scholarly journals Self-Collected Samples in Cervical Cancer Screening: Results of HPV and Pap Self-Collected Samples Compared to Physician-Obtained Specimens

2019 ◽  
Vol 63 (5) ◽  
pp. 379-384
Author(s):  
Bernhard Reinhold Mangold
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Pap Test ◽  
Pap Tests ◽  
Test Sensitivity ◽  
Self Testing ◽  
Hpv Test ◽  
Very High

Objective: In order to increase overall participation in cervical cancer screening, several investigators propose a concept of introducing self-tests. The study presented here compared test results of the Pap test and 4 different HPV test systems of self-collected and physician-collected vaginal specimens. Study Design: 208 patients of a colposcopy clinic had physician-taken and self-taken vaginal samples. All cell samples enabled a liquid-based Pap test and testing for carcinogenic HPV genotypes. In addition, all patients had a colposcopy with or without cervical biopsy and/or conisation. Results: 99 patients had the histological diagnosis of CIN2+. The HPV test sensitivity of self-collected samples differed significantly in this patient group depending on the test system performed. The sensitivity of the self-collected Pap test was significantly lower than HPV testing, but the positive predictive value of the Pap self-test was very high. Conclusion: The results of this study indicate that under the circumstances of self-testing HPV test systems differ in test sensitivity and specificity. Self-collected Pap tests can provide a test result with a very high positive predictive value and introduce therapeutic strategies. In order to improve screening strategies, it could be an opportunity to combine HPV and Pap tests in self-taken vaginal samples, especially in countries with a low income level. In countries with a good medical infrastructure, self-testing has to be introduced with caution.

scholarly journals Performance of HPV16/18 in Triage of Cytological Atypical Squamous Cells of Undetermined Significance

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Xiaoqin Cao ◽  
Shuzheng Liu ◽  
Manman Jia ◽  
Hongmin Chen ◽  
Dongmei Zhao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Statistical Tests ◽  
Predictive Values ◽  
Squamous Cells ◽  
Link Type ◽  
Hpv Test ◽  
Undetermined Significance

Context. Human papillomavirus (HPV) testing is widely used in cervical cancer screening in women; however, its efficiency in triaging women with atypical squamous cells of undetermined significance (ASC-US) needs to be validated. Objective. To evaluate the performance of HPV16/18 in the triage of women with ASC-US. Methods. Women presenting for routine cervical cancer screening had cervical specimens collected, with which both liquid-based cytology (LBC) and hrHPVs were examined; those with ASC-US cytology underwent colposcopy. HPV16/18 and 12 other types were tested with domestic hybridization capture and chemiluminescence signal amplification (DH3). Performance characteristics of HPV test (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for identification of cervical intraepithelium neoplasma (CIN) grade 2 or worse (CIN2+), and CIN grade 3 or worse (CIN3+)) were determined using standard statistical tests. Results. 317 women with ASC-US were eligible for the study. HrHPV prevalence was 15.77% (50/317); HPV16/18 prevalence was 3.61% (20/317). Sensitivity and specificity of HPV16/18 for detection of CIN 2+ were 64.71% and 97% and 64.29% and 96.37% for detection of CIN 3+, respectively. The positive predictive values (PPVs) and negative predictive values (NPVs) of HPV16/18 were 55.00% and 97.98% for CIN2+ and 45.00% and 98.32% for CIN3+, respectively. Conclusion. HPV16/18 can be considered as an effective method to triage women with ASC-US as its good clinical performance. Trial Registration. This trial is registered with Henan Cancer Hospital Medical Ethics Committee on July 5, 2016 (http://www.anti-cancer.com.cn), with registry no.: 2016037.

PP62 Cost-Effectiveness Of Cervical Cancer Screening In Estonia

2019 ◽  
Vol 35 (S1) ◽  
pp. 49-49
Author(s):  
Triin Võrno ◽  
Kaja-Triin Laisaar ◽  
Terje Raud ◽  
Kai Jõers ◽  
Doris Meigas-Tohver ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Screening Program ◽  
Pap Test ◽  
Cancer Screening Program ◽  
Hpv Test ◽  
Cervical Cancer Screening Program ◽  
The Cost

IntroductionIn Estonia, organized cervical cancer screening program is targeted at women aged 30–55(59) years and Pap-tests are taken every five years. Since cervical cancer is associated with human papillomavirus (HPV), a number of countries have introduced the HPV-test as the primary method of screening. The objective of this study was to evaluate the cost-effectiveness of organized cervical cancer screening program in Estonia by comparing HPV- and Pap-test based strategies.MethodsFor the cost-effectiveness analysis, a Markov cohort model was developed. The model was used to estimate costs and quality-adjusted life-years (QALYs) of eight screening strategies, varying the primary screening test and triage scenarios, upper age limit of screening, and testing interval. Incremental cost-effectiveness ratios (ICERs) were calculated in comparison to current screening practice as well as to the next best option. Sensitivity analysis was performed by varying one or more similar parameter(s) at a time, while holding others at their base case value. The analysis was performed from the healthcare payer perspective adopting a five percent annual discount rate for both costs and utilities.ResultsIn the base-case scenario, ICER for HPV-test based strategies in comparison to the current screening practice was estimated at EUR 8,596–9,786 per QALY. For alternative Pap-test based strategies ICER was estimated at EUR 2,332–2,425 per QALY. In comparison to the next best option, HPV-test based strategies were dominated by Pap-test based strategies. At the cost-effectiveness threshold of EUR 10,000 per QALY Pap-testing every three years would be the cost-effective strategy for women participating in the screening program from age 30 to 63 (ICER being EUR 3,112 per QALY).ConclusionsDecreasing Pap-test based screening interval or changing to HPV-test based screening can both improve the effectiveness of cervical cancer screening program in Estonia, but based on the current cost-effectiveness study Pap-test based screening every three years should be preferred.

Identification of ideal strategy of cervical cancer screening in Japan based on Fukui cervical cancer screening study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17025-e17025
Author(s):  
Tetsuji Kurokawa ◽  
Akiko Shinagawa ◽  
Yoko Chino ◽  
Motohiro Kobayashi ◽  
Yoshio Yoshida
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Screening Method ◽  
Hpv Testing ◽  
Abnormal Cytology ◽  
Predictive Values ◽  
Hpv Status

e17025 Background:The estimated age-standardized incidence rate for cervical cancer is higher in Japan than in North America and the UK. It is important to improve cancer screening. The introduction of HPV testing with cytology for triage of those that test positive for cervical cancer screening has been challenging. The Fukui Cervical Cancer Screening (FCCS) study was designed to determine the best cervical cancer screening method in the Japanese population. We performed a subanalysis using baseline data of FCCS study to determine the performance of cytology, the human papillomavirus (HPV) testing and cotesting with cytology and HPV testing, and to evaluate whether the stratification of HPV16, HPV18, and 12 other hrHPV types appropriately balances risks and harms in the Japanese cancer screening population. Methods:The study enrolled 7,584 women aged 25 years or older undergoing routine screening. All women underwent liquid-based cytology (LBC) and cobas HPV testing. Women with abnormal cytology regardless of the HPV status, women with positive hrHPV results regardless of cytology results, and women randomly selected from among those with normal cytology and negative hrHPV results were referred for colposcopy. Results:The prevalence of hrHPV, HPV16, and HPV18 was 6.8%, 1.2%, and 0.5%, respectively. The estimated sensitivities for cervical intraepithelial neoplasia (CIN) 2 or worse for cytology, HPV testing, and cotesting with cytology and HPV testing were 71%, 92%, and 100%, respectively. The estimated positive predictive values for cytology, HPV testing, and cotesting with cytology and HPV testing were 33%, 21% and 21%, respectively. Using a strategy whereby those with abnormal cytology or positive HPV16 genotype undergo colposcopy and biopsy results in a sensitivity of 85% and a positive predictive value of 33%. This strategy results in improved sensitivity while at the same time maintains the positive predictive value compared to screening with cytology alone. Conclusions:Baseline data from the FCCS study suggests that strategy of using colposcopy for women with abnormal cytology and/or HPV16 positivity appropriately balances risks and harms for Japanese women. Clinical trial information: UMIN000025977.

scholarly journals Evaluation of Liquid Based Cytology (LBC) and Conventional Pap’s Smear Test as Methods of Cervical Cancer Screening

2022 ◽  
Vol 6 (1) ◽  
pp. 36
Author(s):  
Mehdi Ashik Chowdhury ◽  
Asim Ranjan Barua ◽  
- Asaduzzaman ◽  
Mohammad Mahabubul Hoque ◽  
DM Arifur Rahman
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Cervical Cancer Screening ◽  
Predictive Value ◽  
Pap Smear ◽  
Molecular Techniques ◽  
Smear Preparation ◽  
Liquid Based Cytology

Background: Cervical cancer screening can actually prevent most cervical cancers and also facilitates early detection which allows fruitful treatment.Objective: To evaluate and compare the efficacy of Liquid-based cytology (LBC) with conventional Pap smear test.Methods: This crosssectional study was conducted between March 2015 and June 2017. A total of 72 women participated in this study attending the Out-Patient Department (OPD) of Gynaecology (Colposcopy Clinic) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, for VIA test. The smears prepared by the conventional Pap smear method and Liquid-based cytology method were observed by two independent observers in Department of Pathology of the same institution.Results: The mean age of the patients was 40.22±12.29 years. Considering histopathology as gold standard, in conventional Pap smear preparation our data suggested its sensitivity 87.5%, specificity 92.2%, accuracy 91.7%, positive predictive value 58.3% and negative predictive value 98.3%. In contrast, in Liquid-based cytology, we found its sensitivity 75.0%, specificity 90.6%, accuracy 88.9%, positive predictive value 50.0% and negative predictive value 96.7%.Conclusion: LBC has practical advantages over conventional preparation by producing monolayer of cells, smaller area to screen, reproducibility and availability of doing adjunct molecular techniques from residual sample. However, conventional preparation shows better sensitivity and positive predictive value and almost similar specificity, negative predictive value and accuracy with LBC.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 36-40

scholarly journals Point-Counterpoint: Cervical Cancer Screening Should Be Done by Primary Human Papillomavirus Testing with Genotyping and Reflex Cytology for Women over the Age of 25 Years

2015 ◽  
Vol 53 (9) ◽  
pp. 2798-2804 ◽  
Author(s):  
Mark H. Stoler ◽  
R. Marshall Austin ◽  
Chengquan Zhao
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Positive Likelihood Ratio ◽  
Pap Test ◽  
The United States ◽  
Primary Screening ◽  
Screening Algorithm ◽  
Hpv Test

Screening for cervical cancer with cytology testing has been very effective in reducing cervical cancer in the United States. For decades, the approach was an annual Pap test. In 2000, the Hybrid Capture 2 human papillomavirus (HPV) test was approved by the U.S. Food and Drug Administration (FDA) for screening women who have atypical squamous cells of underdetermined significance (ASCUS) detected by Pap test to determine the need for colposcopy. In 2003, the FDA approved expanding the use of the test to include screening performed in conjunction with a Pap test for women over the age of 30 years, referred to as “cotesting.” Cotesting allows women to extend the testing interval to 3 years if both tests have negative results. In April of 2014, the FDA approved the use of an HPV test (the cobas HPV test) for primary cervical cancer screening for women over the age of 25 years, without the need for a concomitant Pap test. The approval recommended either colposcopy or a Pap test for patients with specific high-risk HPV types detected by the HPV test. This was based on the results of the ATHENA trial, which included more than 40,000 women. Reaction to this decision has been mixed. Supporters point to the fact that the primary-screening algorithm found more disease (cervical intraepithelial neoplasia 3 or worse [CIN3+]) and also found it earlier than did cytology or cotesting. Moreover, the positive predictive value and positive-likelihood ratio of the primary-screening algorithm were higher than those of cytology. Opponents of the decision prefer cotesting, as this approach detects more disease than the HPV test alone. In addition, the performance of this new algorithm has not been assessed in routine clinical use. Professional organizations will need to develop guidelines that incorporate this testing algorithm. In this Point-Counterpoint, Dr. Stoler explains why he favors the primary-screening algorithm, while Drs. Austin and Zhao explain why they prefer the cotesting approach to screening for cervical cancer.

scholarly journals The Role of Self-Collection by Vaginal Lavage for the Detection of HPV and High-Grade Intraepithelial Neoplasia

2017 ◽  
Vol 61 (6) ◽  
pp. 425-433 ◽  
Author(s):  
Larissa de Melo Kuil ◽  
Adriana Tarla Lorenzi ◽  
Maíra Degiovani Stein ◽  
Júlio César Possati Resende ◽  
Márcio Antoniazzi ◽  
...  
Keyword(s):  
High Risk ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Pap Test ◽  
Intraepithelial Neoplasia ◽  
Cervical Cytology ◽  
High Grade ◽  
Vaginal Lavage ◽  
Hpv Test ◽  
High Risk Hpv

Objective: To compare the results of cervical cytology and high-risk HPV tests using samples obtained using two different collection modalities in a population of Brazilian women: self-collection (vaginal lavage) and cervical Pap testing. Methods: We enrolled 204 women who were aged 18-64 years and had previously obtained abnormal cervical cytology test results; 83.8% of them agreed to participate. The sample was divided into two aliquots: one for the cytological study and one for the molecular analysis of high-risk HPV. Results: Fifty-eight percent of the participants preferred to utilize self-collection as an alternative screening method. However, we noticed that the HPV positivity rate was significantly lower in self-collected samples when compared to those obtained using the conventional collection method (p = 0.035). The cytology tests of the samples obtained via self-collection were sensitive and had a positive predictive value and an area under the curve (AUC) that were significantly lower than those of the Pap test. However, the specificity and negative predictive value of these tests were similar. When compared with the HPV test, the self-collected samples demonstrated lower accuracy in predicting high-grade cervical intraepithelial neoplasia or worse, with a significantly lower sensitivity, positive predictive value, and AUC than the cervical Pap test samples. Conclusion: Self-collection by vaginal lavage is simple and well accepted by women. Due to its limitations, however, self-collection by lavage should be utilized with caution.

scholarly journals HPV and Pap testing among white, black, and hispanic women: results from a survey study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Ilana M. Ventura ◽  
Selena Zhong ◽  
Ipek Bilgen ◽  
David Dutwin ◽  
Jane L. Delgado
Keyword(s):  
Cervical Cancer ◽  
Black Women ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Hispanic Women ◽  
Survey Study ◽  
Hpv Testing ◽  
Health Providers ◽  
Pap Tests ◽  
Hpv Test

AbstractWhile the Pap test, HPV vaccine, and HPV test are important tools to promote cervical health, the American Cancer Society (ACS) recently updated its cervical cancer prevention recommendations to give primacy to HPV testing for cervical cancer screening. We investigate how women’s health providers view these changes, and the extent to which they have reached American women. To do so, we present results from a novel two-survey study of women’s health providers (N = 558) and White, Black, and Hispanic women (N = 1900). We find that a minority of providers report that the HPV test alone is adequate for cervical cancer screening (18%, CI = 14%, 21%) while 96% (CI = 94%, 97%) indicated that women should regularly have both Pap and HPV screenings. Black (88% CI = 86%, 91%) and Hispanic (87% CI = 84%, 89%) women report lower rates of Pap tests compared to White women (94%, CI = 92%, 96%). Only 35% (CI = 33%, 37%) of women report having had an HPV test, and these levels were similar across groups. White (29%, CI = 25%, 33%) and Hispanic women (26% CI = 23%, 29%) report statistically similar levels of provider recommendation for joint Pap-HPV testing, while Black women report statistically lower rates (22%, CI = 18%, 25%). These patterns hold after controlling for several important socio-demographic variables in logistic regression models. The continued lower rates of Pap tests among Black and Hispanic women, combined with low rates of HPV testing is likely to hinder the ability to reduce cervical cancer incidence and mortality, particularly for Hispanic and Black women.

scholarly journals Conventional Pap Smear Cytology in a Tertiary Care Center

2021 ◽  
Vol 17 (2) ◽  
pp. 117-123
Author(s):  
Tika Kumari Gurung ◽  
Shree Prasad Adhikari ◽  
Ayushma Adhikari ◽  
Reecha Shrestha ◽  
Chum Maya Pun ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Pap Smear ◽  
Tertiary Care ◽  
Pap Test ◽  
Low Grade ◽  
Test Results ◽  
Pap Tests ◽  
Intraepithelial Lesion ◽  
Bethesda System

Abstract: Background: Cervical cancer is the fourth most common cancer in women with high mortality. Since it is a preventable cancer, screening for cervical cancer with Papanicolaou test (Pap Test) is considered as the stepping stone in its cure by detecting  at its premalignant state. The two methods of acquiring the sample for cytology are Conventional method and liquid based cytology. Methods:  The Pap test  results of the patients who visited the outpatient clinic of the Gynecologic Department of Gandaki Medical College and Teaching Hospital from January 2012 to December 2017 were reviewed and analyzed from the medical records. The findings of Pap test results were tabulated and categorized as per Bethesda system of classification (2001). Results:  A total of 2004 Pap tests were taken. All of the patients in the study were married with mean age of 39.7±10.3 years. A total of 1291(64.42%) Pap tests were normal or negative for intraepithelial lesion whereas 578(28.84%) were inflammatory smears while 37(1.85%) were inadequate for evaluation. There was a presence of low grade intraepithelial lesion in 4(0.2%)  and high grade intraepithelial lesion in 15(0.75%). Atypical squamous cell of undetermined significance (ASCUS) was noted in 11(0.55%) and frank malignancy was noted in 1(0.05%) of total Pap test samples. Conclusion: In a developing country like Nepal, Pap test is still the preferred cervical cancer screening tool. All women should undergo the screening test for cervical cancer with any feasible available test. Key words: Bethesda system; cervical cancer; HPV; Pap Test.

scholarly journals Persistent Disparities in Cervical Cancer Screening Uptake: Knowledge and Sociodemographic Determinants of Papanicolaou and Human Papillomavirus Testing Among Women in the United States

2020 ◽  
Vol 135 (4) ◽  
pp. 483-491
Author(s):  
Nicole L. Johnson ◽  
Katharine J. Head ◽  
Susanna Foxworthy Scott ◽  
Gregory D. Zimet
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Health Insurance ◽  
Human Papillomavirus ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Pap Test ◽  
The United States ◽  
Populations At Risk ◽  
Hpv Test

Objectives Cervical cancer is the second-most common type of cancer among women aged 15-44, and racial, ethnic, and economic disparities exist in survival rates despite widely available screening tests and early treatment options. The objective of this study was to describe the association among knowledge, sociodemographic characteristics, and cervical cancer screening, with the goal of developing interventions to prevent cervical cancer in populations at risk of the disease. Methods In 2017, we conducted a nationwide survey of women in the United States aged ≥18 who had ever received a Papanicolaou (Pap) test (N = 630). We conducted t tests and one-way analysis of variance to determine sociodemographic differences (age, education, race, ethnicity, income, type of health insurance) in knowledge about cervical cancer screening (Pap test and human papillomavirus [HPV] test). We used logistic regressions to define significant determinants of cervical cancer screening behaviors in the previous 5 years. Results Of 629 respondents, 407 (64.7%) had an annual household income <$30 000, and 322 of 536 (60.1%) respondents had government-provided health insurance. Of 630 women who had ever had a Pap test, 425 (67.5%) had an HPV test. Hispanic and non-Hispanic white women were more likely than Hispanic and non-Hispanic black women (odds ratio [OR] = 2.49; 95% CI, 1.12-4.54; P = .02) and women with government-provided health insurance (OR = 1.91; 95% CI, 1.08-3.37; P = .03) were more likely than women with private health insurance to have received a Pap test in the previous 5 years. Knowledge of HPV was a significant predictor of having received an HPV test in the previous 5 years (OR = 1.37; 95% CI, 1.22-1.54; P < .001). Conclusion Disparities in cervical cancer screening among sociodemographic groups of women suggest the need for targeted interventions to improve knowledge about Pap and HPV tests.

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