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Clinical implementation of a cervical cancer screening program via co-testing at a university hospital

The Human Papillomavirus (HPV) test is a crucial technology for cervical cancer prevention because it enables programs to identify women with high-risk HPV infection who are at risk of developing cervical cancer. Current U.S. Preventive Services Task Force recommendations include cervical cancer scr...

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Autores principales: Denninghoff, Valeria, von Petery, Felicitas, Fresno, Cristóbal, Galarza, Mercedes, Torres, Florencia, Avagnina, Alejandra, Fishkel, Vanina, Krupitzki, Hugo, Fiorillo, Angel, Monge, Fernando
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714701/
https://www.ncbi.nlm.nih.gov/pubmed/36454784
http://dx.doi.org/10.1371/journal.pone.0278476
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author Denninghoff, Valeria
von Petery, Felicitas
Fresno, Cristóbal
Galarza, Mercedes
Torres, Florencia
Avagnina, Alejandra
Fishkel, Vanina
Krupitzki, Hugo
Fiorillo, Angel
Monge, Fernando
author_facet Denninghoff, Valeria
von Petery, Felicitas
Fresno, Cristóbal
Galarza, Mercedes
Torres, Florencia
Avagnina, Alejandra
Fishkel, Vanina
Krupitzki, Hugo
Fiorillo, Angel
Monge, Fernando
author_sort Denninghoff, Valeria
collection PubMed
description The Human Papillomavirus (HPV) test is a crucial technology for cervical cancer prevention because it enables programs to identify women with high-risk HPV infection who are at risk of developing cervical cancer. Current U.S. Preventive Services Task Force recommendations include cervical cancer screening every three years with cervical cytology alone or every five years with either high-risk HPV testing alone or high-risk HPV testing combined with cytology (co-testing). In Argentina, 7,548 new cervical cancer cases are diagnosed each year with 3,932 deaths attributed to this cause. Our study aims to show the clinical implementation of a cervical cancer screening program by concurrent HPV testing and cervical cytology (co-testing); and to evaluate the possible cervical cancer screening scenarios for Latin America, focusing on their performance and average cost. A cervical cancer screening five year program via co-testing algorithm (Hybrid-2-Capture/cytology) was performed on women aged 30–65 years old at a university hospital. Statistical analysis included a multinomial logistic regression, and two cancer screening classification alternatives were tested (cytology-reflex and HPV-reflex). A total of 2,273 women were included, 91.11% of the participants were double-negative, 2.55% double-positive, 5.90% positive-Hybrid-2-Capture-/negative-cytology, and 0.44% negative-Hybrid-2-Capture/positive-cytology. A thorough follow-up was performed in the positive-Hybrid-2-Capture group. Despite our efforts, 21 (10.93%) were lost, mainly because of changes on their health insurance coverage which excluded them from our screening algorithm. Of the 171 women with positive-Hybrid-2-Capture results and follow-up, 68 (39.77%) cleared the virus infection, 64 (37.43%) showed viral persistence, and 39 (22.81%) were adequately treated after detection via colposcopy/biopsy of histological HSIL (High-Grade Squamous Intraepithelial Lesion). The prevalence of high-risk HPV in this population was 192 women (8.45%), with HSIL histology detection rates of 17 per 1,000 screened women. A multinomial logistic regression analysis was performed over the women with positive-Hybrid-2-Capture considering the follow up (clearance, persistence and HSIL) as dependent variable, and the cytology test results (positive- or negative-cytology and Atypical Squamous Cells of Undetermined Significance, ASC-US) as independent variable. The model supported a direct association between cytology test results and follow up: negative-cytology/clearance, ASC-US/persistence, and positive-cytology/HSIL with the following probabilities of occurrence for these pairs 0.5, 0.647 and 0.647, respectively. Cytology could be considered a prognostic-factor in women with a positive-Hybrid-2-Capture. These findings suggest that the introduction of co-testing could diminish the burden of cervical cancer in low-and middle-income-countries, acting as a tool against inequity in healthcare.
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spelling pubmed-97147012022-12-02 Clinical implementation of a cervical cancer screening program via co-testing at a university hospital Denninghoff, Valeria von Petery, Felicitas Fresno, Cristóbal Galarza, Mercedes Torres, Florencia Avagnina, Alejandra Fishkel, Vanina Krupitzki, Hugo Fiorillo, Angel Monge, Fernando PLoS One Research Article The Human Papillomavirus (HPV) test is a crucial technology for cervical cancer prevention because it enables programs to identify women with high-risk HPV infection who are at risk of developing cervical cancer. Current U.S. Preventive Services Task Force recommendations include cervical cancer screening every three years with cervical cytology alone or every five years with either high-risk HPV testing alone or high-risk HPV testing combined with cytology (co-testing). In Argentina, 7,548 new cervical cancer cases are diagnosed each year with 3,932 deaths attributed to this cause. Our study aims to show the clinical implementation of a cervical cancer screening program by concurrent HPV testing and cervical cytology (co-testing); and to evaluate the possible cervical cancer screening scenarios for Latin America, focusing on their performance and average cost. A cervical cancer screening five year program via co-testing algorithm (Hybrid-2-Capture/cytology) was performed on women aged 30–65 years old at a university hospital. Statistical analysis included a multinomial logistic regression, and two cancer screening classification alternatives were tested (cytology-reflex and HPV-reflex). A total of 2,273 women were included, 91.11% of the participants were double-negative, 2.55% double-positive, 5.90% positive-Hybrid-2-Capture-/negative-cytology, and 0.44% negative-Hybrid-2-Capture/positive-cytology. A thorough follow-up was performed in the positive-Hybrid-2-Capture group. Despite our efforts, 21 (10.93%) were lost, mainly because of changes on their health insurance coverage which excluded them from our screening algorithm. Of the 171 women with positive-Hybrid-2-Capture results and follow-up, 68 (39.77%) cleared the virus infection, 64 (37.43%) showed viral persistence, and 39 (22.81%) were adequately treated after detection via colposcopy/biopsy of histological HSIL (High-Grade Squamous Intraepithelial Lesion). The prevalence of high-risk HPV in this population was 192 women (8.45%), with HSIL histology detection rates of 17 per 1,000 screened women. A multinomial logistic regression analysis was performed over the women with positive-Hybrid-2-Capture considering the follow up (clearance, persistence and HSIL) as dependent variable, and the cytology test results (positive- or negative-cytology and Atypical Squamous Cells of Undetermined Significance, ASC-US) as independent variable. The model supported a direct association between cytology test results and follow up: negative-cytology/clearance, ASC-US/persistence, and positive-cytology/HSIL with the following probabilities of occurrence for these pairs 0.5, 0.647 and 0.647, respectively. Cytology could be considered a prognostic-factor in women with a positive-Hybrid-2-Capture. These findings suggest that the introduction of co-testing could diminish the burden of cervical cancer in low-and middle-income-countries, acting as a tool against inequity in healthcare. Public Library of Science 2022-12-01 /pmc/articles/PMC9714701/ /pubmed/36454784 http://dx.doi.org/10.1371/journal.pone.0278476 Text en © 2022 Denninghoff et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Denninghoff, Valeria
von Petery, Felicitas
Fresno, Cristóbal
Galarza, Mercedes
Torres, Florencia
Avagnina, Alejandra
Fishkel, Vanina
Krupitzki, Hugo
Fiorillo, Angel
Monge, Fernando
Clinical implementation of a cervical cancer screening program via co-testing at a university hospital
title Clinical implementation of a cervical cancer screening program via co-testing at a university hospital
title_full Clinical implementation of a cervical cancer screening program via co-testing at a university hospital
title_fullStr Clinical implementation of a cervical cancer screening program via co-testing at a university hospital
title_full_unstemmed Clinical implementation of a cervical cancer screening program via co-testing at a university hospital
title_short Clinical implementation of a cervical cancer screening program via co-testing at a university hospital
title_sort clinical implementation of a cervical cancer screening program via co-testing at a university hospital
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714701/
https://www.ncbi.nlm.nih.gov/pubmed/36454784
http://dx.doi.org/10.1371/journal.pone.0278476
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