Protecting the underscreened women in developed countries: the value of HPV test

Ibáñéz, Raquel Sanchez; Autonell, Josefina; Sardà, Montserrat; Crespo, Nayade; Piqué, Pilar; Pascual, Alfons; Marti, Carmen Gonzalez; Fibla, Montserrat; Gutiérrez, Cristina; Lloveras, Belén; Moreno-Crespi, Judit; Torrent, Anna; Baixeras, Núria; Alejo, María; Bosch, F. Xavier; Sanjosé, Sílvia de

doi:10.1186/1471-2407-14-574

Cited by 17 publications

(20 citation statements)

References 32 publications

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“…We have now an ongoing program to actively identify this population [ 5 ]. A recent evaluation of this strategy [ 29 ] showed that underscreened women had a high burden of cervical disease. Attempts to extend these initiatives into an organized activity are undergoing [ 30 ] a randomized trial inviting these women to participate in the screening program.…”

Section: Discussionmentioning

confidence: 99%

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions

Ibáñéz

Alejo

Combalía

et al. 2015

BioMed Research International

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Objective. Audit of women with invasive cervical cancer (CC) is critical for quality control within screening activities. We analysed the screening history in the 10 years preceding the study entry in women with and without CC during 2000–2011. Methods. 323 women with CC from six pathology departments in Catalonia (Spain) and 23,782 women with negative cytology were compared. Age, previous history of cytologies, and histological type and FIGO stage were collected from the pathology registries. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%). Results. History of cytology was registered in 26.2% of CC cases and in 78% of the control women (P < 0.0001) and its frequency decreased with increasing age. Compared to women with squamous cell carcinoma, adenocarcinoma cases were significantly more likely to have a cytology within the 3-year interval preceding cancer diagnosis (OR = 2.6 CI 95%: 1.2–5.6) and to have normal cytology results in previous screenings (OR = 2.4 CI 95%: 1.2–4.5). FIGO II–IV cases were more common among older women (older than 60 years). Conclusions. Absence of prior screening history was extremely common among CC cases compared to controls. Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.

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Section: Discussionmentioning

confidence: 99%

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions

Ibáñéz

Alejo

Combalía

et al. 2015

BioMed Research International

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“…The laboratories included were Hospital Universitario Dr. Josep Trueta, Consorcio hospitalario de Vic, Hospital Universitario Joan XXIII, Hospital del Mar, Hospital universitario de Bellvitge, Hospital de Granollers, Hospital de Althaia, and Laboratorio de Atención Primaria Dr. Robert. The main outcome was histological confirmation of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) [ 10 , 11 ]. The risk of CIN2+ was evaluated following a Kaplan–Meier approaches.…”

Section: Methodsmentioning

confidence: 99%

“…The evaluation of cotesting was performed on a group of 1,832 underscreened women with a mean age of 54.1 years (range 40–88 years) [ 10 ]. The majority (92.4%) had both negative screening tests and 338 women were recommended to stop screening for being over 65 years old with a negative cotesting.…”

Section: The Evaluation Of the Hpv Testmentioning

confidence: 99%

Screening of cervical cancer in Catalonia 2006–2012

Sanjosé

Ibáñéz

Rodríguez-Salés

et al. 2015

ecancer

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The early detection of intraepithelial lesions of the cervix, through the periodic examination of cervical cells, has been fundamental for the prevention of invasive cervical cancer and its related mortality. In this report, we summarise the cervical cancer screening activities carried out in Catalonia, Spain, within the National Health System during 2008–2011. The study population covers over two million women resident in the area. The evaluation includes 758,690 cervical cytologies performed on a total of 595,868 women. The three-year coverage of cervical cytology among women aged between 25 and 65 years was 40.8%. About 50% of first screened women with negative results had not returned to the second screening round. The introduction of high-risk human papillomavirus DNA (HPV) detection, as a primary screening cotest with cytology among women over age 40 with a poor screening history, significantly improved the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), being far superior to cytology alone. Cotesting did not improve the detection of CIN2+. The use of the HPV test for the triage of atypical squamous cell undetermined significance (ASC-US) improved the selection of women at high risk of CIN2+.Sampling (both cytology and HPV test) was largely performed by midwives (66.7%), followed by obstetricians (23.8%) and nurses (7%). Over half of the centres (54.8%) had full use of online medical records. During the study period, educational activities for professionals and for women were carried out periodically.The organisation of screening as a population activity in which women are actively called to the screening visit and the introduction of HPV testing as a primary screening tool are strongly recommended to ensure the maximum population impact in the reduction of the cervical cancer burden.

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“…In the autonomous region of Catalonia, several actions have been implemented since 2006 to increase coverage of select populations [5]. Analysis of the Catalonian data has revealed poor regular attendance, of once screened women, and high prevalence of cervical lesions in women high poor screening history [6–7]. Some studies from Spain have reported that between 50–80% of women with invasive cervical cancer had not undergone cytology testing during the 10 years prior to their cancer diagnosis [8–10].…”

Section: Introductionmentioning

confidence: 99%

Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial

et al. 2017

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BackgroundOpportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage.MethodsThe CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a “rescue” visit as the screening visit resulting from the study invitation.ResultsAmong the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50–59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women.ConclusionsThe study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age.Trial RegistrationClinicalTrials.gov NCT01373723

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Protecting the underscreened women in developed countries: the value of HPV test

Cited by 17 publications

References 32 publications

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions

Screening of cervical cancer in Catalonia 2006–2012

Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial

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