programas cribado cancer

Nota bibliográfica cribado c cérvix 2013-09

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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