Evaluation of the effectiveness of high-risk human papilloma self-sampling test for cervical cancer screening in Bolivia

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Abstract

Background

In Bolivia the incidence and mortality rates of uterine cervix cancer are the highest in America. The main factor contributing to this situation is the difficulty of establishing and maintaining quality prevention programs based on cytology. We aimed to evaluate the effectiveness of HR-HPV testing on self-collected samples to detect cervical intra-epithelial neoplasia and identify the best combination of screening tests.

Methods

A total of 469 women, divided in two groups, were included in this study. The first group included 362 women that underwent three consecutively primary screening tests: self-collected sampling for HR-HPV detection, conventional cervical cytology and visual inspection under acetic acid (VIA). The second group included 107 women referred with a positive HR-HPV test that underwent conventional cervical cytology and VIA. The presence of high grade intraepithelial lesion (CIN 2+) or invasive cancer was verified by colposcopy and biopsy.

Result

In the screening group the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer were 100, 76, 44% for the VIA, HR-HPV test and cytology, respectively. In the referred group, the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer by VIA and cytology were 100 and 81%, respectively.

Conclusions

VIA and HR-HPV self-sampling were the best combination to detect CIN2+ lesions. Cytology analysis gave the poorest performance.

Related collections

Most cited references 31

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Overview of the European and North American studies on HPV testing in primary cervical cancer screening.

Jack Cuzick, Christine Clavel, Karl-Ulrich Petry … (2006)

Several studies suggest that HPV testing is more sensitive than cytology in primary cervical screening. These studies had different designs and were reported in different ways. Individual patient data were collected for all European and North American studies in which cytology was routinely performed and HPV testing was included as an additional parallel test. More than 60,000 women were included. The sensitivity and specificity of HPV testing were compared with routine cytology, both overall and for ages <35, 35-49 and 50+. The age-specific prevalence of high risk HPV (hr-HPV) was also analysed. HPV testing was substantially more sensitive in detecting CIN2+ than cytology (96.1% vs. 53.0%) but less specific (90.7% vs. 96.3%). The sensitivity of HPV testing was similar in all studies carried out in different areas of Europe and North America, whereas the sensitivity of cytology was highly variable. HPV sensitivity was uniformly high at all ages, whereas the sensitivity of cytology was substantially better in women over the age of 50 than in younger women (79.3% vs. 59.6%). The specificity of both tests increased with age. Positivity rates for HPV testing in women without high-grade CIN were region dependent. These results support the use of HPV testing as the sole primary screening test, with cytology reserved for women who test HPV positive. Large demonstration projects are needed to fully evaluate this strategy. Copyright 2006 Wiley-Liss, Inc.

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Effective screening programmes for cervical cancer in low- and middle-income developing countries.

A M Budukh, R. Sankaranarayanan, R. Rajkumar (2000)

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.

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Screening for cancer in low- and middle-income countries.

R. Sankaranarayanan (2024)

Screening programs involve testing asymptomatic individuals with an accurate screening test to identify those likely to have the disease of interest and to further investigate them to confirm or exclude the disease. The aim of cancer screening is to prevent cancer deaths and improve quality of life by finding cancers early and by effectively treating them. A decision to introduce a screening program in public health services depends on the evidence that the benefits outweigh the harms of screening, disease burden, availability of suitable screening test, effective treatment, adequate resources, and efficient health services. Screening programs should achieve high participation for testing, diagnosis, and treatment to be effective and efficient.

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Author and article information

Contributors

Gustavo Allende: gustavomarzo24@gmail.com

Pedro Surriabre: pedro.surriabre@gmail.com

Neli Ovando: neliovando@gmail.com

Pamela Calle: pamela89calle@gmail.com

Andrea Torrico: andrea.torricoferrufino@gmail.com

Jaime Villarroel: drjaimeclaudiovillarroelsalinas@hotmail.com

Michel Bossens: michel.bossens@gmail.com

Véronique Fontaine: Veronique.Fontaine@ulb.ac.be

Patricia Rodriguez: p.rodriguez@umss.edu.bo

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 3 April 2020

Publication date PMC-release: 3 April 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 259

Affiliations

[1 ]GRID grid.10491.3d, ISNI 0000 0001 2176 4059, Laboratory of Virology, Faculty of Medicine, , Universidad Mayor de San Simón, ; Cochabamba, Bolivia

[2 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, Unité de Microbiologie Pharmaceutique et Hygiène, Faculté de Pharmacie, , Université Libre de Bruxelles (ULB), ; CP205/2, Campus Plaine, Boulevard du Triomphe, 1050 Brussels, Belgium

[3 ]Anatomopathology Laboratory of the Bolivian-Japanese hospital, Cochabamba, Bolivia

[4 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, Research Laboratory in Human Reproduction, Campus Erasme, Faculty of Medicine, , Universite libre de Bruxelles, ; Brussels, ULB Belgium

Article

Publisher ID: 4963

DOI: 10.1186/s12879-020-04963-2

PMC ID: 7119273

PubMed ID: 32245369

SO-VID: 59b7ebf8-1bbe-4baf-bca2-cbf51fd43bbc

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 27 September 2019

Date accepted : 11 March 2020

Funding

Funded by: ARES-CCD

Award ID: PRD 2013

Award Recipient : Pedro Surriabre Neli Ovando Pamela Calle Andrea Torrico Patricia Rodriguez

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: cervical intra-epithelial neoplasia,cytology,human papillomavirus testing, visual inspection with acetic acid

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: cervical intra-epithelial neoplasia, cytology, human papillomavirus testing, visual inspection with acetic acid

Evaluation of the effectiveness of high-risk human papilloma self-sampling test for cervical cancer screening in Bolivia

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HIV Self-Testing

Most cited references 31

Overview of the European and North American studies on HPV testing in primary cervical cancer screening.

Effective screening programmes for cervical cancer in low- and middle-income developing countries.

Screening for cancer in low- and middle-income countries.

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