Human Papillomavirus Testing In Screening Research Articles

The Effect of Cervical Cancer Education Given to Women in Turkey on Knowledge, Attitudes, and Health Beliefs: A Randomized Controlled Study.

The objective of this study was to ascertain the impact of cervical cancer education provided to women in Turkey on their knowledge, attitudes, and health beliefs. The study was conducted in accordance with the pretest-posttest randomized controlled trial model. The participants were randomly assigned to either the experimental or the control groups. The study was completed with a total of 105 women, 51 of whom were in the experimental group and 54 of whom were in the control group. The personal information form, the human papillomavirus (HPV) knowledge scale, and the health belief model scale for cervical cancer and Pap smear test were employed as data collection instruments. The data were analyzed using the SPSS 25.0 package program, and the number, percentage, independent samples t-test, and paired t-test were utilized for data analysis. Upon completion of the training program, the mean scores of the experimental group demonstrated a statistically significant increase in knowledge related to general HPV information, HPV screening tests, general HPV vaccines, and HPV vaccine programs when compared to the control group (p<0.001). Upon conclusion of the educational intervention, it was determined that the mean scores of cervical cancer sensitivity, caring, health motivation, Pap smear utility, and motivation of women in the experimental group exhibited an increase, while their general perception of Pap smear demonstrated a decrease (p<0.05). The findings of this study indicate that educational initiatives targeting women regarding cervical cancer have a beneficial impact on their knowledge, attitudes, and health beliefs. NCT05990270 registered on https://clinicaltrials.gov/.

Health beliefs and associated factors related to HPV and HPV vaccination in a sample of Turkish women: A cross-sectional study.

This study was conducted to determine women's health beliefs about HPV and HPV vaccination and factors associated with health beliefs. This cross-sectional study was conducted with 300 women aged 21-64 in Turkey. Data were collected using the human papillomavirus (HPV) knowledge scale (HPV-KS) and the health belief model scale for human papillomavirus and its vaccination (HBMS-HPVV). The mean age of the women who participated in the study was 35.16±9.52 years. Of them, 72.3% heard of the HPV test, 30.3% had an HPV test, 62% heard of HPV vaccination, and 9.7% had HPV vaccination. Educational level, hearing about the HPV vaccine, and HPV knowledge level were significant predictors of perceived benefit (p<.001). HPV knowledge level significantly predicted perceived susceptibility (p<.001). HPV knowledge level and hearing about HPV tests and vaccines were significant predictors of perceived severity (p<.001). A high level of education, a high level of HPV knowledge, and hearing about HPV tests and the HPV vaccine positively affect women's health beliefs. Health belief model-based education programs should be used to improve women's HPV knowledge and health beliefs about HPV and the HPV vaccine. In addition to women's health beliefs, cervical cancers can only be prevented by including the HPV vaccine in national immunization programs and increasing the coverage of HPV screening tests.

The current state of the problem of cervical screening

the article summarizes the issue of prevention of cervical cancer - the most common disease associated with the human papillomavirus (HPV). The main goal of this study is to generalize the etiology of cervical cancer, to note unique opportunities for its prevention, as well as to develop screening tests for HPV as one of the most effective strategies. Explore how current HPV diagnostics detect E6/E7 DNA or mRNA in cervical/vaginal specimens using molecular technologies. To find out whether HPV screening tests are more sensitive than cytology or visual examination with acetic acid as the primary screening method, and even more clinically valuable for detecting subtle cytological changes as a hybrid test. Through a detailed study of literature sources, their systematization and approaches to solving the problem, it was found that technical and laboratory capabilities are very limited in underserved places, so women have to travel long distances and make some efforts to prevent and treat cervical cancer. The relevance of the study of this pathology lies in the fact that cervical cancer is a serious public health problem and is the fourth most common cancer in women worldwide, accounting for about 604,000 new cases every year. And the practical implementation of an HPV screening program can face many problems, and measures must be taken to overcome these problems without compromising the detection of the disease. These measures could include reducing the frequency of screening using the WHO global strategy to offer HPV screening tests at ages 35 and 45, implementing high-throughput testing technology, and improving access to vaginal HPV screening tests for women in remote areas. Improving informational education for those who do not want to undergo a gynecological examination. Another important strategy is to implement a see-and-treat approach using a healthcare delivery platform that requires limited laboratory technician skills. In addition, the development and large-scale implementation of more specific HPV testing technologies that are much cheaper and easier to use in a non-laboratory setting than currently available options should be a priority for underserved facilities. At the same time, there is a need to develop and initiate implementation of an affordable and readily available intermediate or secondary test with optimal specificity to triage or separate clinically insignificant HPV infections that do not require colposcopy. The results of this study may be of interest to primary care physicians, gynecologists, oncologists, and therapists.

First international proficiency study on human papillomavirus testing in cervical cancer screening

BackgroundAlthough cervical screening using Human Papillomavirus (HPV) testing is globally recommended public health policy, there has been no international proficiency studies specifically targeting HPV testing for cervical screening. ObjectiveTo obtain the first global overview of the current proficiency of HPV testing services for cervical cancer screening. Study designA coded proficiency panel of 12 samples containing HPV types 16, 18, 31, 33, 45, 52, 58 or 35/39/51/56/59/68 in human DNA in varying amounts as well as control. Datasets detecting at least a) 10 International Units (IU) of HPV16 and 18, b) 1000 IU of HPV types 31, 33, 45, 52, 58 and c) having no false positives were considered proficient. ResultsIn total, 84 laboratories worldwide submitted 158 datasets (some laboratories used >1 HPV testing platform). Of those, 122 (77%) were 100% proficient. Only 14/158 datasets (9%) contained false positive results. Comparison of results with assays approved by the Food and Drug Administration (FDA) suggest that future proficiency requirements should also accommodate assays detecting only 100 IU of HPV16/18. A pool of low oncogenicity HPV types that contributed very little to sensitivity, but adversely affected specificity, was detectable by most datasets. ConclusionInternationally recognized proficiency studies of HPV screening, traceable to international standards, provided an overview of current testing performance. There was a high level of proficiency in terms of sensitivity and few false positives, but specificity was not optimal and further research on optimal specificity of HPV screening tests may be warranted.

Polymorphism of KIR Genes in Women with Human Papillomavirus Infection

Molecular biology screening techniques for early detection of human papillomavirus (HPV) infection in the National CervicalUterine Cancer Program in Cuba provide the opportunity to treat premalignant lesions and prevent progression to cervicaluterine cancer. Objectives: To identify 14 high-risk HPV genotypes in women aged 30 to 50 with negative previous cytology and to identify the polymorphism of killer immunoglobulin-like receptor (KIR) genes in a subsample of HPV-positive women. Methods: HPV screening tests were performed on 3,115 women using the COBAS 4800 system with the HPV COBAS kit (Roche, Germany). For KIR gene typing, 60 randomly selected HPV-positive women were analyzed using a molecular method based on hybridization probes on a LUMINEX flow analyzer with the LIFECODES KIR-SSO typing kit (Immucor, USA). Results: 295 (9.5%) women tested positive for one of the 14 high-risk genotypes. The highest percentage of positive women was found among those aged 30 to 39 years (12.0%). Fourteen women had coinfection with HPV16 or HPV18 along with another highrisk genotype. There was a high frequency of genes encoding activating receptors such as KIR 2DL1 (98.3%), KIR 2DL3 (98.3%), and KIR 2DS4*all full length (93.3%). Conclusions: The prevalence of HPV in Cuban women with normal cytology is lower than the global average, with activating KIR genes predominating among positive cases.

Knowledge and perceptions regarding Human Papillomavirus (HPV) and willingness to receive HPV vaccination among university students in a north-eastern city in Turkey

BackgroundFor a HPV vaccination program to be successful, it is important that the target population has sufficient knowledge about HPV and HPV vaccines. The aim of this study was to evaluate HPV-related knowledge levels among students at a university in northern Turkey, to assess vaccination willingness, and to determine factors associated with HPV-related knowledge.MethodsThis cross-sectional study was conducted on 824 (93.1%) students studying at 16 different faculties. The study population was identified through the proportional stratified sampling method. Data were collected through a questionnaire including socio-demographic characteristics and the HPV Knowledge Scale. Multiple linear regression analysis was performed to identify factors that may be associated with knowledge scores.Results43.6% of the students had never heard of HPV, 50.6% of them had never heard of HPV screening tests or HPV vaccination. Only 2.7% of the students were vaccinated against HPV and 15.7% were willing to receive HPV vaccination. Awareness of HPV and willingness to receive vaccination were found to be higher among women, while previous experience with sexual intercourse was higher in men (p < 0.05). The mean HPV knowledge score was quite low (6.74 ± 7.13 out of 29 points). The studying in a field related to health sciences, being a senior student, intending to be vaccinated, being a woman, having had sex were found to be associated with high knowledge levels (p < 0.05).ConclusionsEducational programmes should be developed to increase university students' knowledge about HPV and the HPV vaccine.

Human papillomavirus vaccine administration among women in the Eastern Mediterranean region of Turkey: prevalence and barriers.

Human papillomavirus (HPV) vaccines are very effective in preventing HPV infection and related diseases. This study aimed to determine the prevalence of the HPV vaccine administration and barriers to vaccination among women aged 15-49 years. This cross-sectional study was conducted on 401 women aged 15-49 years. The prevalence of women who received the HPV vaccine, their knowledge about HPV in general, HPV screening tests, HPV vaccine and the current HPV vaccination program were evaluated. Barriers to getting the HPV vaccine were questioned. The mean age of women who had received the HPV vaccine was 30.87±8.89 and the mean age at the first sexual intercourse was 22 years. 3.2% of women received HPV vaccine. The most important factor impeding the vaccination was unawareness of the HPV vaccine and the high cost of the vaccine. If the vaccine was free, most (81.2%) of the participants stated that they would vaccinate themselves and their children (72.8%). The highest lack of information was observed about the vaccination program and vaccinated women were more informed about HPV, HPV screening tests, HPV vaccine and the vaccination program. The increase in the knowledge about the HPV vaccination program increased the probability of getting vaccinated by an odds ratio (OR) of 4.43 times. The most important barriers to HPV vaccination were the lack of public funding for vaccines and the lack of information. We recommend increasing educational activities on the HPV vaccination program and public funding of vaccination.

Micronucleus and FTIR spectroscopy analysis as screening tests for HPV vírus detection

Human Papillomavirus (HPV) infection is the main precursor of cervical cancer. Pap Smear is the main diagnostic method of this neoplasm by cytological analysis, however presents a high rate of false-negative cases. This study aimed to verify if micronucleus (MN) frequency test and the Fourier Transform Infrared (FTIR) Spectroscopy analysis may be alternative useful techniques to detect HPV in cervical fluid. Fifty samples with normal cytology obtained from patients after cytopathological examination were divided into two groups based on the presence or absence of HPV by previous analysis of molecular biology. Of the fifty samples analyzed, 46% showed the presence of MN in the cells. The frequency of MN observed was higher in the samples with HPV positive and was related with age, use of oral contraceptives and use of alcoholic beverages (p &lt;0.001). FTIR analysis spectra showed high peak DNA and proteins in samples with a high frequency of MN (1170cm-1; 1516cm-1; 1404cm-1; 1473cm-1) compared with samples with absence of MN, probably due to chromosomal histones and MN constituents. However, no statistically significant difference was observed between these groups considering that the FTIR is a screening test and not specific. Thus, by the FTIR technique it was not possible to classify the samples by the spectral differences presented. The MN test can be considered a screening test for the detection of HPV, being possible to use it in clinical practice because it is a practical, simple, low-cost and non-invasive method. However, it is important to carry out studies in larger sample groups to investigate the application of the MN test and FTIR spectroscopy in the diagnosis of this infection and in the application in the prevention of cervical cancer.

An Overview of HPV Screening Tests to Improve Access to Cervical Cancer Screening Amongst Underserved Populations: From Development to Implementation.

Cervical cancer is the most common human papillomavirus (HPV)-related disease. Knowledge of the natural history and aetiology of cervical cancer offers unique opportunities for its prevention, and the development of HPV screening tests is one of the most effective strategies. The current HPV diagnostics detect HPV DNA or E6/E7 mRNA in cervical/vaginal samples using molecular-based technologies. HPV screening tests are more sensitive than cytology or visual inspection with acetic acid (VIA) as a primary screening method and are even more clinically valuable in triaging mild cytological abnormalities as a hybrid test. As technical and laboratory resources are grossly limited in marginalized or underserved settings which thus require that women travel long distances for screening and treatment. The practical implementation of an HPV-based screening programme may face many challenges and measures should be instituted to overcome these challenges without compromising disease detection. These measures may include a reduction in screening frequency using the WHO global strategy of offering HPV screening tests at 35 and 45 years of age, adoption of a high throughput testing technology, and improved access to vaginal HPV self-sampling screening tests to women in remote settings or those who are reluctant to undergo gynecologic examination. Another important strategy is the implementation of a “see-and-treat” approach using a point-of-care platform that requires limited skills of laboratory technicians. In addition, the development and large-scale incorporation of more specific HPV testing technologies that are much cheaper and easier to use in non-laboratory settings than the currently available options should be prioritized for underserved settings. At the same time, there is a need to develop and commence the implementation of an affordable and readily available intermediate or secondary test with optimal specificity for triaging or segregating clinically unimportant HPV infections that do not require colposcopy.

Online Education Improves Clinicians’ Knowledge and Competence Related to Advances in Cervical Cancer Screening [A44

INTRODUCTION: Women who test positive on primary screening tests for human papillomavirus (HPV) infection are triaged with Pap to determine whether a colposcopy is needed. The diagnostic variability of Paps may lead to missed diagnosis. Clinicians would benefit from education that will provide expert guidance on best-practice triage strategies for women who test HPV-positive. METHODS: The educational initiative consisted of an online video-based continuing medical education (CME) discussion among three experts, with synchronized slides. Intervention included pre/post study assessment, and McNemar tests (P&lt; .05 level) determined statistical significance. Learners who improved (answered ≥1 questions correctly pre-education than post) were identified. Data are reported from 1/11/2021-10/17/2021. RESULTS: The analysis set consisted of obstetrician-gynecologists (ob-gyns) (n=1,086) and primary care providers (PCPs) (n=296). Pre- vs. post-education decisions demonstrated significant improvement (P&lt;.001) in knowledge and competence related to the following for HPV positive women (pre% vs. post%): Knowledge regarding the limitations of traditional cytology methods: 20% of ob-gyns improved (36% pre, 48% post, P&lt;.001); 21% of PCPs improved (28% pre, 41% post, P&lt;.001). Knowledge regarding newer methodologies to triage women with abnormal screening results: 41% of ob-gyns improved (31% pre, 67% post, P&lt;.001); 33% of PCPs improved (24% pre, 49%,P&lt;.001). Competence related to follow-up care: 21% of ob-gyns (16% pre, 30% post, P&lt;.001); 11% of PCPs improved (18% pre, 24% post; P&lt;.05). CONCLUSION: The intervention demonstrates improvements and highlights the role of online video-based CME discussion in improving knowledge and competence related to clinicians’ ability to triage women who are HPV positive or have an abnormal Pap test. Additional gaps were identified for future education.

Cervical Precancers and Cancers Attributed to HPV Types by Race and Ethnicity: Implications for Vaccination, Screening, and Management.

Racial and ethnic variations in attribution of cervical precancer and cancer to human papillomavirus (HPV) types may result in different HPV vaccine protection, screening test coverage, and clinical management. Pooling data from 7 US studies, we calculated the proportional attribution of precancers and cancers to HPV types using HPV DNA typing from diagnosis. All statistical tests were 2-sided. For all racial and ethnic groups, most cases of cervical intraepithelial neoplasia grade 3 (CIN3) (84.2%-90.8% of 5526) and squamous cell carcinoma (SCC) (90.4%-93.8% of 1138) were attributed to types targeted by the 9-valent vaccine. A higher proportion of CIN3s were attributed to nonvaccine HPV types among non-Hispanic Black women (15.8%) compared with non-Hispanic Asian or Pacific Islander (9.7%; P = .002), non-Hispanic White (9.2%; P < .001), and Hispanic (11.3%; P = .004) women. The proportion of SCCs attributed to 9-valent types was similar by race and ethnicity (P = .80). A higher proportion of CIN3s were attributed to nonvaccine HPV35 among non-Hispanic Black (9.0%) compared with non-Hispanic Asian or Pacific Islander (2.2%), non-Hispanic White (2.5%), and Hispanic (3.0%; all P < .001) women. Compared with CIN3, the proportion of SCCs attributed to HPV35 among non-Hispanic Black women (3.2%) was lower and closer to other groups (0.3%-2.1%; P = .70). The 9-valent HPV vaccine will prevent nearly all cervical precancers and invasive cancers among major racial and ethnic groups in the United States. Adding HPV35 to vaccines could prevent a small percentage of CIN3s and SCCs, with greater potential impact for CIN3s among Black women. HPV screening tests target high-risk HPV types, including HPV35. Future genotyping triage strategies could consider the importance of HPV35- and other HPV16-related types.

Prevalence and Genotype Distribution of Human Papillomavirus From 9,182 Individuals Participated Health Examination.

Human papillomavirus (HPV) is the cause of nearly all cervical cancers and the primary cause of anal cancers. Prevalence of HPV varies largely among countries and regions, and population-based data are largely insufficient. The aim of this study is to determine the prevalence and genotype distribution of HPV infection among the women received a general health check. In the years 2015, 2016, and 2017, a total of 553,654 individuals received a general health check in the Sichuan Provincial People's Hospital. Among them, 9,182 unselected and asymptomatic individuals received the HPV screening test. Samples of exfoliated endocervical cells were collected and DNA isolation was performed with a Cell Lysis Kit. Fragments of HPV DNA were amplified by PCR. Twenty-one different HPV genotypes, including HPV 6, 11, 16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 53, 56, 58, 59, 66, 68, and CP8304, were detected from PCR products using a GenoArray Diagnostic Hybridization Kit. HPV genotype was read on the colored position on the array. A total of 1,207 individuals were positive for at least one HPV genotype, giving a crude prevalence of 13.2% (95% CI: 12.5 - 13.9%). The prevalence did not differ much among age groups. HPV-positive individuals were 291, 389, and 527 in 2015, 2016, and 2017, respectively. The majority of the HPV-positive participants (960/1,207 = 80%) had one type of virus. Approximately 15% had two genotypes of HPV. One individual had HPV of 6 different genotypes, including 16, 18, 52, 53, 56, and CP8304. The most frequent genotype was 52, followed by CP8304, 58, and 53. The oncogenic types 16 and 18 were found in 112 and 52 participants, corresponding to a prevalence of 0.9% (CI: 0.8 - 1.1%) and 0.4% (CI: 0.3 - 0.6%), respectively, for the 9,182 individuals included in this study. The prevalence of 13.2% for HPV among unselected and asymptomatic individuals who received a general health check is high in the Sichuan area. Identification of high-risk HPV types is essential for preventing or early detection of cervical cancers and consequently save life.

Cytological Immunostaining of HMGA2, LRP1B, and TP63 as Potential Biomarkers for Triaging Human Papillomavirus-Positive Women

Background: Since human papillomavirus (HPV) DNA testing has been promoted as primary screening strategy, the triage method has also evolved from morphological testing to a molecular biomarker detection to improve screening efficiency. In this study, we investigated the performance of three HPV integration hot-spots, HMGA2, LRP1B, and TP63, as potential triage markers in HPV screening tests. Materials and Methods: This cross-sectional study was conducted from November 2016 to December 2017 in the First Affiliated Hospital of Sun Yat-sen University. Immunocytochemistry was carried out using residual cervical cell samples from 121 HPV-positive cases (23 normal, 24 cervical intraepithelial neoplasia (CIN) 1, and 74 CIN2+). Results: Of the 121 cases, 77 showed completely paired for the three biomarkers. In these 77 cases, receiver operating characteristic (ROC) analysis of HMGA2 showed the best potential for detecting CIN2+ among HPV+ cases (sensitivity 70%; specificity 91.89%; AUC 0.839). TP63 was second most effective biomarker (AUC 0.838; sensitivity 80%; specificity 81.08%). In contrast, LRP1B had the smallest AUC (0.801) among the three biomarkers but had the highest sensitivity (90%) and specificity (56.76%). To test the triage value of combining the three biomarkers, logistic regression was conducted followed by ROC comparison analysis. Promisingly, the combination of the three biomarkers gave the largest AUC of 0.951 with 92.5% sensitivity and 89.1% specificity (P < .0001 compared to liquid-based cytology test by Z-test). Conclusions: A combination of HMGA2, LRP1B, and TP63 as potential biomarkers may be useful for screening during triage of HPV-positive patients, particularly for detecting CIN2 + .

Gardasil Vaccination for Recurrent Laryngeal Papillomatosis in Adult Men Second Report: Negative Conversion of HPV in Laryngeal Secretions

In our first report on antibody levels in middle-aged and older men with recurrent laryngeal papillomatosis (RLP), we reported increases in human papillomavirus (HPV) antibody levels similar to those seen in adult women and young men. We posited that HPV antibodies produced in laryngeal mucus by Gardasil would prevent postoperative reinfection in patients with RLP. This is a case series study. The purpose of this study was to examine whether Gardasil injection effectively inhibits recurrence of RLP. Specifically, in this second report, whether HPV antibodies produced in laryngeal secretions by Gardasil are capable of causing negative conversion of HPV-DNA (deoxyribonucleic acid) in laryngeal mucosa was investigated. A total of 11 patients for whom antibodies were measured in the first report were studied. Before vaccination and after 1 year Post-vaccination, HPV screening tests were performed on laryngeal secretions, and whether HPV-DNA negative conversion had occurred was evaluated. At the time of collection of laryngeal secretions, the presence or absence of laryngeal papillomas was examined. Before vaccination, all patients were HPV low-risk positive on laryngeal secretion screening tests. After vaccination, three patients were positive. Laryngeal papillomas remained in five patients. The HPV-DNA test showed negative conversion in eight of 11 (72.7%) patients after vaccination. Residual laryngeal papillomas were found in five of 11 (45.5%) patients. The serum HPV antibody titer did not differ significantly between the group in which laryngeal secretions showed HPV negative conversion and the group in which conversion did not occur. The serum antibody titer did not differ significantly as a function of whether there were residual tumors.

Adjunct screening of cervical or vaginal samples using careHPV testing with Pap and aided visual inspection for detecting high-grade cervical intraepithelial neoplasia

ObjectiveTo evaluate the performance of careHPV DNA testing for human papillomavirus (HPV) on cervical and vaginal samples (CHPV and VHPV respectively) in adjunct screening together with visual inspection of the cervix by acetic acid (VIA) or Papanicolaou (Pap) tests in the detection of high-grade cervical intraepithelial neoplasia (CIN). Subjects and methodsA cross-sectional study examined 4658 women 30–59 years of age by performing screening tests for HPV using careHPV on cervical and vaginal samples together with Pap and VIA. The CHPV and VHPV test results were presented as a ratio of viral load expressed in relative light units (RLUs) to the mean RLU from a positive control set at 1pg/mL cut-off (CO). Performances of various pairs of screening tests in parallel and sequential settings were computed through the detection rates of CIN, percentages of unnecessary colposcopic referrals of screen positives, and compared with stand-alone tests. ResultsThe screening positivity of CHPV, VHPV, Pap and VIA ranged from 2.4% to 5.5%. The highest sensitivity (72%) was observed for the combination of CHPV and VIA in parallel, followed by 65.6% for CHPV and Pap, and 59% for all other combinations (VHPV and Pap, VHPV and VIA, and VIA and Pap). The percentage of unnecessary colposcopic referrals in the parallel setting of CINII+ detection ranged from 2.8% to 6.0%. Sequential testing of CHPV or VHPV with other tests yielded very low sensitivities with a reduction in unnecessary colposcopic referrals. ConclusionCervical careHPV testing (CHPV) in parallel with VIA was the option that performed best in the detection of high-grade CIN and could be a feasible option for low-resource countries (LRCs).

A Comprehensive Review of Dysregulated miRNAs Involved in Cervical Cancer.

MicroRNAs(miRNAs) have become the center of interest in oncology. In recent years, various studies have demonstrated that miRNAs regulate gene expression by influencing important regulatory genes and thus are responsible for causing cervical cancer. Cervical cancer being the third most diagnosed cancer among the females worldwide, is the fourth leading cause of cancer related mortality. Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening have greatly reduced cervical cancer. Yet, thousands of women continue to be diagnosed with and die of this preventable disease annually. This has necessitated the scientists to ponder over ways of evolving new methods and chalk out novel treatment protocols/strategies. As miRNA deregulation plays a key role in malignant transformation of cervical cancer along with its targets that can be exploited for both prognostic and therapeutic strategies, we have collected and reviewed the role of miRNA in cervical cancer. A systematic search was performed using PubMed for articles that report aberrant expression of miRNA in cervical cancer. The present review provides comprehensive information for 246 differentially expressed miRNAs gathered from 51 published articles that have been implicated in cervical cancer progression. Of these, more than 40 miRNAs have been reported in the literature in several instances signifying their role in the regulation of cancer. We also identified 40 experimentally validated targets, studied the cause of miRNAs dysregulation along with its mechanism and role in different stages of cervical cancer. We also identified and analysed miRNA clusters and their expression pattern in cervical cancer. This review is expected to further enhance our understanding in this field and serve as a valuable reference resource.

Role of Human Papillomavirus Testing in Screening of Cervical Neoplasia

Human papillomavirus (HPV) is the causative agent of cervical intraepithelial neoplasia and cervical cancer. HPV and cytology co-tests in women aged 30 years or older every 5 years as primary cervical screening is recommended for developed countries. In HPV-positive and cytology-negative women, follow-up with co-tests at 12 months is recommended. Nevertheless, if HPV-16 or HPV-18 is positive, direct colposcopy is recommended. In mild cytological abnormality and HPV-negative women, routine screening should be continued as per age-specific guidelines. Women with history of cervical intraepithelial neoplasia grade 2 or more should be followed at least 20 years even after age 65 years. In area with very limited resource, a single visit “screen-and-treat” visual inspection with acetic acid might be reasonable. Although the policies of cervical screening vary in different regions, the future screening strategies when the young HPV vaccinated population reaches the screening age will need to be renovated.

An Evaluation of Novel, Lower-Cost Molecular Screening Tests for Human Papillomavirus in Rural China

New, lower-cost tests that target high-risk human papillomavirus (HR-HPV) have been developed for cervical cancer screening in lower-resource settings but large, population-based screening studies are lacking. Women ages 25 to 65 years and living in rural China (n = 7,543) self-collected a cervicovaginal specimen, had 2 cervical specimens collected by a clinician, and underwent visual inspection after acetic acid (VIA). The self- and one clinician-collected specimens underwent HR-HPV DNA testing by careHPV (QIAGEN) and Hybrid Capture 2 (HC2; QIAGEN) and the other clinician-collected specimen was tested for HPV16, 18, and 45 E6 using OncoE6 (Arbor Vita Corporation). Women who screened positive for any test and a random sample of those negative on all tests underwent colposcopic evaluation. The percent test positive was 1.8% for HPV E6 oncoprotein, between 14% and 18% for HR-HPV DNA testing, and 7.3% for VIA. The sensitivity for cervical intraepithelial neoplasia grade 3 or more severe (CIN3(+); n = 99) was 53.5% for OncoE6, 97.0% for both careHPV and HC2 testing of the clinician-collected specimen, 83.8% for careHPV testing and 90.9% for HC2 testing of the self-collected specimen, and 50.5% for VIA. OncoE6 had the greatest positive predictive value (PPV), at 40.8% for CIN3(+), compared with the other tests, which had a PPV of less than 10%. OncoE6 tested 70.3% positive for HPV16, 18, or 45-positive CIN3(+) and tested negative for all HPV16-, 18-, or 45-negative CIN3(+) (P < 0.0001). HPV E6 oncoprotein detection is useful for identifying women who have cervical precancer and cancer.

Recommendations for a national agenda to substantially reduce cervical cancer

Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease. In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA. Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal. Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women-particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts canlead the way towards a dramatic reduction in this preventable disease in our country.

Will New Human Papillomavirus Diagnostics Improve Cervical Cancer Control Efforts?

With the causal link between specific types of human papillomavirus (HPV) and cervical cancer firmly established, efforts have turned to assessing the relative merits of offering HPV testing in screening, triage, and posttreatment management. Many unanswered questions remain, but a growing body of evidence supports a role for HPV testing in cervical cancer prevention programs. Already, clinical centers that serve thousands of women in Europe and the United States have incorporated HPV DNA tests in triage algorithms.