programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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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.


Nota bibliográfica cribado c cérvix 2013-01

Canadian Task Force on Preventive Health Care. Recommendations on screening for cervical cancer. CMAJ 2013 Jan 8;185(1):35-45. DOI:10.1503/cmaj.121505; 10.1503/cmaj.121505. PMID:23297138. PMCID:PMC3537778.

Zhao C, Weng B, Li Z, Yang H, Austin RM. Follow-up outcomes of a large cohort of low-risk women with negative imaged liquid-based cytology and negative HPV test results. Am J Clin Pathol 2013 Jan;139(1):32-38. DOI:10.1309/AJCP4DF7ACLBFFGY; 10.1309/AJCP4DF7ACLBFFGY. PMID:23270896.

Recently updated cervical screening guidelines have proposed a 5-year screening interval for women aged 30 years and older with "double-negative" Papanicolaou (Pap) and high-risk human papillomavirus (hrHPV) results (DNR); however, published US follow-up data on women with DNR tested with US Food and Drug Administration (FDA) - approved HPV testing are limited to studies from Kaiser Permanente using conventional Pap smear cytology. Between July 2005 and June 2006, 4,112 patients with DNR who were screened with computer-imaged liquid-based cytology (LBC) (ThinPrep) and Hybrid Capture 2 (HC2) hrHPV tests of LBC vial fluid were identified. Cytologic or histopathologic data were available for 3,211 patients who were followed up for a mean 44 months. Among 2,960 patients aged 30 years and older with DNR, follow-up cervical abnormalities of cervical intraepithelial neoplasia (CIN) 3 or more severe (CIN3+) were documented in 5 (0.17%), including 1 endocervical adenocarcinoma. After DNR, CIN+ diagnoses were significantly more likely in women younger than 50 years than in older women. These data are consistent with previously published US and international studies that have consistently documented low rates of histopathologic CIN3+ during years of follow-up after DNR. Large-scale nationwide data are needed to further assess the level of risk of invasive cervical cancer after DNR using different available hrHPV testing methods.

Centers for Disease Control and Prevention (CDC). Cervical cancer screening among women aged 18-30 years - United States, 2000-2010. MMWR Morb Mortal Wkly Rep 2013 Jan 4;61(51-52):1038-1042.PMID:23282861.

These findings showed that Pap testing practices for young women have been moving toward the latest guidelines. However, the data also showed a concerning trend: among women aged 22-30 years, who should be screened every 3 years, the proportion who reported never having had a Pap test increased from 6.6% to 9.0%. More effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening.


Nota bibliográfica cribado c cérvix 2012-12

Ogilvie GS, Krajden M, van Niekerk DJ, Martin RE, Ehlen TG, Ceballos K, et al. Primary cervical cancer screening with HPV testing compared with liquid-based cytology: results of round 1 of a randomised controlled trial - the HPV FOCAL Study. Br J Cancer 2012 Dec 4;107(12):1917-1924.
DOI:10.1038/bjc.2012.489; PMID:23169286. PMCID:PMC3516684.

Conclusion: After subsequent screening of women who were either hrHPV positive/cytology negative or ASC-US positive/HPV negative, women randomised to the HPV arms had increased CIN2+ detection compared with women randomised to the cytology arm.


Nota biliográfica cribado c cérvix 2012-11

Arbyn M, de Sanjose S, Saraiya M, Sideri M, Palefsky J, Lacey C, et al. EUROGIN 2011 roadmap on prevention and treatment of HPV-related disease. Int J Cancer 2012 Nov 1;131(9):1969-1982. DOI:10.1002/ijc.27650; 10.1002/ijc.27650. PMID:22623137. PMCID:PMC3429628.

The EUROGIN 2011 roadmap reviews the current burden of human papillomavirus (HPV)-related morbidity, as well as the evidence and potential practice recommendations regarding primary and secondary prevention and treatment of cancers and other disease associated with HPV infection. HPV infection causes ~600,000 cases of cancer of the cervix, vulva, vagina, anus and oropharynx annually, as well as benign diseases such as genital warts and recurrent respiratory papillomatosis. Whereas the incidence of cervical cancer has been decreasing over recent decades, the incidence of anal and oropharyngeal carcinoma, for which there are no effective screening programs, has been rising over the last couple of decades. Randomized trials have demonstrated improved efficacy of HPV-based compared to cytology-based cervical cancer screening. Defining the best algorithms to triage HPV-positive women, age ranges and screening intervals are priorities for pooled analyses and further research, whereas feasibility questions can be addressed through screening programs. HPV vaccination will reduce the burden of cervical precancer and probably also of invasive cervical and other HPV-related disease in women. Recent trials demonstrated that prophylactic vaccination also protects against anogenital HPV infection, anogenital intraepithelial lesions and warts associated with vaccine types, in males; and anal HPV infection and anal intraepithelial neoplasia in MSM. HPV-related oropharyngeal cancer could be treated less aggressively because of better survival compared to cancers of the oropharynx unrelated to HPV. Key findings in the field of cervical cancer prevention should now be translated in cost-effective strategies, following an organized approach integrating primary and secondary prevention, according to scientific evidence but adapted to the local situation with particular attention to regions with the highest burden of disease.


Nota bibliográfica cribado de c cervix 2012-10

Sopina E, Ashton T. Cost-effectiveness of a cervical screening program with human papillomavirus vaccine. International Journal of Technology Assessment in Health Care 2011 Oct;27(4):290-7.


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