Cervical screening in high-income countries: the need for quality assurance, adjunct biomarkers and rational adaptation to HPV vaccination

Abstract Background: The epidemiology on the human papillomavirus (HPV) among females in Southern China is not well-established. Baseline data on the prevalence of HPV infection in China prior to mass prophylactic HPV vaccination would be useful. Thus, this study aimed to determine the type-specific HPV prevalence and distribution among females from Southern China prior to mass HPV vaccination. Methods: A retrospective cross-sectional study employing 214,715 women attending ChenZhou NO.1 People’s Hospital for cervical screening during 2012-2018 was conducted prior to widespread HPV vaccination. HPV genotype was detected using nucleic acid molecular diversion hybridization tests. The overall prevalence, age-specific prevalence, type distribution, and annual trend were analyzed. Results: The overall HPV prevalence was 18.71% (95% confidence interval [CI], 18.55%-18.88%) among Southern China females. During 2012–2018, the prevalence of HPV infection showed a downward tendency, from 21.63% (95% CI, 21.07%-22.20%) in 2012 to 18.75% (95% CI, 18.35%-19.16%) in 2018. Age-specific HPV distribution displayed a peak at young women aged less than 21 years (33.11%, 95% CI, 31.13%-35.15%), 20.07% (95% CI, 19.70%-20.44%) among women aged 21-30 years, 17.29% (95% CI, 17.01%-17.57%) among women aged 31-40 years, 17.23% (95% CI, 16.95%-17.51%) among women aged 41-50 years, 21.65% (95% CI, 21.11%-22.20%) among women aged 51-60 years, and 25.95% (95% CI, 24.86%-27.07%) among women aged over 60 years. Of the 21 subtypes identified, the most three prevalent high-risk HPV (HR-HPV) genotypes were HPV52 (5.12%; 95% CI, 21.11%-22.20%), -16 (2.96%; 95% CI, 2.89%-3.03%), and -58 (2.51%; 95% CI, 2.44%-2.58%); the predominant low-risk HPV (LR-HPV) genotypes were HPV81 (1.86%; 95%CI, 1.80%-1.92%) and -6 (0.69%; 95% CI, 0.66%-0.73%) respectively. Incidence of HR-HPV only, LR-HPV only and mixed LR- and HR-HPV were 15.17%, 2.07% and 1.47% respectively. Besides, single HPV infection accounted for 77.30% of all positive cases in this study.Conclusions: This study highlights 1) a high prevalence of HPV infection among females with a decreasing tendency towards 2012-2018, especially for young women under the age of 21 prior to mass HPV vaccination; 2) HPV52, -16 and -58 were the predominant HPV genotypes, suggesting potential use of HPV vaccine covering these HPV genotypes in Southern China.

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Cervical neoplasia

Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health ◽

10.1093/med/9780198783497.003.0030 ◽

2019 ◽

pp. 357-364

Keyword(s):

Cervical Cancer ◽

Screening Program ◽

Cervical Screening ◽

Hpv Vaccination ◽

Invasive Cervical Cancer ◽

Intraepithelial Neoplasia ◽

Cervical Neoplasia ◽

Women Living With Hiv ◽

The Bethesda System ◽

Common Malignancy

Cervical neoplasia provides an overview of the 4th most common malignancy in women worldwide, including the premalignant phase. Specific terminology used in cytology and histology (including atypia, dyskaryosis, cervical intraepithelial neoplasia (CIN), cervical glandular intraepithelial neoplasia (CGIN) and invasive cervical cancer (ICC) are explained, and the epidemiology and risk factors (with an emphasis on human papilloma virus (HPV)) for this common malignancy are included. Clinical presentation is outlined. Cervical screening is discussed, including the role of HPV testing, and both the British Association for Cytopathology/NHS cervical screening program 2013 classification of cervical cytology and the Bethesda system (used more widely worldwide) are explained. Diagnosis includes colposcopic examination of the cervix, and the management of both CIN and cervical cancer are included. HPV vaccination, pregnancy, and women living with HIV (including ICC as AIDS-defining) are discussed.

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HPV‐vaccination and cancer cervical screening in 53WHOEuropean Countries: An update on prevention programs according to income level

Cancer Medicine ◽

10.1002/cam4.2048 ◽

2019 ◽

Vol 8 (5) ◽

pp. 2524-2534 ◽

Cited By ~ 6

Author(s):

Emma Altobelli ◽

Leonardo Rapacchietta ◽

Valerio F. Profeta ◽

Roberto Fagnano

Keyword(s):

Cervical Screening ◽

Hpv Vaccination ◽

Prevention Programs ◽

Income Level

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Factors influencing the acceptance of HPV vaccine among civil servants in Delta State Secretariat

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191176 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1227

Author(s):

Uchechukwuka Nnemdi Okwe ◽

Helen Chime ◽

Ezekiel Uba Nwose

Keyword(s):

Low Income ◽

Cervical Screening ◽

Hpv Vaccination ◽

Time Constraints ◽

Survey Method ◽

High Income Group ◽

Cross Sectional ◽

Vaccination Programs ◽

Factors Influencing ◽

Structured Questionnaire

Background: The importance of cervical screening and HPV vaccination cannot be overemphasized. Yet, the level of uptake of HPV vaccination has never been evaluated among Secretariat personnel in Delta State of Nigeria. This part-of-four piece of study aimed to identify the barriers to the acceptance of HPV vaccination in Delta State, Nigeria.Methods: A cross-sectional, descriptive survey method was adopted using a structured questionnaire. 285 participants were included. The structured questionnaire included questions on acceptance of HPV vaccination and the factors influencing acceptability. Statistical analysis included percentage proportions of respondents. Absolute and relative frequencies of the factors were also determined. Chi-squared analysis was performed based on dichotomy of participants based on yes/no response to being vaccinated.Results: Less than 8% of respondents have completed the HPV vaccination program. Low income earners have accepted the vaccination more than the high income group (p <0.003). Nature of work implying time constraints was an absolute factor. Accessibility is one of four factors that were significantly associated (p <0.002).Conclusions: Given the observation on nature of work and associated implication of time constraints and also inaccessibility as potentially major factors; it suffices to suggest that acceptance of HPV vaccination may be improved by expounding the days and sites of vaccination programs to be closer to the offices and scheduled around lunch-break times.

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Decline of HPV infections in Scandinavian cervical screening populations after introduction of HPV vaccination programs

Vaccine ◽

10.1016/j.vaccine.2018.05.019 ◽

2018 ◽

Vol 36 (26) ◽

pp. 3820-3829 ◽

Cited By ~ 15

Author(s):

Joakim Dillner ◽

Mari Nygård ◽

Christian Munk ◽

Maria Hortlund ◽

Bo T. Hansen ◽

...

Keyword(s):

Cervical Screening ◽

Hpv Vaccination ◽

Vaccination Programs

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A brief history of economic evaluation for human papillomavirus vaccination policy

Sexual Health ◽

10.1071/sh10018 ◽

2010 ◽

Vol 7 (3) ◽

pp. 352 ◽

Cited By ~ 18

Author(s):

Philippe Beutels ◽

Mark Jit

Keyword(s):

Human Papillomavirus ◽

Economic Evaluation ◽

Policy Making ◽

Cervical Screening ◽

Hpv Vaccination ◽

Health Economic Evaluation ◽

Developed Countries ◽

Economic Evaluations ◽

Human Papillomavirus Vaccination ◽

Screening Programs

Background: This commentary discusses key issues for health economic evaluation and modelling, applied to human papillomavirus (HPV) vaccine programs. Methods: We outline some of the specific features of HPV disease and vaccination, and associated policy questions in light of a literature search for economic evaluations on HPV vaccination. Results: We observe that some policy questions could not be reliably addressed by many of the 43 published economic evaluations we found. Despite this, policy making on universal HPV vaccination followed shortly after vaccine licensure in many developed countries, so the role economic evaluation played in informing these decisions (pre-dating 2008) seems to have been fairly limited. For more recent decisions, however, economic evaluation is likely to have been used more widely and more intensively. Conclusions: We expect future cost-effectiveness analyses to be more instrumental in policy making regarding vaccines covering more HPV types, therapeutic HPV vaccines, and novel diagnostic tests for biomarkers of HPV infection and disease integrated with cervical screening programs.

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HPV testing for primary cervical screening: Laboratory issues and evolving requirements for robust quality assurance

Journal of Clinical Virology ◽

10.1016/j.jcv.2015.10.025 ◽

2016 ◽

Vol 76 ◽

pp. S22-S28 ◽

Cited By ~ 8

Author(s):

Francesca Maria Carozzi ◽

Annarosa Del Mistro ◽

Kate Cuschieri ◽

Helena Frayle ◽

Cristina Sani ◽

...

Keyword(s):

Quality Assurance ◽

Cervical Screening ◽

Hpv Testing

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High-Throughput Genotyping of Oncogenic Human Papilloma Viruses with MALDI-TOF Mass Spectrometry

Clinical Chemistry ◽

10.1373/clinchem.2007.092627 ◽

2008 ◽

Vol 54 (1) ◽

pp. 86-92 ◽

Cited By ~ 37

Author(s):

Anna Söderlund-Strand ◽

Joakim Dillner ◽

Joyce Carlson

Keyword(s):

High Throughput ◽

Cervical Screening ◽

Blot Hybridization ◽

Hpv Vaccination ◽

Intraepithelial Neoplasia ◽

Comparison Method ◽

Dot Blot ◽

Vaccination Programs ◽

Screening Programs ◽

Cervical Disease

Abstract Background: Human papilloma virus (HPV) is the major cause of cervical cancer. Use of HPV genotyping in cervical screening programs and for monitoring the effectiveness of HPV vaccination programs requires access to economical, high-throughput technology. Methods: We used the Sequenom MassARRAY platform to develop a high-throughput mass spectrometric (MS) method for detecting 14 specific oncogenic HPV genotypes in multiplex PCR products. We compared results from 532 cervical cell samples to the comparison method, reverse dot blot hybridization (RDBH). Results: The MS method detected all samples found positive by RDBH. In addition, the MS method identified 5 cases of cervical disease (cervical intraepithelial neoplasia of grade I or higher) that RDBH analysis had missed. Discrepancies in specific genotypes were noted in 20 samples, all positive by MS, with an overall concordance of κ = 0.945. Conclusions: The MS high-throughput method, with a processing capacity of 10 × 384 samples within 2 working days and at a consumables cost of about US$2 per sample, performed as well as or better than the comparison method.

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