Missed Opportunities for Cervical Cancer Screening of HMO Members Developing Invasive Cervical Cancer (ICC)

Kinney, Walter; Sung, Hai‐Yen; Kearney, Kathleen A.; Miller, Marie Grisham; Sawaya, George F.; Hiatt, Robert A.

doi:10.1006/gyno.1998.5135

Cited by 67 publications

(34 citation statements)

References 17 publications

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“…Up to 60% of women diagnosed as having invasive cervical cancer were not screened despite health maintenance organization enrollment (18). It has been shown that HPV is causally linked to the development of cervical cancer (4), and numerous studies have revealed a high sensitivity for the HPV test in detecting cervical cancer and its precursors, whereas specificity was usually lower in comparison to cytology (5).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Aberrant DNA Methylation and Human Papillomavirus DNA in Cervicovaginal Specimens to Detect Invasive Cervical Cancer and Its Precursors

Widschwendter

Gattringer

Ivarsson

et al. 2004

Clinical Cancer Research

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Purpose: Cancer of the uterine cervix is an important cause of death in women worldwide. Pap smears as a tool for screening decreased the incidence and mortality of cervical cancer dramatically. This proof of principle study aimed to develop a potential tool for cervical screening using a test that can be applied by patients without visiting a physician and to increase the coverage rate, especially of the high-risk population with low socioeconomic status.Experimental Design: Human papillomavirus (HPV) DNA testing and methylation analysis of DNA obtained from cervicovaginal specimens of 13, 31, and 11 patients with no dysplasia/low-grade squamous intraepithelial lesion (SIL), high-grade SIL, and invasive cervical cancer, respectively, collected on a tampon, was performed using PCRbased methods to detect invasive cervical cancer and study whether these changes are already present in the precursor lesions.Results: High-risk HPV DNA was present in 68 and 82% of patients with high-grade SIL and invasive cervical cancer. DNA methylation of the 11 genes tested increased with severity of the cervical lesion. Unsupervised hierarchical cluster analysis using solely information on DNA methylation of the 11 genes was able to predict the presence of invasive cervical cancers: one of the two clusters formed contained 9 of 11 invasive cervical cancers, as well as two high-grade SILs.Conclusions: HPV DNA and DNA methylation analyzed in cervicovaginal specimens are able to predict invasive cervical cancers. To detect all high-grade SILs when applying this test, genes that become methylated earlier throughout cervical carcinogenesis have to be defined.

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Section: Discussionmentioning

confidence: 99%

Analysis of Aberrant DNA Methylation and Human Papillomavirus DNA in Cervicovaginal Specimens to Detect Invasive Cervical Cancer and Its Precursors

Widschwendter

Gattringer

Ivarsson

et al. 2004

Clinical Cancer Research

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“…1,2,[9][10][11] Women who do not respond to invitations for conventional smears may be inclined to respond to a self-sampling technique, [12][13][14][15][16][17][18] but this has never been tested in the setting of a regular screening program. Although the sensitivity for high-grade cervical intraepithelial neoplasia (CIN) of cytological specimens obtained from self-sampled vaginal material is lower than the sensitivity of conventional cytology, studies have shown that selfsampled cervicovaginal specimens (SSVS) are highly representative for the high-risk human papillomavirus (hrHPV) DNA status of the cervix.…”

mentioning

confidence: 98%

Human papillomavirus testing on self‐sampled cervicovaginal brushes: An effective alternative to protect nonresponders in cervical screening programs

Bais

Kemenade

Berkhof

et al. 2007

Intl Journal of Cancer

152

155

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Women not attending cervical screening programs are at increased risk of cervical cancer. We investigated in these nonresponders to what extent offering self-sampling devices for cervicovaginal brushes for high-risk human papillomavirus (hrHPV) testing would induce participation and, if so, what the yield of precursor (i.e. CIN2 or worse) lesions following self-sampling would be. In addition, we assessed screening history of participants and costs per detected high-grade CIN2 or worse ("CIN2+") lesion in comparison to the regular program in the Netherlands. Nonresponders received a device for hrHPV testing (self-sampling group, n=2,546) or an extra recall for conventional cytology (control group, n=284). The percentage of self-sampling responders were compared with responders in the recall group. hrHPV positive self-sampling responders were invited for cytology and colposcopy. CIN2+ yield and costs per detected CIN2+ were evaluated. Active response was higher in the self-sampling than in the control group (34.2 vs. 17.6%; p<0.001). hrHPV positive self-sampling responders were less likely to have a prior screening history than screening participants (p<0.001), indicating that they are regular nonresponders. hrHPV prevalence was similar (8.0 vs. 6.8%; p=0.11), but CIN2+ yield was higher in self-sampling responders compared to screening participants (1.67 vs. 0.97%; OR=2.93, 95% CI 1.48-5.80; p=0.0013). Costs per CIN2+ lesion detected via self-sampling were in the same range as those calculated for conventional cytological screening (euro 8,836 vs. euro 7,599). Offering self-sampling for hrHPV testing in nonresponders is an attractive adjunct to effectively increase population coverage of screening without the adverse effect of markedly increased costs per detected CIN2+ lesion.

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“…For example, in one study of a large prepaid health plan with few barriers to access, most of the women with invasive cervical cancer had not had a Pap smear in the three years before their diagnosis, even though 75 percent had been seen in primary care outpatient clinics during that period. 5 Another strategy to reduce the incidence of cancer is to minimize errors related to the sampling technique itself and the interpretation of the findings. These errors account for approximately one fourth of all cases of invasive cervical cancer.…”

Section: Strategies and Evidencementioning

confidence: 99%

Current Approaches to Cervical-Cancer Screening

Sawaya¹,

Brown²,

Washington³

et al. 2001

N Engl J Med

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Missed Opportunities for Cervical Cancer Screening of HMO Members Developing Invasive Cervical Cancer (ICC)

Cited by 67 publications

References 17 publications

Analysis of Aberrant DNA Methylation and Human Papillomavirus DNA in Cervicovaginal Specimens to Detect Invasive Cervical Cancer and Its Precursors

Analysis of Aberrant DNA Methylation and Human Papillomavirus DNA in Cervicovaginal Specimens to Detect Invasive Cervical Cancer and Its Precursors

Human papillomavirus testing on self‐sampled cervicovaginal brushes: An effective alternative to protect nonresponders in cervical screening programs

Current Approaches to Cervical-Cancer Screening

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