programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c cérvix 2014-06

Muwonge R, Wesley RS, Nene BM, Shastri SS, Jayant K, Malvi SG, et al. Evaluation of cytology and visual triage of human papillomavirus-positive women in cervical cancer prevention in India. Int J Cancer. 2014;134(12):2902–9. Available from: doi: 10.1002/ijc.28627. PMID: 24272364.

Cytology triage may be considered in settings where adequate infrastructure exists, whereas VIA triage may be suitable in settings with limited or no cytology infrastructure.

Dugué P-A, Lynge E, Rebolj M. Mortality of non-participants in cervical screening: Register-based cohort study. Int J Cancer. 2014;134(11):2674–82. Available from: doi: 10.1002/ijc.28586. PMID: 24288241.

Non-participants in cervical screening had substantially higher all-cause mortality than participants, and a particularly increased risk of HPV-related causes of death. These results indicate that improper control for the selective uptake of cervical screening may result in overestimating its effectiveness.

Qiao Y-L, Jeronimo J, Zhao F-H, Schweizer J, Chen W, Valdez M, et al. Lower cost strategies for triage of human papillomavirus DNA-positive women. Int J Cancer. 2014;134(12):2891–901. Available from: doi: 10.1002/ijc.28616. PMID: 24248915.

Using human papillomavirus (HPV) testing for cervical cancer screening in lower-resource settings (LRS) will result in a significant number of screen-positive women. This analysis compares different triage strategies for detecting cervical precancer and cancer among HPV-positive women in LRS. This was a population-based study of women aged 25-65 years living in China (n = 7,541). Each woman provided a self-collected and two clinician-collected specimens. The self-collected and one clinician-collected specimen were tested by two HPV DNA tests-careHPVTM and Hybrid Capture 2; the other clinician-collected specimen was tested for HPV16/18/45 E6 protein. CareHPVTM-positive specimens were tested for HPV16/18/45 DNA. HPV DNA-positive women underwent visual inspection with acetic acid (VIA) and then colposcopic evaluation with biopsies. The performance for detection of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) among HPV DNA-positive women was assessed for different triage strategies: HPV16/18/45 E6 or DNA detection, VIA, colposcopic impression, or higher signal strength (≥10 relative light units/positive control [rlu/pc]). The percent triage positive ranges were 14.8-17.4% for VIA, 17.8-20.9% for an abnormal colposcopic impression; 7.9-10.5% for HPV16/18/45 E6; 23.4-28.4% for HPV16/18/45 DNA; and 48.0-62.6% for higher signal strength (≥10 rlu/pc), depending on the HPV test/specimen combination. The positivity for all triage tests increased with severity of diagnosis. HPV16/18/45 DNA detection was approximately 70% sensitive and had positive predictive values (PPV) of approximately 25% for CIN3+. HPV16/18/45 E6 detection was approximately 50% sensitive with a PPV of nearly 50% for CIN3+. Different triage strategies for HPV DNA-positive women provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for prevalent CIN3+


Nota bibliográfica cribado c cérvix 2014-05

Ibáñez R, Félez-Sánchez M, Godínez JM, Guardià C, Caballero E, Juve R, et al. Interlaboratory Reproducibility and Proficiency Testing within the Human Papillomavirus Cervical Cancer Screening Program in Catalonia, Spain.J Clin Microbiol. 2014;52(5):1511–8. Available from: doi: 10.1128/JCM.00100-14. PMID: 24574284.

 In Catalonia, a screening protocol for cervical cancer, including human papillomavirus (HPV) DNA testing using the Digene Hybrid Capture 2 (HC2) assay, was implemented in 2006. In order to monitor interlaboratory reproducibility, a proficiency testing (PT) survey of the HPV samples was launched in 2008. The aim of this study was to explore the repeatability of the HC2 assay’s performance. Participating laboratories provided 20 samples annually, 5 randomly chosen samples from each of the following relative light unit (RLU) intervals: ≥10. Kappa statistics were used to determine the agreement levels between the original and the PT readings. The nature and origin of the discrepant results were calculated by bootstrapping. A total of 946 specimens were retested. The kappa values were 0.91 for positive/negative categorical classification and 0.79 for the four RLU intervals studied. Sample retesting yielded systematically lower RLU values than the original test (P < 0.005), independently of the time elapsed between the two determinations (median, 53 days), possibly due to freeze-thaw cycles. The probability for a sample to show clinically discrepant results upon retesting was a function of the RLU value; samples with RLU values in the 0.5 to 5 interval showed 10.80% probability to yield discrepant results (95% confidence interval [CI], 7.86 to 14.33) compared to 0.85% probability for samples outside this interval (95% CI, 0.17 to 1.69). Globally, the HC2 assay shows high interlaboratory concordance. We have identified differential confidence thresholds and suggested the guidelines for interlaboratory PT in the future, as analytical quality assessment of HPV DNA detection remains a central component of the screening program for cervical cancer prevention.

Pan Q-J, Hu S-Y, Guo H-Q, Zhang W-H, Zhang X, Chen W, et al. Liquid-based cytology and human papillomavirus testing: a pooled analysis using the data from 13 population-based cervical cancer screening studies from China. Gynecol Oncol. 2014;133(2):172–9. Available from: doi: 10.1016/j.ygyno.2014.03.008. PMID: 24631450.

CONCLUSIONS: The results of the current study support the use of the cervical cancer screening guidelines in China.

Rask J, Lynge E, Franzmann M, Hansen B, Hjortebjerg A, Rygaard C, et al. Impact of technology on cytology outcome in cervical cancer screening of young and older women. Int J Cancer. 2014;134(9):2168–79. Available from: doi: 10.1002/ijc.28532. PMID: 24122730.

Little is known about age-dependent variation in outcomes of cervical cytology with modern technologies. This population-based study evaluated age-dependent changes after routine implementation of ThinPrep and SurePath technology in two independent laboratories, and controlled for time trends in a third laboratory using manually read conventional cytology continually. Data were collected from the Danish National Health Care Registers. For each laboratory, we compared proportions of abnormal cytology defined as atypical squamous cells of undetermined significance or worse (ASCUS+) by age and technology phase. The study included 489,960 cytological samples with no recent abnormality from women aged 23-59 years, routinely screened between 1998 and 2007. Implementation of SurePath liquid-based cytology (LBC) was followed by an increase in abnormal cytology in women aged 23-29 years from 4.6 to 6.1%, relative proportion (RP): 1.31 [95% confidence interval (CI): 1.08-1.61], and a decrease in women aged 45-59 years from 2.9 to 2.0%, RP: 0.71 (95% CI: 0.60-0.83). Implementation of ThinPrep LBC was followed by a decrease in abnormal cytology both in women aged 23-29 years from 7.7 to 6.8%, RP: 0.89 (95% CI: 0.78-1.02) and in women aged 45-59 years from 3.4 to 1.0%, RP: 0.30 (95% CI: 0.24-0.37). With implementation of imaging-assisted reading, regardless of the brand of technology, the proportion of abnormality increased by around 30% in all age groups (range from 19 to 41%). In the laboratory with unchanged technology no trends in abnormality proportions were observed. The impact of LBC implementation on cytological abnormality proportions varied considerably across age groups.

Broberg G, Gyrd-Hansen D, Miao Jonasson J, Ryd M-L, Holtenman M, Milsom I, et al. Increasing participation in cervical cancer screening: offering a HPV self-test to long-term non-attendees as part of RACOMIP, a Swedish randomized controlled trial. Int J Cancer. 2014;134(9):2223–30. Available from: doi: 10.1002/ijc.28545. PMID: 24127304.

Offering a self-test for HPV as an alternative to Pap smears increases participation among long-term non-attendees. Offering various screening options can be a successful method for increasing participation in this group.

Vicus D, Sutradhar R, Lu Y, Elit L, Kupets R, Paszat L. The association between cervical cancer screening and mortality from cervical cancer: a population based case-control study. Gynecol Oncol. 2014;133(2):167–71. Available from: doi: 10.1016/j.ygyno.2014.02.037. PMID: 24589414.
CONCLUSION: No association between cervical cancer screening and mortality from cervical cancer under the age of 30 was found. This could be due to there being a small or having no effect or due to the fact that mortality from cervical cancer under the age of 30 is extremely rare


Nota bibliográfica cribado c cérvix 2014-04

Wilson ML. The challenges of cervical cancer screening. Am J Clin Pathol. 2014;141(4):453. Available from: doi: 10.1309/AJCPHTJCYILM5FRF. PMID: 24619741.

Davey DD, Goulart R, Nayar R. 2013 statement on human papillomavirus DNA test utilization. Am J Clin Pathol. 2014;141(4):459–61.
Available from: doi: 10.1309/AJCPKXBQLWOJ4ZUB. PMID: 24619744.
Landy R, Birke H, Castanon A, Sasieni P. Benefits and harms of cervical screening from age 20 years compared with screening from age 25 years. Br J Cancer. 2014;110(7):1841–6.  Available from:
Conclusions: To prevent one frank invasive cancer, one would need to do between 12 500 and 40 000 additional screening tests in the age group 20–24 years and treat between 300 and 900 women
Baldur-Felskov B, Dehlendorff C, Munk C, Kjaer SK. Early Impact of Human Papillomavirus Vaccination on Cervical Neoplasia—Nationwide Follow-up of Young Danish Women. J Natl Cancer Inst. 2014;106(3).
Available from: doi: 10.1093/jnci/djt460.
Conclusions Six years after licensure of the quadrivalent HPV vaccine in Denmark, a reduced risk of cervical lesions is observed at the population level.


Nota bibliográfica cribado c cérvix 2014-03

Xue X, Kim MY, Castle PE, Strickler HD. A new method to address verification bias in studies of clinical screening tests: cervical cancer screening assays as an example. J Clin Epidemiol. 2014;67(3):343–53. Available from: doi: 10.1016/j.jclinepi.2013.09.013. PMID: 24332397.
CONCLUSION: The proposed approach is an easy to apply and accurate method for addressing verification bias in studies of multiple screening methods


Nota bibliográfica cribado c cérvix 2014-02

Wentzensen N, Schiffman M. Filling a gap in cervical cancer screening programmes. Lancet Oncol. 2014;(0). Available from: doi:

Arbyn M, Verdoodt F, Snijders PJF, Verhoef VMJ, Suonio E, Dillner L, et al. Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: a meta-analysis. Lancet Oncol. 2014;15(2):172–83. Available from: doi:

Interpretation In screening programmes using signal-based assays, sampling by a clinician should be recommended. However, HPV testing on a self-sample can be suggested as an additional strategy to reach women not participating in the regular screening programme. Some PCR-based HPV tests could be considered for routine screening after careful piloting assessing feasibility, logistics, population compliance, and costs.

Dickinson JA, Miller AB, Popadiuk C. When to start cervical screening: epidemiological evidence from Canada. BJOG An Int J Obstet Gynaecol. 2014;121(3):255–60. Available from: doi: 10.1111/1471-0528.12484


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