Women's intentions to receive cervical cancer screening with primary human papillomavirus testing

Smith, Laurie; Niekerk, Dirk J. van; Khurshed, Fareeza; Krajden, Mel; Saraiya, Mona; Goel, Vivek; Rimer, Barbara K.; Greene, Sheila; Hobbs, Suzanne Havala; Coldman, Andrew J.; Franco, Eduardo L.

doi:10.1002/ijc.28324

Cited by 46 publications

(80 citation statements)

References 43 publications

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“…Yet, four out of 10 providers reported recommending primary HPV testing to women of all ages. No firm consensus on the appropriate screening intervals emerged, but both providers in the current study and women (Ogilvie et al, 2013) appear to be less supportive of primary HPV testing intervals longer than 3 years. Provider support for annual HPV testing was especially troubling.…”

Section: Discussionmentioning

confidence: 67%

Primary HPV testing recommendations of US providers, 2015

Cooper¹,

Saraiya

2017

Preventive Medicine

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Objective To investigate the HPV testing recommendations of US physicians who perform cervical cancer screening. Methods Data from the 2015 DocStyles survey of U.S. health care providers were analyzed using multivariate logistic regression to identify provider characteristics associated with routine recommendation of primary HPV testing for average-risk, asymptomatic women ≥30 years old. The analysis was limited to primary care physicians and obstetrician-gynecologists who performed cervical cancer screening (N = 843). Results Primary HPV testing for average-risk, asymptomatic women ≥30 years old was recommended by 40.8% of physicians who performed cervical cancer screening, and 90.1% of these providers recommended primary HPV testing for women of all ages. The screening intervals most commonly recommended for primary HPV testing with average-risk, asymptomatic women ≥30 years old were every 3 years (35.5%) and annually (30.2%). Physicians who reported that patient HPV vaccination status influenced their cervical cancer screening practices were almost four times more likely to recommend primary HPV testing for average-risk, asymptomatic women ≥30 years old than other providers (Adj OR = 3.96, 95% CI = 2.82–5.57). Conclusion Many US physicians recommended primary HPV testing for women of all ages, contrary to guidelines which limit this screening approach to women ≥25 years old. The association between provider recommendation of primary HPV testing and patient HPV vaccination status may be due to anticipated reductions in the most oncogenic HPV types among vaccinated women.

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Section: Discussionmentioning

confidence: 67%

Primary HPV testing recommendations of US providers, 2015

Cooper¹,

Saraiya

2017

Preventive Medicine

Self Cite

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“…Key messaging should be developed to address the concerns around an HPV‐positive result: destigmatize HPV by emphasizing the high prevalence; highlight HPV positivity does not indicate a woman has or will develop cervical cancer; ensure women are aware HPV may have been present for years, and does not reflect partner infidelity or promiscuity; move the focus of HPV testing from “STI identification” to an enhanced test for cervical cancer prevention. A key indicator of a woman's intention to receive HPV testing is endorsement by her care provider; therefore, clinicians play a significant role alleviating distress by being prepared for the concerns and questions women will have. Cytology has been the primary cervical screening tool for decades.…”

Section: ±P16 ± Ki67mentioning

confidence: 99%

Eurogin roadmap 2017: Triage strategies for the management of HPV‐positive women in cervical screening programs

Cuschieri

Ronco²,

Lörincz

et al. 2018

Intl Journal of Cancer

142

150

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Cervical cancer screening will rely, increasingly, on HPV testing as a primary screen. The requirement for triage tests which can delineate clinically significant infection is thus prescient. In this EUROGIN 2017 roadmap, justification behind the most evidenced triages is outlined, as are challenges for implementation. Cytology is the triage with the most follow-up data; the existence of an HR-HPV-positive, cytology-negative group presents a challenge and retesting intervals for this group (and choice of retest) require careful consideration. Furthermore, cytology relies on subjective skills and while adjunctive dual-staining with p16/Ki67 can mitigate inter-operator/-site disparities, clinician-taken samples are required. Comparatively, genotyping and methylation markers are objective and are applicable to self-taken samples, offering logistical advantages including in low and middle income settings. However, genotyping may have diminishing returns in immunised populations and type(s) included must balance absolute risk for disease to avoid low specificity. While viral and cellular methylation markers show promise, more prospective data are needed in addition to refinements in automation. Looking forward, systems that detect multiple targets concurrently such as next generation sequencing platforms will inform the development of triage tools. Additionally, multistep triage strategies may be beneficial provided they do not create complex, unmanageable pathways. Inevitably, the balance of risk to cost(s) will be key in decision making, although defining an acceptable risk will likely differ between settings. Finally, given the significant changes to cervical screening and the variety of triage strategies, appropriate education of both health care providers and the public is essential.

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“…Regional guidelines on screening interval, age of screening commencement, and appropriate triage pathways, coupled with comprehensive education and dissemination throughout the health care system play an important role in mitigating over-screening. However, in order for hpv-based screening to be optimized, practitioners will need to be adequately educated on how to manage hpv-positive results and equipped with messaging to handle concerns and questions women may have about hpv, given recommendations from physicians and other clinicians are known to influence patient behaviours 47 . Physician education should include strategies to address adverse emotional responses women may have when informed they have an hpv infection 48 .…”

Section: Health Care System Considerationsmentioning

confidence: 99%

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

et al. 2018

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The success of cytology (Pap screening) programs is undeniable and has drastically reduced cervical cancer rates in high-income settings where it has been implemented 1 . However, cytology for primary cervical cancer screening has a number of limitations including poor sensitivity, a taxing demand on human and operational infrastructure, high health system costs, and limited uptake rates, leading researchers and policy-makers to question whether further gains in public health are possible using this approach 2 . Persistent infection with high-risk genotypes of human papillomavirus (hpv) is well established as the necessary cause for development of cervical cancer 3 . Research has shown a 30% improvement in sensitivity in detecting high-grade lesions, cervical squamous intraepithelial neoplasia (cin) grade 2 or greater (cin2+), can be achieved with high-risk hpv dna testing compared with cytology 4 . A negative hpv test confers two-fold greater reassurance against the development of cervical cancer over three years compared with a negative cytology test 2,5 . The Netherlands has recently transitioned from cytology to hpv testing for primary cervical cancer screening in their National program. Many organized screening programs intend to implement primary hpv screening 6-9 , including Australia, which will begin implementation in December 2017.A consistent barrier to cytology-based cervical cancer screening is non-attendance, which can be addressed through hpv testing using self-collected samples. Primary cervical cancer screening with hpv dna testing allows for the opportunity of self-collected samples, which is not possible with cytology. In hpv self-collection the sample is obtained vaginally by the woman herself, using a device such as a swab or brush. The swab is subsequently tested for high-risk strains of hpv in a laboratory. With this approach to screening, programs can mail self-collection kits directly to women who are overdue for screening as an alternative to a clinic-based visit. Self-collected cervical samples receiving hpv testing show comparable cin2+ sensitivity compared with clinician-collected samples tested with cytology and with hpv 10-12 . Self-collection has proven to be highly acceptable among women 13 .Huma n papillomav ir us self-collection has t he potential to overcome many of the personal and systemlevel barriers to screening that exist for cytology or other clinic-based screening methods. Some women, particularly those who have experienced abuse 14 or are otherwise marginalized, may find self-sampling preferable because of such things as cultural/religious embarrassment or discomfort associated with a pelvic exam 13,[15][16][17] . Time, transportation, inconvenient clinic hours, or not having a regular practitioner are also relevant factors associated with under-screening that can be mitigated through hpv self-collection using mailed samples 13,16,17 . However, there are psychosocial barriers to hpv screening, including women's lack of awareness and fears around hpv and cervical cancer...

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Women's intentions to receive cervical cancer screening with primary human papillomavirus testing

Cited by 46 publications

References 43 publications

Primary HPV testing recommendations of US providers, 2015

Primary HPV testing recommendations of US providers, 2015

Eurogin roadmap 2017: Triage strategies for the management of HPV‐positive women in cervical screening programs

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

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