France, on cervical cancer screening practices. Using data from a nationally representative permanent sample of health insurance beneficiaries, we analyzed smear test use of eligible women for the years 2006-2014. Our longitudinal sample was an unbalanced panel comprising 180,167 women eligible from 1 to 9 years each. We took into account that during our study period some women were exposed to another incentive for screening participation: the implementation in 2010 of organized screening (OS) in a limited number of areas. To evaluate the effect of P4P, we defined three different measures of smear utilization. For each measure, we specified binary panel-data models to estimate annual probabilities and to compare each estimate to the 2011 baseline level. To explore the combined effect of P4P and OS in areas exposed to both incentives, we computed interaction terms between year dummies and area of residence. We found that P4P had a modest positive effect on recommended screening participation. This effect is likely to be transient as annual smear use, both for the whole sample and among women overdue for screening, increased only in 2013 and decreased again in 2014. The combined effect of P4P and OS on screening participation was not cumulative during the first years of coexistence.
Collapse
Affiliation(s)
- Panayotis Constantinou
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France.
| | - Jonathan Sicsic
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France
| | - Carine Franc
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France
| |
Collapse
|
33
|
Benard VB, Greek A, Roland KB, Hawkins NA, Lin L, Saraiya M. Change in Provider Beliefs Regarding Cervical Cancer Screening Intervals After an Educational Intervention. J Womens Health (Larchmt) 2016; 25:422-7. [DOI: 10.1089/jwh.2015.5706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vicki B. Benard
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - April Greek
- Division of Health and Analytics, Battelle, Seattle, Washington
| | - Katherine B. Roland
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nikki A. Hawkins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lavinia Lin
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
34
|
Naber SK, de Kok IMCM, Matthijsse SM, van Ballegooijen M. The potential harms of primary human papillomavirus screening in over-screened women: a microsimulation study. Cancer Causes Control 2016; 27:569-81. [PMID: 26970740 PMCID: PMC4796367 DOI: 10.1007/s10552-016-0732-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is well acknowledged that HPV testing should not be performed at young age and at short intervals. Cytological screening practices have shown that over-screening, i.e., from a younger age and at shorter intervals than recommended, is hard to avoid. We quantified the consequences of a switch to primary HPV screening for over-screened women, taking into account its higher sensitivity but lower specificity than cytology. METHODS The health effects of using the HPV test instead of cytology as the primary screening method were determined with the MISCAN-Cervix model. We varied the age women start screening and the interval between screens. In the sensitivity analyses, we varied the background risk of cervical cancer, the HPV prevalence, the discount rate, the triage strategy after cytology, and the test characteristics of both cytology and the HPV test. RESULTS For women screened 5 yearly from age 30, 32 extra deaths per 100,000 simulated women were prevented when switching from primary cytology to primary HPV testing. For annual screening from age 20, such a switch resulted in 6 extra deaths prevented. It was associated with 9,044 more positive primary screens in the former scenario versus 76,480 in the latter. Under all conditions, for women screened annually, switching to HPV screening resulted in a net loss of quality-adjusted life years. CONCLUSION For over-screened women, the harms associated with a lower test specificity outweigh the life years gained when switching from primary cytology to primary HPV testing. The extent of over-screening should be considered when deciding on inclusion of primary HPV screening in cervical cancer screening guidelines.
Collapse
Affiliation(s)
- Steffie K Naber
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Inge M C M de Kok
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | |
Collapse
|
35
|
Popadiuk C, Gauvreau CL, Bhavsar M, Nadeau C, Asakawa K, Flanagan WM, Wolfson MC, Coldman AJ, Memon S, Fitzgerald N, Lacombe J, Miller AB. Using the Cancer Risk Management Model to evaluate the health and economic impacts of cytology compared with human papillomavirus DNA testing for primary cervical cancer screening in Canada. ACTA ACUST UNITED AC 2016; 23:S56-63. [PMID: 26985148 DOI: 10.3747/co.23.2991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Canada, discussion about changing from cytology to human papillomavirus (hpv) dna testing for primary screening in cervical cancer is ongoing. However, the Canadian Task Force on Preventive Health Care has not yet made a recommendation, concluding that the evidence is insufficient. METHODS We used the cervical cancer and hpv transmission models of the Cancer Risk Management Model to study the health and economic outcomes of primary cytology compared with hpv dna testing in 14 screening scenarios with varying screening modalities and intervals. Projected cervical cancer cases, deaths, colposcopies, screens, costs, and incremental cost-effectiveness were evaluated. We performed sensitivity analyses for hpv dna test costs. RESULTS Compared with triennial cytology from age 25, 5-yearly hpv dna screening alone from age 30 resulted in equivalent incident cases and deaths, but 55% (82,000) fewer colposcopies and 43% (1,195,000) fewer screens. At hpv dna screening intervals of 3 years, whether alone or in an age-based sequence with cytology, screening costs are greater, but at intervals of more than 5 years, they are lower. Scenarios on the cost-effectiveness frontier were hpv dna testing alone every 10, 7.5, 5, or 3 years, and triennial cytology starting at age 21 or 25 when combined with hpv dna testing every 3 years. CONCLUSIONS Changing from cytology to hpv dna testing as the primary screening test for cervical cancer would be an acceptable strategy in Canada with respect to incidence, mortality, screening and diagnostic test volumes.
Collapse
Affiliation(s)
- C Popadiuk
- Department of Women's Health, Memorial University, St. John's, NL
| | - C L Gauvreau
- Canadian Partnership Against Cancer, Toronto, ON
| | - M Bhavsar
- Canadian Partnership Against Cancer, Toronto, ON
| | | | | | | | | | - A J Coldman
- Canadian Partnership Against Cancer, Toronto, ON
| | - S Memon
- Canadian Partnership Against Cancer, Toronto, ON
| | - N Fitzgerald
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Lacombe
- Canadian Partnership Against Cancer, Toronto, ON
| | - A B Miller
- Dalla Lana School of Public Health, Toronto, ON
| |
Collapse
|
36
|
Bosch FX, Robles C, Díaz M, Arbyn M, Baussano I, Clavel C, Ronco G, Dillner J, Lehtinen M, Petry KU, Poljak M, Kjaer SK, Meijer CJLM, Garland SM, Salmerón J, Castellsagué X, Bruni L, de Sanjosé S, Cuzick J. HPV-FASTER: broadening the scope for prevention of HPV-related cancer. Nat Rev Clin Oncol 2016; 13:119-32. [PMID: 26323382 DOI: 10.1038/nrclinonc.2015.146] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human papillomavirus (HPV)-related screening technologies and HPV vaccination offer enormous potential for cancer prevention, notably prevention of cervical cancer. The effectiveness of these approaches is, however, suboptimal owing to limited implementation of screening programmes and restricted indications for HPV vaccination. Trials of HPV vaccination in women aged up to 55 years have shown almost 90% protection from cervical precancer caused by HPV16/18 among HPV16/18-DNA-negative women. We propose extending routine vaccination programmes to women of up to 30 years of age (and to the 45-50-year age groups in some settings), paired with at least one HPV-screening test at age 30 years or older. Expanding the indications for HPV vaccination and much greater use of HPV testing in screening programmes has the potential to accelerate the decline in cervical cancer incidence. Such a combined protocol would represent an attractive approach for many health-care systems, in particular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged >30 years and the optimal number of HPV-screening tests required in vaccinated women remain important research issues. Cost-effectiveness models will help determine the optimal combination of HPV vaccination and screening in public health programmes, and to estimate the effects of such approaches in different populations.
Collapse
Affiliation(s)
- F Xavier Bosch
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Claudia Robles
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Mireia Díaz
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | | | - Christine Clavel
- Centre Hospitalier Universitaire (CHU) Reims, Université de Reims Champagne-Ardenne and Institut National de la Santé et de la Recherche Médicale UMR-S 903, Reims, France
| | - Guglielmo Ronco
- Unit of Cancer Epidemiology, Centre for Cancer Prevention (CPO), Torino, Italy
| | - Joakim Dillner
- Departments of Laboratory Medicine, Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matti Lehtinen
- University of Tampere, School of Health Sciences, Tampere, Finland
| | - Karl-Ulrich Petry
- Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Susanne K Kjaer
- Virus, Lifestyle &Genes, Danish Cancer Society Research Centre; and Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Centre (VUmc), Amsterdam, Netherlands
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital; Murdoch Childrens Research Institute; and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Xavier Castellsagué
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Silvia de Sanjosé
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| |
Collapse
|
37
|
MacLaughlin KL, Faubion SS, Long ME, Pruthi S, Casey PM. Should the annual pelvic examination go the way of annual cervical cytology? ACTA ACUST UNITED AC 2015; 10:373-84. [PMID: 25259899 DOI: 10.2217/whe.14.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The value of pelvic examination for healthy asymptomatic women has been called into question given the lack of benefit for ovarian and endometrial cancer screening, the ability to screen for sexually transmitted infections without a pelvic examination, and the uncoupling of the procurement of contraception with a pelvic examination. Still, there are indications for performing pelvic examinations in symptomatic women and in some high risk women. How do we as clinicians apply current evidence and expert opinion to our medical practice? Our recommendation to consider a pelvic examination at 3-5-year intervals with cervical cancer screening to elicit gynecologic and sexual health concerns offers a compromise between continuation of unnecessary annual pelvic examinations and complete elimination of these examinations.
Collapse
Affiliation(s)
- Kathy L MacLaughlin
- Department of Family Medicine, 200 First Street SW, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
38
|
Abstract
Cancer screening has long been an important component of the struggle to reduce the burden of morbidity and mortality from cancer. Notwithstanding this history, many aspects of cancer screening remain poorly understood. This article presents a summary of basic principles of cancer screening that are relevant for researchers, clinicians, and public health officials alike.
Collapse
Affiliation(s)
- Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Room 5E108, Bethesda, MD 20910, USA.
| |
Collapse
|
39
|
Vaccines against human papillomavirus in low and middle income countries: a review of safety, immunogenicity and efficacy. Infect Agent Cancer 2015; 10:17. [PMID: 26075018 PMCID: PMC4465311 DOI: 10.1186/s13027-015-0012-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/21/2015] [Indexed: 12/13/2022] Open
Abstract
Currently, there is limited data on the immunogenicity and efficacy of human papillomavirus vaccines in Low and Middle income countries (LMIC). The review aims to summarize the current status from published HPV vaccine safety, immunogenicity and efficacy studies in low and middle income countries (LMIC). Electronic databases (PubMed/MEDLINE and HINARI) were searched for peer reviewed English language articles on HPV vaccination in LMIC that have so far been published from 1st January 2006 up to 30th January 2015. Eligible studies were included if they had used the bivalent (bHPV) or quadrivalent HPV (qHPV) vaccines in a LMIC and investigated safety, immunogenicity and/or efficacy. The main findings were extracted and summarized. A total of fourteen HPV vaccine studies assessing safety, Immunogenicity and efficacy of the bivalent or quadrivalent vaccines in LMIC were included. There are only ten published clinical trials where a LMIC has participated. There was no published study so far that assessed efficacy of the HPV vaccines in Sub-Saharan Africa. From these studies, vaccine induced immune response was comparable to that from results of HICs for all age groups. Studies assessing HPV vaccine efficacy of the bivalent or quadrivalent vaccine within LMIC were largely missing. Only three studies were found where a LMIC was part of a multi center clinical trial. In all the studies, there were no vaccine related serious adverse events. The findings from the only study that investigated less than three doses of the bivalent HPV-16/18 vaccine suggest that even with less than three doses, antibody levels were still comparable with older women where efficacy has been proven. The few studies from LMIC in this review had comparable safety, Immunogenicity and efficacy profiles like in HIC. Overall, the LMIC of Africa where immune compromising/modulating situations are prevalent, there is need for long term immunogenicity as well as surveillance studies for long term clinical effectiveness after two and three dose regimens.
Collapse
|
40
|
Hills RL, Kulbok PA, Clark M. Evaluating a Quality Improvement Program for Cervical Cancer Screening at an Urban Safety Net Clinic. Health Promot Pract 2015; 16:631-41. [DOI: 10.1177/1524839915587269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article evaluates a quality improvement program for improving guideline-consistent cervical cancer screening practices in an urban safety net clinic. Quality improvement initiatives that combine policy with practice are particularly timely in light of the alignment of cervical cancer screening guidelines released in 2012 by the most influential national organizations. A descriptive comparison design was employed using the Healthy People 2020 target of 93% screened according to guidelines. Provider-, patient-, and workflow-based strategies included (1) addition of a clinical decision support system, (2) provider educational outreach, (3) patient reminder letters, and (4) development of a clinic procedure manual. Through the application of an established quality measurement tool, three quality indicators were measured: screened according to evidence-based guidelines, not screened, and screened more frequently than recommended. Data from the sample (N = 1,032) were collected at baseline and 12 months postimplementation. Each quality indicator category was significant at follow-up. Patients screened according to guidelines nearly doubled while the number of underscreened patients was reduced by nearly half. Similarly, there was a threefold decrease in patients screened more frequently than recommended. Clinical administrators, quality improvement specialists, and health care providers in primary care settings can use the strategies implemented in this study as a starting point for continuous quality improvement initiatives for cervical cancer screening.
Collapse
Affiliation(s)
- Robin L. Hills
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Pamela A. Kulbok
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Myra Clark
- University of Virginia School of Nursing, Charlottesville, VA, USA
| |
Collapse
|
41
|
Thomas CC, Richards TB, Plescia M, Wong FL, Ballard R, Levin TR, Calonge BN, Brawley OW, Iskander J. CDC Grand Rounds: the future of cancer screening. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:324-7. [PMID: 25837243 PMCID: PMC4584530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Cancer is the second leading cause of death in the United States, with 52% of deaths caused by cancers of the lung and bronchus, female breast, uterine cervix, colon and rectum, oral cavity and pharynx, prostate, and skin (melanoma). In the 1930s, uterine cancer, including cancer of the uterine cervix, was the leading cause of cancer deaths among women in the United States. With the advent of the Papanicolaou (Pap) test in the 1950s to detect cellular level changes in the cervix, cervical cancer death rates declined significantly. Since this first cancer screening test, others have been developed that detect the presence of cancer through imaging procedures (e.g., mammography, endoscopy, and computed tomography) and laboratory tests (e.g., fecal occult blood tests).
Collapse
Affiliation(s)
- Cheryll C. Thomas
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC,Corresponding author: Cheryll C. Thomas, , 770-488-3254
| | - Thomas B. Richards
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Marcus Plescia
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Faye L. Wong
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | - Theodore R. Levin
- The Permanente Medical Group, Inc., and Kaiser Permanente Medical Center, Walnut Creek and Antioch, California
| | | | | | | |
Collapse
|
42
|
Morales Martínez Á, Blanco Rodríguez L, Morales Martínez C, Tejuca Somoano S. [Cervical cancer screening: Is active recruitment worth the effort?]. Aten Primaria 2015; 47:653-8. [PMID: 25824868 PMCID: PMC6983784 DOI: 10.1016/j.aprim.2014.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/16/2014] [Accepted: 12/04/2014] [Indexed: 12/01/2022] Open
Abstract
Objetivos Conocer el porcentaje de mujeres que han realizado una citología en los últimos 5 años y el ámbito de realización. Detectar alteraciones citológicas precursoras de cáncer de cérvix en mujeres sin cribado o con cribados inadecuados y conocer la prevalencia de determinaciones de VPH positivas. Diseño Estudio descriptivo transversal. Emplazamiento Centro de Salud de Natahoyo, Gijón. Participantes Mujeres de 40 a 50 años residentes en la zona básica y adscritas al centro de salud. Métodos Recogida de información en bases de datos, telefónicamente y por encuestas en domicilios. Captación activa, en atención primaria, de mujeres sin cribado o con cribado inadecuado para realizar citología y determinación de VPH. Resultados De las 1.420 mujeres de 40 a 50 años 1.236 (87%) habían realizado una citología en los últimos 5 años y 184 (13%) nunca habían hecho una citología o llevaban más de 5 años sin hacerla. De las 184 mujeres sin cribado o con cribados inadecuados 108 (el 58,7%) accedieron a realizar citología y determinación de VPH. En las citologías realizadas no se diagnosticó ninguna displasia de alto grado. El 8,3% de las determinaciones de VPH fueron positivas. Conclusiones En nuestra población existe una alta cobertura del cribado oportunista de cáncer de cérvix. La captación activa de mujeres que se encontraban fuera del programa de cribado no resultó rentable.
Collapse
Affiliation(s)
| | | | | | - Sonia Tejuca Somoano
- Servicio de Ginecología y Obstetricia, Hospital Fundación de Jove, Gijón, España
| |
Collapse
|
43
|
Al-Kadri HM, Kamal M, Bamuhair SS, Omair AA, Bamefleh HS. Prevalence and characteristics of abnormal Papanicolaou smear in Central Saudi Arabia. Saudi Med J 2015; 36:117-22. [PMID: 25630016 PMCID: PMC4362183 DOI: 10.15537/smj.2015.1.9141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives: To assess the prevalence and characteristics of abnormal pap smear in the central region of Saudi Arabia. Methods: In this retrospective case control study conducted in the Departments of Obstetrics and Gynecology, and Histopathology at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, all pap smears screened for Saudi women between 2008 and 2011 were reviewed. Approximately 5000 pap smears are screened annually at King Abdulaziz Medical City utilizing the Bethesda III System (2001). All abnormal smears patients’ data were collected and compared to the data of randomly selected 200 normal smears’ patients. Results: Abnormal pap smear prevalence was found to be 4.3% (841/19,650 Saudi patients were found with atypical epithelial cells abnormalities). Its prevalence in the years 2008 was 5.7%, 2009 was 4.9%, 2010 was 4.2%, and 2011 was 2.5%. Abnormal smear patients have lower parity (p=0.001), and were less likely to use intra-uterine devices (p=0.03) compared with normal smear patients. Presence of abnormal cervical appearance was associated with increased epithelial cell abnormalities (p=0.045). The only positive history that has characterized patients with epithelial cell abnormalities was their previous history of abnormal pap smear (p=0.001). Squamous cell abnormalities were identified in 91% of the patients (767/841), and glandular cell abnormalities were identified in 9% of the patients (74/841). Conclusion: Prevalence of abnormal pap smears in central Saudi Arabia is relatively low, while advanced glandular abnormalities prevalence was observed to be high.
Collapse
Affiliation(s)
- Hanan M Al-Kadri
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, PO Box 57374, Riyadh 11574, Kingdom of Saudi Arabia. Tel. +966 (11) 8011111 Ext. 13611. Fax. +966 (11) 8011111 Ext. 13128. E-mail.
| | | | | | | | | |
Collapse
|
44
|
Roland KB, Greek A, Hawkins NA, Lin L, Benard VB. Provider beliefs associated with cervical cancer screening interval recommendations: A pilot study in Federally Qualified Health Centers. Prev Med Rep 2015. [PMID: 26203428 PMCID: PMC4508246 DOI: 10.1016/j.pmedr.2015.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Among providers who serve low-income and uninsured women, resistance to extending the cervical cancer screening interval following normal Pap and co-test results has been documented. Our objective was to examine provider characteristics and beliefs associated with guideline-consistent screening interval recommendations. Method We collected cross-sectional survey data between 2009 and 2010 from 82 primary care providers in six Federally Qualified Health Centers in Illinois, USA. The relationships between characteristics, beliefs, and screening interval recommendations (1 year vs. 3 years) were tested with Pearson chi-square, negative binomial and ordered logistic regression. Results Compared to providers who recommended annual intervals after a normal co-test, providers who recommended a guideline-consistent (i.e., 3 years) screening interval were significantly more likely to report the goodness, ease, and benefit of their recommendation and perceived encouragement for a 3-year interval from professional organizations and journals (p < .05). Providers who recommended a 3-year interval were also less likely to report that longer intervals increase patient risk for cervical cancer (p < .05). Interval recommendations were not associated with provider specialty, gender, or years in practice. Conclusion Messages that promote the benefits of longer screening intervals after a normal co-test, the natural history of human papillomavirus and cervical cancer, and low risk of developing cancer with a longer interval may be useful to promote evidence-based screening in this population of Federally Qualified Health Center providers. Dissemination of targeted messages through professional journals and specialty organizations should be considered. Annual cervical cancer screening is common, but not recommended by guidelines. Pilot study assessed provider factors associated with screening recommendations. Screening recommendations are associated with positive beliefs about screening tests. Perceived risk of the patient developing cancer between screenings is significant. Professional journals and organizations can disseminate screening interval messages.
Collapse
Affiliation(s)
- Katherine B Roland
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - April Greek
- Battelle, Health & Analytics, Seattle, WA, USA
| | - Nikki A Hawkins
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Lavinia Lin
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Vicki B Benard
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| |
Collapse
|
45
|
Immunogenicity of bivalent HPV vaccine among partially vaccinated young adolescent girls in Uganda. Vaccine 2014; 32:6303-11. [DOI: 10.1016/j.vaccine.2014.08.071] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/16/2014] [Accepted: 08/27/2014] [Indexed: 11/21/2022]
|
46
|
Arbyn M, Fabri V, Temmerman M, Simoens C. Attendance at cervical cancer screening and use of diagnostic and therapeutic procedures on the uterine cervix assessed from individual health insurance data (Belgium, 2002-2006). PLoS One 2014; 9:e92615. [PMID: 24690620 PMCID: PMC3972167 DOI: 10.1371/journal.pone.0092615] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/23/2014] [Indexed: 12/03/2022] Open
Abstract
Objective To assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data. Methods The Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25–64 that had a Pap smear within the last 3 years. Results Cervical cancer screening coverage was 61% at national level, for the target population of women between 25 and 64 years old, in the period 2004–2006. Differences between the 3 regions were small, but varied more substantially between provinces. Coverage was 70% for 25–34 year old women, 67% for those aged 35–39 years, and decreased to 44% in the age group of 60–64 years. The median screening interval was 13 months. The screening coverage varied substantially by social category: 40% and 64%, in women categorised as beneficiary or not-beneficiary of increased reimbursement from social insurance, respectively. In the 3-year period 2004–2006, 3.2 million screen tests were done in the target group consisting of 2.8 million women. However, only 1.7 million women got one or more smears and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman in three years of time. Colposcopy was excessively used (number of Pap smears over colposcopies = 3.2). The proportion of women with a history of conisation or hysterectomy, before the age of 65, was 7% and 19%, respectively. Conclusion The screening coverage increased slightly from 59% in 2000 to 61% in 2006. The screening intensity remained at a high level, and the number of cytological examinations was theoretically sufficient to cover more than the whole target population.
Collapse
Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
- * E-mail:
| | - Valérie Fabri
- Intermutualistic Agency (IMA/AIM), Brussels, Belgium
| | - Marleen Temmerman
- Department of Gynaecology and Obstetrics, Ghent University, Ghent, Belgium
- Director, Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Cindy Simoens
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
- Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
47
|
Vicus D, Sutradhar R, Lu Y, Elit L, Kupets R, Paszat L. The association between cervical cancer screening and mortality from cervical cancer: a population based case-control study. Gynecol Oncol 2014; 133:167-71. [PMID: 24589414 DOI: 10.1016/j.ygyno.2014.02.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To estimate the effect of cervical cancer screening on mortality from cervical cancer in women between the ages of 20 and 69 residing in Ontario by 5 year age groups. METHODS An Ontario population based case-control study of women between ages 20 and 69 was performed. Cases were women who were diagnosed with cervical cancer between January 1, 1998 and December 31, 2008 who died from cervical cancer within this period. Controls were women without a diagnosis of cervical cancer between January 1, 1998 and December 31, 2008 who were alive on the case's date of death. Exposure was defined as cervical cytology history. Conditional logistic regression was used to estimate the strength of association between mortality from cervical cancer and screening in 5 year incremental age intervals. RESULTS We identified 1052 cases and 10,494 controls. Less than 2.5% of women who died from cervical cancer were under the age of 30. Cervical cancer screening performed 3-36 months prior to the date of diagnosis was found to be protective of mortality from cervical cancer in women over the age of 30 (odds ratio=0.28-0.60; p<0.05 in all strata). In women under the age of 30 cervical cancer screening was not found to be protective of mortality from cervical cancer (odds ratio=1.58-2.43; non significant). CONCLUSION No association between cervical cancer screening and mortality from cervical cancer under the age of 30 was found. This could be due to there being a small or having no effect or due to the fact that mortality from cervical cancer under the age of 30 is extremely rare.
Collapse
Affiliation(s)
- Danielle Vicus
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institue of Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Rinku Sutradhar
- Institue of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Yan Lu
- Institue of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Laurie Elit
- Division of Gynecologic Oncology, Division of Obstetrics and Gynecology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Rachel Kupets
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institue of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Lawrence Paszat
- Institue of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | |
Collapse
|
48
|
Yabroff KR, Francisci S, Mariotto A, Mezzetti M, Gigli A, Lipscomb J. Advancing comparative studies of patterns of care and economic outcomes in cancer: challenges and opportunities. J Natl Cancer Inst Monogr 2014; 2013:1-6. [PMID: 23962506 DOI: 10.1093/jncimonographs/lgt005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- K Robin Yabroff
- Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr, 3E436, Rockville, MD 20850, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Cuzick J, Myers O, Hunt WC, Robertson M, Joste NE, Castle PE, Benard VB, Wheeler CM. A population-based evaluation of cervical screening in the United States: 2008-2011. Cancer Epidemiol Biomarkers Prev 2013; 23:765-73. [PMID: 24302677 DOI: 10.1158/1055-9965.epi-13-0973] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical screening consumes substantial resources, but little is known about utilization in the United States or compliance with guideline recommendations. METHODS To describe population screening coverage, utilization, and outcomes and examine time trends from 2008 to 2011, cervical cytology reports from women residing in New Mexico (981,063 tests from 511,381 women) were evaluated. RESULTS From 2008 to 2011 cervical screening utilization decreased at all ages, but especially in younger women, with a two-third reduction at ages 15 to 20 years. Ninety-four percent of women ages 25 to 29 years were screened within 48 months but coverage decreased at older ages to 69% at 45 to 49 years and 55% at 60 to 64 years. Intervals between screening tests were significantly longer in 2011 compared with 2008 [HR = 1.23; 95% confidence intervals (CI), 1.22-1.24], although the commonest rescreening interval was 13 months. In 2011, 91.9% of screening tests for women ages 21 to 65 years were negative, 6.6% showed minor abnormalities, and 1.0% high-grade abnormalities. High-grade abnormality rates were relatively constant over time, but minor abnormalities and atypical cells cannot rule out high-grade (ASC-H) were increasing. CONCLUSIONS This population-based evaluation of cervical screening shows high coverage under the age of 40 years, but lower levels in older women. Screening under age 21 years is becoming less common and screening intervals are lengthening, reflecting updates in national screening guidelines. IMPACT Assessment of cervical screening intervals and population outcomes is essential for accurately estimating the impact and effectiveness of changing recommendations and vaccination against human papilloma virus infections.
Collapse
Affiliation(s)
- Jack Cuzick
- Authors' Affiliations: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Division of Epidemiology, Department of Internal Medicine; Department of Pathology, University of New Mexico Health Sciences Center, House of Prevention Epidemiology (HOPE), Albuquerque, New Mexico; Global Cancer Initiative, Chestertown, Maryland; and Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Dugué PA, Lynge E, Rebolj M. Mortality of non-participants in cervical screening: Register-based cohort study. Int J Cancer 2013; 134:2674-82. [DOI: 10.1002/ijc.28586] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 11/06/2022]
Affiliation(s)
| | - Elsebeth Lynge
- Department of Public Health; University of Copenhagen; Copenhagen, Denmark
| | - Matejka Rebolj
- Department of Public Health; University of Copenhagen; Copenhagen, Denmark
| |
Collapse
|