Risk Of Invasive Cervical Cancer Research Articles

Long-term prediction by DNA methylation of high-grade cervical intraepithelial neoplasia: Results of the ARTISTIC cohort.

Methylation markers have shown potential for triaging high-risk HPV-positive (hrHPV+) women to identify those at increased risk of invasive cervical cancer (ICC). Our aim was to assess the performance of the S5 DNA methylation classifier for predicting incident high-grade cervical intraepithelial neoplasia (CIN) and ICC among hrHPV+ women in the ARTISTIC screening trial cohort. The S5 classifier, comprising target regions of tumour suppressor gene EPB41L3 and L1 and L2 regions of HPV16, HPV18, HPV31, and HPV33, was assayed by pyrosequencing in archived hrHPV+ liquid-based samples from 343 women with high-grade disease (139 CIN2, 186 CIN3, and 18 ICC) compared to 800 hrHPV+ controls. S5 DNA methylation correlated directly with increasing severity of disease and inversely with lead time to diagnosis. S5 could discriminate between hrHPV+ women who developed CIN3 or ICC and hrHPV+ controls (p <.0001) using samples taken on average 5 years before diagnosis. This relationship was independent of cytology at baseline. The S5 test showed much higher sensitivity than HPV16/18 genotyping for identifying prevalent CIN3 (93% vs. 61%, p = .01) but lower specificity (50% vs. 66%, p <.0001). The S5 classifier identified most women at high risk of developing precancer and missed very few prevalent advanced lesions thus appearing to be an objective test for triage of hrHPV+ women. The combination of methylation of host and HPV genes enables S5 to combine the predictive power of methylation with HPV genotyping to identify hrHPV-positive women who are at highest risk of developing CIN3 and ICC in the future.

Abstract C141: From insights to action: Engaging women living with HIV in the data-driven development of an mHealth intervention for cervical cancer prevention and HPV self-sampling

Abstract Background: Women living with HIV (WLH) face a higher risk of invasive cervical cancer (CC) due to a greater incidence and longer persistence of high-risk human papillomavirus (HPV) infection. Health education programs, including text-messaging interventions, have demonstrated effectiveness in improving CC and HPV knowledge and promoting recommended screening. Emerging strategies involving self-collected cervicovaginal samples as an alternative to office-based HPV screening offer additional promise in reaching women who face several obstacles to timely care, such as WLH. Purpose: This mixed-methods study aims to describe the data-driven development of a four-week text-messaging intervention, named “My Self-Sampling, HPV Awareness, Results, and Empowerment (MySHARE)”, to improve CC prevention knowledge and promote HPV self-sampling among WLH. Methods: Surveys (n=81) and focus group discussions (FGDs; n=39) were conducted among WLH in the Washington-Baltimore metropolitan region, with the findings guiding the development of MySHARE. Results: While most WLH indicated that in-person group sessions were their typical source of health information, they highlighted the impracticality of these sessions since the pandemic and expressed openness to a text-messaging intervention. Survey results informed the logistical aspects and functionality of the intervention, while FGD participants' responses, guided by constructs from the Protection Motivation Theory, shaped the content of the text-messaging library. The library covered topics such as CC and HPV knowledge, prevention behaviors, and HPV self-sampling. Conclusions: This study emphasizes the significance of engaging the target population in intervention development. WLH participants provided clear and actionable recommendations, which, together with best practices in digital health technology, directed decisions on the intervention delivery platform, messaging timing and frequency, and text-messaging content. Low-cost and accessible interventions like MySHARE have the potential to substantially enhance CC and HPV knowledge, as well as screening rates, among historically underserved populations, particularly during public health crises. Citation Format: Daisy Le, Annie Coriolan Ciceron, Min (Jaime) Jeong Jeon, Lorien C. Abroms, Carla J. Berg. From insights to action: Engaging women living with HIV in the data-driven development of an mHealth intervention for cervical cancer prevention and HPV self-sampling [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C141.

Long-term risks of invasive cervical cancer following HPV infection: follow-up of two screening cohorts in Manchester

BackgroundLong-term follow-up of large cohorts is needed to determine the effects of HPV and screening on CIN3 (grade 3 cervical intraepithelial neoplasia) and ICC (invasive cervical cancer).MethodsWomen were recruited when attending for routine cervical screening in Greater Manchester, UK: 1987–93 for the Manchester Cohort (MC: 47,625 women) and 2001–03 for the ARTISTIC Cohort (AC: 24,496 women). Both were followed through national registration for cancer incidence and mortality to 2020.ResultsRisk patterns following HPV infection differed for CIN3 and ICC. Risk of ICC in the MC rises for 30 years following a single positive HPV test, reaching 2.5% (95% CI: 1.3–4.5%). A similar pattern was seen in the AC, but the risks of cancer were approximately halved. CIN3 was diagnosed much sooner in the AC due to more efficient cytology. More sensitive HPV testing was able to better predict future risk.ConclusionThe sensitivity of HPV testing and cytology influences the CIN3 detection rate. Sensitive HPV testing enables effective risk stratification. Increased risk of ICC is observed 15–30 years after HPV infection. Women testing HPV + should be followed until their infection clears. Discharging women from screening programmes whilst they remain HPV + may not be safe, even if cytology and colposcopy tests are normal.

Non-adherence to cervical cancer screening recommendations among women in Eswatini: a cross-sectional study

BackgroundIn 2018, Eswatini had the world's highest age-standardised cervical cancer incidence rate. Cervical cancer screening reduces women’s risk of invasive cervical cancer. Data on adherence to cervical cancer screening recommendations in Eswatini are scarce. The purpose of the current study was to determine Eswatini women’s self-reported adherence to cervical cancer screening recommendations, attitudes toward screening, and factors associated with non-adherence.MethodsA cross-sectional survey of women (n = 377) aged 25 to 59 accessing primary healthcare clinics (n = 4) in Eswatini assessed screening participation, attitudes and knowledge regarding cervical cancer screening, and socio-demographic variables. Adjusted logistic regression was used to assess factors associated with non-adherence to Eswatini cervical cancer screening recommendations.ResultsOne hundred and sixty-six (44%) women were classified as adherent to cervical cancer screening recommendations. Attitudinal barriers endorsed by over one-third of participants included a perceived low risk of cervical cancer (n = 161, 43%) and a view that screening is likely to be painful (n = 146, 38%). Participants had higher odds of being classified as non-adherent if they: were single compared with married (OR = 1.78, 95% CI: 1.05, 3.01, p = 0.03), perceived screening as likely painful (OR = 4.43, 95% CI: 2.62, 7.46, p < 0.001); and had not been advised by a doctor/ nurse to screen (OR = 2.82, 95% CI: 1.71, 4.64, p < 0.001). Also, a 1-year increase in age was associated with an increase in the odds of being classified as non-adherent (OR = 1.42, 95% CI: 1.39, 1.45, p = 0.01).ConclusionsSelf-reported adherence was moderate among this group of women. Tailored interventions are needed to increase participation in cervical cancer screening, especially for those women with characteristics associated with being classified as non-adherent. Primary healthcare clinic nurses (and other health providers) may contribute toward improving participation in cervical cancer screening by advising eligible women to screen and providing health education addressing negative attitudes toward screening.

Low erythrocyte folate levels and increased risk of invasive cervical cancer in Chinese women

To investigate the relationship between erythrocyte folate levels and cervical lesions. Using a case-control method, patients with cervical lesions from September 2021 to February 2022 in the Department of Obstetrics and Gynecology, Jiangnan University Hospital were selected as study subjects. After cervical biopsy, 40 cases of cervical intraepithelial neoplasia (CIN) CIN3 and 65 cases of cervical cancer as case group. The normal population of 120 cases attending the same period served as the control group. A competitive model was used to establish a chemiluminescence immunoassay (CLIA) for human erythrocyte folate. Erythrocyte folate levels of 225 subjects were determined. Serum folate levels were 7.82 ± 3.13, 8.04 ± 3.58, and 7.58 ± 4.30 ng/ml in the control, CIN3, and cervical cancer groups, with no statistically significant differences (p=0.959). Erythrocyte folate levels were 307.27 ± 122.95, 306.52 ± 189.77, and 285.42 ± 125.74 ng/ml, respectively, with statistically significant differences (p=0.03). In a population of middle-aged Chinese women, the lower the erythrocyte folate value, the greater the risk of cervical cancer. In addition, serum folate levels were not associated with cervical lesions.

Atypical glandular cells and development of cervical cancer: Population-based cohort study.

The effect of cervical screening on cervical adenocarcinoma has been variable, possibly because the risk associated with the precursor atypical glandular cells (AGC) is not well known. A cohort of all 885 women in the capital region of Sweden with AGC, a concomitant human papillomavirus (HPV) analysis, and a histopathology was followed until 2019. Cumulative incidence proportions of cervical intraepithelial lesion grade 3 or worse (CIN3+) by HPV type was determined by 1-Kaplan-Meier estimates. Hazard ratios (HR) for CIN3+ or for invasive cancer were estimated with Cox regression. After 2 years of follow-up, the cumulative incidence proportions of CIN3+ were 80% (95% confidence interval [CI]: 74-86%), 58% (95% CI: 50-60%) and 10% (95% CI: 5-18%) among HPV16/18 positive, "other HPV" positive and HPV-negative women, respectively. Among the 300 women with HPV16/18 positive AGC, 217 developed CIN3+ of which 35 were invasive cervical cancer. The 2-year cumulative invasive cancer risk for HPV16/18 positive AGC was 17% (95% CI: 12-24%). Primary HPV-screening had a similar yield of CIN3+ as cytology screening, albeit HPV-negative AGC is by design not detected by HPV screening. Among 241 women with HPV-negative AGC, 11 developed CIN3+ mostly after clinically indicated samples. We found no significant risk differences depending on age or sampling indication. The low CIN3+ risk after HPV-negative AGC implies safety of primary HPV screening. The high risk of invasive cervical cancer after HPV16/18 positive AGC implies that management of this finding is a priority in cervical screening.

Abstract PO-255: Cervical cancer prevention and HPV self-sampling awareness and acceptability among women living with HIV: A qualitative investigation from the patients' and providers' perspectives

Abstract Background: Women living with HIV (WLH) bear a disproportionate risk of invasive cervical cancer due to greater incidence and longer persistence of high-risk HPV infection. Emerging strategies that involve women collecting their own cervicovaginal sample as an alternative to traditional office-based HPV screening may be a promising approach to reach women who face several obstacles to timely care, such as WLH. Little is known, however, about the facilitators and barriers to HPV self-sampling uptake that may be unique to this particularly vulnerable population. Purpose: This study describes their knowledge, experiences, and needs regarding cervical cancer screening, specifically HPV self-sampling, and seeks to reconcile it with the views of their providers' who have been proven to have great influences on their patients' decision-making processes. Methods: In this qualitative study, we recruited 10 providers and 39 WLH from the Washington DC metropolitan region to participate in semi-structured interviews and focus group discussions. Emergent themes were assessed using an inductive process, employing an open coding method. Results: Knowledge of cervical cancer and HPV was generally limited among WLH; and as expressed by the providers, was often fueled by proximity to someone affected by cervical cancer or personal experience. Most WLH were not familiar with HPV self-sampling: but despite some of the providers' skepticism, expressed their willingness to try it. While some providers worried that it would be an added burden, the WLH highlighted convenience, ease of use, and affordability as facilitators to the uptake of HPV self-sampling. Conclusions: The experiences identified herein may be used to (1) inform tailored interventions designed to increase cervical cancer prevention among under-screened WLH and (2) guide patient-centered communication strategies to improve engagement, patient satisfaction, quality of life, and health outcomes among vulnerable populations. Citation Format: Daisy Le, Annie Coriolan Ciceron, Min (Jaime) Jeong Jeon, Jose Bordon, Jeanne Jordan, Anne Monroe. Cervical cancer prevention and HPV self-sampling awareness and acceptability among women living with HIV: A qualitative investigation from the patients' and providers' perspectives [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-255.

Understanding barriers to access and utilization of cervical cancer screening services among women living with HIV in Kenya and Uganda: a cross-sectional study

INTRODUCTION: Invasive cervical cancer (ICC) is preventable and curable. However, it is the fourth leading cause of cancer mortality among women globally, especially in low- and middle-income countries. Whereas studies reveal the existence of ICC pre-cancerous lesion screening services in Kenya and Uganda, uptake of these services remains low, highlighting the existence of unidentified barriers. This study explored factors that impede access and utilization of pre-cancerous cervical screening services among women living with HIV in low resource settings in Uganda and Kenya. METHODS: a cross-sectional study design was used in six selected health facilities in Uganda and Kenya. A systematic cluster randomized sampling was used to select health facilities for women living with HIV who were invited to participate in the interviews. Data collection, coding, categorization, and statistical analysis of quantitative data were employed to rank and correlate among the most critical factors of the Health Belief Model framework. RESULTS: the results showed a negative correlation between the perceived barriers and the risk of accessing the services (-0.95, p-value 0.003) and the perceived severity (-0.95, p-value 0.004), both mean that the barriers for the women are so high that they prefer to delay the visit to the hospital. More, there was a positive correlation between perceived risk for ICC and perceived severity (0.90, p-value 0.01), meaning that a high perception of risk of ICC will increase its severity. Health system barriers to access such as lack of supplies, information, and limited staffing were also revealed. CONCLUSION: the study uncovered the health system barriers affecting ICC screening services at health facilities in Kenya and Uganda and their effects on the perceived illness. Also, it highlights the strengths and challenges while providing recommendations to promote health that includes the most vulnerable women with HIV living in socially deprived areas.

Experiences of cervical cancer screening in HIV-positive women in Zimbabwe.

BackgroundThe primary purpose of screening is to detect individuals in danger of cervical cancer so as to prevent further progression of the disease. Cervical cancer remains a global concern, as it ranks as the fourth most commonly diagnosed female malignancy worldwide. It is the commonest female cancer in Zimbabwe. Women living with human immunodeficiency virus (HIV) have a disproportionate risk of invasive cervical cancer, as they are 2–12 times more likely to develop pre-cancerous lesions. As a result of the increased risk, routine screenings are suggested. Few women are screened for cervical cancer in Zimbabwe.ObjectivesThis study aimed at describing the experiences of screening for cervical cancer and motivation behind screening.MethodThe study employed a qualitative research approach. In-depth one to one interviews and focus group discussions were conducted using interview and focus group guides. The study was conducted at an opportunistic infections clinic in Mpilo Central Hospital. Data analysis was performed by using Giorgi’s descriptive method of data analysis.ResultsThe themes that emerged from data analysis were facilitators to screening for cervical cancer, community awareness of cervical cancer screening, free cervical cancer treatment and more screening centres and integrating cervical cancer screening with HIV care.ConclusionIn-depth understanding of the factors that enable women to take part in cervical cancer screening is essential so that these factors can be strengthened to improve uptake of cervical cancer screening services.

Abstract 22: Screening and Treatment of Female Sex Workers for Cervical Precancers in Cameroon

Abstract Purpose: To prevent cervical cancer among female sex workers (FSWs) who are at high risk of acquiring HPV infections (through occupational exposure) that may progress to invasive cervical cancer (ICC) if not treated. Methods: With funding from a Prevent Cancer Foundation grant and in collaboration with Horizons Femmes, an NGO that provides services to FSWs, the Women's Health Program (WHP) of the Cameroon Baptist Convention Health Services screened FSWs in three large Cameroonian cities with visual inspection with acetic acid and Lugol's iodine (VIA/VILI) enhanced by digital cervicography (DC) and collected vaginal specimens from FSWs aged 30+ years for AmpFire HPV genotyping. Results: Of the 757 FSWs who were screened in August 2020, 510 (67.4%) were aged 30 or over, 308 (60.4%) had one or more high risk HPV types and 47(9.2%) had positive VIA/VILI-DC (34 with ablative eligible lesions and 13 with LEEP eligible lesions). Of the women less than age 30, 27(10.9%) had positive VIA/VILI-DC (92.6% with ablative and 7.4% LEEP eligible lesions). Of the 74 women with ablative and LEEP eligible lesions, 38 (64.4%) and 8 (53.3%) respectively were treated. Of 272 women aged 30+years who were HPV positive but DC negative, 61 (22.4%) were treated with thermal ablation. The WHP continues to follow up on FSWs who need treatment and is analyzing HPV genotypes' frequency and their relation to the VIA/VILI-DC results. Conclusions: With appropriate education and support, FSWs can be screened for cervical cancer and a high proportion of those with positive screening tests can be appropriately treated to reduce their risk of ICC. Citation Format: Simon Manga, Kathleen Nulah, Florence Manjuh, Joel Fokom, Denisse Ngatchou, Edith Welty, Sanjay Shete, Margaret Liang, Thomas Welty. Screening and Treatment of Female Sex Workers for Cervical Precancers in Cameroon [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 22.

Cervical cancer incidence stratified by age in women with HIV compared with the general population in the United States, 2002-2016.

Recommendations for the age of initiating screening for cervical cancer in women with HIV (WWH) in the United States have not changed since 1995 when all women (regardless of immune status) were screened for cervical cancer from the age of onset of sexual activity, which often occurs in adolescence. By 2009, recognizing the lack of benefit as well as harms in screening young women, guidelines were revised to initiate cervical cancer screening for the general population at age 21 years. By comparing cervical cancer incidence in young WWH to that of the general population, we assessed the potential for increasing the recommended age of initiating cervical cancer screening in WWH. We compared age-specific invasive cervical cancer (ICC) rates among WWH to the general population in the United States HIV/AIDS Cancer Match Study. We estimated standardized incidence ratios as the observed number of cervical cancer cases among WWH divided by the expected number, standardized to the general population by age, race/ethnicity, registry, and calendar year. ICC rates among WWH were elevated across all age groups between ages 25 and 54 years (SIR = 3.80; 95% CI 3.48--4.15) but there were zero cases among ages less than 25 years. The absence of ICC among WWH less than 25 years supports initiating cervical cancer screening at age 21 years, rather than adolescence, to prevent cancers in WWH at ages with higher risk of ICC.

Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire.

PURPOSEMajor improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire.METHODSA repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model.RESULTSDuring the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% (P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% (P < 10−4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 (P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]).CONCLUSIONDespite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.

Genomic characterisation of cervical cancer and human papillomavirus: new opportunities for precision medicine.

The study by Sarah Bowden and colleagues 1 Bowden SJ Bodinier B Kalliala I et al. Genetic variants and cervical preinvasive and invasive disease: a genome-wide association study. Lancet Oncol. 2021; 22: 560-569 Summary Full Text Full Text PDF Scopus (7) Google Scholar in The Lancet Oncology is a valuable addition to the understanding of host susceptibility to invasive cervical cancer and its best-established precancerous lesion (cervical intra-epithelial neoplasia grade 3 [CIN3]). The study from the UK Biobank cohort is large: 4005 women with CIN3, 764 with invasive cervical cancer, and 145 545 control women (all born between the late 1930s and 1970). Briefly, the report provides new evidence for a role of PAX8, CLPTM1L, and HLA genes in cervical carcinogenesis pointing to the importance of the disruption of apoptotic and immune functions. The replication of results in an independent dataset from Finland and the addition of a mendelian randomisation study on selected invasive cervical cancer risk factors are major assets. Genetic variation in cervical preinvasive and invasive disease: a genome-wide association studyOur results provide new evidence for the genetic susceptibility to cervical cancer, specifically the PAX8, CLPTM1L, and HLA genes, suggesting disruption in apoptotic and immune function pathways. Future studies integrating host and viral, genetic, and epigenetic variation, could further elucidate complex host–viral interactions. Full-Text PDF Open Access

HPV Vaccine Reduces Risk of Invasive Cervical Cancer

HPV Vaccine Reduces Risk of Invasive Cervical Cancer

HPV Vaccination and the Risk of Invasive Cervical Cancer

(Abstracted from N Engl J Med 2020;383:1340–1348) Because of the well-established association between oncogenic types of human papillomavirus (HPV) and cervical cancer, as of December 2019 a total of 124 countries and territories had implemented HPV vaccination programs. Studies have demonstrated that HPV vaccination protects against HPV infection, genital warts, and high-grade precancerous cervical lesions.

HPV Vaccination and the Risk of Invasive Cervical Cancer

BackgroundThe efficacy and effectiveness of the quadrivalent human papillomavirus (HPV) vaccine in preventing high-grade cervical lesions have been shown. However, data to inform the relationship between quadrivalent HPV vaccination and the subsequent risk of invasive cervical cancer are lacking.MethodsWe used nationwide Swedish demographic and health registers to follow an open population of 1,672,983 girls and women who were 10 to 30 years of age from 2006 through 2017. We assessed the association between HPV vaccination and the risk of invasive cervical cancer, controlling for age at follow-up, calendar year, county of residence, and parental characteristics, including education, household income, mother’s country of birth, and maternal disease history.ResultsDuring the study period, we evaluated girls and women for cervical cancer until their 31st birthday. Cervical cancer was diagnosed in 19 women who had received the quadrivalent HPV vaccine and in 538 women who had not received the vaccine. The cumulative incidence of cervical cancer was 47 cases per 100,000 persons among women who had been vaccinated and 94 cases per 100,000 persons among those who had not been vaccinated. After adjustment for age at follow-up, the incidence rate ratio for the comparison of the vaccinated population with the unvaccinated population was 0.51 (95% confidence interval [CI], 0.32 to 0.82). After additional adjustment for other covariates, the incidence rate ratio was 0.37 (95% CI, 0.21 to 0.57). After adjustment for all covariates, the incidence rate ratio was 0.12 (95% CI, 0.00 to 0.34) among women who had been vaccinated before the age of 17 years and 0.47 (95% CI, 0.27 to 0.75) among women who had been vaccinated at the age of 17 to 30 years.ConclusionsAmong Swedish girls and women 10 to 30 years old, quadrivalent HPV vaccination was associated with a substantially reduced risk of invasive cervical cancer at the population level. (Funded by the Swedish Foundation for Strategic Research and others.)

Cervical Cancer Screening Uptake and Associated Factors among HIV-Positive Women in Ethiopia: A Systematic Review and Meta-Analysis.

Background Women living with human immunodeficiency virus (HIV) are more likely to develop an increased risk of invasive cervical cancer. Morbidity and mortality due to cervical cancer could be reduced with early detection through cervical screening. Though uptake of cervical screening was investigated in Ethiopia, inconsistent findings were reported. Therefore, this systematic review and meta-analysis was designed to estimate the pooled prevalence of cervical cancer screening uptake among HIV-positive women and its associated factors in Ethiopia. Methods A comprehensive search of PubMed/MEDLINE, Scopus, EMBASE, CINAHL, Google Scholar, Science Direct, and Cochrane Library was conducted. The data were extracted using a standardized data extraction format. Statistical analysis was done using the STATA, version 14, software. The heterogeneity of the studies was assessed using the I2 test. Funnel plots and Egger's test were used to check publication bias. A random effects model was computed to estimate the pooled prevalence of cervical cancer screening uptake. Moreover, pooled odds ratios with 95% confidence intervals were used to determine the association of identified determinant factors with cervical cancer screening uptake. Results A total of 10358 studies were retrieved, and 7 studies were included in the meta-analysis. The pooled prevalence of cervical cancer screening uptake among HIV-positive women in Ethiopia was 18.17% (95% CI : 11.23, 25.10) with exhibited heterogeneity (I2 = 96.6%; p < 0.001). Educational status of women (AOR = 3.50; 95% CI : 1.85, 6.07), knowledge of women on cervical cancer (AOR = 3.26; 95% CI : 2.50, 4.43), and perceived susceptibility (AOR = 3.26; 95% CI : 2.26, 4.26) were significantly associated with cervical cancer screening uptake among HIV-positive women. Conclusion The uptake of cervical cancer screening among HIV-positive women in Ethiopia was low. The findings of this study suggest the need to improve the existing national strategies of cervical cancer screening so as to strengthen reproductive health education and promotion, in addition to providing screening services. Furthermore, cervical screening service should be integrated to the routine care and treatment, so that HIV-positive women can get counseling services in every clinical contact.

Are CIN3 risk or CIN3+ risk measures reliable surrogates for invasive cervical cancer risk?

• Discuss ASCCP guideline. • CIN3 reliable surrogates for cervical cancer? • The Pittsburgh Cervical Cancer Screening Model.

Differences in cervical test coverage by age, socioeconomic status, ethnic origin and municipality type – A nationwide register-based study

An invitational organized cervical cancer screening together with widely spread opportunistic testing has coexisted for decades in Finland. The aim of this study was to examine the coverage of cervical tests by age, socioeconomic status, ethnicity and municipality type within and outside the organized screening program. We had a cohort of women of whom 1,2 million were in the target age range of screening and residing in Finland in 2010–2014. Data on Pap and/or HPV -tests within and outside the screening program were collected from the Mass Screening Registry, the pathology laboratories and the health insurance reimbursement registry and five-year population coverages of tests were reported. The total test coverage was 86.0%; 95% CI, (85.8–86.1), and was notably lower for those with an unknown socioeconomic status and pensioners (68.8%; 95% CI, (67.9–69.6) and 77.1%; 95% CI, (76.5–77.6), respectively) compared to upper-level employers (89.8%; 95% CI, (89.5–90.2)). Coverage was also lower for non-native speaking women (72.4%; 95% CI, (71.8–73.0)) compared to native speakers (86.9%; 95% CI, (86.7–87.0)) and for women living in urban municipalities (85.5%; 95% CI, (85.3–85.7)) compared to semi-urban (87.4%; 95% CI, (87.0–87.8)). Although overall coverage was high, tests within and outside the program seemed to concentrate on women with presumably good access to health services. Tests outside the program were especially common among young women who are at a low risk of invasive cervical cancer. Efforts should be made to reduce excessive opportunistic testing and to increase attendance at the program among hard-to-reach populations.

Differing Age-Specific Cervical Cancer Incidence Between Different Types of Human Papillomavirus: Implications for Predicting the Impact of Elimination Programs.

The elimination of cervical cancer rests on high efficacy of human papillomavirus (HPV) vaccines. The HPV type distribution among cases of invasive cervical cancer (ICC) is used to make predictions about the impact of eliminating different types of HPV, but accumulating evidence of differences in age-specific cancer incidence by HPV type exists. We used one of the largest population-based series of HPV genotyping of ICCs (n = 2,850; Sweden, 2002–2011) to estimate age-specific ICC incidence by HPV type and obtain estimates of the cancer-protective impact of the removal of different HPV types. In the base case, the age-specific ICC incidence had 2 peaks, and the standardized lifetime risk (SLTR, the lifetime number of cases per birth cohort of 100,000 females) for HPV-positive ICC was 651 per 100,000 female births. In the absence of vaccine types HPV 16 and HPV 18, the SLTR for ICC was reduced to 157 per 100,000 female births (24% of HPV-positive SLTR). Elimination of all 9 types that can currently be vaccinated against reduced the remaining SLTR to 47 per 100,000 female births (7%), the remaining ICC incidence only slowly increasing with age. In conclusion, after elimination of vaccine-protected HPV types, very few cases of ICC will be left, especially among fertile, reproductive-age women.