Medicolegal Affairs

Frable, William J.; Austin, R. Marshall; Greening, Shirley E.; Collins, Robert J.; Hillman, Roger L.; Kobler, Terry Paul; Koss, Leopold G.; Mitchell, Heather; Percy, Ron; Rosenthal, Dorothy L.; Sidoti, Mark S.; Somrak, Theresa M.

doi:10.1159/000331537

Cited by 36 publications

(9 citation statements)

References 10 publications

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“…6 False negatives can have detrimental consequences on women who receive cervical screening, and it is crucial to determine what represents acceptable false-negative rates within programs. 7,8 This is further complicated by legal standards in the United Kingdom and Ireland requiring that screeners have "absolute confidence" in negative tests. 9,10 However, screening tests are far from perfect, 11 and while HPV testing is more sensitive than liquid-based cytology (LBC), the decreased specificity and potential for increased incidence of false-positive cases increases the potential for unnecessary and possibly deleterious interventions.…”

Section: Introductionmentioning

confidence: 99%

“…False negatives can have detrimental consequences on women who receive cervical screening, and it is crucial to determine what represents acceptable false-negative rates within programs . This is further complicated by legal standards in the United Kingdom and Ireland requiring that screeners have “absolute confidence” in negative tests .…”

Section: Introductionmentioning

confidence: 99%

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Modeling Cervical Cancer Screening Strategies With Varying Levels of Human Papillomavirus Vaccination

et al. 2021

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IMPORTANCE Cervical cancer screening is a lifesaving intervention, with an array of approaches, including liquid-based cytology (LBC), molecular testing for human papillomavirus (HPV) infection, and combinations via parallel cotesting or sequential triage. Maximizing screening efficacy while minimizing overtreatment is vital, especially when considering how the HPV vaccine will affect the interpretation of results. OBJECTIVES To estimate the likely outcomes of different screening modalities and to model how the increasing uptake of the HPV vaccine could affect the interpretation of screening results. DESIGN, SETTING, AND PARTICIPANTS This decision analytic model established a simple Markov model to compare the outcomes of different cervical cancer screening modalities on a simulated population of women (aged Ն25 years), considering different levels of HPV vaccination. MAIN OUTCOMES AND MEASURES The number of cases of cervical intraepithelial neoplasia (CIN) grade 2 and 3 detected and missed, the number of false positives, and the number of tests required to achieve a given level of accuracy. Positive and negative predictive values of different modalities were simulated under varying levels of HPV vaccination and therefore HPV prevalence. RESULTS In a simulated population of 1000 women aged 25 years and older with an HPV prevalence of 2%, HPV-based modalities outperformed LBC-based approaches, detecting 19% more true positives (HPV test sensitivity, 89.9% [95% CI, 88.6%-91.1%]; LBC test sensitivity, 75.5% [95% CI, 66.6%-82.7%]). While cotesting markedly reduced missed cases, detecting 29% more true positives than LBC alone (19.5 [95% CI, 19.3-19.7] per 1000 women screened vs 15.1 [95% CI, 13.3-16.5] per 1000 women screened), it unacceptably increased excess colposcopy referral by 94% (184.4 [95% CI, 181.8-188.0] false positives per 1000 women screened vs 95.1 [95% CI, 93.1-97.0] false positives per 1000 women screened). By contrast, triage testing with reflex screening substantially reduced false positives by a factor of approximately 10 (eg, HPV with LBC triage, 9.6 [95% CI, 9.3-10.0] per 1000 women screened). Over a lifetime of screening, reflex approaches with appropriate test intervals maximized therapeutic efficacy; as HPV vaccination rates increased, HPV-based screening approaches resulted in fewer unnecessary colposcopies than LBC approaches (HPV testing, 80% vaccine coverage: 44.1 [95% CI, 40-45.9] excess colposcopies; LBC testing, 80% vaccine coverage: 96.9 [95% CI, 96.8-97.0] excess colposcopies). CONCLUSIONS AND RELEVANCEIn this decision analytic model, the effectiveness of cervical cancer screening was dependent on the prevalence of cervical dysplasia and/or HPV infection or vaccination in a population as well as the sensitivity and specificity of various modalities. Although screening is lifesaving, overtesting or modalities inappropriate to the target population may cause significant harm, including overtreatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Modeling Cervical Cancer Screening Strategies With Varying Levels of Human Papillomavirus Vaccination

et al. 2021

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“…Os números de falso-negativos e falso-positivos aumentam em pacientes com mais de 40 anos de idade. Nas citologias inconclusivas, admite-se que 40% a 80% das pacientes são submetidas a colposcopias desnecessárias (GAY et al, 1985;FRABLE, AUSTIN, GREENING, 1998;APGAR & BROTZMAN, 1999;MORIN et al, 2000).…”

Section: Um Grupo De Citologistas Americanos Dounclassified

“…Diante desses dados, aumentou-se muito a preocupação com a garantia de qualidade dos laboratórios, intensificando melhorias nas técnicas de exame, nos critérios citológicos analisados e releitura de lâminas. Nos EUA foram estabelecidas normas com o objetivo de melhorar o desempenho dos laboratórios (FRABLE et al, 1998;VACHER-LAVENU, 2000). No Brasil ainda não existem regulamentações específicas, porém, a necessidade de um programa de controle de qualidade já é reconhecida pelas entidades da área (MENDONÇA, 1998).…”

Section: Um Grupo De Citologistas Americanos Dounclassified

Comparação entre a repetição da colpocitologia oncologica com leitura por diferentes observadores e a captura hibrida II no diagnostico histologico de NIC 2 e/ou 3

Santos¹,

Derchain²

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“…Muitas vezes os processos inflamatórios e a metaplasia imatura geram confusão na interpretação. Além disso, os números de falso-negativos e falso-positivos aumentam em pacientes com mais de 40 anos de idade (FERENCZY et al, 1997;FRABLE et al, 1998).…”

Section: Introductionunclassified

Teste de DNA-HPV por captura hibrida II e colpocitologia oncologica no diagnostico e seguimento de mulheres com lesões de baixo grau no colo uterino

Santos¹,

Derchain²

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Dedico esta tese ... ... ao meu pai, por tudo que representou e representa na minha vida, como homem e profissional. ... à minha mãe, pelo amor e berço como base para a vida. ...à minha filha, pelo sentido e objetivo de viver. ... à minha esposa, pelo apoio, companheirismo e paciência. ... à minha orientadora, Profa Sophie, pelo exemplo, incentivo, aprendizado e resgate do sentido da profissão médica, ensino, pesquisa e como pessoa em meio a tantas adversidades e inversão de valores em nosso país. v Agradecimentos

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Medicolegal Affairs

Cited by 36 publications

References 10 publications

Modeling Cervical Cancer Screening Strategies With Varying Levels of Human Papillomavirus Vaccination

Modeling Cervical Cancer Screening Strategies With Varying Levels of Human Papillomavirus Vaccination

Comparação entre a repetição da colpocitologia oncologica com leitura por diferentes observadores e a captura hibrida II no diagnostico histologico de NIC 2 e/ou 3

Teste de DNA-HPV por captura hibrida II e colpocitologia oncologica no diagnostico e seguimento de mulheres com lesões de baixo grau no colo uterino

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