programas cribado cancer

Nota bibliográfica cribado c cérvix 2013-02

Steens A, Wielders CCH, Bogaards JA, Boshuizen HC, de Greeff SC, de Melker HE. Association between human papillomavirus vaccine uptake and cervical cancer screening in the Netherlands: Implications for future impact on prevention. International Journal of Cancer 2013;132(4):932-943. DOI:10.1002/ijc.27671. PMID:22689326.

Our results, based on 89% of girls invited for vaccination in 2009 (n = 337,368), show that vaccination status was significantly associated with mothers' screening participation (odds ratio: 1.54 [95% confidence interval: 1.51?1.57]). If a mother's screening is taken as proxy of a girl's future screening, only 13% of the girls will not participate in either program compared to 23% if screening alone is available. The positive association between vaccination and screening resulted in slightly lower model estimates of the impact of vaccination on cancer incidence, compared to estimates assuming no association. Girls with nonwestern ethnicities, with young mothers, who live in urban areas with low socioeconomic status, are at risk for nonparticipation. A significant part of potential nonscreeners may be reached through HPV vaccination. Estimates made before vaccination was introduced only slightly overestimated its impact on cervical cancer incidence.

Maarit K Leinonen, Pekka Nieminen, Stefan Lönnberg, Nea Malila, Matti Hakama, Arun Pokhrel, et al. Detection rates of precancerous and cancerous cervical lesions within one screening round of primary human papillomavirus DNA testing: prospective randomised trial in Finland. BMJ 2012 BMJ Publishing Group Ltd;345 DOI:10.1136/bmj.e7789.

Conclusions Primary HPV DNA screening detects more cervical lesions than primary cytology within one screening round of five years. Even if the detection rate of CIN 3 or AIS increased in the HPV arm in both age groups, the absolute difference in cumulative rates in women aged 35 years or older was small. By carefully selecting age groups and screening intervals, HPV screening could increase the overall detection rate of cervical precancerous lesions only slightly. However, these findings should be interpreted in the context of the high level of opportunistic screening that occurs in Finland.

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