Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment

Winer, Rachel L.; Lin, John; Tiro, Jasmin A.; Miglioretti, Diana L.; Beatty, Tara; Gao, Hongyuan; Kimbel, Kilian; Thayer, Chris; Buist, Diana S.M.

doi:10.1001/jamanetworkopen.2019.14729

Cited by 68 publications

(83 citation statements)

References 33 publications

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“…2 It is understandable given these factors that the effect of this mailed HPV kit on screening uptake was modest, with an increase of only 8.9% (95% CI, 7.8%-10.0%) over usual care. 1 Despite an increase in screening uptake, the primary outcome of detected or treated CIN2+ was not significantly different among those who received the HPV kit than among those who underwent usual care reminders. This may be partly because of low prevalence of dysplasia in this population.…”

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confidence: 88%

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Home Screening for Human Papillomavirus Falls Short in Initial Application, Remains Promising

Moss¹,

Chou²,

Coleman³

2019

JAMA Netw Open

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In their randomized clinical trial, Winer et al 1 studied the effect of mailed human papillomavirus (HPV) self-screening kits vs usual care reminders on cervical cancer screening among underscreened women (ie, women whose last Papanicolaou test was more than 3.4 years before the intervention) in the Kaiser Permanente health care system. As the authors note, 1 the challenges of increasing cervical cancer screening uptake are daunting, and overcoming those challenges has the potential to drastically reduce morbidity and mortality from cervical cancer. Given the barriers to in-clinic screening, the idea of home HPV testing to increase cancer prevention efforts is appealing. Although the intervention did not lead to a statistically significant increase in the primary outcomes of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) detection (relative risk, 1.49; 95% CI, 0.61-3.64) or treatment (relative risk, 1.70; 95% CI, 0.67-4.32), the intervention increased screening uptake (relative risk, 1.51; 95% CI, 1.43-1.60) and reduced the time to screening uptake (median [interquartile range] time to screening uptake: 37 [22-49] days vs 80 [43-129] days). 1 While the trial is admirable in its design and large sample size, several limitations prevent it from having broad implications for cervical cancer screening at this time.Of 9960 women in the intervention group, only 1206 (12.1%) returned the kit, 1 which may have been due to several factors. First, patients were instructed to undergo clinic-based screening regardless of home HPV screening; thus, motivation to use the kit may have been low. Second, some patients may have been aware that they were not due for screening based on American Society for Colposcopy and Cervical Pathology guidelines. Kits were mailed to patients slightly more than 3 years after their last screening, and patients older than 30 years with previous negative cotesting (ie, normal Papanicolaou cytology and negative HPV testing) would have almost 2 years before their next recommended screening was due. Third, patients may have been wary of home screening given that vaginal HPV testing is not approved by the US Food and Drug Administration for risk stratification in cervical cancer screening. Furthermore, patients may have lacked knowledge regarding the superior sensitivity and negative predictive value of HPV testing. 2 It is understandable given these factors that the effect of this mailed HPV kit on screening uptake was modest, with an increase of only 8.9% (95% CI, 7.8%-10.0%) over usual care. 1 Despite an increase in screening uptake, the primary outcome of detected or treated CIN2+ was not significantly different among those who received the HPV kit than among those who underwent usual care reminders. This may be partly because of low prevalence of dysplasia in this population.The study population had low HPV test positivity (12%) compared with more diverse clinic settings and age ranges, in which high-risk HPV may be as prevalent as 35%. 3 It is especially concerning that slightly less ...

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confidence: 88%

“…3 It is especially concerning that slightly less than half of patients (41%) who had positive test results for HPV-16 or HPV-18 did not adhere to the recommended colposcopy. 1 This percentage may have been further diminished by the 6-month limitation on measurement of follow-up for enrolled patients.…”

mentioning

confidence: 99%

Home Screening for Human Papillomavirus Falls Short in Initial Application, Remains Promising

Moss¹,

Chou²,

Coleman³

2019

JAMA Netw Open

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“…HRHPV selfsampling at home is recommended if a primary molecular testing is required, or if a reflex testing is required in case of an ASC-US or LSIL abnormal cytology result [9].…”

Section: Minor Screening Abnormalities -A Definition and The Recommenmentioning

confidence: 99%

Possible deferral of diagnostic and therapeutic procedures for patients with abnormal screening tests results in cervical cancer secondary prevention in current SARS-CoV-2 pandemic Interim guidelines of the Polish Society of Gynecologists and Obstetricians and the Polish Society of Colposcopy and Cervical Pathophysiology

Jach

Mazurec

Trzeszcz³

et al. 2020

Ginekol Pol

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The Polish Society of Gynecologists and Obstetricians and Polish Society of Colposcopy and Cervical Pathophysiology Interim Guidelines goal at aiding gynecologists in providing a cervical cancer prevention care during the evolving SARS-CoV-2 pandemic. Presented guidelines were developed on a review of limited data and updated when new relevant publications were revealed. Timing for deferrals of diagnostic-therapeutic procedures were mostly covered in the guidelines. Also, a support for the existing Polish recommendations on abnormal screening results in a subject of minor and major screening abnormalities terminology were given. The guidelines are obligatory for the specified COVID-19 pandemic period only and they might be changed depending on the new available evidence.

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“…Several criteria exist to assess the degree of change, including the nucleus/cytoplasm ratio, nuclear shape and intensity of the nuclear marks and chromatin. Currently, the Bethesda classification is the most widely used for cytological diagnosis of cervical samples and categorises abnormal cells in L-SIL and H-SIL [19]. The vast majority of L-SIL represents morphological changes associated with active HPV replication (for example, koilocytosis), while H-SIL indicates cell transformation, characterised mainly by nuclear changes.…”

Section: Existing Tests For the Examination Of Cervical Lesion Pap Smmentioning

confidence: 99%

“…Despite its great specificity, this methodology has limited sensitivity in detecting precursor lesions of the cervix, a fact that can be attributed to the variation in the interpretation of this method has a variability of 34 to 94% in the detection of H-SIL and is not decisive in the classification of atypical samples defined as "squamous cells atypical meaning of uncertainty" [19,22].…”

Section: Existing Tests For the Examination Of Cervical Lesion Pap Smmentioning

confidence: 99%

Screening and Identification of New Biomarkers for the Control of Cervical Cancer

Uyeda¹,

Subramanian²

2020

Preprint

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Cervical cancer (CC) is the most common cancer in women worldwide and is almost always associated with repeated infections by human papillomavirus (HPV). Screening by traditional tests associated with biomarker identification techniques for low- or high-grade injuries, are becoming increasingly important in diagnosis and prognosis, avoiding countless deaths. This article explores existing literature on the main serum biomarkers and the identification of biomarkers associated with the oncogenesis of HPV expression in the identification of pre-cancerous lesions and of CC for an effective treatment, with reduction of recurrence, as well as we explain strategies for the development of biomarkers based on DNA, proteins and other markers. We also describe how markers of chromosomal instability host DNA, promoting hypo- or hypermethylation of DNA, as well as polymorphisms and epigenetic events in the p53 gene. Finally, we discuss changes in gene expression using cDNA microarray techniques and changes in the expression of proteins and markers identified through mass spectrometry (MS).

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Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment

Cited by 68 publications

References 33 publications

Home Screening for Human Papillomavirus Falls Short in Initial Application, Remains Promising

Home Screening for Human Papillomavirus Falls Short in Initial Application, Remains Promising

Screening and Identification of New Biomarkers for the Control of Cervical Cancer

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