Effect of organised cervical cancer screening on cervical cancer mortality in Europe: a systematic review

Zielonke, N.; Gini, Andrea; Anttila, Ahti; Segnan, Nereo; Vokó, Zoltán; Ivanuš, Urška; McKee, Martin; Kok, Inge M.C.M. de; Veerus, Piret; Heinävaara, Sirpa; Sarkeala, Tytti; Csanádi, Marcell; Pitter, J; Széles, György; Minozzi, Silvia; Senore, Carlo; Ballegooijen, Marjolein van; Kok, Inge Driesprong de; Heijnsdijk, Eveline A.M.; Jansen, Erik E.L.; Koning, Harry J. de; Vogelaar, Iris Lansdorp –; Ravesteyn, Nicolien van; Jarm, Katja; Mlakar, Dominika Novak; Primic-Žakelj, Maja; Priaulx, Jennifer

doi:10.1016/j.ejca.2019.12.013

Cited by 155 publications

(132 citation statements)

References 38 publications

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“…According to the International Agency for Research on Cancer (IARC), CCS programs have been shown to be an effective strategy to reduce the incidence of the disease [4,[6][7][8]. Evidence shows that cervical cancer mortality was reduced in European countries that implemented organized CCS programs [9]. Reduction in cervical cancer incidence and mortality in opportunistic screening ranged from 10 to 60% worldwide [8].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review

Marques

Nunes

Antunes

et al. 2020

Int J Equity Health

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Background Cervical cancer screening has been effective in reducing incidence and mortality of cervical cancer, leading European countries to implement screening programs. However, migrant women show lower screening participation compared to nationals. This scoping review aims to provide a synthesis of the growing evidence on factors associated with participation in cervical cancer screening among migrant women in Europe. Methods Electronic peer-reviewed databases were searched in November 2019 for studies on factors related to the participation of migrants in cervical cancer screening conducted in EU/EFTA countries, using comprehensive search expressions. Retrieved articles were screened and those eligible were selected for data extraction. Quantitative and qualitative studies were included. Factors were classified in barriers and facilitators and were divided into further categories. Results Twenty out of 96 articles were selected and analyzed. Factors associated with participation in cervical cancer screening were classified in categories related to sociodemographic, healthcare-system, psychological, migration, knowledge, language, and cultural factors. Lack of information, lack of female healthcare providers, poor language skills, and emotional responses to the test (especially fear, embarrassment and discomfort) were the most reported barriers to cervical cancer screening. Encouragement from healthcare providers and information available in migrants’ languages were frequently stated as facilitators. Results on the role of sociodemographic factors, such as age, education, employment and marital status, are the most conflicting, highlighting the complexity of the issue and the possibility of interactions between factors, resulting in different effects on cervical cancer screening participation among migrant women. Several identified barriers to screening are like those to access to healthcare services in general. Conclusions Efforts to increase migrant women’s participation in CCS must target barriers to access to healthcare services in general but also specific barriers, including cultural differences about sexuality and gender, past traumatic personal experiences, and the gender and competences of healthcare professionals performing CCS. Healthcare services should strengthen resources to meet migrants’ needs, including having CCS information translated and culturally adapted, as well as healthcare providers with skills to deal with cultural background. These findings can contribute to improve CCS programs among migrant women, reducing health disparities and enhancing their overall health and well-being.

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Section: Introductionmentioning

confidence: 99%

Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review

Marques

Nunes

Antunes

et al. 2020

Int J Equity Health

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“…Cervical cancer represents one of the most important issues worldwide. The estimated incidence in Europe is 10.6 per 100,000 [1]. Cervical cancer represents a source of ongoing concern for the health care since it correlates with a high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

“…Cervical cancer represents a source of ongoing concern for the health care since it correlates with a high mortality rate. And it is one of the most preventable type of cancer because it develops over a long time [1].…”

Section: Introductionmentioning

confidence: 99%

Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women

et al. 2020

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Objective: This study aimed to identify predictors of recurrence/persistence of cervical intraepithelial neoplasia grade 2+ (CIN2+) lesion (r-CIN2+) after primary conization. Methods: Retrospective analysis involving all consecutive women having conization for CIN2+ between 1998 and 2018. The risk of r-CIN2+ was assessed using Kaplan-Meier and Cox models. Results: Data of 3,212 women were retrospectively identified. After a mean follow-up of 47 (±22.2) months, 112 (3.5%) patients developed r-CIN2+. Mean time interval between prior conization and diagnosis of r-CIN2+ was 26.2 (±13.2) months. Via multivariate analysis, presence of high-risk human papillomavirus (HPV) types at the time of CIN2+ diagnosis, hazard ratio (HR)=3.40 (95% confidence interval [CI]=1.66-6.95) for HPV16/18 and HR=2.59 (95% CI=1.21-5.55) for HPV types other than 16/18, positive margins at primary conization, HR=4.11 (95% CI=2.04-8.26) and HPV persistence after conization, HR=16.69 (95% CI=8.20-33.9), correlated with r-CIN2+, independently. Considering age-specific HPV types distribution, we observed that HPV16/18 infection correlated to an increased risk of r-CIN2+ only in young women (aged ≤25 years; p=0.031, log-rank test); while in the older population (>25 years) HPV type(s) involved had not impact on r-CIN2+ risk (p>0.200, log-rank test). Conclusion: HPV persistence is the main factor predicting r-CIN2+. Infection from HPV16/18 has a detrimental effect in young women, thus highlighting the need of implementing vaccination against HPV in this population. Further prospective studies are warranted for tailoring clinical decision-making for post-conization follow-up on the basis of risk factors.

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“…In the vaccine era, organized cervical cancer screening remains one of the most effective measures to reduce cervical cancer incidence and mortality. 1 Liquid-based cytology (LBC) and HPV test are the two most common cervical screening strategies. In spite of the inherent advantages of LBC in cervical screening, the low sensitivity of LBC often causes missed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

<p>Evaluating the Performance of p16<sup>INK4a</sup> Immunocytochemistry in Cervical Cancer Screening</p>

Song

Ai-min

et al. 2020

CMAR

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Purpose: When used for cervical cancer primary screening, liquid-based cytology (LBC) has a high specificity but a low sensitivity. For histological diagnosis of high-grade lesions, p16 INK4a immunostaining has proven to be useful. Therefore, our objective was to evaluate the use of p16 INK4a immuno-cytology as a primary screen and a secondary screen after primary high-risk human papillomavirus (hrHPV) screening or LBC screening. Methods: A total of 1197 cytology slides were immuno-stained using automatic p16 INK4a staining system (PathCIN ® p16 INK4a) in two studies from cervical screening programs. In the primary screening study, 875 slides were randomly selected and analyzed for p16 INK4a. In the secondary screening study, 322 of the remaining slides were chosen by virtue of being HPV 16/18+, other hrHPV+/LBC≥ASC-US, or HPV-negative/LBC ≥LSIL. The sensitivity and specificity for detection of cervical intraepithelial neoplasia 2/3 or worse (CIN2+/CIN3+) were compared based on p16 INK4a , LBC and HPV test results. Results: In combining two studies, there were 431 cases with biopsy pathology. They included 83 cases with CIN2+ and 41 cases with CIN3+. The p16 positivity rate increased with pathologic and cytologic severity (P<0.0001). For primary screening: p16 immunocytology was more specific than HPV testing and was similar in sensitivity. Also, p16 immuno-cytology compared favorably with routine LBC (≥ASC-US or ≥LSIL) in sensitivity and specificity. For secondary screening: after LBC screening, "Triaging ASC-US with p16" gave a higher specificity and a similar sensitivity as compared to the "Triaging ASC-US with hrHPV" algorithm. After HPV primary screening, p16 immuno-cytology was more specific than LBC (≥ASC-US); the calculated colposcopy referral rate was also decreased by using p16 immuno-cytology as triage. Triage of "HPV16/18 and p16" had higher specificity and similar sensitivity as compared to triage of "HPV16/18 and LBC ≥ASC-US". Conclusion: For primary screening, p16 INK4a immuno-cytology compares favorably to routine LBC and HPV testing. p16 INK4a immunostaining could be an efficient triage to reduce the colposcopy referral rate after primary hrHPV screening or LBC screening. Therefore, p16 INK4a immuno-cytology may be applicable as a favorable technology for cervical cancer screening.

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Effect of organised cervical cancer screening on cervical cancer mortality in Europe: a systematic review

Abstract: a on behalf of the EU-TOPIA consortium 1

Cited by 155 publications

References 38 publications

Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review

Factors associated with cervical cancer screening participation among migrant women in Europe: a scoping review

Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women

<p>Evaluating the Performance of p16<sup>INK4a</sup> Immunocytochemistry in Cervical Cancer Screening</p>

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