A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

Nahvijou, Azin; Hadji, Maryam; Ahmad, Badariah; Tourang, Fatemeh; NedaBayat, NedaBayat; Weiderpass, Elisabete; Daroudi, Rajabali; Amini, Ali; Zendehdel, Kazem

doi:10.7314/apjcp.2014.15.19.8229

Cited by 30 publications

(36 citation statements)

References 63 publications

(171 reference statements)

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“…Persistent expression of the E6 and E7 proteins of the high-risk type HPV16 virus is a key risk factor for cervical cell transformation and the maintenance of a malignant phenotype (Gan et al, 2014;He et al, 2014), and represents the primary mechanism by which the virus escapes host cell immune surveillance after HPV infection. Thus, the immune escape mechanism of HPV has become the focus of current research (Niebler et al, 2013;Nahvijou et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Correlation of E6 and E7 levels in high-risk HPV16 type cervical lesions with CCL20 and Langerhans cells

Jiang¹,

Xue²

2015

Genet. Mol. Res.

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ABSTRACT. The human papillomavirus (HPV)16 E6 and E7 correlation with chemokine ligand (CCL)20 expression and Langerhans cells (LCs) in cervical lesions was investigated. We enrolled 43 patients with surgically treated cervical lesions from the Department of Gynecology in our hospital, and 20 controls without cervical lesions. Subjects were divided by pathology: HPV16(-) and HPV16(+) normal cervical groups (N = 10 each), and HPV16(+) cervical intraepithelial neoplasia (CIN), cervical invasive carcinoma (N = 15 each), and in situ carcinoma (N = 13) groups. E6, E7, the LC surface marker CD1a, and CCL20 were analyzed by immunohistochemistry. E6 and E7 in HPV16-type lesions were correlated with CCL20 and LCs. The average high power field cell numbers of CD1a + LCs in the HPV(-) and HPV(+) normal cervix groups, and the CINI-II, CINIII in situ and cervical carcinoma groups were 22.89 ± 4.84, 13.7 ± 2.26, 9.2 ± 1.68, 5.9 ± 1.59, and 5.5 ± 1.58, respectively. Significant between-group differences existed except between cervical carcinoma and CINIII groups (P < 0.05). CCL20 + rates in each group were 70, 60, 60, 15.38, and 13.33%, respectively. E6/E7-positive expression rates in each group were 20/20, 66.7/66.7, 76.9/69.2, and 86.67/73.3%, respectively. CCL20 was positively correlated with CD1a (r = 0.649), and negatively correlated with E7 (r = -0.946) and E6 (r = -0.949). CD1a was negatively correlated with E6 (r = -0.632) and E7 (r = -0.632). Downregulation of CCL20 leading to LC decline is a key factor in cervical lesions. High-risk HPV-type lesions might inhibit the chemokine CCL20 through E6 and E7 to escape the immune response.

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Section: Introductionmentioning

confidence: 99%

Correlation of E6 and E7 levels in high-risk HPV16 type cervical lesions with CCL20 and Langerhans cells

Jiang¹,

Xue²

2015

Genet. Mol. Res.

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“…Similarly, a systematic review by Nahivjou and colleagues 13 of cc screening strategies from an economic standpoint suggested that hpv dna testing-starting at age 30 or older, with screening intervals of 5 years or more-was the most cost-effective strategy. They also found that, in some countries, national guidelines did not match scenarios emerging from cost-effectiveness studies.…”

Section: Discussionmentioning

confidence: 99%

“…A negative hpv dna test is associated with an 0.27% cumulative incidence rate of cervical intraepithelial neoplasia grade 3 or worse after 6 years; the rate for women with a negative cytology result is 0.97% 30 . Thus, screening intervals more frequent than 5 years are not recommended for primary hpv dna testing 4,13 . According to our model, moving from 5-yearly to triennial hpv dna testing would cost more than $100,000 per additional qaly gained.…”

Section: Discussionmentioning

confidence: 99%

“…In Europe, several countries start cc screening at later ages and use longer intervals than Canada does. For example, in Finland and the Netherlands, whose cc rates are comparable to those in Canada, cytology screening has been offered at 5-year intervals to women beginning at age 30 [11][12][13] . In 2013, the Canadian Task Force on Preventive Health Care (ctfphc) recommended routine screening for women 30-69 years of age, with weaker recommendations to routinely screen women 25-29 years of age.…”

Section: Introductionmentioning

confidence: 99%

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Using the Cancer Risk Management Model to Evaluate the Health and Economic Impacts of Cytology Compared with Human Papillomavirus DNA Testing for Primary Cervical Cancer Screening in Canada

et al. 2016

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“…There is a wide variation in the cervical screening strategies in different countries. 24 The main variations are related to type of screening test, starting age, and screening intervals. HPV testing, Pap smear tests, and visual inspection with acetic acid (VIA), are three types of screening tests that are used for cervical screening worldwide.…”

Section: Discussionmentioning

confidence: 99%

Priority Setting for Improvement of Cervical Cancer Prevention in Iran

Majidi

Ghiasvand

Hadji

et al. 2015

Int J Health Policy Manag

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Background: Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting. Methods: We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran. Results: From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry. Conclusion: A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran. Implications for policy makers • Policy-makers, scientific community, governmental agencies, private sectors, and non-governmental organizations (NGOs) should contribute to the planning and implementation of an organized cervical cancer prevention program. Cervical cancer screening and treatment services should be accessible and affordable for all women in the country • Improvement of population-based cancer registry program and establishment of cervical screening registry are necessary for regular monitoring and evaluation of the screening program and should be prioritized in parallel to screening program. • Funding agencies should support research priorities suggested in this study. The results from these studies can be used for improvement of invasive cervical cancer (ICC) prevention in the future. Implications for publicWe suggested prioritizing public awareness and providing necessary information to the women about cervical cancer prevention and importance of regular attendance in the cervical screening program. Women should consider the criteria of the national guideline for attendance in the screening program, including starting age, and screening intervals. As emphasized in this study, follow-up and management of the abnormal tests and precancerous lesions is crucial. Women who receive an abnorm...

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A Systematic Review of Economic Aspects of Cervical Cancer Screening Strategies Worldwide: Discrepancy between Economic Analysis and Policymaking

Cited by 30 publications

References 63 publications

Correlation of E6 and E7 levels in high-risk HPV16 type cervical lesions with CCL20 and Langerhans cells

Correlation of E6 and E7 levels in high-risk HPV16 type cervical lesions with CCL20 and Langerhans cells

Using the Cancer Risk Management Model to Evaluate the Health and Economic Impacts of Cytology Compared with Human Papillomavirus DNA Testing for Primary Cervical Cancer Screening in Canada

Priority Setting for Improvement of Cervical Cancer Prevention in Iran

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