Effectiveness of a two‐stage strategy with <scp>HPV</scp> testing followed by visual inspection with acetic acid for cervical cancer screening in a low‐income setting

Tebeu, Pierre Marie; Domgue, Joël Fokom; Crofts, Victoria; Flahaut, Emmanuel; Catarino, Rosa; Untiet, Sarah; Vassilakos, Pierre; Petignat, Patrick

doi:10.1002/ijc.29250

Cited by 47 publications

(48 citation statements)

References 43 publications

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“…One strength of our study was the low number of patients lost to follow‐up (1.1%). We observed a drastic reduction in loss to follow‐up, compared with the 25% rate in a previous study of HPV‐positive women in Cameroon . Low health literacy, poverty, lack of resources, and geographical conditions are some of the barriers of follow‐up of Cameroonian women.…”

Section: Discussioncontrasting

confidence: 42%

Cervical cancer screening in a low‐resource setting: a pilot study on an HPV‐based screen‐and‐treat approach

et al. 2017

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Cervical cancer (CC) is the leading cause of cancer‐related death among women in sub‐Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)‐based CC screen‐and‐treat approach in a low‐resource context. We recruited 1012 women aged 30–49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self‐sampling, which was tested for high‐risk HPV (HR‐HPV) DNA using the point‐of‐care Xpert HPV assay. All HPV‐positive women were invited for visual inspection with acetic acid and Lugol's iodine (VIA/VILI) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR‐HPV with pathological VIA/VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% (n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV16, HPV18/45 and other HR‐HPV types, respectively. Overall, 107/185 (57.8%) VIA/VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse (CIN2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high‐grade lesions among HR‐HPV positive women was higher than that of VIA/VILI in all age groups. The sensitivity and specificity of VIA/VILI in detecting CIN2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen‐positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV‐based screen‐and‐treat approach is feasible in a low‐resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV16‐ and/or HPV18/45‐positive is a practical approach for the treatment of CIN2+. The combination of HPV‐testing and VIA/VILI for CC screening might reduce overtreatment.

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Section: Discussioncontrasting

confidence: 42%

Cervical cancer screening in a low‐resource setting: a pilot study on an HPV‐based screen‐and‐treat approach

et al. 2017

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“…Sequential screening is a strategy that can increase specificity and, according to the World Health Organisation, is a recommended option in cervical cancer screening(26). However, sequential testing might jeopardise sensitivity(27). In this study, MRI reduced the need for biopsy by 68% in men with PSA ≥3.0 ng/ml (common cut-off for biopsy), but at a cost of lowered sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Role of Magnetic Resonance Imaging in Prostate Cancer Screening: A Pilot Study Within the Göteborg Randomised Screening Trial

et al. 2016

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Background Magnetic resonance imaging (MRI) and targeted biopsies (TB) have shown potential to more accurately detect significant prostate cancer (PC) compared to prostate-specific antigen (PSA) and systematic biopsies (SB). Objective To compare sequential screening (PSA + MRI) with conventional PSA screening. Design, Setting and Participants Of 384 attendees in the 10th screening round of the Göteborg randomised screening trial, 124 men, median age 69.5, had a PSA of ≥1.8 ng/ml and underwent a prebiopsy MRI. Men with suspicious lesions on MRI and/or PSA ≥3.0 ng/ml were referred for biopsy. SB was performed blinded to MRI results and TB was performed in men with tumour-suspicious findings on MRI. Three screening strategies were compared (PSA≥3.0+SB; PSA≥3.0+MRI+TB and PSA≥1.8+MRI+TB). Outcome Measurements and Statistical Analysis Cancer detection rates, sensitivity and specificity were calculated per screening strategy and compared using McNemar´s test. Results and Limitations In total, 28 PC were detected, of which 20 were diagnosed in biopsy-naïve men. Both PSA≥3.0+MRI and PSA≥1.8+MRI significantly increased specificity compared with PSA≥3.0+SB (0.92 and 0.79 vs. 0.52; p<0.002 for both), while sensitivity was significantly higher for PSA≥1.8+MRI compared with PSA>=3.0+MRI (0.73 vs. 0.46, p=0.008). The detection rate of significant cancer was higher with PSA≥1.8+MRI compared to PSA≥3.0+SB (5.9 vs. 4.0%), while the detection rate of insignificant cancer was lowered by PSA≥3.0+MRI (0.3 vs. 1.2%). The primary limitation of this study is the small sample of men. Conclusion A screening strategy with a lowered PSA cut-off followed by TB in MRI-positive men seems to increase the detection of significant cancers while improving specificity. If replicated, these results may contribute to a paradigm shift in future screening. Patient Summary Major concerns in prostate-specific antigen screening are overdiagnosis and underdiagnosis. We evaluated whether prostate magnetic resonance imaging could improve the balance of benefits to harm in prostate cancer screening, and we found promising potential of using magnetic resonance imaging in addition to prostate-specific antigen.

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“…In total, 13 of the included studies were cohort studies, and 8 reported cross‐sectional findings in eligible populations.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of self‐sampling for HPV testing in Africa

Nodjikouambaye

Adawaye

Bouassa

et al. 2020

Intl J Gynecology & Obste

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Background: Human papillomavirus (HPV) testing may be feasible for primary cervical cancer screening in low-resource countries. Objective: To compare self-sampling by women with clinician-performed sampling for HPV testing in Africa. Search strategy: MEDLINE, Google scholar, EMBASE, and several journals were searched from 2000 until 2015 using relevant terms. Selection criteria: Selected studies compared self-sampled and clinician-sampled HPV tests. Data collection and analysis: Data extraction forms included description of the type of HPV screening, description of any additional intervention components, study design, sample size, follow-up periods, analytic approach, reported numerical outcomes, results, and limitations.Results: Twenty-five studies were identified. Women of a wide age range were successful at self-sampling in many African countries. More than 95% of self-samples yielded HPV DNA results. The concordance in test results between self-collected samples and clinician-collected samples was reasonably high in most studies. In all studies, the quality of cytology from self-sampling matched that of clinician-sampling. Women were generally positive about self-collection, but noted some concerns. Conclusion: Self-sampling for HPV DNA testing seems to represent a feasible alternative to the Pap test. Further research is needed to provide a solid evidence base to inform using of self-sampling for HPV DNA testing for primary cervical cancer screening. K E Y W O R D SHPV screening; Human papillomavirus; Physician obtained smear; Self-sampling; Sub-Saharan Africa

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Effectiveness of a two‐stage strategy with HPV testing followed by visual inspection with acetic acid for cervical cancer screening in a low‐income setting

Cited by 47 publications

References 43 publications

Cervical cancer screening in a low‐resource setting: a pilot study on an HPV‐based screen‐and‐treat approach

Cervical cancer screening in a low‐resource setting: a pilot study on an HPV‐based screen‐and‐treat approach

Role of Magnetic Resonance Imaging in Prostate Cancer Screening: A Pilot Study Within the Göteborg Randomised Screening Trial

A systematic review of self‐sampling for HPV testing in Africa

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