Cross-sectional study of patient- and physician-collected cervical cytology and human papillomavirus☆
Section snippets
Materials and methods
Between January 1999 and June 2000 we performed a cross-sectional study of patient- and physician-performed sampling for cervical cytology and oncogenic HPV. A total of 334 women seeking care at three colposcopy clinics (University of Arizona Health Sciences Center, Tucson, Arizona; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; and ISSSTE, Hermosillo, Mexico) were enrolled in the study. The University of Arizona Human Subjects Committee approved this study, as did the
Results
Three hundred thirty-four women were enrolled into the study: 108 from Tucson, Arizona; 100 from Lima, Peru; and 126 from Hermosillo, Mexico. The mean age of women enrolled in the study was 36.9 (range 18–67, standard deviation [SD] 11.3), and the mean parity was 2.3 (range 0–10, SD 1.9). An analysis of variance revealed that mean age did not statistically differ between the three study sites (P ≥ .05), although parity was significantly higher (2.7) among women from Peru (P ≤ .01) than among
Discussion
Eighty percent of cervical cancer occurs in developing world settings, where it is responsible for 200,000–300,000 deaths each year.1 By comparison, last year in the United States there were approximately 4900 deaths from cervical cancer.2 This dramatic disparity has been attributed to the ubiquity of cytology-based screening programs in developed nations.7 Efforts to implement cytologic screening programs in the developing world have met a variety of barriers, including inadequate material
Acknowledgements
The authors express their sincere appreciation to the women in Tucson, Hermosillo, and Lima who participated in this study. They also acknowledge the contributions of the technical team (S. Vanzzini, B. Monaco, T. Fernandez, J. Wein, M. Abramsen, L. Vaught, K. Harrigill, C. Kavanagh, and K. Hatch) and the statistical review provided by J. Ranger-Moore and S. Carvajal.
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Cited by (77)
Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice
2023, Gynecologie Obstetrique Fertilite et SenologieLong-term CIN3+ risk of HPV positive women after triage with FAM19A4/miR124-2 methylation analysis
2019, Gynecologic OncologyExperience with HPV self-sampling and clinician-based sampling in women attending routine cervical screening in the Netherlands
2019, Preventive MedicineCitation Excerpt :Therefore, several countries have replaced cytology by HPV testing as the primary screening method (Wentzensen et al., 2017). While cytology cannot be performed on a self-collected cervicovaginal sample due to the lack of a sufficient number of intact cervical cells (indicator cells), HPV testing can be performed reliably on self-sampled specimen (HPV self-sampling) (Garcia et al., 2003). Hence, the introduction of HPV-based screening opens up the possibility of offering self-sampling to women.
VALHUDES: A protocol for validation of human papillomavirus assays and collection devices for HPV testing on self-samples and urine samples
2018, Journal of Clinical VirologyCitation Excerpt :Reflex cytology combined or not with genotyping for HPV16/18 are recommended in several guidelines for management of hrHPV-positive women [48]. Whereas HPV16/18 genotyping can be easily applied on self-samples (vaginal and first-void urine), cytology on self-samples is not recommended due to the substantially lower sensitivity compared to cytology on a clinician-taken specimen [49–51] and the higher rates of suboptimal sample adequacy [49]. Consequently, molecular rather than morphological triage approaches obviate the need for an additional clinic visit for women who are hrHPV-positive on their self-sample which is likely to compromise the efficiency of a strategy offering self-sampling kits to unscreened or under-screened women.
Validation of the FAM19A4/mir124-2 DNA methylation test for both lavage- and brush-based self-samples to detect cervical (pre)cancer in HPV-positive women
2016, Gynecologic OncologyCitation Excerpt :Of these, cytology, either or not combined with HPV16/18 genotyping analysis, is currently most widely accepted [15,28]. However, cytology on self-collected (cervico-)vaginal specimens is unreliable [29]. Therefore, cytology triage would require an additional visit to a clinician for cervical scrape collection.
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The Population Council, Latin America Office, provided seed funding for this study. Thin-layer liquid cytology collection materials were provided at no cost by Cytyc Corp. (Boxborough, Massachusetts). This study was partially supported by grants from the National Institutes of Health (no. CA82715) and the Health Resource Services Administration (no. 316210). BB’s participation was partially underwritten by a career development grant from the University of Arizona.