Download or read book The Comparative Effectiveness of Cytology Testing and HPV DNA Testing Based Primary Screening Pathways within a Cervical Screening Program written by Patrick Kimuyu and published by GRIN Verlag. This book was released on 2018-01-26 with total page 19 pages. Available in PDF, EPUB and Kindle. Book excerpt: Literature Review from the year 2018 in the subject Medicine - Diagnostics, grade: 1, Egerton University, language: English, abstract: Primary screening of cervical cancer has been faced with an array of challenges which are attributable to the lack of appropriate technology. These challenges compromised the effectiveness of screening programs in different countries. It is apparent that the detection of cervical cancer precursors forms the basis for the success of screening programs for cervical cancer leading to the reduction of cervical cancer incidence and prevalence trends. Currently, there are two diagnostic methods that can be used for primary screening of cervical cancer: Pap cytology and HPV DNA test. However, the comparative effectiveness of this diagnostic tests indicate that HPV test is more effective than Pap cytology which is used as a first-line diagnostic method in cervical cancer prevention programs in many countries. Cytology testing and HPV testing differ significantly on the level of accuracy and sensitivity. Evidence studies indicate that HPV test exhibits high sensitivity and accuracy compared to Pap test. In a publicly-financed healthcare system such as the US, Canadian and EU, HPV testing has been proven to be more cost-effective than Pap test. Therefore, there is need to adopt HPV test for triage and primary screening.

Download or read book Automation assisted and Liquid based Cytology for Cervical Cancer Screening written by Australia. Medical Services Advisory Committee and published by . This book was released on 2009 with total page 182 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Cost Effectiveness of Primary Hpv Testing for Cervical Cancer Screening written by Ka-Man Choi and published by . This book was released on 2017-01-26 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation, "Cost-effectiveness of Primary HPV Testing for Cervical Cancer Screening: a Systematic Review" by Ka-man, Choi, 蔡嘉敏, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Background: Human papillomavirus (HPV) DNA test is more sensitive and can detect more high-grade cervical intraepithelial lesions than cytology test in cervical cancer screening. There are studies confirming HPV test being more effective in cervical cancer screening by detecting the persistence of HPV infection that could lead to cancer. However, the costs associated with a HPV test is higher than a cytology test. Moreover, HPV test is less specific which could subject more women to further triage tests or unnecessary invasive diagnostic procedures. Therefore healthcare costs could possibly increase if primary HPV screening is to be adopted. Study objective: The aim of the study is to systematically review the cost-effectiveness of primary HPV testing in cervical cancer screening Method: Electronic search was performed in three biomedical databases (PubMed, Medline, Cochrane Library) and one economic evaluation database to identify relevant studies. Studies were selected according to the explicit inclusion and exclusion criteria defined. Only those studies carried out in high-income countries were included so that result could be better applied to Hong Kong. Results: A total of 19 studies were included in this systematic review. Cytology-only method is generally not cost-effective. To be cost-effective, it has to be performed in a longer screening interval which would reduce not only the screening costs but also a reduction in the health outcomes. Among the different options in HPV-based primary screening, HPV testing with cytology triage is the most cost-effective strategy in many of the studies. Combined HPV/cytology co-screening could achieve the biggest health benefit but is also most costly. HPV-based screening is more cost-effective for those >30 years of age and is usually less cost-effective if applied to young women. From the result in sensitivity analysis, HPV-based screening is sensitive to an increase in the costs of the HPV test, a low HPV test sensitivity and a low screening compliance rate. Conclusion: Primary HPV screening is cost-effective and generally performs better than cytology screening. The result of this systematic review guides the future direction of developing an optimal cervical screening strategy in Hong Kong. Local context has to be considered when examining the cost-effectiveness of primary HPV testing for cervical screening. Good quality local epidemiological data on HPV infection and cervical cancer and screening would be required to aid future research on the application of HPV test for cervical cancer screening in Hong Kong. DOI: 10.5353/th_b5098438 Subjects: Medical screening Cervix uteri - Cancer - Diagnosis

Download or read book Cervical Cancer Screening in Developing Countries written by World Health Organization and published by World Health Organization. This book was released on 2002 with total page 90 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cervical cancer is the second most common cancer among women worldwide, with 80 per cent of deaths occurring in developing countries. It is an important area for cancer control programmes because of the burden of the disease and the potential for effective prevention via screening. This publication is based on a comprehensive consultation undertaken by WHO in 2001, involving leading experts in the field of cancer epidemiology, screening and treatment. It focuses on the current situation in low and middle income countries, discusses the efficacy of screening methods available, and assesses potential future developments.

Download or read book Clinical Gynecology written by Eric J. Bieber and published by Cambridge University Press. This book was released on 2015-04-23 with total page 1127 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written with the busy practice in mind, this book delivers clinically focused, evidence-based gynecology guidance in a quick-reference format. It explores etiology, screening, tests, diagnosis, and treatment for a full range of gynecologic health issues. The coverage includes the full range of gynecologic malignancies, reproductive endocrinology and infertility, infectious diseases, urogynecologic problems, gynecologic concerns in children and adolescents, and surgical interventions including minimally invasive surgical procedures. Information is easy to find and absorb owing to the extensive use of full-color diagrams, algorithms, and illustrations. The new edition has been expanded to include aspects of gynecology important in international and resource-poor settings.

Download or read book The Bethesda System for Reporting Cervical Cytology written by Ritu Nayar and published by Springer. This book was released on 2015-04-13 with total page 342 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book offers clear, up-to-date guidance on how to report cytologic findings in cervical, vaginal and anal samples in accordance with the 2014 Bethesda System Update. The new edition has been expanded and revised to take into account the advances and experience of the past decade. A new chapter has been added, the terminology and text have been updated, and various terminological and morphologic questions have been clarified. In addition, new images are included that reflect the experience gained with liquid-based cytology since the publication of the last edition in 2004. Among more than 300 images, some represent classic examples of an entity while others illustrate interpretative dilemmas, borderline cytomorphologic features or mimics of epithelial abnormalities. The Bethesda System for Reporting Cervical Cytology, with its user-friendly format, is a “must have” for pathologists, cytopathologists, pathology residents, cytotechnologists, and clinicians.

Download or read book European Guidelines for Quality Assurance in Cervical Cancer Screening written by Marc Arbyn and published by . This book was released on 2008 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recoge: 1. Epidemiological guidelines for quality assurance in cervical cancer screening - 2. Methods for screening and diagnosis - 3. Laboratory guidelines and quality assurance practices for cytology - 4. Techniques and quality assurance guidelines for histopathology - 5. Management of abnormal cervical cytology - 6. Key performance indicators - 7. Annexes.

Download or read book WHO guideline for screening and treatment of cervical pre cancer lesions for cervical cancer prevention written by World Health Organization and published by World Health Organization. This book was released on 2024-06-05 with total page 65 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this publication, recommendations for the Use of dual-stain cytology to triage women after a positive test for human papillomavirus (HPV) are presented. Dual-stain cytology can be used as a triage test in cervical “screen, triage and treat" algorithms for cancer prevention. It is performed on liquid-based cytology (LBC) slides (not on conventional Pap smears) to detect the presence of two proteins: p16 and Ki-67. Recommendation for the general population of women: In a screen, triage and treat approach using HPV Nucleic Acid Tests (NATs) as the primary screening test among the general population of women, WHO suggests using partial genotyping, colposcopy, VIA, cytology or dual-stain cytology to triage women after a positive HPV NATs result. When providing dual-stain cytology to triage women after a positive HPV NAT, WHO suggests: using samples collected by the health worker; and retesting with HPV NATs 24 months after a negative dual-stain cytology result. These are conditional recommendations based on low-certainty evidence for dual-stain cytology as a triage test. No recommendation was made for using dual-stain cytology to triage women living with HIV after a positive HPV DNA test, because evidence on the outcomes of using dual-stain cytology applicable to this population was minimal.

Download or read book Screening for Cervical Cancer with High risk Human Papillomavirus Testing written by Joy Melnikow and published by . This book was released on 2018 with total page 150 pages. Available in PDF, EPUB and Kindle. Book excerpt: IMPORTANCE: Cervical cancer can be prevented with early detection and treatment of precancerous lesions that are caused primarily by infection with high-risk strains of human papillomavirus (hrHPV). Current guidelines for screening in the United States focus on cytology screening with the Papanicolaou (Pap) test, with hrHPV cotesting as an option for women ages 30 to 65 years that allows for longer rescreening intervals. Evidence from large trials evaluating screening programs involving primary hrHPV testing (hrHPV alone as the initial test) and cotesting may inform new screening strategies. Evidence supporting cytology screening is well established, so this review evaluated screening with hrHPV testing alone (i.e., primary hrHPV testing) or as cotesting with cytology compared to cytology alone to address whether these forms of screening provide better protection from cervical cancer and allow for longer rescreening intervals. Rates of cervical cancer are very low among routinely screened women in the United States, but not all women are routinely screened, and there are significant racial/ethnic disparities in morbidity and mortality from cervical cancer. CONCLUSIONS AND RELEVANCE: Eight large randomized trials, four of primary hrHPV testing and four of hrHPV cotesting, contributed to the evidence comparing use of hrHPV testing as part of cervical cancer screening with cytology alone for detection of CIN3+. All trials were conducted in the context of organized screening programs, with heterogeneous screening strategies and followup protocols. Interpretation of trial findings was limited by the fact that after one round of screening, only one trial conducted further screening applying the originally assigned strategies in the control and intervention arms. In all other trials, both arms received the same test at Round 2 (either cytology alone or hrHPV cotesting). Primary hrHPV testing increased detection of CIN3+ in the initial round of screening by as much as 2- to 3-fold. Only the trial of primary hrHPV testing, where all women with a positive hrHPV test were referred to colposcopy, had results from two rounds of screening. In that study, CIN3+ detection in Round 1 was 3-fold higher in the primary hrHPV testing arm, and cumulative detection was 1.8-fold higher after the second round of screening. Evidence was mixed in cotesting trials. No trial showed a significant increase in CIN 3+ detection in Round 1 for cotesting. In two of four trials, CIN3+ detection was lower in Round 2 in the hrHPV cotesting arm and higher in the cytology alone arm. Cumulative CIN3+ detection was similar between intervention and control study arms in all trials. Because no trial sustained the intervention and control group protocols beyond two screening rounds, evidence comparing the long-term outcomes of primary hrHPV testing or cotesting with cytology was lacking. Data to compare potential harms of different screening strategies were similarly limited, and none of the included trials or observational studies reported on harms of the screening test or treatments. False-positive rates and referrals to colposcopy were in some trials 2- to 3-fold higher with hrHPV-based screening strategies relative to cytology alone in the first screening round, and evidence was lacking to determine whether these differences might persist over multiple screening rounds. Risks of missed ICC were very low regardless of the screening strategy used. An IPD meta-analysis suggested a lower rate of ICC with hrHPV screening strategies, but this analysis pooled data from trials with distinctly different screening strategies and hrHPV test types, adding uncertainty to interpretation of the findings. In most trials and in a large U.S.-based observational study, women younger than age 30 to 35 years had higher rates of hrHPV positivity and CIN3+, accompanied by higher rates of colposcopy. No completed studies compared different screening intervals. All of the RCTs on hrHPV screening were conducted in countries with organized screening programs, which are not available to most women in the United States. Rigorous comparative research is needed in U.S. screening settings to examine longer screening intervals, long-term outcomes, and to identify effective strategies for outreach and screening of poorly screened and unscreened women. The higher sensitivity of hrHPV testing in a single round may have potential to improve outcomes in this high-risk population.

Download or read book Human Papillomavirus and Cervical Cancer written by International Agency for Research on Cancer and published by . This book was released on 1989 with total page 180 pages. Available in PDF, EPUB and Kindle. Book excerpt: This volume reviews the evidence for a causal link between sexually transmitted infection with human papillomavirus (HPV) and the occurrence of cervical cancer, from a variety of different angles. Epidemiological studies and clinical, pathological, and cytological aspects of HPV infection are reviewed. Modern methods for analyzing HPV-DNA types by molecular biological techniques are described, and the statistical problems to be overcome in epidemiological work are explained. The volume was prepared by a broad team of experts from around the world, who met in Copenhagen in March 1988 to reach a consensus on the present state of understanding and to establish directions for future work.

Download or read book Comprehensive Cervical Cancer Control written by World Health Organization and published by World Health Organization. This book was released on 2006 with total page 284 pages. Available in PDF, EPUB and Kindle. Book excerpt: Most women who die from cervical cancer, particularly in developing countries, are in the prime of their life. They may be raising children, caring for their family, and contributing to the social and economic life of their town or village. Their death is both a personal tragedy, and a sad and unnecessary loss to their family and their community. Unnecessary, because there is compelling evidence, as this Guide makes clear, that cervical cancer is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively. Unfortunately, the majority of women in developing countries still do not have access to cervical cancer prevention programmes. The consequence is that, often, cervical cancer is not detected until it is too late to be cured. An urgent effort is required if this situation is to be corrected. This Guide is intended to help those responsible for providing services aimed at reducing the burden posed by cervical cancer for women, communities and health systems. It focuses on the knowledge and skills needed by health care providers, at different levels of care.

Download or read book Epidemiologic Investigation of the Value of Human Papillomavirus HPV Testing and Genotyping in Cervical Cancer Screening in Canada written by Sandra Isidean and published by . This book was released on 2018 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: "Papanicolaou (Pap) cytology-based cervical cancer screening was introduced in Canada decades ago, and has since led to substantial reductions in cervical cancer incidence and mortality rates. These rates have leveled off over the past decade, however, indicating that further gains under this screening paradigm are unlikely. The low sensitivity of Pap cytology, alongside costly infrastructure and personnel requirements needed to maintain effective cytology-based cervical screening programs, have also remained important limitations associated with this ongoing screening strategy. The understanding that virtually all cervical cancers are caused by persistent infection with oncogenic genotypes of human papillomavirus (HPV), referred to as high-risk HPV (HR-HPV), has led to major advances in cervical cancer prevention, and a renewed focus on maximizing the effectiveness and efficiency of screening strategies in Canada and elsewhere.The overall aim of this doctoral research was to examine the clinical value of HR-HPV testing and genotyping among women undergoing routine primary cervical cancer screening in Canada. Data from the Canadian Cervical Cancer Screening Trial (CCCaST; n=10,154) were used to accomplish the following objectives: (i) evaluate the short-term (up to 36 months) ability of HPV DNA testing and Pap testing (individually and jointly) to detect high-grade cervical lesions and cervical cancer; (ii) assess the long-term (up to 120 months) prognostic value of HPV DNA testing and Pap testing (individually and jointly) to detect high-grade cervical lesions and cervical cancer; (iii) examine to what extent the separate detection of HPV genotypes in cervical samples provides additional risk stratification for detecting high-grade cervical lesions and cervical cancer among HPV+ women.Within this dissertation, the predictive abilities of enrollment HR-HPV testing (to include genotyping) and Pap cytology results to detect CIN2+ were assessed and compared using the Kaplan-Meier method, the log-rank test, and multivariable Cox proportional hazards (PH) regression during each of two follow-up periods (protocol-defined and extended). A flexible generalization of the Cox PH model allowed for simultaneous testing of the following important assumptions imposed a priori by a conventional Cox PH model: proportionality of hazards (PH assumption), and linearity of the relationship between continuous predictors and the logarithm of the hazard (linearity assumption). If one or both of these assumptions were rejected, non-proportional (i.e., time-dependent (TD)) and/or non-linear (NL) covariate effects were modeled. The performance of various HR-HPV and Pap cytology screening strategies to triage HR-HPV+ women to colposcopy were also compared.Work within this dissertation indicates that cervical cancer screening incorporating HR-HPV testing for women aged ≥30 years may allow for greater disease detection than cytology-based screening, and permit safe extensions of screening intervals. HR-HPV genotype-specific testing could provide further improvement in the positive predictive value of such screening. Primary HR-HPV testing also provided a similar or greater level of reassurance against disease risks as currently recommended screening strategies. Concerns surrounding primary HR-HPV screening (namely, its reduced specificity) may be effectively mitigated via triage of HR-HPV+ women to colposcopy and further follow-up. Finally, due to violations of the PH assumption, conventional Cox PH model estimates considerably underestimated adjusted hazard ratios associated with positive HR-HPV testing results, either alone or in conjunction with cytology results, early on in the follow-up periods." --

Download or read book Screening for Cervical Cancer written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-04-18 with total page 278 pages. Available in PDF, EPUB and Kindle. Book excerpt: We undertook this systematic review to assist the U.S. Preventive Services Task Force (USPSTF) in updating its 2003 recommendation on cervical cancer screening. During the planning phase of this evidence review on cervical cancer screening, the Agency for Healthcare Research and Quality decided to fund a separate modeling study to be conducted simultaneously. The USPSTF determined that the scope for both the systematic review and the modeling study would focus on important clinical questions that could inform effective use of screening in practice. This systematic review focuses on when to begin screening and on updating test accuracy and harms data on liquid-based cytology (LBC) and human papillomavirus (HPV) testing, either alone or in combination with cytology. The modeling study focuses on the effectiveness of strategies that use different ages at which to begin screening and different screening intervals. These two reports are intended to provide the USPSTF with complementary information to update its recommendation on cervical cancer screening. Using the USPSTF's methods we developed an analytic framework and five key questions (KQs) to guide our literature search. These KQs include: KQ1: When should cervical cancer screening begin, and does this vary by screening technology or by age, sexual history, or other patient characteristics? KQ2: To what extent does liquid-based cytology improve sensitivity, specificity, and diagnostic yield and reduce indeterminate results and inadequate samples compared to conventional cervical cytology? KQ3: What are the benefits of using HPV testing as a screening test, either alone or in combination with cytology, compared with not testing for HPV? KQ4: What are the harms of liquid-based cytology? KQ5: What are the harms of using HPV testing as a screening test, either alone or in combination with cytology?This report's scope differs from the 2002 USPSTF evidence report in several ways. KQ1, which was not included in the 2002 evidence report, addresses when cervical cancer screening should begin. Both LBC and automated screening technologies were evaluated in the prior review, and the evidence was determined to be insufficient to recommend for or against the use of these technologies in cervical cancer screening programs. For this review, we updated the evidence regarding LBC (KQ2) and focused on studies that evaluated either ThinPrep or SurePath, which are both FDA approved. The previous review evaluated the sensitivity and specificity of the HPV test for detection of histologically proven HSIL and LSIL. The authors also evaluated the use of the HPV test as a tool to facilitate triage of women with abnormal cytology. The current review expanded the scope of KQ3 to evaluate the evidence regarding the use of HPV testing in the following scenarios: 1. Primary screening with HPV test alone. 2. HPV testing with cytology triage of positive HPV (reflex cytology). 3. Combination HPV and cytology testing (co-testing). 4. Cytology testing with HPV triage of positive cytology (reflex HPV). We addressed one contextual question that evaluated the efficacy of screening in women older than age 65 years according to the USPSTF's specified nonsystematic approach. The previous review addressed this question systematically, and the USPSTF recommended against routinely screening women older than age 65 years, based on limited evidence regarding the benefits of continued screening in these women. We did not update the direct evidence for screening in women after a hysterectomy because the prior USPSTF recommendation to discontinue screening after hysterectomy for benign disease is clearly supported. Because the HPV vaccine is so new, data to determine the long-term efficacy of the vaccine or how the HPV vaccine will affect screening is limited. Therefore, the USPSTF did not include a KQ addressing the impact of the HPV vaccine on cervical cancer screening.

Download or read book What is the Clinical and Cost Effectiveness of Human Papillomavirus HPV Testing Followed by Liquid based Cytology Triage of Positive Results in Primary Screening for Cervical Cancer written by and published by . This book was released on 2012 with total page 8 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Making Choices in Health written by World Health Organization and published by World Health Organization. This book was released on 2003 with total page 364 pages. Available in PDF, EPUB and Kindle. Book excerpt: "The Guide, in Part I, begins with a brief description of generalized CEA and how it relates to the two questions raised above. It then considers issues relating to study design, estimating costs, assessing health effects, discounting, uncertainty and sensitivity analysis, and reporting results. Detailed discussions of selected technical issues and applications are provided in a series of background papers, originally published in journals, but included in this book for easy reference in Part II." (from the back cover).

Download or read book Holland Frei Cancer Medicine written by Robert C. Bast, Jr. and published by John Wiley & Sons. This book was released on 2017-03-10 with total page 2004 pages. Available in PDF, EPUB and Kindle. Book excerpt: Holland-Frei Cancer Medicine, Ninth Edition, offers a balanced view of the most current knowledge of cancer science and clinical oncology practice. This all-new edition is the consummate reference source for medical oncologists, radiation oncologists, internists, surgical oncologists, and others who treat cancer patients. A translational perspective throughout, integrating cancer biology with cancer management providing an in depth understanding of the disease An emphasis on multidisciplinary, research-driven patient care to improve outcomes and optimal use of all appropriate therapies Cutting-edge coverage of personalized cancer care, including molecular diagnostics and therapeutics Concise, readable, clinically relevant text with algorithms, guidelines and insight into the use of both conventional and novel drugs Includes free access to the Wiley Digital Edition providing search across the book, the full reference list with web links, illustrations and photographs, and post-publication updates

Download or read book Human Papillomavirus DNA Testing with Cytology Triage in Cervical Screening written by Lyndsay Ann Richardson and published by . This book was released on 2011 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: The causal association between Human Papillomavirus (HPV) and cervical cancer has enabled developments in modern cervical screening technologies. In place of traditional Papanicolaou (Pap) testing as the sole screening modality, support is mounting for primary screening via tests for HPV DNA detection, reserving Pap cytology for triage of HPV-positive women. Since interpretation of Pap smears is a subjective procedure, revealing HPV-positivity may influence cytotechnician assessments of cellular abnormalities. Objectives: We simulated the HPV/Pap triage algorithm within three different screening populations with the objective of assessing and comparing diagnostic properties (sensitivity, specificity, positive and negative predictive values) of Pap cytology as a triage test when cytotechnicians are made aware of the patient's cervical HPV status. Methods: We conducted a post-hoc analysis of previously collected cervical slides and clinical data from ...