Organized Cervical Screening Research Articles

ARE AWARENESS CAMPAIGNS EFFECTIVE IN INCREASING UPTAKE OF CERVICAL CANCER SCREENING TEST BY WOMEN: A STUDY IN A MUNICIPALITY IN CENTRAL NEPAL?

Background: Cervical cancer is one of the most common cancers and a leading cause of mortality among Nepalese women, but almost completely preventable by a screening test. This study aimed to find out the association of knowledge and attitude about cervical cancer and its screening test on the uptake of cervical pap smear test. Methods: A cross-sectional study was carried out among women aged 20 to 65 years residing in Madi Municipality located in the central region of Nepal. Probability systematic sampling technique was used to select 300 samples for the study. Data were collected using structured interview schedule, and these were analysed in IBM SPSS version 20 for windows using descriptive and inferential statistics. Results: Out of 300 married women, median age (IQR) was 40 (54-32) years. Despite 42.7% women having adequate knowledge about cervical cancer and 49% women having favourable attitude towards cervical pap smear, only 6.7% participants had undergone cervical pap smear test at least once in their life. There was no significant association between knowledge about cervical cancer and pap smear, and pap smear utilization. This shows that good knowledge does not always translate into action. Conclusions: Population-based organized cervical pap smear screening program must be implemented to increase pap smear utilization. Health awareness campaigns in the absence of organized cervical screening program are largely ineffective.

Post-conization surveillance in an organized cervical screening program with more than 23,000 years of follow-up

BackgroundCervical cancer is preventable through screening and vaccination against high-risk human papillomavirus (hr-HPV). For a screening program to be successful it is vital that the clinical management and follow-up regime of patients with abnormal screening results is well developed and that the attendance rate for follow-up is high. The aim of the study was to analyze how effective conization with recommended follow-up was in preventing subsequent cervical cancer, and to evaluate how clinical follow-up recommendations are obeyed in the region of Skåne, Sweden.MethodsAll women (n = 8835) who had undergone conization in the region of Skåne, Sweden, between the years of 2015 and 2021 were identified. Individuals with confirmed cervical cancer in the conization material were referred for additional treatment (n = 114), leaving 8721 included in the follow-up. Adherence to follow-up and cytological, histopathological and HPV status at follow-up were collected at eight, 12 and 24 months post-conization. The total follow-up time was from January 1, 2015, to January 30, 2023.ResultsWithin 12 months post-conization, 90% of the patients conducted a cytological cervical sample. The rates of a negative test of cure (HPV negative and normal cytology) were 69.7%, 76.3% and 84.4% at eight, 12 and 24 months post-conization respectively. The clearance of HPV was 79.6%, 80.8% and 87.8% at eight, 12 and 24 months post-conization respectively. Out of 5613 patients with a negative test of cure within one year after conization, no cervical cancer was found during follow-up and 11 (0.2%) women developed high-grade intraepithelial lesions/adenocarcinoma in situ (HSIL/AIS) with an average time from conization to new diagnosis of 42 months. The mean follow-up time was 32.1 months.ConclusionsThe clearance rate of hr-HPV post cervical conization due to dysplasia appears to be high within eight months. With a negative test of cure post cervical conization, the risk of cervical cancer within the following three years seems to be extremely low and the risk of developing HSIL/AIS was lower than the incidence of HSIL/AIS in the general screening population.

Evaluation of Visual Inspection of Cervix with Acetic Acid in Detecting Precancerous Lesions

Background: Cervical cancer is a major public health problem in Bangladesh without widespread organized cervical screening programs. The acetic acid visual inspection of the cervix (VIA) is an efficient, low-cost screening test that can be paired with easy treatment procedures for early cervical lesions provided by skilled health workers. To evaluate the effect of any prevention program on cervical cancer incidence and mortality rates, women aged 25 to 50 must be adequately covered. VIA is a cost-saving method of screening, according to mathematical modeling of the expenses of various screening procedures in Bangladesh. Methods: Total 100 eligible woman who randomly came to the VIA centre of BSMMU were examined by VIA detection of well defined, opaque, acetowhite lesions close to the squamocolumner junction or in transitional zone or dense acetowhitening of ulcero proliferative growth on the cervix constitute a positive VIA Those who had abnormal results in screening test and those who had clinically suspicions lesion were sent for colposcopic evaluation and directed biopsy were taken from colposcopically suspected area. The final diagnosis was based on histology. Results: Healthy cervix was in 11 cases (11%) suspected inflammation was 4 cases (4%), CIN-I was 58 cases (58%), CIN-II was in 14 cases (14%), CNN-III was in 10 cases (10%), and invasive carcinoma was in 3 case (3%). Out of 100 patients biopsied, cervical intraepithelial neoplasia found among 81% cases of which CIN was in 52.5%, CIN II was in 17% and CIN III was in 8.5%. Invasive carcinoma found in 3% and inflammation was in 4% cases. Conclusion: VIA was as effective as colposcopy at detecting various grades of intraepithelial cervix lesions. Here, VIA was suitable for the diagnosis, follow-up care, and epidemiological research of cervical cancer, as well as for the detection of precancerous lesions in low resource settings.

Colposcopic performance in a birth cohort previously eligible for human papillomavirus vaccination

Sweden started subsidized quadrivalent human papillomavirus vaccination for girls aged 13 to 17 in 2007. Since 2012, vaccination has been offered to all girls aged 10 to 12 within a school-based vaccination program, with a coverage of 80% or more. In addition, the vaccine has been offered on-demand as catch-up vaccination for girls aged 13 to 18, with a cumulative coverage of 55% to 60%. Since the first women in Sweden eligible for human papillomavirus vaccination entered the cervical screening program, questions on how to evaluate colposcopic findings among vaccinated women have arisen. Evidence is inconsistent on whether colposcopic features for the detection of cervical lesions are influenced by specific human papillomavirus genotypes and what role they can play in the prevention of invasive cervical cancer in vaccinated women. The primary objective of the study was to compare colposcopic evaluation in vaccinated and unvaccinated women entering the organized cervical screening program. Women in the 1994 and 1995 birth cohorts who entered the cervical screening program at age 23 in 1 region in Sweden were identified. Colposcopy was performed within 2 to 4 months after a positive screening result in accordance with national guidelines. Colposcopic performance was evaluated according to national guidelines with the Swede score and colposcopic impression. Punch biopsies were taken from colposcopic lesions and as "random biopsies" in the absence of lesions. These biopsies were used as the gold standard for the analysis. An endocervical sample was analyzed for cytologic findings and detection of 14 high-risk human papillomavirus genotypes. All colposcopic imaging was saved digitally for re-review. Vaccination status was obtained through linkage to national vaccination registries. Results were compared between vaccinated and unvaccinated women. In 2018 and 2019, 160 out of 165 (98%) women with a positive screening result attended colposcopy, of which 90 (56%) were vaccinated and 70 (44%) were unvaccinated. Only 7 out of 90 (5%) women in the vaccinated group were human papillomavirus 16/18-positive, compared with 23 out of 70 (33%) in the unvaccinated group (P<.001). There was a total of 61 out of 160 (38%) women with high-grade lesions-33 out of 90 (37%) in the vaccinated group and 28 out of 70 (40%) in the unvaccinated group (P=.697). There was 64% (21/33) of vaccinated women and 75% (21/28) of unvaccinated women with high-grade squamous intraepithelial lesions who had a Swede score of 6 to 10 (indicating high-grade squamous intraepithelial lesions) (P=.124). The sensitivity was slightly higher for the detection of high-grade squamous intraepithelial lesions in unvaccinated women using both colposcopic tests (Swede score, 0.67 vs 0.75; colposcopic impression, 0.67 vs 0.68), but the difference was not statistically significant. We found no statistically significant difference between the colposcopic evaluation of vaccinated and unvaccinated women, although human papillomavirus vaccination reduced the prevalence of human papillomavirus 16/18 infection in human papillomavirus-vaccinated women. Our results indicate that colposcopic examination is still a useful tool in vaccinated women entering the organized cervical screening program.

Feasibility of sending a direct send HPV self-sampling kit to long-term non-attenders in an organized cervical screening program

IntroductionNon-participation in screening is a main risk factor for cervical cancer. Human-papillomavirus (HPV) self-sampling may be an alternative to repeated invitations for non-attenders. Several studies have concluded that participation among non-attenders increases significantly when offering self-sampling kits for HPV. However, participation rates are highly variable between settings, and therefore pilots to determine optimal implementation strategy have been recommended before routine roll out. Materials and MethodsAll women who had not participated in the organized screening program for at least 10 years aged 33–62 in one Swedish county were identified through screening registers. HPV self-sampling kits were sent to all eligible women. Participation was defined as returning a self-sample kit or attending routine screening within 6 months. Women who did not submit the kit within 8 weeks were randomized to receive a written reminder. HPV-positive women were referred directly to colposcopy without prior triage. Biopsies for histopathologic confirmation were used as gold standard. ResultsAmong eligible women, 150/741 (20.2%) returned the self-sample kit or attended routine screening. A randomized written reminder was sent out to 319/591 non-responders and another 11 women returned the kit. In total, 23/147 (16.3%) of returned kits were HPV positive. Out of the 23 HPV-positive women, 17 (74%) attended colposcopy; 10/17 (59%) had a histopathological high-grade squamous intraepithelial lesions (HSIL) or cervical cancer. The most common HPV type was HPV 52, and 2 out of 3 women with HPV 16 had a histopathologically confirmed cancer. ConclusionThe direct send kit strategy and referral of all HPV-positive women to colposcopy without prior triage appears to be feasible if resources are available and should be prioritized given the high prevalence of HSIL lesions and cancer among non-attenders. A written reminder might further increase attendance.

Cervical testing beyond the screening target age – A register-based cohort study from Finland

ObjectiveIt has been proposed that cervical cancer screening should be continued in women with previous abnormal results or irregular attendance. We examined the coverage and factors that might influence cervical testing beyond the age range of the organized cervical screening programme in Finland. The national programme invites women in every five years least until the age of 60. After the stopping age, only opportunistic service is available. MethodsData on cervical testing were collected from the Mass Screening Registry and providers of opportunistic Pap/HPV-testing and were linked with information on socio-economic variables. The study included 373,353 women who had at least one invitation to the national screening programme between ages 50–60 years, and who were aged 65–74 years in the follow-up period 2006–2016. Multivariable binomial regression models were conducted to determine associations. ResultsAltogether 33% of the study population had been tested at least once at ages 65–74 years. Previous regular screening attendance (adjRR 1.70; 95% CI 1.67–1.73) and earlier abnormal results (adjRR 2.08; 95% CI 2.04–2.12) were most clearly related to higher testing adherence at older age. Other factors related to higher testing adherence were urban area of residence, domestic mother tongue, high education level, and high socio-economic status. ConclusionTesting at older age was frequent with normal results, whereas only a small proportion of women with earlier abnormal results or irregular attendance were tested. The upper age limit of the national programme should be raised to 65 years, and the invitations thereafter should be targeted to selected high-risk groups.

Gaps between recommendations and their implementation: A register-based study of follow-up after abnormalities in cervical cancer screening

Follow-up after screen-detected abnormalities is crucial for the success of cervical cancer screening programs but is usually not closely monitored in official screening statistics. We determined how the follow-up deviated from the recommendations in the Danish organized program. Using Danish nationwide population-based registers, the follow-up pathways of 60,199 women aged 23–59 with non-negative screening samples from 2012 to 2014 were mapped until end of 2018. We studied the timeliness and appropriateness of follow-up tests after cervical cytology screening and the total resource use in accordance with the national recommendations. Regression analyses were used to determine variations in adherence according to age, provider type, region, and history of abnormalities. Among women referred for immediate colposcopy, 91.3% (95% CI: 90.9%–91.6%) attended within four months as recommended, whereas up to about half of the women with a recommendation for a repeat test received this test either too early or very late. Overall, only 43% (95% CI: 42.9%–43.7%) of women with non-negative screening tests received the recommended follow-up, whereas 18% (95% CI: 17.6%–18.2%) received more than was recommended, 35% (95% CI: 34.4%–35.1%) received some follow-up but less than recommended and 4% (95% CI: 3.9%–4.2%) were not followed up at all. These proportions varied by screening diagnosis, woman's age, type of health care provider, region, and history of abnormalities. On average, women underwent more tests of each type than recommended by the guidelines. Deviations from follow-up recommendations are very frequent even in organized cervical screening programs and should be routinely monitored by screening program statistics.

National guidelines for management of cervical squamous intraepithelial lesion: A survey of European Federation for colposcopy members

ObjectivesThe management of women with cervical squamous intraepithelial lesions (SIL) is fundamental to prevention of cervical cancer in an organized cervical screening programme. Clinical guidance should improve quality of care and clinical effectiveness if developed and implemented appropriately. This survey provides an update on the current situation of national guidelines for management of cervical SIL amongst member countries of European Federation for Colposcopy (EFC). Study designA questionnaire was sent to representatives of each member country of EFC. The questionnaire contained questions on: guidelines for management of cervical SIL of the National Societies/Associations of Colposcopy or others national societies/associations including the development and the consultation processes, guidelines for management of lower genital tract diseases and the regulations in each country for colposcopy practice. ResultsWe received responses from all 34 member countries. Thirty countries reported a national guideline for management of cervical SIL that were developed by, or in conjunction with, their national societies or associations of colposcopy. In most cases there was adherence to the recommended steps for guideline development: they were developed by a multi-disciplinary group of specialists (29 countries) and society members were consulted before publication (21 countries). A small number of countries (8) reported to have guidelines for the management of lower genital tract dysplasia (e.g. vulval disease) developed by other national societies. In most countries (26) the colposcopists are obliged to follow the guidelines but this is regulated in only 6 and in 12 countries the colposcopists need to be certified by the national society of colposcopy in order to practice. ConclusionThere are advances in the development and provision of country specific guidance on the management of cervical SIL. Most EFC member countries have appropriate national guidelines that were developed using a clear methodology, are updated according to progresses in the field and are accessible online to current practitioners. These guidelines support colposcopists to follow evidence-based practice and provides understanding of best practice in guideline development and access.

Development of Decision Aids for Organized Cervical Carcinoma Screening in Germany

The Federal Joint Committee has decided to introduce organized cervical carcinoma screening in 2020. The present work describes the development of decision aids that will be sent to women in this program. A systematic search for qualitative studies and surveys was conducted to gather information on experiences, attitudes and information needs. Furthermore, we searched for systematic reviews on advantages and disadvantages of screening. An existing decision analysis for cervical carcinoma screening in Germany was used. The designs were subjected to a qualitative test (focus groups with 26 women and 8 expert interviews), to a quantitative user test (online survey n=2,014 women) and to a public hearing. Most women found the decision aids informative and helpful. The majority would recommend the use of these materials to others. For many women, part of the information was new, although they had been involved in cervical cancer screening for some time. The presentation of the advantages and disadvantages was judged to be balanced. However, 10% changed their attitude towards participation and 70% of women would attend screening. The decision aids found a high acceptance among the users. They can help to reduce knowledge deficits on cervical carcinoma screening and support a informed decision making.

Retrospective examination of the Hungarian breast and cervical cancer screening programmes according to mortality and morbidity data

Introduction: The organized breast and cervical screening programs were implemented in the framework of public health program in Hungary in order to reduce breast cancer mortality by 30% and cervical cancer mortality by 60% in given age groups within 10 years by 2012. Aim: The aim of our study was to conduct a retrospective analysis of mortality and morbidity data and to evaluate the effectiveness of the implemented screening programs. Method: Descriptive statistical analysis was performed by age-standardized mortality and morbidity data between 1980 and 2015 with special regard to the period of 2002-2012. Results: Breast cancer mortality of women aged 45-64 reduced by 28.3%, the incidence reduced by 23.6% and the incidence of in situ carcinoma increased by 242% between 2002 and 2012. Cervical cancer mortality of women aged 25-64 years reduced by 25.5%, the incidence reduced by 21.2%, and the incidence of in situ carcinoma increased by 13.3% during 2002-2012. Conclusion: Although both breast cancer and cervical cancer mortality substantially decreased in Hungary, the decrease in cervical cancer did not reach the target value. Orv Hetil. 2019; 160(49): 1948-1956.

Colposcopic and histopathologic evaluation of women with HPV persistence exiting an organized screening program

Human papillomavirus-based screening has a higher sensitivity for precursors of cervical cancer compared with cytology-based screening. However, more evidence is needed on optimal management of human papillomavirus-positive women. The objective of the study was to compare the risk of histopathologically confirmed cervical intraepithelial lesions grade 2 or worse after 1 and 3 years of human papillomavirus persistence, respectively, and evaluate the clinical management of human papillomavirus-positive women in the 56-60 year age group. This was a randomized health care policy offering human papillomavirus screening to 50% of resident women aged 56-60 years in the Stockholm/Gotland region of Sweden during January 2012 through May 2014. Women who were human papillomavirus positive/cytology negative at baseline were referred for a repeat test after 1 or 3 years. In case of human papillomavirus persistence, women were referred for colposcopy, including biopsies and endocervical sampling. The human papillomavirus prevalence was 5.5% (405 womenof 7325 attending). Among the 405 human papillomavirus-positive women, 313 were reflex test cytology negative at baseline and were referredfor a repeat human papillomavirus test, 176 women after 1 year and 137 women after 3 years. After 1 year, 91 of 176 (52%) were persistently human papillomavirus positive and after 3 years 55 of 137 (40%) (P= .042). In repeat cytology, 10 of the 91 (12%) were positive after 1 year and 15 of 55 (33%) after 3 years (P= .005). The attendance rates for colposcopy were similar: 82 of 91 (90%) in the 1 year group and 45 of 55 (82%) in the 3 year group. All women attending colposcopy were postmenopausal, and endocervical sampling and punch biopsies were performed to facilitate colposcopic management, with a positive predictive value of 43-50% and 28-31%, respectively. Histopathologically confirmed cervical intraepithelial lesions grade 2 or worse was found in 19 of 82 women (23%) and 9 of 45 women (20%) in the 1 year and 3 year groups, respectively, and registry linkage follow-up found no cancers in either group. Human papillomavirus genotyping was predictive of cervical intraepithelial lesions grade 2 or worse, and human papillomavirus 16 was the most common genotype at human papillomavirus persistence, occurring in 18% of the cases in the 1 year group and 20% in the 3 year group. It was safe to postpone repeat human papillomavirus tests for 3 years in postmenopausal women attending the organized cervical screening program. There was a high risk for cervical intraepithelial lesions grade 2 or worse at follow-up and noteworthy yields from human papillomavirus genotyping as well as endocervical sampling and random biopsies in the absence of visible colposcopic lesions.

Increasing participation in cervical screening by targeting long-term nonattenders: Randomized health services study.

High screening participation in the population is essential for optimal prevention of cervical cancer. Offering a high-risk human papillomavirus (HPV) self-test has previously been shown to increase participation. In this randomized health services study, we evaluated four strategies with regard to participation. Women who had not attended organized cervical screening in 10 years were eligible for inclusion. This group comprised 16,437 out of 413,487 resident women ages 33-60 (<4% of the screening target group). Among these 16,437 long-term nonattenders, 8,000 women were randomized to either (i) a HPV self-sampling kit sent directly; (ii) an invitation to order a HPV self-sampling kit using a new open source eHealth web application; (iii) an invitation to call a coordinating midwife with questions and concerns; or (iv) the standard annual renewed invitation letter with prebooked appointment time (routine practice). Overall participation, by arm, was (i) 18.7%; (ii) 10.7%; (iii) 1.9%; and (iv) 1.7%. The relative risk of participation in Arm 1 was 11.0 (95% CI 7.8-15.5), 6.3 (95% CI 4.4-8.9) in Arm 2 and 1.1 (95% CI 0.7-1.7) in Arm 3, compared to Arm 4. High-risk HPV prevalence among women who returned kits in study Arms 1 and 2 was 12.2%. In total, 63 women were directly referred to colposcopy from Arms 1 and 2; of which, 43 (68.3%) attended and 17 had a high-grade cervical lesion (CIN2+) in histology (39.5%). Targeting long-term nonattending women with sending or offering the opportunity to order self-sampling kits further increased the participation in an organized screening program.

PCN57 EXAMINATION OF HEALTH INSURANCE DISEASE BURDEN OF CERVICAL CANCER IN HUNGARY: A REAL WORLD STUDY

The burden of malignanttumour diseases is much higher in the Eastern European countries than in Western Europe because they have limited financial resources in health care. Therefore, it is especially important to evaluate cost-effectiveness of certain actions during the decision making processes. The aim of our analysis is to define the annual health insurance disease burden of cervical cancer for the National Health Insurance Fund of Hungary (NHIFH). The analysis was performed.by the funding database of 2014 data which covered all services and types of care funded by NHIFH. We analysed the in situ diseases (D06), the benign disorders (C53), and the malignant ones (D26.0). The treatment included the costs of the following: care by the general practitioner, outpatient care, caregivers’ fee, CT/MR, PET laboratory tests, home care, patient transportation, acute and chronic inpatient care, price subsidy of medicaments, and price subsidy to medical devices. In 2014 the NHIFH spent 1.05 billion Hungarian Forint (HUF) (3.41 million EUR) for the treatment of cervical cancer patients. The patients, and most of the funded cases (96.85%) were paid due to people treated with malignant cervical tumours while in situ (2.94%) and beningn (0.21%) cancers represents smaller proportion. The highest expense item appeared in the acute inpatient care, which was annually 700.87 million HUF (2.27 million EUR) representing 66.56% of total health insurance expenditure. Expenditures for CT/MRI examinations (108.59 million HUF; 351.82 thousand EUR), medical devices (92.12 million HUF; 298.46 thousand EUR) and outpatient care (58.85 million HUF; 190.65 thousand EUR) are also important cost elements accounting for 10.3%, 8.8% and 5.6% of total health insurance expenditures, respectively. Cervical cancer represents a significant burden for the Hungarian health insurance system.The increased participation on organized cervical screening might change the health insurance expenditures of cervical cancer.

HPV testing for cervical cancer screening: technical improvement of laboratory logistics and good clinical performance of the cobas 6800 in comparison to the 4800 system

BackgroundEuropean guidelines for cervical cancer screening now recommend the use of clinically validated assays for high-risk HPV-DNA sequences as primary test in women older than 30 years, performed in centralized laboratories, and run on systems providing automated solutions for all steps.MethodsWe conducted a comparison study, according to the international guidelines, nested within the organized population-based cervical screening program, between the cobas 4800 and 6800 systems (Roche Diagnostics), to evaluate accuracy and reproducibility of HPV test results and laboratory workflow. In Italy implementation of HPV cervical screening is under way on a regional basis; in Veneto it started in June 2015, following a piloting phase; the assay in use in the three centralized laboratories is the cobas 4800 HPV test, run on the cobas 4800 system. Comparison of HPV results with a new version of the assay (cobas 6800/8800 HPV) run on the cobas 6800 system, and intra- and inter-reproducibility analyses have been conducted in samples collected in PreservCyt medium (Hologic) from women without and with a subsequent diagnosis of high-grade lesion.ResultsSamples from women older than 30 years attending organized cervical cancer screening were used. Clinical sensitivity and specificity were evaluated on 60 cases and 925 controls, respectively; intra-laboratory reproducibility and inter-laboratory agreement by the 6800 system were evaluated on 593 and 460 specimens, respectively. Our results showed a very high agreement (> 98%) for overall qualitative results between the two systems; clinical sensitivity and specificity of the HPV assay run on 6800 were non-inferior to those of the HPV assay run on 4800 (p = 0,0157 and p = 0,0056, respectively, at the recommended thresholds of 90 and 98%); kappa values of 0.967 and 0.969 were obtained for intra- and inter-laboratory reproducibility analyses in the 6800 system. The 6800 platform displayed several technological improvements over the 4800 system, with higher throughput and laboratory productivity, and lower operator’s hands-on time.ConclusionsThe new cobas 6800/8800 HPV assay run on the 6800 instrument is suitable for use in large centralized laboratories included within population-based cervical cancer screening programs.

Why Do Women Get Cervical Cancer in an Organized Screening Program in Canada?

The aim of the study was to determine factors associated with the development of cervical malignancy among women participating in an organized cervical screening program. A population-based retrospective cohort study was performed examining the screening histories 2 to 10 years before diagnosis of invasive cancer in Ontario women between 2011 and 2014. A total of 2,002 cases of cervical cancer were identified; 1,358 (68%) were squamous cell carcinomas and 644 (32%) were adenocarcinomas. The mean age at the time of diagnosis was 50.3 years. More than 60% of the cohort had at least 1 cytology test within 2 to 10 years of their diagnosis. Of the women having a cytology result 24 to 36 months before diagnosis, 69% had a normal cytology whereas only 7% had a high-grade cytology result. Stage of cancer was most advanced in women who did not have cytology in the 2 to 10 years before their diagnosis. On multivariate regression, those with cervical cancer who were less likely to have undergone screening include older age, advanced stage, lower income, not having a family physician, and those diagnosed with adenocarcinoma. Although nonparticipation in screening is the greatest factor associated with cervical cancer diagnosis, failure of cervical cytology to detect cytologic abnormalities in women 2 to 3 and 3 to 5 years before diagnosis is of concern. Efforts must be directed to recruitment of women for screening as well as improving the sensitivity of screening tests to detect existing abnormalities.

Visual Inspection of Cervix with Acetic Acid (VIA) as a Screening Tool for Early Detection of Cervical Pre-Cancer &amp; Cancer.

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

СУЧАСНИЙ ПОГЛЯД НА СКРИНІНГ РАКУ ШИЙКИ МАТКИ: ДОСВІД В УКРАЇНІ ТА СВІТІ

One of the important medical problems consists in the prevalence and incidence of cervical cancer, implementation of innovative technologies in the diagnostics and treatment of this pathology. Every six months, half a million women around the globe are taken ill by this disease, and 270 thousand women die of it. Undoubtedly, the major burden of this disease falls on developing countries. However, for economically developed countries with a well organized cervical screening, this problem remains topical too. In European countries, cervical screening allowed to significantly reduce the cervical cancer incidence in 80-90s of the previous century, for instance, in Great Britain, Sweden, and Finland. However, even in these countries, for the past 15-20 years, the number of women suffering from cervical cancer has not decreased. The main reason lies in epidemiological, social, and ecologic peculiarities of the modern world. If modern tendencies of cervical cancer incidence growth retain, then an annual number of people with cervical cancer may reach 1 million by 2050. Based on the WHO assessment, there exist all prerequisites for cervical cancer elimination. Vaccination allows creating a sufficiently powerful collective immunity against HPV. There exist quite specific and sensitive methods for diagnostics and treatment of cervical precancer, which are being improved every year. &nbsp;We are witnessing a change of diagnostic paradigm of cervical screening. The co-testing strategy came to replace the traditional PAP testing. Increased sensitivity and specificity of cytologic testing is achieved using the method of liquid-based cytology together with HPV testing. Initial HPV screening provides promising results, ensuring wide coverage of female population thanks to the possibility of independent sampling. In Ukraine, cervical cancer incidence constituted 4,157 people in 2016-2017, while the death rate amounted to 1,757 women. The mortality rate up to one year constitutes 16.7%. It is worth noting that in 2017, the increase in cervical cancer incidence (21.5 against 20 per 100 thousand of the female population) and mortality (9 against 8.7 respectively) was recorded. Every day in Ukraine, 6 women die of this disease. And this happens despite the fact that we do have the infrastructure for opportunist cervical screening. Implementation of a new generation cervical screening will enable revolutionary HPV prevention, improved diagnostics, and treatment of cervical precancer.

Self-sampling with HPV mRNA analyses from vagina and urine compared with cervical samples

BackgroundIn order to increase coverage in the organized cervical screening program, self-sampling with HPV analyses has been suggested. ObjectivesThe aim was to compare human papillomavirus (HPV) mRNA detection in vaginal and urine self-collected samples with clinician-taken cervical samples and the corresponding clinician-taken histological specimens. Study designSelf-collected vaginal, urine and clinician-taken cervical samples were analyzed from 209 women with the Aptima mRNA assay (Hologic Inc, MA, USA). Cervical cytology, colposcopy, biopsy and/or the loop electrosurgical excision procedure (LEEP) were performed in every examination. ResultsThe sensitivity of the HPV mRNA test in detecting high-grade squamous intraepithelial lesions (HSIL)/adenocarcinoma in situ (AIS)/cancer cases was as follows: for the vaginal self-samples 85.5% (95% CI; 75.0–92.8), the urinary samples 44.8% (95% CI; 32.6–57.4), and for routine cytology 81.7% (95% CI; 70.7–89.9). For the clinician-taken cervical HPV samples the sensitivity of the HPV mRNA test in detecting HSIL/AIS/cancer was 100.0% (95% CI; 94.9–100.0). The specificity of the HPV mRNA was similar for the clinician-taken cervical HPV samples and the self-samples: 49.0% vs. 48.1%. The urinary HPV samples had a specificity of 61.9% and cytology had a specificity of 93.3%. ConclusionThe sensitivity of the Aptima HPV mRNA test in detecting HSIL/AIS/cancer from vaginal self-samples was similar to that of routine cytology. The Aptima HPV mRNA vaginal self-sampling analysis may serve as a complement in screening programs.

Evaluation of Recall and Reminder Letters on Retention Rates in an Organized Cervical Screening Program

ObjectiveIt is key for women to return to screening at regular intervals to ensure the effectiveness of early detection and protective effects of the Pap test. A correspondence program was initiated in Ontario in 2013 to implement a recall and reminder letter sent to women 2.9 years from their prior normal Pap test. This study sought to evaluate the impact of the recall letter and reminder on retention rates for cervical screening. MethodsA cohort study with a historical control was carried out with an exposed group, defined as women receiving a letter for recall in the week of November 21–27, 2013, and a non-exposed, control arm of women who did not receive the letter but who would have been eligible for correspondence in the same time period in 2012. ResultsThe study population comprised 5182 women in the exposed group and 4223 women in the non-exposed group. Women receiving the letter were more likely to return to screening, with an aOR of 1.82 (95% CI 1.66–1.99). Other significant factors included being registered with a Patient Enrolment Model family physician and having a series of prior Pap tests in the past screening history. ConclusionA correspondence program benefits the retention of women in organized cervical screening programs.

Cervical HPV type-specific pre-vaccination prevalence and age distribution in Croatia.

The main etiological factor of precancerous lesion and invasive cervical cancer are oncogenic human papillomaviruses types (HPVs). The objective of this study was to establish the distribution of the most common HPVs in different cervical lesions and cancer prior to the implementation of organized population-based cervical screening and HPV vaccination in Croatia. In this study, 4,432 cervical specimens, collected through a 16-year period, were tested for the presence of HPV-DNA by polymerase chain reaction (PCR) with three sets of broad-spectrum primers and type-specific primers for most common low-risk (LR) types (HPV-6, 11) and the most common high-risk (HR) types (HPV-16, 18, 31, 33, 45, 52, 58). Additional 35 archival formalin-fixed, paraffin embedded tissue of cervical cancer specimens were analyzed using LiPA25 assay. The highest age-specific HPV-prevalence was in the group 18–24 years, which decreased continuously with age (P<0.0001) regardless of the cytological diagnosis. The prevalence of HR-HPV types significantly increased (P<0.0001) with the severity of cervical lesions. HPV-16 was the most common type found with a prevalence (with or without another HPV-type) of 6.9% in normal cytology, 15.5% in atypical squamous cells of undetermined significance, 14.4% in low-grade squamous intraepithelial lesions, 33.3% in high-grade squamous intraepithelial lesions, and 60.9% in cervical cancer specimens (P<0.0001). This study provides comprehensive and extensive data on the distribution of the most common HPV types among Croatian women, which will enable to predict and to monitor the impact of HPV-vaccination and to design effective screening strategies in Croatia.