Can the careHPV test performed in mobile units replace cytology for screening in rural and remote areas?

Lorenzi, Adriana Tarlá; Fregnani, José Humberto Tavares Guerreiro; Possati-Resende, Júlio César; Antoniazzi, Márcio; Scapulatempo‐Neto, Cristovam; Syrjänen, Stina; Villa, Luisa L.; Longatto‐Filho, Adhemar

doi:10.1002/cncy.21718

Cited by 19 publications

(26 citation statements)

References 48 publications

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“…Extracted specimens (2-5 mL of the eluted DNA) were tested for high-risk HPV DNA using the cobas HPV test (Roche Molecular Systems) run on the fully automated cobas 4800 testing platform. The cobas HPV test is a DNA test for high-risk HPV, and the results are reported in three separate channels: HPV16 individually, HPV18 individually, and a pool of 12 other high-risk HPV genotypes [11 definite high-risk, cancer-associated, HPV types (HPV31, 33,35,39,45,51,52,56,58,59, and 68) plus one possibly HPV genotype (HPV66)]. A fourth channel measures b-globin for specimen adequacy.…”

Section: Hpv Testingmentioning

confidence: 99%

Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil

Castle

Silva

Consolaro

et al. 2019

Cancer Prevention Research

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Most cervical cancers occur in women who do not participate in cervical-cancer screening. We therefore evaluated adherence to screening for clinic-based Pap testing, self-collected sampling for HPV testing, and choice of the 2 among 483 unscreened/underscreened women in Brazil. Three public Basic Health Units (BHU) were each randomly assigned to three arms: (i) Pap testing at the BHU (N ¼ 160), (ii) "Self&HPV" (self-collection for HPV testing) (N ¼ 161), and (iii) "Choice" between self-collection and HPV testing and Pap test at the local BHU (N ¼ 162). The theory-based (PEN-3 and Health Belief Model) intervention in all three arms was implemented by trained Community Health Workers (CHW) at participants' home. With the first invitation, 60.0% in the Pap arm, 95.1% [154 of 161 (95.7%) who selected Self&HPV and 0 of 1 (0.0%) a Two-sided, Fisher exact test; bolded values highlight statistical significance (P < 0.05). b Among women ages 50 and older. c Women had undergone screening in <4 years were ineligible for the study.Castle et al.

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Section: Hpv Testingmentioning

confidence: 99%

Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil

Castle

Silva

Consolaro

et al. 2019

Cancer Prevention Research

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“…The quantitative descriptive studies (n ¼ 22) measured various implementation, clinical and service-related outcomes, and generally explicitly or implicitly stated the objective of evaluating the performance of the MSU program. The nonrandomized observational studies (n ¼ 7) sought to answer more specific questions, often with respect to comparisons in screening modalities such as the effectiveness of MSU as compared with fixed clinic screening (13)(14)(15)(16); breast cancer studies comparing digital to film-screen mammography (17,18); cervical cancer studies comparing conventional Pap cytology with liquid-based Pap cytology (Pap-LBC) tests (19,20) or human papillomavirus (HPV) testing with Pap-LBC (21). Two RCTs for mammography screening sought to establish evidence of mortality reductions associated with screening (22,23).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All 10 multiphasic programs reported screening for cervical cancer. Notably, many of the cervical cancer screening studies were in low-resource settings in Brazil, Peru, South Africa, India, Thailand, and Taiwan (15,20,21,(24)(25)(26)(27). The studies report diverse outcomes of detection of precancerous cervical lesions and invasive cancer, as described in Table 3.…”

Section: Screening Tests By Cancer Sitementioning

confidence: 99%

“…Examples of operations of MSUs in regions distant from centralized services include cervical cancer screening in tents in the Andes Mountains of Peru (26); a mammography unit transported by boat and plane to reach Arctic regions in Canada (14); an MSU mammography program serving residents of 26 inhabited islands in Scotland (28); a semi-mobile colonoscopy program for high-risk individuals in South Africa residing over 500 km away from the nearest hospital (29); and MSU interventions for breast and cervical cancer in the rural interior and Amazonian states of Brazil (21,30). In addition, MSUs fill a unique niche in urban areas by targeting underscreened groups who may be within a reasonable physical proximity to a fixed clinic, but less likely to access services due costs, awareness, and perceived barriers (26,(31)(32)(33)(34)(35)(36)(37).…”

Section: Mechanisms For Increasing Delivery Access and Demand For Smentioning

confidence: 99%

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Mobile Screening Units for the Early Detection of Cancer: A Systematic Review

Greenwald

El‐Zein

Bouten

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Mobile screening units (MSUs) provide cancer screening services outside of fixed clinical sites, thereby increasing access to early detection services. We conducted a systematic review of the performance of MSUs for the early detection of cancer. Databases (MEDLINE, EMBASE, Cochrane Library, WHO Global Health Library, Web of Science, PsycINFO) were searched up to July 2015. Studies describing screening for breast, cervical, and colon cancer using MSUs were included. Data were collected for operational aspects including the performance of exams, screening tests used, and outcomes of case detection. Of 268 identified studies, 78 were included. Studies investigated screening for cancers including breast ( = 55), cervical ( = 12), colon ( = 1), and multiphasic screening for multiple cancers ( = 10). The median number of screening exams performed per intervention was 1,767 (interquartile range 5,656-38,233). Programs operated in 20 countries, mostly in North America (36%) and Europe (36%); 52% served mixed rural/urban regions, while 35% and 13% served rural or urban regions, respectfully. We conclude that MSUs have served to expand access to screening in diverse contexts. However, further research on the implementation of MSUs in low-resource settings and health economic research on cost-effectiveness of MSUs compared with fixed clinics to inform policymakers is needed. .

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“…Moreover, some of the newer HPV testing platforms have been designed with the capability to be run at the point-of-care and can be easily incorporated into health care programs aimed at the under-served. 9,10 The value of point-of-care testing is avoidance of the costs and inevitable attrition that occurs when women need to be recalled to obtain their results.…”

mentioning

confidence: 99%

The time is now to implement HPV testing for primary screening in low resource settings

Kuhn

Denny

2017

Preventive Medicine

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Unacceptable disparities in cervical cancer between richer and poorer countries persist and serve as reminders of gross disparities in access to and quality of screening services. HPV testing is well-suited to address some of the barriers to implementing adequate screening programs in low resource settings. HPV testing has considerably better sensitivity than cytology providing the same extent of safety with fewer rounds of screening. New robust HPV testing platforms require little to no skill by laboratory workers and some can be used at the point-of-care. This allows for a round of screening to be accomplished in one or two visits, reducing costs and the inevitable attrition that occurs when women need to be recalled to obtain their results. HPV testing is ideal for incorporating into the new “screen-and-treat” approaches designed to overcome limitations of conventional, multi-visit, colposcopy-based approaches to screening. Visual inspection with acetic acid (VIA) is the screening test that has been used most widely in screen-and-treat programs to date but the performance characteristics of this test are poor. HPV-based screen-and-treat is more effective in reducing disease in the population and reduces over-treatment intrinsic to this approach. HPV testing can be adapted or combined with other molecular tests to improve treatment algorithms. Infrastructure established to support VIA-based screen-and-treat can effectively incorporate HPV testing. We are poised at a critical juncture in public health history to implement HPV testing as part of primary screening and thereby improve women’s health in low resource settings.

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Can the careHPV test performed in mobile units replace cytology for screening in rural and remote areas?

Cited by 19 publications

References 48 publications

Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil

Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil

Mobile Screening Units for the Early Detection of Cancer: A Systematic Review

The time is now to implement HPV testing for primary screening in low resource settings

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