Extended duration of the detectable stage by adding HPV test in cervical cancer screening

Marie, None Müller; Ballegooijen, Marjolein van; Rozendaal, Lawrence; Meijer, Chris J.L.M.; Habbema, J. Dik F.

doi:10.1038/sj.bjc.6601355

Cited by 16 publications

(22 citation statements)

References 20 publications

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“…Viral clearance often precedes the cytological normalisation. Adding detection of the hr-HPV to the conventional cytological screening could safely lengthen the interval period by 2-5 years depending on the PSP of each country [82]. This would lead to a substantial decrease in the recommended lifetime number of smears.…”

Section: Hpv Assessment In Screeningmentioning

confidence: 98%

Detection, management, and follow‐up of pre‐malignant cervical lesions and the role for human papillomavirus

Hamont

Bekkers

Massuger

et al. 2007

Reviews in Medical Virology

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Cervical cytological pathology is common. Prevention of cervical cancer by detecting the disease process at an early and pre-malignant stage is practised globally either through population-based screening programmes (PSP) or through non-organised ones. High-grade cervical intraepithelial neoplasia (CIN) detected by cervical cytological screening is extensively visualised by colposcopy and successively treated by, for instance, large loop electro-surgical excision of the transformation zone. Persistent infections with certain high-risk human papillomavirus (hr-HPV) genotypes play an essential role in cervical cancer carcinogenesis by mechanisms discussed in this review. HPV assessment, either DNA detection or HPV genotyping, could enhance the current cervical cancer screening programmes. Furthermore, primary prevention of cervical cancer through the introduction of HPV vaccines looks promising although the current vaccines merely protect against two hr-HPV genotypes, leaving a niche for at least 11 other hr-HPV's. Cervical screening in the post-vaccination era cannot be abolished but could be altered, as discussed in this review. Algorithms with the primary objective of hr-HPV testing followed by subjective cytology assessment in HPV-positive women could be a solution for both pre- and post-vaccination screening.

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Section: Hpv Assessment In Screeningmentioning

confidence: 98%

Detection, management, and follow‐up of pre‐malignant cervical lesions and the role for human papillomavirus

Hamont

Bekkers

Massuger

et al. 2007

Reviews in Medical Virology

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“…In a Dutch study (2,250 women aged 34-54 years), only 1 woman with HPV-negative at baseline (N 5 2,129) developed CIN3 compared to 12 of the 121 women with HPV-positive at baseline in a mean follow-up of 6.4-years. 33 In a Swedish population-based prospective study (n 5 5,696, age 32-38), HPV-16, -31, and -33 were associated with significant risk of progression to CIN21 during a mean follow-up of 4.1-years. 19 A longitudinal follow-up study in Brazil enrolling women with normal cytology and HPV results available from the first 2 visits found that the relative risk (RR) of developing high-grade squamous intraepithelial lesion was highest 12.27 (2.6-57.5) among HPV-16 or -18 positive in both visits, followed by positive for same type other than HPV-16 or -18 (RR 9.68; 2.6-36.2) and 2 positive tests for different types (RR 4.08, 1.4-11.7) as compared to HPV-negative.…”

Section: Discussionmentioning

confidence: 99%

Host and viral factors in relation to clearance of human papillomavirus infection: A cohort study in Taiwan

Lai

Chao

Chang

et al. 2008

Intl Journal of Cancer

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Human papillomavirus (HPV) persistence is essential for cervical cancer development. We accrued nested-cohort subjects from a population-based study to investigate the host and viral factors related to outcome of HPV infection. Women (age ≥ 30 years old) with HPV-positive but normal cytology and negative colposcopy were invited to participate. After signing informed consent, every participant completed a structured questionnaire and had 6-monthly follow-ups of Pap smear, HPV testing and colposcopy. Total and type-specific HPV clearance rates as well as host and viral factors associated with clearance in 3-year longitudinal followup were analyzed. Adjusted hazard ratios (HRs) of progression to ≥ cervical intraepithelial neoplasia (CIN) 2 according to baseline HPV of the women with normal cytology were calculated from national registry database. Among the 626 eligible women, 526 (median age 47, 29-75) were enrolled and 412 returned for followup at least once. The median follow-up of enrolled subjects was 23 months (range 6.8-39). The 3-year cumulative total HPV clearance rate was 49.0% (95% confidence interval [CI]: 43.3-54.7%). The median 3-year cumulative type-specific HPV clearance rate was 50.0% (range 0-100.0%) with a median time to clearance of 12.4 months (6.4-24.5). Older age was associated with significantly decreased total HPV clearance and decreased type-specific clearance in HPV-18 and -53, while high viral load was associated with decreased total and type-specific clearance. After adjusting confounding variables, the HR of developing CIN2 in baseline HPVpositive women was 34.0-fold (95% CI: 15.5-74.7) as compared to HPV-negative women. ' 2008 Wiley-Liss, Inc.Key words: human papillomavirus; genotype; viral load; clearance Cervical cancer is one of the leading cancers in female worldwide. 1 There is strong epidemiological and molecular biological evidence indicating that human papillomavirus (HPV) plays a central role in the etiology of cervical cancer. 2,3 Over 90% of cervical cancers and their precursor lesions are attributable to HPV infection. 4,5 However, the prevalence of genital-tract HPV infections has been reported to range from 1.4 to 25.6% in cytologically normal population. 6 It is widely believed that persistent HPV infection is necessary for the development of cervical cancer. 3,7,8 Incorporation of HPV testing into cervical cancer screening has been advocated, although specificity is decreased with expected increase in sensitivity in early detection of high-grade cervical neoplasms. 9-11 However, identifying infection of high-risk HPV causes anxiety in the individual woman. Because of lack of adequate knowledge in predicting outcome, the appropriate management is unclear except periodical follow-up.Several 8,13 HPV variants 17 have been reported associated with HPV persistence/decreased clearance, whereas ever users of oral contraceptives were associated with faster clearance. 15 Multiple infections, viral load 15 and smoking 8 were unrelated to clearance in other longitudinal follow-u...

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“…The risk that a woman will develop high-grade CIN within that period of time seems acceptable since it will be exceptional to take place within 5 years given that a persistent hrHPV infection is required. 4,34 Precursor lesions are detectable within an average of 10-15 years before progression to cancer. 35 Thus, even though our study only covers 12 months of follow-up, it seems reasonable to return women with a hrHPV negative persistent BMD smear into the screening program without additional surveillance or treatment.…”

Section: Discussionmentioning

confidence: 99%

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

Bais

Rebolj

Snijders

et al. 2005

Intl Journal of Cancer

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In the Netherlands 2% of cervical smears in the cervical cancer screening program are read as borderline or mildly dyskaryotic cytology (BMD smear). Only in about 10% of these women a highgrade CIN lesion (CIN II-III) is present; therefore referral is for the majority unnecessary. In our study triage with high-risk HPV (hrHPV) testing was used to identify women at risk for development of high-grade CIN lesions after a repeat BMD smear. A ''wait-and-see'' period was incorporated allowing clearance of HPV and regression of the lesion. Women with a low-grade lesion, irrespective of their HPV status, were monitored at 12 months; women with a high-grade lesion were monitored at 6 and 12 months. Fifty-one of the 105 women (49%) were hrHPV negative at baseline; none of them showed progression of the lesion within the first year of follow-up (NPV 100%). High-grade CIN was present in 1 patient who was HPV negative at baseline (2%); she demonstrated regression after 12 months. Nineteen of the hrHPV positive women (35%) demonstrated a high-grade CIN lesion at baseline and 3 cleared hrHPV after 6 months, with a subsequent regression of CIN. Ten women remained hrHPV positive with persistence of high-grade CIN and were eventually treated. At baseline, 35 hrHPV positive women demonstrated a low-grade lesion, 19 remained hrHPV positive after 12 months and 5 developed high-grade CIN. Sixteen out of the 35 cleared the hrHPV infection without progression of the lesion. In conclusion, triage, using hrHPV testing for women with persistent BMD cytology, can select women who are not at risk for development of high-grade CIN. We recommend return to the screening program without referral for colposcopic examination if hrHPV is absent. For hrHPV positive women, a repeat hrHPV test after another 6 months is suggested. Referral is only required if persistence of hrHPV is established. ' 2005 Wiley-Liss, Inc.Key words: HPV; triage; borderline or mild dyskaryosis; guidelinesIn the Dutch population-based cervical cancer-screening program, women between 30 and 60 years of age undergo a cytological smear every 5th year. Recent surveys showed that about 2% of these smears contained borderline or mildly dyskaryotic (BMD) changes. 1,2 According to current screening guidelines, in these cases cytology is repeated after 6 months and (if negative) after 12 months. When cytology is persistently abnormal, women are referred to the gynaecologist where colposcopic examination is performed and a biopsy is taken for histological examination. When histology shows no or low-grade dysplasia ( CIN I) women will be kept under cytological surveillance without immediate treatment. High-grade dysplasia (CIN II-III) or a worse lesion will be treated. Only 10% of women with a single BMD smear show a high-grade CIN lesion. [3][4][5][6] Consequently, there is a need for an improved risk assessment of women with BMD.Infection with high-risk HPV (hrHPV) has been established as an important etiological factor in the carcinogenesis of cervical cancer. 7,8 Persistence of hr...

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Extended duration of the detectable stage by adding HPV test in cervical cancer screening

Cited by 16 publications

References 20 publications

Detection, management, and follow‐up of pre‐malignant cervical lesions and the role for human papillomavirus

Detection, management, and follow‐up of pre‐malignant cervical lesions and the role for human papillomavirus

Host and viral factors in relation to clearance of human papillomavirus infection: A cohort study in Taiwan

Triage using HPV‐testing in persistent borderline and mildly dyskaryotic smears: Proposal for new guidelines

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