scholarly journals Self-Collection for Cervical Screening Programs: From Research to Reality

Cancers ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1053 ◽  
Author(s):  
David Hawkes ◽  
Marco H. T. Keung ◽  
Yanping Huang ◽  
Tracey L. McDermott ◽  
Joanne Romano ◽  
...  

In 2018, there were an estimated 570,000 new cases of cervical cancer globally, with most of them occurring in women who either had no access to cervical screening, or had not participated in screening in regions where programs are available. Where programs are in place, a major barrier for women across many cultures has been the requirement to undergo a speculum examination. With the emergence of HPV-based primary screening, the option of self-collection (where the woman takes the sample from the vagina herself) may overcome this barrier, given that such samples when tested using a PCR-based HPV assay have similar sensitivity for the detection of cervical pre-cancers as practitioner-collected cervical specimens. Other advantages of HPV-based screening using self-collection, beyond the increase in acceptability to women, include scalability, efficiency, and high negative predictive value, allowing for long intervals between negative tests. Self-collection will be a key strategy for the successful scale up of cervical screening programs globally in response to the WHO call for all countries to work towards the elimination of cervical cancer as a public health problem. This review will examine self-collection for HPV-based cervical screening including the collection devices, assays and possible routine laboratory processes considering how they can be utilized in cervical screening programs.

2018 ◽  
Vol 13 (1) ◽  
pp. 24-27
Author(s):  
Zebunnessa Parvin ◽  
Lutfun Naher ◽  
Sanjoy Kumar Das ◽  
Shafeya Khanam ◽  
Nasrin Rosy

Cervical cancer continues to be a major public health problem in Bangladesh in the absence of satisfactory and organized cervical screening programs. World Health Organization (WHO) considered cervical cancer as a preventable disease, as it can be identified in the pre-invasive stage. Visual inspection of the cervix with acetic acid (VIA) is an effective, inexpensive screening test that can be combined with simple treatment procedure for early cervical lesions, provided by trained health workers. To evaluate the value of visual inspection with acetic acid (VIA) for early detection of cervical pre-cancer and cancer in low resource country like Bangladesh, diluted acetic acid 5% was applied to the cervix and visual inspection was done. VIA tests were done for at least 3 years interval, in case of married woman, for cervical cancer screening. Women with positive results were sent for colposcopy. From January to December 2014, in Gynae OPD of the Faridpur Medical College Hospital, Faridpur, a total of 2000 women were screened by VIA test. Fourty-one VIA positive cases were identified and referred for colposcopy. Out of 41 cases, 27 patients underwent colposcopic examination, among them CIN-1 was found in 21 cases, CIN-2 in 2 cases and CIN-3 in 2 cases. However, two cases were colposcopically negative. So even during gynecological practice, if we arrange a setup for cervical screening by VIA test, many women can be saved from future development of carcinoma cervix later in their lives.Faridpur Med. Coll. J. Jan 2018;13(1): 24-27


2021 ◽  
Vol 2 (4) ◽  
pp. 23-29
Author(s):  
I.P. Sharipova ◽  
◽  
E.I. Musabaev ◽  

Viral infections are responsible for 15–20% of all human cancers. Infection with oncogenic viruses can contribute to various stages of carcinogenesis. Despite effective screening methods, cervical cancer continues to be a major public health problem. There are large differences in morbidity and mortality from cervical cancer by geographic region. The age-specific prevalence of HPV varies widely in different populations and has shown two peaks of HPV positiveness in young and older women. Around the world, there have been many studies on the epidemiology of HPV infection and oncogenic properties due to different HPV genotypes. However, there are still many countries where population prevalence has not yet been determined. Moreover, screening strategies for cervical cancer differ from country to country. Organized cervical screening programs are potentially more effectivethan opportunistic screening programs.Key words:Human papillomavirus, cervical cancer, screening, dysplasia


2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sharon Hanley

Abstract Focus and outcomes for participants Rationale for the symposium, including for its inclusion in the Congress Cervical cancer, caused by persistent infection with oncogenic human papillomavirus (HPV), is one of the most preventable and treatable forms of cancer, yet more than 300,000 women die from the disease annually and over 500,000 cases are diagnosed. Modelling has shown that effective integration of HPV immunization programmes, HPV-based screening, and access to high-quality cancer treatment and palliative care services has the potential to eliminate cervical cancer in most countries in the world over the next century. In 2018, the Director-General of WHO made a global call to action for the elimination of cervical cancer as a public health problem. As a result, WHO has developed a global strategy towards eliminating cervical cancer as a public health problem due for endorsement at the World Health Assembly in May 2020, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of HPV vaccination of 90%, twice-lifetime cervical screening of 70%, and treatment of pre-invasive lesions and invasive cancer of 90%. As the first country to establish a national HPV immunization programme and one of the first countries to move to an HPV based screening programme, Australia has played a leading role in the global battle against cervical cancer and is on course to eliminate the disease within the next decade. However, while the burden of disease and the highest mortality from cervical cancer occur in lower income countries, factors such as the inequitable cervical cancer burden in Indigenous populations and vaccine hesitancy mean that significant barriers to the elimination of cervical cancer also exists within high-income countries. This session will have seven experts working in four countries within the Asia Pacific region. By sharing experiences and providing evidence-based guidance on key technical and strategic issues, we hope to generate a comprehensive understanding and new knowledge on factors impacting participation in, and the potential for effective scale up of, cervical cancer control programmes within the region. Presentation program Names of presenters -Dr Kate Simms is a Postdoctoral Research Fellow at Cancer Council NSW, Australia. Her research focusses on modelling the impact of HPV vaccination and cervical cancer screening across a range of settings, including predictions for the potential elimination of cervical cancer across 181 countries. -Associate Professor Julia Brotherton is a public health physician and Medical Director of VCS Population Health. She is involved in research and policy development informing the implementation and evaluation of HPV vaccination programs in Australia and is member of the WHO Director General's Expert Advisory Group on Cervical Cancer Elimination. -Assistant Professor Sharon Hanley is a cancer epidemiologist at Hokkaido University, Japan. Her research interests include HPV vaccine hesitancy and HPV self-sampling to increase cervical screening uptake in never/under screened Japanese women. - Associate Professor Lisa Whop is an Indigenous Senior Research Fellow at the Australian National University, Canberra, Australia. Her research focuses on improving health outcomes for Aboriginal and Torres Strait Islander people with cancer, with a key focus on equity. - Dr Megan Smith is a Postdoctoral Research Fellow whose research focuses on optimizing and successfully implementing cervical cancer prevention, at the population level and in different population subgroups. She has contributed to a large number of reports to government, including several evaluations that have directly informed policy in Australia, New Zealand and England. -Professor Andrew Vallely is a clinical epidemiologist at the Kirby Institute, University of New South Wales, Australia. He recently completed a field evaluation comparing point-of-care Xpert HPV testing using self-collected specimens with visual inspection of the cervix with acetic acid (VIA), to detect high-grade cervical disease. - Professor Woo Yin Ling is a Consultant Obstetrician and Gynaecologist at the University of Malaya. She is the programme designer of Project ROSE (Removal of Obstacles to Cervical Screening), a novel cervical screening research programme which employs HPV self-sampling and digital technology to increase access to cervical screening in Malaysia. Names of facilitator or chair Assistant Professor Sharon J.B. Hanley, Hokkaido University and Professor John Kaldor, Kirby Institute, University of New South Wales?


BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Francesca Bladt ◽  
Felyx Wong ◽  
Francesca Bladt

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.


2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Charlotte A. Brown ◽  
Johnannes Bogers ◽  
Shaira Sahebali ◽  
Christophe E. Depuydt ◽  
Frans De Prins ◽  
...  

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.


2018 ◽  
Vol 25 (1) ◽  
pp. 8 ◽  
Author(s):  
B. Wood ◽  
A. Lofters ◽  
M. Vahabi

Background Self-sampling for human papillomavirus (hpv) has the potential to reach marginalized populations that are underserved for cervical cancer screening. However, before implementing an alternative screening strategy such as self-sampling for under- and never-screened women, the key processes, facilitators, and barriers to reform need to be understood.Methods A descriptive qualitative study was conducted that involved semi-structured interviews with Canadian and international cancer screening health care providers and policy-makers. Respondents were purposively selected from a list of thirty stakeholders generated through an environmental scan. The interviews were transcribed verbatim and analyzed using directed content analysis.Results Nineteen stakeholders participated in the interviews. Most respondents thought that self-sampling was an appropriate cervical screening alternative for hard-to-reach populations, as it addressed barriers to cervical screening related to various social determinants of health. All respondents emphasized that transitioning to hpv primary screening would catalyze a policy shift towards self-sampling. Clinician respondents were less enthusiastic about self-sampling strategies since that discouraged women’s appointments with primary care providers, because cervical screening offered an opportunity to discuss other preventive health topics. There also was little consensus between respondents on whether the state of evidence was satisfactory to integrate a self-sampling option into policy, or whether more Canadian research was needed.Conclusion Canadian cervical cancer screening stakeholders should collaborate to identify the knowledge gaps that researchers should address and leverage the existing literature to implement tailored, patient-centred alternative cervical screening strategies. The transition to hpv primary screening would be a key first step in the broad implementation of hpv self-sampling in Canada.


2018 ◽  
Vol 4 ◽  
pp. e154 ◽  
Author(s):  
Kelwin Fernandes ◽  
Davide Chicco ◽  
Jaime S. Cardoso ◽  
Jessica Fernandes

Cervical cancer remains a significant cause of mortality all around the world, even if it can be prevented and cured by removing affected tissues in early stages. Providing universal and efficient access to cervical screening programs is a challenge that requires identifying vulnerable individuals in the population, among other steps. In this work, we present a computationally automated strategy for predicting the outcome of the patient biopsy, given risk patterns from individual medical records. We propose a machine learning technique that allows a joint and fully supervised optimization of dimensionality reduction and classification models. We also build a model able to highlight relevant properties in the low dimensional space, to ease the classification of patients. We instantiated the proposed approach with deep learning architectures, and achieved accurate prediction results (top area under the curve AUC = 0.6875) which outperform previously developed methods, such as denoising autoencoders. Additionally, we explored some clinical findings from the embedding spaces, and we validated them through the medical literature, making them reliable for physicians and biomedical researchers.


Author(s):  
Julianne Williams ◽  
Ivo Rakovac ◽  
Jocelyn Victoria ◽  
Tatiana Tatarinova ◽  
Marilys Corbex ◽  
...  

Abstract Background Screening programs play an important role in a comprehensive strategy to prevent cervical cancer, a leading cause of death among women of reproductive age. Unfortunately, there is a dearth of information about rates of cervical cancer testing, particularly in Eastern Europe and Central Asia where levels of cervical cancer are among the highest in the WHO European Region. The purpose of this article is to report on the lifetime prevalence of cervical cancer testing among females aged 30–49 years from across the WHO European region, and to describe high-level geographic and socioeconomic differences. Methods We used data from the European Health Information Survey and the WHO STEPwise approach to Surveillance survey to calculate the proportions of women who were tested for cervical cancer. Results The percentage of tested women ranged from 11.7% in Azerbaijan to 98.4% in Finland, with the lowest percentages observed in Azerbaijan, Tajikistan and Uzbekistan. Testing was lower in Eastern Europe (compared to Western Europe), among low-income countries and among women with lower levels of education. Conclusion Effective cervical cancer screening programs are one part of a larger strategy, which must also include national scale-up of human papilloma virus vaccination, screening and treatment.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18020-e18020
Author(s):  
Dilyara Kaidarova ◽  
Raikhan Bolatbekova ◽  
Alma Zhylkaidarova ◽  
Tolkyn Sadykova ◽  
Yerlan Kukubassov ◽  
...  

e18020 Background: Cervical cancer is the second most common cancer in women worldwide, where the majority of registered patients are in developing countries. Screening programs in developed countries have reduced morbidity and mortality from cervical cancer by more than 2 times. Cervical cancer (CC) is the most common gynecological cancer in Kazakhstan (KZ). Standardized incidence rate of CC was 18.2 per 100,000, while the mortality rate was 6.2 per 100,000, in 2019. The National Cervical Screening program in KZ uses cytology (Pap test) from 2008. Screening program funded by the State budget. In 2016, Experts of imPACT Mission analyzed the CC screening and made recommendations for improvement. Since 2018 target age of CC screening expanded to 30-70 years and shortened the interval to 4 years, strengthened the control of patients with pre-cancerous pathology. Until 2018, people came to a fixed age; today we start CC screening within the target age at any age at the time of the first visit. The purpose of this study is to analyze cytological screening results in KZ after imPACT recommendations. Methods: Coverage, the number of screened women, the level of pre-cancer detection and cervical cancer during screening have been obtained from specific reports (form № 025, № 08) for 2008-2019. Results: The total number of screened women was in 6.775.975. There is a decrease in the number of screened women by 32% from 2008 to 2017. Since improvement of CC screening we increased coverage from 49.9% in 2017 (abs. number 409.124) to 89% in 2019 (abs. number 954.322). According to the results of screening, 2603 cases of CC were registered in 12 years. Analysis of screening results showed a marked increase in the detection of CC with an increasing by 67%. The persentage of registered cases of ASH+HSIL increased from 0.136% to 0.673%. Conclusions: there has been an increase in the coverage by screening of the target population since the screening update. During the study period, there has been an improvement in the detection of precancerous pathology and cancer in the early stage. Despite the positive results of screening, sufficient coverage by screening, certain successes in detecting the initial stage of CC, mortality rate from CC remain high, which makes it necessary to improve the screening of CC in KZ through the introduction of HPV-screening.


Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 376 ◽  
Author(s):  
Joseph Tota ◽  
Salaheddin M. Mahmud ◽  
Alex Ferenczy ◽  
François Coutlée ◽  
Eduardo L. Franco

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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