Cervical Cancer Screening with HPV Testing: Updates on the Recommendation

Carvalho, Carla Fabrine; Bragança, Joana Fróes; Derchain, Sophie; Zeferino, Luíz Carlos; Vale, Diama Bhadra

doi:10.1055/s-0041-1739314

Cited by 6 publications

(7 citation statements)

References 48 publications

(143 reference statements)

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“…HPV testing in Brazil is available only in some private clinics or for specific research projects. 27 The women in our sample did not have access to this technology. Considering that HPV testing in women under 30 years is controversial because of its low sensitivity in this group, it is unlikely that the recommendations will be changed in the next years.…”

Section: Discussionmentioning

confidence: 99%

Safety of Conservative Management of High-Grade Squamous Intraepithelial Lesion in Women Under 30 Years Old

Bonás

Discacciati

Videira

et al. 2022

Women's Health Reports

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Objectives: To evaluate the outcomes of conservative management in young women with high-grade squamous intraepithelial lesion (HSIL). Methods: A retrospective cohort study included women younger than 30 years referred with HSIL (cytology or biopsy) managed conservatively from 2012 to 2019, in Campinas/Brazil. Regression was the outcome when no evidence of HSIL was observed in at least two consecutive follow-ups. Kaplan–Meyer method was used to determine regression probabilities. Other tests were chi-square or Fisher, Mann–Whitney and COX regression. Results: During the study period, 89 patients were included. No progression to microinvasive or invasive cancer was observed. Sixty-one (69%) patients were younger than 25 years, and 28 (31%) were aged 25–30 years. Spontaneous regression was seen in 64 (72%) and persistence in 25 (28%) of the overall sample. The average time to regression was 15.4 months (standard deviation [SD] = 7.7), and the follow-up time was 31.6 months (SD 19.0). Age, parity, first sexual intercourse, smoking, hormonal contraception, and colposcopy impression were not different among women with regression or persistence. Regression probabilities were, respectively, 28.9%, 60.2%, and 78.1% after 12, 18, and 24 months. Most of the events happened between 12 and 18 months of follow-up. Conclusions: Conservative management in women younger than 30 years was safe: spontaneous regression was observed in 72% of all women younger than 30 with HSIL managed conservatively. No clinical variable was relevant, influencing regression. In 2 years the regression probability was 78%.

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Section: Discussionmentioning

confidence: 99%

Safety of Conservative Management of High-Grade Squamous Intraepithelial Lesion in Women Under 30 Years Old

Bonás

Discacciati

Videira

et al. 2022

Women's Health Reports

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“…The recommendation in many settings is to start HPV DNA testing at 30 years, but this can be done from 25 years if resources are available [ 21 ]. The age to start HPV DNA testing has been a subject of many discussions [ 22 ]. Of clinical importance are persistent HPV infections.…”

Section: Discussionmentioning

confidence: 99%

Antenatal and postnatal cervical precancer screening to increase coverage: experience from Battor, Ghana

Effah,

Tekpor,

Klutsey

et al. 2023

ecancer

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Background Cervical precancer screening in low-resource settings is largely opportunistic with low coverage. Many women in these settings, where the burden of cervical cancer is highest, only visit health institutions when pregnant or after delivery. We explored screening during antenatal and postnatal visits aimed at increasing coverage. Methods Pregnant women (in any trimester) attending antenatal care (ANC) and women attending postnatal care (PNC; 6–10 weeks) clinics were screened at Catholic Hospital, Battor and at outreach clinics from February to August 2022 (08/02/2022 to 02/08/2022). At the same visit, cervical specimens were obtained for high-risk human papillomavirus (hr-HPV) DNA testing (with the Sansure MA-6000 PCR platform) followed by either visual inspection with acetic acid (VIA) or mobile colposcopy with the enhanced visual assessment system. Results Two hundred and seventy and 107 women were screened in the antenatal and postnatal groups, respectively. The mean ages were 29.4 (SD, 5.4) in the ANC group and 28.6 (SD, 6.4) years in the PNC group. The overall hr-HPV prevalence rate was 25.5% (95% confidence interval (CI), 21.1–29.9) disaggregated as 26.7% (95% CI, 21.4–31.9) in the ANC group and 22.4% (95% CI, 14.5–30.3) in the PNC group ( p = 0.3946). Overall, 58.9% of pregnant women (28.3% hr-HPV+) and 66.4% of postnatal women (22.5% hr-HPV+) only visited a health facility when pregnant or after delivery (at Child Welfare Clinics). The VIA ‘positivity’ rate for all screened women was 5.3% (95% CI, 3.1–7.6), disaggregated into 5.2% (95% CI, 2.5–7.8) in the ANC group and 5.7% (95% CI, 1.3–10.1) in the PNC group ( p -value = 0.853). Conclusion A significant number of women in Ghana only visit a health facility during pregnancy or after delivery. ANC and PNC clinics would offer opportunities to increase coverage in cervical precancer screening in low-resource settings. Relying on community nurses ensures that such programs are readily integrated into routine care of women and no opportunity is missed.

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“…HPV detection tests were recommended by WHO as the primary screening method for both the general population of women and WLWH ( 9 ), as they are more effective than cytology in reducing CC incidence and mortality, due to higher sensitivity, negative predictive value (NPV) and reproducibility ( 30 , 31 ). Although HPV detection tests have not yet been incorporated into SUS, recommendations to guide professionals working in scenarios in which these tests are available have already been published, so they can be used based on scientific evidence and according to best practices ( 32 ). Additionally, studies investigating the molecular approach shift in CC screening in the Brazilian context have been conducted and published ( 33 – 37 ).…”

Section: Cervical Cancer Mitigation Through Vaccination Screening And...mentioning

confidence: 99%

“…As the benefits, harms and programmatic costs of these triage methods are similar, the choice depends on feasibility, training, program quality assurance and resources ( 9 ). From the Brazilian perspective a recent review suggests that reflex liquid-based cytology or partial genotyping should be performed after a positive HPV test to avoid unnecessary colposcopies and follow-up losses ( 32 ). Other triage options under investigation are mRNA-HPV, extended genotyping, dual staining, and methylation ( 49 ).…”

Section: Cervical Cancer Mitigation Through Vaccination Screening And...mentioning

confidence: 99%

Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination

et al. 2022

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As a middle-income country, Brazil has one of the largest public health systems worldwide, which deals with free and universal access to health care. Regarding cervical cancer, the country possesses a large infrastructure for the screening of premalignant and malignant lesions, but yet based on old technology, having Papanicolaou as the major screening method, followed by colposcopy and treatment. Also, large disparities in access are present, which makes effectiveness of screening and treatment in different regions of the country highly unequal. In this review, we describe and evaluate the current screening, treatment and prophylactic (HPV vaccination) strategies to combat cervical cancer in Brazil, and discuss potential incorporation of more recent technologies in these areas in the country to pave its way toward cervical cancer elimination.

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Cervical Cancer Screening with HPV Testing: Updates on the Recommendation

Cited by 6 publications

References 48 publications

Safety of Conservative Management of High-Grade Squamous Intraepithelial Lesion in Women Under 30 Years Old

Safety of Conservative Management of High-Grade Squamous Intraepithelial Lesion in Women Under 30 Years Old

Antenatal and postnatal cervical precancer screening to increase coverage: experience from Battor, Ghana

Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination

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