Challenges in starting organised screening programmes for cervical cancer in the new member states of the European Union

Nicula, Florian Al.; Anttila, Ahti; Neamţiu, Luciana; Žakelj, Maja Primic; Tachezy, Ruth; Chil, Arkadiusz; Grce, Magdalena; Kesić, Vesna

doi:10.1016/j.ejca.2009.07.025

Cited by 54 publications

(35 citation statements)

References 9 publications

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“…During the period from December 2009 to August 2010, we prospectively enrolled all of the women attending the routine organized national cervical screening program within a network of 16 outpatient gynecology services with nationwide geographical coverage. In the Slovenian National Cervical Cancer Screening Program, which started in 2003, each woman between the ages 20 and 64 years is invited to have a preventive gynecological examination, together with a PAP smear once every 3 years (after two consecutive negative smears taken 1 year apart) (35). All smear and histology reports are gathered in a central database, which is linked to the Central Population Registry.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Clinical and Analytical Performance of the Abbott RealTime High Risk HPV Test to the Performance of Hybrid Capture 2 in Population-Based Cervical Cancer Screening

et al. 2011

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The clinical performance of the Abbott RealTime High Risk HPV (human papillomavirus) test (RealTime) and that of the Hybrid Capture 2 HPV DNA test (hc2) were prospectively compared in the population-based cervical cancer screening setting. In women >30 years old (n ‫؍‬ 3,129), the clinical sensitivity of RealTime for detection of cervical intraepithelial neoplasia of grade 2 (CIN2) or worse (38 cases) and its clinical specificity for lesions of less than CIN2 (3,091 controls) were 100% and 93.3%, respectively, and those of hc2 were 97.4% and 91.8%, respectively. A noninferiority score test showed that the clinical specificity (P < 0.0001) and clinical sensitivity (P ‫؍‬ 0.011) of RealTime were noninferior to those of hc2 at the recommended thresholds of 98% and 90%. In the total study population (women 20 to 64 years old; n ‫؍‬ 4,432; 57 cases, 4,375 controls), the clinical sensitivity and specificity of RealTime were 98.2% and 89.5%, and those of hc2 were 94.7% and 87.7%, respectively. The analytical sensitivity and analytical specificity of RealTime in detecting targeted HPV types evaluated with the largest sample collection to date (4,479 samples) were 94.8% and 99.8%, and those of hc2 were 93.4% and 97.8%, respectively. Excellent analytical agreement between the two assays was obtained (kappa value, 0.84), while the analytical accuracy of RealTime was significantly higher than that of hc2. RealTime demonstrated high intralaboratory reproducibility and interlaboratory agreement with 500 samples retested 61 to 226 days after initial testing in two different laboratories. RealTime can be considered to be a reliable and robust HPV assay clinically comparable to hc2 for the detection of CIN2؉ lesions in a populationbased cervical cancer screening setting.High-risk genotypes of human alpha papillomaviruses (hrHPV) are etiologically linked to virtually all cervical carcinomas and their immediate precursors-high-grade cervical intraepithelial neoplasia (CIN) lesions (49). HPV DNA testing has therefore become an important part of cervical carcinoma screening and management algorithms in several countries (reviewed in references 10 and 41). The four main clinical applications of HPV DNA testing at present are (i) triage of women with equivocal screening cytology results in order to determine which patients should be referred for colposcopy, (ii) follow-up of women with abnormal screening cytology results who are negative at initial colposcopy/biopsy, (iii) prediction of the therapeutic outcome after treatment of high-grade CIN lesion, and (iv) primary screening of women Ն30 years old in combination with the Pap smear to detect cervical cancer precursors (1, 3, 10-11, 13, 15).Several in-house and more than 35 commercial assays for the detection of hrHPV are currently available (reviewed in references 11, 40, and 44). These assays have significantly different clinical performance for high-grade CIN lesion detection and are not necessarily useful for primary screening (21, 40). The Hybrid Capture 2 HPV DNA Test (hc2; Qia...

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Section: Methodsmentioning

confidence: 99%

Comparison of Clinical and Analytical Performance of the Abbott RealTime High Risk HPV Test to the Performance of Hybrid Capture 2 in Population-Based Cervical Cancer Screening

et al. 2011

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“…Since the publication of early studies in support of cervical screening, the literature continues to be heavily dominated by European evidence and programme description. In 2003, a unanimously adopted European Union recommendation promised equal access to organised cervical screening for all women in the cervical screening target population in all EU member states [93,94] making a considerable variation in policy, practice and process performance [95] within the region all the more notable. As the most recent IARC survey highlighted, a large number of women in Europe and beyond do not have access to free Pap testing under any type of programme, including some that are organised [2,35,96].…”

Section: Discussionmentioning

confidence: 99%

‘Organised’ cervical screening 45 years on: How consistent are organised screening practices?

Williams

Carter

Rychetnik

2014

European Journal of Cancer

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Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term 'organised' is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies.

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“…Other new member countries (Czech Republic, Poland, Estonia, Lithuania, and Latvia) have already established at least partially functioning organized screening programs but are dealing with several important obstacles, such as low coverage (less than 20%) of target population within the program (22). Although cervical cancer is recognized as the most urgent public health care problem in Romania, the screening infrastructure in the country is insufficient and financial resources are less than 10% of the necessary amount (17).…”

Section: Cervical Cancer Screening Practices In Countries Of Eumentioning

confidence: 99%

Cervical Cancer Burden and Prevention Activities in Europe

Kesić

Poljak

Rogovskaya

2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Cervical cancer is an important public health care problem in Europe. The overall incidence rate of cervical cancer in Europe is 10.6 per 100,000. However, within Europe, the incidence rates significantly differ, being lower in Western Europe where prevention programs are better developed. Significantly higher are the incidence and mortality rates in Central and Eastern Europe, being in close correlation to the intensity of organized screening. Human papillomavirus (HPV) vaccines are being delivered to the low-incidence populations that already have extensive screening programs, whereas the high-incidence countries have not implemented the vaccination programs yet. The resolution of the problem of cervical cancer control in Europe will be a matter of the implementation of public health care programs across the whole continent. Cancer Epidemiol Biomarkers Prev; 21(9); 1423-33. Ó2012 AACR.

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Challenges in starting organised screening programmes for cervical cancer in the new member states of the European Union

Cited by 54 publications

References 9 publications

Comparison of Clinical and Analytical Performance of the Abbott RealTime High Risk HPV Test to the Performance of Hybrid Capture 2 in Population-Based Cervical Cancer Screening

Comparison of Clinical and Analytical Performance of the Abbott RealTime High Risk HPV Test to the Performance of Hybrid Capture 2 in Population-Based Cervical Cancer Screening

‘Organised’ cervical screening 45 years on: How consistent are organised screening practices?

Cervical Cancer Burden and Prevention Activities in Europe

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