Lower Risk Of Cervical Cancer Research Articles

Abstract IA1: Progress in scaling up cervical cancer prevention in health services of developing countries

Abstract Cervical cancer is a major threat to women's health accounting for 528,000 new cases and 266,000 deaths annually around 2012, of which 85% occurred in low- and middle-income (LMICs). Substantial declines in cervical cancer incidence and mortality rates can be achieved by integrating HPV vaccination and cervical screening in public health services in LMICs. Since 2007, HPV vaccination has been introduced in national immunization programs in 73 countries, of which 33 are LMICs; in addition it has been introduced in pilot programs in another 17 countries, mostly in sub-Saharan Africa. It is particularly impressive that 7 out of 8 girls have access to HPV vaccination in Latin Region. So far, more than 270 million doses have been administered globally with excellent safety profile and high acceptance, despite the negative publicity surrounding HPV vaccination. The falling vaccine prices, possibility of new vaccines from China and India and the currently recommended two-dose schedule will make HPV vaccination more feasible. Screening is yet to be widely implemented in many LMICs and many of these countries lack the health care infrastructure and resources to introduce efficient screening programs. Screening has been sub-optimally performing in some LMICs for lack of adequate coverage, follow-up and quality assurance. A number of countries have introduced visual inspection (VIA) screening in their health services as opportunistic or pilot programs. HPV testing is the most effective cervical screening tool and HPV negative women are at very low risk for cervical cancer. Currently Mexico and Argentina have introduced HPV screening. The eventual availability of a simple, affordable, faster and accurate HPV tests will facilitate wider HPV screening in LMICs. Planned investments to implement HPV vaccination of single year cohorts of 9-13 year old girls and at least a single HPV screening of women between 30-59 will save many precious lives in developing countries. Citation Format: Rengaswamy Sankaranarayanan. Progress in scaling up cervical cancer prevention in health services of developing countries [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr IA1.

Effectiveness of cervical screening after age 60 years according to screening history: Nationwide cohort study in Sweden.

BackgroundThe relatively high incidence of cervical cancer in women at older ages is a continuing concern in countries with long-established cervical screening. Controversy remains on when and how to cease screening. Existing population-based studies on the effectiveness of cervical screening at older ages have not considered women’s screening history. We performed a nationwide cohort study to investigate the incidence of cervical cancer after age 60 years and its association with cervical screening at age 61–65, stratified by screening history at age 51–60.Methods and findingsUsing the Total Population Register, we identified 569,132 women born between 1 January 1919 and 31 December 1945, resident in Sweden since age 51. Women’s cytological screening records, cervical cancer occurrence, and FIGO stage (for those diagnosed with cancer) were retrieved from national registers and medical charts. We calculated the cumulative incidence of cervical cancer from age 61 to age 80 using a survival function considering competing risk, and estimated the hazard ratio (HR) of cervical cancer in relation to screening status at age 61–65 from Cox models, adjusted for birth cohort and level of education, conditioning on women’s screening history in their 50s. In women unscreened in their 50s, the cumulative incidence up to age 80 was 5.0 per 1,000 women, and screening at age 61–65 was associated with a lower risk for cervical cancer (HR = 0.42, 95% CI 0.24–0.72), corresponding to a decrease of 3.3 cancer cases per 1,000 women. A higher cumulative incidence and similarly statistically significant risk decrease was seen for women with abnormal smears in their 50s. In women adequately or inadequately screened with only normal results between age 51 and age 60, the cumulative incidence of cervical cancer from age 61 to 80 was 1.6 and 2.5 per 1,000 women, respectively, and further screening at age 61–65 was not associated with statistically significant decreases of cervical cancer risk up to age 80, but with fewer cancer cases of advanced stages at age 61–65. Adjustment for potential lifestyle confounders was limited.ConclusionsIn this study, cervical screening with cytology at age 61–65 was associated with a statistically significant reduction of subsequent cervical cancer risk for women who were unscreened, or screened with abnormalities, in their 50s. In women screened with normal results in their 50s, the risk for future cancer was not sizeable, and the risk reduction associated with continued screening appeared limited. These findings should inform the current debate regarding age and criteria to discontinue cervical screening.

Genetic variants within microRNA‐binding site of RAD51B are associated with risk of cervical cancer in Chinese women

RAD51B plays a central role in homologous recombinational repair (HRR) of DNA double‐strand breaks (DSBs), which is important to prevent genomic instability, a hallmark of cancer. Recent studies suggested that common genetic variants of RAD51B may contribute to cancer susceptibility. In this study, we aimed to investigate whether potentially functional variants within miRNA‐binding sites of RAD51B are associated with risk of cervical cancer. A total of 1486 cervical cancer patients and 1536 cancer‐free controls were enrolled, and two genetic variants, rs963917 (A > G) and rs963918 (T > C), were genotyped in all participants. Using multivariate logistic regression analyses, we found that G allele of rs963917 conferred lower risk of cervical cancer compared to A allele (adjusted OR = 0.89, 95% CI = 0.80–0.99, P = 0.039). Similarly, rs963918 allele C was associated with a decreased risk for cervical cancer compared with allele T (adjusted OR = 0.84, 95% CI = 0.74–0.94, P = 0.004). Haplotype analyses showed that haplotype GC was also correlated with lower risk (OR = 0.83, 95% CI = 0.73–0.95, P = 0.005) compared with the most common haplotype AT. In summary, our study suggested that miRNA‐binding site genetic variants of RAD51B may modify the susceptibility to cervical cancer, which is important to identify individuals with differential risk for this malignancy and to improve the effectiveness of preventive intervention.

Perceptions of cervical cancer risk and screening among transmasculine individuals: patient and provider perspectives

Transmasculine people (individuals assigned a female sex at birth who identify as male or masculine) are at risk of cervical cancer. Despite low rates of Pap test use in this population, research examining the determinants of cervical cancer screening among transmasculine individuals is scarce. We conducted in-depth interviews and focus groups with 49 participants (32 transmasculine patients and 17 healthcare providers) in order to examine transmasculine individuals’ and healthcare providers’ perceptions of cervical cancer risk and screening among individuals on the transmasculine continuum. Overall, patients believed that transmasculine individuals should receive regular Pap tests, especially in the event of gynaecological concerns. While healthcare providers’ views varied, many perceived transmasculine individuals to be at low risk of cervical cancer. Contrary to existing screening guidelines, several providers believed that transmasculine individuals who did not engage in penile-vaginal intercourse with cisgender men, expressed discomfort about Pap testing or intended to obtain a hysterectomy might not need to be screened regularly or at all. Our findings underscore the importance of educating patients and providers about cervical cancer risk among transmasculine individuals and establishing evidence-based guidelines for cervical cancer screening in this underserved population.

Associations between antioxidant vitamins and the risk of invasive cervical cancer in Chinese women: A case-control study.

Previous studies on the associations between dietary antioxidant vitamins and the risk of cervical cancer remain inconsistent, and little evidence is available for serum antioxidant vitamins, which provide more accurate measurements of these nutrients. We conducted a case-control study of 458 incident cases with invasive cervical cancer and 742 controls to assess the effects of diet or serum antioxidant vitamins. Higher serum antioxidant vitamins were associated with a lower risk of cervical cancer after adjusting for potential confounders. The odds ratios (ORs) for the highest (vs. lowest) quartile were 0.66 (95% confidence interval [CI] = 0.46–0.93; P = 0.024) for α-carotene, 0.63 (95% CI = 0.45–0.90; P = 0.006) for β-carotene, 0.53 (95% CI = 0.37–0.74; P < 0.001) for vitamin E, and 0.48 (95% CI = 0.33–0.69; P < 0.001) for vitamin C. Dietary intakes of vitamins E and C were inversely associated with the risk of cervical cancer. Risk of cervical cancer from serum antioxidant vitamins was more evident in passive smokers than non-passive smokers. These findings indicated that antioxidant vitamins (mainly α-carotene, β-carotene, and vitamins E and C) might be beneficial in reducing the risk of invasive cervical cancer in Chinese women, especially in passive smokers.

The significantly lower risk of cervical cancer at and after the recommended age to begin and end screening compared to breast and colorectal cancer

ObjectiveWe compare risk of cervical, colorectal, and breast cancer (and two pre-cancers: cervical intraepithelial neoplasia (CIN) grade 2–3 and colorectal adenomas) at and after the recommended ages to begin and end screening in the United States. MethodsSurveillance, Epidemiology, and End Results data were used with Monte Carlo simulations to estimate risk at and after the ages to screen. ResultsAt the age to begin screening, absolute risk of breast and colorectal cancer was 381 and 53 times higher, respectively, than cervical cancer (0.0122, 95% CI: 0.0089–0.0162 and 0.0017, 95% CI: 0.0012–0.0023 vs. 3.2e−5, 95% CI: 2.3e−5–4.3e−5). Risk of colorectal adenomas and breast cancer was 45 and 2.4 times higher than CIN 2–3 (0.2319, 95% CI: 0.1287–0.3624 and 0.0122, 95% CI: 0.0089–0.0017 vs. 0.0051, 95% CI: 0.0029–0.0081). After the age to end screening, breast and colorectal cancer risk was 17 and 11 times higher, respectively, than cervical cancer. ConclusionsRisk of cervical cancer at and after the recommended ages for screening is significantly lower than that of breast and colorectal cancer. Differences may become more pronounced in the era of HPV vaccines. Comparison of risk between cancers provides a novel perspective to inform future guideline development.

Serum carotenoid, retinol and tocopherol concentrations and risk of cervical cancer among Chinese women.

Despite many epidemiological studies on the effects of dietary antioxidant micronutrients on risk of cervical cancer, the findings remain uncertain and little evidence is available for serum nutrient markers. The present study aimed to examine the relationship between serum carotenoid, retinol and tocopherol concentrations and risk of cervical cancer among Chinese women. We conducted a hospital-based case- control study in which 358 adults (158 incident cases and 200 controls) were recruited from Xinjiang, China. Serum levels of carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin), retinol, and tocopherols (α-tocopherol and γ-tocopherol) were assessed by reverse-phase high-performance liquid chromatography. We found inverse associations between serum carotenoid (α-carotene, β-carotene, and lutein/zeaxanthin) and tocopherol (α-tocopherol) concentrations and the risk of cervical cancer after adjusting for potential confounders, but a null association for retinol. The ORs for 1-SD increase were 0.71 (95% CI: 0.56- 0.92; p=0.003) for total carotenoids and 0.75 (95% CI: 0.60-0.94; p=0.008) for total tocopherols. These results show that higher serum concentrations of some carotenoids and tocopherols are associated with a lower risk of cervical cancer among Chinese women.

Association of myeloperoxidase polymorphism (G463A) with cervix cancer.

Cervical cancer is the fourth most common cancer affecting women worldwide, according to the latest IARC release with 528 000 new cases every year. Infection by high-risk human papillomavirus (HPV) is necessary but not sufficient for progression to cancer. Epithelial tissues, the target of HPV infection, are heavily exposed to reactive oxygen species (ROS). Hypochlorous acid (HOCl) is a very potent ROS, and it is produced by myeloperoxidase (MPO). MPO, a lysosomal enzyme expressed in polymorphonuclear neutrophils (PMN), has the potential to kill HPV transformed cells, as a component of an intercellular induced-apoptosis pathway. This enzyme catalyzes the production of HOCl in the presence of hydrogen peroxide (H2O2). The H2O2 produced by the Doderlein's bacillus will interact with MPO, contributing to the intercellular induced-apoptosis pathway. We studied a functional polymorphism in the promoter region of MPO (G463A) and how it may affect the risk of developing cervix cancer. A sample of 100 patients with invasive cervical cancer and 122 control women were genotyped for MPO polymorphism by PCR-RFLP method. The statistical method used was χ(2). We found that women with the GG genotype had lower risk for cervical cancer than the women who displayed the heterozygous genotype GA (OR = 0.546, 95 % CI = 0.315-0.939, p = 0.028, OR = 2.210, 95 % CI = 1.257-3.886, p = 0.008, respectively). The genotype that leads to a higher concentration of ROS (GG) presents itself as a protection factor in comparison to the homozygous genotype (AA). This can be explained by the interaction of HOCl and superoxide of transformed cells that will generate apoptosis-inducing hydroxyl radicals.

Cervical Screening at Age 50–64 Years and the Risk of Cervical Cancer at Age 65 Years and Older: Population-Based Case Control Study

There is little consensus, and minimal evidence, regarding the age at which to stop cervical screening. We studied the association between screening at age 50-64 y and cervical cancer at age 65-83 y. Cases were women (n = 1,341) diagnosed with cervical cancer at age 65-83 y between 1 April 2007 and 31 March 2012 in England and Wales; age-matched controls (n = 2,646) were randomly selected from population registers. Screening details from 1988 onwards were extracted from national databases. We calculated the odds ratios (OR) for different screening histories and subsequent cervical cancer. Women with adequate negative screening at age 65 y (288 cases, 1,395 controls) were at lowest risk of cervical cancer (20-y risk: 8 cancers per 10,000 women) compared with those (532 cases, 429 controls) not screened at age 50-64 y (20-y risk: 49 cancers per 10,000 women, with OR = 0.16, 95% CI 0.13-0.19). ORs depended on the age mix of women because of the weakening association with time since last screen: OR = 0.11, 95% CI 0.08-0.14 at 2.5 to 7.5 y since last screen; OR = 0.27, 95% CI 0.20-0.36 at 12.5 to 17.5 y since last screen. Screening at least every 5.5 y between the ages 50 and 64 y was associated with a 75% lower risk of cervical cancer between the ages 65 and 79 y (OR = 0.25, 95% CI 0.21-0.30), and the attributable risk was such that in the absence of screening, cervical cancer rates in women aged 65+ would have been 2.4 (95% CI 2.1-2.7) times higher. In women aged 80-83 y the association was weaker (OR = 0.49, 95% CI 0.28-0.83) than in those aged 65-69 y (OR = 0.12, 95% CI 0.09-0.17). This study was limited by an absence of data on confounding factors; additionally, findings based on cytology may not generalise to human papillomavirus testing. Women with adequate negative screening at age 50-64 y had one-sixth of the risk of cervical cancer at age 65-83 y compared with women who were not screened. Stopping screening between ages 60 and 69 y in women with adequate negative screening seems sensible, but further screening may be justifiable as life expectancy increases.

Increasing Cervical Cancer Screening for a Multiethnic Population of Women in South Texas

Cervical cancer is a preventable disease. Precancers can be identified and treated through cervical screenings. The HPV vaccine prevents precancers from becoming cancers. The aim of the A Su Salud Cervical Cancer Prevention Program was to apply well-understood health promotion techniques and increase the rate of cervical cancer screening among a high-risk, multiethnic, low-income population in South Texas. Qualitative research was used to identify uptake barriers and tailor media messaging. Using existing resources, we applied evidence-based strategies in novel ways that changed personal behaviors, leading to cancer screening, risk reduction, and early detection. We created a database to track a cohort of 32,807 women and measured cervical cancer screenings over 3 years. Our analysis revealed an increase in cervical cancer screenings after use of highly targeted automated telephone reminders and media dissemination on multiple platforms. Those women at low risk for cervical cancer obtained the highest proportion of Pap tests. This innovative, theory-based program increased overall Pap tests up to 9% among women enrolled in a safety net hospital financial assistance plan. This study fills a gap in research on Pap test compliance in uninsured, mostly Hispanic women by building on cultural strengths and tailored messaging.

The Risk of Cancer among Taiwanese Female Registered Nurses: A Nationwide Retrospective Study

BackgroundTo evaluate the risk of cancer among Taiwanese female registered nurses (RNs) using a nationwide population-based dataset.MethodsWe recruited female RNs without antecedent cancer from the Taiwan National Health Insurance Research database during 2000–2010. Standardized incidence ratios (SIRs) of cancer were calculated. We also compared rates of Papanicolaou (Pap) smear use between the RNs and the general population matched by age and sex.ResultsA total of 2,077 cancers developed among 184,809 female RNs, with a follow-up of 1,371,910 person-years (median follow-up of 7.86 years), leading to an increased SIR of 1.10 [95% confidence interval (CI) 1.05–1.15]. RNs aged between 40–59 years also had a significantly increased SIR (1.14, 95% CI 1.08–1.21). For specific cancer types, RNs had an increased SIR for breast (1.28, 95% CI 1.19–1.37), thyroid (1.26, 95% CI 1.10–1.43), lung and mediastinum (1.36, 95% CI 1.13–1.62), and uterine cancers (1.23, 95% CI 1.01–1.49). A decreased SIR was found for cervix (0.48, 95% CI 0.37–0.61) and liver and biliary tract cancers (0.68, 95% CI 0.50–0.90). Pap smear use averaged 5.80 times per person among female RNs aged 35 years or older and 5.50 times per person in the age-matched control group (p = 0.009).ConclusionThis study found that overall cancer risk was higher among female RNs than general population. For individual cancers, the risks of breast, lung, thyroid and uterine cancer were higher and the risks of cervix and liver cancer were lower than general population. The lower risk of cervical cancer might be partially explained by the increased use of Pap smears in the RNs group. Further large, unbiased population-based prospective studies are needed to investigate the association between nurses and cancer risk and identify the risk factors of cancer in nurses.

Updates of the current screening guidelines for the early detection of cervical cancer

Updates of the current screening guidelines for the early detection of cervical cancer

Abstract PL05-04: Introducing HPV screening into low-resource settings: Opportunities and challenges.

Abstract Despite the promise of a highly efficacious prophylactic human papillomavirus (HPV) vaccination, screening and treatment of precancerous lesions will be needed for generations to come. In its current form, HPV vaccination will not prevent approximately 30% of invasive cervical cancer, does not treat pre-existing infections and precancerous lesions, and remains expensive and not yet feasible for many countries. Even if vaccines were made widely available at a greatly reduced cost and widespread vaccination could be rapidly implemented globally, the benefits of HPV vaccination will not be realized in 30 years or more. With adequate screening and treatment, the vast majority of cervical cancer can be prevented during the typical 10-15 year precancerous period. Unfortunately, successful screening programs in low resource settings have been difficult to achieve because of insensitive screening tests, low population coverage, and inadequate follow-up of screen positives. Cervical screening for carcinogenic HPV infection is being considered for low income countries because HPV testing provides excellent risk stratification and is amenable to vaginal self-collection. Fortunately, tests are being developed for low-resource settings. The natural history of HPV and cervical cancer informs the relative advantage of HPV screening compared to other screening tests that aim to detect precancerous lesions. In most populations, the age-specific prevalence pattern of HPV infections observed in sexually active women resembles that of a typical sexually transmissible infection. Incidence and prevalence peak at young ages soon after the start of sexual activity, with a subsequent decline as women age because their infections clear and fewer incident infections are acquired. The high sensitivity of HPV testing suggests that one or two screens in a lifetime, starting around 30 years of age and ending by menopause, before invasive cervical cancer arises, would be sufficient to substantially reduce cervical cancer mortality. This superior performance was observed in a large community randomized trial from India where HPV screening reduced mortality in just 7 years. The high sensitivity of HPV testing means that most women (80%–90%) who test HPV negative will have reassurance for at least 10 years that they are at low risk of cervical cancer. Numerous studies have demonstrated the long-term negative predictive value of HPV testing. Even when an affordable HPV test is available for low resource settings, challenges remain for successful implementation of HPV screening. Although vaginal sampling allows increased population coverage, it has been associated with loss of sensitivity. Women who screen HPV-positive must be managed adequately and various approaches with unique limitations have been considered. Finally, not all populations experience the same epidemiologic HPV-age trends where prevalence declines in older women. Some population-based HPV studies conducted in Sub-Saharan Africa observed elevated HPV prevalence in older women. In addition, the relationship between HPV and cervical cancer is further complicated in some settings by HIV infection. Compared to HIV-negative women, HIV-positive women are at an increased risk of HPV infection. Once infected, they also have a greater risk of persistent infection and cervical precancer (even with access to HIV antiretroviral therapies). This talk will review HPV epidemiologic research pertaining to the incorporation of HPV testing into cervical cancer prevention initiatives for traditionally underserved communities and low-resource settings. Citation Format: Julia C. Gage. Introducing HPV screening into low-resource settings: Opportunities and challenges. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PL05-04.

Methylenetetrahydrofolate Reductase C677T Polymorphism and Susceptibility to Cervical Cancer and Cervical Intraepithelial Neoplasia: A Meta-Analysis

BackgroundA number of studies have explored the association between methyl enetetrahydrofolate reductase (MTHFR) C677T polymorphism and susceptibility to cervical cancer and cervical intraepithelial neoplasia (CIN). However, results remained controversial. To address this gap, we decided to conduct a meta-analysis of all available published studies.MethodsElectronic literature searches of the PubMed, EmBase and Medline databases were performed up to April 30, 2012. Fixed-effects or random-effects model was used to calculate the pooled ORs for different genetic models.ResultsA total of 12 case-control studies were ultimately identified. No statistical correlation was found between C677T variants and cervical cancer for the overall population. However, subgroup analyses on the White women pointed to a significant protective effect for individuals heterozygous or homozygous for the T-allele (for CT vs. CC: OR = 0.72, 95% CI 0.59–0.88; for TT vs. CC: OR = 0.69, 95% CI = 0.49–0.97; for CT+TT vs. CC: OR = 0.71, 95% CI 0.59–0.86). C677T variants were associated with neither combined nor stratified CIN among the overall population.ConclusionsThis meta-analysis suggests that White women with mutant C677T genotypes might have a lower risk of cervical cancer, yet lacking enough statistical robustness. Further investigations are needed to get more insight into the role of this polymorphism in cervical carcinogenesis.

Performance of p16/Ki-67 Immunostaining to Detect Cervical Cancer Precursors in a Colposcopy Referral Population

Cytology-based screening has limited sensitivity to detect prevalent cervical precancers. Human papilloma virus (HPV) DNA testing is highly sensitive and provides a high, long-term reassurance of low risk of cervical cancer. However, the specificity of HPV DNA testing is limited, requiring additional, more disease-specific markers for efficient screening approaches. Liquid-based cytology samples were collected from 625 women referred to colposcopy. A slide was stained using the CINtec plus cytology assay. Pap cytology and HPV genotyping were conducted from the same vial. Clinical performance characteristics were calculated for all women, stratified by age, and for women referred with a low-grade squamous intraepithelial lesion (LSIL) Pap. p16/Ki-67 positivity increased with histologic severity, from 26.8% in normal histology, 46.5% in CIN1, 82.8% in CIN2 to 92.8% in CIN3. Among women with CIN3, p16/Ki-67 positivity increased from 77.8% for women younger than 30 years without HPV16 to 100% for women 30 years and older with HPV16. The sensitivity and specificity to detect CIN3+ were 93.2% and 46.1%, respectively, and increased to 97.2% and 60.0% among women 30 years and older. In women with high-risk (HR)-HPV-positive atypical squamous cells of undetermined significance (ASC-US) and LSIL, sensitivity and specificity for detection of CIN3 were 90.6% and 48.6%, respectively. p16/Ki-67 testing could reduce referral to colposcopy by almost half while detecting the most severe cases of CIN3. The high sensitivity of p16/Ki-67 with significantly improved specificity compared with HPV testing makes p16/Ki-67 a viable option for LSIL triage. Further studies are required to evaluate p16/Ki-67 as triage marker in HPV-based screening strategies.

Use of electronic health record data to evaluate overuse of cervical cancer screening

National organizations historically focused on increasing use of effective services are now attempting to identify and discourage use of low-value services. Electronic health records (EHRs) could be used to measure use of low-value services, but few studies have examined this. The aim of the study was to: (1) determine if EHR data can be used to identify women eligible for an extended Pap testing interval; (2) determine the proportion of these women who received a Pap test sooner than recommended; and (3) assess the consequences of these low-value Pap tests. Electronic query of EHR data identified women aged 30-65 years old who were at low-risk of cervical cancer and therefore eligible for an extended Pap testing interval of 3 years (as per professional society guidelines). Manual chart review assessed query accuracy. The use of low-value Pap tests (ie, those performed sooner than recommended) was measured, and adverse consequences of low-value Pap tests (ie, colposcopies performed as a result of low-value Pap tests) were identified. Manual chart review confirmed query accuracy. Two-thirds (1120/1705) of low-risk women received a Pap test sooner than recommended, and 21 colposcopies were performed as a result of this low-value Pap testing. Secondary analysis of EHR data can accurately measure the use of low-value services such as Pap testing performed sooner than recommended in women at low risk of cervical cancer. Similar application of our methodology could facilitate efforts to simultaneously improve quality and decrease costs, maximizing value in the US healthcare system.

Persistence of Type-Specific Human Papillomavirus Infection and Increased Long-term Risk of Cervical Cancer

Human papillomavirus (HPV) persistence is the pivotal event in cervical carcinogenesis. We followed a large-scale community-based cohort for 16 years to investigate the role of genotype-specific HPV persistence in predicting cervical cancer including invasive and in situ carcinoma. At the baseline examination in 1991-1992, 11,923 participants (aged 30-65 years) consented to HPV testing and cytology; 6923 participants were reexamined in 1993-1995. For HPV testing, we used a polymerase chain reaction-based assay that detected 39 HPV types. Women who developed cervical cancer were identified from cancer and death registries. Cumulative risks for developing cervical cancer among infected and persistently infected women were calculated by the Kaplan-Meier method. Of 10,123 women who were initially cytologically normal, 68 developed cervical cancer. The 16-year cumulative risks of subsequent cervical cancer for women with HPV16, HPV58 (without HPV16), or other carcinogenic HPV types (without HPV16 or HPV58) were 13.5%, 10.3%, and 4.0%, respectively, compared with 0.26% for HPV-negative women. Women with type-specific persistence of any carcinogenic HPV had greatly increased risk compared with women who were HPV-negative at both visits (hazard ratio = 75.4, 95% confidence interval = 31.8 to 178.9). The cumulative cervical cancer risks following persistent carcinogenic HPV infections increased with age: The risks were 5.5%, 14.4%, and 18.1% for women aged 30-44 years, 45-54 years, and 55 years and older, respectively. However, newly acquired infections were associated with a low risk of cervical cancer regardless of age. HPV negativity was associated with a very low long-term risk of cervical cancer. Persistent detection of HPV among cytologically normal women greatly increased risk. Thus, it is useful to perform repeated HPV testing following an initial positive test.

What women want. Women’s preferences for the management of low‐grade abnormal cervical screening tests: a systematic review

If human papillomavirus (HPV) testing will replace cytology in primary cervical screening, the frequency of low-grade abnormal screening tests will double. Several available alternatives for the follow-up of low-grade abnormal screening tests have similar outcomes. In this situation, women's preferences have been proposed as a guide for management decisions. To determine women's preferences for the follow-up of low-grade cervical screening abnormalities. Using Medical Subject Headings (MeSH) terms, PubMed was searched for articles published up to December 2010. The reference lists of the retrieved studies were consulted. Studies asking women to state a preference between active follow-up and observation for the management of low-grade abnormalities on screening cytology or HPV tests. Information on study design, participants and outcomes was retrieved using a prespecified form. Studies were sorted by design. Thirteen studies were included in the review. In all five studies that surveyed women with abnormal tests before any management had started, two-thirds preferred active follow-up, predominantly as immediate colposcopy, to observation, predominantly as repeated Pap smears. In all but two studies testing other situations, women more often expressed a preference for active follow-up than for observation; however, women appeared to be somewhat more willing to accept observation if reassured of the low risk of cervical cancer. Even for low-grade abnormal cervical tests, women tend to prefer active management strategies. It may be a challenge to meet their expectations of optimal follow-up when HPV testing is used in primary screening.

The influence of knowledge and perception of the risk of cervical cancer on screening behavior in mainland Chinese women

Theories of health behavior and empirical research highlight the risk perception as a significant factor for people adopting cancer screening. However, screening uptakes and risk perception of cervical cancer in mainland Chinese women remains unknown. This paper adopted the protection motivation theory (PMT) to examine Chinese women's knowledge and perceptions of cervical cancer risk and factors influencing utilization of cervical screening. A self-administered questionnaire was completed by 167 participants in mainland China (79 nonscreened and 88 screened women) in 2007 which consisted of four sections: background information, women's attendance pattern for cervical screening, perceptions related to body health and knowledge about cervical cancer and screening, and PMT measures. All women considered themselves at low risk of cervical cancer. No significant association was observed between previous screening uptake and PMT variables. Using multivariate analysis, having children, a perception that visiting doctors regularly is important to health, average and high levels of knowledge about cervical screening were significantly associated with having been received screening. Chinese women demonstrated an unrealistic optimism about their personal risk of cervical cancer. The findings do not support an association between risk perception and screening uptake. In spite of this, current findings revealed some possible factors influencing women's screening behavior. This study highlights the significance of knowledge and culturally-relevant health behavior and beliefs about cervical screening for Chinese women in determining whether or not they receive screening. The promotion of cervical cancer prevention and early detection should be integrated into public education about women's health.

Physicians' Beliefs About Pap Screening Intervals

Recent national clinical practice guidelines recommend repeat Pap smear testing every 2 to 3 years for women at low risk for cervical cancer (risk