Updated evidence-based recommendations for cervical cancer screening in France

Abstract

Introduction A national organized cytology-based cervical cancer screening program was launched in 2018 and rollout is ongoing. Concomitantly, the High Authority for Health (HAS) recently assessed new evidence on primary HPV testing to update screening recommendations. MethodsThe HAS commissioned systematic reviews and meta-analyses to evaluate the effectiveness of primary HPV screening; accuracy of HPV testing on self-samples; effectiveness of self-sampling to reach underscreened women; and triage strategies to manage HPV-positive women. Recommendations developed by the HAS were reviewed by a multidisciplinary group. ResultsCompared with cytology screening, HPV screening is more sensitive to detect precancers but less specific. In women aged ≥30, if the test is negative, HPV screening greatly reduces the risk of developing precancer and cancer for at least 5 years. HPV testing, using validated PCR-based assays, is as sensitive and slightly less specific on self-samples than on cliniciantaken samples. Self-sampling is more effective to reach underscreened women than sending invitations to have a specimen taken by a clinician. Two-time triage strategies ensure a sufficiently high risk if triage-positive to justify referral and low risk if triage-negative allowing release to routine screening. ConclusionsThe HAS recommends three-yearly cytology screening for women aged 25-29 and HPV screening for those aged 30-65 with an extension of the screening interval to 5 years if the HPV test is negative. Self-sampling should be offered to underscreened women aged ≥30. HPV-positive women should be triaged with cytology. Those with abnormal cytology should be referred for colposcopy and those with normal cytology re-tested for HPV 12 months later. Recommendations for implementation of HPV-based screening in the organized program are provided.

Fisetin, a Potent Anticancer Flavonol Exhibiting Cytotoxic Activity against Neoplastic Malignant Cells and Cancerous Conditions: A Scoping, Comprehensive Review

“…It is estimated that in 2020 there were 0.6 million new cases of cervical cancer and 0.34 million of deaths caused by this cancer. While the incidence and mortality of cervical cancer have been decreasing during the last several decade, this trend is mainly attributed to the widespread use of cervical screening [1,40]. However, the search for new chemical compounds that may inhibit the formation of this type of tumor is currently a priority in biomedical science.…”

“…Recent studies have shown that FIS reduces the viability of HeLa cervical cancer cells (IC50 = 36 ± 0.5 µM) [40] and inhibits cell invasion and migration in a concentrationdependent manner. Additionally, cells of other lines, including SiHa and CaSki treated with FIS, show a decrease in mobility [24].…”

Effectiveness and feasibility of self-sampling for human papillomavirus testing for internet-based cervical cancer screening

“…With internet service, women can participate in CCS at home or at facilities nearby, without the need to travel a distance to find medical services and to spend time simply to wait for sampling, which, together with the lack of need for a doctor's involvement in the sampling, is obviously cost-effective. Self-sampling-based HPV testing can increase participation and therefore increase the coverage of CCS (11)(12)(13)(14). In addition, privacy protection and the convenience of selfsampling will also encourage office workers to participate in the screening program.…”

“…Since then, multiple studies have demonstrated that selfcollected samples work as well as provider-collected samples when tested on polymerase chain reaction (PCR) based HPV testing (12)(13)(14). And it could remarkedly expand screening coverage in both urban and rural areas, since it is far less reliant on medical resources (11)(12)(13). Several preliminary research projects in China (8, [14][15][16] has verified that selfsampling offers possibility to make CCS reach under or non-screened women.…”

“…It is obvious that inconvenience for participation is the main barrier for screening coverage because those programs were designed using provider sampling, which makes the screening programs can be conducted only in medical facilities and needs medically underserved women to go long distance for screening ( 6 , 8 , 9 ). High risk human papillomavirus (hr-HPV) had been demonstrated to be the necessary pathogen of cervical cancer, and many studies demonstrated that the high sensitivity of the HPV testing could maximize the effectiveness of CCS and its satisfied negative prediction value enables a 5–10 year of the screening interval ( 4 , 5 , 10 , 11 ).…”