Promising strategies for cervical cancer screening in the post-human papillomavirus vaccination era

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 376 ◽  
Author(s):  
Joseph Tota ◽  
Salaheddin M. Mahmud ◽  
Alex Ferenczy ◽  
François Coutlée ◽  
Eduardo L. Franco
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Human Error ◽  
Pap Smear ◽  
Cervical Screening ◽  
Screening Tests ◽  
Hpv Testing ◽  
Human Papillomavirus Vaccination ◽  
Screening Programs

Human papillomavirus (HPV) vaccination is expected to reduce the burden of cervical cancer in most settings; however, it is also expected to interfere with the effectiveness of screening. In the future, maintaining Pap cytology as the primary cervical screening test may become too costly. As the prevalence of cervical dysplasias decreases, the positive predictive value of the Pap test will also decrease, and, as a result, more women will be referred for unnecessary diagnostic procedures and follow-up. HPV DNA testing has recently emerged as the most likely candidate to replace cytology for primary screening. It is less prone to human error and much more sensitive than the Pap smear in detecting high-grade cervical lesions. Incorporating this test would improve the overall quality of screening programs and allow spacing out screening tests, while maintaining safety and lowering costs. Although HPV testing is less specific than Pap cytology, this issue could be resolved by reserving the latter for the more labour-efficient task of triaging HPV-positive cases. Because most HPV-positive smears would contain relevant abnormalities, Pap cytology would be expected to perform with sufficient accuracy under these circumstances. HPV Pap triage would also provide a low-cost strategy to monitor long-term vaccine efficacy. Although demonstration projects could start implementing HPV testing as a population screening tool, more research is needed to determine the optimal age to initiate screening, the role of HPV typing and other markers of disease progression, and appropriate follow-up algorithms for HPV-positive and Pap-negative women.

scholarly journals A pilot study of risk-stratified cervical cancer screening

2021 ◽  
Vol 1 ◽  
pp. 84
Author(s):  
Jiangrong Wang ◽  
K. Miriam Elfström ◽  
Christer Borgfeldt ◽  
Joakim Dillner
Keyword(s):  
Cervical Cancer ◽  
Pilot Study ◽  
Cancer Risk ◽  
Cervical Screening ◽  
Screening Method ◽  
Screening Tests ◽  
Individual Risk ◽  
Horizon 2020 ◽  
Screening Programs

Background: Cervical screening programs target entire populations, although it is well established that cervical cancer risks can vary >100-fold based, in particular, on the woman’s screening history. Since cervical screening switched to Human Papillomavirus (HPV) testing as the primary screening method, the risk differences are even larger as different HPV types may vary in associated cancer risk by 100 times. Furthermore, HPV infections with the most oncogenic types are declining dramatically because of HPV vaccination programs. Tailoring screening intensity based on the known cancer risk of the individual (risk-stratified screening) therefore has great potential to increase both the sensitivity and specificity. Within Horizon 2020 a major project for RIsk-stratified Screening for Cervical Cancer (RISCC) has therefore been launched. We performed a pilot study of risk-stratified screening to evaluate feasibility and acceptability of offering vaginal HPV self-sampling tests to women with a higher risk of cervical cancer. Methods: We identified resident women who had had either i) atypical glandular cells in screening tests during the past six years (risk >150/100,000 woman-years) or ii) abnormal screening findings above the age of 50, but without sufficient follow-up (risk >65/100,000). The women were invited, either by short message service (SMS) or physical letters, to order an HPV self-sampling kit via the study web-platform. The returned self-collected samples were tested for HPV. If positive, women were invited for clinical follow-up. Results: Among 920 targeted women, 191 (21%) placed an order and 163 (18%) returned a self-collected sample. Among all tested samples, 19 (12%) were positive for hrHPV and 18 of these women attended clinical follow-up. Conclusions: We found that SMS invitations to high-risk women are feasible and result in substantial requests for kits and submission of samples. Future work will focus on improving the efficiency of the procedure and further increasing attendance.

scholarly journals Self-Sampling for HPV Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs

2017 ◽  
Author(s):  
Sarah Gupta ◽  
Christina Palmer ◽  
Elisabeth M. Bik ◽  
Juan P. Cardenas ◽  
Harold Nuñez ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Pap Smear ◽  
Precancerous Lesions ◽  
Hpv Infection ◽  
Nucleic Acid Amplification ◽  
Hpv Testing ◽  
Screening Programs

In most industrialized countries, screening programs for cervical cancer have shifted from cytology (Pap smear or ThinPrep) alone on clinician-obtained samples to the addition of screening for human papillomavirus (HPV), its main causative agent. For HPV testing, self-sampling instead of clinician-sampling has proven to be equally accurate, in particular for assays that use nucleic acid amplification techniques. In addition, HPV testing of self-collected samples in combination with a follow-up Pap smear in case of a positive result is more effective in detecting precancerous lesions than a Pap smear alone. Self-sampling for HPV testing has already been adopted by some countries, while others have started trials to evaluate its incorporation into national cervical cancer screening programs. Self-sampling may result in more individuals willing to participate in cervical cancer screening, because it removes many of the barriers that prevent women, especially those in low socioeconomic and minority populations, from participating in regular screening programs. Several studies have shown that the majority of women who have been underscreened but who tested HPV-positive in a self-obtained sample, will visit a clinic for follow-up diagnosis and management. Additionally, a self-collected sample can also be used for vaginal microbiome analysis, which can provide additional information about HPV infection persistence as well as vaginal health in general.

scholarly journals Self-Sampling for HPV Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs

2017 ◽  
Author(s):  
Sarah Gupta ◽  
Christina Palmer ◽  
Elisabeth M. Bik ◽  
Juan P. Cardenas ◽  
Harold Nuñez ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Pap Smear ◽  
Precancerous Lesions ◽  
Hpv Infection ◽  
Nucleic Acid Amplification ◽  
Hpv Testing ◽  
Screening Programs

In most industrialized countries, screening programs for cervical cancer have shifted from cytology (Pap smear or ThinPrep) alone on clinician-obtained samples to the addition of screening for human papillomavirus (HPV), its main causative agent. For HPV testing, self-sampling instead of clinician-sampling has proven to be equally accurate, in particular for assays that use nucleic acid amplification techniques. In addition, HPV testing of self-collected samples in combination with a follow-up Pap smear in case of a positive result is more effective in detecting precancerous lesions than a Pap smear alone. Self-sampling for HPV testing has already been adopted by some countries, while others have started trials to evaluate its incorporation into national cervical cancer screening programs. Self-sampling may result in more individuals willing to participate in cervical cancer screening, because it removes many of the barriers that prevent women, especially those in low socioeconomic and minority populations, from participating in regular screening programs. Several studies have shown that the majority of women who have been underscreened but who tested HPV-positive in a self-obtained sample, will visit a clinic for follow-up diagnosis and management. Additionally, a self-collected sample can also be used for vaginal microbiome analysis, which can provide additional information about HPV infection persistence as well as vaginal health in general.

scholarly journals Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing

Viruses ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 729 ◽  
Author(s):  
Andreas Chrysostomou ◽  
Dora Stylianou ◽  
Anastasia Constantinidou ◽  
Leondios Kostrikis
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Hpv Vaccination ◽  
Screening Method ◽  
Population Based ◽  
Screening Tests ◽  
Screening Methods ◽  
Hpv Testing ◽  
Screening Programs

Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.

scholarly journals Perception of the Saudi Community towards Human Papilloma Virus Vaccination in Jeddah, Saudi Arabia

2017 ◽  
Vol 9 (9) ◽  
pp. 158
Author(s):  
Ahlam A. Alzahrani ◽  
Nebras AlGhanaim ◽  
Samia Abdulmageed
Keyword(s):  
Cervical Cancer ◽  
Saudi Arabia ◽  
Human Papillomavirus ◽  
Pap Smear ◽  
Hpv Vaccination ◽  
Cross Sectional Study ◽  
Community Perception ◽  
Human Papillomavirus Vaccination ◽  
Cross Sectional ◽  
Males And Females

To examine the awareness and perception of Saudi community towards Human Papillomavirus Vaccination. A cross-sectional study has examined the perception and awareness of Saudi individuals towards Human Papillomavirus HPV vaccination. A sample of 278 Saudi individuals were included. A close-ended survey questionnaire was employed to collect the data of Papillomavirus HPV vaccination. Around, 78.30% female and male participants were unaware of the availability of HPV vaccination against cervical cancer. 90.06% of females supported cervical cancer screening Pap smear by gynecologist after enduring vaccination. Only, 40.66% visited the gynecologist for screening. Results demonstrated 85.77% female agreed on receiving expensive vaccination. Conversely, 97.48% supported on HPV vaccination free of charge. A lack of knowledge about HPV, Pap smear, and cervical cancer. The data obtained can be used as a standard to devise effective awareness programs. Data was collected particularly from Saudi Arabia for evaluating Saudi community perception. Both males and females were observed to be interested in taking vaccination and prevention initiatives against the cervical cancer, whereas, there is a lack of awareness observed among the males and females included in the study.

A brief history of economic evaluation for human papillomavirus vaccination policy

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 352 ◽  
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.

Australian women's needs and preferences for information about human papillomavirus in cervical screening

2005 ◽  
Vol 12 (3) ◽  
pp. 134-141 ◽  
Author(s):  
Kirsten McCaffery ◽  
Les Irwig
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Information Needs ◽  
Pap Smear ◽  
Cervical Screening ◽  
Hpv Infection ◽  
Sexual Partners ◽  
Policy And Practice ◽  
Management Options ◽  
Multiple Sexual Partners

Objective: The role of human papillomavirus (HPV) in cervical cancer and developments in medical technology to prevent cervical cancer has changed information needs for women participating in cervical screening. Design: Qualitative face-to-face interviews were conducted with 19 women diagnosed with HPV infection on their Pap smear following routine cervical screening. Setting: Family planning clinics, general practice and specialist gynaecologist practices in Sydney and the surrounding area, Australia. Main outcome measures: Women's information needs, preferences and experiences of HPV diagnosis. Results: Women wanted further information on different HPV viral types, transmission, implications for sexual partners, prevalence, latency and regression of HPV, their management options and the implications of infection for cancer risk and fertility. Uncertainty about the key aspects of HPV, the style in which the clinician communicated the result and the mode of delivering the result (letter, telephone or consultation) influenced women's psychological response to the diagnosis of HPV. The delivery of results by letter alone was linked to considerable anxiety among the women interviewed. Women's experience of searching the Internet for further information about HPV was reported as difficult, anxiety provoking and contributing to the stigma of the infection because information was often located in the context of other sexually transmitted infections, with multiple sexual partners highlighted as a risk factor for infection. Conclusion: Women participating in cervical screening need high-quality information about HPV and its role in cervical cancer prior to screening rather than afterwards, when they face an abnormal result. The clinician potentially plays an important role in moderating the effects of diagnosis through the manner and mode in which an HPV diagnosis is delivered. Revision of cervical screening policy and practice in light of the changes in the understanding of HPV is recommended.

scholarly journals Clinical Human Papillomavirus Detection Forecasts Cervical Cancer Risk in Women Over 18 Years of Follow-Up

2012 ◽  
Vol 30 (25) ◽  
pp. 3044-3050 ◽  
Author(s):  
Philip E. Castle ◽  
Andrew G. Glass ◽  
Brenda B. Rush ◽  
David R. Scott ◽  
Nicolas Wentzensen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cancer Risk ◽  
Clinical Test ◽  
Low Grade ◽  
Hpv Testing ◽  
Pap Testing ◽  
Health Maintenance ◽  
Hpv Test

Purpose To describe the long-term (≥ 10 years) benefits of clinical human papillomavirus (HPV) DNA testing for cervical precancer and cancer risk prediction. Methods Cervicovaginal lavages collected from 19,512 women attending a health maintenance program were retrospectively tested for HPV using a clinical test. HPV positives were tested for HPV16 and HPV18 individually using a research test. A Papanicolaou (Pap) result classified as atypical squamous cells of undetermined significance (ASC-US) or more severe was considered abnormal. Women underwent follow-up prospectively with routine annual Pap testing up to 18 years. Cumulative incidence rates (CIRs) of ≥ grade 3 cervical intraepithelial neoplasia (CIN3+) or cancer for enrollment test results were calculated. Results A baseline negative HPV test provided greater reassurance against CIN3+ over the 18-year follow-up than a normal Pap (CIR, 0.90% v 1.27%). Although both baseline Pap and HPV tests predicted who would develop CIN3+ within the first 2 years of follow-up, only HPV testing predicted who would develop CIN3+ 10 to 18 years later (P = .004). HPV16- and HPV18-positive women with normal Pap were at elevated risk of CIN3+ compared with other HPV-positive women with normal Pap and were at similar risk of CIN3+ compared with women with a low-grade squamous intraepithelial Pap. Conclusion HPV testing to rule out cervical disease followed by Pap testing and possibly combined with the detection of HPV16 and HPV18 among HPV positives to identify those at immediate risk of CIN3+ would be an efficient algorithm for cervical cancer screening, especially in women age 30 years or older.

scholarly journals A CASE OF CERVICAL INTRAEPITHELIAL NEOPLASIA - MANAGEMENT THROUGH AYURVEDA

2021 ◽  
Vol 9 (12) ◽  
pp. 3143-3150
Author(s):  
Deepthi. G. B ◽  
Gayathri Bhat. N.V
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Disease Incidence ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Treatment Modalities ◽  
Low Grade ◽  
Disease Manifestation ◽  
Mild Dysplasia

Introduction – Cervical cancer is the 2nd most leading prevalent cancer in India. There are an estimated 123,000 new cases of cervical cancer in India every year with 67,000 deaths in women alone. Cervical cancer in Recent studies shows that screening of cervical cancer reduces the disease incidence and disease mortality by 50%. Low- grade squamous intraepithelial lesion (LSIL) is a common abnormal result on a Pap smear cervical test. It’s also known as mild dysplasia. Methodology – Here is a case report of a patient aged 26yrs with complaints of white discharge per vagina with severe itching, on routine cervical screening investigations found to have Low grade squamous intraepithelial neoplasms. She was treated with Ayurvedic sthanika chikitsa (Local therapies) such as Yoni prakshalana (Vaginal douching), and Yoni pichu (Vaginal tamponing) for 7 days along with shaman chikitsa. Later PAP smear was repeated after 1 month of follow up and found to have negative for intraepithelial neoplasia. And there was relief in the symptoms following treatment. Results- In this case, there was a relief of symptoms and on follow up when Pap smear was repeated, there was negative for intraepithelial neoplasia. Ayurvedic treatment modalities such as Sthanika chikitsa which includes yoni prakshalana and Yoni Pichu are the line of treatment for various gynecological problems and help in reducing mortality and morbidity caused due to cervical cancer in India. Discussion- Here Low-grade squamous Intraepithelial neoplasia can be considered as the Sanchaya avastha and hence diagnosing the disease in its Sanchaya avastha i.e mild dysplasia, is important. During Sanchaya avastha there is localized neoplastic changes of cervical cells and there is Manifestation of Low-grade Intraepithelial Neo- plasia. In the later stages of Kriyakala (Stages of disease manifestation) the neoplasia turns into metastasis and further differentiation occurs which Manifests all the symptoms of Cervical Cancer. Hence treatment modalities such as Yoni prakshalana and yoni pichu helps in preventing later conditions such as cervical cancer. Keywords: Cervical Cancer, LSIL, Ayurveda, Sanchaya

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