Screening Tool For Cervical Cancer Research Articles

Perceptions and Acceptability of Self-Testing for Human Papillomavirus Among Women Presenting for Cervical Cancer Screening [27

INTRODUCTION: Current literature supports the use of human papillomavirus (HPV) testing as the primary triage for Pap screening or referral for colposcopy for women age 25–65 years. Self-collected HPV specimens have shown high concordance with clinician-collected specimens. The purpose of this substudy was to investigate the acceptability of HPV self-collection among women presenting for cervical cancer screening. METHODS: Women age 25–65 years coming for cervical cancer screening to Kaiser Permanente, Santa Clara from March–April 2014 were recruited to participate. Those meeting inclusion criteria and with signed informed consent self-collected HPV vaginal swab samples and completed a brief questionnaire regarding their personal experience and perceptions of HPV self-collection. Means or medians and percentages or proportions were used to describe the population and stratify the responses according to age, race, body mass index (BMI, calculated as weight (kg)/[height (m)]2), and household income. RESULTS: The majority of the 303 women completing the questionnaire were non-Hispanic white (36%), Asian (34%), or Hispanic (20%). Mean age was 42 years, and mean BMI 27. Most women (90%) reported no pain or discomfort and felt safe (85%) and comfortable (78%) performing self-collection at home as a first step in cervical cancer screening. For 87% of the women, HPV self-collection was the preferred method. CONCLUSION: As a primary tool for cervical cancer screening, HPV self-collection appears to be highly accepted and the preferred method for HPV collection among Kaiser Permanente Santa Clara patients age 25–65 years requiring cervical cancer screening. Further studies are needed to assess the acceptability, feasibility, and reliability of self-collected HPV specimens in a more demographically diverse population and in the home setting.

Human papillomavirus (HPV) types 16 and 18 in liquid-based cervical cytology samples.

Human papillomavirus (HPV) DNA testing is replacing cervical cytology as a primary cervical cancer screening tool. The aim of this study was to determine the frequency of occurrence of HPV types 16 and 18 in liquid-based cytology (LBC) cervical samples in our set-up. This study comprised of 302 LBC cervical samples. HPV 16 and HPV 18 were detected by polymerase chain reaction (PCR), and the results were compared between normal (n = 155), inflammatory (n = 99), squamous (n = 37) and glandular abnormalities (n = 11). Of our patient cohort, 73.8 % was ≤40 years old. We found HPV 16 DNA in 91/302 (30.1 %) cases and HPV 18 DNA in 21/302 (6.95 %). HPV types 16 and 18 were detected in 25.8 and 4.5 % cytologically normal samples, respectively. HPV 16 was positive in 29.3 % of inflammatory samples. Squamous cervical abnormalities were more often HPV positive (HPV 16 in 48.6 %; HPV 18 in 29.7 %) than glandular abnormalities (36.4 and 18.2 %, respectively). We found high-risk HPV DNA in more than one third of the tested women. A good number of these HPV-positive cases were negative in cervical cytology.

Awareness and utilization of Papanicoloau smear among health care workers in Maiduguri, Nigeria

Context: Cervical cancer is the leading cause of cancer related deaths among women in developing countries. Lack of awareness and comprehensive cervical cancer screening programmes offered in most developing countries are partly responsible for the high burden of disease. In developed countries, routine use of Papanicoloau smear, in part, has led to a decline in cervical cancer incidence and mortality. Objective: To determine the level of awareness, utilisation and factors associated with awareness of Pap smear test as a tool for cervical cancer screening among health care workers (HCW) in Maiduguri north-eastern part of Nigeria. Subjects and Methods: This was a cross-sectional questionnaire based study conducted among 150 health care workers in Maiduguri, between January and March 2010. Simple descriptive statistics was employed in the analysis of data. Results: A total of 150 participants were recruited for the study. The majority (141) of respondents were aware of Papanicolaou smear and 23.3% of the female respondents had done the test previously. Majority (90.8%) of the men were willing to pay for their spouses to do the screening; some of them (20.0%) were indifferent if their spouses perform the cervical screening without their consent. The major reason given for carrying out the test was for prevention of the disease. The major source of information was the hospital (84.7%). Majority of the women were willing to do the test if offered the opportunity either free (70.6%) or with payment (29.4%). A number of socio-demographic variables played crucial roles in awareness and utilisation of Pap smear. These included higher level of educational status ( P = 0.000) of the respondents, increased maternal age ( P = 0.001) and high parity ( P = 0.003). Conclusion: There is poor utilisation of Pap smear among HCW despite high level of awareness and availability of screening services. A number of socio-demographic variables play crucial roles in awareness of Pap smear. The reasons for the low utilisation among health care workers, who are the custodians of health care need to be investigated to improve their utilisation of Pap smear.

Vaginal Self-Sampling for Human Papillomavirus Infection as a Primary Cervical Cancer Screening Tool in a Haitian Population

Vaginal Self-Sampling for Human Papillomavirus Infection as a Primary Cervical Cancer Screening Tool in a Haitian Population

A population-based observational study comparing Cervista and Hybrid Capture 2 methods: improved relative specificity of the Cervista assay by increasing its cut-off.

BackgroundHigh-risk human papillomavirus (HR HPV) testing has been shown to be a valuable tool in cervical cancer screening for the detection of cervical pre-cancer and cancer.MethodsWe report a purely observational study evaluating HR HPV prevalences in residual liquid-based cytology (LBC) samples using both the Cervista™ HPV HR Test and the Digene Hybrid Capture 2 High-Risk HPV DNA Test (HC2) in a sample of 1,741 women aged ≥30 years of a German routine screening population of 13,372 women. Test characteristics were calculated and a novel method for measuring test performances was applied by calculating ratios of sensitivity or specificity.ResultsThe overall agreement of both tests for detection of HR HPV was excellent (κ = 0.8). Relative sensitivities for the detection of histologically confirmed severe cervical intraepithelial dysplasia (CIN3+) were similar for both HPV-tests, which was confirmed by the ratio analysis. However, discrepancy analysis between the Cervista HPV HR test and HC2 revealed a high false positive rate of the Cervista HPV HR test in the cytology normal category.ConclusionsPerformance of the Cervista HPV test in cervical specimens with abnormal cytology is comparable to HC2 as both tests were highly sensitive and specific for the detection of high grade cervical disease. We also demonstrate evidence that modification of the cut-off values drastically reduces the false positive rate in the cytology normal category without affecting the detection of CIN3+, which ultimately improved specificity of the Cervista HPV HR assay.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0674-1) contains supplementary material, which is available to authorized users.

Women's intentions to self-collect samples for human papillomavirus testing in an organized cervical cancer screening program.

BackgroundMounting evidence affirms HPV testing as an effective cervical cancer screening tool, and many organized screening programs are considering adopting it as primary testing. HPV self-collection has comparable sensitivity to clinician collected specimens and is considered a feasible option in hard-to-reach women. We explored women’s intentions to HPV self-collect for cervical cancer screening from a cohort participating in a Canadian randomized controlled cervical cancer screening trial.MethodsWomen aged 25–65 were invited to complete an online survey assessing intentions to be screened with HPV testing instead of the Pap smear. The survey was based in the Theory of Planned Behaviour and questions were included to assess women’s intentions to self-collect for HPV. Demographic characteristics of women who intended to self-collect were compared with those who did not. Demographic and scale variables achieving a p-value <0.1 in the univariate and bivariate analyses were included in the stepwise logistic regression model. The final model was created to predict factors associated with women’s intentions to self-collect an HPV specimen for cervical cancer. Odds ratios were calculated with 95% confidence intervals to identify variables associated with a woman’s intention to self-collect for cervical cancer screening.ResultsThe overall survey response rate was 63.8% (981/1538) with 447 (45.6%) reporting they intended to self-collect, versus 534 (54.4%) reporting they did not. In the univariate analysis, women with more than high school education were more likely to self-collect. Women who intended to receive HPV testing versus the Pap smear were 1.94 times as likely to be in favour of self-collection and those who intended to self-collect had significantly higher attitudinal scores towards HPV self-collection. The adjusted odds ratio and 95% confidence interval from the multivariate analysis demonstrated attitude towards self-collection was the only significant variable predicting a woman’s intention to self-collect (OR 1.25; 95% CI: 1.22, 1.29).ConclusionsThe primary predictor of a woman’s intention to HPV self-collect for cervical cancer screening was her attitude towards the procedure. From a program planning perspective, these results indicate that education and awareness may be significant contributing factors to improving acceptance of self-collection and subsequently, improving screening attendance rates.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1060) contains supplementary material, which is available to authorized users.

HPV Test Recommended as Primary Screening Tool

Abstract An advisory panel of the U.S. Food and Drug Administration unanimously recommended approval of Roche's Cobas human papillomavirus DNA test for use as a primary cervical cancer screening tool for women ages 25 and older. If approved, it could be used in lieu of traditional Pap testing.

Colposcopic evaluation of cervical lesions: a prospective study

Background: The present study was undertaken to evaluate the role of colposcopy as a screening and diagnostic tool for cervical cancer and other cervical lesions in high risk women. Methods: All the women included in the study were subjected to colposcopic examination. Colposcopic findings were compared with cytology and histopathological examination. Accuracy of colposcopic examination was calculated by standard statistical methods. Sensitivity, specificity, Positive Predictive Valve (PPV) and Negative Predictive Valve (NPV) of colposcopic examination was calculated. Results: Three hundred patients underwent colposcopic examination. The overall sensitivity and specificity of colposcopy was 85.85% and 87.65% respectively. Positive predictive value was 75.83% and negative predictive value was 95.38%. The percentage of false negative as well as that of false positive was calculated to be 13.74%. The accuracy of colposcopy was found to be more for high grade lesions as composed to low grade lesions. Conclusions: Colposcopy gives immediate and accurate results and its value as diagnostic modality is undisputed. It should also be considered as a primary screening test for high risk women living in remote areas where women cannot visit the doctor repeatedly as the ideal screening triage cannot be implemented in such situations.

Urine-based human papillomavirus DNA testing as a screening tool for cervical cancer in high-risk women

ObjectiveTo test the hypothesis that self-collected urine could be used to detect high-risk human papillomavirus (HPV) DNA with sensitivity and specificity comparable to those of standard cervical testing. MethodsWomen attending a gynecology clinic for evaluation of abnormal cytology were recruited. Fifty-two participants (21–60years of age) collected urine samples, and clinicians collected cervical brush samples. When appropriate, cervical biopsies were obtained during colposcopy. HPV detection and typing were performed on DNA extracts from each sample, using commercial reagents for L1 consensus polymerase chain reaction (PCR) and type-specific hybridization. HPV 16 viral load was determined by quantitative PCR in HPV 16-positive samples. A diagnostic test analysis was conducted for urine samples. ResultsFifty paired samples were analyzed, with 76% agreement between samples. The 12 discrepant pairs were all urine negative/cervix positive. The most common HPV types detected were 16, 51, 53, and 62. The urine test correctly identified 100% of the uninfected and 65% of the infected patients. ConclusionThe results indicate that HPV DNA detection using urine is less sensitive than cervical sampling in a population with abnormal cytology. Further exploration is warranted to determine clinical utility when other options are unavailable.

Abstract A46: Expression of biomarkers in cervical intraepithelial neoplasia: Potential use screening.

Abstract Background: Persistent infection of high-risk Human papillomavirus (HPV) is recognized as a necessary cause of cervical cancer. Replication and viral integration into the cervix depend on the orderly expression of genes produced by viruses, by inducing the overexpression of multiple molecular proteins or biomarkers. Recently we have identified, 6 genes (CCNB2, CDC20, PRC1, SYCP2, NUSAP1 and CDKN3), which are proposed as universal molecular targets with a sensitivity and specificity close to100%, in cervical cancer. Objective: evaluate the expression of these genes in cervical intraepithelial neoplasia (CIN). Material and method: In this retrospective study we assessed the protein expression of 6 candidates tissue-based biomarkers (CCNB2, CDC20, PRC1, SYCP2, NUSAP1 and CDKN3) in a population based cohort of 200 cervical intraepithelial neoplasia that was collected over the period from 2008 to 2013. The tissue blocks were available and used for tissue microarray (TMA) construction, which included also samples of healthy epithelium. Quantitative RT-PCR was performed to validate expression of genes. Results: The expression of these genes was observed in cervical intraepithelial neoplasia with different pattern shown previously in tumors, but in progression with the advance of the lesion, also shown by IH, evaluated samples, finding a correlation in both methods. Conclusion: These results, may offer an additional strategy to current methods of the PAP, which is of greater use in our population. A test with greater sensitivity and specificity to identify lesions of high grade with more specificity can be a useful tool for cervical cancer screening. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):A46. Citation Format: Ana Maria Espinosa Garcia, Ana Alfaro, Icela Palma, Marco Duran, Jaime Beumen. Expression of biomarkers in cervical intraepithelial neoplasia: Potential use screening. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr A46.

Exploiting Biospectroscopy as A Novel Screening Tool for Cervical Cancer: Towards A Framework to Validate its Accuracy in A Routine Clinical Setting

Biospectroscopy is an emerging field that harnesses the platform of physical sciences with computational analysis in order to shed novel insights on biological questions. An area where this approach seems to have potential is in screening or diagnostic clinical settings, where there is an urgent need for new approaches to objectively interrogate large numbers of samples in an objective fashion with acceptable levels of sensitivity and specificity. This review outlines the benefits of biospectroscopy in screening for precancer lesions of the cervix due to its ability to separate different grades of dysplasia. It evaluates the feasibility of introducing this technique into cervical screening programs on the basis of its ability to identify biomarkers of progression within derived spectra ('biochemical‑cell fingerprints').

New Cervical Cancer Screening Guidelines on Both Sides of the Atlantic

Large population-based trials showed that the human papillomavirus (HPV) DNA test can be even more effective than Pap tests in preventing cervical cancer. Nevertheless, there are still many questions on how to implement HPV testing in screening, and particularly how to manage its lower specificity. In this paper, we compare the recommendations concerning the cervical cancer screening tools proposed by the most influential agencies and scientific societies in the last 3 years. We included six documents that evaluated the use of HPV DNA tests and formulated recommendations: the U.S. Preventive Services Task Force (USPSTF) systematic review and recommendations, the multi-societal USA, Canadian Task Force on Preventive Health Care (CTFPHC), the Dutch Health Council recommendations, and the Italian Health Technology Assessment report. The USPSTF review and the Canadian document concluded that there is no sufficient evidence to recommend HPV as a primary screening test, while the others conclude that HPV tests can be used as the primary screening test in patients starting from 30 years of age. The interval after a negative HPV test is 5 years for all the documents except the Dutch (5-10 year interval). The only relevant difference between recommendations is the role of cytology: co-testing in the USA, triage in Europe. The new European and USA guidelines on cervical cancer screening represent a further step towards protocol harmonisation, even if there are still some differences. This harmonisation was achieved through an evidence-based approach to the introduction of HPV as a primary test and through a general reduction of the intensity of screening protocols.

A study of borderline positive Hybrid Capture 2 tests in the Kaiser Permanente Northern California cervical screening program: Evidence against retesting

Infection with one or more high-risk HPV (hr-HPV) types is a necessary step in the development of cervical cancer, making its detection a useful tool for cervical cancer screening and prevention (Bosch et al., 2002). Hybrid Capture 2 (HC2, Qiagen, Gaithersburg, MD) was the first FDA-approved and is still the most widely used laboratory test for the presence of high-risk HPV DNA as a predictor of who is or is not at risk for cervical cancer and pre-cancer (defined here as cervical intraepithelial neoplasia grade 2 or worse). While HC2 has remarkable sensitivity for cervical intraepithelial neoplasia grade 2 or worse, the transient nature of most hr-HPV infections reduces its specificity as most infections are benign and will resolve without progressing to cervical intraepithelial neoplasia grade 2 or worse. This can be problematic for cervical cancer screening algorithms in which HPV positivity triggers more intensive follow-up; in such algorithms, good specificity is important for reducing the number of costly colposcopic follow-up visits (Cuzick et al., 2008). Although manufacturer specifications indicate a relative light unit (RLU) ratio compared with positive control of 1.0 as the threshold for determining positivity, reclassifying HC2 specimens that are equivocal and fall just above the positive cut-off is one potential way to improve the assay’s specificity (Rijkaart et al., 2010; Rebolj et al., 2011; Sasieni and Castanon, 2011). Some researchers have looked at increasing the RLU cut-off point because HC2 results at this level predict lower risk than higher values (Lorincz et al., 2002). However, equivocal results are not that common and raising the cut-point to 2.0 or 3.0 may only yield a modest improvement in specificity at some cost to sensitivity; i.e., misclassification of women with cervical intraepithelial neoplasia grade 2 or worse lesions whose RLU ratios are equivocal (Rijkaart et al., 2010). Rather than raising the cut-point, a more conservative approach is to repeat the HC2 test on specimens with equivocal results and determine the final test result based on a collective assessment of the test results (Knoepp et al., 2007), however this method requires additional laboratory time and cost to implement, weighing against any savings it yields from reducing the number of colposcopic examinations. In 2001 Kaiser Permanente Northern California added the HC2 assay to its cervical cancer screening program as a triage test for women with a cytologic diagnosis of atypical squamous cells of undetermined significance and, in 2003, as a concurrent test (“cotest”) with cytology for women 30 and older. In the cotesting scheme, women have been managed as follows: 1) women who are HPV-positive with a cytologic diagnosis of atypical squamous cells of undetermined significance, or have more severe (regardless of the HPV test results) are referred for immediate colposcopy; 2) women who test HPV-negative and have cytology of atypical squamous cells of undetermined significance, or who test HPV-positive with negative cytology are rescreened in one year; and 3) if both tests are negative, women are rescreened in three years. For cotests with borderline positive hr-HPV results, interpretation of the repeat test results is used to determine the final hr-HPV test result and hence the need for rescreening visits versus colposcopy. At the time that HC2 was introduced into the Kaiser Permanente Northern California cervical cancer screening algorithm, based on concern over the meaning of borderline-positive HC2-positive results, it was decided that any specimens with borderline or “equivocal” HC2 results, defined as a RLU ratio greater than or equal to 1.0 but less than 3.0, would be re-tested two additional times. The final hr-HPV result was determined by the majority results of the three tests i.e., only one of the two repeats needed to be positive to have the final positive hr-HPV result. To assess the utility of Kaiser Permanente Northern California’s re-testing scheme for equivocal HC2 specimens, HC2 data, cytology results, and histological outcomes (less than cervical intraepithelial neoplasia grade 2, cervical intraepithelial neoplasia grade 2 or worse) were compiled for patients undergoing routine cervical cancer screening at Kaiser Permanente Northern California.

Comparison of single-, double- and triple-combined testing, including Pap test, HPV DNA test and cervicography, as screening methods for the detection of uterine cervical cancer

Cervical cancer is a serious disease that threatens the health of women worldwide. This study compared the sensitivities and false-positive rates of cervical cytology(Pap smear), human papilloma virus(HPV) DNA test, cervicography, first double-combined testing(cervical cytology and HPV DNA test), second double-combined testing(cervical cytology and cervicography) and triple-combined testing(cervical cytology, HPV DNA test and cervicography). The study included 261 patients screened for uterine cervical cancer. All women simultaneously underwent cervical cytology, HPV DNA test and cervicography for uterine cervical cancer screening and colposcopically directed biopsy for diagnostic evaluation. The triple-combined testing was consistently the most sensitive among the cervical screening tests. The second double-combined testing, with a sensitivity rate of 98.1% was more sensitive than the first double-combined test(92.3%). However, cervical cytology was most specific(93.5%) and showed the highest positive predictive value(77.8%). The sensitivity of cervical cytology was markedly improved in combination with HPV DNA test and cervicography. Thus, the triple-combined testing, which improves the high false negativity of cervical cytology, may be an effective tool in uterine cervical cancer screening, pending confirmation of the effectiveness in a mass screening study.

Visual Inspection with Acetic Acid (VIA) Vs Cervical Cytology as Cervical Cancer Screening Tools in South India

Context: With a quarter of all cervical cancers occurring in India, the risk for women to contract this condition is high. The burden remains high because cervical screening programs of adequate scale are lacking. Aims: To compare the performance of visual inspection with acetic acid and cervical cytology in south India. Setting and Design: A cross-sectional study was performed in three villages in one of the south Indian district by recruiting 668 healthy women to undergo VIA and conventional Pap smear examination. Method and Material: Women who had a positive result from any of these tests were subjected to colposcopy and biopsies (if necessary), and women with high-grade cervical intraepithelial neoplasia (CIN) were properly treated. Statistical Analysis: Data was analyzed using statistical software from www.OpenEpi.com Results: Overall test positivity was 21.4% for VIA and 2.24% for Pap smear (LSIL threshold), 1.04% for Pap smear (HSIL threshold). VIA was positive in 70% of the women with CIN 1, 75% of those with CIN 2, 66.66% of women with CIN 3 and in two of two (100%) of women with cancer. Approximately 10% of women with no detectable disease had an abnormal VIA. Conclusions: A combined use of VIA with the Pap test allowed specific detection of cervical abnormalities.

Evaluation of cobas 4800 high-risk HPV test as a tool in cervical cancer screening and cytology triage

To evaluate the feasibility and reliability of cobas 4800 HPV test for cervical cancer screening and cytology referral. cobas 4800 HPV test and hybrid capture 2 (HC-2) were used to detect high risk HPV DNA in 670 specimens of liquid-based cytology collected from three hospitals. The agreement between cobas and HC-2 tests was assessed. HPV PCR detection (HybriBio) and gene sequencing were used for genotyping, and the agreement of HPV16 and 18 genotyped by cobas and HybriBio was evaluated. Histological diagnosis was considered as a gold standard to estimate the sensitivity and specificity of cobas vs. HC-2 in detecting CIN2(+) in cervical lesions. The crude agreement between cobas and HC-2 tests was 89.40%, the Kappa value was 0.778, the positive concordance rate was 86.42%, and the negative concordance rate was 91.36%. The crude agreement rates between cobas and HybriBio on HPV16 and 18 were 88.89% and 94.94%, the Kappa values were 0.777 and 0.753, the positive concordance rates were 98.91% and 100.00%, and the negative concordance rates were 78.41% and 94.44%, respectively. HPV PCR detection (HybriBio) and gene sequencing were considered as adjusted standard: the high risk HPV positive concordance rate was 100%, negative coincidence rate was 94.42%, HPV16 and 18 positive concordance rates were both 100%, and negative concordance rates were 82.35% and 94.44%, respectively. Regarding the detection of CIN2(+), the sensitivity and specificity were 91.07% and 70.97% for cobas, and 93.75% and 71.33% for HC-2, with a non-significant difference between the results of the two tests (P > 0.05). cobas4800 HPV test has good screening sensitivity and specificity in correct detection of HPV16 and 18 and other high-risk HPV virus types.

Intelligent classification of cervical pre-cancerous cells based on the FTIR spectra

Inspired from the great potential of the Fourier-transform infrared (FTIR) spectroscopy as a screening tool for cervical cancer, this paper proposes an intelligent classification of cervical pre-cancerous cells based on the FTIR spectra. It consists of two parts: the extraction of FTIR characteristics and the intelligent classification of the pre-cancerous cells. Peak-corrected area-based features’ extraction (PCABFE) is introduced as a tool for the first part, while the Hybrid Multilayered Perceptron (HMLP) network is employed to classify the cervical pre-cancerous cells according to the Bethesda classification. Correlation test proves the capability of the proposed PCABFE to be as effective as the manual extraction by human experts, while the HMLP network produces a good classification performance with 97.4% of accuracy.

Elements of an Anal Dysplasia Screening Program

The incidence of anal cancer in HIV-infected men who have sex with men (MSM) is highly elevated compared to the general population, as is the incidence of its precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN). MSM in general and other immunocompromised populations are also at higher risk. Treatment of HGAIN may prevent development of cancer, similar to the decrease in cervical cancers that has occurred since the advent of cervical cancer screening programs in women. Cervical cancer screening tools have been adapted and validated for screening, diagnosis, and treatment of anal HGAIN. Anal cancer screening programs have now been available for more than a decade, although they are not yet standards of care. Incorporating screening procedures into practice depends on the available resources in a particular community. This article discusses the procedures for anal cancer screening including cytology, digital anal rectal examinations, high-resolution anoscopy, and biopsy.

Abstract B103: STI clinics as venues for cancer prevention and control among women in Puerto Rico

Abstract Background: Sexually transmitted infections (STIs) clinics have been identified as an important setting for conducting screening programs for cervical cancer. Studies have confirmed that STI patients are at very high risk of yielding abnormal Pap smears and that STI clinics have great potential to carry out cancer screening programs. Despite the fact that these groups of women who attend STI clinics are at higher risk of abnormal cervical cytology, none of the STI clinics in the island offer Pap testing which act as a screening tool for cervical cancer. Study Objectives: To determine the prevalence of compliance of cervical cancer screening among women attending the Centro Latino Americano de Enfermedades de Transmisión Sexual (CLETS) in Puerto Rico and to develop an epidemiological profile of those women who reported not having a Pap smear in the last year. Methods: An ongoing clinic-based cross-sectional study among women 21 years and older attending CLETS for clinical care. A screening of women attending the clinic was performed to determine those who reported to not have had a Pap test in the last year. Women eligible to participate in the study were only those who reported to not have had a (1) Pap test in the last year, (2) being older than 21 years and (3) not being pregnant at the time of the interview. Among these women, a behavioral interview was conducted including sociodemographic, behavioral risk factors (sexual practices), cancer prevention screening practices and self-report of STIs. Results: At the time of this preliminary analysis, 68 participants were screened for participation in the study. Screening interview showed that 65.3% of the women attending the clinic have not had a Pap in the last year. The vast majority (75.0%) was interested in participating in the study; however 37.3% did not meet the inclusion criteria and were not qualified for the study. Among those who qualified (n=32), all of them agreed to participate in the study, indicating a 100% participation rate. The mean age of the study participants was (36±12.6) years old. Sociodemographic characteristics indicate that the majority of the women (76.6%) reported having an annual income less than $10,000, almost half (53.1%) of the sample reported to have not graduated from high school and 68.7% reported being currently unemployed. The majority of the participants were single at the time of the interview (59.4%). A high prevalence of lifetime high-risk number of sexual partners (6 sexual partners of more) was reported among the study sample (57.1%). Self-report data showed that the most common STIs were HIV (36.7%), Genital warts (28.1%) and Chlamydia (21.9%). A quarter (25%) of the women reported an abnormal Pap test and 12.5% reported not having a Pap test more than five years ago. Conclusion: It has been documented that women who attend STI clinics have a high prevalence of sexual partners, as well as a high prevalence of viral and bacterial infections which might put them at risk for long-term sequelae such as cervical cancer. This study also showed a high prevalence of both previous abnormal Pap test and significant time since last Pap test. Behavioral interventions designed to increase awareness of cervical cancer screening prevention among vulnerable and disadvantage population are necessary and STI clinics might help in capturing a dynamic, at-risk population. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B103.

Lack of HPV 16 and 18 detection in serum of colposcopy clinic patients

Background Persistent infection with high-risk human papillomavirus (HPV) types is necessary for the development of high-grade cervical dysplasia and cervical carcinoma. The presence of HPV DNA in the blood of cervical cancer patients has been reported; however, whether HPV DNA is detectable in the blood of patients with pre-invasive cervical disease is unclear. Objectives The objectives of this study were to determine if HPV 16 and HPV 18 DNA could be detected in the serum of colposcopy clinic patients, and if serum HPV detection was associated with grade of cervical disease and HPV cofactors. Study design Samples were selected from a biorepository collected from non-pregnant, HIV-negative women ages 18–69 attending colposcopy clinics at two urban public hospitals. Cervical disease status was based on review of colposcopy, biopsy and cytology findings. Serum HPV DNA detection was conducted using a novel PCR and mass spectroscopy-based assay. Results Of the 116 adequate serum samples, all (100%) were negative for HPV 16 and HPV 18. Over half (51.7%) of participants had cervical HPV 16 and/or HPV 18 infection. Nearly one-third (31.1%) had high grade, 10.3% had low grade, and 50.9% had no cervical disease. Nearly one-third (28.5%) had ever regularly smoked cigarettes, 70.7% had early onset of sexual intercourse, and 75% had ever used oral contraceptives. Conclusions In this colposcopy clinic population with a range of clinical characteristics and established HPV cofactors, HPV DNA was undetectable in their serum. Our findings suggest that serum HPV DNA detection is not a cervical cancer screening tool.