High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, São Paulo, Brazil

Abstract

Every year there are approximately 16,000 new cases of cervical cancer in Brazil. Novel screening technologies may reduce this number by expanding the population coverage but also by improving the detection rate of precursor lesions. We aimed to evaluate human papillomaviruses (HPV)-DNA testing in the context of routine cervical cancer screening in the public health system of the city of São Paulo, Brazil. Women participating in the primary screening program were invited to enroll. Liquid-based cytology samples were collected and cytology and Hr-HPV DNA testing were performed in parallel. Cytologists were blind to HPV results. Women older than 24 years with a positive high-risk HPV test and/or cytology class ! ASC-US were referred to colposcopy. From December 2014 to December 2016, 16,102 women joined the study. High-risk human papilloma-virus (HR HPV) DNA prevalence was 14.9%, whereas cytologic abnormalities were found in 7.2% of the women. Per protocol, 1,592 Hr-HPV þ women, in addition to 72 patients with cytologic classification > lowgrade squamous intraepithelial lesion (LSIL) were referred. A total of 80 cervical intraepithelial neoplasia (CIN2 þ) cases were diagnosed, 79 were Hr-HPV DNA þ and 18 had normal cytology. Hr-HPV DNA detected a significant number of patients with premalignant lesions missed by cytology and all 16 CIN3 þ cases were Hr-HPV DNA þ. HPV genotyping may be useful in the management of Hr-HPV þ women, reducing the burden of colposcopic referral for those harboring genotypes with a weaker association to CIN3 þ. Use of HPV-DNA testing was shown to be feasible and advantageous over current cytologic screening in the public health system.

Avaliação do perfil de mulheres atendidas em centros de referência em saúde de Porto Alegre/RS e relação de alterações citológicas detectadas no exame citopatológico e a presença do HPV

“…Esses dados consideraram pacientes com características semelhantes às observadas em nossa amostra, já que incluíram mulheres em investigação em serviços de referência. 9,19,[22][23][24][25] Quando correlacionamos as amostras positivas para HPV e o seu diagnóstico do EC (Tabela 2), verifica--se que 3 (4,2%) não apresentam alterações atípicas ou lesões precursoras, 6 (30%) possuem o diagnóstico de atipias escamosas, 9 (38,1%) apresentam lesão intraepitelial escamosa de baixo grau e 32 (56,4%) possuem lesão intraepitelial escamosa de alto grau. Estes dados demonstram que a detecção de HPV é, predominantemente, concomitante à detecção de lesões precursoras no EC, tento em vista a correlação estatística encontrada (p<0,05).…”

Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country

“…A discount rate of 5% per year was used, with a sensitivity analysis of 0–10%, according to the Economic Evaluation Guideline of the Ministry of Health [ 33 ]. The results were compared with the Brazilian epidemiological models identified in the literature [ 34 ]. One million women were simulated in hypothetical cohorts after calibrating the model.…”

Attendance for diagnostic colposcopy among high‐risk human papillomavirus positive women in a Brazilian feasibility study

“…Detailed methods of the original feasibility study have been described elsewhere 11 . Non‐pregnant women registered at PCU in São Paulo, and presenting for routine CC screening, were invited to participate.…”

“…We have previously reported results of the first large‐scale feasibility study of liquid‐based cytology (LBC) and hr‐HPV screening in Brazil 11 . The study was conducted in primary care units (PCU) located in the western and southern districts of São Paulo city.…”