A rapid, high-volume cervical screening project using self-sampling and isothermal PCR HPV testing

Abstract Objective Rapid, high-volume screening programs are needed as part of cervical cancer prevention in China. Methods In a 5-day screening project in Inner Mongolia, 3345 women volunteered following a community awareness campaign, and self-swabbed to permit rapid HPV testing. Two AmpFire™ HPV detection systems (Atila Biosystems) were sufficient to provide pooled 15-HPV type data within an hour. HPV+ patients had same-day digital colposcopy (DC) performed by 1 of 6 physicians, using the EVA™ system (MobileODT). Digital images were obtained and, after biopsy of suspected lesions for later confirmatory diagnosis, women were treated immediately based on colposcopic impression. Suspected low- grade lesions were offered treatment with thermal ablation (Wisap), and suspected high-grade lesions were treated with LLETZ. Results Of 3345 women screened, 624 (18.7%) were HPV+. Of these, 88.5% HPV+ women underwent same-day colposcopy and 78 were treated. Later consensus histology results obtained on 197 women indicated 20 CIN2+, of whom 15 were detected and treated/referred at screening (10 by thermal ablation, 4 by LLETZ, 1 by referral). Conclusions Global control of cervical cancer will require both vaccination and screening of a huge number of women. This study illustrates a cervical screening strategy that can be used to screen-and-treat large numbers of women. HPV self-sampling facilitates high-volume screening. Specimens can be tested rapidly, promoting minimal loss-to-follow-up. Specifically, the AmpFire™ system used in this study is highly portable, simple, rapid (92 specimens per 65 min per unit), and economical. Visual triage can be performed on HPV+ women with a portable digital colposcope that provides magnification, lighting, and a recorded image. Diagnosis and appropriate treatment remain the most subjective elements. The digital image is under study for deep-learning based automated evaluation that could assist the management decision, either by itself or combined with HPV typing.

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Facilitators and Barriers to Cervical Cancer Screening in Migori County, Kenya

Journal of Global Oncology ◽

10.1200/jgo.2016.003970 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 82s-82s

Author(s):

Holly Nishimura ◽

Nelly Yatich ◽

Megan Huchko

Keyword(s):

Cervical Cancer ◽

Focus Group ◽

Cancer Prevention ◽

Cervical Cancer Prevention ◽

Sub Saharan Africa ◽

Hpv Testing ◽

Community Members ◽

Screening Programs ◽

Barriers To Screening ◽

Incidence And Mortality

Abstract 77 Background: Cervical cancer, a disease that is largely preventable through organized screening programs, still impacts over 500,000 women every year. Sub-Saharan Africa has the highest global incidence and mortality, largely due to lack of screening coverage. Low-cost and simple-to-implement screening technologies can potentially impact the rates of cervical cancer, if they are acceptable and scalable. As part of a trial to evaluate implementation strategies for cervical cancer prevention in western Kenya, we sought to identify the barriers and facilitators of screening, as well as opinions on a strategy employing self-collection of specimens for human papillomavirus (HPV) testing. Methods: Providers and female community members were recruited for focus groups using purposive sampling. Two focus group discussions (FGDs) with community members (n=24) and one FGD with providers (n=12) and key stakeholders were held in Migori County, Kenya, using structured guides to assess and current cervical cancer knowledge, screening practices, barriers to screening and potential strategies to facilitate screening access and uptake, including self-collected HPV testing. Results: Participants in both groups assessed the education around HPV, cervical cancer, and screening as very low in the community, and identified this lack of education as the main barrier to screening. Community members reported fear of pain and embarrassment as significant barriers to a screening pelvic exam. They also reported that lack of knowledge and discomfort among providers were significant barriers. Having undergone screening themselves or talking to someone with experience increased willingness to screen. Providers reported workload and lack of supplies and trained staff as significant barriers. Most participants in both FGDs felt that self-collection would help address barriers. Women expressed willingness to self-collect if given adequate instructions and if knowledgeable counselors were present to discuss results. Conclusion: Cervical cancer prevention strategies employing effective educational components and self-collected HPV testing could address many of the identified barriers to screening. Key findings from analysis of the focus group transcripts will be used to inform the implementation of community health campaigns. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

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HPV Testing of Self-Collected Vaginal Swabs for Cervical Cancer Prevention in South Africa

Journal of Global Oncology ◽

10.1200/jgo.2016.003749 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 65s-66s ◽

Cited By ~ 1

Author(s):

Louise Kuhn ◽

Rakiya Saidu ◽

Cecilia Svanholm-Barrie ◽

Ana Tergas ◽

Rosalind Boa ◽

...

Keyword(s):

South Africa ◽

Health Care ◽

Cervical Cancer ◽

Conflicts Of Interest ◽

Vaginal Swab ◽

Cervical Cancer Prevention ◽

Hpv Testing ◽

Cervical Sample ◽

Screening Programs ◽

Vaginal Swabs

Abstract 33 Background: Cervical cancer screening programs in Low and Middle Income Countries (LMIC) need to be strengthened. One of the challenges is insufficient health care personnel to achieve optimal coverage. We evaluated the potential of human papillomavirus (HPV) testing using self-collected vaginal swabs to improve screening. Methods: As part of a larger NCI-supported study in Cape Town, South Africa, we recruited 261 HIV-uninfected and 237 HIV-infected women aged 30-60 years, at one primary health care site. All women were instructed to self-collect a vaginal swab on site immediately prior to a gynecologic exam, during which a cervical sample was collected. Both self- and clinician-collected samples were tested for high risk HPV types (16, 18, 45, 31, 33, 35, 52, 58, 51, 59, 39, 56, 66, 68) using Cepheid GeneXpert (HPV XpertTM). All women underwent at least one colposcopy with histological sampling. Classification of endpoint was based on expert pathology review. Results: The HPV prevalence using the cervical vs. self sample, respectively, was 14% vs. 25% among HIV-uninfected and 50% vs. 62% among HIV-infected women. Among women who were diagnosed with grade 2 or 3 cervical intraepithelial neoplasia (CIN) or cervical cancer, 94% were positive on HPV Xpert on the cervical and 88% on the vaginal swab, ignoring HIV status. However, specificity was poor for HPV tests done on self samples, 78% in HIV-uninfected and 52% in HIV-infected women. On a patient preference questionnaire, >90% of women stated they would be prepared to collect a sample at home and two-thirds expressed a preference to be examined by a clinician. Conclusion: Even in self-collected vaginal samples, HPV Xpert has excellent sensitivity for detecting cervical cancer precursor lesions. In LMIC settings where the ratio of health care workers to the population is low, HPV testing of self-collected samples could successfully triage women who require further evaluation and treatment. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Louise Kuhn No relationship to disclose Rakiya Saidu No relationship to disclose Cecilia Svanholm-Barrie No relationship to disclose Ana Tergas Consulting or Advisory Role: Helomics Rosalind Boa No relationship to disclose Jennifer Moodley No relationship to disclose Thomas C. Wright No relationship to disclose David Persing No relationship to disclose Scott Campbell No relationship to disclose Lynette Denny No relationship to disclose

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

Sexual Health ◽

10.1071/sh10022 ◽

2010 ◽

Vol 7 (3) ◽

pp. 376 ◽

Cited By ~ 20

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.

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The Clinical Role of HPV Testing in Primary and Secondary Cervical Cancer Screening

Obstetrics and Gynecology International ◽

10.1155/2013/610373 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

G. Hoste ◽

K. Vossaert ◽

W. A. J. Poppe

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

Screening Methods ◽

Hpv Testing ◽

Clinical Role ◽

Screening Programs ◽

Hpv Test

Traditional population-based cervical screening programs, based on cytology, have successfully reduced the burden of cervical cancer. Nevertheless limitations remain and new screening methods are emerging. Despite vaccination against the 2 most oncogenic types (HPV 16/18), cervical cancer screening will have to continue as an essential public health strategy. As the acquisition of an HR-HPV infection is critical in the progression to (pre-)cancerous cervical lesions, recent research has focused on HR-HPV detection. The sensitivity of HPV testing in primary and secondary prevention outweighs that of cytology, at the cost of slightly lower specificity. Although most of the HR-HPV infections are cleared after conization, new evidence from numerous studies encourages the implementation of HR-HPV testing and genotyping to improve posttreatment surveillance. An HR-HPV test 6 months after conization is a promising useful clinical marker to detect persistence and prevent progression. This review highlights the clinical role of HPV testing in primary and secondary cervical cancer screening.

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

Journal of Oncology ◽

10.1155/2020/8887672 ◽

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.

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Human Papillomavirus Selected Properties and Related Cervical Cancer Prevention Issues

Current Pharmaceutical Design ◽

10.2174/1381612826666200422094205 ◽

2020 ◽

Vol 26 (18) ◽

pp. 2073-2086

Author(s):

Saule Balmagambetova ◽

Andrea Tinelli ◽

Ospan A. Mynbaev ◽

Arip Koyshybaev ◽

Olzhas Urazayev ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cancer Prevention ◽

Screening Program ◽

Hpv Infection ◽

Cervical Cancer Prevention ◽

Point Of View ◽

Prevention Strategies ◽

Middle Income ◽

Screening Programs

High-risk human papillomavirus strains are widely known to be the causative agents responsible for cervical cancer development. Aggregated damage caused by papillomaviruses solely is estimated in at least 5% of all malignancies of the human body and 16% in cancers that affect the female genital area. Enhanced understanding of the complex issue on how the high extent of carcinogenicity is eventually formed due to the infection by the Papoviridae family would contribute to enhancing current prevention strategies not only towards cervical cancer, but also other HPV associated cancers. This review article is aimed at presenting the key points in two directions: the current cervical cancer prevention and related aspects of HPV behavior. Virtually all applied technologies related to HPV diagnostics and screening programs, such as HPV tests, colposcopy-based tests (VIA/VILI), conventional and liquid-based cytology, currently available are presented. Issues of availability, advantages, and drawbacks of the screening programs, as well as vaccination strategies, are also reviewed in the article based on the analyzed sources. The current point of view regarding HPV is discussed with emphasis on the most problematic aspect of the HPV family concerning the observed increasing number of highly carcinogenic types. Present trends in HPV infection diagnostics throughout the human fluids and tissues are also reported, including the latest novelties in this field, such as HPV assay/self-sample device combinations. Besides, a brief outline of the related prevention issues in Kazakhstan, the leading country of Central Asia, is presented. Kazakhstan, as one of the post-soviet middle-income countries, may serve as an example of the current situation in those terrains, concerning the implementation of globally accepted cervical cancer prevention strategies. Along with positive achievements, such as the development of a nationwide screening program, a range of drawbacks is also analyzed and discussed.

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P63 Improving cervical smear uptake through an Automated Voice Messages Reminder

BJS Open ◽

10.1093/bjsopen/zrab032.062 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Francesca Bladt ◽

Felyx Wong ◽

Francesca Bladt

Keyword(s):

Cervical Cancer ◽

Low Cost ◽

Cervical Screening ◽

Telephone Triage ◽

Cervical Smear ◽

Screening Programs ◽

Smear Test ◽

Voice Message ◽

The Uk ◽

Busy Schedule

Abstract National cervical screening programs have played a pivotal role in the prevention of cervical cancer. However, practices across the UK have reached an all-time low in cervical screening uptake. This study aimed to assess the efficacy of implementing an automated voice message reminder within the local general practice (GP) telephone triage system and explore the reasons which deter eligible patients away from cervical screening. A 20-second voice-message reminder in the telephone queue was played, addressing key risk factors along with a message from a child who lost his mother to cervical cancer. From the anonymised GP database, weekly new smear test bookings were monitored from 4 weeks prior until 2 weeks after the intervention was implemented. To qualitatively assess factors which deter patients away from screening, female patients were randomly sampled to fill in an anonymous questionnaire. The use of a low-cost 20 second voice message in the telephone queue across UK GP practices could be an effective method to increase cervical smear test coverage towards the national target of 80%. 35 questionnaire responses were received, main themes reported for not attending screening include embarrassment(37%), busy schedule(32%) and cultural differences(24%). In the week following the intervention, cervical smear tests increased more than 2-fold, from an average of 12 to 26 smears per week. This could be partly due to the convenient timing of voice recording, reminding them to book both appointments simultaneously and the child’s emotive message.

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Working towards a comprehensive understanding of HPV and cervical cancer among Indigenous women: a qualitative systematic review

BMJ Open ◽

10.1136/bmjopen-2021-050113 ◽

2021 ◽

Vol 11 (6) ◽

pp. e050113

Author(s):

Sneha Sethi ◽

Brianna Poirier ◽

Karen Canfell ◽

Megan Smith ◽

Gail Garvey ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Prevention ◽

Ecological Model ◽

Cervical Screening ◽

Hpv Infection ◽

Cervical Cancer Prevention ◽

Social Ecological Model ◽

Indigenous Women ◽

Indigenous Populations ◽

Social Ecological

RationaleIndigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers.ObjectiveThis is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers.MethodsTwo investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a ‘meta-study’ approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated.ResultsFive core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation.ConclusionThe social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers.PROSPERO registration numberCRD42020207643.

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Smartphone-Enhanced Training, QA, Monitoring, and Evaluation of a Platform for Secondary Prevention of Cervical Cancer: Opportunities and Challenges to Implementation in Tanzania

JCO Global Oncology ◽

10.1200/go.20.00124 ◽

2020 ◽

pp. 1114-1123

Author(s):

Karen Yeates ◽

Erica Erwin ◽

Zac Mtema ◽

Frank Magoti ◽

Simoni Nkumbugwa ◽

...

Keyword(s):

Cervical Cancer ◽

Visual Inspection ◽

Screening Program ◽

Cervical Screening ◽

Monitoring And Evaluation ◽

Visual Assessment ◽

Cervical Cancer Prevention ◽

Supportive Supervision ◽

Health Providers

PURPOSE Until human papillomavirus (HPV)–based cervical screening is more affordable and widely available, visual inspection with acetic acid (VIA) is recommended by the WHO for screening in lower-resource settings. Visual inspection will still be required to assess the cervix for women whose screening is positive for high-risk HPV. However, the quality of VIA can vary widely, and it is difficult to maintain a well-trained cadre of providers. We developed a smartphone-enhanced VIA platform (SEVIA) for real-time secure sharing of cervical images for remote supportive supervision, data monitoring, and evaluation. METHODS We assessed programmatic outcomes so that findings could be translated into routine care in the Tanzania National Cervical Cancer Prevention Program. We compared VIA positivity rates (for HIV-positive and HIV-negative women) before and after implementation. We collected demographic, diagnostic, treatment, and loss-to-follow-up data. RESULTS From July 2016 to June 2017, 10,545 women were screened using SEVIA at 24 health facilities across 5 regions of Tanzania. In the first 6 months of implementation, screening quality increased significantly from the baseline rate in the prior year, with a well-trained cadre of more than 50 health providers who “graduated” from the supportive-supervision training model. However, losses to follow-up for women referred for further evaluation or to a higher level of care were considerable. CONCLUSION The SEVIA platform is a feasible, quality improvement, mobile health intervention that can be integrated into a national cervical screening program. Our model demonstrates potential for scalability. As HPV screening becomes more affordable, the platform can be used for visual assessment of the cervix to determine amenability for same-day ablative therapy and/or as a secondary triage step, if needed.

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Role of Protein Biomarkers in the Detection of High-Grade Disease in Cervical Cancer Screening Programs

Journal of Oncology ◽

10.1155/2012/289315 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 12

Author(s):

Charlotte A. Brown ◽

Johnannes Bogers ◽

Shaira Sahebali ◽

Christophe E. Depuydt ◽

Frans De Prins ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

False Negative ◽

Pap Test ◽

Developed Countries ◽

Protein Biomarkers ◽

Ki 67 ◽

Screening Programs

Since the Pap test was introduced in the 1940s, there has been an approximately 70% reduction in the incidence of squamous cell cervical cancers in many developed countries by the application of organized and opportunistic screening programs. The efficacy of the Pap test, however, is hampered by high interobserver variability and high false-negative and false-positive rates. The use of biomarkers has demonstrated the ability to overcome these issues, leading to improved positive predictive value of cervical screening results. In addition, the introduction of HPV primary screening programs will necessitate the use of a follow-up test with high specificity to triage the high number of HPV-positive tests. This paper will focus on protein biomarkers currently available for use in cervical cancer screening, which appear to improve the detection of women at greatest risk for developing cervical cancer, including Ki-67,p16INK4a, BD ProEx C, and Cytoactiv HPV L1.

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