Evaluating the Accuracy of Uterine Cancer Screening with the Regional Cancer Registration System

Yoshida, Yūji; Sato, Shinji; Okamura, Chikako; Nishino, Yoshikazu; Yajima, Akira

doi:10.1159/000327270

Cited by 10 publications

(4 citation statements)

References 12 publications

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“…Compared to visual inspection, HSIL cytology was much more sensitive, and its positive predictive value for CIN2+ was significantly greater (p < 0.01) ( 23 ). A Japanese study used low-grade squamous intraepithelial lesion as the cut-off point, and there was a 94.7% sensitivity for the detection of cervical cancer ( 24 ). Due to the use of different reference tests and different target groups, various studies have reported different accuracy values for conventional cytology ( 8 , 25 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency

et al. 2015

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IntroductionCervical cancer is the second most common cancer among women worldwide. The sensitivity of conventional Pap smear in detecting cervical lesions before cervical cancer is 51%, which means the false negative value is 49%. The aim of this study was to compare two methods for screening for cervical cancer in patients with secondary immunodeficiency, i.e., the conventional Pap smear and colposcopy.MethodsThis cross-sectional study was conducted on 101 immunodeficient patients who were referred to the Gynecologic Clinic at Shahid Sadughi Hospital in Yazd from March 2011 to August 2012. All patients underwent the Pap test, a colposcopy, and a cervical biopsy, with the latter being considered as the gold-standard test.ResultsThe most frequency of immunodeficiency was noted among patients with rheumatoid arthritis (53.3%), and this was followed by patients who were undergoing chemotherapy (30.7%), patients with lupus erythematosus (12.9%), and patients with AIDS (3%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Pap smear were 18.2, 98.5, 85.5, 71.3, and 72.2%, respectively. The respective values for colposcopy were 66.7, 98.94, 80, 97.9, and 97%, respectively.ConclusionIn this study the accuracy, sensitivity, specificity, and negative predictive values of colposcopy were higher than those for the Pap smear in detecting high-grade, cervical, pre-malignant lesions (cervical intraepithelial neoplasia: CIN ≥ 2). Therefore, an annual colposcopy is advised for secondary immunodeficient patients instead of a Pap smear.

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Section: Discussionmentioning

confidence: 99%

Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency

et al. 2015

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“…summarises six strategies that were analysed in the present study. The sensitivity of the Pap smear was assumed to be 94.7% as previously reported 26 . The specificity (reported to be 98.9%) is not included in the model because screening will be repeated in false positives as determined by the cytology results.…”

Section: Methodsmentioning

confidence: 99%

Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost‐effectiveness analysis

Yamamoto

Mori²,

Jacklin

et al. 2011

BJOG

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Objective To assess the cost-effectiveness of universal vaccination of 11-year-old girls against human papillomavirus (HPV) infection and increased screening coverage to prevent cervical cancer in Japan where the coverage of Papanicolaou smears is very low.Design A cost-utility analysis from a societal perspective.Setting Japan, 2010.Population The female Japanese population aged 11 years or older.Methods A Markov model of the natural history of cervical cancer was constructed to compare six strategies: i.e. a screening coverage rate of 20, 50 and 80% with and without routine vaccination at age 11.Main outcome measures Cervical cancer incidence, qualityadjusted life years (QALYs), costs and incremental costeffectiveness ratios.Results Expanding the coverage of Papanicolaou smears from the current level of 20-50 and 80% yields a 45.5 and 63.1% reduction in cervical cancer incidence, respectively. Impact of combined strategies increases with coverage. Coverages of 20, 50 and 80% showed a 66.1, 80.9 and 86.8% reduction in disease, respectively. The costs of strategies with vaccination are four times higher than the cost of strategies without vaccination. Vaccinating all 11-yearold girls with bivalent vaccines with a Papanicolaou smear coverage rate of 50% is likely to be the most cost-effective option among the six strategies.Conclusions The introduction of HPV vaccination in Japan is cost-effective as in other countries. It is more cost-effective to increase the coverage of the Papanicolaou smear along with the universal administration of HPV vaccine.

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“…Since they should be addressed to all health care providers, they need to be easily remembered and put into practice, in order to reduce waste in the health care system and avoid overtreatments and the downstream consequences they may produce in terms of anxiety, fertility outcomes, recurrence/persistence of the disease, overload of health care services. The sensitivity of cervical cytology -often reported as a little more than 50% -in well established settings is over 80% [20][21][22]. Both specificity and positive predictive value are higher for cytology than for HPV testing.…”

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Cervical Cancer Screening Strategies: Not the Test You Take, but the Decision You Make

Liverani¹,

Bolis²

2016

Gynecol Obstet

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in Australia the National Cervical Screening Program will shift from cervical cytology every two years, to HPV DNA testing as the sole primary screening test every five years in women aged 25 to 74 years, together with the implementation of an active HPV vaccination program [1]. Conversely in Japan cervical screening using cytology every two years is still being recommended for population-based and opportunistic screening [2]. While Canadian guidelines also recommend cervical screening with cytology every 3 years [3], in Europe cervical cytology is recommended for women under 30-35 years, and HPV testing as the sole primary screening test every 5-10 years for women above 30-35 years [4]. Actually, guidelines do not represent the real situation in each European country. In the Netherlands, screening is well organised and relies on primary HPV testing every 5 years until 40 years of age and every 10 years for women aged 40 and beyond: no screening is provided for women under 30, nor over 60 years of age [5]. Other countries recommend cytology or HPV testing, and differences are marked even within the same country and sometimes within the same region. As a matter of fact in Italy there are regions employing cytology, other regions employing HPV DNA testing, and one local health unit employing HPV mRNA testing as the sole test, while some regions still do not implement organized screening programs [6]. In the U.S. guidelines for cervical cancer screening are well-structured and -in their effort to reach maximum cost-effectiveness -are articulated into several scenarios. Briefly, cytology alone every 3 years is recommended for women under 30 years, while women aged 30 to 65 years may either continue screening with cervical cytology every 3 years, or offered cotesting (cytology + HPV testing) if they want to be screened less frequently [7][8][9]. Interestingly, European guidelines insist that only one primary test (either cytology or HPV testing) should be used at any given age in cervical cancer screening. In the U.S. until more data and algorithm development will be available, it is judged premature to use HPV testing alone as a valid screening approach [10]. This is the reason why the latest edition of the CDC guidelines published in June 2015 state that HPV testing should not be performed in screening for cervical cancer as a stand-alone test (i.e., without a concurrent Pap test) [11].As we can see, there is considerable disagreement worldwide about cervical cancer screening strategies between countries that have similar population characteristics. The main problem employing HPV testing based strategies in cervical cancer screening is the fact that both positive and negative HPV results are often misinterpreted or overestimated. An HPV positive, cytology negative woman, should repeat both tests after one year interval. Actually, patients too often tend to undergo immediate colposcopic examination, increasing health care costs and patients' anxiety, without benefit and potentially resulting in overtreatments. Not r...

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Evaluating the Accuracy of Uterine Cancer Screening with the Regional Cancer Registration System

Cited by 10 publications

References 12 publications

Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency

Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency

Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost‐effectiveness analysis

Cervical Cancer Screening Strategies: Not the Test You Take, but the Decision You Make

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