scholarly journals The Vaginal Microbiome and Cervical Cancer Screening in Low- and Middle-Income Countries

2019 ◽  
Vol 5 (Supplement_1) ◽  
pp. 6-6
Author(s):  
Supriya D. Mehta

PURPOSE Globally, cervical cancer affects more than a half-million women each year, with disproportionate incidence and mortality for women in low- and middle-income countries. Early detection through cervical cancer screening saves lives but is hampered by poor coverage, suboptimal detection accuracy, and lack of access to and delays in effective treatment. METHODS Emerging evidence that indicates how the vaginal microbiome can modify progression of human papillomavirus (HPV) infection and cervical cancer pathogenesis is surveyed. This presentation features a discussion of how the vaginal microbiome may affect cervical cancer screening and how cervical cancer screening may incorporate vaginal microbiome health in low- and middle-income countries. RESULTS Vaginal dysbiosis as a clinical syndrome may be called bacterial vaginosis (BV), a condition that represents a shift from a Lactobacillus-dominant vaginal microbiome to one that is polymicrobial and often associated with increased mucosal inflammation. Meta-analyses and prospective studies demonstrate an association between vaginal dysbiosis and increased risk of HPV incidence and persistence and high-grade lesions and cancer. Increasing vaginal microbiome diversity is associated with progression of cervical intraepithelial neoplasia. Vaginal microbiota that are associated with greater likelihood of HPV detection in molecular studies are also commonly associated with BV. There are numerous challenges to incorporating microbiome measurement in population-level cervical cancer screening and unanswered research questions on its immediate utility. BV may serve as a measure of vaginal microbiome health, although there are no guidelines or recommendations for regular BV screening and treatment. CONCLUSION Ongoing and planned longitudinal studies should evaluate BV screening in association with high-risk HPV, results of cervical cancer screening, and progression of cervical intraepithelial neoplasia to assess the utility of BV screening and treatment as an adjunct to cervical cancer screening and potential intervention.

2016 ◽  
Vol 7 ◽  
pp. 4-11 ◽  
Author(s):  
Sujha Subramanian ◽  
Rengaswamy Sankaranarayanan ◽  
Pulikkottil Okkuru Esmy ◽  
Jissa Vinoda Thulaseedharan ◽  
Rajaraman Swaminathan ◽  
...  

2017 ◽  
Vol 141 (3) ◽  
pp. 437-446 ◽  
Author(s):  
Alex K. Mezei ◽  
Heather L. Armstrong ◽  
Heather N. Pedersen ◽  
Nicole G. Campos ◽  
Sheona M. Mitchell ◽  
...  

2016 ◽  
Vol 134 (3) ◽  
pp. 239-246 ◽  
Author(s):  
Brody Olson ◽  
Beth Gribble ◽  
Jasmyni Dias ◽  
Cassie Curryer ◽  
Kha Vo ◽  
...  

2021 ◽  
pp. 686-693
Author(s):  
Chemtai Mungo ◽  
Cirilus Ogollah Osongo ◽  
Jeniffer Ambaka ◽  
Magdalene A. Randa ◽  
Benard Samba ◽  
...  

PURPOSE Adjunct cervical cancer screening methods are under evaluation to improve the diagnostic accuracy of human papillomavirus (HPV)-based screening in low- and middle-income countries. We evaluated the feasibility and acceptability of smartphone-based cervicography among HPV-positive women living with HIV (WLWH) in Western Kenya. METHODS HPV-positive WLWH of 25-49 years of age enrolled in a clinical trial (ClinicalTrials.gov identifier: NCT04191967 ) had digital images of the cervix taken using a smartphone by a nonphysician provider following visual inspection with acetic acid. All participants had colposcopy-directed biopsy before treatment. Cervical images were evaluated by three off-site colposcopists for quality, diagnostic utility, and assigned a presumed diagnosis. We determined the proportion of images rates as low, medium, or high quality, interobserver agreement using Cohen’s Kappa statistic, and the off-site colposcopist’s sensitivity and specificity for diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with histopathology. Acceptability was evaluated using a questionnaire. RESULTS One hundred sixty-four HPV-positive WLWH underwent cervicography during the study period. Mean age was 37.3 years. Images from the first 94 participants were evaluated by off-site colposcopists, with a majority (70.9%) rated as high quality. Off-site colposcopists had a sensitivity ranging from 21.4% (95% CI, 0.06 to 0.43) to 35.7% (95% CI, 0.26 to 0.46) and a specificity between 85.5% (95% CI, 0.81 to 0.90) to 94.9% (95% CI, 0.92 to 0.98) for diagnosis of CIN2+ based compared with histopathology. The majority of women, 99.4%, were comfortable having an image of their cervix taken as part of screening. CONCLUSION Cervicography by a nonphysician provider as an adjunct to HPV-based screening among WLWH in a low- and middle-income country setting is feasible and acceptable. However, low sensitivity for diagnosis of CIN2+ by off-site expert colposcopists highlights the limitations of cervicography.


2018 ◽  
Vol 55 (4) ◽  
pp. 318 ◽  
Author(s):  
Smita Asthana ◽  
Pradeep Devarapalli ◽  
Satyanarayana Labani ◽  
Narayanasetti Nagarjuna ◽  
Poonam Panchal

JAMA ◽  
2020 ◽  
Vol 324 (15) ◽  
pp. 1532
Author(s):  
Julia M. Lemp ◽  
Jan-Walter De Neve ◽  
Hermann Bussmann ◽  
Simiao Chen ◽  
Jennifer Manne-Goehler ◽  
...  

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