The value of high-risk HPV testing in cervical cancer surveillance

IntroductionCervical cancer disproportionately burdens low-income and middle-income countries (LMICs) such as Guatemala. Self-collection testing for human papillomavirus (HPV) has been suggested as a form of cervical cancer screening to facilitate access in LMICs. This study assessed and compared the acceptability of self-collection HPV testing in two rural, indigenous and ethnically distinct communities in Guatemala: Santiago Atitlán, Sololá and Livingston, Izabal.MethodsAll participants, women between the ages of 18 and 60, completed a questionnaire. Eligible participants were also asked to self-collect a vaginal sample and complete a questionnaire regarding comfort and acceptability. Self-collected samples were tested for high-risk HPV using the real-time PCR Hybribio kit.ResultsIn the indigenous community of Santiago Atitlán, of 438 age-eligible participants, 94% completed self-collection. Of those, 81% found it comfortable and 98% were willing to use it as a form of screening. In the multiethnic (Afro-Caribbean, indigenous) community of Livingston, of 322 age-eligible participants, 53% chose to self-collect. Among those who took the test, 83% found it comfortable and 95% were willing to use it as a form of screening. In Livingston, literacy (can read and/or write vs cannot read or write) was higher in women who chose to self-collect (prevalence ratio 2.25; 95% CI 1.38 to 3.68). Ethnicity, history of screening and reproductive history were not associated with willingness to self-collect in Livingston. Women in Santiago reported less prior use of healthcare than women in Livingston. Overall, 19% (106/549) of samples tested positive for high-risk HPV.ConclusionAmong women willing to self-collect in rural and indigenous communities in Guatemala, self-collection for HPV testing is highly acceptable. However, willingness to try self-collection might vary across communities and settings. Women from a community that used less healthcare were more likely to choose self-collection. Further research is necessary to determine what factors influence a woman’s choice to self-collect.

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Human Papillomavirus and Pap Smear

American Journal of Lifestyle Medicine ◽

10.1177/1559827611402581 ◽

2011 ◽

Vol 6 (1) ◽

pp. 31-44

Author(s):

Indra Balachandran

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

High Risk ◽

Pap Smear ◽

Precancerous Lesions ◽

The United States ◽

Hpv Infection ◽

Hpv Testing ◽

Pap Smear Screening ◽

High Risk Hpv

High-risk human papillomavirus (HPV) infection and viral persistence is a major risk factor in the development of squamous intraepithelial lesions and invasive carcinoma of the cervix. In the United States, deaths due to squamous cell carcinoma of the cervix have fallen by 75% since the 1960s because of Papanicolaou (Pap) smear screening. However, the traditional Pap had a sensitivity of about 70% for detecting clinically significant precancerous lesions and cancer because of sampling and interpretive errors. The introduction of 2 liquid-based Pap smear collection systems in the 1990s, the use of HPV testing as a triage and co-testing with Pap smear, and the introduction of 2 automated screening devices have had a significant impact on improving the detection of such precancerous lesions. This review provides an analysis of the changes in Pap smear collection, improvements in screening, the evolutionary changes of high-risk HPV testing, reporting terminology of Pap smears, and clinical management guidelines. The future impact of 2 prophylactic HPV vaccines on the incidence of cervical carcinoma is also discussed. This article also discusses alternatives such as primary screening for high-risk HPV testing with visual inspection for cervical cancer detection used in resource-poor settings with a high incidence of cervical cancer.

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1528. Prevalence of Human Papillomavirus Infection and Cervical Intra-Epithelial Lesions in A Subset of Arab American Women in Southeast Michigan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1708 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S765-S765

Author(s):

Anita Shallal ◽

Joseph Trak ◽

Saivaishnavi Kamatham ◽

Omar Fehmi ◽

Sarah Farooqi ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

High Risk ◽

Pap Smear ◽

The United States ◽

Arab American ◽

Hpv Testing ◽

American Women ◽

Arab American Women ◽

High Risk Hpv

Abstract Background The Pap smear is a screening examination that detects abnormal cervical cells and may be paired with human papillomavirus (HPV) testing in order to detect high-risk, oncogenic HPV strains. The incidence of cervical cancer varies among groups due to racial and ethnic disparities, and 80% of cases occur in developing countries. Mortality rates for cervical cancer in the Middle East are disproportionately higher when compared to developed countries. Our study aims to assess the prevalence of HPV and cervical cancer among a subset of Arab-American women in southeast Michigan. Methods The study is a retrospective chart review of women who presented for routine cancer screening as part of the Breast and Cervical Cancer Control Program (BCCCP), at the Arab-American Center for Economic and Social Services Clinic in southeast Michigan between 2003-2019. Paper charts were reviewed for information such as age, date of birth, monthly income, tobacco use, cervix-related gynecological examination performance, cervical cytology results, and HPV testing results. Women between the ages of 21 and 65 were included. In instances where cytology was performed, results and details of high-risk HPV testing were documented. In instances where high-risk HPV testing was performed, negative results were documented as such, and positive results were documented as either positive for HPV 16, 18, or other high-risk strains, or unknown if serotype testing was not available. Results A total of 464 charts from the BCCCP program were reviewed. All women included were uninsured and had immigrated from Middle Eastern countries, including Yemen and Lebanon. The average age of the women was 48.3 years. Of 464 women, 6% (n=28) of women declined to have a Pap smear. 85 women reported they had never had a Pap smear. Of the 436 women who did undergo Pap smear, 42 women (9.6%) had an abnormal pap smear. The remaining results are summarized in Table 1. Table 1 Conclusion Our study results show a trend toward HPV serotype 16 and other serotypes compared to HPV serotype 18 in Arab-American women who recently immigrated to the United States. However, this needs to be studied on a larger cohort of patients to determine if these serotypes are more common among this ethnicity compared to the general population. Disclosures Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

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Results of the first human papilloma virus center in Hungary (2007–2011)

Orvosi Hetilap ◽

10.1556/oh.2011.29233 ◽

2011 ◽

Vol 152 (45) ◽

pp. 1804-1807

Author(s):

Ádám Galamb ◽

Attila Pajor ◽

Zoltán Langmár ◽

Gábor Sobel

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Human Papilloma Virus ◽

Hpv Testing ◽

Papilloma Virus ◽

Cytological Atypia ◽

Hpv Dna ◽

International Data ◽

Hpv Types ◽

High Risk Hpv

Human papilloma virus (HPV) is the most common sexually transmitted infection in the 21st century. It has been established that infections with specific HPV types are contributing factors to cervical cancer. Approximately 99.7% of cervical cancers are associated with high risk HPV types. HPV testing plays an important role in the prevention, by decreasing the prevalence and the mortality of cervical cancer. There are 16 HPV-centers operating in Hungary, in which patients undergo HPV screening, cervical exams, and treatment based on standardized guidelines. Patients and methods: The first HPV-center was founded in 2007 in Budapest, at the 2nd Department of Obstetrics and Gynecology, Semmelweis University. This study aimed to define the presence and prevalence of HPV-DNA in the cervical swab samples obtained from patients in our center. Authors conducted to assess the age-specific-prevalence, and HPV type distribution, the associated cervical abnormalities, comparing our results with international data. Results: Overall 1155 woman underwent HPV-testing and genotyping, using polymerase chain reaction. Overall, 55.5% of patients had positive test for HPV DNA types, in which 38.5% for high-risk HPV DNA. Overall prevalence was the highest among females aged 15 to 25years (62.9%). The most common HPV type found was the high risk type 16 (19.5% among the patients with positive HPV testing). Presence of high risk HPV with concurrent cervical cytological abnormality was in 32%. More than two-thirds of woman with cytological atypia (70.6%) were infected with two or more high risk HPV types. HPV 16 was detected in 32% of patients with cytological abnormalities. Conclusions: The results suggest that the prevalence of HPV in this study population exceeds the international data. The results attracts the attention the peak prevalence of the high risk types in the youngest age-group, and the higher risk of cervical abnormality in case of presence of two or more HPV types. The dominance of type 16 and 18 was predictable, but the strong attendance of type 51 and 31 among patients who had cytological atypia, was slightly surprising. Orv. Hetil., 2011, 152, 1804–1807.

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Review of Research on the Prevention of HPV Infection and Cervical Cancer

Infection International ◽

10.1515/ii-2017-0128 ◽

2016 ◽

Vol 5 (2) ◽

pp. 39-43

Author(s):

Tao Wang

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

High Risk ◽

Cervical Cancer Screening ◽

Epidemiological Survey ◽

Hpv Infection ◽

Hpv Testing ◽

Prevention And Treatment ◽

Preventive Vaccination ◽

High Risk Hpv

AbstractWorldwide, cervical cancer remains as one of the most common malignancies that threaten women's health. An epidemiological survey has shown that high-risk chronic HPV infection is the leading cause of cervical cancer. Thus, the prevention of HPV infection is the main approach to the prevention and treatment of cervical cancer. Sexual behavior, individual immunity, and age are important cofactors in the promotion of HPV infection. Preventive measures that have been gradually implemented worldwide have significantly decreased the incidence of cervical cancer in recent years. These measures include preventive vaccination against common high-risk HPV and cervical cancer screening, which includes HPV testing. HPV testing in cervical cancer screening has received increased attention and provides the basis for the prevention and treatment of cervical cancer. Given that HPV infection rates significantly vary from region to region, procedures for cervical cancer screening should be improved based on regional differences.

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The Laboratory Diagnosis of Genital Human Papillomavirus Infections

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2005/798710 ◽

2005 ◽

Vol 16 (2) ◽

pp. 83-91 ◽

Cited By ~ 17

Author(s):

François Coutlee ◽

Danielle Rouleau ◽

Alex Ferenczy ◽

Eduardo Franco

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Hpv Infection ◽

Human Papillomaviruses ◽

High Grade ◽

Hpv Testing ◽

Screening Programs ◽

Detection Techniques ◽

Hpv Types ◽

High Risk Hpv

Human papillomaviruses (HPVs) are the etiological agents of several genital cancers, including cancer of the uterine cervix. The detection of HPV infection in genital samples may increase the sensitivity of primary and secondary screenings of cervical cancer. HPV testing may also improve the specificity of screening programs, resulting in the avoidance of overtreatment and cost savings for confirmatory procedures. The major determinants of clinical progression of HPV infection include persistence of HPV infection, involvement of high-risk HPV types, high HPV viral load, integration of viral DNA and presence of several potential cofactors. Signal amplification HPV-DNA detection techniques (Hybrid Capture II, Digene Corporation, USA) are standardized, commercially available, and capable of detecting several high-risk HPV types. They also increase the sensitivity of screening for high-grade lesions in combination with cytology. The sensitivity of these techniques to detect high-grade lesions is higher than that of cytology, but the referral rate for colposcopy is greater. These techniques are approved for the triage to colposcopy of women with cervical smears interpreted as atypical squamous cells of undetermined significance. Triage and screening for cervical cancer using HPV will probably be restricted to women aged 30 years or older because of the high prevalence of infection in younger women. Amplification techniques are ideal for epidemiological studies because they minimize the misclassification of HPV infection status. These techniques can detect low HPV burden infections. Consensus primers amplify most genital types in one reaction, and the reverse hybridization of amplicons with type-specific probes allows for the typing of HPV-positive samples. Consensus PCR assays are currently under evaluation for diagnostic purposes. HPV testing is currently implemented for the clinical management of women.

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