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Controversy brews over benefit... LBC no more sensitive than con... Grave prognosis of HPV 16/18 p... FISH marker of CIN progression "Paper smears" used to detect ... Diagnostic accuracy of guided ... 'Screen young and old' message... FUTURE I/II trial shows sustai... Say hello to morpho-molecular ... HPV prevalence in England The multidisciplinary colposco... Clinical review of borderline ... Pilot study of HPV DNA and cyt... Another study confirms high se... TOMBOLA results at odds with o... ThinPrep Imager higher sensiti... NHSCSP 31 highlights TOMBOLA trial throws doubts on... HPV self-testing improves cove... More results from Italian NTCC...

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Controversy brews over benefits of screening a population vaccinated against HPV

26 August 2010 : Controversy has arisen over the potential impact on cervical cancer rates of reduced screening in a population vaccinated against HPV. A recent modeling study reported in The Lancet Infectious Diseases suggests that introduction of the vaccine is unlikely to lead to an increased incidence of cervical cancer as a result of diminished screening. However, a Finnish group disputes this conclusion by claiming that vaccinations alone will not prevent cervical cancer unless their efficacy is longer than 15 years. If the duration of efficacy is shorter and efficient boostering is not organised, the onset of the cancer in women is merely postponed and rates of cervical cancer will ultimately increase.

LBC no more sensitive than conventional cytology, even in hands of experts

26 August 2010 : This study challenges the claim that LBC improves the sensitivity for detection of CIN2+ compared with conventional cytology. A random sample of 818 LBC cases originally reported in the NTCC trial were blindly reviewed by three international cytology exerts.There was no significant difference between the accuracy of the experts and the original interpreters.

http://onlinelibrary.wiley.com/doi/10.1002/cncy.20081/abstract

Grave prognosis of HPV 16/18 positivity in screened populations

24 August 2010 : Existing data on HPV type-specific risk is derived largely from unscreened populations. A case control study in a screened UK population indicates a considerable risk of subsequent invasive cervical cancer in women infected with HPV 16 and 18, particularly in women over 40.

http://onlinelibrary.wiley.com/doi/10.1002/ijc.25485/abstract

FISH marker of CIN progression

21 August 2010 : A FISH assay comprised of chromosomal probes 8q24 and 3q26 to cervical cytology specimens confirms the positive correlation between increasing dysplasia and copy gains and shows promise as a marker in cervical disease progression.

http://www.biomedcentral.com/1471-2407/10/432/abstract

"Paper smears" used to detect cervical HPV

07 August 2010 : A study from India has shown that HPV DNA can be effectively detected using a simple and inexpensive paper smear method for the dry collection of cervical specimens.

http://jmm.sgmjournals.org/cgi/content/abstract/jmm.0.019240-0v1

Diagnostic accuracy of guided cervical biopsies

05 August 2010 : A prospective study in which colposcopically guided cervical biopsies and cone excision were performed in a single procedure, the sensitivity and specificity of biopsies for detecting CIN2+ were 66.2% and 95.0%, respectively. While the positive predictive value was 98.5%, the negative predictive value was only 35.5%. So, cervical biopsies are reliable for confirming cytologically detected high grade disease but are relatively poor at excluding it.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W9P-50HWJ83-4&_user=10&_coverDa...

'Screen young and old' message from Iceland.

23 July 2010 : An analysis of the Icelandic cervical screening programme concludes that, in the HPV vaccine era:
1. Screening should continue to start at age 20 years and stop at 69
2. The optimal age for catch-up HPV vaccination should be considered in the context of sexual practices
3. The age limit and screening intervals for HPV- vaccinated women should not be changed.

This "Editor's Choice" article is FREE for a limited time.

http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2303/homepage/editors__choice.ht...

FUTURE I/II trial shows sustained HPV vaccine efficacy

23 July 2010 : FUTURE (Females United To Unilaterally Reduce Endo-ectocervical disease) was a randomized controlled trial studying the efficacy of the quadrivalent HPV vaccine Gardasil. The trial involved nearly 18000 women in 24 countries. The vaccine provided sustained protection (>95%) against low grade lesions attributable to vaccine HPV types (6, 11, 16, and 18) and a substantial reduction in the burden of these diseases through 42 months of follow-up. Protection against all low grade lesions (regardless of HPV type) was also sgnificant (30%, 75% and 48% for cervical, vulval and vaginal lesions, respectively).

http://www.ncbi.nlm.nih.gov/pubmed/20647284

Say hello to morpho-molecular cytology

21 July 2010 : A paper in Cancer Cytopathology describes a new automated technology in which cytology slides are consecutively scanned for morphological changes and genetic changes in the detection of lung cancer. The authors suggest its utility for mass screening.

http://www3.interscience.wiley.com/journal/123588587/abstract?CRETRY=1&SRETRY=0

HPV prevalence in England

18 July 2010 : An analysis of over 5000 cervical cytology samples and biopsies has confirmed the high prevalence of HPV 16 and/or 18 across multiple sites in England. This promises a high impact from HPV immunisation in due course.

http://www.nature.com/bjc/journal/v103/n2/full/6605747a.html

The multidisciplinary colposcopy meeting: recommendations for future service provision and an analysis of clinical decision making

12 July 2010 : "When significant discrepancies exist between colposcopy, cytology and histopathology, then MDT discussion seems pertinent as MDT discussion can lead to the avoidance of over-treatment. To improve timeliness of treatment, MDT meetings should occur at least monthly. The results of each case discussion should be recorded in the patient case notes, the minutes of each meeting should be circulated to all MDT members and a letter describing MDT recommendations must be sent to the colposcopist responsible for patient care."

http://www3.interscience.wiley.com/journal/123574090/abstract

Clinical review of borderline glandular cells reported on liquid-based cervical cytology

12 July 2010 : "On the basis of our results, it would be considered acceptable to manage women [with borderline glandular cells] under 35 years of age with normal and satisfactory colposcopy conservatively. In women above 35 years of age, we would recommend a diagnostic 'large loop excision of the transformation zone' procedure, irrespective of the colposcopic findings"

http://www3.interscience.wiley.com/journal/123261701/abstract

Pilot study of HPV DNA and cytology testing in Mexican Social Security Program

12 July 2010 : HPV testing for cervical screening has been found to be over 50 per cent more sensitive than cytology in a community-based study in Mexico. This is the largest HPV primary screening study ever to be performed in a Latin American country and points to the readiness of HPV testing for large-scale implementation in Mexico.

http://www.springerlink.com/content/l168723060076tg5/?p=f2ac4f79ddcf49649ac2cf8be9070834&p...

Another study confirms high sensitivity of HPV screening

29 April 2010 : Reporting in this week's BMJ, a Finnish randomized controlled trial has confirmed the superior sensitivity of HPV testing compared with conventional cytology for cervical screening. These results are consistent with most of those previously reported.

http://www.bmj.com/cgi/content/short/340/apr27_1/c1804?rss=1&utm_source=feedburner&utm_med...

TOMBOLA results at odds with other studies

18 April 2010 : Summary of commentary from: Arbyn M, Martin-Hirsch P, Wentzensen N. HPV-based triage of women showing a cervical cytology result of borderline or mild dyskaryosis. BJOG 2010117:641–644.

In TOMBOLA, the sensitivity of hrHPV triage of borderline and mild dyskaryosis was 69.9% and 75.2% for detection of underlying CIN2+ (see research item for 21st March 2010). All other studies, including the ASCUS-LSIL Triage Study (ALTS) showed substantially higher sensitivities.

The differences may be explained by differences in HPV test sensitivity or differences in outcome assessment. Notable in TOMBOLA was the reliance on community based histology outcomes, compared with the more stringent approaches to histological assessment in other studies. Overcalling of CIN1 or squamous metaplasia as CIN2 or CIN3 may mave been an important contributor to the observed results.

ThinPrep Imager higher sensitivity for low grade but not high grade abnormalities

14 April 2010 : A comparison of the sensitivity of the ThinPrep Imaging (TPI) system and conventional cytology for the detection of cellular abnormalities has given mixed results. TPI gave improved detection rates for low grade abnormalities but not for high grade.

http://www3.interscience.wiley.com/journal/122628434/abstract

NHSCSP 31 highlights

14 April 2010 : This publication is a critical review of four types of studies looking at screening and cervical cancer. In brief:

There is "no evidence that screening women aged 22–24 reduced the incidence of cervical cancer at ages 25–29 (OR 1.11, 95% CI 0.83–1.50)."

"The probability of regression for the entire cohort [of 13-22 year-olds with any lesion or HPV infection] was 61% (95% CI 53–70) at 12 months and 91% (95% CI 84–99) at 36 months’ follow up. Only 3% (95% CI 0.7–6.0) progressed to high grade disease."

"...progression rate [from CIN3 to cancer] within five years of diagnosis can be no greater than 1% per year and is more likely to be around 0.5% per year."

"...for every 100 women treated aged 20–24, at best one case of cancer is prevented that would not have been prevented had screening been delayed until age 25."

"...LLETZ was significantly associated with preterm delivery (relative risk (RR) = 1.70, 1.24–2.35), low birth weight."

"...the evidence published since 2002 shows little, if any, benefit from screening women under 25 as far as the prevention of cervical cancer or of advanced cervical cancer is concerned."

"...the Advisory Committee on Cervical Screening (England) was unanimous in its decision not to lower the age at first invitation from 25 to 20."

http://www.cancerscreening.nhs.uk/cervical/publications/nhscsp31.pdf

TOMBOLA trial throws doubts on the value of HPV triage

21 March 2010 : Numerous studies have shown that HPV testing is good at detecting abnormalities in women with low-grade tests and can reduce the number who need to be referred for treatment, especially in the over 35s. However, a recent publication in BJOG seems to cast doubt over the presumed benefits of HPV testing as a means of triage for low grade cytological abnormalities.

In the study 4439 women with borderline changes or mild dyskaryosis received an HPV test and were followed for three years. Outcome was determined by an exit colposcopy examination. Across all ages, 22% of women who had CIN2 or worse were HPV negative. Conversely, 40% of those who were HPV positive did not have CIN. The authors conclude: "...in younger women with low-grade cytological abnormalities, a single HPV test would not be useful in determining who should be referred for colposcopy or the most effective management at colposcopy. In women over 40, a negative HPV test could be used to rule out further investigation."

http://www.bjog.org/details/journalArticle/589553/The_role_of_human_papillomavirus_testing...

HPV self-testing improves coverage and effectiveness in cervical screening

14 March 2010 : PROHTECT (protection by offering HPV testing on cervicovaginal specimens trial) is a cohort study within the setting of the Dutch population based cervical screening programme to assess the feasibility and efficacy of offering cervicovaginal lavage self sampling for high risk HPV testing to women who do not attend the regular screening programme.

Among women who had not responded to a previous screening invitation, self sampling improved compliance and more than doubled the yield of CIN2+ compared with self sampling women who had been screened in the previous round.

http://www.bmj.com/cgi/content/full/340/mar11_1/c1040

More results from Italian NTCC HPV testing trial

04 March 2010 : The latest results from NTCC are reported in the current issue of Lancet Oncology. Briefly, HPV-based screening is more effective than cytology in preventing invasive cervical cancer, by detecting persistent high-grade lesions earlier and providing a longer low-risk period. However, in younger women, HPV screening leads to over-diagnosis of regressive CIN2. The report is accompanied by a freely accessible editorial.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(09)70360-2/fulltext#article...

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