Improving cervical cancer screening in Mexico: results from the Morelos HPV Study

Flores, Yvonne N.; Bishai, David; Lazcano, Eduardo; Shah, Keerti V.; Lörincz, Attila T.; Hernández, Mauricio; Salmerón, Jorge; Ferris, Daron G.; Hernández, Pilar; Sherman, Mark E.; Ronnett, Brigitte M.; Carmona, Enrique J.; Antúnez, Alfredo; Manzanares, Horacio; Uribe, Mario Alexander Melo; Pérez‐Cuevas, Ricardo; Leyva-López, Ahidée; Yunes, Elsa

doi:10.1590/s0036-36342003000900013

Cited by 41 publications

(32 citation statements)

References 59 publications

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“…16 Our findings suggest that women who do not participate in cervical cancer screening programs may be willing to provide a self-collected specimen. 17 Future studies should include an examination of the rate of follow-up testing among women found to be positive for high-risk HPV. In addition, improved methods are necessary to enhance uptake of follow-up interventions.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women

Ogilvie¹,

Krajden²,

Maginley³

et al. 2007

Canadian Medical Association Journal

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4 48 80 0 D espite the availability of cytology screening programs in developed countries, women who are of lower socioeconomic status may not make full use of these programs.1-3 As a result, these women experience higher rates of cervical cancer than women in the general population. 4-6Screening tests that use patient-collected samples may increase the rate of cervical cancer screening in populations that are historically underscreened.7,8 Unlike Papanicolaou smears, which require a clinician to collect the specimen, women can directly obtain a cervicovaginal sample by intravaginal insertion of a swab, tampon or cytobrush.9 These self-collected specimens can then be used to screen for the presence of human papillomavirus types of high oncogenic risk (herein referred to as high-risk HPV), and women whose test results are positive for high-risk HPV can then be encouraged to seek further testing (e.g., Pap smear, colposcopy). In order to examine the feasibility of self-collection of specimens for HPV testing as a part of cervical cancer screening, we offered self-collection of specimens to women in Vancouver's Downtown Eastside. Methods Study populationThe study population included sexually active women over the age of 16 who were homeless or had unstable housing in Vancouver's Downtown Eastside (a region characterized by high rates of drug-related mortality and homelessness 10 ), who were involved in the sex trade or who had a history of alcohol or drug abuse. Women were recruited to the study from November 2004 to October 2005 by outreach nurses using a standardized recruitment statement in women's centres, shelters and alleys. Self-collection of specimens for HPV testing is not a standard part of cervical cancer screening; thus, all women were advised to have a Pap smear within 1 year. Participants were given a diagram that illustrated how to obtain a cervicovaginal specimen. They were instructed to insert a Dacron swab intravaginally, rotate it 3 times and place it in a specimen tube containing specimen transport medium (Digene Corporation). Women were asked to collect the specimen immediately at the closest washroom or private location and to return it to the nurse. Samples were transported to the British Columbia Centre for Disease Control within 24 hours of collection. They were analyzed for the presence of highrisk HPV DNA using the Digene HPV test, as per manufacturer's instructions.Ethical approval for the study was obtained from the Ethics Board at the University of British Columbia. To study the feasibility of self-collected specimens for testing human papillomavirus (HPV) status among hard-to-reach women, outreach nurses recruited women in women's centres, shelters and alleys in Vancouver's Downtown Eastside. Of the 151 participants for whom samples were available, 43 (28.5%) tested positive for high-risk HPV. Outreach nurses were able to recontact 81.4% of the participants who tested positive and referred them for further testing. About 14% (21/151) of participants had never received a Papanicolaou ...

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Section: Discussionmentioning

confidence: 99%

Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women

Ogilvie¹,

Krajden²,

Maginley³

et al. 2007

Canadian Medical Association Journal

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“…There is no statistically significant difference in the sensitivity between cytology and either of the two HPV tests. The specificity of cytology is significantly higher than the specificity of the self HPV test (14% higher, 95% CI of [12][13][14][15][16][17] and clinician HPV test (12%, 95% CI of [9][10][11][12][13][14]. The NPVs of cytology and the HPV tests are similar, but the PPV of cytology is higher than the PPV for the HPV tests and the CIs do not overlap.…”

Section: Test Accuracy For Diagnosis Of High-grade Diseasementioning

confidence: 99%

Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting

et al. 2007

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Objectives To compare the performance and acceptability of unsupervised self-sampling with clinician sampling for high-risk human papillomavirus (HPV) types for the first time in a UK screening setting. Setting Nine hundred and twenty women, from two demographically different centres, attending for routine cervical smear testing Methods Women performed an unsupervised HPV self-test. Immediately afterwards, a doctor or nurse took an HPV test and cervical smear. Women with an abnormality on any test were offered colposcopy.Results Twenty-one high-grade and 39 low-grade cervical intraepithelial neoplasias (CINs) were detected. The sensitivity for high-grade disease (CIN2 þ ) for the self HPV test was 81% (95% confidence interval [CI] 60-92), clinician HPV test 100% (95% CI 85-100), cytology 81% (95% CI 60-92). The sensitivity of both HPV tests to detect high-and low-grade cervical neoplasia was much higher than that of cytology , clinician test 80% [95% CI 68-88], cytology 48% [95% CI 36-61]). For both high-grade alone, and high and low grades together, the specificity was significantly higher for cytology (greater than 95%) than either HPV test (between 82% and 87%). The self-test proved highly acceptable to women and they reported that the instructions were easy to understand irrespective of educational level. Conclusions Our results suggest that it would be reasonable to offer HPV self-testing to women who are reluctant to attend for cervical smears. This approach should now be directly evaluated among women who have been non-attenders in a cervical screening programme.

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“…11 Indeed, findings from the Morelos HPV Study, for example, indicate greater sensitivity for HPV testing compared with Pap testing for detecting cervical intraepithelial neoplasia (CIN) 2/3. 12 One limitation to this study is the fact that we do not know the characteristics of providers who did not respond to the survey, nor their reasons for not participating. In addition, these findings may not be generalizeable to public providers outside of the SSDF system in Mexico City.…”

Section: Discussionmentioning

confidence: 99%

Cervical cancer and the HPV link: identifying areas for education in Mexico City's public hospitals

Aldrich¹,

Landis²,

García

et al. 2006

Salud pública Méx

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ResumenObjetivo. Evaluar el conocimiento y las prácticas de los proveedores de servicios de salud en la Ciudad de México sobre el cáncer cervicouterino y el virus del papiloma humano (VPH); comparar a este respecto a ginecoobstetras (GO) y médicos generales (MG). Material y métodos. En abril del 2003, 187 GO y MG empleados en 15 hospitales afiliados a la Secretaría de Salud del Distrito Federal (SSDF) completaron un cuestionario autoaplicado. Se utilizó la prueba de ji cuadrada de Pearson para evaluar las diferencias entre GO y MG. Resultados. Casi todos los participantes (93%) identificaron el VPH como la causa principal del cáncer cervicouterino. Los GO mostraron un conocimiento más detallado del VPH que los MG, con más probabilidad de haber escuchado de las cepas oncogénicas comunes del VPH (p= 0.000). Un 16% de los médicos contestó incorrectamente que los exá-menes de Papanicolaou deben realizarse cada seis meses y 17% recomendó la histerectomía como una opción de tratamiento para displasia leve o moderada. Conclusiones. Los médicos que se desempeñan en el SSDF demostraron conocimiento básico acerca de la relación entre el cáncer cervicouterino y el VPH. Sin embargo, las normas relativas al tamizaje y manejo son áreas prioritarias para las intervenciones educativas dirigidas a esta población. AbstractObjective. To assess Mexico City physicians' knowledge and practices regarding cervical cancer and human papillomavirus (HPV) to compare obstetricians/gynecologists (ob/gyns) and general practitioners (GPs) on these variables. Material and Methods. In April 2003, 187 ob/gyns and GPs working in 15 hospitals affiliated with the Federal District Secretary of Health (SSDF) completed a self-administered questionnaire. Pearson's chi-square tests were used to compare ob/ gyns and GPs on outcome variables. Results. Nearly all providers (93%) identified HPV as the principal cause of cervical cancer. Ob/gyns had more detailed knowledge about HPV than GPs and were more likely to have heard of common oncogenic strains (p=.000). Sixteen percent of all physicians incorrectly stated that Pap tests should be performed every six months regardless of previous results, and 17% recommended hysterectomy as an option for treating mild or moderate dysplasia. Conclusions. While SSDF physicians had basic knowledge about the cervical cancer-HPV link, screening and management norms are priority areas for educational interventions.

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Improving cervical cancer screening in Mexico: results from the Morelos HPV Study

Cited by 41 publications

References 59 publications

Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women

Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women

Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting

Cervical cancer and the HPV link: identifying areas for education in Mexico City's public hospitals

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