Cervical Cancer Screening: Is the Age Group 30–65 Years Optimum for Screening in Low-Resource Settings?

Sharda, Akhileshwar; Kumar, Dinesh; Fulzele, Rajshree; Dwivedi, Reena; Gupta, Sanjay

doi:10.1007/s13224-021-01479-w

Cited by 4 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings revealed that patients over the age of 50 had a higher risk value for ECC (H +) > CDB, aligning with the previous clinical report [20]. From a cost-benefit perspective, Shepherd et al also suggested routine ECC for individuals over 50 [19], whereas mainstream studies questioned the value of routine ECC in younger women, excluding those aged 21-29 might result in the underdiagnosis of approximately 19% of HSIL cases [40]. This suggested that the possibility of additional HSIL + detection through ECC should not be overlooked in younger women, and personalized prediction and management based on other risk factors were necessary.…”

Section: Comparison With Previous Studiessupporting

confidence: 89%

PAX1 methylation as a robust predictor: developing and validating a nomogram for assessing endocervical curettage (ECC) necessity in human papillomavirus16/18-positive women undergoing colposcopy

Lu,

Wu,

et al. 2024

Clin Epigenet

View full text Add to dashboard Cite

Objective The major challenge in routine endocervical curettage (ECC) among Human Papillomavirus (HPV) 16/18-positive patients is that only a small fraction benefit. Nevertheless, current reported models often overestimate the validity and necessity of ECC, making it difficult to improve benefits for patients. This research hypothesized that assessing paired boxed gene 1 methylation levels (PAX1m) and clinical characteristics could enhance the predictive accuracy of detecting additional high-grade squamous intraepithelial lesions or worse (HSIL +) through ECC that were not identified by colposcopy-directed biopsy (CDB). Methods Data from 134 women with HPV16/18 positivity undergoing CDB and ECC between April 2018 and April 2022 were collected and analyzed. Quantitative methylation-specific polymerase chain reaction (qMSP) was utilized to measure PAX1m, expressed as ΔCp. Univariate and multivariate regression analyses were conducted to screen variables and select predictive factors. A nomogram was constructed using multivariate logistic regression to predict additional HSIL + detected by ECC. The discrimination, calibration, and clinical utility of the nomogram were evaluated using receiver operating characteristic curves (ROC) and the calibration plot. Results Age (odds ratio [OR], 5.654; 95% confidence interval [CI], 1.131–37.700), cytology (OR, 24.978; 95% CI, 3.085–540.236), and PAX1 methylation levels by grade (PAX1m grade) (OR, 7.801; 95% CI, 1.548–44.828) were independent predictive factors for additional detection of HSIL + by ECC. In HPV16/18-positive women, the likelihood of additional detection of HSIL + through ECC increased with the severity of cytological abnormalities, peaking at 43.8% for high-grade cytological lesions. Moreover, when cytological findings indicated low-grade lesions, PAX1 methylation levels were positively correlated with the additional detection of HSIL + by ECC (P value < 0.001). A nomogram prediction model was developed (area under curve (AUC) = 0.946; 95% CI, 0.901–0.991), demonstrating high sensitivity (90.9%) and specificity (90.5%) at the optimal cutoff point of 107. Calibration analysis confirmed the model’s strong agreement between predicted and observed probabilities. Conclusion The clinical nomogram presented promising predictive performance for the additional detection of HSIL + through ECC among women with HPV16/18 infection. PAX1 methylation level could serve as a valuable tool in guiding individualized clinical decisions regarding ECC for patients with HPV 16/18 infection, particularly in cases of low-grade cytological findings.

show abstract

Section: Comparison With Previous Studiessupporting

confidence: 89%

PAX1 methylation as a robust predictor: developing and validating a nomogram for assessing endocervical curettage (ECC) necessity in human papillomavirus16/18-positive women undergoing colposcopy

Lu,

Wu,

et al. 2024

Clin Epigenet

View full text Add to dashboard Cite

show abstract

“…12,13 In India, the frequency of abnormal biopsies in women > 65 years old was also high (47.3%), demonstrating a higher frequency of cervical alterations among older women who continue the screening, corroborating the present study. 14 When analyzing biopsies from 15 women with premalignant lesions, only 18.7% had followed the guidelines; among 10 cases of SCC, only 1 had followed the protocols, although all cases of adenocarcinomas had improper screening history. For glandular lesions, the difficulty in representing endocervical cells, especially among older women with some grade of retraction, may explain the screening not being performed appropriately.…”

Section: Discussionmentioning

confidence: 99%

“… 12 13 In India, the frequency of abnormal biopsies in women > 65 years old was also high (47.3%), demonstrating a higher frequency of cervical alterations among older women who continue the screening, corroborating the present study. 14 …”

Section: Discussionmentioning

confidence: 99%

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

Zago,

Camilo-Júnior,

D'Ávilla

et al. 2023

Rev Bras Ginecol Obstet

View full text Add to dashboard Cite

Objective To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not. Methods The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not. Results Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188–15.932; p = 0.0002). Conclusion Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.

show abstract

“…Con respecto a la edad óptima para iniciar y finalizar la tamización, se ha demostrado que, si bien la mayoría de las lesiones cervicales significativas se detectan en el grupo de edad de 30 a 65 años, es probable que alrededor del 19 % de las lesiones escamosas de alto grado (ASC-H/LIEAG) y el 13 % de las lesiones glandulares (AGC-NOS /AGC-FN) se pasen por alto si se excluyen de la tamización mujeres menores de 30 y mayores de 65 años. Por lo tanto, se recomienda, especialmente en entornos de bajos recursos, que el costo de la detección incurrida al incluir estos grupos de edad debe sopesarse frente a los beneficios ofrecidos 5 .…”

unclassified

Respuesta a: “Comentarios acerca del artículo “Tamización primaria con prueba ADN-VPH en mujeres menores de 30 años: evaluación de tecnología sanitaria””

Garzón-Olivares

Grillo‐Ardila

Amaya-Guío

2023

Rev. colomb. obstet. ginecol.

View full text Add to dashboard Cite

Carta al editor de marzo de 2023Sr. Editor. Agradecemos los comenatrios realizados en la carta al editor enviada por los doctores Campos-Ponce, Castro-Mamani y Ocaña-Fernández, sin embargo, quisiéramos hacer algunas consideraciones a lo allí expresado.El cáncer de cuello uterino (CCU) ocupa el cuarto lugar en incidencia y mortalidad por cáncer en mujeres menores de 30 años en el mundo. Para el año 2020, según la Agencia Internacional de Investigación sobre el Cáncer (IARC, por sus siglas en inglés), se reportaron 22.884 casos nuevos y 5.297 muertes en este grupo etario (tasas de incidencia ajustadas, TIa) de 1,1 y 0,26 por 100.000 mujeres, respectivamente). Para el mismo año, las tasas de incidencia y mortalidad reportadas fueron mayores para Latinoamérica y el Caribe, (2,0 por 100.000 y 0,42 por 100.000 respectivamente) (1).Para la detección del CCU se dispone, actualmente, de estrategias basadas en la citología, la prueba de ADN del VPH o la inspección visual con acético (VIA). Las tres pruebas han demostrado su utilidad

show abstract

Cervical Cancer Screening: Is the Age Group 30–65 Years Optimum for Screening in Low-Resource Settings?

Cited by 4 publications

References 12 publications

PAX1 methylation as a robust predictor: developing and validating a nomogram for assessing endocervical curettage (ECC) necessity in human papillomavirus16/18-positive women undergoing colposcopy

PAX1 methylation as a robust predictor: developing and validating a nomogram for assessing endocervical curettage (ECC) necessity in human papillomavirus16/18-positive women undergoing colposcopy

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

Respuesta a: “Comentarios acerca del artículo “Tamización primaria con prueba ADN-VPH en mujeres menores de 30 años: evaluación de tecnología sanitaria””

Contact Info

Product

Resources

About