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Downham L, Rol ML, Forestier M, Romero P, Mendoza L, Mongelós P, Picconi MA, Colucci MC, Padin VM, Flores AP, Zúñiga M, Ferrera A, Cabrera Y, Crispín MF, Ramirez AT, Cele L, Diop-Ndiaye H, Samaté D, Manga P, Thiam FB, Rodriguez MI, DSouza JP, Nyaga VN, Diop M, Sebitloane M, Sánchez GI, Teran C, Calderon A, Wiesner C, Murillo R, Herrero R, Baena A, Almonte M. Field experience with the 8-HPV-type oncoprotein test for cervical cancer screening among HPV-positive women living with and without HIV in LMICs. Int J Cancer 2024. [PMID: 38602045 DOI: 10.1002/ijc.34953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 04/12/2024]
Abstract
Overexpression of HPV-oncoproteins E6 and E7 is necessary for HPV-driven cervical carcinogenesis. Hence, these oncoproteins are promising disease-specific biomarkers. We assessed the technical and operational characteristics of the 8-HPV-type OncoE6/E7 Cervical Test in different laboratories using cervical samples from HPV-positive women living with (WLWH) and without HIV. The 8-HPV-type OncoE6/E7 Test (for short: "OncoE6/E7 test") was performed in 2833 HIV-negative women and 241 WLWH attending multicentric studies in Latin America (ESTAMPA study), and in Africa (CESTA study). Oncoprotein positivity were evaluated at each testing site, according to HIV status as well as type-specific agreement with HPV-DNA results. A feedback questionnaire was given to the operators performing the oncoprotein test to evaluate their impression and acceptability regarding the test. The OncoE6/E7 test revealed a high positivity rate heterogeneity across all testing sites (I2: 95.8%, p < .01) with significant lower positivity in WLWH compared to HIV-negative women (12% vs 25%, p < .01). A similar HPV-type distribution was found between HPV DNA genotyping and oncoprotein testing except for HPV31 and 33 (moderate agreement, k = 0.57). Twenty-one laboratory technicians were trained on oncoprotein testing. Despite operators' concerns about the time-consuming procedure and perceived need for moderate laboratory experience, they reported the OncoE6/E7 test as easy to perform and user-friendly for deployment in resource-limited settings. The high positivity rate variability found across studies and subjectivity in test outcome interpretation could potentially results in oncoprotein false positive/negative, and thus the need for further refinements before implementation of the oncoprotein testing in screen-triage-and-treat approaches is warranted.
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Affiliation(s)
- Laura Downham
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Mary Luz Rol
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathilde Forestier
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Pilar Romero
- Instituto Nacional de Cancerología, Bogota, Colombia
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Pamela Mongelós
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - María Celeste Colucci
- Instituto Nacional de Enfermedades Infecciosas-ANLIS Dr Malbrán, Buenos Aires, Argentina
| | - Valeria Mariel Padin
- Instituto Nacional de Enfermedades Infecciosas-ANLIS Dr Malbrán, Buenos Aires, Argentina
| | - Ana Paula Flores
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Michael Zúñiga
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Yessy Cabrera
- Instituto de Investigaciones en Microbiología, Escuela de Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Marcela Farfan Crispín
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Arianis Tatiana Ramirez
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Londiwe Cele
- University of Kwazulu Natal, Durban, South Africa
| | | | - Dianke Samaté
- Laboratoire Bactériologie-Virologie, CHU Aristide le Dantec, Dakar, Senegal
| | - Pascaline Manga
- Laboratoire Bactériologie-Virologie, CHU Aristide le Dantec, Dakar, Senegal
| | | | - Maria Isabel Rodriguez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Jyoshma P DSouza
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Victoria Nyawira Nyaga
- Department of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Mamadou Diop
- Laboratoire Bactériologie-Virologie, CHU Aristide le Dantec, Dakar, Senegal
| | | | | | - Carolina Teran
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | | | - Raul Murillo
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Caja Costarricense del Seguro Social, Puntarenas, Costa Rica
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
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Downham L, Jaafar I, Rol ML, Nyawira Nyaga V, Valls J, Baena A, Zhang L, Gunter MJ, Arbyn M, Almonte M. Accuracy of HPV E6/E7 oncoprotein tests to detect high-grade cervical lesions: a systematic literature review and meta-analysis. Br J Cancer 2024; 130:517-525. [PMID: 37973957 PMCID: PMC10876647 DOI: 10.1038/s41416-023-02490-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Cervical carcinogenesis is mediated by the HPV-E6 and E7 oncoproteins, considered as biomarkers usable in managing screen-positive women. METHODS We conducted a systematic review and meta-analysis assessing the accuracy of HPV-E6/E7-oncoprotein tests to detect underlying cervical-precancer and cancer. We included studies reporting data on oncoprotein test accuracy detecting cervical intraepithelial neoplasia grade 3 or worse. Random effects logistic regression models were applied for pooling absolute and relative accuracy. RESULTS Twenty-two studies were included. Sensitivity and specificity estimates ranged from 54.2% (95%CI: 45.2-63.0) to 69.5% (95%CI:60.8-76.9) and from 82.8% (95%CI: 50.4-95.8) to 99.1 (95%CI: 98.8-99.3), respectively in the population irrespective of HPV status. Higher sensitivity estimates ranging from 60.8% (95%CI: 49.6-70.9) to 75.5% (95%CI: 71.7-78.9) but lower specificity estimates ranging from 83.7% (95%CI: 76.1-89.3) to 92.1% (95%CI: 88.5-94.6) were observed in studies enrolling high-risk-HPV-positive women. Studies recruiting only HIV-positive women showed a pooled sensitivity of 46.9% (95%CI: 30.6-63.9) with a specificity of 98.0% (95%CI: 96.8-98.7). CONCLUSIONS The high specificity of oncoprotein tests supports its use for triaging HPV-positive women. However, oncoprotein-negative women would not be recommended to undertake routine screening, requiring further follow-up. Large-scale and longitudinal studies are needed to further investigate the role of E6/E7-oncoprotein detection in predicting the risk of developing cervical pre-cancer and cancer.
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Affiliation(s)
- Laura Downham
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
| | - Iman Jaafar
- Department of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Mary Luz Rol
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Victoria Nyawira Nyaga
- Department of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Idibell, Barcelona, Spain
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Li Zhang
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Marc Arbyn
- Department of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, France
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Simms KT, Keane A, Nguyen DTN, Caruana M, Hall MT, Lui G, Gauvreau C, Demke O, Arbyn M, Basu P, Wentzensen N, Lauby-Secretan B, Ilbawi A, Hutubessy R, Almonte M, De Sanjosé S, Kelly H, Dalal S, Eckert LO, Santesso N, Broutet N, Canfell K. Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population. Nat Med 2023; 29:3050-3058. [PMID: 38087115 PMCID: PMC10719104 DOI: 10.1038/s41591-023-02600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/19/2023] [Indexed: 12/17/2023]
Abstract
In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health problem. To support the strategy, the WHO published updated cervical screening guidelines in 2021. To inform this update, we used an established modeling platform, Policy1-Cervix, to evaluate the impact of seven primary screening scenarios across 78 low- and lower-middle-income countries (LMICs) for the general population of women. Assuming 70% coverage, we found that primary human papillomavirus (HPV) screening approaches were the most effective and cost-effective, reducing cervical cancer age-standardized mortality rates by 63-67% when offered every 5 years. Strategies involving triaging women before treatment (with 16/18 genotyping, cytology, visual inspection with acetic acid (VIA) or colposcopy) had close-to-similar effectiveness to HPV screening without triage and fewer pre-cancer treatments. Screening with VIA or cytology every 3 years was less effective and less cost-effective than HPV screening every 5 years. Furthermore, VIA generated more than double the number of pre-cancer treatments compared to HPV. In conclusion, primary HPV screening is the most effective, cost-effective and efficient cervical screening option in LMICs. These findings have directly informed WHO's updated cervical screening guidelines for the general population of women, which recommend primary HPV screening in a screen-and-treat or screen-triage-and-treat approach, starting from age 30 years with screening every 5 years or 10 years.
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Affiliation(s)
- Kate T Simms
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
| | - Adam Keane
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Diep Thi Ngoc Nguyen
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michaela T Hall
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Gigi Lui
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Cindy Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- SUCCESS Project, Expertise France, Paris, France
| | - Owen Demke
- Global Diagnostics, Clinton Health Access Initiative, Kigali, Rwanda
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Silvia De Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Helen Kelly
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shona Dalal
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Linda O Eckert
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
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Sebitloane HM, Forestier M, Ginindza TG, Dhlomo W, Moodley-Govender E, Darragh TM, Baena A, Herrero R, Almonte M, Broutet N, De Vuyst H. Cervical Cancer Screening and Treatment algorithms using Human Papillomavirus testing - lessons learnt from a South African pilot randomized controlled trial. Cancer Epidemiol Biomarkers Prev 2023:730088. [PMID: 37955560 DOI: 10.1158/1055-9965.epi-23-0752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/06/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND To report quantitative and qualitative results on cervical cancer (CC) HPV-based screening and treatment algorithms, with/out triage with visual inspection after acetic acid (VIA), followed by ablative treatment (AT). METHODS Women 30-54 years-old from Durban, South Africa were recruited, regardless of HIV status, randomized into one of two study arms and screened for HPV. VIA-triage arm: HPV-positive women were triaged using VIA, biopsied and received AT if VIA-positive and eligible; no-triage arm: eligible HPV-positive women received AT. Women ineligible for AT were referred to colposcopy. Women were asked about side effects immediately and one week after AT. Retention to screening and treatment algorithms was compared between arms. RESULTS 350 women (275 HIV-uninfected and 75 women living with HIV, (WLWH)) were allocated to receive HPV testing with VIA-triage (n=175) or no-triage (n=175). HPV prevalence was 28% (95%CI=23-33); WLWH: 52% (95%CI=40-64) vs HIV-uninfected: 21% (95%CI=17-27) (p<0.05). Among women who underwent VIA triage with histological diagnosis, 3/17 were VIA negative with CIN2+; 14/18 were VIA positive with CONCLUSION This pilot demonstrated the feasibility of implementing screening and treatment algorithms, including performing triage and treatment in one visit; however VIA triage did not reduce overtreatment and missed some precancerous lesions. IMPACT This study reports on implementation feasibility of two WHO screening and treatment algorithms (with/out VIA-triage). Although the retention to screening and treatment algorithms was high in both arms, the question of how best triaging HPV-positive women deserves further consideration, particularly for WLWH.
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Affiliation(s)
| | | | | | | | | | - Teresa M Darragh
- University of California, San Francisco, San Francisco, CA, United States
| | - Armando Baena
- International Agency For Research On Cancer, Lyon, France
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomedicas, San Jose, Costa Rica
| | | | | | - Hugo De Vuyst
- International Agency For Research On Cancer, Lyon, France
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Ramírez AT, Valls J, Baena A, Rojas FD, Ramírez K, Álvarez R, Cristaldo C, Henríquez O, Moreno A, Reynaga DC, Palma HG, Robinson I, Hernández DC, Bardales R, Cardinal L, Salgado Y, Martínez S, González E, Guillén D, Fleider L, Tatti S, Villagra V, Venegas G, Cruz-Valdez A, Valencia M, Rodríguez G, Terán C, Picconi MA, Ferrera A, Kasamatsu E, Mendoza L, Calderon A, Luciani S, Broutet N, Darragh T, Almonte M, Herrero R. Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study. Lancet Reg Health Am 2023; 26:100593. [PMID: 37766799 PMCID: PMC10520426 DOI: 10.1016/j.lana.2023.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/28/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Background Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30-64 years participating in the ESTAMPA study. Methods Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0-53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3-96.7). Specificity was 96.5% (95% CI: 96.3-96.7) using cytology and 88.7% (95% CI: 88.3-89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%-100% and 83.6-90.8%, respectively). Interpretation The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding IARC/WHO, UNDP, HRP/WHO, NCI and local funders.
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Affiliation(s)
- Arianis Tatiana Ramírez
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Joan Valls
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Armando Baena
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Freddy David Rojas
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica
| | - Katherine Ramírez
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica
| | - Rodrigo Álvarez
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica
| | - Carmen Cristaldo
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Adrián Moreno
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - Daysi Colque Reynaga
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Hans González Palma
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Diana Carolina Hernández
- Laboratorio de citología, IPS Universitaria, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Rosa Bardales
- Departamento Laboratorio Clínico y Anatomía Patológica, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Lucia Cardinal
- Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina
| | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Emmanuel González
- Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Dr. Enrique Baltodano Briceño, Guanacaste, Costa Rica
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Diego Guillén
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
- Caja Costarricense de Seguro Social, Departamento de Patología, Hospital Max Peralta, Cartago, Costa Rica
| | - Laura Fleider
- Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina
| | - Silvio Tatti
- Hospital de Clínicas, Jose de San Martín, Buenos Aires, Argentina
| | | | - Gino Venegas
- Clínica Angloamericana, Lima, Perú
- Escuela de Medicina Humana, Universidad de Piura, Lima, Perú
| | | | - Marleny Valencia
- Laboratorio de citología, IPS Universitaria, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | | | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Annabelle Ferrera
- Instituto de Infecciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Alejandro Calderon
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San Jose, Costa Rica
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, DC, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
| | - Teresa Darragh
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Maribel Almonte
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
| | - Rolando Herrero
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
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Baena A, Paolino M, Villarreal-Garza C, Torres G, Delgado L, Ruiz R, Canelo-Aybar C, Song Y, Feliu A, Maza M, Jeronimo J, Espina C, Almonte M. Latin America and the Caribbean Code Against Cancer 1st Edition: Medical interventions including hormone replacement therapy and cancer screening. Cancer Epidemiol 2023; 86 Suppl 1:102446. [PMID: 37852728 DOI: 10.1016/j.canep.2023.102446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
Prostate, breast, colorectal, cervical, and lung cancers are the leading cause of cancer in Latin America and the Caribbean (LAC) accounting for nearly 50% of cancer cases and cancer deaths in the region. Following the IARC Code Against Cancer methodology, a group of Latin American experts evaluated the evidence on several medical interventions to reduce cancer incidence and mortality considering the cancer burden in the region. A recommendation to limit the use of HRT was issued based on the risk associated to develop breast, endometrial, and ovarian cancer and on growing concerns related to the over-the-counter and without prescription sales, which in turn bias estimations on current use in LAC. In alignment with WHO breast and cervical cancer initiatives, biennial screening by clinical breast examination (performed by trained health professionals) from the age of 40 years and biennial screening by mammography from the age of 50 years to 74, as well as cervical screening by HPV testing (either self-sampling or provider-sampling) every 5-10 years for women aged 30-64 years, were recommended. The steadily increasing rates of colorectal cancer in LAC also led to recommend colorectal screening by occult blood testing every two years or by endoscopic examination of the colorectum every 10 years for both men and women aged 50-74 years. After evaluating the evidence, the experts decided not to issue recommendations for prostate and lung cancer screening; while there was insufficient evidence on prostate cancer mortality reduction by prostate-specific antigen (PSA) testing, there was evidence of mortality reduction by low-dose computed tomography (LDCT) targeting high-risk individuals (mainly heavy and/or long-term smokers) but not individuals with average risk to whom recommendations of this Code are directed. Finally, the group of experts adapted the gathered evidence to develop a competency-based online microlearning program for building cancer prevention capacity of primary care health professionals.
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Affiliation(s)
- Armando Baena
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad / Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Cynthia Villarreal-Garza
- Centro de Cáncer de Mama, Hospital Zambrano Hellion - TecSalud, Tecnológico de Monterrey, Monterrey, Mexico
| | - Gabriela Torres
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Lucia Delgado
- Escuela de Graduados, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Rossana Ruiz
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Carlos Canelo-Aybar
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Yang Song
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Mauricio Maza
- Department of Noncommunicable Diseases and Mental Health, Unit of Noncommunicable Diseases, Violence, and Injury Prevention, Pan American Health Organization, Washington, DC, USA
| | - Jose Jeronimo
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Maribel Almonte
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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7
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Espina C, Feliu A, Maza M, Almonte M, Ferreccio C, Finck C, Herrero R, Dommarco JR, de Almeida LM, Arrossi S, García PJ, Garmendia ML, Mohar A, Murillo R, Santamaría J, Tortolero-Luna G, Cazap E, Gabriel OO, Paonessa D, Zoss JW, Luciani S, Carvalho A, Schüz J. Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework). Cancer Epidemiol 2023; 86 Suppl 1:102402. [PMID: 37852725 DOI: 10.1016/j.canep.2023.102402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 10/20/2023]
Abstract
Preventable risk factors are responsible of at least 40% of cases and almost 45% of all cancer deaths worldwide. Cancer is already the leading cause of death in almost half of the Latin American and the Caribbean countries constituting a public health problem. Cost-effective measures to reduce exposures through primary prevention and screening of certain types of cancers are critical in the fight against cancer but need to be tailored to the local needs and scenarios. The Latin America and the Caribbean (LAC) Code Against Cancer, 1st edition, consists of 17 evidence-based recommendations for the general public, based on the most recent solid evidence on lifestyle, environmental, occupational, and infectious risk factors, and medical interventions. Each recommendation is accompanied by recommendations for policymakers to guide governments establishing the infrastructure needed to enable the public adopting the recommendations. The LAC Code Against Cancer has been developed in a collaborative effort by a large number of experts from the region, under the umbrella strategy and authoritative methodology of the World Code Against Cancer Framework. The Code is a structured instrument ideal for cancer prevention and control that aims to raise awareness and educate the public, while building capacity and competencies to policymakers, health professionals, stakeholders, to contribute to reduce the burden of cancer in LAC.
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Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France.
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Mauricio Maza
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Maribel Almonte
- World Health Organization (WHO), Department of Sexual and Reproductive Health and Research, Geneva, Switzerland
| | - Catterina Ferreccio
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile
| | - Carolyn Finck
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, Costa Rica
| | | | - Liz Maria de Almeida
- National Cancer Institute of Brazil (INCA), Prevention and Surveillance, Rio de Janeiro, Brazil
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad (CEDES), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Alejandro Mohar
- Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas (UNAM), Tlalpan, Mexico
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Eduardo Cazap
- Sociedad Latinoamercia y del Caribe de Oncología Médica (SLACOM), Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Buenos Aires, Argentina
| | - Owen O Gabriel
- Owen King EU Hospital, Department of Oncology, Saint Lucia
| | - Diego Paonessa
- Asociación Latina e Ibérica Contra el Cáncer (ALICC), Buenos Aires, Argentina
| | - J Walter Zoss
- Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Rio de Janeiro, Brazil
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Andre Carvalho
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
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8
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Baena A, Mesher D, Salgado Y, Martínez S, Villalba GR, Amarilla ML, Salgado B, Flores B, Bellido‐Fuentes Y, Álvarez‐Larraondo M, Valls J, Lora O, Virreira‐Prout G, Figueroa J, Turcios E, Soilán AM, Ortega M, Celis M, González M, Venegas G, Terán C, Ferrera A, Mendoza L, Kasamatsu E, Murillo R, Wiesner C, Broutet N, Luciani S, Herrero R, Almonte M. Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen-positive women: results from the ESTAMPA study. Int J Cancer 2023; 152:1581-1592. [PMID: 36451311 PMCID: PMC10107773 DOI: 10.1002/ijc.34384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
VIA is recommended for triage of HPV-positive women attending cervical screening. In the multicentric ESTAMPA study, VIA performance for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among HPV-positive women was evaluated. Women aged 30-64 years were screened with HPV testing and cytology and referred to colposcopy if either test was positive. At colposcopy visit, study-trained midwives/nurses/GPs performed VIA ahead of colposcopy. VIA was considered positive if acetowhite lesions were observed in or close to the transformation zone. Ablative treatment eligibility was assessed for VIA positives. Performance indicators were estimated. Three thousand one hundred and forty-two HPV-positive women were included. Sensitivity for CIN3+ was 85.9% (95% CI 81.2-89.5) among women <50 years and, although not significant, slightly lower in women 50+ (78.0%, 95% CI 65.9-86.6). Overall specificity was 58.6% (95% CI 56.7-60.5) and was significantly higher among women 50+ (70.3%, 95% CI 66.8-73.5) compared to women <50 (54.3%, 95% CI 52.1-56.5). VIA positivity was lower among women 50+ (35.2%, 95% CI 31.9-38.6) compared to women <50 (53.2, 95% CI 51.1-55.2). Overall eligibility for ablative treatment was 74.5% and did not differ by age. VIA sensitivity, specificity, and positivity, and ablative treatment eligibility varied highly by provider (ranges: 25%-95.4%, 44.9%-94.4%, 8.2%-65.3%, 0%-98.7%, respectively). VIA sensitivity for cervical precancer detection among HPV-positive women performed by trained providers was high with an important reduction in referral rates. However, scaling-up HPV screening triaged by VIA will be challenging due to the high variability of VIA performance and providers' need for training and supervision.
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Affiliation(s)
- Armando Baena
- International Agency for Research on CancerLyonFrance
| | - David Mesher
- International Agency for Research on CancerLyonFrance
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV ServiceUK Health Security AgencyLondonUK
| | - Yuli Salgado
- Instituto Nacional de CancerologíaBogotáColombia
| | | | - Griselda Raquel Villalba
- Hospital Materno Infantil de San LorenzoMinisterio de Salud Pública y Bienestar SocialSan LorenzoParaguay
| | | | - Brenda Salgado
- Instituto de Investigaciones en Microbiología, Escuela de MicrobiologíaUniversidad Nacional Autónoma de HondurasTegucigalpaHonduras
| | - Bettsy Flores
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
| | | | | | - Joan Valls
- International Agency for Research on CancerLyonFrance
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | - Oscar Lora
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
- Hospital Gineco‐Obstétrico y Neonatal “Dr Jaime Sánchez Porcel”SucreBolivia
| | - Gonzalo Virreira‐Prout
- Hospital Gineco‐Obstétrico y Neonatal “Dr Jaime Sánchez Porcel”SucreBolivia
- Seguro Social Universitario (SSU)SucreBolivia
| | | | - Elmer Turcios
- Programa Nacional contra el CáncerTegucigalpaHonduras
| | - Ana María Soilán
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Marina Ortega
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | | | | | - Gino Venegas
- Clínica AngloamericanaLimaPeru
- Escuela de Medicina HumanaUniversidad de PiuraLimaPeru
| | - Carolina Terán
- Facultad de MedicinaUniversidad Mayor, Real y Pontificia de San Francisco Xavier de ChuquisacaSucreBolivia
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Escuela de MicrobiologíaUniversidad Nacional Autónoma de HondurasTegucigalpaHonduras
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la SaludUniversidad Nacional de AsunciónSan LorenzoParaguay
| | - Raúl Murillo
- International Agency for Research on CancerLyonFrance
- Centro Javeriano de OncologíaHospital Universitario San IgnacioBogotáColombia
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Silvana Luciani
- Pan American Health Organization (PAHO)WashingtonDistrict of ColumbiaUSA
| | - Rolando Herrero
- International Agency for Research on CancerLyonFrance
- Agencia Costarricense de Investigaciones Biomédicas (ACIB)Fundación InciensaGuanacasteCosta Rica
| | - Maribel Almonte
- International Agency for Research on CancerLyonFrance
- Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
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9
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Valls J, Baena A, Venegas G, Celis M, González M, Sosa C, Santin JL, Ortega M, Soilán A, Turcios E, Figueroa J, Rodríguez de la Peña M, Figueredo A, Beracochea AV, Pérez N, Martínez-Better J, Lora O, Jiménez JY, Giménez D, Fleider L, Salgado Y, Martínez S, Bellido-Fuentes Y, Flores B, Tatti S, Villagra V, Cruz-Valdez A, Terán C, Sánchez GI, Rodríguez G, Picconi MA, Ferrera A, Mendoza L, Calderón A, Murillo R, Wiesner C, Broutet N, Luciani S, Pérez C, Darragh TM, Jerónimo J, Herrero R, Almonte M. Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study. Lancet Glob Health 2023; 11:e350-e360. [PMID: 36796982 PMCID: PMC10020136 DOI: 10.1016/s2214-109x(22)00545-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women. METHODS This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30-64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit. FINDINGS Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7-49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9-93·2) for CIN3+, whereas specificity was 50·1% (48·5-51·8) for less than CIN2 and 47·1% (45·5-48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3-95·3] in those aged 30-49 years vs 77·6% [68·6-85·0] in those aged 50-65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8-47·6] vs 61·8% [58·7-64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001). INTERPRETATION Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women. FUNDING WHO; Pan American Health Organization; Union for International Cancer Control; National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development, and Innovation; NCI of Argentina and Colombia; Caja Costarricense de Seguro Social; National Council for Science and Technology of Paraguay; International Agency for Research on Cancer; and all local collaborative institutions.
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Affiliation(s)
- Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Gino Venegas
- Clínica Angloamericana, Lima, Peru; Escuela de Medicina Humana, Universidad de Piura, Lima, Peru
| | - Marcela Celis
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Carlos Sosa
- Hospital Monseñor Victor Manuel Sanabria Martínez, Puntarenas, Costa Rica
| | - Jorge Luis Santin
- Hospital Monseñor Victor Manuel Sanabria Martínez, Puntarenas, Costa Rica
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay; Instituto Nacional del Cáncer, Ministerio de Salud Pública y Bienestar Social, Capiatá, Paraguay
| | - Ana Soilán
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay; Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Elmer Turcios
- Programa Nacional contra el Cáncer, Tegucigalpa, Honduras
| | | | | | - Alicia Figueredo
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Natalia Pérez
- Hospital de Clínicas, Facultad de Medicina, Montevideo, Uruguay
| | | | - Oscar Lora
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia; Hospital Gineco-Obstétrico y Neonatal Dr Jaime Sánchez Porcel, Sucre, Bolivia
| | | | - Diana Giménez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Laura Fleider
- Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina
| | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | | | - Bettsy Flores
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Silvio Tatti
- Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina
| | | | | | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | | | | | - Annabelle Ferrera
- Instituto de Infecciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Alejandro Calderón
- Caja Costarricense de Seguro Social, Región Pacífico Central, San José, Costa Rica
| | - Raul Murillo
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Carlos Pérez
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Teresa M Darragh
- Department of Pathology, University of California, San Francisco, CA, USA
| | - José Jerónimo
- Liga contra el Cáncer-Peru, Lima, Peru; US National Cancer Institute, Bethesda, MD, USA
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Agencia Costarricense de Investigaciones Biomédicas, Fundación Inciensa, Guanacaste, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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10
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Basiletti JA, Valls J, Poklépovich T, Fellner MD, Rol M, Alonso R, Correa RM, Colucci MC, Rodríguez de la Peña M, Falabella PG, Saíno A, Campos J, Herrero R, Almonte M, Picconi MA. Human papillomavirus genotyping using next generation sequencing (NGS) in cervical lesions: Genotypes by histologic grade and their relative proportion in multiple infections. PLoS One 2022; 17:e0278117. [PMID: 36417453 PMCID: PMC9683586 DOI: 10.1371/journal.pone.0278117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
Sensitive and specific genotyping of human papillomaviruses (HPVs) is critical for the surveillance and monitoring of the vaccine effectiveness. Here, HPV genotypes were identified in 137 cervical samples with different histology (79 ≤CIN1 and 58 CIN3+) using Nested-PCR followed by Next-Generation sequencing (NGS) and relative proportions for each genotype in multiple infections were computed. All samples had been previously genotyped by PCR-Reverse Blotting Hybridization (PCR-RBH) thus allowing for a concordance analysis between both techniques. Multiple infections were present in 85% of ≤CIN1 cases compared to only 41% in CIN3+ cases (p<0.001). Among ≤CIN1 cases a towering genotypic diversity was observed, considering both low (LR-) and high risk (HR-) HPV genotypes; while among CIN3+, diversity was lower, HR-HPVs prevailing in most cases, especially HPV16. Furthermore, the predominance of HR-HPV genotypes in the proportions identified in each sample was higher in CIN3+ cases [(HPV16 (62.5%), followed by HPV31 and HPV58 (8.3% each)], than in ≤CIN1 cases [(HPV16 (17.7%), followed by HPV52 (14.7%) and HPV31 (10.3%)]. Agreement between PCR-RBH and NGS was higher than 90% for all genotypes (with an overall Kappa of 0.7), even though NGS identified eighty-nine positive results for HPV genotypes that had not been detected by PCR-RBH, evidencing its greater sensitivity. These results suggest that a reduction in genotypic diversity and/or an increase in the relative proportion of HR-HPVs in multiple infections can be considered as a biomarker for the potential risk of malignant progression.
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Affiliation(s)
- Jorge Alejandro Basiletti
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Malbrán”, Buenos Aires, Argentina
| | - Joan Valls
- Early Detection, Prevention & Infection Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Tomás Poklépovich
- Unidad Operativa Centro de Genómica y Bioinformática, ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - María Dolores Fellner
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Malbrán”, Buenos Aires, Argentina
| | - Maryluz Rol
- Early Detection, Prevention & Infection Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Rafael Alonso
- Departamento de Métodos Cuantitativos, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Rita Mariel Correa
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Malbrán”, Buenos Aires, Argentina
| | - María Celeste Colucci
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Malbrán”, Buenos Aires, Argentina
| | | | - Paula Gabriela Falabella
- Servicio de Ginecología, Hospital Nacional “Prof. Posadas”, El Palomar, Provincia de Buenos Aires, Argentina
| | - Agustina Saíno
- Servicio de Anatomía Patológica, Hospital Nacional “Prof. Posadas”, El Palomar, Provincia de Buenos Aires, Argentina
| | - Josefina Campos
- Unidad Operativa Centro de Genómica y Bioinformática, ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, San José, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention & Infection Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - María Alejandra Picconi
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas-ANLIS “Dr. Malbrán”, Buenos Aires, Argentina
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11
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Rol ML, Picconi MA, Ferrera A, Sánchez GI, Hernández MDLL, Lineros J, Peraza A, Brizuela M, Mendoza L, Mongelós P, Cabrera Y, Rodríguez de la Peña M, Correa RM, Terán C, Colque Reynaga D, García L, Ramírez AT, Hernández-Nevarez P, Doimi F, Ramón M, Arias-Stella J, Zúñiga M, Villagra V, Bobadilla ML, Cardinal L, Valls J, Lucas E, Baena A, Fleider L, Venegas G, Cruz-Valdez A, Rodríguez G, Calderón A, Wiesner C, Luciani S, Broutet N, Herrero R, Almonte M. Implementing HPV testing in 9 Latin American countries: The laboratory perspective as observed in the ESTAMPA study. Front Med (Lausanne) 2022; 9:1006038. [PMID: 36465901 PMCID: PMC9714610 DOI: 10.3389/fmed.2022.1006038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Replacement of cytology screening with HPV testing is recommended and essential for cervical cancer elimination. HPV testing for primary screening was implemented in 12 laboratories within 9 Latin American countries, as part of the ESTAMPA cervical cancer screening study. Our observations provide information on critical operational aspects for HPV testing implementation in diverse resource settings. Methods We describe the implementation process of HPV testing in ESTAMPA, focusing on laboratory aspects. We assess the readiness of 12 laboratories to start HPV testing and their continuity capacity to maintain good quality HPV testing until end of recruitment or up to December 2021. Readiness was based on a checklist. Information from the study database; regular meetings and monitoring visits; and a questionnaire on laboratory operational aspects sent in May 2020 were used to assess continuity capacity. Compliance with seven basic requirements (readiness) and eight continuity requirements (continuity capacity) was scored (1 = compliant, 0 = not compliant) and totaled to classify readiness and continuity capacity as very limited, limited, moderate or high. Experiences, challenges, and enablers of the implementation process are also described. Results Seven of 12 laboratories had high readiness, three moderate readiness, and of two laboratories new to HPV testing, one had limited readiness and the other very limited readiness. Two of seven laboratories with high readiness also showed high continuity capacity, one moderate continuity capacity, and the other four showed limited continuity capacity since they could not maintain good quality HPV testing over time. Among three laboratories with moderate readiness, one kept moderate continuity capacity and two reached high continuity capacity. The two laboratories new to HPV testing achieved high continuity capacity. Based on gained expertise, five laboratories have become part of national screening programs. Conclusion High readiness of laboratories is an essential part of effective implementation of HPV testing. However, high readiness is insufficient to guarantee HPV testing high continuity capacity, for which a "culture of quality" should be established with regular training, robust monitoring and quality assurance systems tailored to local context. All efforts to strengthen HPV laboratories are valuable and crucial to guarantee effective implementation of HPV-based cervical screening.
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Affiliation(s)
- Mary Luz Rol
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - María de la Luz Hernández
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- SMS-Oncology, Amsterdam, Netherlands
| | - Joana Lineros
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Ana Peraza
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Marisol Brizuela
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Pamela Mongelós
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Yessy Cabrera
- Grupo de Infección y Cáncer, Universidad de Antioquia, Medellín, Colombia
| | | | - Rita Mariel Correa
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Deisy Colque Reynaga
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Arianis Tatiana Ramírez
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Franco Doimi
- Laboratorio de Patología Oncológica SAC, Lima, Peru
| | - María Ramón
- Laboratorio de Patología Oncológica SAC, Lima, Peru
| | | | - Michael Zúñiga
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, San José, Guanacaste, Costa Rica
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Gino Venegas
- Clínica Angloamericana, Lima, Peru
- Liga contra el Cáncer, Lima, Peru
| | | | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | | | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, DC, United States
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, San José, Guanacaste, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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12
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Shastri SS, Temin S, Almonte M, Basu P, Campos NG, Gravitt PE, Gupta V, Lombe DC, Murillo R, Nakisige C, Ogilvie G, Pinder LF, Poli UR, Qiao Y, Woo YL, Jeronimo J. Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update. JCO Glob Oncol 2022; 8:e2200217. [PMID: 36162041 PMCID: PMC9812449 DOI: 10.1200/go.22.00217] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To update resource-stratified, evidence-based recommendations on secondary prevention of cervical cancer globally. METHODS American Society of Clinical Oncology convened a multidisciplinary, multinational Expert Panel to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, formal consensus-based process, and modified ADAPTE process to adapt existing guidelines was conducted. Other experts participated in formal consensus. RESULTS This guideline update reflects changes in evidence since the previous update. Five existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. RECOMMENDATIONS Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies vary by the following setting: maximal: age 25-65 years, every 5 years; enhanced: age 30-65 years, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: age 30-49 years, every 10 years; basic: age 30-49 years, one to three times per lifetime. For basic settings, visual assessment is used to determine treatment eligibility; in other settings, genotyping with cytology or cytology alone is used to determine treatment. For basic settings, treatment is recommended if abnormal triage results are obtained; in other settings, abnormal triage results followed by colposcopy is recommended. For basic settings, treatment options are thermal ablation or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure or ablation is recommended; with a 12-month follow-up in all settings. Women who are HIV-positive should be screened with HPV testing after diagnosis, twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information is available at www.asco.org/resource-stratified-guidelines.
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Affiliation(s)
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Nicole G Campos
- Harvard University T.H. Chan School of Public Health, Boston, MA
| | | | | | - Dorothy C Lombe
- Regional Cancer Treatment Services, MidCentral District Health Board, Palmerston North, New Zealand
| | | | | | | | | | - Usha R Poli
- India Institute of Public Health, Hyderabad, India
| | - Youlin Qiao
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Ginindza TG, Forestier M, Almonte M. Cervical cancer screening by visual inspection and HPV testing in Eswatini. Prev Med 2022; 161:107144. [PMID: 35810934 PMCID: PMC9343965 DOI: 10.1016/j.ypmed.2022.107144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/23/2022] [Accepted: 07/02/2022] [Indexed: 11/24/2022]
Abstract
In 2009, visual inspection with acetic acid (VIA) followed by cryotherapy (VIA-and-cryotherapy), was introduced into the Eswatini cervical cancer prevention programme. We present screening results of 654 women attending VIA-and-cryotherapy who participated in a sexually transmitted infections prevalence study, at which samples for HPV DNA testing and liquid-based cytology (LBC) were also collected. VIA positives (VIA+) ineligible for cryotherapy, suspected cancers and women with high-grade squamous intraepithelial or worse lesions (HSIL+) on LBC were referred for diagnosis and treatment. Women with negative VIA who were HPV positive (HPV+) and those VIA+ treated with cryotherapy were recalled for another VIA one-year later. The positivity rates of VIA, HPV, atypical squamous cells of undetermined significance or worse cytology abnormalities (LBC ASCUS+) and low-grade squamous intraepithelial or worse lesions (LBC LSIL+) were 9.7%, 42.6%, 13.2% and 5.3%, respectively. HPV testing detected 29 of 31 LSIL+ (93.6%, 95%CI: 78.6-99.2) while VIA only detected 11 (35.6%, 95%CI: 19.2-54.6). The HIV prevalence was 43% (95%CI: 39.2-46.9). HIV positives were at increased risk of being VIA+ (age-adjusted odds ratio: 2.5, 95%CI: 1.5-4.3), HPV+ (3.7, 2.6-5.3) and having LSIL+ (16.3, 4.9-54.8). The ineligibility rates for cryotherapy were 38% (24 of 63 VIA+), and 46% among HIV positives (18 of 39 VIA+). HPV testing was substantially more sensitive than VIA, thus, HPV followed by ablative treatment may be more effective. However, the high ineligibility for cryotherapy highlights the need for improving the assessment of eligibility for ablative treatment and for strengthening colposcopy, particularly in populations with high HIV prevalence.
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Affiliation(s)
- Themba G Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Cancer and Infectious Disease Epidemiology Research Unit (CIDERU), Durban, South Africa
| | | | - Maribel Almonte
- International Agency for Research on Cancer (IARC), Lyon, France.
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14
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Correa RM, Baena A, Valls J, Colucci MC, Mendoza L, Rol M, Wiesner C, Ferrera A, Fellner MD, González JV, Basiletti JA, Mongelos P, Rodriguez de la Peña M, Saino A, Kasamatsu E, Velarde C, Macavilca N, Martinez S, Venegas G, Calderón A, Rodriguez G, Barrios H, Herrero R, Almonte M, Picconi MA. Distribution of human papillomavirus genotypes by severity of cervical lesions in HPV screened positive women from the ESTAMPA study in Latin America. PLoS One 2022; 17:e0272205. [PMID: 35905130 PMCID: PMC9337688 DOI: 10.1371/journal.pone.0272205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
Abstract
The proportion of HPV16 and 18-associated cervical cancer (CC) appears rather constant worldwide (≥70%), but the relative importance of the other HR-HPV differs slightly by geographical region. Here, we studied the HPV genotype distribution of HPV positive Latin American (LA) women by histological grade, in a sub-cohort from the ESTAMPA study; we also explored the association of age-specific HPV genotypes in severe lesions. Cervical samples from 1,252 participants (854 ≤CIN1, 121 CIN2, 194 CIN3 and 83 CC) were genotyped by two PCRs-Reverse Blotting Hybridization strategies: i) Broad-Spectrum General Primers 5+/6+ and ii) PGMY9/11 PCRs. HPV16 was the most frequently found genotype in all histological grades, and increased with the severity of lesions from 14.5% in ≤ CIN1, 19.8% in CIN2, 51.5% in CIN3 to 65.1% in CC (p < 0.001). For the remaining HR-HPVs their frequency in CC did not increase when compared to less severe categories. The nonavalent vaccine HR-types ranked at the top in CC, the dominant ones being HPV16 and HPV45. HR-HPV single infection occurs, respectively, in 57.1% and 57.0% of ≤CIN1 and CIN2, increasing to 72.2% and 91.6% in CIN3 and CC (p<0.001). No association between age and HPV type was observed in CC, although the risk of HPV16 infection in CIN3 cases increased with age. Results confirm the relevance of HPV16 in the whole clinical spectrum, with a strong rise of its proportion in CIN3 and cancer. This information will be relevant in evaluating the impact of HPV vaccination, as a baseline against which to compare genotype changes in HPV type-specific distribution as vaccinated women participate in screening in LA region. Likewise, these data may help select the best HPV testing system for HPV-based efficient, affordable, and sustainable screening programmes.
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Affiliation(s)
- Rita Mariel Correa
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Armando Baena
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Joan Valls
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - María Celeste Colucci
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay, San Lorenzo, Paraguay
| | - Maryluz Rol
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tagucigalpa, Honduras
| | - María Dolores Fellner
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Joaquín Víctor González
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Jorge Alejandro Basiletti
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Pamela Mongelos
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay, San Lorenzo, Paraguay
| | | | - Agustina Saino
- Sección Histología, Servicio Anatomía Patológica, Hospital Nacional “Prof. Posadas”, El Palomar, Argentina
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay, San Lorenzo, Paraguay
| | - Carlos Velarde
- Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Perú
| | | | | | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social, Región Pacífico Central, San José, Costa Rica
| | | | - Hernán Barrios
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay, San Lorenzo, Paraguay
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, San José, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - María Alejandra Picconi
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia de HPV, Instituto Nacional de Enfermedades Infecciosas- ANLIS "Dr. Malbrán", Buenos Aires, Argentina
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15
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Basu P, Carvalho AL, Almonte M, Chajès V, Weiderpass E. Pulling the investment levers on implementation research in oncology. Lancet Oncol 2022; 23:451-452. [PMID: 35358451 DOI: 10.1016/s1470-2045(22)00025-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Partha Basu
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France.
| | - Andre L Carvalho
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
| | - Véronique Chajès
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
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16
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Broutet N, Jeronimo J, Kumar S, Almonte M, Murillo R, Huy NVQ, Denny L, Kapambwe S, Bhatla N, Sebitloane M, Zhao F, Gravitt P, Adsul P, Rangaraj A, Dalal S, Newman M, Chowdhury R, Church K, Nakisige C, Diop M, Parham G, Thomson KA, Basu P, Steyn P. Implementation research to accelerate scale-up of national screen and treat strategies towards the elimination of cervical cancer. Prev Med 2022; 155:106906. [PMID: 34896155 DOI: 10.1016/j.ypmed.2021.106906] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical cancer is a significant public health problem, with 570,000 new cases and 300,000 deaths of women per year globally, mostly in low- and middle-income countries. In 2018 the WHO Director General made a call to action for the elimination of cervical cancer as a public health problem. MAIN BODY New thinking on programmatic approaches to introduce emerging technologies and screening and treatment interventions of cervical precancer at scale is needed to achieve elimination goals. Implementation research (IR) is an important yet underused tool for facilitating scale-up of evidence-based screening and treatment interventions, as most research has focused on developing and evaluating new interventions. It is time for countries to define their specific IR needs to understand acceptability, feasibility, and cost-effectiveness of interventions as to design and ensure effective implementation, scale-up, and sustainability of evidence-based screening and treatment interventions. WHO convened an expert advisory group to identify priority IR questions for HPV-based screening and treatment interventions in population-based programmes. Several international organizations are supporting large scale introduction of screen-and-treat approaches in many countries, providing ideal platforms to evaluate different approaches and strategies in diverse national contexts. CONCLUSION For reducing cervical cancer incidence and mortality, the readiness of health systems, the reach and effectiveness of new technologies and algorithms for increasing screening and treatment coverage, and the factors that support sustainability of these programmes need to be better understood. Answering these key IR questions could provide actionable guidance for countries seeking to implement the WHO Global Strategy towards cervical cancer elimination.
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Affiliation(s)
| | - Jose Jeronimo
- Consultant for the US National Cancer Institute, MD, USA
| | | | - Maribel Almonte
- International Agency for Research in Cancer (IARC), Lyon, France
| | | | | | | | | | - Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Fanghui Zhao
- Chinese Academy of Medical Sciences, Beijing, China
| | - Patti Gravitt
- University of Maryland Baltimore, Baltimore, MD, USA
| | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, USA
| | | | - Shona Dalal
- World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Mamadou Diop
- Cancer Institute, Le Dantec Hospital, Cheikh Anta Diop University, Senegal
| | - Groesbeck Parham
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry A Thomson
- PATH, Sexual & Reproductive Health Program, Seattle, WA, USA
| | - Partha Basu
- International Agency for Research in Cancer (IARC), Lyon, France
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17
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Arbyn M, Simon M, Peeters E, Xu L, Meijer CJLM, Berkhof J, Cuschieri K, Bonde J, Ostrbenk Vanlencak A, Zhao FH, Rezhake R, Gultekin M, Dillner J, de Sanjosé S, Canfell K, Hillemanns P, Almonte M, Wentzensen N, Poljak M. 2020 list of human papillomavirus assays suitable for primary cervical cancer screening. Clin Microbiol Infect 2021; 27:1083-1095. [PMID: 33975008 DOI: 10.1016/j.cmi.2021.04.031] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Only clinically validated HPV assays can be accepted in cervical cancer screening. OBJECTIVES To update the list of high-risk HPV assays that fulfil the 2009 international validation criteria (Meijer-2009). DATA SOURCES PubMed/Medline, Embase, Scopus, references from selected studies; published in January 2014 to August 2020. STUDY ELIGIBILITY CRITERIA HPV test validation studies and primary screening studies, involving testing with an index HPV test and a comparator HPV test with reporting of disease outcome (occurrence of histologically confirmed cervical precancer; CIN2+). PARTICIPANTS Women participating in cervical cancer screening. INTERVENTIONS Testing with an index and a comparator HPV test of clinician-collected cervical specimens and assessment of disease outcome ( METHODS Assessment of relative clinical accuracy (including non-inferiority statistics index vs comparator assay) and test reproducibility in individual studies; random effects meta-analyses of the relative clinical sensitivity and specificity of index vs comparator tests. RESULTS Seven hrHPV DNA tests consistently fulfilled all validation criteria in multiple studies using predefined test positivity cut-offs (Abbott RealTime High Risk HPV, Anyplex II HPV HR Detection, BD Onclarity HPV Assay, Cobas 4800 HPV Test, HPV-Risk Assay, PapilloCheck HPV-Screening Test and Xpert HPV). Another assay (Alinity m HR HPV Assay) was fully validated in one validation study. The newer Cobas 6800 HPV Test, was validated in two studies against Cobas 4800. Other tests partially fulfilled the international validation criteria (Cervista HPV HR Test, EUROArray HPV, Hybribio's 14 High-Risk HPV, LMNX Genotyping Kit GP HPV, MALDI-TOF, RIATOL qPCR and a number of other in-house developed assays) since the non-inferior accuracy was reached after a posteriori cut-off optimization, inconsistent accuracy findings in different studies, and/or insufficient reproducibility assessment. The APTIMA HPV Assay targeting E6/E7 mRNA of hrHPV was fully validated in one formal validation study and showed slightly lower pooled sensitivity but higher specificity than the standard comparator tests in seven screening studies. However, the current international validation criteria relate to DNA assays. The additional requirement for longitudinal performance data required for non-DNA based HPV assays was not assessed in this review. CONCLUSIONS Eleven hrHPV DNA assays fulfil all requirements for use in cervical cancer screening using clinician-collected specimens.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium.
| | - Marie Simon
- Haute Autorité de Santé, Saint Denis, France
| | - Eliana Peeters
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Lan Xu
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chris J L M Meijer
- Department of Pathology, Amsterdam University Medical Centre, location VUMC, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anja Ostrbenk Vanlencak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Remila Rezhake
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The 3rd Affiliated Teaching Hospital of Xinjiang Medical University (Affiliated Cancer Hospital), Urumqi, China
| | - Murat Gultekin
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Ankara, Turkey
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia
| | - Peter Hillemanns
- Departments of Gynaecology and Obstetrics, Hannover Medical School, Germany
| | | | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer, Institute, Bethesda, MD, USA
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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18
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Baena A, Agudelo MC, Lopez C, Ramírez AT, Castañeda KM, Bedoya AM, Riveros M, Posada G, Borrero M, Buitrago CA, Suescun D, Gomez LJ, Ochoa JC, Stoler M, Gage J, Castle PE, Sasieni P, Almonte M, Herrero R, Sanchez GI. Comparison of immediate colposcopy, repeat conventional cytology and hrHPV testing for the clinical management of ASC-US cytology in routine health services of Medellin, Colombia: The ASCUS-COL Trial. Int J Cancer 2020; 148:1394-1407. [PMID: 33006400 DOI: 10.1002/ijc.33318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/17/2020] [Accepted: 09/03/2020] [Indexed: 12/24/2022]
Abstract
In the context of opportunistic cervical cancer screening settings of low-and-middle-income countries, little is known about the benefits of high-risk human papillomavirus (hrHPV) testing on high-grade cervical abnormality detection among women with atypical squamous cells of undetermined significance (ASC-US) cytology in routine clinical practice. We compared the effectiveness of immediate colposcopy (IC), conventional cytology at 6 and 12 months (colposcopy if ≥ASC-US) (RC), and hrHPV testing (colposcopy if hrHPV-positive) (HPV) to detect cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) among women aged 20-69 years with ASC-US in routine care. Participants (n=2,661) were evenly randomized into three arms (n=882 IC, n=890 RC, n=889 HPV) to receive services by routine healthcare providers and invited to an exit visit 24 months after recruitment. Histopathology was blindly reviewed by a quality-control external panel (QC). The primary endpoint was the first QC-diagnosed CIN2+ or CIN3+ detected during three periods: enrolment (≤6 months for IC and HPV, ≤12 months for RC), follow-up (between enrolment and exit visit), and exit visit. The trial is completed. Colposcopy was done on 88%, 42%, and 52% of participants in IC, RC, and HPV. Overall, 212 CIN2+ and 52 CIN3+ cases were diagnosed. No differences were observed for CIN2+ detection (p=0.821). However, compared to IC, only HPV significantly reduced CIN3+ cases that providers were unable to detect during the 2-year routine follow-up (relative proportion 0.35, 95% CI 0.09-0.87). In this context, hrHPV testing was the most effective and efficient management strategy for women with ASC-US cytology.
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Affiliation(s)
- Armando Baena
- Group Infection and Cancer, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Maria C Agudelo
- Group Infection and Cancer, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Carolina Lopez
- Department of Pathology School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Arianis Tatiana Ramírez
- Group Infection and Cancer, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Kelly Melisa Castañeda
- Group Infection and Cancer, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Astrid M Bedoya
- Group Infection and Cancer, School of Medicine, Universidad de Antioquia, Medellin, Colombia
- School of Microbiology, Universidad de Antioquia, Medellin
| | - Marcela Riveros
- Department of Pathology, Pablo Tobon Uribe Hospital, Medellin, Colombia
| | | | - Mauricio Borrero
- Department of Gynecology and Obstetrics, School of Medicine, Universidad de Antioquia,, Medellin, Colombia
| | - Carlos A Buitrago
- Department of Gynecology and Obstetrics, Clinica SOMA, Medellin, Colombia
| | - David Suescun
- Department of Pathology, Laboratory of Pathology and Cytology Suescun, Medellin, Colombia
| | - Luis J Gomez
- Medical Scientific Direction, Dinamica IPS, Medellin, Colombia
| | - Juan C Ochoa
- Department of Gynecology and Obstetrics, Unidad Videodiagnóstica de la Mujer, Medellin, Colombia
| | - Mark Stoler
- Department of Pathology and Laboratory Medicine, University of Virginia, Charlottesville, VA, USA
| | - Julia Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, USA
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
| | - Maribel Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer / World Health Organization. Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer / World Health Organization. Lyon, France
- Agencia Costarricense de Investigaciones Biomédicas, Guanacaste, Costa Rica
| | - Gloria I Sanchez
- Group Infection and Cancer, School of Medicine, Universidad de Antioquia, Medellin, Colombia
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Baena A, De Vuyst H, Mesher D, Kasubi M, Yuma S, Mwaiselage J, Zouiouich S, Mlay P, Kahesa C, Landoulsi S, de la Luz Hernandez M, Lucas E, Herrero R, Almonte M, Broutet N. Reproducibility of a Rapid Human Papillomavirus Test at Different Levels of the Healthcare System in Tanzania: The AISHA Study. Cancer Epidemiol Biomarkers Prev 2020; 29:2261-2268. [PMID: 32856600 DOI: 10.1158/1055-9965.epi-20-0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/23/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To inform policy makers in Tanzania if and how best to implement rapid HPV testing, we assessed the interobserver reproducibility of careHPV test at three different levels of the healthcare system in an urban and a rural region of Tanzania. METHODS Women aged 30 to 50 years were screened by careHPV testing in two primary healthcare centers (PHC), two district hospitals (DiH), and two regional hospitals (ReH). Aliquots were retested at regional (ReH) and national referral laboratories (NRL). Reproducibility was evaluated using agreement and kappa index measures. Intralaboratory reproducibility was also evaluated in a set of 10 positive and 10 negative samples. RESULTS Samples from 1,134 women were locally tested and retested at ReH and/or NRL. Test results from Dar es Salaam ReH and Kilimanjaro PHC showed clear quality problems including suspicion of contamination during testing or aliquoting. After excluding these samples, 18.8% of 743 women were HPV positive at clinic level. The resulting careHPV reproducibility at different levels of the healthcare system was very good [agreement 95.7%, 95% confidence interval (CI), 94.0-96.9; kappa, 0.86, 95% CI, 0.81-0.91]. Intralaboratory agreement was also very good across four different experiments, with Fleiss' kappa between 0.87 (95% CI, 0.61-1.00) and 1.00 (0.75-1.00). CONCLUSIONS Rapid HPV testing was highly reproducible between lower and higher levels of the healthcare system in Tanzania; however, performance seems to be operator dependent. IMPACT The careHPV test seems to be a feasible option for cervical cancer screening in an organized, decentralized system and in limited-resource settings if quality assurance measures are in place.
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Affiliation(s)
- Armando Baena
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Hugo De Vuyst
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France.
| | - David Mesher
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France.,Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, United Kingdom
| | - Mabula Kasubi
- Department of Microbiology/Immunology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Safina Yuma
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Julius Mwaiselage
- Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Semi Zouiouich
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Pendo Mlay
- Department of Gynecology and Obstetrics, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Crispin Kahesa
- Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Sihem Landoulsi
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Maria de la Luz Hernandez
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Maribel Almonte
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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20
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Soto-Salgado M, Almonte M, Ortiz AP, Suarez EL, Pericchi LR, Baena A, Herrero R. Abstract LB-165: Risk factor prediction models for triage of HR-HPV positive women: The Estampa study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-lb-165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Cervical cancer remains an important public health problem worldwide, being the 4th most common cancer in women globally. HPV testing has been proposed for primary cervical cancer screening, given its higher sensitivity compared to cytology to detect cervical cancer precursors. However, HPV testing may lead to costly and unnecessary increases in follow-ups and/or treatments for transiently HPV positive women. Thus, triage methods are needed for HR-HPV positive women to determine optimal management. This study aims to construct and validate a risk prediction model for cervical pre-cancer based on demographics, clinical, and lifestyle characteristics among HR-HPV positive women. Methods: This analysis from the Multicentric study of cervical cancer screening and triage with HPV testing (ESTAMPA) included HR-HPV positive women aged 30-65 recruited on nine countries in Latin America from 2012 to 2019 (n=4565). The outcomes were: (1) cervical intraepithelial neoplasia grade 2 or more severe disease (CIN2+), and (2) CIN grade 3 or more severe disease (CIN3+) before final pathology review. Covariates included demographic characteristics and cervical cancer risk factors. Univariate logistic regression models were used to assess potential predictors of CIN2+ and CIN3+, controlling for the effect of the country of residence, using a multilevel approach. A multivariate logistic regression model was used to predict outcomes. After computing the probability of CIN2+ and CIN3+ among participants, we categorized these probabilities in deciles, to set the scale boundaries. Receiver-operating curves (ROC) and the Area under the Curves (AUC) were constructed. Sensitivity, specificity and predictive values were used to summarize the performance of the scoring system. Results: The prevalence of CIN2+ and CIN3+ in the study population were 14.7% and 9.7%, respectively. Age at recruitment, history of last Pap test, number of pregnancies, use of oral contraceptives, cigarette use and age at first sexual intercourse were significantly associated (p<0.05) with having CIN2+ and CIN3+. The AUC for the risk factor prediction model was 0.66 for CIN2+ and 0.69 for CIN3+. The optimal cutpoint selected by the Youden's statistic was the 5th decile for CIN2+ and 6th decile for CIN3+. This optimal point was for women with probabilities of CIN2+ greater than 13% and greater than 10% for CIN3+. Thus, in these deciles the number of referrals to colposcopy decreased from 100% to 60% for CIN2+ (100% to 49% for CIN3+), and the sensitivity and specificity obtained in this decile was 80% and 43% for CIN2+, respectively (73% and 54% for CIN3+). Conclusions: Our risk prediction model demonstrated a close to acceptable discrimination. This risk prediction model has the potential to reduce the number of HR-HPV positive women who are referred to colposcopy or treatment unnecessarily, reducing the burden for the patient and the healthcare system. Further analyses after pathology review are underway.
Citation Format: Marievelisse Soto-Salgado, Maribel Almonte, Ana Patricia Ortiz, Erick L. Suarez, Luis R. Pericchi, Armando Baena, Rolando Herrero. Risk factor prediction models for triage of HR-HPV positive women: The Estampa study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-165.
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Affiliation(s)
| | - Maribel Almonte
- 2International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Erick L. Suarez
- 4University of Puerto Rico Graduate School of Public Health, San Juan, PR
| | | | - Armando Baena
- 2International Agency for Research on Cancer (IARC), Lyon, France
| | - Rolando Herrero
- 2International Agency for Research on Cancer (IARC), Lyon, France
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Honaryar MK, Tarasenko Y, Almonte M, Smelov V. Epidemiology of Cancers in Men Who Have Sex with Men (MSM): A Protocol for Umbrella Review of Systematic Reviews. Int J Environ Res Public Health 2020; 17:E4954. [PMID: 32660003 PMCID: PMC7400300 DOI: 10.3390/ijerph17144954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022]
Abstract
While earlier studies on men having sex with men (MSM) tended to examine infection-related cancers, an increasing number of studies have been focusing on effects of sexual orientation on other cancers and social and cultural causes for cancer disparities. As a type of tertiary research, this umbrella review (UR) aims to synthesize findings from existing review studies on the effects of sexual orientation on cancer. Relevant peer-reviewed systematic reviews (SRs) will be identified without date or language restrictions using MEDLINE, Cochrane Database of Systematic Reviews, and the International Prospective Register for Systematic Reviews, among others. The research team members will prepare the data extraction forms. Two reviewers will independently assess extracted SRs using the Assessment of Methodological Quality of Systematic Reviews. A third reviewer will weigh in to resolve discrepancies. The reviewers will be blinded to publisher, journal, and authors, making their judgements on the title, year, and abstract. The Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist will guide data synthesis. By collating evidence from multiple reviews into one accessible and usable document, our first UR on global epidemiology of malignancies among MSM would serve as an evidence-based decision-making tool for the public health community.
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Affiliation(s)
- Manoj Kumar Honaryar
- Prevention and Implementation Group (PRI), International Agency for Research on Cancer (IARC), World Health Organization (WHO), 150 Cours Albert Thomas, 69372 Lyon, France; (M.K.H.); (M.A.)
- Service des Urgences, Hôpital Lariboisiere, Assistance Publique Hôpitaux de Paris (Aphp), 2 Rue Ambroise Paré, 75010 Paris, France
| | - Yelena Tarasenko
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Dr, Statesboro, GA 30458, USA;
| | - Maribel Almonte
- Prevention and Implementation Group (PRI), International Agency for Research on Cancer (IARC), World Health Organization (WHO), 150 Cours Albert Thomas, 69372 Lyon, France; (M.K.H.); (M.A.)
| | - Vitaly Smelov
- Prevention and Implementation Group (PRI), International Agency for Research on Cancer (IARC), World Health Organization (WHO), 150 Cours Albert Thomas, 69372 Lyon, France; (M.K.H.); (M.A.)
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen, Denmark
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Wan M, Almonte M, Gelfand J, Ogdie A. 514 Using design thinking to develop a decision aid for patients with psoriatic disease. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arrossi S, Almonte M, Herrero R, Gago J, Sánchez Antelo V, Szwarc L, Thouyaret L, Paolino M, Wiesner C. Psycho-social impact of positive human papillomavirus testing in Jujuy, Argentina results from the Psycho-Estampa study. Prev Med Rep 2020; 18:101070. [PMID: 32257775 PMCID: PMC7113430 DOI: 10.1016/j.pmedr.2020.101070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
Human papillomavirus (HPV) testing can have a negative impact on women's lives which might also result in abandoning the follow-up and treatment process. This study measured the psycho-social impact of HPV-positivity among HPV-tested women from Jujuy, Argentina, a middle-low income setting. In this cross-sectional study (2015-2016), the psycho-social impact of HPV-positivity was measured using the Psycho-Estampa Scale, specifically designed and validated to be used in screening contexts. We measured mean scores for each of the five scale domains, and the Overall Impact score (Values from 1: No impact to 4: Heavy impact). We compared scores according to cytology triage diagnosis using ordinal logistic regression. A total of 163 HPV-positive women were recruited at the Centro Carlos Alvarado hospital and included in the study sample; of these, 124 (76.1%) had normal triage cytologies. The overall Impact score was between low and moderate (mean:2.56, SD:0.65). The highest psycho-social impact was measured in the Worries about cancer and treatment domain (mean score:3.60, SD:0.60), followed by Sexuality domain (mean:2.50; SD:1.00). The Uncertainty about information provided by health providers domain had the lowest mean score (mean:2.14, SD:0.73). Compared to women with normal cytologies (n = 124), women with abnormal cytologies (n = 39) had a higher likelihood of greater overall Psycho-social Impact (OR: 2.91; p = 0.0036). No statistically significant differences were found in scores of specific domains according to cytology results. It is important to devise specific counseling interventions to reduce the psycho-social impact of HPV-Testing as primary screening and its potential effect on completion of the diagnosis/ treatment process.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Maribel Almonte
- International Agency for Research on Cancer/World Health Organization (IARC-WHO), 150 Cours Albert Thomas, Lyon 69372, France
| | - Rolando Herrero
- International Agency for Research on Cancer/World Health Organization (IARC-WHO), 150 Cours Albert Thomas, Lyon 69372, France
| | - Juan Gago
- New York University-NYU, School of Medicine, USA
| | | | - Lucila Szwarc
- Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Av. Julio A. Roca 781, Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Carolina Wiesner
- Instituto Nacional de Cancerología, Calle 1 No.9-85, Bogotá, Colombia
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24
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Almonte M, Murillo R, Sánchez GI, González P, Ferrera A, Picconi MA, Wiesner C, Cruz-Valdez A, Lazcano-Ponce E, Jerónimo J, Ferreccio C, Kasamatsu E, Mendoza L, Rodríguez G, Calderón A, Venegas G, Villagra V, Tatti S, Fleider L, Terán C, Baena A, Hernández MDLL, Rol ML, Lucas E, Barbier S, Ramírez AT, Arrossi S, Rodríguez MI, González E, Celis M, Martínez S, Salgado Y, Ortega M, Beracochea AV, Pérez N, Rodríguez de la Peña M, Ramón M, Hernández-Nevarez P, Arboleda-Naranjo M, Cabrera Y, Salgado B, García L, Retana MA, Colucci MC, Arias-Stella J, Bellido-Fuentes Y, Bobadilla ML, Olmedo G, Brito-García I, Méndez-Herrera A, Cardinal L, Flores B, Peñaranda J, Martínez-Better J, Soilán A, Figueroa J, Caserta B, Sosa C, Moreno A, Mural J, Doimi F, Giménez D, Rodríguez H, Lora O, Luciani S, Broutet N, Darragh T, Herrero R. Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol. BMJ Open 2020; 10:e035796. [PMID: 32448795 PMCID: PMC7252979 DOI: 10.1136/bmjopen-2019-035796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT01881659.
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Affiliation(s)
- Maribel Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Raúl Murillo
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Paula González
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | | | | | | | | | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Gino Venegas
- Clínica Angloamericana, Lima, Perú
- Escuela de Medicina Humana, Universidad de Piura, Lima, Perú
| | | | - Silvio Tatti
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Armando Baena
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - María de la Luz Hernández
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- SMS-Oncology, Amsterdam, The Netherlands
| | - Mary Luz Rol
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Eric Lucas
- Screening Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Sylvaine Barbier
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Arianis Tatiana Ramírez
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - María Isabel Rodríguez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Marcela Celis
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Instituto Nacional del Cáncer, Ministerio de Salud Pública y Bienestar Social, Capiatá, Paraguay
| | - Andrea Verónica Beracochea
- Centro de Salud Ciudad de la Costa, ASSE, Ciudad de la Costa, Uruguay
- Hospital Policial, DNASS, Montevideo, Uruguay
| | - Natalia Pérez
- Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay
| | | | | | | | | | - Yessy Cabrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - María Celeste Colucci
- Instituto Nacional de Enfermedades Infecciosas - ANLIS Malbrán, Buenos Aires, Argentina
| | | | | | | | - Gladys Olmedo
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Betsy Flores
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Jhacquelin Peñaranda
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Ana Soilán
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | | | - Benedicta Caserta
- Departamento de Anatomía Patológica y Citología, Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Carlos Sosa
- Hospital Monseñor Víctor Manuel Sanabria Martínez, CCSS, Puntarenas, Costa Rica
| | - Adrián Moreno
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Juan Mural
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Diana Giménez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Hernando Rodríguez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Oscar Lora
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
- Hospital Gineco-Obstétrico y Neonatal "Dr Jaime Sánchez Porcel", Sucre, Bolivia
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, District of Columbia, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Teresa Darragh
- Department of Pathology, University of California, San Francisco, California, USA
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
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Pilleron S, Cabasag CJ, Ferlay J, Bray F, Luciani S, Almonte M, Piñeros M. Cervical cancer burden in Latin America and the Caribbean: Where are we? Int J Cancer 2020; 147:1638-1648. [PMID: 32150288 DOI: 10.1002/ijc.32956] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 12/24/2022]
Abstract
In May 2018, the World Health Organization (WHO) called for the elimination of cervical cancer. To monitor this initiative, we examined cervical cancer incidence and mortality in the Latin America and Caribbean (LAC) region using GLOBOCAN 2018, Cancer Incidence in Five Continents Series, and the WHO Mortality Database. We estimated the number of cases and age-standardized rates (ASRs) for cervical cancer incidence and mortality for 2018. We also presented the ASRs for recorded cervical cancer incidence from the period 2008 to 2012. We calculated annual rates and analyzed trends in cervical cancer incidence and mortality for all ages combined and for the following age groups: 0-29, 30-49, 50-64 and 65+. Finally, we calculated the estimated average annual percentage change in incidence and mortality rates for the past 10 years. In 2018, an estimated 56,000 new cervical cancer cases and 28,000 cervical cancer deaths occurred among women in LAC with great variations between subregions and countries/territories. Overall, trends in cervical cancer incidence and mortality have decreased over the past decade; however, the rates are still above the elimination threshold of 4 per 100,000 in most LAC countries/territories. Despite the encouraging trends observed, achieving the elimination of cervical cancer in the region still requests substantial political commitment and economic effort. Population-based cancer registries are critical in monitoring the elimination initiative.
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Affiliation(s)
- Sophie Pilleron
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Citadel J Cabasag
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Silvana Luciani
- Unit of Non-communicable Diseases, Violence and Injuries Prevention, PAHO, Washington, District of Columbia, USA, USA
| | - Maribel Almonte
- Prevention and Implementation Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Marion Piñeros
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Ferrera A, Valladares W, Cabrera Y, de la Luz Hernandez M, Darragh T, Baena A, Almonte M, Herrero R. Performance of an HPV 16/18 E6 oncoprotein test for detection of cervical precancer and cancer. Int J Cancer 2019; 145:2042-2050. [PMID: 30684396 DOI: 10.1002/ijc.32156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/23/2018] [Accepted: 12/20/2018] [Indexed: 11/06/2022]
Abstract
HPV testing is a better alternative for cervical cancer screening, but additional procedures are required for triage of HPV positive women. HPV encoded oncoproteins E6 and E7, as the main effectors of HPV carcinogenicity represent promising triage alternatives. To evaluate performance of the test, we included 155 women from a screening study and 59 from the same referral population attending colposcopy and with precancerous lesions. All were HPV-tested with HC2 and genotyped with LiPA, and cervical swabs were tested for HPV16/18 E6 oncoproteins. Histologic specimens were reviewed and adjudicated using p16 immunohistochemistry and 55 women had confirmed histologic HSIL, 31 (56.3%) associated with HPV 16/18, 23 with other HPV types and one HPV negative. Sensitivity and specificity were estimated with histologic HSIL/cancer as gold standard. E6 oncoprotein was detectable in all but one HSIL and in all cancers where HPV16/18 DNA was detected, but in none of the cases associated with other HPV types or HPV negatives. Among the few HPV16/18 DNA positive subjects initially without HSIL (n = 4) who were E6 oncoprotein positive, precancer was detected during follow-up in 2 out of 3 with available information. Estimated sensitivity for HPV16/18-related HSIL+ was 96.8% (95%CI = 83.8-99.8) and for all HSIL+ regardless of HPV type it was 56.4% (95%CI = 43.3-68.6). Specificity was 97.5% (95%CI = 93.7-99.0). E6 oncoprotein proved as a highly sensitive and specific marker for detection of HPV16/18-related HSIL lesions in this Honduran population with limited previous screening and may be useful as a triage method in screening programs, particularly in low income countries.
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Affiliation(s)
- Annabelle Ferrera
- Escuela de Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Wendy Valladares
- Escuela de Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Yessy Cabrera
- Escuela de Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Maria de la Luz Hernandez
- Prevention and Implementation Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Teresa Darragh
- Department of Pathology, UCSF Mt. Zion Medical Center, San Francisco, CA
| | - Armando Baena
- Prevention and Implementation Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Maribel Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
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Kasamatsu E, Rodríguez Riveros MI, Soilan AM, Ortega M, Mongelós P, Páez M, Castro A, Cristaldo C, Báez FR, Centurión CC, Vester J, Barrios H, Villalba G, Amarilla ML, Giménez G, Caubere E, Hernández MDLL, Baena A, Almonte M, Herrero R, Mendoza LP. Factors associated with high-risk human papillomavirus infection and high-grade cervical neoplasia: A population-based study in Paraguay. PLoS One 2019; 14:e0218016. [PMID: 31246959 PMCID: PMC6597051 DOI: 10.1371/journal.pone.0218016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/23/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer (CC) is one of the leading causes of cancer mortality among women from Paraguay, with high incidence and mortality rates (31.2 and 16 per 100 000 women, respectively). Although the risk factors associated with high-risk human papillomavirus (hrHPV) infection and preneoplastic cervical lesions are widely studied, population-based characteristics of particular settings may influence the feasibility of HPV-based CC screening implementation. This study aimed to explore factors associated with hrHPV infection and high-grade cervical neoplasia in hrHPV-positive (hrHPV+) women from Paraguay. METHODS A total of 5677 women aged 30-64 years from the Central Department of Paraguay were screened with HPV test (Hybrid Capture 2) and Pap smear. Sociodemographic and risk factor interviews were conducted. hrHPV+ women were referred to colposcopy and women with an abnormal colposcopy had a biopsy taken. The outcomes recorded were the hrHPV status and the presence of high-grade cervical intraepithelial neoplasia or worse (CIN2+) among hrHPV+ women. Associations were investigated using multivariate logistic regressions. RESULTS hrHPV prevalence was 13.8% (95%CI 13.0-14.8). This value decreased with the age of women (p-trend<0.001) and increased with the lifetime number of sexual partners (p-trend<0.001) and number of previous female partners of their current male partner if women had had one lifetime sexual partner (p-trend<0.001), increasing from 3.06 (95%CI 0.073-20.9) if partners had had one previous female partner to 9.19 (95%CI 2.36-61.1) if they had had eight or more. In hrHPV+ women, CIN2+ prevalence was 10.7% (95%CI 8.58-13.2) and increased with time since the last Pap smear (p-trend<0.001) and with the increasing number of pregnancies (p-trend = 0.05). CONCLUSION In these settings, the sexual behavior of women and their male partners is associated with hrHPV infection. In hrHPV+ women, underscreening practices and multiple pregnancies are associated with CIN2+. This knowledge can contribute to public health policies for CC prevention and control in Paraguay.
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Affiliation(s)
- Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - María Isabel Rodríguez Riveros
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Ana María Soilan
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Pamela Mongelós
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Malvina Páez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Amalia Castro
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Carmen Cristaldo
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Fátima Romina Báez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Claudia Carolina Centurión
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Jaime Vester
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Hernán Barrios
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Griselda Villalba
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - María Luisa Amarilla
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
| | - Graciela Giménez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
| | - Elodie Caubere
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | | | - Armando Baena
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Maribel Almonte
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Rolando Herrero
- International Agency for Research on Cancer, IARC/WHO, Lyon, France
| | - Laura Patricia Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción (IICS-UNA), San Lorenzo, Paraguay
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Robles C, Hernández MDLL, Almonte M. [Alternative HPV vaccination schedules in Latin America]. Salud Publica Mex 2018; 60:693-702. [PMID: 30699274 DOI: 10.21149/9810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/26/2018] [Indexed: 01/15/2023] Open
Abstract
In 2008, the first HPV vaccination program in Latin America started in Panama, targeting girls aged 10-11 years with a 3-dose vaccine schedule, an initiative that was to be followed by other Latin American countries after local feasibility and population acceptability evaluations were completed. A 3-dose vaccine regimen over six months was originally chosen for HPV vaccines, copying the Hepatitis B vaccine schedule (0, 1-2, 6 months). Alternative vaccine schedules have been proposed afterwards based on: i) noninferior immunogenicity or immune response levels compared to those at which clinical efficacy has been proven (i.e., those observed in a 3-dose HPV vaccine schedule in women aged 15-26), and, ii) proven efficacy in clinical trials and/or effectiveness among women who were provided less than three doses due to a lack of adherence to a 3-dose vaccine schedule. In 2014, based on the available evidence and the potential increase in coverage by expansion of vaccination target groups, particularly in low and middle income countries (LMIC), the World Health Organization recommended a 2-dose schedule with at least a 6-month interval between doses for females up to 15 years of age and a 3-dose schedule for older women. More recently, it has been suggested that 1-dose HPV vaccination schemes may provide enough protection against HPV infection and may speed up the introduction of HPV vaccination in LMIC, where most needed.
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Affiliation(s)
- Claudia Robles
- Prevention and Implementation Group, International Agency for Research on Cancer (IARC/WHO). Lyon, France
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L'Hospitalet. Barcelona, Spain
- Bellvitge Biomedical Research Institute, L'Hospitalet. Barcelona, Spain
| | - María de la Luz Hernández
- Prevention and Implementation Group, International Agency for Research on Cancer (IARC/WHO). Lyon, France
| | - Maribel Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer (IARC/WHO). Lyon, France
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Ginindza TG, Almonte M, Dlamini X, Sartorius B. Distribution of cervical abnormalities detected by visual inspection with acetic acid in Swaziland, 2011-2014: A retrospective study. Afr J Prim Health Care Fam Med 2018; 10:e1-e7. [PMID: 30456977 PMCID: PMC6244366 DOI: 10.4102/phcfm.v10i1.1773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/12/2018] [Accepted: 08/15/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer worldwide among women, with the number of new cases increasing from 493 243 in 2002 to 527 000 in 2012. These numbers are likely to be underestimated because given the lack of registration resources, cervical cancer deaths are usually under-reported in low-income countries. AIM To describe the distribution of and trends in visual inspection with acetic acid (VIA) to detected cervical abnormalities in Swaziland by reviewing records of VIA examinations performed at two main hospitals in Swaziland between 2011 and 2014. SETTING Mbabane Government Hospital and Realign Fitkin Memorial (RFM). METHODS Records of cervical screening using VIA at the Mbabane government hospital and RFM hospital between 2011 and 2014 were retrieved. Positivity rates (PRs) of VIA with 95% confidence intervals (95% CI) were calculated and used as proxies of cervical abnormalities. Odds ratios of the association between VIA-detected cervical abnormalities and human immunodeficiency virus (HIV) status were estimated using logistic regressions. RESULTS VIA was positive in 1828 of 12 151 VIA records used for analysis (15%, 95% CI: 14.4-15.7). VIA was positive in 9% (36 of 403) women under the age of 20, in 15.5% (1714 of 11 046) of women aged 20-49 years and in 11.1% (78 of 624) of women aged 50-64 years. A decreasing trend of VIA positivity was observed over time at both screening centres (p for trend < 0.001). Of 2697 records with Papanicolaou results, 20% (67 of 331) VIA-positives and only 5% (114 of 2366) VIA negatives had high-grade squamous intraepithelial lesion. Among 4578 women with reported HIV status, 1702 were HIV-positive (37.2%, 95% CI: 35.8-38.6). The prevalence of HIV in VIA-positive women was 62.5% (95% CI: 58.7-66.2), almost double that among VIA-negative women (33.0%, 95% CI: 31.6-34.5) and that among all women screened (p < 0.001). HIV-positive women were 3.4 times more likely to have cervical abnormalities on VIA than HIV-negative women (OR: 3.4, 95% CI: 2.8-4.0, p < 0.01). CONCLUSION The high VIA PRs observed over four years in this study may reflect the prevalence of cervical abnormalities, in particular, in HIV-positive women. VIA is not a robust screening test, but it can play a major role in strengthening and expanding cervical cancer screening prevention programmes in resource-limited countries.
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Affiliation(s)
- Themba G Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal.
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30
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Robles C, Wiesner C, Martinez S, Salgado Y, Hernandez M, Lucas E, Lineros J, Romero P, Herrero R, Almonte M, Murillo R. Impact of operational factors on HPV positivity rates in an HPV-based screening study in Colombia. Int J Gynaecol Obstet 2018; 143:44-51. [PMID: 29944728 DOI: 10.1002/ijgo.12574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/06/2018] [Accepted: 06/25/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the effect of operational factors on the positivity rates of three HPV assays. METHODS Within the cross-sectional ESTAMPA study, women aged 30-64 years were recruited at healthcare centers from Soacha, Colombia, during 2012-2015. Cervical samples were collected for cotesting with Hybrid Capture 2 (HC2; Qiagen, Gaithersburg, MD, USA), and either Aptima (Hologic, Marlborough, MA, USA) or Cobas 4800 (Roche Diagnostics, Indianapolis, IN, USA). The effect of operational factors on assay performance was assessed using adjusted positivity rates obtained from logistic regression models. RESULTS There were 4168 women included. For samples collected in assay-specific medium, positivity rate differences were associated with the expertise of the nurse collecting the sample (P=0.014 HC2; P=0.091 Aptima) and if sample collection occurred after an initial cytology (P=0.025 HC2; P=0.033 Aptima). If PreservCyt medium (Hologic) was used, HC2 positivity differences were observed depending on the time between sample collection and processing (P=0.026) and on the laboratory technician processing the samples (P=0.003). No differences were observed for PreservCyt samples processed with Aptima or Cobas. CONCLUSION Nurse expertise, collection of previous cytology, processing time, and laboratory technician could influence HPV assay performance. Suitable quality assurance protocols for HPV-based screening programs are required. ClinicalTrials.gov: NCT01881659.
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Affiliation(s)
- Claudia Robles
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Carolina Wiesner
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Sandra Martinez
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Yuly Salgado
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Mariluz Hernandez
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Eric Lucas
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Johana Lineros
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Pilar Romero
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Rolando Herrero
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Maribel Almonte
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Raul Murillo
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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Baena A, Guevara E, Almonte M, Arias-Stella J, Sasieni P, Sanchez GI. Factors related to inter-observer reproducibility of conventional Pap smear cytology: a multilevel analysis of smear and laboratory characteristics. Cytopathology 2017; 28:192-202. [PMID: 28029192 DOI: 10.1111/cyt.12410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify factors that influence the inter-observer reproducibility of the routine, conventional Pap smear cytology (Pap smear test) in a network of certificated laboratories in a middle-income Latin American country. METHODS Twenty-six laboratories provided each an average of 26 negative for malignancy (NILM) and high-grade squamous intraepithelial lesion (HSIL) Pap smears. An external panel reviewed the slides. The kappa index and multilevel logistic regression were used to estimate the reproducibility and odds ratios (OR) of a false result with 95% confidence intervals (95% CI), respectively. Results are presented for laboratories that collect (collector laboratories) and do not collect (non-collector laboratories) samples. RESULTS The agreements ranged widely (median kappa 0.51, range 0.16-0.70). The overall false-positive (FP) and false-negative (FN) rates were 31% (95% CI 27-35) and 11% (95% CI 7-17). Among collector laboratories (N = 14), a bigger sample collection volume decreased the probability of a FP (OR-adjusted 0.05, 95% CI 0.02-0.1) whereas the number of quality defects (OR-adjusted 1.67, 95% CI 1.25-2.24), high workload (OR-adjusted 5.52, 95% CI 3.85-7.92) and collection by cytotechnologists (OR-adjusted 1.28, 95% CI 1.15-1.42) or health professionals (OR-adjusted 2.26, 95% CI 2.04-2.49) instead of nursing assistants increased it. Among non-collector laboratories (N = 9), the FP rate increased with the number of quality defects (OR-adjusted 1.86, 95% CI 1.06-3.26) but decreased if the samples were collected by health professionals instead of nursing assistants (OR-adjusted 0.37, 95%CI 0.17-0.80). No significant associations were observed for FN. CONCLUSIONS Staff in charge of cervical sampling significantly determined the reproducibility of the Pap smear test, but this depended on whether the laboratory collects samples or read samples collected elsewhere.
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Affiliation(s)
- A Baena
- Infection and Cancer Group, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - E Guevara
- Infection and Cancer Group, School of Medicine, Universidad de Antioquia, Medellin, Colombia
| | - M Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - J Arias-Stella
- Institute of Pathology and Molecular Biology, Arias Stella, Lima, Peru
| | - P Sasieni
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - G I Sanchez
- Infection and Cancer Group, School of Medicine, Universidad de Antioquia, Medellin, Colombia
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Ginindza TG, Dlamini X, Almonte M, Herrero R, Jolly PE, Tsoka-Gwegweni JM, Weiderpass E, Broutet N, Sartorius B. Prevalence of and Associated Risk Factors for High Risk Human Papillomavirus among Sexually Active Women, Swaziland. PLoS One 2017; 12:e0170189. [PMID: 28114325 PMCID: PMC5256897 DOI: 10.1371/journal.pone.0170189] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/30/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND High risk human papillomavirus (hr-HPV) infection and the dual burden of HIV remains a huge challenge in some low-income countries (LICs) such as Swaziland with limited or no data. We estimated the prevalence and investigated determinants of hr-HPV, including HIV infection among sexually active women in Swaziland. METHODS A total of 655 women aged between 15 and 49 years from five health facilities were randomly enrolled using a cross-sectional study design. Cervical cells were tested for hr-HPV types using GeneXpert HPV Assays. RESULTS The overall weighted hr-HPV prevalence was 46.2% (95%CI: 42.8-49.5). Of hr-HPV infected women, 12.4% (95%CI: 8.6-17.5) were HPV16-positive, 13.8% (95%CI:12.0-15.8) were positive for HPV18/45, 26.7% (95%CI: 24.2-29.3) for HPV31/33/35/52/58, 7.6% (95%CI: 7.6-11.9) for HPV51/59 and 11.0%, (95%CI: 7.9-15.3) for HPV39/56/66/68. Prevalence of hr-HPV decreased with increasing age. Overall HIV prevalence remained high (42.7%; 95%CI: 35.7-46.2). HIV infection was associated with hr-HPV infection (Adjusted OR = 4.9, 95%CI: 3.043-7.8, p<0.001). Overall hr-HPV/HIV co-infection was 24.4% (95%CI: 20.3-29.1) which was significantly higher among younger age groups (p<0.001). Prevalence of multiple group hr-HPV infection was significantly higher in HIV-positive versus -negative women (27.7% and 12.7% respectively, p<0.001). The presence, absence or unknown of history of STI with HIV did not appear to modify the relationship with hr-HPV (OR = 4.2, 95%CI: 2.6-7.1, OR = 4.6, 95%CI: 2.8-7.7, p<0.001, p<0.001 and OR = 4.1, 95%CI: 1.3-13.4, p<0.021 respectively). CONCLUSION The prevalence of hr-HPV infection was high and significantly associated with HIV among sexually active women. Furthermore, the study has provided essential information about the HIV link with hr-HPV infections which may explain the high prevalence among HIV infected women. This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among youth and HIV infected people.
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Affiliation(s)
- Themba G. Ginindza
- Department of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Maribel Almonte
- International Agency for Research on Cancer (IARC), Prevention and Implementation Group, Lyon, France
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), Prevention and Implementation Group, Lyon, France
| | - Pauline E. Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Joyce M. Tsoka-Gwegweni
- Department of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Nathalie Broutet
- World Health Organization; Department of Reproductive Health and Research, Geneva, Switzerland
| | - Benn Sartorius
- Department of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Armaroli P, Villain P, Suonio E, Almonte M, Anttila A, Atkin WS, Dean PB, de Koning HJ, Dillner L, Herrero R, Kuipers EJ, Lansdorp-Vogelaar I, Minozzi S, Paci E, Regula J, Törnberg S, Segnan N. European Code against Cancer, 4th Edition: Cancer screening. Cancer Epidemiol 2015; 39 Suppl 1:S139-52. [PMID: 26596722 DOI: 10.1016/j.canep.2015.10.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 12/23/2022]
Abstract
In order to update the previous version of the European Code against Cancer and formulate evidence-based recommendations, a systematic search of the literature was performed according to the methodology agreed by the Code Working Groups. Based on the review, the 4th edition of the European Code against Cancer recommends: "Take part in organized cancer screening programmes for: Bowel cancer (men and women); Breast cancer (women); Cervical cancer (women)." Organized screening programs are preferable because they provide better conditions to ensure that the Guidelines for Quality Assurance in Screening are followed in order to achieve the greatest benefit with the least harm. Screening is recommended only for those cancers where a demonstrated life-saving effect substantially outweighs the potential harm of examining very large numbers of people who may otherwise never have, or suffer from, these cancers, and when an adequate quality of the screening is achieved. EU citizens are recommended to participate in cancer screening each time an invitation from the national or regional screening program is received and after having read the information materials provided and carefully considered the potential benefits and harms of screening. Screening programs in the European Union vary with respect to the age groups invited and to the interval between invitations, depending on each country's cancer burden, local resources, and the type of screening test used For colorectal cancer, most programs in the EU invite men and women starting at the age of 50-60 years, and from then on every 2 years if the screening test is the guaiac-based fecal occult blood test or fecal immunochemical test, or every 10 years or more if the screening test is flexible sigmoidoscopy or total colonoscopy. Most programs continue sending invitations to screening up to the age of 70-75 years. For breast cancer, most programs in the EU invite women starting at the age of 50 years, and not before the age of 40 years, and from then on every 2 years until the age of 70-75 years. For cervical cancer, if cytology (Pap) testing is used for screening, most programs in the EU invite women starting at the age of 25-30 years and from then on every 3 or 5 years. If human papillomavirus testing is used for screening, most women are invited starting at the age of 35 years (usually not before age 30 years) and from then on every 5 years or more. Irrespective of the test used, women continue participating in screening until the age of 60 or 65 years, and continue beyond this age unless the most recent test results are normal.
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Affiliation(s)
- Paola Armaroli
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Patricia Villain
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Eero Suonio
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1NY, United Kingdom
| | - Peter B Dean
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Harry J de Koning
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Lena Dillner
- Department of Infectious Disease, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Eugenio Paci
- ISPO-Cancer Prevention and Research Institute, Occupational and Environmental Epidemiology Unit, Ponte Nuovo - Padiglione Mario Fiori, Via delle Oblate 2, 50141 Florence, Italy
| | - Jaroslaw Regula
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Gastroenterology, 02-781 Warsaw, Poland
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm Regional Cancer Centre, PO Box 6909, S-102 39 Stockholm, Sweden
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy.
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Villain P, Gonzalez P, Almonte M, Franceschi S, Dillner J, Anttila A, Park JY, De Vuyst H, Herrero R. European Code against Cancer 4th Edition: Infections and Cancer. Cancer Epidemiol 2015; 39 Suppl 1:S120-38. [PMID: 26589774 DOI: 10.1016/j.canep.2015.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 12/15/2022]
Abstract
Of the 2,635,000 new cancer cases (excluding non-melanoma skin cancers) occurring in the European Union (EU) in 2012, it is estimated that approximately 185,000 are related to infection with human papillomaviruses (HPVs), hepatitis B and C viruses (HBV and HCV), and Helicobacter pylori (H. pylori). Chronic infection with these agents can lead to cancers of the cervix uteri, liver, and stomach, respectively. Chronic infection with HCV can also lead to B-cell non-Hodgkin lymphoma. Human immunodeficiency virus (HIV) infection continues to be of major public health importance in several EU countries and increases cancer risk via HIV-induced immunosuppression. The fourth edition of the European Code Against Cancer presents recommendations on effective and safe preventive interventions in order to reduce the risk of infection-related cancers in EU citizens. Based on current available evidence, the fourth edition recommends that parents ensure the participation of their children in vaccination programs against HBV (for newborns) and HPV (for girls). In the 'Questions and Answers' (Q&As) section about vaccination and infections in the website for the European Code Against Cancer, individuals who are at risk of chronic HBV or HCV are advised to seek medical advice about testing and obtaining treatment when appropriate. Individuals most at risk of HIV are advised to consult their doctor or healthcare provider to access counselling and, if needed, testing and treatment without delay. Information about H. pylori testing and treatment is also provided as testing might currently be offered in some high-risk areas in Europe. The rationale and supporting evidence for the recommendations on vaccination in the European Code Against Cancer, and for the main recommendations on vaccination and infection in the Q&As, are explained in the present review.
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Affiliation(s)
- Patricia Villain
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Paula Gonzalez
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Silvia Franceschi
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden
| | - Ahti Anttila
- Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland
| | - Jin Young Park
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Hugo De Vuyst
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France.
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Bryant D, Hibbitts S, Almonte M, Tristram A, Fiander A, Powell N. Human papillomavirus type 16 L1/L2 DNA methylation shows weak association with cervical disease grade in young women. J Clin Virol 2015; 66:66-71. [PMID: 25866341 DOI: 10.1016/j.jcv.2015.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/20/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Persistent infection with human papillomavirus (HPV) type 16 causes the majority of cervical cancers. Genital HPV infection is very common, but neoplastic progression is uncommon. There is an urgent need for biomarkers associated with cervical neoplasia, to enable triage of women who test positive for HPV. OBJECTIVES To assess the ability of quantitative measurement of HPV16 DNA methylation to separate samples of different cytological and histological grades from young women, among whom rates of HPV infection are high. STUDY DESIGN DNA methylation was quantified by pyrosequencing of bisulphite converted DNA from liquid based cytology samples from 234 women (mean age 20.6 years) who tested positive for HPV16 and showed varying degrees of neoplasia. Methylation was assessed at CpGs in the HPV E2 and L1/L2 regions. RESULTS The performance of methylation-based classifiers was assessed by ROC curve analyses. The best combination of CpGs (5600 and 5609) achieved AUCs of 0.656 (95% CI=0.520-0.792) for separation of cytologically normal and severely dyskaryotic samples, and 0.639 (95% CI=0.547-0.731) for separation of samples with or without high-grade neoplasia (CIN2+/-). CONCLUSIONS The data are consistent with HPV L1/L2 methylation being a marker of the duration of infection in a specific host. Assessment of HPV DNA methylation is hence a promising biomarker to triage HPV-positive cytology samples, but may have limited utility in young women. Future studies assessing the likely utility of HPV DNA methylation as a potential triage biomarker must take account of women's age.
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Affiliation(s)
- Dean Bryant
- School of Medicine, Heath Park, Cardiff University, CF64 3RL, UK.
| | | | - Maribel Almonte
- Prevention and Implementation Group, IARC, Lyon CEDEX 08, France.
| | - Amanda Tristram
- School of Medicine, Heath Park, Cardiff University, CF64 3RL, UK.
| | - Alison Fiander
- School of Medicine, Heath Park, Cardiff University, CF64 3RL, UK.
| | - Ned Powell
- School of Medicine, Heath Park, Cardiff University, CF64 3RL, UK.
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Almonte M, Ferreccio C, Luciani S, Gonzales M, Delgado JM, Santos C, Alvarez M, Cuzick J, Sasieni P. Visual inspection after acetic acid (VIA) is highly heterogeneous in primary cervical screening in Amazonian Peru. PLoS One 2015; 10:e0115355. [PMID: 25635965 PMCID: PMC4312028 DOI: 10.1371/journal.pone.0115355] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/22/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Conventional cytology (Pap) and visual inspection after the application of acetic acid (VIA) are currently used in primary screening in Peru. Studies suggest that the quality of VIA is highly variable. Over 36 000 women were screened with Pap and VIA in the TATI (Tamizaje y Tratamiento Inmediato de Lesiones Cervico-uterinas) project conducted in Amazonian Peru. Within a nested study to compare several screening techniques (C-TATI), a total of 5435 women were additionally screened with liquid-based cytology (LBC) and high-risk human papillomavirus testing (HR-HPV). We investigate the variation of positivity rates of VIA, Pap, LBC and HR-HPV in C-TATI and of VIA in the full TATI intervention. METHODS At the screening visit, midwives collected three cervical samples for Pap, LBC and HC2 before performing VIA. The dispersion factor "D" (D = Pearson chi-square value/degrees-of-freedom) was used to measure the variability of tests results. Within C-TATI, the variability of positivity rates of VIA, Pap, LBC and HR-HPV was also graphically assessed with box- and scatter plots by midwife and month of screening. Funnel plots and smoothed scatter plots were used to correlate the variation of VIA by the number of examinations performed by each midwife over the full TATI intervention. RESULTS Consistently over TATI, VIA results were highly variable, independently of the examiner, the time when the test was performed and the number of tests the examiner performed (D>6, p-values<0.001). In C-TATI, VIA results varied the most while those of HR-HPV varied the least (Ds>25, p-values<0.001 for VIA, Ds<1.6, p-values>0.05 for HR-HPV). No evidence for correlation between the number of VIAs done per midwife and the variability of VIA results was observed. CONCLUSION The lack of over-dispersion for HR-HPV detection suggests that the variable VIA results do not reflect true variation in underlying disease, but a lack of consistency in human judgement.
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Affiliation(s)
- Maribel Almonte
- International Agency for Research on Cancer, Lyon, France
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDIS-FONDAP, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, DC, United States of America
| | | | | | - Carlos Santos
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Manuel Alvarez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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Pereira-Scalabrino A, Almonte M, Dos-Santos-Silva I. Country-level correlates of cervical cancer mortality in Latin America and the Caribbean. Salud Publica Mex 2013; 55:5-15. [PMID: 23370254 DOI: 10.1590/s0036-36342013000100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/19/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify country-level correlates of geographical variations in cervical cancer (CC) mortality in Latin America and the Caribbean (LAC). MATERIALS AND METHODS CC mortality rates for LAC countries (n=26) were examined in relation to country-specific socio-economic indicators (n=58) and Human Papilloma Virus (HPV) prevalence using linear regression models. RESULTS High mortality at ages <5 years, low per capita total expenditure on health, and low proportion of the population with access to sanitation were identified as the best independent predictors of CC mortality (R² =77%). In the subset of countries (n=10) with HPV prevalence estimates, these socio-economic indicators together with high-risk HPV prevalence explained almost all the between-country variability in CC mortality (R² =98%). CONCLUSION The findings suggest that continuing socioeconomic improvements in LAC countries will be associated with further reductions in CC mortality even in the absence of organised population-based screening and vaccination programmes.
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Affiliation(s)
- Ana Pereira-Scalabrino
- Unidad de Epidemiología Nutricional y Genética, Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
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Elwood PC, Almonte M, Mustafa M. Is There Enough Evidence for Aspirin in High-Risk Groups? Curr Colorectal Cancer Rep 2012. [DOI: 10.1007/s11888-012-0149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Baena A, Almonte M, Valencia ML, Martínez S, Quintero K, Sánchez GI. [Trends and social indicators of both mortality breast cancer and cervical cancer in Antioquia, Colombia, 2000-2007]. Salud Publica Mex 2011; 53:486-492. [PMID: 22282141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 09/08/2011] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To estimate the mortality age-standardized rates (ASR) for breast and cervical cancer from 2000-2007 and explore social indicators that explain the variability of rates in Antioquia. MATERIAL AND METHODS The ASR was estimated by the direct method and linear regression was used to relate social indicators with rates by subregion. RESULTS Breast and cervical cancer mortality ASRs in Antioquia were 11.3 and 9.1 per 100 000 woman-years respectively. In Medellin, the breast cancer mortality ASR was 12.5, 1.8 times the rate of cervical cancer. A decrease of cervical cancer ASR between 2000 and 2007 was observed in Medellin (p-value=0.03) but not in the rest of Antioquia. Cervical cancer mortality ASR was related to the percentage of poverty (p-value=0.0003). CONCLUSIONS Mortality due to these neoplasms has remained constant in Antioquia. The wide variation in mortality from cervical cancer between regions seems to be associated with poverty.
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Affiliation(s)
- Armando Baena
- Grupo Infección y Cáncer, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
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Almonte M, Sasieni P, Cuzick J. Incorporating human papillomavirus testing into cytological screening in the era of prophylactic vaccines. Best Pract Res Clin Obstet Gynaecol 2011; 25:617-29. [DOI: 10.1016/j.bpobgyn.2011.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/01/2011] [Accepted: 05/09/2011] [Indexed: 11/28/2022]
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Almonte M, Silva IDS, Asare A, Gilham C, Sargent A, Bailey A, Turner A, Desai M, Kitchener HC, Peto J. Sexual behavior and HPV infection in British women, by postal questionnaires and telephone interviews. J Med Virol 2011; 83:1238-46. [DOI: 10.1002/jmv.22085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2011] [Indexed: 11/05/2022]
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Yang HS, Tamayo R, Almonte M, Horten B, DaSilva M, Gangi M, Vazquez E, Joseph D, Okamoto P, Scholl T. Clinical significance of MUC1, MUC2 and CK17 expression patterns for diagnosis of pancreatobiliary arcinoma. Biotech Histochem 2011; 87:126-32. [PMID: 21438791 DOI: 10.3109/10520295.2011.570276] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pancreatic cancer is characterized by aggressive growth and resistance to treatment. Identification of unique biomarkers for diagnosis and prognosis is important for treatment of this disease. We investigated the expression patterns of mucin 1 (MUC1), mucin 2 (MUC2) and cytokeratin 17 (CK17) in both normal tissues and metastatic adenocarcinomas using immunohistochemistry (IHC). We have shown that MUC1 (pan-epithelial membrane mucin), MUC2 (intestinal-type secretory mucin) and CK17 can be used as a panel of markers to distinguish collectively pancreatobiliary carcinoma from other primary site carcinomas. Tumors originating in the pancreatobiliary system showed an expression pattern of MUC1 (+), MUC2 (-) and CK17 (+). By contrast, tumors arising from the colorectal region were MUC1 (-), MUC2 (+) and CK17 (-), while tumors originating from non-pancreatobiliary system tissue expressed a MUC1 (+), MUC2 (-) and CK17 (-) profile. More importantly, the MUC1 (+), MUC2 (-) and CK17 (+) result showed greater sensitivity than CA19-9 by IHC, which is the currently accepted and widely used pancreatic tumor marker for diagnosing pancreatic cancer. Thirteen of 51 cases (25%) of pancreatobiliary adenocarcinomas with the pattern MUC1 (+), MUC2 (-) and CK17 (+) showed no immunoreactivity for CA19-9, while 34/51 (67%) cases having MUC1 (+), MUC2 (-) and CK17 (+) were correlated with positive CA19-9 staining. Our data support using an antibody panel of MUC1, MUC2 and CK17 to enhance current methods for pancreatic cancer diagnosis by identifying specifically the primary tissue of origin.
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Affiliation(s)
- H S Yang
- Genzyme Genetics, Westborough, Massachusetts 01581, USA.
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Benton JL, Eaglesham DJ, Almonte M, Citrin PH, Marcus MA, Adler DL, Jacobson DC, Poate JM. Correlation of Electrical, Structural, and Optical Properties of Erbium In Silicon. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-301-119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTAn understanding of the electrical, structural, and optical properites of Er in Si is necessary to evaluate this system as an opto-electronic material. Extended x-ray absorption fine structure, EXAFS, measurements of Er-implanted Si show that the optically active impurity complex is Er surrounded by an O cage of 6 atoms. The Er photoluminescence intensity is a square root function of excitation power, while the free exciton intensity increases linearly. The square root dependence of the 1.54μm-intensity is independent of measurement temperature and independent of co-implanted species. Ion-implantation of Er in Si introduces donor activity, but spreading resistance carrier concentration profiles indicate that these donors do not effect the optical activity of the Er.
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Almonte M, Murillo R, Sánchez GI, Jerónimo J, Salmerón J, Ferreccio C, Lazcano-Ponce E, Herrero R. [New paradigms and challenges in cervical cancer prevention and control in Latin America]. Salud Publica Mex 2010; 52:544-59. [PMID: 21271014 DOI: 10.1590/s0036-36342010000600010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 11/22/2010] [Indexed: 11/21/2022] Open
Abstract
Cervical cancer continues to be a significant health problem in Latin America. The use of conventional cytology to detect precancerous cervical lesions has had almost no major impact on reducing cervical cancer incidence and mortality rates, which are still high in the region. The availability of new screening tools to detect precancerous lesions provide great opportunities for cervical cancer prevention in the region, as do highly efficacious HPV vaccines able to prevent nearly all lesions associated with HPV-16 and -18 when applied before viral exposure. This paper summarizes the scientific evidence and regional experiences related to: i) the use of HPV testing and visual inspection after the application of acetic acid (VIA) in primary screening and ii) the implementation of adolescent HPV vaccination programs. Finally, we outline a number of recommendations for different resource settings. The feasibility of implementing successful and sustainable national cervical cancer prevention programs in Latin American countries in the region will depend on health priorities and the availability of infrastructure and health personnel--as determined by rigorous local situational analysis.
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Affiliation(s)
- Maribel Almonte
- Cancer Research UK, Centre for Epidemiology, Mathematics & Statistics, Wolfson Institute of Preventive Medicine, Queen Mary University, London, UK.
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Kitchener HC, Almonte M, Gilham C, Dowie R, Stoykova B, Sargent A, Roberts C, Desai M, Peto J. ARTISTIC: a randomised trial of human papillomavirus (HPV) testing in primary cervical screening. Health Technol Assess 2010; 13:1-150, iii-iv. [PMID: 19891902 DOI: 10.3310/hta13510] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Primary cervical screening uses cytology to detect cancer precursor lesions [cervical intraepithelial neoplasia stage 3 or beyond (CIN3+)]. Human papillomavirus (HPV) testing could add sensitivity as an adjunct to cytology or as a first test, reserving cytology for HPV-positive women. This study addresses the questions: Does the combination of cytology and HPV testing achieve a reduction in incident CIN3+?; Is HPV testing cost-effective in primary cervical screening?; Is its use associated with adverse psychosocial or psychosexual effects?; and How would it perform as an initial screening test followed by cytology for HPV positivity? DESIGN ARTISTIC was a randomised trial of cervical cytology versus cervical cytology plus HPV testing, evaluated over two screening rounds, 3 years apart. Round 1 would detect prevalent disease and round 2 a combination of incident and undetected disease from round 1. SETTING Women undergoing routine cervical screening in the NHS programme in Greater Manchester. PARTICIPANTS In total 24,510 women aged 20-64 years were enrolled between July 2001 and September 2003. INTERVENTIONS HPV testing was performed on the liquid-based cytology (LBC) sample obtained at screening. Women were randomised in a ratio of 3:1 to have the HPV test result revealed and acted upon if persistently positive in cytology-negative cases or concealed. A detailed health economic evaluation and a psychosocial and psychosexual assessment were also performed. MAIN OUTCOME MEASURES The primary outcome was CIN3+ in round 2. Secondary outcomes included an economic assessment and psychosocial effects. A large HPV genotyping study was also conducted. RESULTS In round 1 there were 313 CIN3+ lesions, representing a prevalence in the revealed and concealed arms of 1.27% and 1.31% respectively (p = 0.81). Round 2 (30-48 months) involved 14,230 (58.1%) of the women screened in round 1 and only 31 CIN3+ were detected; the CIN3 rate was not significantly different between the revealed and concealed arms. A less restrictive definition of round 2 (26-54 months) increased CIN3+ to 45 and CIN3+ incidence in the arms was significantly different (p = 0.05). There was no difference in CIN3+ between the arms when rounds 1 and 2 were combined. Prevalence of high-risk HPV types was age-dependent. Overall prevalence of HPV16/18 increased with severity of dyskaryosis. Mean costs per woman in round 1 were 72 pounds and 56 pounds for the revealed and concealed arms (p < 0.001); an age-adjustment reduced these mean costs to 65 pounds and 52 pounds. Incremental cost-effectiveness ratio for detecting additional CIN3+ by adding HPV testing to LBC screening in round 1 was 38,771 pounds. Age-adjusted mean cost for LBC primary screening with HPV triage was 39 pounds compared with 48 pounds for HPV primary screening with LBC triage. HPV testing did not appear to cause significant psychosocial distress. CONCLUSIONS Routine HPV testing did not add significantly to the effectiveness of LBC in this study. No significant adverse psychosocial effects were detected. It would not be cost-effective to screen with cytology and HPV combined but HPV testing, as either triage or initial test triaged by cytology, would be cheaper than cytology without HPV testing. LBC would not benefit from combination with HPV; it is highly effective as primary screening but HPV testing has twin advantages of high negative predictive value and automated platforms enabling high throughput. HPV primary screening would require major contraction and reconfiguration of laboratory services. Follow-up continues in ARTISTIC while maintaining concealment for a further 3-year round of screening, which will help in screening protocol development for the post-vaccination era.
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Affiliation(s)
- H C Kitchener
- School of Cancer and Imaging Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
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Robles SC, Ferreccio C, Tsu V, Winkler J, Almonte M, Bingham A, Lewis M, Sasieni P. Assessing participation of women in a cervical cancer screening program in Peru. Rev Panam Salud Publica 2009; 25:189-95. [DOI: 10.1590/s1020-49892009000300001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Almonte M, Albero G, Molano M, Carcamo C, García PJ, Pérez G. Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine 2008; 26 Suppl 11:L16-36. [PMID: 18945400 DOI: 10.1016/j.vaccine.2008.06.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The incidence of cervical cancer in Latin America and the Caribbean (LAC) is among the highest in the world. Because there are major demographic shifts happening in LAC countries (population growth, urbanization and ageing) cervical cancer incidence and mortality will likely continue to be a significant public health problem. Overall human papillomavirus (HPV) prevalence in the LAC general population has been found to be 2-fold higher than the average worldwide prevalence. The large HPV and cancer burden may be explained by the highly prevalent HPV variants of HPV types -16 and 18, which have an increased oncogenic potential. Given the major mode of transmission of genital HPV is sexual, certain, patterns of sexual behaviour (early age at first sexual intercourse, number of sexual partners and sexual behaviour of the partner) are associated with an increased risk of HPV genital acquisition. Although HPV infection is necessary for carcinogenesis, certain co-factors (high parity, long term use of oral contraceptives, smoking and co-infection with the human immunodeficiency virus (HIV)) help in the progression from infection to cancer. Many studies that have contributed to this evidence have been carried out in LAC and are reviewed and summarised in this article. Since HPV vaccines will likely take years to implement, and many more years to show impact on disease, cervical cancer screening programmes remain as the key intervention to control disease in LAC in the years to come.
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Affiliation(s)
- Maribel Almonte
- Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Herrero R, Ferreccio C, Salmerón J, Almonte M, Sánchez GI, Lazcano-Ponce E, Jerónimo J. New approaches to cervical cancer screening in Latin America and the Caribbean. Vaccine 2008; 26 Suppl 11:L49-58. [PMID: 18945402 DOI: 10.1016/j.vaccine.2008.05.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cervical cancer remains an important public health problem in the Latin America and Caribbean region (LAC), with an expected significant increase in disease burden in the next decades as a result of population ageing. Prophylactic human papillomavirus (HPV) vaccine is currently unaffordable in LAC countries. However, even if vaccination was implemented, an additional two decades will be required to observe its impact on HPV related disease and cancer. With some exceptions, cytology-based screening programs have been largely ineffective to control the problem in the region, and there is a need for new approaches to the organization of screening and for use of newly developed techniques. Several research groups in LAC have conducted research on new screening methods, some of which are summarized in this paper. A recommendation to reorganize screening programs is presented considering visual inspection for very low resource areas, improvement of cytology where it is operating successfully and HPV DNA testing followed by visual inspection with acetic acid (VIA) or cytology as soon as this method becomes technically and economically sustainable. This could be facilitated by the incorporation of new, low-cost HPV DNA testing methods and the use of self-collected vaginal specimens for selected groups of the population. An important requisite for screening based on HPV testing will be the quality assurance of the laboratory and the technique by validation and certification measures.
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Affiliation(s)
- Rolando Herrero
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica.
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Parkin DM, Almonte M, Bruni L, Clifford G, Curado MP, Piñeros M. Burden and Trends of Type-Specific Human Papillomavirus Infections and Related Diseases in the Latin America and Caribbean Region. Vaccine 2008; 26 Suppl 11:L1-15. [PMID: 18945399 DOI: 10.1016/j.vaccine.2008.05.043] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- D Maxwell Parkin
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom.
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Murillo R, Almonte M, Pereira A, Ferrer E, Gamboa OA, Jerónimo J, Lazcano-Ponce E. Cervical Cancer Screening Programs in Latin America and the Caribbean. Vaccine 2008; 26 Suppl 11:L37-48. [DOI: 10.1016/j.vaccine.2008.06.013] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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