Regression of low-grade squamous intra-epithelial lesions in young women

Moscicki, Anna‐Barbara; Shiboski, Stephen; Hills, Nancy K.; Powell, Kimberly; Jay, Naomi; Hanson, Evelyn; Miller, Susanna; Canjura-Clayton, Lisa K; Farhat, Sepidah; Broering, Jeanette M.; Darragh, Teresa M.

doi:10.1016/s0140-6736(04)17354-6

Cited by 383 publications

(276 citation statements)

References 22 publications

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“…Human papillomavirus (HPV) infections are among the most common sexually transmitted diseases (Bauer et al, 1991;Ho et al, 1998;Moscicki et al, 2001) and are implicated in both benign and malignant disease of the genital epithelia (Bosch et al, 1995;Galloway, 1994;Gissmann et al, 1983;Munoz, 2000;Pisani et al, 1993). To meet medical needs imposed by HPV infection, several experimental vaccines have been developed and are currently in human clinical trials (Brown et al, 2001;Evans et al, 2001;Harro et al, 2001), and one has been shown to be effective in preventing persistent viral infection (Koutsky et al, 2002).…”

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confidence: 99%

Human papillomavirus type 6 virus-like particles present overlapping yet distinct conformational epitopes

Wang

Cook

Lee

et al. 2003

Journal of General Virology

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The epitope for a human papillomavirus (HPV) type 6 conformation-dependent, neutralizing monoclonal antibody (mAb) was partially mapped using HPV L1 recombinant virus-like particles (VLPs). The mAb H6.J54 is cross-reactive with the closely related HPV types 6 and 11. By making HPV-6-like amino acid substitutions in the cottontail rabbit papillomavirus (CRPV) major capsid protein L1, we were able to transfer H6.J54 binding activity into a CRPV/HPV-6 hybrid L1 protein.Full binding activity was achieved with only nine amino acid changes and identified a region centred on the HPV-6 residues 49-54. This region has previously been shown to be a critical part of HPV-6 type-specific epitopes. Fine mapping of the region by scanning a series of alanine substitution mutations showed that in HPV-6 VLPs this type-common epitope overlaps HPV-6 type-specific epitopes.

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mentioning

confidence: 99%

Human papillomavirus type 6 virus-like particles present overlapping yet distinct conformational epitopes

Wang

Cook

Lee

et al. 2003

Journal of General Virology

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“…In contrast, reducing opportunistic screening among women before the age of 30 years cannot be expected to remarkably increase the incidence of detected cases of CIN in the programme (rather decrease the overall CIN burden in the female population), as the large majority of CIN lesions regress naturally in young women. 14 In this study the CIN3 detection rate among women aged 30-60 years was 1.9 per 1000 screening tests while in the Netherlands the corresponding rate has been about 5 per 1,000. 25 It is possible that in Finland a larger proportion of pre-cancers are detected while still in the low-grade phase.…”

Section: Discussionmentioning

confidence: 53%

Divergent coverage, frequency and costs of organised and opportunistic Pap testing in Finland

Salo

Nieminen

Kilpi

et al. 2013

Intl Journal of Cancer

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We evaluated the overall coverage, frequency and costs of Pap testing by screening modality and health care provider in Finland. Information about Pap testing in the Finnish female population of 2.7 million was obtained from nationwide populationbased registry data. Among women aged 25-69 years, 87% had had a Pap test taken within or outside the organised programme at least once during the last 5 years and half of those screened in the organised programme had also had at least one Pap test taken outside the programme. Of the annual average of 530,000 Pap tests taken, 84% were taken for screening purposes and 16% as follow-up. Forty percent of the 446,000 annual screening tests were taken in the organised programme, 55% as opportunistic tests in public primary or student health care or by private providers and 5% in public secondary health care. One-fifth of all opportunistic screening Pap tests were taken from women aged <25. The voluminous opportunistic Pap testing in public primary health care was concentrated in young women aged 25-29 whereas the bulk of opportunistic testing in private health occurred in age groups eligible for organised screening. The total cost of all screening Pap tests was e22.4 million, of which 71% incurred in opportunistic screening. Of the 84,000 annual follow-up Pap tests and their e8.3 million total costs,~60% incurred in organised screening or in secondary health care.The organised screening programme for cervical cancer in Finland was started in the 1960s. 1 Within the programme women between 30 and 60 years of age are invited for screening every 5 years. 2 In addition, some municipalities invite also women aged 25 and/or 65 years. 3 The overall attendance rate to organised screening has been 70% with some variation by age and region. All Pap tests taken in the organised programme, including their results, are registered in the Mass Screening Registry. 4 Pap testing outside the organised programme is frequent but is not registered centrally. Until now, only survey data have been available to estimate the volume of such opportunistic testing and its impact on the incidence of cervical cancer. [5][6][7][8] According to the national guidelines in Finland, screening for cervical cancer should only take place every 5 years within the organised, population-based programme. 9 The effectiveness of this policy has been shown in several cohort and case-control studies. 10 The national guidelines recommend that asymptomatic women below age 25 should not be screened because of a negligible cancer risk. Moreover, organised screening in this age group has not shown to be effective. 11 The majority of new lesions in young women are known to regress spontaneously and because of the long average duration of the precancerous stages the few emerging precancers can be treated timely. 12-14 Previous reports suggest that the effectiveness and cost-effectiveness of organised screening is appropriate. 15,16 However, the role of opportunistic Pap testing in overall screening has remained unknown due to l...

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“…Histological detection of CIN lesions, especially with regard to mild lesions, is shown to vary by differences in diagnostic criteria, follow-up recommendations and referral rates [16]. Also, a high frequency of screening might lead to overdiagnosis of CIN lesions that have a high chance of regression [17][18][19]. Furthermore, the detection of CIN1 lesions in DES daughters might suffer from histological misclassification due to the common presence of VCEC and a wider transformation zone [20].…”

Section: Discussionmentioning

confidence: 99%

Risk of Cervical Intra-epithelial Neoplasia and Invasive Cancer of the Cervix in DES Daughters

Verloop

Leeuwen

Helmerhorst

et al. 2017

Obstetrical &Amp; Gynecological Survey

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• Information on CIN was based on the nationwide pathology registry.• No increased risk for CIN2+ was found among DES daughters.• DES daughters with DES-related malformations had higher rates of CIN1 probably due to screening. Objective. Women exposed to diethylstilbestrol in utero (DES) have an increased risk of clear cell adenocarcinoma (CCA) of the vagina and cervix, while their risk of non-CCA invasive cervical cancer is still unclear. a b s t r a c t a r t i c l e i n f oMethods. We studied the risk of pre-cancerous (CIN) lesions and non-CCA invasive cervical cancer in a prospective cohort of 12,182 women with self-reported DES exposure followed from 2000 till 2008. We took screening behavior carefully into account. Incidence was obtained through linkage with the Netherlands Nationwide Pathology database (PALGA). General population data were also derived from PALGA.Results. The incidence of CIN1 was increased (Standardized Incidence Ratio (SIR) = 2.8, 95% Confidence Interval (CI) = 2.3 to 3.4), but no increased risk was observed for CIN2+ (CIN2, CIN3 or invasive cancer) compared to the screened general population (SIR = 1.1, 95% CI = 0.95 to1.4). Women with DES-related malformations had increased risks of both CIN1 and CIN2+ (SIR = 4.1, 95%CI = 3.0 to 5.3 and SIR = 1.5, 95%CI = 1.1 to 2.0, respectively). For CIN2 +, this risk increase was largely restricted to women with malformations who were more intensively screened.Conclusions. An increased risk of CIN1 among DES daughters was observed, especially in women with DES-related malformations, probably mainly due to screening. The risk of CIN2+ (including cancer) was not increased. However, among DES daughters with DES-related malformations a true small risk increase for non-CCA cervical cancer cannot be excluded.

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Regression of low-grade squamous intra-epithelial lesions in young women

Cited by 383 publications

References 22 publications

Human papillomavirus type 6 virus-like particles present overlapping yet distinct conformational epitopes

Human papillomavirus type 6 virus-like particles present overlapping yet distinct conformational epitopes

Divergent coverage, frequency and costs of organised and opportunistic Pap testing in Finland

Risk of Cervical Intra-epithelial Neoplasia and Invasive Cancer of the Cervix in DES Daughters

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