Secondary Prevention Of Cervical Cancer Research Articles

Safety and adherence to self-administered intravaginal 5-fluorouracil cream following cervical intraepithelial neoplasia (CIN) 2/3 treatment among HIV-positive women in Kenya: A phase 1 clinical trial.

To determine the safety, tolerance, and adherence to self-administered intravaginal 5% fluorouracil (5FU) cream as adjuvant therapy following cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) treatment among women living with HIV (WLWH) in Kenya. A Phase I Pilot trial was performed among 12 WLWH in Kenya, aged 18-49 years between March 2023-February 2024 (ClinicalTrial.gov NCT05362955). Participants self-administered 2g of 5FU intravaginally every other week for eight applications. Safety was assessed using a standardized grading scale, and adherence was evaluated using self-report, inspection of used applicators, and weighing of the study drug. The mean age and CD4 count were 43.9 years and 781 cells/mm3, respectively. Seven (58%) had an 8th-grade education or less. All 12 reported at least one grade I adverse event (AE), 1 (8%) reported a grade 2 AE, no grade 3 or 4 AEs were reported. Increased vaginal discharge (n=9, 75%) and irritation (n=5, 42%), with a mean duration of 3.2 and 2.8 days, respectively, were the most commonly reported AEs. Provider-observed AEs included grade 1 cervical erythema and superficial abrasions. All participants tolerated all eight 5FU doses, and 96% adherence was demonstrated. Self-administered 5FU following CIN2/3 treatment among WLWH in Kisumu, Kenya, was safe, tolerable, and associated with high adherence. Randomized trials are needed to investigate whether adjuvant 5FU can improve treatment outcomes or serve as primary cervical precancer treatment in sub-Saharan Africa. A self-administered therapy may be transformative in increasing access to treatment and, hence, secondary prevention of cervical cancer.

CERVICAL CANCER PREVENTION CAMPAIGN IN THE CITY OF CÁCERES, MT

Objective: to promote women's health in the municipality of Cáceres-MT, through clinical consultation and collection of Papanicolau exam. Method: experience report about a joint effort due to "Março Lilás" for the collection of conventional cervical-vaginal cytopathological examination in March 2023. Results: 53 women between the ages of 18 and 55 participated in the study. Health education lectures were held before the preventive examination, through which topics such as early diagnosis and prevention of cervical cancer were discussed. Conclusion: through the action, the women assisted had access to secondary prevention of cervical cancer, demonstrating the importance of collective actions in health for the early screening of potential cases of the disease.

Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana.

Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana. A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores. Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students. Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.

Rates of Primary and Secondary Prevention of Cervical Cancer: A Study in a Province in the South of Italy.

In Italy, cervical cancer represents the fifth most prevalent cancer in women under 50 years of age and is one of the most commonly detected lesions globally. Given the developing burden of the disease and the availability of both primary and secondary prevention measures, their accurate surveillance is of paramount importance. The aim of this study was to evaluate the trends in cervical cancer screening adherence in the period between 2020 and 2022, as well as to evaluate positive tests, identifying the most frequently associated genotypes and the vaccination coverage. The study sample was made up of 6880 women from the health district of Messina. We highlighted that there was a high proportion of positive results in the investigated period, with a high prevalence of HSIL. Moreover, HPV vaccination coverage was clearly inadequate, as was adherence to screening, both far away from WHO goals. This finding is probably linked to inadequate communication and awareness of the issue in the population and to the lack of data relating to tests carried out privately. In accordance with existing data in the literature, the introduction of the HPV-DNA test in Sicily made it possible to identify women positive for the genotypes most frequently involved in the etiopathogenesis of neoplastic lesions (genotypes 16 and 18), as well as for those in the "others" category, which should be investigated because some of them could have an impact on carcinogenicity and, for this reason, a future vaccine including them could represent a new prevention weapon.

P16/Ki67 dual stain triage versus cytology in primary human papillomavirus-based cervical cancer screening with limited genotyping.

The introduction of primary human papillomavirus (HPV) cervical cancer screening requires the implementation of an appropriate triage strategy that will be effective in detecting high-grade cervical disease without losing diagnostic specificity. From the 30.066 screening tests results, a total of 1086 with available high-risk human papillomavirus (HRHPV) with limited genotyping, cytology, and p16/Ki67 dual-stain were selected. Two triage strategies for primary HPV screening were analyzed retrospectively based on the study group. Performance characteristics for p16/Ki67 and cytology triage in the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+) were calculated, detected in colposcopic biopsy. In HPV16/18-positive cases, primary HPV with p16/Ki67 triage was significantly more specific than cytology (53.1%/16.8% for CIN2+; p < 0.0001; 45.9%/17.0% for CIN3+; p < 0.0001), with yielded sensitivity (95.7%/84.8% for CIN2+; p = 0.0955; 100.0%/87.5% for CIN3+; p = 0.0832). In other HRHPV-positive cases (N16/N18), p16/Ki67 triage was also significantly higher specific (51.3%/15.3% for CIN2+; p < 0.0001; 44.5%/16.5% for CIN3+; p < 0.0001), with sensitivity (92.3%/74.4% for CIN2+; p = 0.0522; 90.9%/81.8% for CIN3+; p = 0.5637). Diagnostic predictive values were significantly higher for p16/Ki67 triage with the highest PPV in HPV16/18-positive cases for CIN2+ (45.4%; 95% confidence interval [CI]: 35.2-55.8; p < 0.0001) and very high NPV in all HPV-positive cases regardless of detected genotype (96.3%-100.0%). The risk (1-NPV) for CIN3+ in HRHPV16/18-positive/p16/Ki67-negative women was 0.0%. Superior diagnostic performance compared to cytology for detecting cervical cancer precursors indicates that p16/Ki67 dual-immunostain may be a highly effective tool of triage in primary HPV screening with limited HPV 16/18 genotyping in secondary cervical cancer prevention.

DNA methylation as a triage marker for colposcopy referral in HPV-based cervical cancer screening: a systematic review and meta-analysis

BackgroundScreening plays a key role in secondary prevention of cervical cancer. High-risk human papillomavirus (hrHPV) testing, a highly sensitive test but with limited specificity, has become the gold standard frontline for screening programs. Thus, the importance of effective triage strategies, including DNA methylation markers, has been emphasized. Despite the potential reported in individual studies, methylation markers still require validation before being recommended for clinical practice. This systematic review and meta-analysis aimed to evaluate the performance of DNA methylation-based biomarkers for detecting high-grade intraepithelial lesions (HSIL) in hrHPV-positive women.MethodsHence, PubMed, Scopus, and Cochrane databases were searched for studies that assessed methylation in hrHPV-positive women in cervical scrapes. Histologically confirmed HSIL was used as endpoint and QUADAS-2 tool enabled assessment of study quality. A bivariate random-effect model was employed to pool the estimated sensitivity and specificity as well as positive (PPV) and negative (NPV) predictive values.ResultsTwenty-three studies were included in this meta-analysis, from which cohort and referral population-based studies corresponded to nearly 65%. Most of the women analyzed were Dutch, and CADM1, FAM19A4, MAL, and miR124-2 were the most studied genes. Pooled sensitivity and specificity were 0.68 (CI 95% 0.63–0.72) and 0.75 (CI 95% 0.71–0.80) for cervical intraepithelial neoplasia (CIN) 2+ detection, respectively. For CIN3+ detection, pooled sensitivity and specificity were 0.78 (CI 95% 0.74–0.82) and 0.74 (CI 95% 0.69–0.78), respectively. For pooled prevalence, PPV for CIN2+ and CIN3+ detection were 0.514 and 0.392, respectively. Furthermore, NPV for CIN2+ and CIN3+ detection were 0.857 and 0.938, respectively.ConclusionsThis meta-analysis confirmed the great potential of DNA methylation-based biomarkers as triage tool for hrHPV-positive women in cervical cancer screening. Standardization and improved validation are, however, required. Nevertheless, these markers might represent an excellent alternative to cytology and genotyping for colposcopy referral of hrHPV-positive women, allowing for more cost-effective screening programs.

Epidemiological features of the incidence of cervical intraepithelial neoplasia in the modern megapolis

Background. Information on the incidence of cervical intraepithelial neoplasia (CIN) is relevant for planning and evaluating the effectiveness of medical care at the stage of secondary prevention of cervical cancer. Aim. To analyze the incidence of CIN and benign diseases of the cervix: erosion and ectropion, leukoplakia, polyp, according to medical organizations in Yekaterinburg in 2013–2019. Materials and methods. A descriptive epidemiological study of the incidence of cervical pathology in the population of women in Yekaterinburg in 2013–2019 was conducted. The forms of Federal Statistical Observation No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”, in terms of erosion and ectropion, and data from the city’s women’s consultations on the number of cases of CIN, leukoplakia and cervical polyp were examined. Information on the number of female population of the city from Sverdlovskstat was used. Results. The primary incidence of CIN increased throughout the follow-up period. The indicator increased by 1.7 times compared to 2013 (p &lt; 0.001) in 2016, it had a maximum value in 2019 – 215.5 per 100 thousand women and was 3.2 times more than in 2013 (p &lt; 0.001). The dynamics of the primary incidence of other types of cervical pathology: ectropion, leukoplakia and cervical polyp, was characterized by the absence of significant changes (p &gt; 0.05) in 2013–2019. The increase in the overall incidence of CIN was registered from 2014 to 2019 in comparison with 2013 (p &lt; 0.001). The indicator of the overall incidence of CIN in 2019 was 2.1 times higher than in 2013 (p &lt; 0.001). Conclusions. The growth of primary and total incidence of CIN in the population of Yekaterinburg women noted since the beginning of the XXI century continued in 2013–2019. The primary incidence rate of CIN had the maximum value in 2019. The increase in the incidence of CIN is associated with the natural spread of the disease, accessibility and improvement in the quality of medical care.

ASSESSMENT OF AWARENESS AND RISK FACTORS FOR CERVICAL CANCER AMONG YOUNG WOMEN IN ALMATY

Relevance: Currently, in the world, including Kazakhstan, the increasing number of new cervical cancer cases among women of reproductive age is a socio-demographic problem. The increase in cervical cancer incidence among young women, the high prevalence of human papillomavirus (HPV) infection among young sexually active women, the lack of screening programs for the early detection of cervical cancer in young women, the need to take urgent measures to increase awareness of young women about risk factors for cervical cancer and methods of prevention and determined the relevance of this study.&#x0D; The study aimed to estimate the awareness, identify risk factors for cervical cancer, and assess the state of reproductive health of young women of Almaty by questioning.&#x0D; Methods: The article presents an analytical study of the intermediate results of a survey of young women aged 18 to 32 years and living in Almaty. Participants received full information on the upcoming survey. The questionnaire collected information on socio-demographic data, awareness of cervical cancer prevention, and women’s gynecological history. The questionnaire contained 30 questions in total and took 10 minutes to complete.&#x0D; Results: Among young women in Almaty, low awareness of primary and secondary prevention of cervical cancer was revealed in all age groups. The most common risk factors for cervical cancer among young women in Almaty were an early onset of sexual activity, smoking, and hormonal contraceptive uptake.&#x0D; Conclusion: The survey showed the problem of low awareness of girls about cervical cancer and the risk factors for developing cervical cancer. Based on these data, we can state the need for educational work on these issues among young people.

ASSESSMENT OF AWARENESS AND RISK FACTORS FOR CERVICAL CANCER AMONG YOUNG WOMEN IN ALMATY

Relevance: Currently, in the world, including Kazakhstan, the increasing number of new cervical cancer cases among women of reproductive age is a socio-demographic problem. The increase in cervical cancer incidence among young women, the high prevalence of human papillomavirus (HPV) infection among young sexually active women, the lack of screening programs for the early detection of cervical cancer in young women, the need to take urgent measures to increase awareness of young women about risk factors for cervical cancer and methods of prevention and determined the relevance of this study.&#x0D; The study aimed to estimate the awareness, identify risk factors for cervical cancer, and assess the state of reproductive health of young women of Almaty by questioning.&#x0D; Methods: The article presents an analytical study of the intermediate results of a survey of young women aged 18 to 32 years and living in Almaty. Participants received full information on the upcoming survey. The questionnaire collected information on socio-demographic data, awareness of cervical cancer prevention, and women’s gynecological history. The questionnaire contained 30 questions in total and took 10 minutes to complete.&#x0D; Results: Among young women in Almaty, low awareness of primary and secondary prevention of cervical cancer was revealed in all age groups. The most common risk factors for cervical cancer among young women in Almaty were an early onset of sexual activity, smoking, and hormonal contraceptive uptake.&#x0D; Conclusion: The survey showed the problem of low awareness of girls about cervical cancer and the risk factors for developing cervical cancer. Based on these data, we can state the need for educational work on these issues among young people.

Maximizing the cost-effectiveness of cervical screening in the context of routine HPV vaccination by optimizing screening strategies with respect to vaccine uptake: a modeling analysis

BackgroundRegarding primary and secondary cervical cancer prevention, the World Health Organization proposed the cervical cancer elimination strategy that requires countries to achieve 90% uptake of human papillomavirus (HPV) vaccines and 70% screening uptake. The optimal cervical screening strategy is likely different for unvaccinated and vaccinated cohorts upon national HPV immunization. However, health authorities typically only provide a one-size-fits-all recommendation for the general population. We aimed to evaluate the cost-effectiveness for determining the optimal screening strategies for vaccinated and unvaccinated cohorts.MethodsWe considered the women population in Hong Kong which has a unique HPV infection and cervical cancer epidemiology compared to other regions in China and Asia. We used mathematical models which comprise a deterministic age-structured compartmental dynamic component and a stochastic individual-based cohort component to evaluate the cost-effectiveness of screening strategies for cervical screening. Following the recommendations in local guidelines in Hong Kong, we considered strategies that involved cytology, HPV testing, or co-testing as primary cervical screening. We also explored the impacts of adopting alternative de-intensified strategies for vaccinated cohorts. The 3-year cytology screening was used as the base comparator while no screening was also considered for vaccinated cohorts. Women’s lifetime life years, quality-adjusted life years, and costs of screening and treatment were estimated from the societal perspective based on the year 2022 and were discounted by 3% annually. Incremental cost-effectiveness ratios (ICERs) were compared to a willingness to pay (WTP) threshold of one gross domestic product per capita (US $47,792). Probabilistic and one-way sensitivity analyses were conducted.ResultsAmong unvaccinated cohorts, the strategy that adds reflex HPV to triage mild cytology abnormality generated more life years saved than cytology-only screening and could be a cost-effective alternative. Among vaccinated cohorts, when vaccine uptake was 85% (based on the uptake in 2022), all guideline-based strategies (including the cytology-only screening) had ICERs above the WTP threshold when compared with no screening if the vaccine-induced protection duration was 20 years or longer. Under the same conditions, HPV testing with genotyping triage had ICERs (compared with no screening) below the WTP threshold if the routine screening interval was lengthened to 10 and 15 years or screening was initiated at ages 30 and 35 years.ConclusionsHPV testing is a cost-effective alternative to cytology for vaccinated cohorts, and the associated optimal screening frequency depends on vaccine uptake. Health authorities should optimize screening recommendations by accounting for population vaccine uptake.

Screen-and-Treat Approach in Secondary Prevention of Cervical Cancer among HIV-Infected Women in Faith Alive Hospital, Jos Nigeria

Screen-and-Treat Approach in Secondary Prevention of Cervical Cancer among HIV-Infected Women in Faith Alive Hospital, Jos Nigeria

The incidence of cervical intraepithelial neoplasia and its correlation with the results of histopathological examination in the female population of the Podlaskie Voivodeship

&lt;br&gt;Introduction: Cervical cancer was the seventh most common malignant tumor among women in the Podlaskie Voivodeship in 2016. The development of this cancer is preceded by the occurrence of cervical intraepithelial neoplasia (CIN). Pap smear is still the basic method of secondary prevention of cervical cancer. If the result of the Pap test is positive, further diagnosis is necessary (colposcopy, histopathological examination).&lt;/br&gt; &lt;br&gt;Aim: The aim of the study was to assess the incidence of intraepithelial cervical lesions and its correlation with the results of histopathological examination in the female population of the Podlaskie Voivodeship.&lt;/br&gt; &lt;br&gt;Material and methods: 51,136 Pap smear tests were analyzed (retrospectively). The tests were performed in the Podlaskie Voivodeship from January 2012 to December 2019. Of this group, 134 patients had a histopathological examination. The results of both studies were compared.&lt;/br&gt; &lt;br&gt;Results: Among the cytological tests performed in private offices, incorrect results accounted for 1.35%. The value is two times lower than in the case of tests carried out in the prevention program in Podlaskie Voivodeship. The results were consistent in 77% of patients diagnosed with HSIL and in 35% of patients diagnosed with LSIL.&lt;/br&gt; &lt;br&gt;Conclusions: The obtained congruence of cytological and histopathological results is comparable to the data in the literature. The creation of a central registry of pap smears would be helpful in the quality monitoring and the number of abnormal results.&lt;/br&gt;

Mobilizing stakeholders to drive the cervical cancer elimination agenda in Kenya: The national cervical cancer stakeholders' forum 2022.

Kenya is among the nineteen countries in Sub-Saharan Africa with the highest burden of cervical cancer globally. The high burden of cervical cancer in developing countries reflects the absence of effective cervical cancer prevention programs with limited resources invested to provide comprehensive services. We aimed to engage stakeholders in a structured consultative forum, to gain insights and forge effective partnerships to drive the cervical cancer elimination agenda in Kenya. The National Cervical Cancer Stakeholders Consultative Forum was organized as a part of activities to commemorate the National Cervical Cancer Awareness Month on 19th January 2022 in Nairobi, Kenya. The overall goal of the meeting was to provide a forum to sensitize stakeholders on the National Cervical Cancer Prevention and Control Program (NCCP) with a view to strengthen partnerships, increase coordination for improved service delivery and to provide a forum for resource mobilisation and alignment of key stakeholders towards elimination of cervical cancer in Kenya. Nominal group technique was adopted for structured discussions, and the findings analysed to derive key themes. Key challenges to primary and secondary prevention of cervical cancer were identified as low awareness, stigma and misinformation, high unmet need for treatment of early lesions, few health care providers with capacity to screen and treat, inadequate supplies, inefficient health information systems and poor referral pathways. Championing integration of cervical cancer screening and treatment services into routine health programs, strengthening policy implementation and robust monitoring and evaluation were identified as critical interventions. The National Cervical Cancer Stakeholders Forum 2022 provided insights for enabling Kenya to progress on the 2030 elimination targets. Such forums can be useful in bringing all actors together to evaluate achievements and identify opportunities for more effective national cervical cancer prevention and control programs.

Scientific evidence for the effectiveness of primary and secondary (screening) prevention of cervical cancer

The evidence of HPV vaccination effectiveness is overwhelming. The randomized clinical trials showed that all three vaccines currently in use, bivalent (CERVARIX), quadrivalent (GARDASIL) and nanvalent (GARDASIL9) effectively prevent HPV infection, cervical intraepithelial neoplasia (CIN) 1–3 and invasive cervical cancer. The results of clinical trials have been confirmed by real life evidence – population data from countries were vaccination of 12–13 girls started in 2006–08. HPV vaccination is safe. This is proven by long term follow up of the cohorts of vaccinated women. In 2020 the WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. The document includes the interim targets for 2030: vaccination of 90% of girls by 15 years; HPV testing based screening at age 35 and 45 of 70% of women; treatment of 90% of women with screening detected cervical pathology; treatment of 90% of women with precancerous lesions and cancer of the cervix. Under elimination of cervical cancer WHO means the decrease in its incidence down to 4 cases per 100 000 population. This goal will be achieved by 2030 in countries that started HPV vaccination 15 years ago in 2006–2007.In Russia incidence of cervical cancer is on increase since 1993 from 10, 2 to 16, 1 in 2018. It is predicted that the increase will continue and in 2030 the age standardized incidence rate will reach 20 per 100 000 women. HPV vaccination and HPV test based screening will change the direction of the trend from increase to decrease and save several hundreds of lives

The changing role for extended resections in an era of advanced radiotherapy techniques and novel therapies in gynaecological malignancy

Pelvic exenteration, first described in 1948 and subsequently refined, may be offered as a last hope of cure to patients with recurrent or locally advanced pelvic tumours, where radiotherapy is not an option. It is a complex, morbid, ultra-radical procedure involving en-bloc resection of the female reproductive organs, lower urinary tract, and a portion of the rectosigmoid.This article discusses the evolution of and current indications for pelvic exenteration in gynaecologic oncology as well as the reasons for its decline: primary and secondary prevention of cervical cancer (the recurrence of which is the most common indication for exenteration); improvements in treatment of cervical, endometrial, vaginal and vulvar cancer in the primary and recurrent setting; and the advent of novel therapies.

The possibilities of opportunistic cervical screening in the assisted reproductive technology clinic

Secondary prevention of cervical cancer in the conditions of opportunistic cervical screening by co-testing in 5618 women over 30 years of age allowed to identify a high-risk group of cervical cancer for further examination using viral load assessment, immunocytochemical determination of the level of cancer proteins p16INK4a and Ki-67, extended video colposcopy and cervical biopsy with histological examination of surgical material. The obtained data demonstrated the expediency of changing the testing strategy by integrating the methods tested in the framework of opportunistic screening into the nationwide population screening program for cervical cancer.

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update.

To update resource-stratified, evidence-based recommendations on secondary prevention of cervical cancer globally. American Society of Clinical Oncology convened a multidisciplinary, multinational Expert Panel to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, formal consensus-based process, and modified ADAPTE process to adapt existing guidelines was conducted. Other experts participated in formal consensus. This guideline update reflects changes in evidence since the previous update. Five existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies vary by the following setting: maximal: age 25-65 years, every 5 years; enhanced: age 30-65 years, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: age 30-49 years, every 10 years; basic: age 30-49 years, one to three times per lifetime. For basic settings, visual assessment is used to determine treatment eligibility; in other settings, genotyping with cytology or cytology alone is used to determine treatment. For basic settings, treatment is recommended if abnormal triage results are obtained; in other settings, abnormal triage results followed by colposcopy is recommended. For basic settings, treatment options are thermal ablation or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure or ablation is recommended; with a 12-month follow-up in all settings. Women who are HIV-positive should be screened with HPV testing after diagnosis, twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information is available at www.asco.org/resource-stratified-guidelines.

Impact of primary care provider teaching on knowledge of colposcopy for women newly diagnosed with abnormal cervical cytology (422)

Impact of primary care provider teaching on knowledge of colposcopy for women newly diagnosed with abnormal cervical cytology (422)

Secondary prevention and treatment of cervical cancer - update from Poland

Introduction. Cervical cancer is the 4th most common cancer in terms of incidence and mortality in women worldwide. The aim of the study was to investigate and analyze the effects of Poland’s publicly funded cervical cancer screening and treatment programs. Material and methods. The study analyzed the financial and epidemiological data provided by the Polish National Health Fund and the Polish National Cancer Registry on the prevention and treatment of cervical cancer in Poland in 2011–2017. Results. Our study identified a systematic reduction in the number of patients undergoing cervical cytology. Despite high levels of financial expenditure, no correlation was found between the total cost of benefits in PLN million (W = 0.911; p = 0.404) and mortality expressed by the standardized coefficient (W = 0.884; p = 0.243). Conclusions. Despite decreasing mortality rates in cases of cervical cancer in Poland, the organization and delivery of prevention and treatment programs should be considered insufficient.

HPV test kao primarni test skrininga u prevenciji cervikalnog karcinoma u Republici Hrvatskoj

The knowledge that persistent infection with the human papillomavirus (HPV) is a necessary cause of cervical cancer has led to changes in strategies for the prevention and early detection of this cancer, with aim to eradicate it. Primary prevention through the use of vaccines that prevent HPV infection has been implemented since 2006, while secondary prevention of cervical cancer has been significantly improved by the introduction of the HPV test, either as the only method of primary screening or in combination with the Pap test. Screening based on the Pap smear has been unquestionably successful in reducing incidence and mortality in the last century. More recently, there have been gradual changes in the use of the HPV test, from its use as a reflex test after the detection of mild cytological abnormalities, through co-testing, to the use of the HPV test as the only test in primary screening thanks to the evidence gathered from the use of large, randomized research and meta-analysis. The advantages of using the HPV test over the Pap test include a higher sensitivity in detecting premalignant lesions, a higher negative predictive value of the test, and a safe extension of the time interval between screenings. However, the introduction of the HPV test as a primary screening test is not so simple and requires strict testing quality control and elaborate guidelines to ensure an optimal strategy and prevent additional burden on the healthcare system. This review presents the national cervical cancer screening program in the Republic of Croatia, the problems that prevented the start of a pilot project in one Croatian county selected for the introduction of the HPV test as a primary screening test in the prevention of cervical carcinoma, and the tasks ahead in the next period which would ensure the smooth implementation of the pilot project and implement the HPV test as the primary screening test in Croatia. Based on the results of the pilot project, it is necessary to precisely define: the age at which primary HPV testing should start and stop in the cervical cancer screening program, the examination interval after a negative primary HPV test, further procedures with women with a positive primary HPV test, the procedures for conducting reflex cytological testing and further treatment of the patient in accordance with the findings, the possibilities and justification of introducing self-sampling as part of the cervical cancer screening program based on the HPV test as the primary screening test, and finally the type of HPV test that is most suitable for the primary screening in Croatia.