Cost-Effectiveness of Rescreening Conventionally Prepared Cervical Smears by PAPNET Testing

Schechter, Clyde B.

doi:10.1159/000334021

Cited by 35 publications

(17 citation statements)

References 5 publications

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“…Most concluded that cervical cancer screening in the general population is cost-effective. The average ICER ranged between $25,000 and $50,000/LYS with biennial and triennial screening (43,44). The cost-effectiveness of cervical cancer screening among renal transplant recipients has not been assessed.…”

Section: Cervical Cancer Screeningmentioning

confidence: 99%

Cancer Screening in Renal Transplant Recipients

Wong

Chapman

Craig

2008

Clinical Journal of the American Society of Nephrology

106

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Increased cancer risk is well established in the renal transplant population. Little, however, is known about the benefits and harms of cancer screening, treatment effectiveness, and the overall cancer prognosis in renal transplant recipients. In this study, we critically appraised guidelines for cancer screening in the renal transplant and general populations using standard criteria for an evidence-based screening program. Guidelines were included when they were applied to adult participants, had objectives specific to cancer screening, and were written in English. Recommendations for breast and colorectal cancer screening in the general population were supported by evidence of cancer-specific mortality benefits from randomized, controlled trials of cancer screening. Convincing evidence from observational studies had demonstrated population cervical cancer screening was effective, also, test performance of mammography, faecal occult blood testing, and Pap smear were accurate. Population breast, colorectal, and cervical cancer screening also appeared to be good value for money in the general population. On the contrary, recommendations for cancer screening in renal transplant recipients were entirely extrapolated from data in the general population. Studies in the general population have led to the development of cancer screening guidelines in transplant recipients. Because of increased cancer risk, differences in diagnostic test performance, competing risks for deaths from causes such as cardiovascular disease and reduced overall life expectancies, validity of their recommendations are uncertain. Future studies are needed to address these issues to provide the necessary evidence for informed decision-making.

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Section: Cervical Cancer Screeningmentioning

confidence: 99%

Cancer Screening in Renal Transplant Recipients

Wong

Chapman

Craig

2008

Clinical Journal of the American Society of Nephrology

106

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“…This leads to repeated cytological testing, unnecessary and more invasive clinical investigation and possible overtreatment, and thus represents both an unnecessary burden for women participating in cervical screening programs and tremendous additional costs. 4,14,15 Due to these limitations, there is a strong demand for additional, more sensitive and specific markers to improve cervical cancer screening programs. 15,16 In women with abnormal smears, histological analysis of biopsy samples is used to establish the definitive diagnosis of the underlying lesion.…”

mentioning

confidence: 99%

Overexpression of p16INK4A as a specific marker for dysplastic and neoplastic epithelial cells of the cervix uteri

et al. 2001

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Cytological screening for cervical cancer or its precursors using Papanicolaou's smear test (Pap test) has been highly efficient to reduce the morbidity and mortality of cervical cancer. However, evaluation of the Pap test relies on subjective diagnostic parameters and is affected by a high rate of false-positive and false-negative results. More objective diagnostic parameters to identify truly dysplastic or neoplastic cells in cervical smears as well as in cervical biopsy samples would therefore avoid insecurity for many patients and the high screening costs associated with repeated testing. Cervical dysplasia is induced by persistent infections through highrisk types of human papillomaviruses (HPVs). Outgrowth of dysplastic lesions is triggered by increasing expression of two viral oncogenes, E6 and E7, which both interact with various cell cycle-regulating proteins. Among these is the retinoblastoma gene product pRB, which is inactivated by E7. pRB inhibits transcription of the cyclin-dependent kinase inhibitor gene p16 INK4a . Increasing expression of the viral oncogenes in dysplastic cervical cells might thus be reflected by increased expression of p16 INK4a . In line with this hypothesis, we observed marked overexpression of p16 INK4a in all cervical intraepithelial neoplasm (CIN) I lesions (n ‫؍‬ 47) except those associated with low-risk HPV types (n ‫؍‬ 7), all CIN II lesions (n ‫؍‬ 32), all CIN III lesions (n ‫؍‬ 60) and 58 of 60 invasive cervical cancers. In contrast, no detectable expression of p16 INK4a was observed in normal cervical epithelium (n ‫؍‬ 42), inflammatory lesions (n ‫؍‬ 48) and low-grade cervical lesions (CIN I) associated with low-risk HPV types (n ‫؍‬ 7). Dysplastic cells could also be identified in cervical smears using a specific p16 INK4a monoclonal antibody. These data demonstrate that p16 INK4a is a specific biomarker to identify dysplastic cervical epithelia in sections of cervical biopsy samples or cervical smears.

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“…The detection of a few additional positive cases by nnbt carries a relatively high cost although one that is comparable to that of other quality control (QC) procedures. 15,16 We also showed that nnbt is useful in detecting interpretation errors. To our knowledge, this is the first time that such a study has been performed.…”

Section: Discussionmentioning

confidence: 74%