programas cribado cancer

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: http://www.ncbi.nlm.nih.gov/pubmed/24574284. 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: http://www.ncbi.nlm.nih.gov/pubmed/24631450. 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: http://www.ncbi.nlm.nih.gov/pubmed/24122730. 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: http://www.ncbi.nlm.nih.gov/pubmed/24127304. 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: http://www.ncbi.nlm.nih.gov/pubmed/24589414. 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
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