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.
Mahmud SM, Kliewer E V, Lambert P, Bozat-Emre S, Demers AA. Effectiveness of the Quadrivalent Human Papillomavirus Vaccine Against Cervical Dysplasia in Manitoba, Canada. J Clin Oncol. 2014; Available from: http://jco.ascopubs.org/content/early/2014/01/06/JCO.2013.52.4645.abstract. doi: 10.1200/JCO.2013.52.4645.
Purpose Effectiveness of the quadrivalent human papillomavirus (QHPV) vaccine Conclusion A significant percentage of vaccinated women may not be protected against HSIL and lesser dysplasia especially if they were vaccinated at older age (≥ 18) or had abnormal cytology before vaccination. These findings affirm the importance of vaccination before any significant exposure to HPV occurs and underscore the need for screening programs that cover all sexually active women, even if they were vaccinated.
Harper DM, Groner JA. Positive High-Risk HPV Test with Negative Cytology—A Conundrum and Blessing of Our Latest Technology. Cancer Epidemiol Biomarkers Prev. 2014;23(1):10–1. Available from: http://cebp.aacrjournals.org/content/23/1/10.short. doi: 10.1158/1055-9965.EPI-13-0708.
Dijkstra MG, van Niekerk D, Rijkaart DC, van Kemenade FJ, Heideman DAM, Snijders PJF, et al. Primary hrHPV DNA Testing in Cervical Cancer Screening: How to Manage Screen-Positive Women? A POBASCAM Trial Substudy. Cancer Epidemiol Biomarkers Prev. 2014;23(1):55–63. Available from: http://cebp.aacrjournals.org/content/23/1/55.abstract. doi: 10.1158/1055-9965.EPI-13-0173.
Conclusions: Triaging hrHPV-positive women by cytology at baseline and after 6 to 12 months, possibly in combination with baseline HPV16/18 genotyping, seems acceptable for cervical cancer screening.Impact: Implementable triage strategies are provided for primary hrHPV screening in an organized setting. Cancer Epidemiol Biomarkers Prev; 23(1); 55–63. ©2013 AACR.
Dijkstra MG, Snijders PJF, Arbyn M, Rijkaart DC, Berkhof J, Meijer CJLM. Cervical cancer screening: on the way to a shift from cytology to full molecular screening. Ann Oncol. 2014; Available from: http://annonc.oxfordjournals.org/content/early/2014/01/19/annonc.mdt538.abstract. doi: 10.1093/annonc/mdt538.
Cytology-based nation-wide cervical screening has led to a substantial reduction of the incidence of cervical cancer in western countries. However, the sensitivity of cytology for the detection of high-grade precursor lesions or cervical cancer is limited; therefore, repeated testing is necessary to achieve program effectiveness. Additionally, adenocarcinomas and its precursors are often missed by cytology. Consequently, there is a need for a better screening test. The insight that infection with high-risk human papillomavirus (hrHPV) is the causal agent of cervical cancer and its precursors has led to the development of molecular tests for the detection of hrHPV. Strong evidence now supports the use of hrHPV testing in the prevention of cervical cancer. In this review, we will discuss the arguments in favor of, and concerns on aspects of implementation of hrHPV testing in primary cervical cancer screening, such as the age to start hrHPV-based screening, ways to increase screening attendance, requirements for candidate hrHPV tests to be used, and triage algorithms for screen-positive women.
Castañón A, Landy R, Cuzick J, Sasieni P. Cervical Screening at Age 50–64 Years and the Risk of Cervical Cancer at Age 65 Years and Older: Population-Based Case Control Study. Franco EL, editor. PLoS Med. 2014;11(1):e1001585. Available from: http://dx.plos.org/10.1371/journal.pmed.1001585. doi: 10.1371/journal.pmed.1001585.
Conclusions: Women with adequate negative screening at age 50–64 y had one-sixth of the risk of cervical cancer at age 65–83 y compared with women who were not screened. Stopping screening between ages 60 and 69 y in women with adequate negative screening seems sensible, but further screening may be justifiable as life expectancy increases.
Rositch AF, Silver MI, Gravitt PE. Cervical cancer screening in older women: new evidence and knowledge gaps. PLoS Med. 2014;11(1):e1001586. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3891623&tool=pmcentrez&rendertype=abstract. doi: 10.1371/journal.pmed.1001586. PMID: 24453947.
Anne Rositch and colleagues discuss the study by Peter Sasieni and colleagues on cervical cancer screening in older women and describe the further information needed to help inform decisions about whether to extend screening programs beyond 65 years for women with adequate negative screening. Please see later in the article for the Editors’ Summary.
Burki TK. Cervical cancer: screening and risk with age. Lancet Oncol. (0). Available from: http://www.sciencedirect.com/science/article/pii/S1470204514700324. doi: http://dx.doi.org/10.1016/S1470-2045(14)70032-4
Ogilvie GS, Smith LW, van Niekerk DJ, Khurshed F, Krajden M, Saraiya M, et al. Women’s intentions to receive cervical cancer screening with primary human papillomavirus testing. Int J Cancer. 2013;133(12):2934–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23754203. doi: 10.1002/ijc.28324. PMID: 23754203.
Use of primary HPV testing may optimize the screening paradigm, but programs should ensure robust planning and education to mitigate any negative impact on screening attendance rates.
Sancho-Garnier H, Tamalet C, Halfon P, Leandri FX, Le Retraite L, Djoufelkit K, et al. HPV self-sampling or the Pap-smear: a randomized study among cervical screening nonattenders from lower socioeconomic groups in France. Int J Cancer. 2013;133(11):2681–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23712523. doi: 10.1002/ijc.28283. PMID: 23712523.
Offering self-sampling increased participation rates while the use of HPV testing increased the detection of cervical lesions (≥CIN2) in comparison to the group of women receiving a second invitation for a Pap-smear. However, low compliance to follow-up in the self-sampling group reduces the effectiveness of this screening approach in nonattenders women and must be carefully managed.
Schiffman M, Solomon D. Clinical practice. Cervical-cancer screening with human papillomavirus and cytologic cotesting. N Engl J Med. 2013;369(24):2324–31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24328466. doi: 10.1056/NEJMcp1210379. PMID: 24328466
*Isidean SD, Franco EL. Embracing a new era in cervical cancer screening. Lancet. 2013;6736(13):10–1. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673613620280. doi: 10.1016/S0140-6736(13)62028-0.
*Ronco G, Dillner J, Elfström KM, Tunesi S, Snijders PJF, Arbyn M, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer : follow-up of four European randomised controlled trials. Lancet. 2013;39(13):1–9. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673613622187. doi: 10.1016/S0140-6736(13)62218-7.
Interpretation HPV-based screening provides 60—70% greater protection against invasive cervical carcinomas compared with cytology. Data of large-scale randomised trials support initiation of HPV-based screening from age 30 years and extension of screening intervals to at least 5 years.
García-Garrido AB, Vázquez-Rodríguez JA, Grande-González E, Ramos-Barrón MÁ. [Coverage and costs of opportunistic screening for cervical cancer in Cantabria (Spain).]. Gac Sanit. 2013;(xx):6–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23845269. doi: 10.1016/j.gaceta.2013.05.007. PMID: 23845269.
CONCLUSIONS: Only 26% of women in Cantabria attended screening within the intervals recommended in the current opportunistic protocol. The cost data provided in this study may be useful for future economic evaluations.
Rodríguez-Salés V, Roura E, Ibáñez R, Peris M, Bosch FX, Coma E E, et al. [Coverage of cervical cancer screening in Catalonia, Spain (2008-2011).]. Gac Sanit. 2013;(xx). Available from: http://www.ncbi.nlm.nih.gov/pubmed/23916983. doi: 10.1016/j.gaceta.2013.05.009. PMID: 23916983.
CONCLUSIONS: Cervical screening coverage in the National Health Service of Catalonia includes one in three women. Second round participation was poor. Existing computer systems in primary care centers can ensure monitoring of population-based screening programs for cervical cancer. These systems could be used to plan an organized screening program to ensure wider coverage and better follow-up
Ikenberg H, Bergeron C, Schmidt D, Griesser H, Alameda F, Angeloni C, et al. Screening for Cervical Cancer Precursors With p16/Ki-67 Dual-Stained Cytology: Results of the PALMS Study. J Natl Cancer Inst. 2013;105(20):1550–7. Available from: http://jnci.oxfordjournals.org/content/105/20/1550.abstract. doi: 10.1093/jnci/djt235.
Conclusions The p16/Ki-67 dual-stained cytology combines superior sensitivity and noninferior specificity over Pap cytology for detecting CIN2+. It suggests a potential role of dual-stained cytology in screening, especially in younger women where HPV testing has its limitations.
Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer. Lancet. 2013;382(9895):889–99.
Available from: http://www.sciencedirect.com/science/article/pii/S0140673613600227. doi: http://dx.doi.org/10.1016/S0140-6736(13)60022-7.
Summary Cervical cancer is caused by human papillomavirus infection. Most human papillomavirus infection is harmless and clears spontaneously but persistent infection with high-risk human papillomavirus (especially type 16) can cause cancer of the cervix, vulva, vagina, anus, penis, and oropharynx. The virus exclusively infects epithelium and produces new viral particles only in fully mature epithelial cells. Human papillomavirus disrupts normal cell-cycle control, promoting uncontrolled cell division and the accumulation of genetic damage. Two effective prophylactic vaccines composed of human papillomavirus type 16 and 18, and human papillomavirus type 16, 18, 6, and 11 virus-like particles have been introduced in many developed countries as a primary prevention strategy. Human papillomavirus testing is clinically valuable for secondary prevention in triaging low-grade cytology and as a test of cure after treatment. More sensitive than cytology, primary screening by human papillomavirus testing could enable screening intervals to be extended. If these prevention strategies can be implemented in developing countries, many thousands of lives could be saved.
Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors. Eur J Cancer. 2013;49(15):3262–73.
Available from: http://www.sciencedirect.com/science/article/pii/S0959804913003584. doi: http://dx.doi.org/10.1016/j.ejca.2013.04.024.
Interpretation In countries where effective screening has been in place for a long time the consequences of underlying increases in cohort-specific risk were largely avoided. In the absence of screening, cohort-led increases or, stable, cervical cancer ASRs were observed. Our study underscores the importance of strengthening screening efforts and augmenting existing cancer control efforts with HPV vaccination, notably in those countries where unfavourable cohort effects are continuing or emerging.
Castanon A, Landy R, Sasieni P. How much could primary human papillomavirus testing reduce cervical cancer incidence and morbidity? J Med Screen. 2013;20(2):99–103. Available from: http://msc.sagepub.com/content/20/2/99.abstract. doi: 10.1177/0969141313492313.
Abstract Human papillomavirus (HPV) testing is being considered as the primary screening test for cervical cancer in England, rather than the currently used cytology test. We aimed to estimate the impact of primary HPV testing on incidence and morbidity of cervical cancer in England by estimating the proportion of cervical cancer diagnosed within 6 years of a negative cytology. We used a population-based case-control study of prospectively recorded data on cervical screening in England between 1988 and 2012, including 8774 women with invasive cervical cancer aged 25 to 64 and 17,341 controls. We used incidence rates in 2010 to estimate absolute risks. We found that 38.8% of all women with cervical cancer had a negative test within 6 years of diagnosis. Assuming HPV testing is 95% sensitive for cancers that would develop over the next 6 years but were missed by cytology, and that 4.3% of those diagnosed by cytology would be missed by HPV testing, we estimate that a maximum of 32.6% of current cases in women invited for screening aged 25 to 64 could be prevented. This translates to a reduction in the rate of cervical cancer in this age group of 4.2 per 100,000 women per year in England, equivalent to 587 cancers.
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