scholarly journals Assessing the implementation of population based cervical cancer screening in Amadora, Portugal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Leite ◽  
S Pereira ◽  
D Vaz ◽  
T Smet ◽  
C Portilheiro ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Intraepithelial Neoplasia ◽  
Cost Effective ◽  
Target Population ◽  
Population Based ◽  
Screening Tests

Abstract Background Population-based cervical cancer screening (CCS) are deemed to be more cost-effective than opportunistic screening and to reduce inequalities. Implementation in Portugal has been heterogeneous, at the regional level. In Amadora healthcare cluster (Lisbon area), implementation started in April 2018 in a pilot unit and was scaled-up. We aimed to assess population-based CCS implementation in Amadora. Methods Population-based CCS targets women aged 30-65, and utilises liquid-based cytology with partial HPV genotyping (HPV16/18 and other high-risk HPV - hrHPV). Samples positive for other hrHPV undergo a cytology. HPV16/18+ and other hrHPV+ with ≥ASCUS (atypical squamous cells of undetermined significance) are referred to colposcopy. We assessed implementation according to key indicators extracted from our information system: geographic coverage, number of tests, positive results, positive predictive value of referral (number of cervical intraepithelial neoplasia-CIN/number colposcopies). Results As of 30 August 2019, CCS were in place in 4 of the 9 units, potentially covering 20904 women (48.4% of the target population). 1797 womem performed screening within the programme. Invitation for screening is currently implemented in 1 of the 4 units. Screening results were available for 1702 women, 11,1% were HPV+. From these, 26,5% were HPV 16/18+ and 86.2% positive for other hrHPV. Among the latter, 63.2% were negative for intraepithelial lesion and 36.8% were ≥ASCUS. Overall, of these 189 women, 51.3% (n = 97) were referred for colposcopy. Colposcopy results were available for 37 women, of which 13 had a CIN. PPV of referral was 35.1% (95%confidence interval: 20.7;52.6). Conclusions Despite being a population-based screening most tests are still opportunistic. There is still a limited number of colposcopies results but the current PPV of referral is low and requires further investigation. Implementation towards a full population-based screening in Amadora should continue. Key messages Implementation of a population-based cervical cancer screening in Amadora, Portugal is underway but most screening tests are still applied in an opportunistic manner. A limited number of results is avaliable to estimate positive predictive value of referral to colposcopy. Results available indicate a value of 35.1%, which requires further investigation.

scholarly journals Effect of introducing human papillomavirus genotyping into real-world screening on cervical cancer screening in China: a retrospective population-based cohort study

2021 ◽  
Vol 13 ◽  
pp. 175883592110109
Author(s):  
Binhua Dong ◽  
Huachun Zou ◽  
Xiaodan Mao ◽  
Yingying Su ◽  
Hangjing Gao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cohort Study ◽  
Human Papillomavirus ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Cox Regression ◽  
Intraepithelial Neoplasia ◽  
Population Based ◽  
Hpv Genotyping ◽  
Cytology Screening

Background: China’s Fujian Cervical Pilot Project (FCPP) transitioned cervical cancer screening from high-risk human papillomavirus (HR-HPV) nongenotyping to genotyping. We investigated the clinical impact of this introduction, comparing performance indicators between HR-HPV genotyping combined with cytology screening (HR-HPV genotyping period) and the previous HR-HPV nongenotyping combined with cytology screening (HR-HPV nongenotyping period). Methods: A retrospective population-based cohort study was performed using data from the FCPP for China. We obtained data for the HR-HPV nongenotyping period from 1 January 2012 to 31 December 2013, and for the HR-HPV genotyping period from 1 January 2014 to 31 December 2016. Propensity score matching was used to match women from the two periods. Multivariable Cox regression was used to assess factors associated with cervical intraepithelial neoplasia of grade 2 or worse (CIN2+). The primary outcome was the incidence of CIN2+ in women aged ⩾25 years. Performance was assessed and included consistency, reach, effectiveness, adoption, implementation and cost. Results: Compared with HR-HPV nongenotyping period, in the HR-HPV genotyping period, more CIN2+ cases were identified at the initial screening (3.06% versus 2.32%; p < 0.001); the rate of colposcopy referral was higher (10.87% versus 6.64%; p < 0.001); and the hazard ratio of CIN2+ diagnosis was 1.64 (95% confidence interval, 1.43–1.88; p < 0.001) after controlling for health insurance status and age. The total costs of the first round of screening (US$66,609 versus US$65,226; p = 0.293) were similar during the two periods. Higher screening coverage (25.95% versus 25.19%; p = 0.007), higher compliance with age recommendations (92.70% versus 91.69%; p = 0.001), lower over-screening (4.92% versus 10.15%; p < 0.001), and reduced unqualified samples (cytology: 1.48% versus 1.73%, p = 0.099; HR-HPV: 0.57% versus 1.34%, p < 0.001) were observed in the HR-HPV genotyping period. Conclusions: Introduction of an HR-HPV genotyping assay in China could detect more CIN2+ lesions at earlier stages and improve programmatic indicators. Evidence suggests that the introduction of HR-HPV genotyping is likely to accelerate the elimination of cervical cancer in China.

scholarly journals Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal

2018 ◽  
Vol 56 (214) ◽  
pp. 917-923
Author(s):  
Niresh Thapa ◽  
Muna Maharjan ◽  
Girishma Shrestha ◽  
Narayani Maharjan ◽  
Deborah Lindell ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Negative Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Odds Ratio ◽  
Screening Program ◽  
Diagnostic Odds Ratio ◽  
Screening Tests ◽  
Resource Setting

Introduction: In Nepal, cervical cancer is the most common female cancer. Unfortunately, there is no uniform effective screening system available all around the country. The objective of this study is to evaluate the cytology, Visual Inspection with Acetic Acid and with Lugol’s Iodine alone or in combination to detect a pre-cancerous lesion in rural Nepal.Methods: It is an analytical cross-sectional study. Convenience sampling technique was used to select participants who were apparently healthy, married, non- pregnant women of aged 20-65 years for cervical cancer screening program. Screening tests were performed on all eligible women (n=2143) after socio-demographic and reproductive health data collection. A biopsy was applied as a gold standard test. Cross-tabulations were used to describe the test sensitivity, specificity, positive predictive value, and negative predictive value at a 95% confidence interval. Diagnostic odds ratio was also calculated. Results: A majority, 2143 (94%), of women accepted and participated in this study. The sensitivity vs specificity of cytology, VIA, and VILI was 57.1% vs 98.3%, 71.4% vs 88.8% and 78.6% vs 85.1%, and of the co-testing of ‘Both positive VIA and VILI’ and ‘Either positive VIA or VILI’ was 64.3% vs 85.7% and 90.1% vs 83.7% respectively. Negative predictive value of all tests exceeded 99.7%. Cytology had the highest Diagnostic odds ratio (64.9), followed by the co-test ‘Either positive VIA or VILI’ (27.7).Conclusions: Cervical cancer screening by co-testing ‘Either positive VIA or VILI’ is more useful than cytology; VIA and or VILI are easy, safe, feasible and well-accepted tests in a low resource setting, Nepal.

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.

Identification of ideal strategy of cervical cancer screening in Japan based on Fukui cervical cancer screening study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17025-e17025
Author(s):  
Tetsuji Kurokawa ◽  
Akiko Shinagawa ◽  
Yoko Chino ◽  
Motohiro Kobayashi ◽  
Yoshio Yoshida
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Screening Method ◽  
Hpv Testing ◽  
Abnormal Cytology ◽  
Predictive Values ◽  
Hpv Status

e17025 Background:The estimated age-standardized incidence rate for cervical cancer is higher in Japan than in North America and the UK. It is important to improve cancer screening. The introduction of HPV testing with cytology for triage of those that test positive for cervical cancer screening has been challenging. The Fukui Cervical Cancer Screening (FCCS) study was designed to determine the best cervical cancer screening method in the Japanese population. We performed a subanalysis using baseline data of FCCS study to determine the performance of cytology, the human papillomavirus (HPV) testing and cotesting with cytology and HPV testing, and to evaluate whether the stratification of HPV16, HPV18, and 12 other hrHPV types appropriately balances risks and harms in the Japanese cancer screening population. Methods:The study enrolled 7,584 women aged 25 years or older undergoing routine screening. All women underwent liquid-based cytology (LBC) and cobas HPV testing. Women with abnormal cytology regardless of the HPV status, women with positive hrHPV results regardless of cytology results, and women randomly selected from among those with normal cytology and negative hrHPV results were referred for colposcopy. Results:The prevalence of hrHPV, HPV16, and HPV18 was 6.8%, 1.2%, and 0.5%, respectively. The estimated sensitivities for cervical intraepithelial neoplasia (CIN) 2 or worse for cytology, HPV testing, and cotesting with cytology and HPV testing were 71%, 92%, and 100%, respectively. The estimated positive predictive values for cytology, HPV testing, and cotesting with cytology and HPV testing were 33%, 21% and 21%, respectively. Using a strategy whereby those with abnormal cytology or positive HPV16 genotype undergo colposcopy and biopsy results in a sensitivity of 85% and a positive predictive value of 33%. This strategy results in improved sensitivity while at the same time maintains the positive predictive value compared to screening with cytology alone. Conclusions:Baseline data from the FCCS study suggests that strategy of using colposcopy for women with abnormal cytology and/or HPV16 positivity appropriately balances risks and harms for Japanese women. Clinical trial information: UMIN000025977.

scholarly journals Is Primary HPV with Secondary p16/Ki67 Dual-Stain an Alternative HSIL-Risk Detection Strategy in Cervical Cancer Screening for Women under 30 Years?

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2012
Author(s):  
Martyna Trzeszcz ◽  
Maciej Mazurec ◽  
Robert Jach ◽  
Karolina Mazurec ◽  
Zofia Jach ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Age Groups ◽  
Intraepithelial Neoplasia ◽  
Screening Strategy ◽  
Screening Tests ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Predictive Values ◽  
Age Range

Recently, cervical cancer rates elevation has been noted in women aged 20–39 years in regions with a very high human development index (HDI). The onset of cancer elevation rates is observed in the age range of 25–29 years, which should necessitate effective precancer screening in younger age groups, including those <25 years. From 30.066 liquid-based screening tests results (n = 30.066), 3849 liquid-based cytology, 1321 high-risk human papillomavirus (HRHPV) and 316 p16/Ki67 performed in women <30 years were selected. Performance characteristics were calculated for three screening models: primary HRHPV with p16/Ki67 triage, primary cytology with reflex HPV and primary cytology alone. Primary HRHPV with p16/Ki67 triage was significantly more sensitive in high-grade squamous intraepithelial lesion quantified with cervical intraepithelial neoplasia grade 2 or worse [HSIL(CIN2+)] detection than cytology with reflex HRHPV and cytology alone (83.3% vs. 70.8%/45.8%) and had significantly higher diagnostic predictive values (PPV:29.4%/21.3%/22.9%; NPV:91.7%/82.9%/82.2%, respectively at CIN2+ threshold). The number of colposcopies per HSIL(CIN2+) detection indices was 3.4, 4.7 and 4.4, respectively. Primary HPV testing in women <30 years with p16/Ki67 triage of HPV-positive cases might be an effective cervical cancer screening strategy for HSIL(CIN2+) detection with superior diagnostic performance when compared with primary cytology-based models. Women <25 years might also benefit from an introduction to a more sensitive screening approach.

scholarly journals Evaluation of Liquid Based Cytology (LBC) and Conventional Pap’s Smear Test as Methods of Cervical Cancer Screening

2022 ◽  
Vol 6 (1) ◽  
pp. 36
Author(s):  
Mehdi Ashik Chowdhury ◽  
Asim Ranjan Barua ◽  
- Asaduzzaman ◽  
Mohammad Mahabubul Hoque ◽  
DM Arifur Rahman
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Pap Smear ◽  
Molecular Techniques ◽  
Smear Preparation ◽  
Liquid Based Cytology

Background: Cervical cancer screening can actually prevent most cervical cancers and also facilitates early detection which allows fruitful treatment.Objective: To evaluate and compare the efficacy of Liquid-based cytology (LBC) with conventional Pap smear test.Methods: This crosssectional study was conducted between March 2015 and June 2017. A total of 72 women participated in this study attending the Out-Patient Department (OPD) of Gynaecology (Colposcopy Clinic) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, for VIA test. The smears prepared by the conventional Pap smear method and Liquid-based cytology method were observed by two independent observers in Department of Pathology of the same institution.Results: The mean age of the patients was 40.22±12.29 years. Considering histopathology as gold standard, in conventional Pap smear preparation our data suggested its sensitivity 87.5%, specificity 92.2%, accuracy 91.7%, positive predictive value 58.3% and negative predictive value 98.3%. In contrast, in Liquid-based cytology, we found its sensitivity 75.0%, specificity 90.6%, accuracy 88.9%, positive predictive value 50.0% and negative predictive value 96.7%.Conclusion: LBC has practical advantages over conventional preparation by producing monolayer of cells, smaller area to screen, reproducibility and availability of doing adjunct molecular techniques from residual sample. However, conventional preparation shows better sensitivity and positive predictive value and almost similar specificity, negative predictive value and accuracy with LBC.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 36-40

scholarly journals Cervical cancer screening by conventional Pap smear versus liquid based cytology

2019 ◽  
Vol 14 (2) ◽  
pp. 22-25
Author(s):  
Subi Basnyat ◽  
Gehanath Baral ◽  
Karishma Malla
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Cervical Cancer Screening ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Pap Smear ◽  
Premalignant Lesions ◽  
Cross Sectional ◽  
Liquid Based Cytology

Aims: To evaluate Liquid Based Cytology (LBC) diagnostic performance compared with Conventional Pap Smear (CPS) for cervical cancer screening and to compare the sensitivity and specificity of the two cytology methods with gold standard cervical biopsy. Methods: This is a hospital based cross-sectional study conducted from April 2017 to April 2018 in 110 sample randomly selected at gynecology OPD in Paropakar Maternity and Women’s Hospital. Paired samples (CPS and LBC) were taken from the same patient. Abnormal epithelial lesion detected in LBC and CPS was sent for biopsy. Bethedsa reporting system was followed and data analyzed in terms of diagnostic accuracy. Results: LBC vs CPS for satisfactory report was 96.4% vs 91.8% while unsatisfactory was 3.6% vs 1.8% (p=0.02). The detection of premalignant lesions was ASCUS 2.7%, HSIL 4.5%, ASCUS-H 1.8% and LSIL 0.9% by LBC while by CPS- ASC-US 0.9%, HSIL 3.6%, LSIL 1.8% and ASC-H 0.9% were detected. The sensitivity and specificity of LBC vs CPS was 100% vs 88% and 81.8% vs 99% respectively. The positive predictive and negative predictive value of LBC vs CPS was 81.8% vs 88% and 100% vs 99% respectively. Conclusions: Cell pick-up was satisfactory in both LBC and CPS. The sensitivity and positive predictive value of CPS is similar whereas the positive predictive value of LBC is less than its sensitivity. Cervical cancer screening with CPS is effective alternative over LBC by its cost and level of accuracy.

Testing Cervicography and Cervicoscopy as Screening Tests for Cervical Cancer

1993 ◽  
Vol 79 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Silvia Cecchini ◽  
Rita Bonardi ◽  
Antonia Mazzotta ◽  
Grazia Grazzini ◽  
Anna Iossa ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Screening Test ◽  
Detection Rate ◽  
Pap Test ◽  
Cost Effective ◽  
Screening Tests ◽  
Screening Methods ◽  
Abnormal Cytology

Aims and Background Suboptimal sensitivity is currently reported for Pap test in screening for cervical cancer. Colposcopy is known to be more sensitive than cytology but its use as a screening test is not possible due to costs and complexity. Screening by cervicography has been suggested as a compromise being less costly and feasible. The present study evaluates the feasibility of screening by cervicography and cervicoscopy (naked eye examination of the cervix after acetic acid lavage) on a consecutive screening series. Methods Cervicography and cervicoscopy were performed by the smear taker in subjects consecutively attending a screening clinic. Women with abnormal cytology (atypia or more severe lesion) and/or abnormal cervicography or cervicoscopy (acetowhite lesion) underwent colposcopic assessment. The three screening methods were compared according to positivity rate, CIN 2-3 detection rate and positive predictive value. Results 2105 consecutive subjects were screened. Positivity rate was 3.8 %, 15.3 % or 25.4 % for cytology, cervicography or cervicoscopy, respectively, 486 of 555 women attended the assessment phase, 281 directed biopsies were performed and 8 CIN 2-3 lesions were detected. Cytology, cervicography and cervicoscopy, detected 5.5, or 7 of 8 CIN 2-3 lesions, respectively. The positive predictive value was 0% for cytologic atypia, 25 % for cytologic SIL, 1.75 % for cervicography and 2.05% for cervicoscopy. Detecting one CIN 2-3 lesion at cytology cost $ 5,543. The cost per each additional cytologically negative CIN 2-3 lesion detected at cervicography or cervicoscopy was $ 12,947 or $ 3,916, respectively. Conclusions The study confirms the limited sensitivity of cytology for CIN 2-3. The association of cervicography was not cost effective. Cervicoscopy was poorly specific but increased the detection rate of CIN 2-3 at relatively low costs. Cervicoscopy is worth further evaluation as a screening test.

scholarly journals Population Based Study of Cervical Cancer Screening in Bharatpur, Nepal

2015 ◽  
Vol 1 (4) ◽  
pp. 3-8
Author(s):  
Ang Tshering Sherpa ◽  
Balman Singh Karki ◽  
Johanne Sundby ◽  
Mari Nygard ◽  
Silvia Franceschii ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Developing Countries ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Pap Smear ◽  
Significant Proportion ◽  
Target Population ◽  
Population Based ◽  
International Agency ◽  
Incidence And Mortality

Cervical cancer is the most common form of cancer among women in developing countries. Hospital based data in Nepal also showed cervical cancer is most commonly occurring cancer among women in Nepal. Pap smear is the very significant screening test for reduction of incidence and mortality from cervical cancer but many developing countries failed to obtain high coverage of target population. Hence failed to achieve major impact of cervical cancer screening. National guidelines for cervical cancer and prevention in Nepal is formulated in 2010 and set target population age range of 30-60 with 50% coverage of target population with in a five years span. This study was aimed to elicit baseline survey of cervical cancer screening in a locale where resource for cervical cancer screening is easily available. Population based cross sectional study was done from October 2006 to March 2007. 1547 ever married women aged 16–59 were selected with cluster randomization procedure from Bharatpur municipalities, where BPKMCH (BP Koirala Memorial Cancer Hospital) is located. Free cervical cancer screening was conducted in collaboration with International Agency for Research on Cancer (IARC) France and BPKMCH. Ethical clearance was obtained from Nepal Health Research council. Interviews were performed using a standard questionnaire to elicit required information. Out of 1033 participants 394 were 16-29 years old. Among them 117 (30%) had at least one Pap test prior coming to the clinic. 16(4%) were age 16-19, 42(11%) were age 20-24 and 59 (15%) were age 25-29. This concludes Present opportunistic cervical cancer screening in Bharatpur is directed towards screening significant proportion of women with less risk.DOI: http://dx.doi.org/10.3126/jmmihs.v1i4.11994Journal of Manmohan Memorial Institute of Health SciencesVol. 1, Issue 4, 2015page : 3-8 

Sign in / Sign up

Export Citation Format

Share Document