Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): a community-based randomised controlled trial

Lazcano‐Ponce, Eduardo; Lörincz, Attila T.; Cruz-Valdéz, Aurelio; Salmerón, Jorge; Uribe, Patricia Martínez; Velasco-Mondragón, Eduardo; Nevarez, P Hernández; Acosta, Rodrigo; Hernández-Ávila, Mauricio

doi:10.1016/s0140-6736(11)61522-5

Cited by 190 publications

(169 citation statements)

References 27 publications

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“…Previous studies have shown that self-sampling can increase the participation rate in population-based screening and allows the efficient detection of CIN2/ 3þ lesions (33)(34)(35)(36)(37)(38). Because triage by methylation markers is possible on the same sample used for hrHPV testing, this would obviate the need of additional visits to the physician for cytology triage (12).…”

Section: Discussionmentioning

confidence: 99%

Methylation Analysis of the FAM19A4 Gene in Cervical Scrapes Is Highly Efficient in Detecting Cervical Carcinomas and Advanced CIN2/3 Lesions

Strooper

Meijer

Berkhof

et al. 2014

Cancer Prevention Research

102

147

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Primary testing for human papillomavirus (HPV) in cervical screening requires triage to differentiate women with transient infection from those with persistent infection who require more intensive management given their risk for cervical (pre)cancer. In this study, the clinical performance of a novel methylation marker FAM19A4 for the triage of high-risk (hr)HPV-positive women was evaluated. Using a trainingvalidation set approach, we analyzed a FAM19A4 quantitative methylation-specific PCR (qMSP). The training set comprised hrHPV-positive cervical scrapes of 43 women with cervical intraepithelial neoplasia grade 3 or worse (CIN3þ) and 135 women with CIN1. The validation set comprised hrHPV-positive cervical scrapes of 52 women with CIN2þ, including 33 CIN3þ, 19 CIN2, and 166 women with CIN1. The methylation threshold of FAM19A4 qMSP that gave rise to CIN3þ specificity of 70% in the training set was applied in the validation set. This resulted in CIN3þ sensitivity of 75.8% [95% confidence interval (CI), 61.1-90.4] at 67.0% (95% CI, 60.3-73.8) specificity. Next, the validated qMSP was applied to an independent series of hrHPV-positive cervical scrapes of 22 women with cervical cancer, 29 with advanced CIN2/3 [i.e., women with a known preceding hrHPV infection (PHI) lasting !5 years as proxy of longer duration of lesion existence], and 19 with early CIN2/3 (i.e., PHI <5 years). All carcinomas (22/22) and advanced CIN2/3 lesions (29/29) were FAM19A4 methylation-positive, compared with 42.1% (8/19; 95% CI, 19.9-64.3) of early CIN2/3 lesions. In conclusion, FAM19A4 is an attractive triage marker for hrHPVpositive women, with a high reassurance for the detection of cervical carcinoma and advanced CIN2/3 lesions. Cancer Prev Res; 7(12); 1251-7. Ó2014 AACR.

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Section: Discussionmentioning

confidence: 99%

Methylation Analysis of the FAM19A4 Gene in Cervical Scrapes Is Highly Efficient in Detecting Cervical Carcinomas and Advanced CIN2/3 Lesions

Strooper

Meijer

Berkhof

et al. 2014

Cancer Prevention Research

102

147

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“…Randomized controlled trials [12][13][14][15][16][17][18][19][20][21] found participation in cervical screening to be significantly higher if women were sent an HPV self-sampling kit rather than an invitation letter for a Pap test, though participation rates in self-sampling arms of the trials varied widely between countries. Studies have also shown self-sampling to be generally acceptable to women, athough uncertainty about performing the sampling correctly, or confidence in the physician's procedure, was a concern observed across cultural, religious, and ethnic groups.…”

mentioning

confidence: 99%

Self-sampling for cervical screening: Could it overcome some of the barriers to the Pap test?

2014

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Objectives: To determine which groups of women would be most likely to take part in self-sampling for cervical screening, and what they perceive as the key barriers and benefits to self-sampling. Methods: A random sample of 3000 women aged 18-69 in Victoria, Australia, were asked questions about ''taking their own Pap test'' in a telephone survey about cervical screening; 2526 answered the questions about self-sampling. The terminology ''Pap test'' was used in questions, due to the very low understanding of HPV and its link to cervical cancer. Results: One-third of women (34.0%) indicated they would prefer to self-sample, 57.2% would not and 8.7% were unsure. Preference for self-sampling was significantly stronger among women who had not had a Pap test for more than three years (64.8%, p < .001) or who had never had one (62.1%, p < .001), compared with those up-to-date (27.0%). Convenience was a key benefit (37.8%), as was less embarrassment (31.5%). For those who did not want to self-sample or were unsure, key factors included professionals being more skilled (53.4% and 28.2% respectively), and doubts about being able to do it properly (28.9% and 23.6%). Conclusions: Self-sampling was most popular among women who needed to have a Pap test, and could potentially reach some women who are not participating appropriately in cervical screening. Key barriers to participation could be addressed by providing information about the test being for HPV, and being easier to do properly than a Pap test.

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“…Furthermore, new technologies can be applied to vaginal self-collected samples, which may increase participation in cervical cancer screening. Evidence is accumulating in the region with positive indications for the application of self-sampling in large communities of low resource settings (18)(19)(20).…”

Section: New Screening Toolsmentioning

confidence: 99%

Cervical Cancer in Latin America and the Caribbean: The Problem and the Way to Solutions

Villa

2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Latin America and the Caribbean have one of the highest incidence and mortality rates from cervical cancer in the world. In this region, age-adjusted incidence rates range from 20 to 80 per 100,000 women per year. Overall, the mortality rates are extremely high in spite of the availability of Pap screening in several countries. Women from lower socioeconomic status, often less educated, are unaware of cervical cancer screening or have no access to it. Despite the efforts to reorganize screening programs in the region, in a few countries, only a slight decrease in cervical cancer mortality has been observed. New modalities for primary and secondary screening should be evaluated and disseminated, including HPV testing and vaccination against the most common HPV types. HPV prophylactic vaccines were approved in most Latin American countries, but only few are considering its implementation in national immunization programs. Besides cost and other logistical issues, lack of recommendation by policy makers or lawmakers is deterring the introduction of HPV vaccines in the region. Furthermore, studies conducted in the region have indicated that HPV vaccination only or vaccination supplemented with screening may be considered a cost-effective strategy to reduce mortality by cervical cancer. Cancer Epidemiol Biomarkers Prev; 21(9); 1409-13. Ó2012 AACR.

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Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): a community-based randomised controlled trial

Cited by 190 publications

References 27 publications

Methylation Analysis of the FAM19A4 Gene in Cervical Scrapes Is Highly Efficient in Detecting Cervical Carcinomas and Advanced CIN2/3 Lesions

Methylation Analysis of the FAM19A4 Gene in Cervical Scrapes Is Highly Efficient in Detecting Cervical Carcinomas and Advanced CIN2/3 Lesions

Self-sampling for cervical screening: Could it overcome some of the barriers to the Pap test?

Cervical Cancer in Latin America and the Caribbean: The Problem and the Way to Solutions

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