scholarly journals Cervical Cancer Screening Guidelines in the Postvaccination Era: Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Carlo A. Liverani ◽  
Jacopo Di Giuseppe ◽  
Luca Giannella ◽  
Giovanni Delli Carpini ◽  
Andrea Ciavattini
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Hpv Vaccination ◽  
Screening Strategy ◽  
Cervical Cancer Prevention ◽  
Dna Test ◽  
Hpv Dna ◽  
Screening Guidelines ◽  
Screening Programs

Cervical cancer is relatively rare in high-income countries, where organized screening programs are in place, as well as opportunistic ones. As the human papillomavirus (HPV) vaccination rates increase, the prevalence of cervical precancers and cancers is going to decrease rapidly very soon, even if, in the most optimistic scenario, it is unlikely that optimal vaccination coverage will be achieved. Then, the optimal screening paradigm for cervical cancer prevention in the postvaccination era is still debated. Screening guidelines are being developed with the aim of reducing the number of tests a woman needs during her lifetime, in order to receive the maximum benefit from screening, while decreasing potential harms that may result with the use of a screening strategy (overdiagnosis, overtreatment, anxiety, and costs). With this purpose in mind, new management guidelines for cervical cancer screening abnormalities are recommendations based on risks, not on results. This review aims to summarize the process that led to the introduction of the HPV DNA test in screening programs and the different screening strategies. Moreover, it aims to introduce the new risk-based guidelines for the future, where full HPV genotyping can resize the risk on the basis of specific high-risk genotypes. In the same way, the data regarding HPV vaccination could be introduced as soon as women vaccinated with the nonavalent vaccine reach the screening age, with the recommendation of a prolonged screening interval.

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 The prevalence of hrHPV among the isolated community in the Highland of Bario, Sarawak, East Malaysia

2019 ◽  
Author(s):  
Abigail Rembui Jerip ◽  
Mardiana Kipli ◽  
Cheng-Siang Tan
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Outreach Program ◽  
Low Resource Settings ◽  
Dna Test ◽  
Hpv Dna ◽  
Low Resource ◽  
Cervical Swab

Abstract Background Malaysia has introduced the free Pap smear as the primary cervical cancer screening program since the 1960s but has only achieved the national coverage of 22%. The coverage would be much lower in the rural communities especially in Sarawak where many villages are still inaccessible by road, and communities are living in low resource settings. In this study, we have evaluated Qiagen’s careHPV system as a point-of-care HPV diagnostic test together with the visualization using acetic acid (VIA) in the isolated community in the Highland of Bario which are predominantly from the Kelabit ethnicity. Methods Women attending the cervical cancer outreach program were recruited. Consent was obtained and a cervical swab was clinician-collected and screened for High-risk HPV DNA using the careHPV system. Cervical examination using VIA was offered to all women age <50-year. hrHPV positive women were recruited during their follow-up session and the second cervical swab was collected for HPV genotyping using consensus primer-nested PCR to elucidate the infecting HPV genotypes. Results Seventy-five women from the age of 27-83 (mean age 55) attended the cervical cancer screening clinic and 8% (n=6/75) of them were positive for hrHPV. Only 33 women were screened using VIA and 21.2% (n=7/33) were found to be positive. A majority of the women (58.6%) were above the age of 50-year and not recommended for VIA to be performed. Thus, it was not feasible to correlate the results obtained from the HPV DNA test and VIA. Only four hrHPV positive women returned for follow-up and genotyping revealed HPV52 in 2 of four women tested suggesting that HPV52 may be the predominant genotype in Bario. Conclusions The careHPV system is portable and can be used in low resource settings as long as reliable electricity is available. We found that careHPV DNA test is more objective compared to VIA and can be used to screen women outside the recommended eligible age. This is especially true for older women in the rural who have never had any form of cervical cancer screening before.

scholarly journals State of the Science: Screening, Surveillance, and Epidemiology of HPV-Related Malignancies

2021 ◽  
pp. 1-12
Author(s):  
Rahel Ghebre ◽  
J. Michael Berry-Lawhorn ◽  
Gypsyamber D’Souza
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
High Resolution ◽  
Cervical Cancer Screening ◽  
Task Force ◽  
Hpv Vaccination ◽  
Cancer Society ◽  
Screening Guidelines ◽  
Cancer Precursors ◽  
The U.S

Oropharyngeal, cervical, vulvar, and anal cancers share a common risk factor of HPV infection. HPV vaccination is currently recommended at age 11 or 12 to prevent new HPV infections for all genders with catch-up vaccination recommened up to age 26. Despite the known effectiveness of HPV vaccination to prevent HPV-related cancer, there is continued low uptake in the United States; only 40% of eligible persons were vaccinated in 2018, though rates are 70% among teenagers. Current American Cancer Society cancer screening guidelines recommend cervical cancer screening, but do not have specific recommendations for screening for other HPV-related cancers. Oropharyngeal cancer precursors have yet to be identified, and there are currently no routine screening tests for oropharyngeal cancer recommended by the U.S. Preventive Services Task Force. The U.S. Preventive Services Task Force and American Cancer Society recommend cervical cancer screening for women at average risk up to age 65, and screening guidelines do not currently differ by HPV vaccination status. Primary HPV DNA testing was first approved for cervical cancer screening in 2016 and was shown to be superior for cervical cancer prevention. Vulvar and anal cancer precursors have been identified, but optimal screening remains unclear. Examination of the anal canal and perianus is best performed by trained clinicians using high-resolution anoscopy, and effectiveness of using high-resolution anoscopy to detect and treat anal high-grade squamous intraepithelial lesions to prevent cancer is actively being researched. Current multistep approaches to control HPV-related malignancies include HPV vaccination coupled with cervical cancer screening or surveillance for oropharyngeal, vulvar, and anal cancers.

scholarly journals Novel concepts in cervical cancer screening: a comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Elkanah Omenge Orang’o ◽  
Edwin Were ◽  
Oliver Rode ◽  
Kapten Muthoka ◽  
Michael Byczkowski ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Screening Program ◽  
Hpv Infection ◽  
High Morbidity ◽  
Ki 67 ◽  
Dna Test ◽  
Hpv Dna ◽  
Triage Test

Abstract Background Screening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology. Methods We prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a p16INK4a /Ki-67 (CINtecPLUS®) dual stained slide that was prepared using the ThinPrep® 2000 Processor and evaluated by a pathologist trained in the methodology. Results In 701 of a total of 800 women aged 18–64 years, all three investigations were performed and data could be analyzed. The HPV, VIA and dual stain cytology positivity were 33%, 7%, and 2% respectively. The HPV positivity rate of VIA positive cases was 32%. The five most common HPV types were HPV16, 52, 68, 58 and 35. The OR among HIV infected women of an HPV infection, VIA positivity and positive dual stain cytology were 2.6 (95%CI 1.5–4.3), 1.9 (95%CI 0.89–4.4) and 3.4 (95%CI 1.07–10.9) respectively. The sensitivity of VIA to detect a p16INK4a/Ki-67 positive transforming infection was 13% (95%CI 2–38). Conclusions Primary HPV testing appears feasible and should be considered as a primary screening test also in LMICs. The poor sensitivity of VIA renders it unsuitable as a triage test for HPV positive women. The utility of p16INK4a/Ki-67 dual stain cytology as a triage test for HPV positive women in LMICs should be further studied.

Population-based cervical cancer screening using high-risk HPV DNA test and liquid-based cytology in Northern Thailand

Pathology ◽  
2014 ◽  
Vol 46 ◽  
pp. S68
Author(s):  
Sumalee Siriaunkgul ◽  
Jongkolnee Settakorn ◽  
Kornkanok Sukpun ◽  
Jatupol Srisomboon ◽  
Prapaporn Suprasert ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Cervical Cancer Screening ◽  
Population Based ◽  
Dna Test ◽  
Hpv Dna ◽  
Liquid Based Cytology ◽  
High Risk Hpv ◽  
Hpv Dna Test

scholarly journals Evaluation of a new p16INK4A ELISA test and a high-risk HPV DNA test for cervical cancer screening: Results from proof-of-concept study

2007 ◽  
Vol 120 (11) ◽  
pp. 2435-2438 ◽  
Author(s):  
Constance Mao ◽  
Akhila Balasubramanian ◽  
Mujun Yu ◽  
Nancy Kiviat ◽  
Ruediger Ridder ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Cervical Cancer Screening ◽  
Elisa Test ◽  
Proof Of Concept ◽  
Dna Test ◽  
Hpv Dna ◽  
High Risk Hpv ◽  
Hpv Dna Test

scholarly journals Precision Prevention: The 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors

2021 ◽  
Vol 2 (3) ◽  
pp. 274-280
Author(s):  
Ritu Nayar
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cancer Prevention ◽  
Cervical Cancer Screening ◽  
Hpv Vaccination ◽  
Management Strategies ◽  
Hpv Infection ◽  
Cervical Cancer Prevention ◽  
Screening Tests ◽  
Consensus Guidelines

The approach to cervical cancer prevention has evolved significantly over the past two decades. HPV immunization has decreased the specificity of screening modalities and HPV-based testing has been replacing our previously successful morphology-only approach. Additionally, there is much more emphasis on providing precision prevention, rather than the previously used “one-fits-all” management strategies. A number of new biomarkers are entering clinical practice and being integrated into cervical cancer screening and management in order to enable a more personalized assessment of the risk for precancer/cancer for an individual patient. The 2019 ASCCP Risk-Based Management Consensus Guidelines expand on the concept of “equal management for equal risk”. They consider a patient’s history in addition to current test results to provide recommendations for increased surveillance/treatment in patients at higher risk for CIN3+ while minimizing interventions for lower-risk patients who have new versus persistent HPV infection. Clinical management decisions are based on immediate risk and 5-year risk estimates for CIN3+, which are determined by referencing an extensive risk table compiled by the National Cancer Institute (NCI). The course of action for a given patient is recommended by comparison of the risk in the risk database, to the predetermined clinical action thresholds. These guidelines address the need for simplification and offer some stability for the provider while being conducive to the incorporation of anticipated continued technologic advances in methods for cervical cancer prevention. Their enduring nature will allow for changes needed based on risk reduction as HPV vaccination uptake increases and vaccinated women reach screening age. Similarly, the design allows for the addition of new tests into the risk assessment calculations after their approval by applicable regulatory agencies and review/consensus approval by the ASCCP new technology and enduring guidelines workgroups. As cytopathologists, we must be familiar with the scientific advancements in primary and secondary prevention, evolving screening and management guidelines, and participate actively in the multidisciplinary approach for the prevention of cervical cancer.

Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care: evidence from midterm review of the Zimbabwe Cervical Cancer Prevention and Control strategy (2016-2020).

2020 ◽  
Author(s):  
Oscar Tapera ◽  
Anna M Nyakabau ◽  
Ndabaningi Simango ◽  
Bothwell T Guzha ◽  
Shamiso Jombo-Nyakuwa ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cancer Prevention ◽  
Cervical Cancer Screening ◽  
Prevention And Control ◽  
Hpv Vaccination ◽  
Cervical Cancer Prevention ◽  
Draft Report ◽  
Cancer Prevention And Control ◽  
And Control

Abstract Background Cervical cancer is the fourth most common cancer amongst women globally and it accounts for many cancer deaths among females in Zimbabwe. The objective of this midterm review was to measure the progress of cervical cancer prevention and control interventions in Zimbabwe. Methods A mixed methods approach was used for the midterm review. Secondary data was collected from programme documents, published and grey literature. Primary data was collected in six provinces, including Harare Metropolitan. Key informant interviews were conducted with officials from relevant departments in the Ministry of Health and Child Care (MoHCC) and partners working in cervical cancer spaces. Two focus group discussions with beneficiaries were facilitated in Manicaland and Matabeleland South Provinces. After data analysis, a draft report was presented to a technical working group to validate the findings and to fill in any gaps. Results The cervical cancer strategy led to the raising of awareness especially around cervical cancer screening and this created demand for services. Coverage of HPV vaccination achieved by 2019 was 86% against a target of 80%. Every district in Zimbabwe had a screening site with a total of 106 clinics across the whole country. Almost two thirds (66%) of women with precancerous lesions received treatment in 2018 against a target of 80%. Tertiary hospitals are offering surgery to eligible women with cervical cancer and there are ongoing efforts towards establishing two centres of excellence in the country. There are opportunities for collaborative, coordinated comprehensive cervical cancer care and research at institutions (public and academic) that can be strengthened and better coordinated by MoHCC. Successes scored in fundraising for ZCCPCS strategy thematic areas including awareness, cervical cancer screening and HPV vaccination set the pace for comprehensive inclusion of diagnosis, treatment and palliative care. Conclusions This midterm review revealed a myriad of gaps of the strategy particularly in diagnosis, treatment and care of cervical cancer and the primary focus was on secondary prevention. Lessons learnt reveals that development and implementation of the next strategy will require increased stakeholder collaboration between government, private sector, academia and non-governmental organizations for more sustainable cervical cancer interventions.

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