Design and methods of the evaluation of an HPV-based cervical cancer screening strategy in Mexico: the Morelos HPV study

Flores, Yvonne N.; Shah, Keerti V.; Lazcano, Eduardo; Hernández, Mauricio; Bishai, David; Ferris, Daron G.; Lörincz, Attila T.; Hernández, Pilar; Salmerón, Jorge

doi:10.1590/s0036-36342002000400007

Cited by 28 publications

(28 citation statements)

References 10 publications

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“…There is no statistically significant difference in the sensitivity between cytology and either of the two HPV tests. The specificity of cytology is significantly higher than the specificity of the self HPV test (14% higher, 95% CI of [12][13][14][15][16][17] and clinician HPV test (12%, 95% CI of [9][10][11][12][13][14]. The NPVs of cytology and the HPV tests are similar, but the PPV of cytology is higher than the PPV for the HPV tests and the CIs do not overlap.…”

Section: Test Accuracy For Diagnosis Of High-grade Diseasementioning

confidence: 99%

Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting

et al. 2007

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Objectives To compare the performance and acceptability of unsupervised self-sampling with clinician sampling for high-risk human papillomavirus (HPV) types for the first time in a UK screening setting. Setting Nine hundred and twenty women, from two demographically different centres, attending for routine cervical smear testing Methods Women performed an unsupervised HPV self-test. Immediately afterwards, a doctor or nurse took an HPV test and cervical smear. Women with an abnormality on any test were offered colposcopy.Results Twenty-one high-grade and 39 low-grade cervical intraepithelial neoplasias (CINs) were detected. The sensitivity for high-grade disease (CIN2 þ ) for the self HPV test was 81% (95% confidence interval [CI] 60-92), clinician HPV test 100% (95% CI 85-100), cytology 81% (95% CI 60-92). The sensitivity of both HPV tests to detect high-and low-grade cervical neoplasia was much higher than that of cytology , clinician test 80% [95% CI 68-88], cytology 48% [95% CI 36-61]). For both high-grade alone, and high and low grades together, the specificity was significantly higher for cytology (greater than 95%) than either HPV test (between 82% and 87%). The self-test proved highly acceptable to women and they reported that the instructions were easy to understand irrespective of educational level. Conclusions Our results suggest that it would be reasonable to offer HPV self-testing to women who are reluctant to attend for cervical smears. This approach should now be directly evaluated among women who have been non-attenders in a cervical screening programme.

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Section: Test Accuracy For Diagnosis Of High-grade Diseasementioning

confidence: 99%

Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting

et al. 2007

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“…Specimens containing the target DNA were denatured and hybridised with an HPV RNA probe cocktail (13 full-length RNA probes recognising oncogenic HPV types 16,18,31,33,35,39,45, 51, 52, 56, 58, 59 and 68). Results are expressed as the ratio of the relative light units (RLU) given by the test specimen to that given by a 1 pg/ml HPV DNA control.…”

Section: Laboratory Techniquesmentioning

confidence: 99%

“…Additionally, the Hybrid Capture II test can be automated; the results are not subject to human judgement; they have been successfully implemented in several Latin American laboratories and have shown excellent inter-laboratory agreement. 14,[27][28][29][30][31][32][33][34][35][36] There was only one insufficient sample for testing, a remarkable achievement compared to inadequate rates for cytology (5% for LBC and 11% for CC).…”

Section: Hpv Testingmentioning

confidence: 99%

Cervical screening by visual inspection, HPV testing, liquid‐based and conventional cytology in Amazonian Peru

Almonte

Ferreccio

Winkler

et al. 2007

Intl Journal of Cancer

110

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Cervical cancer is an important public health problem in many developing countries, where cytology screening has been ineffective. We compared four tests to identify the most appropriate for screening in countries with limited resources. Nineteen midwives screened 5,435 women with visual inspection (VIA) and collected cervical samples for HPV testing, liquid-based cytology (LBC) and conventional cytology (CC). If VIA was positive, a doctor performed magnified VIA. CC was read locally, LBC was read in Lima and HPV testing was done in London. Women with a positive screening test were offered colposcopy or cryotherapy (with biopsy). Inadequacy rates were 5% and 11% for LBC and CC respectively, and less than 0.1% for VIA and HPV. One thousand eight hundred eightyone women (84% of 2,236) accepted colposcopy/cryotherapy: 79 had carcinoma in situ or cancer (CIS1), 27 had severe-and 42 moderate-dysplasia on histology. We estimated a further 6.5 cases of CIS1 in women without a biopsy. Sensitivity for CIS1 (specificity for less than moderate dysplasia) was 41.2% (76.7%) for VIA, 95.8% (89.3%) for HPV, 80.3% (83.7%) for LBC, and 42.5% (98.7%) for CC. Sensitivities for moderate dysplasia or worse were better for VIA (54.9%) and less favourable for HPV and cytology. In this setting, VIA and CC missed the majority of high-grade disease. Overall, HPV testing performed best. VIA gives immediate results, but will require investment in regular training and supervision. Further work is needed to determine whether screened-positive women should all be treated or triaged with a more specific test. ' 2007 Wiley-Liss, Inc.Key words: Pap smear; hybrid capture; low-resource settings; clinical trial; screening Cervical cancer is the commonest female cancer, a major cause of death and an important public health problem in many developing countries. 1 Screening by routine cytology, using Papanicolaou stain (Pap), has had a major impact on cervical cancer rates in many developed countries, but not in any developing country despite its widespread use. 2-4 A number of other cervical screening tests have been proposed. Here, we wanted to identify the most appropriate test for use in developing countries with high rates of cervical cancer and limited resources.In Peru, as in most Latin American countries, cervical cancer is usually detected in an advanced incurable stage, despite widespread use of cytology screening. 5,6 Others have documented numerous problems of screening in Peru. Samples may be poorly collected, slides may be incorrectly labelled and some never reach the laboratory. Cytology results are sometimes wrongly transcribed or are not reported. 6 Cytology laboratories suffer from deficient infrastructure, inadequate training and supervision, staff shortages, lack of followup procedures and lack of internal and external quality control leading to suboptimal reading of cytology for which considerable expertise is required. This study was set up to investigate a variety of screening tests that may be more effective in such a setting.L...

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“…El cáncer cervicouterino (CaCu) se encuentra entre las primeras causas de muerte en mujeres de todos los grupos de edad (Flores et al, 2002;IMSS, 2009). Según datos del Banco Mundial, en 2001 se estimaron un total de 26,000 muertes relacionadas con esta enfermedad en Latinoamérica.…”

Section: Introductionunclassified

“…De acuerdo con varios estudios, existe evidencia significativa de que dicho cáncer afecta en mayor medida a países en vías de desarrollo que a países desarrollados como consecuencia de los siguientes factores: ausencia de una infraestructura de salud pública bien desarrollada, baja calidad de las dietas consumidas en dichos países, escaso acceso a la información, bajos niveles de mayor educación, inequidad de género, acceso limitado a los servicios, pobreza y ausencia de métodos de prevención básicos y servicios de detección oportuna (Flores et al, 2002;SSA, 2002;OPS, 2004). Cerca del 86% de los casos de CaCu ocurren en países en vías de desarrollo, representando el 13% de los cánceres femeninos (OMS, 2010).…”

Section: Introductionunclassified

Evaluación de proyectos de inversión con beneficios intangibles : aplicación del modelo costo - efectividad en la prevención del cáncer cervicouterino

Madrigal

Flores

2013

cys

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Resumen: El objetivo del presente trabajo consiste en analizar el modelo costo-efectividad como medida para evaluar los beneficios intangibles de un proyecto de salud pública relacionado con la prevención del cáncer cervicouterino. Tomando como punto de partida la situación actual de la evolución del cáncer cervical, se identifican dos métodos esenciales para la evaluación económica de los proyectos de salud: el análisis costo-beneficio y el análisis costoefectividad. Los resultados enfatizan la importancia de la utilización de índices basados no solo en términos monetarios, sino también en medidas no monetarias. De esta forma, se sientan las bases para la utilización de medidas intangibles en la evaluación de proyectos de inversión, por medio del desarrollo de índices tales como calidad, satisfacción, salud, riesgo, percepción y aprendizaje.

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Design and methods of the evaluation of an HPV-based cervical cancer screening strategy in Mexico: the Morelos HPV study

Cited by 28 publications

References 10 publications

Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting

Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting

Cervical screening by visual inspection, HPV testing, liquid‐based and conventional cytology in Amazonian Peru

Evaluación de proyectos de inversión con beneficios intangibles : aplicación del modelo costo - efectividad en la prevención del cáncer cervicouterino

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