Articles

Cervical cancer is a leading cause of mortality in women worldwide. We believe that knowledge sharing and education is an important key. Below you can find a selection of articles of great interest within the field of Cervical Cancer and advanced technology which can play a distinct role in the future of health care.

Categories 
Cervical cytological abnormalities
Evaluation of a Scoring System
Infectious causes of Cancer
Population Impact of Human Papillomavirus/Cytology Cervical Cotesting
Self sampling HPV
Telecolposcopy network
Telemedicine
Triaging device for VIA/HPV positive


Cervical cytological abnormalities

Follow-up of women with cervical cytological abnormalities showing atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion: a nationwide cohort study – Sundström et al 2016

Women managed with repeat cytology within 6 months after atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion cytology had a similar risk of cervical cancer compared with colposcopy/biopsy (incidence rate ratio, 1.1, 95% confidence interval, 0.5e2.5, and incidence rate ratio, 2.0, 95% confi- dence interval, 0.6e6.5, respectively) among women aged 22e27 years. For women aged 28 years and older, women managed with repeat cytology had a higher risk for cervical cancer than women managed with colposcopy/biopsy.

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Evaluation of a Scoring System

The Swede Score: Evaluation of a Scoring System Designed to Improve the Predictive Value of Colposcopy – Boring et al 2009

Swede scores of 8 or more had a sensitivity, specificity, and positive and negative predictive values of 38%, 95%, 83%, and 70%, respectively, for lesions where the final diagnosis was CIN 2 or higher. Using the same cutoff score of 8 or higher, the first 100 examinations had similar results compared with the second set, show- ing that no major learning curve existed when using the Swede score.

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Infectious causes of Cancer

Progression of HPV infection to detectable cervical lesions or clearance in adult women: Analysis of the control arm of the VIVIANE study – Skinner et al 2016

The analysis population included 2,838 women with no high grade or missing cytology data at baseline (Fig. 1a). Women who acquired an HPV infection were generally younger, had first sexual intercourse at a younger age, had more sexual partners, were more likely to smoke, were more likely to have a history of Chlamydia trachomatis infection, and were less likely to have been pregnant compared with women who did not acquire an infection (Supporting Information Table 1). Median follow-up in the study was 47.9 months. A total of 1,073 (37.8%) women experienced 2,615 HPV infections of any duration before the last study visit; 708 (24.9%) women experienced 1,130 6MPIs and 465 (16.4%) women experienced 611 12MPIs (Fig. 1a). At baseline, 507 (17.9%) women had a prevalent HPV infection; of these, 319 (11.2%) women were subsequently identified as having a 6MPI and 214 (7.5%) as having a 12MPI (Fig. 1b). During follow-up, 888 (31.3%) women experienced an HPV infection, includ- ing 528 (18.6%) with a subsequently identified 6MPI and 311 (11.0%) with a subsequently identified 12MPI (Fig. 1c).

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Population Impact of Human Papillomavirus/Cytology Cervical Cotesting

The Population Impact of Human Papillomavirus/Cytology Cervical Cotesting at 3-Year Intervals: Reduced Cervical Cancer Risk and Decreased Yield of Precancer per Screen – Silver et al 2016

Thirty-seven participants were enrolled between September 2012 and March 2014. The largest proportion of participants (46%) was enrolled from the telecolposcopy network. Others were enrolled through outside institutions (43%), in-house referrals (8%), or direct advertisement (3%). Most participants were motivated to join the study to take care of their health issues. Only 2 participants joined the Facebook private page. Of 24 participants who qualified for vaccination, only 1 terminated early due to an unanticipated move.

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Self sampling HPV

Direct comparison of two vaginal self-sampling devices for the detection of human papillomavirus infections. Jentschke et al 2016

Evaluation of 136 patients with complete data (136/146; 93.2%) showed high agreement of overall hr-HPV detection rates between self-collected and clinician-collected specimens (Evalyn: 91.2% [kappa 0.822]; Qvintip: 89.0% [kappa 0.779]). Colposcopy and histological evaluation revealed 55 women without cervical intraepithelial neoplasia (CIN), 32 CIN1, 34 CIN2, 14 CIN3 and one adenocarcinoma in situ. Hr-HPV testing detected all CIN3+ cases on the clinician-taken or Evalyn self-samples (14/14) and 93% of them on the Qvintip samples (13/14). There was no significant difference regarding the sensitivity for CIN2+ or CIN3+ and specificity of hr-HPV testing on self- vs. clinician samples and on Evalyn vs. Qvintip. Based on signal intensities of -globin, the observed DNA concentration with Evalyn samples (mean CN: 22.0; 95%-CI: 21.5–22.6) was found to be significantly higher compared to that of Qvintip samples (mean CN: 23.8; 95%-CI 23.2–24.4), regardless of the order of self-sampling (p < 0.0001). Most women considered self-sampling easy and comfortable. Qvintip was considered easier than the Evalyn Brush to understand (p < 0.001) and to use (p = 0.002).

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Telecolposcopy network

A Novel Use of a Statewide Telecolposcopy Network for Recruitment of Participants in a Phase I Clinical Trial of a Human Papillomavirus Therapeutic Vaccine – Stratton et al 2016

Thirty-seven participants were enrolled between September 2012 and March 2014. The largest proportion of participants (46%) was enrolled from the telecolposcopy network. Others were enrolled through outside institutions (43%), in-house referrals (8%), or direct advertisement (3%). Most participants were motivated to join the study to take care of their health issues. Only 2 participants joined the Facebook private page. Of 24 participants who qualified for vaccination, only 1 terminated early due to an unanticipated move.

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Telemedicine

Application of a Telecolposcopy Program in Rural Settings – Hitt et al 2016

Over a 15-month time period, 940 unique patients were seen using telecolposcopy. Telecolposcopy was done at eight spoke sites across Arkansas representing patients from 72 of the 75 counties. Data for risk factors that include smoking, first sexual experience, and number of sexual partners in past 12 months and in a lifetime are discussed. Pap results and impression are provided. In addition, avoided transportation costs and travel time have been calculated and included.

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Triaging device for VIA/HPV positive women

Evaluation of a compact, rechargeable, magnifying device to triage VIA and HPV positive women in cervical cancer screening program in rural India – Basu et al 2016

Sensitivity and specificity of Gynocular were 96.4 and 47.1%, respectively, to detect HSIL + at the threshold of IFCPC grade 1 findings. Increasing threshold to grade 2 changed sensitivity and specificity to 92.9 and 94.1 %, respectively. Optimum combination of sensitivity and specificity as determined by the cut-off Swed score of 5. Triaging of VIA/HPV positive women to treat using grade 2 criteria would have resulted in modest over treatment and missing of very few high-grade lesions.

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