Cytological early detection of cervical carcinoma: possibilities and limitations. Analysis of failures

Möbius, G

doi:10.1007/bf01686460

Cited by 17 publications

(12 citation statements)

References 21 publications

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“…We forecast that a policy of HPV testing for women with mildly abnormal smears would have little effect on the overall incidence of invasive cancer when compared with a policy of repeat cytology. Onc reason for this is that our analysis rcflccts the substantial proportion of invasivc cancer known to occur in unscreened or inadequately screened women (Wain et al, 1992;Mobius, 1993;Herrero et al, 1992). Enhancing the screening process without increasing coverage will thus have no effect on many cancers.…”

Section: Discussionmentioning

confidence: 99%

Can papilloma virus testing be used to improve cervical cancer screening?

1996

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This report investigates different options for using human papillomavirus (HPV) testing in cervical cancer prevention. These options are evaluated by a stochastic model of the progression of pre-malignancy and its relationship to HPV infection. Three screening policies are compared: 2 based on cytological screening, with or without HPV testing, and I in which HPV testing is the primary screening method. A policy of HPV testing for women with mildly abnormal smears would have little effect on the overall incidence of invasive cancer when compared with a policy of repeat cytology, provided follow-up is efficient. Moreover, the potential value of HPV testing as a primary screening method is strongly dependent on the proportion of neoplasias that are HPV-negative. Important factors in assessing the future role of HPV testing would be cost-effectiveness and benefits from improved compliance.Cervical screening is effective in reducing cervical cancer mortality but expensive, complex to organisc and often considered inefficient (Benedet et al., 1992; Smith et al., 1989;Herbst et al., 1992). Detection of human papillomavirus (HPV) DNA in exfoliated cervical cells offers a potentially automatic and cheap diagnostic test without the subjectivity and sampling problems of cervical cytology or the expense of colposcopy. Clinical series and case-control studies have shown a very strong association between HPV types 16, 18, 31 and 33 and cervical cancer, supported by a dose-response relationship for HPV 16 and an increased rate of progression to more advanced pre-cancer among HPV 16/18-positive women (Mufioz and Bosch, 1992). The common genital papillomaviruses have been divided into risk groups for progressive pre-cancer and invasive cancer, and a set of HPV types detected by PCR has been associated with at least 93% of, and possibly all, cervical cancer (Bosch et al., 1995;Meijer et al., 1992).HPV testing may have future application either in the management of women with mild cytological abnormalities, improving the sensitivity of cytology for high-grade pre-cancer (Cuzick et al., 1995;Cox et al., 1995), or as an alternative screening test (Meijer et al., 1992). An overview of the likely impact of HPV testing is important to direct research on HPV detection technology and its application in practice. However, to determine appropriate investigations is not simple since cytology, colposcopy and HPV tests can be combined sequentially in many complex ways as part of a screening programme. There is still uncertainty about the prevalence and natural history of HPV infections and their relation to cervical pre-cancer, as wcll as the accuracy and sequential use of HPV tests. There are also many variations in possible screening intervals, coverage and follow-ups.We have previously described a mathematical model of the development and progression of pre-cancer (Sherlaw-Johnson et al., 1994). This was used to compare colposcopic with cytological management of mildly abnormal smears under a wide range of variations in natural history...

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Section: Discussionmentioning

confidence: 99%

Can papilloma virus testing be used to improve cervical cancer screening?

1996

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“…Interestingly and significantly, the incidence of cervical carcinoma before screening was much higher in former West Germany as well as in former East Germany than in almost all other European countries [9,10]. In the State of Mecklenburg-Vorpommern, part of former East Germany, the incidence was very high: 38.9 per 100,000 women in 1969 [11], i.e. 2–3 times higher than the figures in Finland, England or Sweden (fig.…”

Section: Discussionmentioning

confidence: 99%

Persistent Carcinoma in Cervical Cancer Screening: Non-Participation Is the Most Significant Cause

Marquardt

Büttner

Broschewitz³

et al. 2011

Acta Cytologica

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Objective: It was the aim of this study to determine the screening history of all invasive cervical carcinomas between 2004 and 2009 in one of the Federal States of Germany. Study Design: The pooled data sets of all in-state laboratories, corrected and supplemented by data of the State Cancer Registry, were used. The screening histories of all patients, their age and tumor types were collated and analyzed. Results: Of 617 patients with invasive carcinoma of the cervix, 373 (60%) had not had a cervical smear within the past 5 years. In 188 patients (31%), an incomplete screening history was found, whereas only 9% of women had participated regularly. In non-participants, late tumor stages (stage T1B and higher) were predominant and found in 86%. In contrast, in the group with regular screening histories more than half of all cases (54%) were microinvasive carcinomas (stage T1A) with excellent prognosis. Lack of follow-up or refusal of treatment by patients played a minor yet significant role. Conclusions: Non-participation is still by far the most common reason for persistent cases of cervical carcinoma in the German screening program.

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“…1 Considerable attention has been focused on specific shortcomings of the Pap test despite its population-based successes. 2 Errors in sampling, preparation, and screening account for the majority of false-negative Pap results. The development of new sampling devices, slide preparation technologies, automated screening devices, and molecular methods such as high-risk human papillomavirus (HPV) detection are a response to some of these limitations.…”

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confidence: 99%