Advances in cervical cancer screening and human papillomavirus vaccines

Cervical cancer is causally linked to human papillomavirus (HPV) and constitutes a major health problem for women. Nearly 80% of the 510,000 cases reported worldwide each year occur in developing countries which lack organized screening programmes. Cervical screening has effectively reduced the incidence of and mortality from invasive cervical cancer in industrialized countries, but is not completely protective. Cervical screening is now undergoing modernization and has seen several changes in recent years. These aim to enhance the overall efficiency and effectiveness of screening, reduce rates of inadequate sampling, increase sensitivity rates and facilitate ancillary technologies, such as HPV testing. This review discusses these advances and the development of HPV vaccines.

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Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000161 ◽

2019 ◽

Vol 29 (4) ◽

pp. 669-675

Author(s):

Irenjeet Bains ◽

Yoon Hong Choi ◽

Kate Soldan ◽

Mark Jit

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cost Effectiveness ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

Clinical Impact ◽

Hpv Testing ◽

Life Years ◽

The Impact

ObjectivesIn England, human papillomavirus (HPV) testing is to replace cytological screening by 2019–2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing.MethodsAn individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25–64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses.ResultsHPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer.ConclusionsEngland's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.

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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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HPV-testing in cervical screening

HEALTH OF WOMAN ◽

10.15574/hw.2016.112.100 ◽

2016 ◽

pp. 100-102

Author(s):

O. Rykova ◽

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Human Papilloma Virus ◽

Key Words ◽

Cervical Screening ◽

Pap Test ◽

Carcinogenic Risk ◽

Hpv Testing ◽

Papilloma Virus ◽

Liquid Based Cytology

The article presents modern laboratory aspects of cervical screening, which include assessment of infection with human papillomavirus (HPV) high carcinogenic risk. Key words: cervical cancer, cervical screening, traditional cytology, liquid-based cytology, PAP-test, human papilloma virus.

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Human papillomavirus in cervical screening and vaccination

Clinical Science ◽

10.1042/cs20050230 ◽

2006 ◽

Vol 110 (5) ◽

pp. 543-552 ◽

Cited By ~ 16

Author(s):

Emma J. Crosbie ◽

Henry C. Kitchener

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

High Risk ◽

Residual Disease ◽

Cervical Screening ◽

Hpv Infection ◽

Hpv Testing ◽

Hpv Dna ◽

Hpv Test ◽

High Risk Hpv

Recent decades have witnessed a reduction in the incidence of cervical cancer in countries where screening programmes have achieved broad coverage. The recognized importance of high-risk HPV (human papillomavirus) infection in the aetiology of cervical cancer may introduce a role for HPV DNA testing in cervical screening programmes. Positive HPV DNA tests indicate women at risk of cervical cancer with greater sensitivity, but reduced specificity, compared with exfoliative cytology. Combining HPV testing with cytology may be useful in the triage of minor cytological abnormalities into those requiring referral to colposcopy (HPV positive) compared with those who can be safely managed by cytological surveillance (HPV negative). With its high sensitivity and high-negative-predictive value, HPV testing may also be useful for predicting treatment failure, since residual disease is very unlikely in the event of a negative HPV test. Ultimately, prevention is better than cure, and the advent of HPV prophylactic vaccines may obviate the need for population-based cervical screening programmes in the future. A multivalent vaccine administered to adolescents prior to the onset of sexual activity and boosted at regular intervals throughout their sexually active life may provide protection against type-specific HPV infection, malignant precursors and invasive cervical disease. Several large randomized placebo-controlled trials have been conducted with promising results. For those generations of women already exposed to high-risk HPV infection, therapeutic vaccines may offer advantages over conventional treatment, although much work still needs to be done.

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Human papillomavirus prevalence among women with cervical intraepithelial neoplasia III and invasive cervical cancer from Goiânia, Brazil

Memórias do Instituto Oswaldo Cruz ◽

10.1590/s0074-02762003000200003 ◽

2003 ◽

Vol 98 (2) ◽

pp. 181-184 ◽

Cited By ~ 26

Author(s):

SH Rabelo-Santos ◽

L Zeferino ◽

LL Villa ◽

JP Sobrinho ◽

RG Amaral ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cervical Intraepithelial Neoplasia ◽

Invasive Cervical Cancer ◽

Intraepithelial Neoplasia

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Human papillomavirus type 16 genomic variation in women with subsequent in situ or invasive cervical cancer: prospective population-based study

British Journal of Cancer ◽

10.1038/s41416-018-0311-7 ◽

2018 ◽

Vol 119 (9) ◽

pp. 1163-1168 ◽

Cited By ~ 3

Author(s):

Laila Sara Arroyo-Mühr ◽

Camilla Lagheden ◽

Emilie Hultin ◽

Carina Eklund ◽

Hans-Olov Adami ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Invasive Cervical Cancer ◽

Population Based ◽

Genomic Variation ◽

Population Based Study ◽

Human Papillomavirus Type 16

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“They Should Be Asking Us”: A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening

Global Qualitative Nursing Research ◽

10.1177/2333393618783632 ◽

2018 ◽

Vol 5 ◽

pp. 233339361878363 ◽

Cited By ~ 4

Author(s):

Brianne Wood ◽

Virginia L. Russell ◽

Ziad El-Khatib ◽

Susan McFaul ◽

Monica Taljaard ◽

...

Keyword(s):

Health Care ◽

Cervical Cancer ◽

Decision Making ◽

Cancer Screening ◽

Shared Decision Making ◽

Cervical Cancer Screening ◽

Cervical Screening ◽

Hpv Testing ◽

Shared Decision ◽

Care Providers

In this study, we examine from multiple perspectives, women’s shared decision-making needs when considering cervical screening options: Pap testing, in-clinic human papillomavirus (HPV) testing, self-collected HPV testing, or no screening. The Ottawa Decision Support Framework guided the development of the interview schedule. We conducted semi-structured interviews with seven screen-eligible women and five health care professionals (three health care providers and two health system managers). Women did not perceive that cervical screening involves a “decision,” which limited their knowledge of options, risks, and benefits. Women and health professionals emphasized how a trusted primary care provider can support women making a choice among cervical screening modalities. Having all cervical screening options recommended and funded was perceived as an important step to facilitate shared decision making. Supporting women in making preference-based decisions in cervical cancer screening may increase screening among those who do not undergo screening regularly and decrease uptake in women who are over-screened.

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