Introduction of molecular HPV testing as the primary technology in cervical cancer screening: Acting on evidence to change the current paradigm

Tota, Joseph E.; Bentley, J.; Blake, Jennifer; Coutlée, François; Duggan, Máire A.; Ferenczy, Alex; Franco, Eduardo L.; Fung-Kee-Fung, Michael; Gotlieb, Walter H.; Mayrand, Marie‐Hélène; McLachlin, Meg; Murphy, Joan; Ogilvie, Gina; Ratnam, Sam

doi:10.1016/j.ypmed.2016.11.029

Cited by 99 publications

(93 citation statements)

References 91 publications

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“…Clinically validated hpv tests are considerably more sensitive than cytology-whether conventional or liquid-based-to detect cervical precancer and cancer 4 . This comes at the expense of a small loss in specificity relative to cytology.…”

Section: El Franco Mph Drph Frsc Fcahs Ocmentioning

confidence: 99%

Self-Sampling for Cervical Cancer Screening: Empowering Women to Lead a Paradigm Change in Cancer Control

Franco

2018

Current Oncology

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In this new era of precision medicine and patient-centred care, the advent of self-sampling in cervical cancer screening is among the most disruptive innovations in cancer control and prevention. However, it has taken a long time to mature as an idea. The concept of self-sampling with swabs or brushes as a reliable substitute for providercollected cervical specimens has been the focus of at least 25 years of research. Although obtaining an adequate cytology specimen for cervical cancer screening served as the initial rationale 1 , it was the pragmatic goal of obtaining repeated samples for studying the natural history of genital human papillomavirus infection that drove much of this research 2,3 . The original aim of making the experience of participating in cervical cancer screening less daunting to women failed to be realized initially because the tradeoff between convenience to the woman and quality of the cervical sample was far from ideal.Given that it is an intuitively simple and attractive idea, why did it take so long for self-sampling to mature as a technological innovation? During most of the last 70 years, cervical cancer screening has been based on the Papanicolaou (Pap) cytology technique, which relies on the microscopic identification by a cytotechnician or cytopathologist of cellular abnormalities in optimally stained cervical samples smeared on glass slides. These samples must be representative of the ecto-and endocervix to be deemed adequate. For this to happen, a properly trained health care provider, i.e., a physician or nurse, must use a speculum to visualize the cervical os and transformation zone and collect cellular samples from the inner and outer perimeter of the latter using devices such as a wooden spatula, cytobrush, or broom-like device. The transformation zone perimeter is the origin of most neoplastic cervical lesions. Samples that do not properly reflect the cellular composition of the ecto-and endocervix are thus likely to yield false-negative cytology results in women with precancerous or cancerous lesions. Exceptionally, a cytotechnician reading such a Pap smear with meticulous attention to detail may fortuitously find an isolated cluster of dysplastic or malignant cells. However, an exhaustive smear scanning takes time. In the high-volume routine of most cytopathology laboratories, not more than a few minutes are spent per slide, which makes sample quality paramount in cervical cancer screening via cytology. The advent of liquid-based cytology improved the efficiency and ease of smear processing and reading but did not eliminate the need for a speculum-assisted and properly collected cervical sample by a health care provider. It is thus of no surprise that under the stringent quality control of specimen adequacy for cytology screening self-sampling never became much of a promise.The advent of molecular testing for nucleic acid of oncogenic genotypes of human papillomavirus (hpv) made self-sampling an attractive idea for cervical cancer screening again. Clinically validated hpv...

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Section: El Franco Mph Drph Frsc Fcahs Ocmentioning

confidence: 99%

Self-Sampling for Cervical Cancer Screening: Empowering Women to Lead a Paradigm Change in Cancer Control

Franco

2018

Current Oncology

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“…Recent cervical cancer prevention and control innovations target persistent infection of oncogenic human papillomavirus (hpv)-a necessary cause of cervical cancer 6,7 . These include hpv vaccination programs that target school-age girls before exposure to hpv and hpv dna primary screening test, a test with greater sensitivity and higher positive predictive value than Pap testing 6,[8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

“…These include hpv vaccination programs that target school-age girls before exposure to hpv and hpv dna primary screening test, a test with greater sensitivity and higher positive predictive value than Pap testing 6,[8][9][10][11][12][13] . Currently, many jurisdictions, including most Canadian provinces, are considering replacing the Pap test with hpv testing, which may overcome some of the performance limitations of cytology, particularly the low positive predictive value in the era of hpv vaccination.…”

Section: Introductionmentioning

confidence: 99%

Strategies to Reach Marginalized Women for Cervical Cancer Screening: A Qualitative Study of Stakeholder Perspectives

2018

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“…Studies found lower risk of high-grade pre-cancerous lesions following a negative hpv result compared with a negative cytology result and suggested that screening women every five years with hpv dna testing is as safe as screening with cytology every three years [37][38][39] . Furthermore, hpv dna testing is an automated and objective procedure to detect hpv and less prone to human error in collection and interpretation of the specimen 8,34 .…”

mentioning

confidence: 99%

“…Although much of the existing literature on hpv self-sampling comes from Europe [40][41][42][43][44][45][46][47][48][49][50][51][52] , a few Canadian studies are available [53][54][55][56][57][58][59][60][61][62] with an even smaller number involving trialing of selfsampling 54,[60][61][62] . The literature provides solid evidence of the validity of hpv self-sampling compared with cliniciancollected cervical samples 8,[43][44][45] , as well as of women's high acceptance of self-sampling and their positive attitudes towards it.…”

mentioning

confidence: 99%

HPV Self-Sampling: A Promising Approach to Reduce Cervical Cancer Screening Disparities in Canada

Vahabi

Lofters

2018

Current Oncology

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Human papillomavirus (hpv) is the primary cause of cervical, anal, and other genital cancers, which are preventable through screening and early treatment. Cervical cancer is a major public health problem, with profound individual impacts in terms of life expectancy and quality of life, as well as societal impacts in terms of economic burden [1][2][3][4] . In Canada, an estimated 1,550 women will be diagnosed with cervical cancer in 2017, and 400 will die from it. In Ontario, Canada's most populous and diverse province, 630 women are diagnosed annually with cervical cancer, and 150 die from it 2 . The mean overall health care cost per patient during the first five years after being diagnosed with cervical cancer is projected to be about $68,745 4 in Ontario. This does not include the cost associated with loss of economic productivity and family life disruption related to emotional and psychological stress.Cervical cancer deaths and associated health care and social costs can be avoided through appropriate screening. Currently, screening is performed via the Pap test (cytological examination of the peeled cells from the cervix), which requires a visit to a doctor's office. This approach has shown effectiveness for early identification and removal of precancerous abnormalities 5 and has been considered as the primary reason for the observed reduction in cervical cancer incidence and mortality in high-income countries like Canada 2,3,6-8 . The most current cervical cancer screening guidelines recommend that women be screened by Papanicolaou (Pap) tests at least once every three years starting at 21 years of age if sexually active and discontinuing at age 70 2 . For hiv-positive women, recommendation includes receiving screening at the initial assessment and at six months, with an annual follow-up for women with normal results. Despite these clear screening guidelines and a universal health care system, screening participation has remained lower than desired over the past two decades in Ontario, holding steady at 60% to 65% since 2002 3 .Under/never utilization of cancer screening has been reported to be more predominant among certain vulnerable women, such as immigrants and women of low income, those belonging to visible minority groups, women living with hiv (wlhiv) and those with disability 9-23 . Low levels of screening among these hard-to-reach women have been related to individual-level barriers such as cultural barriers (e.g., modesty, language), lack of knowledge about cervical cancer risk factors and preventive measures, not knowing where to go for the test, and transportation difficulties; physician-level barriers, such as lack of a family physician, lack of physician recommendation, or having a male provider; and system-level barriers, such as inconvenient clinic hours and indirect costs associated with screening (e.g., for childcare, taking time off work) [10][11][12][13][14][15][17][18][19][20][21][22][23][24][25][26][27] . Two Canadian retrospective population-based studies in Ontario showed that cancer...

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Introduction of molecular HPV testing as the primary technology in cervical cancer screening: Acting on evidence to change the current paradigm

Cited by 99 publications

References 91 publications

Self-Sampling for Cervical Cancer Screening: Empowering Women to Lead a Paradigm Change in Cancer Control

Self-Sampling for Cervical Cancer Screening: Empowering Women to Lead a Paradigm Change in Cancer Control

Strategies to Reach Marginalized Women for Cervical Cancer Screening: A Qualitative Study of Stakeholder Perspectives

HPV Self-Sampling: A Promising Approach to Reduce Cervical Cancer Screening Disparities in Canada

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