What next in cervical cancer screening?
Authors:
B. Sehnal 1; J. Sláma 2
Authors‘ workplace:
Onkogynekologické centrum, Gynekologicko-porodnická klinika Nemocnice Na Bulovce a 1. LF UK, Praha, přednosta prof. MUDr. M. Zikán, Ph. D
1; Onkogynekologické centrum, Gynekologicko-porodnická klinika Všeobecné fakultní nemocnice a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc.
2
Published in:
Ceska Gynekol 2020; 85(4): 236-243
Category:
Original Article
Overview
Introduction: The main aim of organized national cervical cancer screening programs is to decrease incidence and mortality of this malignancy. A total of 770 cases of cervical cancer and 354 deaths from the disease were noticed in the Czech Republic in 2017 which means the incidence 14,5 new cases per 100 000 women. The Czech national cervical cancer screening program is based on cytology (Pap smear) testing in asymptomatic women once a year.
Objective: To provide an overview of new possibilities and potential tools in cervical cancer screening worldwide and in the Czech Republic.
Setting: Gynecologic Oncology Center, Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague.
Methods: For this review, we have used the results of studies, review articles, and guidelines of national cervical cancer screening programs published in English. We summarize the current knowledge of molecular genetic methods being applied in the screening of cervical carcinoma.
Conclusion: The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of new possibilities of cervical cancer screening worldwide. HPV testing use for cervical cancer screening is now a reality with a quite lot of countries. Nevertheless, HPV testing is mainly used in the stratification of patients with unclear results of a cytological (PAP smear) result in the Czech Republic. While there is a wide and growing consensus that HPV molecular testing is the most accurate and cost-effective method of primary screening, there is a comparative lack of consensus regarding the optimal stratification of patients with proven HPV infections. Biomarkers, such a p16/Ki67 dual immunostaining, a methylation of viral DNA, a detection of E6/E7 mRNA, and others have been proposed for triage of HPV positive women. New possibilities and approaches in strategy of cervical cancer screening are discussed.
Keywords:
cervical cancer – screening – molecular methods – HPV test – p16/Ki67 – Methylation – E6/E7 mRNA
Sources
1. Arbyn, M., Weiderpass, W., Bruni, L., et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health, 2020, 8, e191–203.
2. Cuschieri, K., Ronco, G., Lorincz, A., et al. Eurogin roadmap 2017: Triage strategies for the management of HPV-positive women in cervical screening programs. Int J Cancer, 2018, 143(4), p. 735–745.
3. Černá, K., Němcová, J. Molekulárně genetické metody ve skriningu karcinomu děložniho hrdla. Česk Patol, 2018, 54(4), s. 169–174.
4. De Strooper, LMA., Verhoef, VMJ., Berkhof, J., et al. Validation of the FAM19A4/mir124-2 DNA methylation test for both lavage- and brush-based self-samples to detect cervical (pre)cancer in HPV-positive women. Gynecol Oncol, 2016, 141, p. 341–347.
5. Derbie, A., Mekonnen, D., Woldeamanuel, Y., et al. HPV E6/ E7 mRNA test for the detection of high grade cervical intraepithelial neoplasia (CIN2+): a systematic review. Infect Agent Cancer, 2020, 7, 15, p. 9. doi: 10.1186/s13027-020-0278-x.
6. Ebell, MH., Thai, TN., Royalty, KJ. Cancer screening recommendations: an international comparison of high income countries. Public Health Rev, 2018, 2, 39, p. 7. doi: 10.1186/s40985-018- 0080-0.
7. Khan, MJ., Castle, PE., Lorincz, AT., et al. The elevated 10-years risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst, 2005, 20, 97(14), p. 1072–1079.
8. Kinkorová Luňáčková, I., Májek, O. Karcinom děložního hrdla v ČR a možnosti jeho prevence. Česk Patol, 2018, 63(4), s. 164–168.
9. Kjaer, SK., Frederiksen, K., Munk, C., Iftner, T. Long-term absolute risk of cervical intraepithelial neoplasia grade 3 or worse following human papillomavirus infection: role of persistence. J Natl Cancer Inst, 2010, 102, p. 1478–1488.
10. Májek, O., Dušek, L., Dvořák, V. Výsledky screeningu karcinomu hrdla děložního v ČR. Ústní sdělení, 12. konference Sekce kolposkopie a cervikální patologie ČGPS ČLS JEP, Orea Hotel Pyramida, Praha, 29. 11.–1. 12. 2019.
11. McMenamin, M., McKenna, M., McDowell, A. Clinical tility of CINtec PLUS Triage in Equivocal Cervical Cytology and Human Papillomavirus Primary Screening. Am J Clin Pathol, 2018, 24, 150(6), p. 512–521.
12. Meijer, CJ., Berkhof, J., Castle, PE., et al. Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older. Int J Cancer, 2009, 124, p. 516–520.
13. Ondryášová, H., Koudeláková, V., Drábek, J., et al. Pilotní studie pro využití samoodběrové soupravy a molekulární diagnostiky HPV infekce pro skrínink karcinomu děložního čípku. Čes Gynek, 2015, 80, 6, s. 436–443.
14. Peeters, E., Wentzensen, N., Bergeron, C., Arbyn, M. Metaanalysis of the accuracy of p16 or p16/Ki-67 immunocytochemistry versus HPV testing for the detection of CIN2+/CIN3+ in triage of women with minor abnormal cytology. Cancer Cytopathol, 2019, 127, p. 169–180.
15. Petry, KU., Barth, C., Wasem, J., Neumann, A. A model to evaluate the costs and clinical effectiveness of human papilloma virus screening compared with annual Papanicolaou cytology in Germany. Eur J Obstet Gynecol Reprod Biol, 2017, 212, p. 132–139.
16. Rijkaart, DC., Berkhof, J., van Kemenade, FJ., et al. Evaluation of 14 triage strategies for HPV DNA-positive women in population-based cervical screening. Int J Cancer, 2012, 130, p. 602–610.
17. Sláma, J. Současné limity prevence karcinomu děložního hrdla v České republice. Čes Gynek, 2017, 82(6), s. 482–486.
18. Svod.cz [internetova stranka]. Česky narodni webovy portal epidemiologie nadorů. System pro vizualizaci onkologickych dat. Institut biostatistiky a analyz Lekařske a Přirodovědecke fakulty Masarykovy univerzity (IBA MU). Dostupny z: http:/ / www.svod.cz.
19. Tjalma, WA. Diagnostic performance of dual-staining cytology for cervical cancer screening: a systematic literature review. Eur J Obstet Gynecol Reprod Biol, 2017, 210, p. 275–280.
20. Tosuner, Z., Türkmen, İ., Arici, S., et al. Immunocytoexpression profile of ProExC in smears interpreted as ASCUS, ASC-H, and cervical intraepithelial lesion. J Cytol, 2017, 34(1), p. 34–38.
21. United Kingdom – National Cervical Screening Program: https://www.gov.uk/government/publications/cervical-screening- -primary-hpv-screening-implementation/cervical-screening-implementation-guide-for-primary-hpv-screening.
22. Wentzensen, N., Arbyn, M. HPV-based cervical cancer screening - facts, fiction, and misperceptions. Prev Med, 2017, 98, p. 33–35.
23. Whitlock, EP., Vesco, KK., Eder, M., et al. Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med, 2011, 15, 155(10), p. 687–697.
24. Wilting, SM., Verlaat, W., Jaspers, A., et al. Methylationmediated transcriptional repression of microRNAs during cervical carcinogenesis. Epigenetics, 2013, 8, p. 220–228.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2020 Issue 4
Most read in this issue
- Cesarean scar defect – manifestation, diagnostics, treatment
- What next in cervical cancer screening?
- Benefits of exercise in the prenatal and postnatal period
- Assisted reproductive methods – current status and perspectives