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1.
Reprod Health ; 18(1): 213, 2021 Oct 26.
Article in English | MEDLINE | ID: covidwho-1779654

ABSTRACT

BACKGROUND: Human papillomavirus is the most common cause of sexually transmitted diseases. Various studies report that positive human papillomavirus diagnosis results in psychosexual issues for the infected and reduces their quality of life. However, the adaptation of the infected has not been addressed yet. The present study aims to identify the process by which individuals infected with human papillomavirus adapt to their disease. METHOD: This is a qualitative work of research with a grounded theory design. The setting of the study was the skin clinic of Shahid Faghihi Hospital in Shiraz. The participants consisted of 27 individuals: 18 patients, 3 doctors, 2 counselors, and 4 spouses of patients. The subjects were selected via purposeful and theoretical sampling method until data saturation was reached. Data were collected through face-to-face, in-depth, semi-structured interviews from April 2019 to December 2020. The collected data were analyzed using Corbin and Strauss's method (2015) and MAXQDA 2018. RESULTS: The theory which emerged from the data was "trying to maintain resilience in the absence of psychological security." Analysis of data showed the main concern of participants in adapting to their diagnosis with human papillomavirus was "life stress". "Stigma and ignorance" was found to be a contextual condition and "paradox in support" was an intervening condition in the patients' adaptation. The patients' action/interaction responses to their main concern in the context in question were "emotional confrontation" and "maintaining resilience." The outcome was "oscillation between tension and tranquility." CONCLUSION: The present study explains the process by which patients with human papillomavirus adapt to their condition. Identification of the concerns of patients with human papillomavirus and the factors which affect their adaptation can help healthcare policy-makers and providers develop effective support plans in order to increase patients' quality of life. Early interventions, e.g. counseling care providers to modify their behaviors toward alleviating the psychosexual tension of the infected, can facilitate the adaptation of the infected and decrease the consequences of the infection for them.


Human papillomavirus (HPV) is the most common cause of sexually transmitted diseases. Almost all men and women get the infection at least once throughout their lives. The high-risk types of HPV account for about 5% of cancer cases globally. HPV can cause anogenital cancers and warts in both genders. In this grounded theory study, we conducted 27 in-depth interviews with Iranian patients, their spouses, and health care providers from April 2019 to December 2020. The collected data were analyzed using Corbin and Strauss's method (2015) and MAXQDA 2018. The participants were concerned about tension in family relationships, being stigmatized, getting cancer, recurrence of warts, transferring their disease to others, and changes in the appearance of their genitalia. They stated that HPV is regarded as a shameful disease in society. Most of the participants said they had never heard anything about HPV. The patients' action/interaction responses to their concerns were "emotional confrontation" and "maintaining resilience." These strategies helped the patients recover some of their tranquility. However, some of patients' concerns were persistent and kept them oscillating between tension and tranquility. An understanding of the patients' perception of their disease is essential to development of effective educational interventions to change patients' perspective on their situation and improve their recovery. Furthermore, because of the low level of public awareness about HPV and sexual health and the flow of misinformation to the infected, it is recommended that educational interventions focus on the patients' concerns.


Subject(s)
Alphapapillomavirus , Papillomavirus Infections , Grounded Theory , Humans , Papillomaviridae , Papillomavirus Infections/diagnosis , Quality of Life , Social Stigma
2.
BMC Womens Health ; 22(1): 110, 2022 Apr 09.
Article in English | MEDLINE | ID: covidwho-1779636

ABSTRACT

BACKGROUND: High-risk human papillomavirus (HPV) causes 99% of cervical cancer cases. Despite available prevention methods through the HPV vaccine and two screening modalities, women continue to die from cervical cancer worldwide. Cervical cancer is preventable, yet affects a great number of women living with HIV (WLH). Low screening rates among WLH further exacerbate their already high risk of developing cervical cancer due to immunosuppression. This study explores WLH's current cervical cancer knowledge, screening barriers and facilitators, and sources of health information. METHODS: Focus group discussions were conducted with 39 WLH aged 21 years old or older, who resided in the Washington-Baltimore Metropolitan Area. Emergent themes were classified and organized into overarching domains and assembled with representative quotations. RESULTS: The women had limited knowledge of HPV and the cervical cancer screening guidelines for WLH. Coronavirus 2019 (COVID-19) pandemic has amplified screening barriers due to decreased accessibility to usual medical appointment and cervical cancer screenings. Screening facilitators included knowing someone diagnosed with cervical cancer and provider recommendations. WLH indicated that they obtained health information through in-person education (providers, peer groups) and written literature. Due to the pandemic, they also had to increasingly rely on remote and technology-based communication channels such as the internet, social media, television, radio, email, and short message service (SMS) text messaging. CONCLUSIONS: Future health interventions need to explore the possibility of sharing messages and increasing cervical cancer and HPV knowledge of WLH through the use of SMS and other technology-based channels.


Subject(s)
COVID-19 , HIV Infections , Papillomavirus Infections , Uterine Cervical Neoplasms , Adult , Early Detection of Cancer/methods , Female , HIV Infections/diagnosis , Health Knowledge, Attitudes, Practice , Humans , Mass Screening/methods , Pandemics/prevention & control , Papillomavirus Infections/complications , Papillomavirus Infections/diagnosis , Papillomavirus Infections/prevention & control , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control , Young Adult
3.
Int J Environ Res Public Health ; 19(5)2022 02 24.
Article in English | MEDLINE | ID: covidwho-1715329

ABSTRACT

The aim of this study was to assess the effectiveness of HPV self-sampling for cervical cancer screening and the best means of service delivery, with a specific focus on under-screened women, particularly during the COVID-19 pandemic. Using three arms of service delivery (social media, school outreach and underserved outreach), we recruited under-screened women aged 30-65 years from two population groups: the general public and specific underserved communities, from whom self-sampled specimens and optional clinician-sampled cervical specimens were obtained for HPV testing. A total of 521 self-sampling kits were distributed, of which 321 were returned, giving an overall uptake rate of 61.6%. The response rate was higher in the face-to-face underserved outreach (65.5%) compared to social media (22.8%) and school outreach (18.2%). The concordance for HPV detection between self-sampled and clinician-sampled specimens was 90.2% [95% confidence interval (CI) 85.1-93.8%; Cohen's kappa 0.59 (95% CI 0.42-0.75)]. Overall, 89.2% of women were willing to have self-sampling again. In conclusion, HPV self-sampling is an effective method for cervical cancer screening and can be considered as an option, particularly in women who are reluctant or unable to attend regular screening. Various service deliveries could be considered to increase participation in cervical cancer screening.


Subject(s)
Alphapapillomavirus , COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , Early Detection of Cancer/methods , Female , Hong Kong/epidemiology , Humans , Middle Aged , Pandemics , Papillomaviridae , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , SARS-CoV-2 , Self Care/methods , Uterine Cervical Neoplasms/prevention & control
5.
Cytopathology ; 33(3): 350-356, 2022 May.
Article in English | MEDLINE | ID: covidwho-1577413

ABSTRACT

BACKGROUND: The coronavirus pandemic has had a profound impact on the cervical screening programme in Wales for the eligible women, sample takers, and laboratory and colposcopy services. AIMS: To explore what changes due to the pandemic have adversely affected screening outcomes in Wales and what lessons can be learned to improve cervical screening in Wales and elsewhere. METHODS: A review of the screening performance in 2020 and the first quarter of 2021 in Wales as well as a comparison with other cervical screening programme responses to the pandemic. RESULTS: A 3 month pause of screening together with a change in a variety of working practices, including social distancing, use of personal protective equipment, use of virtual meetings, and home working have been implemented. The combination of a pause to the issuing of invitations, plus reduced services in primary and secondary care, together with population lockdown, have contributed to longer waiting times for colposcopy and potentially delayed cancer diagnoses. Some programme changes which were being evaluated prior to the pandemic could be developed now to mitigate the impact of the pandemic such as improved information, increased screening intervals for human papillomavirus-based screening programmes, and home working for call and recall staff. CONCLUSIONS: Despite a considerable short-term interruption to the cervical screening programme, some changes introduced as a result of the coronavirus pandemic could provide key lessons learnt for improvement for cervical cancer prevention services.


Subject(s)
Cervical Intraepithelial Neoplasia , Coronavirus Infections , Coronavirus , Papillomavirus Infections , Uterine Cervical Neoplasms , Cervical Intraepithelial Neoplasia/diagnosis , Colposcopy , Early Detection of Cancer , Female , Humans , Mass Screening , Pandemics/prevention & control , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Pregnancy , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears
6.
Anal Biochem ; 635: 114445, 2021 12 15.
Article in English | MEDLINE | ID: covidwho-1565506

ABSTRACT

The outbreak of COVID-19 makes epidemic prevention and control become a growing global concern. Nucleic acid amplification testing (NAAT) can realize early and rapid detection of targets, thus it is considered as an ideal approach for detecting pathogens of severe acute infectious diseases. Rapid acquisition of high-quality target nucleic acid is the prerequisite to ensure the efficiency and accuracy of NAAT. Herein, we proposed a simple system in which magnetic nanoparticles (MNPs) based nucleic acid extraction was carried out in a plastic Pasteur pipette. Different from traditional approaches, this proposed system could be finished in 15 min without the supports of any electrical instruments. Furthermore, this system was superior to traditional MNPs based extraction methods in the aspects of rapid extraction and enhancing the sensitivity of a NAAT method, accelerated denaturation bubbles mediated strand exchange amplification (ASEA), to the pathogens from various artificial samples. Finally, this Pasteur pipette system was utilized for pathogen detection in actual samples of throat swabs, cervical swabs and gastric mucosa, the diagnosis results of which were identical with that provided by hospital. This rapid, easy-performing and efficiency extraction method ensures the applications of the NAAT in pathogen detection in regions with restricted resources.


Subject(s)
Infections/diagnosis , Magnetite Nanoparticles , Nucleic Acid Amplification Techniques/methods , Nucleic Acids/isolation & purification , COVID-19/diagnosis , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Human papillomavirus 16/isolation & purification , Humans , Papillomavirus Infections/diagnosis , Pneumonia, Mycoplasma/diagnosis , SARS-CoV-2/isolation & purification
7.
Nihon Koshu Eisei Zasshi ; 68(11): 719-727, 2021 Dec 04.
Article in Japanese | MEDLINE | ID: covidwho-1554772

ABSTRACT

Objectives We investigated the participation and detection rates of cervical lesions in cervical screening non-attenders offered HPV (human papillomavirus) self-sampling with cytology triage.Methods From 2016 to 2018, HPV self-sampling was routinely offered as an option, along with cytology, to all non-attenders in Ebetsu City, Japan. The primary endpoints were ≥CIN2 and ≥CIN3 detection rates, and secondary endpoints were abnormal cytology rates and follow-up compliance.Results Overall, recall invitations were mailed to 6,116 non-attenders, with a response rate of 15.9% (cytology: 6.5%, HPV testing: 9.4%). Of the responders to undergo HPV self-sampling, 11.7% had a positive result and were referred to cytology triage. Moreover, ≥CIN2 and ≥CIN3 detection rates were 1.7% and 0.9%, respectively, in the HPV self-sampling group, and 1.0% and 0.8%, respectively, in the cytology group, showing no statistically significant differences. In those who underwent cytology triage following an HPV positive test, ≥CIN2 and ≥CIN3 detection rates were 23.8% and 11.9%, respectively, which was significantly higher than those who only underwent cytology alone.Conclusion HPV self-sampling followed by cytology triage is highly effective at detecting high grade disease in non-attenders. Thus, multi-municipality-based studies to standardize processes involving this method are warranted. Furthermore, HPV self-sampling could be a promising method for inviting non-attenders who have difficulty undergoing cervical screening in the COVID-19 pandemic era.


Subject(s)
COVID-19 , Cervical Intraepithelial Neoplasia , Papillomavirus Infections , Uterine Cervical Neoplasms , Cervical Intraepithelial Neoplasia/diagnosis , Early Detection of Cancer , Feasibility Studies , Female , Humans , Mass Screening , Pandemics , Papillomavirus Infections/diagnosis , SARS-CoV-2 , Triage , Uterine Cervical Neoplasms/diagnosis
8.
Prev Med ; 154: 106900, 2022 01.
Article in English | MEDLINE | ID: covidwho-1541024

ABSTRACT

An increasing body of evidence supports the validity of self-sampling as an alternative to clinician collection for primary Human Papillomavirus (HPV) screening. Self-sampling effectively reaches underscreened women and can be a powerful strategy in low- and high-resource settings for all target ages. This work aims to summarize the current use of HPV self-sampling worldwide. It is part of a larger project that describes cervical cancer screening programmes and produces standardized coverage estimates worldwide. A systematic review of the literature and official documents supplemented with a formal World Health Organisation country consultation was conducted. Findings show that the global use of HPV self-sampling is still limited. Only 17 (12%) of countries with identified screening programs recommend its use, nine as the primary collection method, and eight to reach underscreened populations. We identified 10 pilots evaluating the switch to self-sampling in well-established screening programs. The global use of self-sampling is likely to increase in the coming years. COVID-19's pandemic has prompted efforts to accelerate HPV self-sampling introduction globally, and it is now considered a key element in scaling up screening coverage. The information generated by the early experiences can be beneficial for decision-making in both new and existing programs.


Subject(s)
COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Humans , Mass Screening , Papillomaviridae , Papillomavirus Infections/diagnosis , SARS-CoV-2 , Self Care , Specimen Handling , Uterine Cervical Neoplasms/diagnosis , Vaginal Smears
9.
Nihon Koshu Eisei Zasshi ; 68(11): 719-727, 2021 Dec 04.
Article in Japanese | MEDLINE | ID: covidwho-1350538

ABSTRACT

Objectives We investigated the participation and detection rates of cervical lesions in cervical screening non-attenders offered HPV (human papillomavirus) self-sampling with cytology triage.Methods From 2016 to 2018, HPV self-sampling was routinely offered as an option, along with cytology, to all non-attenders in Ebetsu City, Japan. The primary endpoints were ≥CIN2 and ≥CIN3 detection rates, and secondary endpoints were abnormal cytology rates and follow-up compliance.Results Overall, recall invitations were mailed to 6,116 non-attenders, with a response rate of 15.9% (cytology: 6.5%, HPV testing: 9.4%). Of the responders to undergo HPV self-sampling, 11.7% had a positive result and were referred to cytology triage. Moreover, ≥CIN2 and ≥CIN3 detection rates were 1.7% and 0.9%, respectively, in the HPV self-sampling group, and 1.0% and 0.8%, respectively, in the cytology group, showing no statistically significant differences. In those who underwent cytology triage following an HPV positive test, ≥CIN2 and ≥CIN3 detection rates were 23.8% and 11.9%, respectively, which was significantly higher than those who only underwent cytology alone.Conclusion HPV self-sampling followed by cytology triage is highly effective at detecting high grade disease in non-attenders. Thus, multi-municipality-based studies to standardize processes involving this method are warranted. Furthermore, HPV self-sampling could be a promising method for inviting non-attenders who have difficulty undergoing cervical screening in the COVID-19 pandemic era.


Subject(s)
COVID-19 , Cervical Intraepithelial Neoplasia , Papillomavirus Infections , Uterine Cervical Neoplasms , Cervical Intraepithelial Neoplasia/diagnosis , Early Detection of Cancer , Feasibility Studies , Female , Humans , Mass Screening , Pandemics , Papillomavirus Infections/diagnosis , SARS-CoV-2 , Triage , Uterine Cervical Neoplasms/diagnosis
10.
Molecules ; 26(7)2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1302415

ABSTRACT

The potential of first-void (FV) urine as a non-invasive liquid biopsy for detection of human papillomavirus (HPV) DNA and other biomarkers has been increasingly recognized over the past decade. In this study, we investigated whether the volume of this initial urine stream has an impact on the analytical performance of biomarkers. In parallel, we evaluated different DNA extraction protocols and introduced an internal control in the urine preservative. Twenty-five women, diagnosed with high-risk HPV, provided three home-collected FV urine samples using three FV urine collection devices (Colli-Pee) with collector tubes that differ in volume (4, 10, 20 mL). Each collector tube was prefilled with Urine Conservation Medium spiked with phocine herpesvirus 1 (PhHV-1) DNA as internal control. Five different DNA extraction protocols were compared, followed by PCR for GAPDH and PhHV-1 (qPCR), HPV DNA, and HBB (HPV-Risk Assay), and ACTB (methylation-specific qPCR). Results showed limited effects of collection volume on human and HPV DNA endpoints. In contrast, significant variations in yield for human endpoints were observed for different DNA extraction methods (p < 0.05). Additionally, the potential of PhHV-1 as internal control to monitor FV urine collection, storage, and processing was demonstrated.


Subject(s)
Biomarkers , DNA, Viral , Molecular Diagnostic Techniques , Papillomaviridae , Papillomavirus Infections/diagnosis , Papillomavirus Infections/urine , Adult , DNA, Viral/isolation & purification , DNA, Viral/urine , Female , Humans , Middle Aged , Papillomaviridae/genetics , Papillomavirus Infections/virology , Reproducibility of Results , Sensitivity and Specificity , Workflow , Young Adult
11.
Prev Med ; 151: 106596, 2021 10.
Article in English | MEDLINE | ID: covidwho-1294325

ABSTRACT

The COVID-19 pandemic has a major impact on a wide range of health outcomes. Disruptions of elective health services related to cervical screening, management of abnormal screening test results, and treatment of precancers, may lead to increases in cervical cancer incidence and exacerbate existing health disparities. Modeling studies suggest that a short delay of cervical screening in subjects with previously negative HPV results has minor effects on cancer outcomes, while delay of management and treatment can lead to larger increases in cervical cancer. Several approaches can mitigate the effects of disruption of cervical screening and management. HPV-based screening has higher accuracy compared to cytology, and a negative HPV result provides longer reassurance against cervical cancer; further, HPV testing can be conducted from self-collected specimens. Self-collection expands the reach of screening to underserved populations who currently do not participate in screening. Self-collection and can also provide alternative screening approaches during the pandemic because testing can be supported by telehealth and specimens collected in the home, substantially reducing patient-provider contact and risk of COVID-19 exposure, and also expanding the reach of catch-up services to address backlogs of screening tests that accumulated during the pandemic. Risk-based management allows prioritizing management of patients at highest risk of cervical cancer while extending screening intervals for those at lowest risk. The pandemic provides important lessons for how to make cervical screening more resilient to disruptions and how to reduce cervical cancer disparities that may be exacerbated due to disruptions of health services.


Subject(s)
COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Humans , Mass Screening , Pandemics , Papillomaviridae , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology
12.
BMJ Open ; 11(6): e051118, 2021 06 29.
Article in English | MEDLINE | ID: covidwho-1288397

ABSTRACT

INTRODUCTION: Squamous cell carcinoma of the anus is a common cancer among sexual minority men, especially HIV-positive sexual minority men; however, there is no evidenced-based national screening protocol for detection of anal precancers. Our objective is to determine compliance with annual anal canal self-sampling or clinician-sampling for human papillomavirus (HPV) DNA. METHODS AND ANALYSIS: This is a prospective, randomised, two-arm clinical study to evaluate compliance with annual home-based versus clinic-based HPV DNA screening of anal canal exfoliated cells. The setting is primary care community-based clinics. Recruitment is ongoing for 400 HIV-positive and HIV-negative sexual minority men and transgender persons, aged >25 years, English or Spanish speaking, no current use of anticoagulants other than nonsteroidal anti-inflammatory drugs and no prior diagnosis of anal cancer. Participants are randomised to either receive a swab in the mail for home-based collection of an anal canal specimen at 0 and 12 months (arm 1) or attend a clinic for clinician collection of an anal canal specimen at 0 and 12 months (arm 2). Persons will receive clinic-based Digital Anal Rectal Examinations and high-resolution anoscopy-directed biopsy to assess precancerous lesions, stratified by study arm. Anal exfoliated cells collected in the study are assessed for high-risk HPV persistence and host/viral methylation. The primary analysis will use the intention-to-treat principle to compare the proportion of those who comply with 0-month and 12-month sampling in the home-based and clinic-based arms. The a priori hypothesis is that a majority of persons will comply with annual screening with increased compliance among persons in the home-based arm versus clinic-based arm. ETHICS AND DISSEMINATION: The study has been approved by the Medical College of Wisconsin Human Protections Committee. Results will be disseminated to communities where recruitment occurred and through peer-reviewed literature and conferences. TRIAL REGISTRATION NUMBER: NCT03489707.


Subject(s)
Anus Neoplasms , Papillomavirus Infections , Pharmaceutical Preparations , Anal Canal , Anus Neoplasms/diagnosis , Anus Neoplasms/prevention & control , Early Detection of Cancer , Homosexuality, Male , Humans , Male , Papillomavirus Infections/diagnosis , Papillomavirus Infections/prevention & control , Prospective Studies , Randomized Controlled Trials as Topic , Wisconsin
14.
Prev Med ; 151: 106623, 2021 10.
Article in English | MEDLINE | ID: covidwho-1240652

ABSTRACT

COVID-19 has disrupted cervical screening in several countries, due to a range of policy-, health-service and participant-related factors. Using three well-established models of cervical cancer natural history adapted to simulate screening across four countries, we compared the impact of a range of standardised screening disruption scenarios in four countries that vary in their cervical cancer prevention programs. All scenarios assumed a 6- or 12-month disruption followed by a rapid catch-up of missed screens. Cervical screening disruptions could increase cervical cancer cases by up to 5-6%. In all settings, more than 60% of the excess cancer burden due to disruptions are likely to have occurred in women aged less than 50 years in 2020, including settings where women in their 30s have previously been offered HPV vaccination. Approximately 15-30% of cancers predicted to result from disruptions could be prevented by maintaining colposcopy and precancer treatment services during any disruption period. Disruptions to primary screening had greater adverse effects in situations where women due to attend for screening in 2020 had cytology (vs. HPV) as their previous primary test. Rapid catch-up would dramatically increase demand for HPV tests in 2021, which it may not be feasible to meet because of competing demands on the testing machines and reagents due to COVID tests. These findings can inform future prioritisation strategies for catch-up that balance potential constraints on resourcing with clinical need.


Subject(s)
COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Humans , Mass Screening , Papillomavirus Infections/diagnosis , Papillomavirus Infections/prevention & control , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
15.
Prev Med ; 144: 106294, 2021 03.
Article in English | MEDLINE | ID: covidwho-1152692

ABSTRACT

Cervical cancer remains the fourth most common cancer in women, with 85% of deaths occurring in LMICs. Despite the existence of effective vaccine and screening tools, efforts to reduce the burden of cervical cancer must be considered in the context of the social structures within the health systems of LMICs. Compounding this existing challenge is the global COVID-19 pandemic, declared in March 2020. While it is too soon to tell how health systems priorities will change as a result of COVID-19 and its impact on the cervical cancer elimination agenda, there are opportunities to strengthen cervical screening by leveraging on several trends. Many LMICs maximized the strengths of their long established community-based primary care and public health systems with expansion of surveillance systems which incorporated mobile technologies. LMICs can harness the momentum of the measures taken against COVID-19 to consolidate the efforts against cervical cancer. Self-sampling, molecular human papillomavirus (HPV) testing and digital health will shift health systems towards stronger public health and primary care networks and away from expensive hospital-based care investments. While COVID-19 will change health systems priorities in LMICs in ways that may de-prioritize cervical cancer screening, there are significant opportunities for integration into longer-term trends towards universal health coverage, self-care and digital health.


Subject(s)
COVID-19/epidemiology , Developing Countries , Health Priorities , Papillomavirus Infections/diagnosis , Uterine Cervical Neoplasms/diagnosis , COVID-19/prevention & control , COVID-19/transmission , Early Detection of Cancer , Female , Humans
16.
J Med Screen ; 28(2): 213-216, 2021 06.
Article in English | MEDLINE | ID: covidwho-1140458

ABSTRACT

OBJECTIVES: To quantify the secondary impacts of the COVID-19 pandemic disruptions to cervical cancer screening in the United States, stratified by step in the screening process and primary test modality, on cervical cancer burden. METHODS: We conducted a comparative model-based analysis using three independent NCI Cancer Intervention and Surveillance Modeling Network cervical models to quantify the impact of eight alternative COVID-19-related screening disruption scenarios compared to a scenario of no disruptions. Scenarios varied by the duration of the disruption (6 or 24 months), steps in the screening process being disrupted (primary screening, surveillance, colposcopy, excisional treatment), and primary screening modality (cytology alone or cytology plus human papillomavirus "cotesting"). RESULTS: The models consistently showed that COVID-19-related disruptions yield small net increases in cervical cancer cases by 2027, which are greater for women previously screened with cytology compared with cotesting. When disruptions affected all four steps in the screening process under cytology-based screening, there were an additional 5-7 and 38-45 cases per one million screened for 6- and 24-month disruptions, respectively. In contrast, under cotesting, there were additional 4-5 and 35-45 cases per one million screened for 6- and 24-month disruptions, respectively. The majority (58-79%) of the projected increases in cases under cotesting were due to disruptions to surveillance, colposcopies, or excisional treatment, rather than to primary screening. CONCLUSIONS: Women in need of surveillance, colposcopies, or excisional treatment, or whose last primary screen did not involve human papillomavirus testing, may comprise priority groups for reintroductions.


Subject(s)
COVID-19 , Early Detection of Cancer , Uterine Cervical Neoplasms/diagnosis , Adult , Colposcopy , Cytological Techniques , Female , Humans , Middle Aged , Models, Statistical , Papillomaviridae/isolation & purification , Papillomavirus Infections/diagnosis , United States , Uterine Cervical Neoplasms/epidemiology
17.
Cancer Epidemiol Biomarkers Prev ; 30(3): 432-434, 2021 03.
Article in English | MEDLINE | ID: covidwho-1133380

ABSTRACT

Cervical cancer screening has undergone a transformation in recent decades. Historically, programs were based on cervical cytology (i.e., "Pap smear"), which had to be repeated often because of its limited sensitivity and reproducibility. In more recent years, the discovery of human papillomavirus (HPV) as the necessary cause of virtually all cervical cancers has led to the introduction of HPV testing into clinical practice, first as a triage test for minor cytologic abnormalities, then in conjunction with cervical cytology (cotesting), and most recently, as a standalone screening test. Multiple randomized trials have shown that HPV-based screening has higher sensitivity compared with cytology, providing great reassurance against cervical precancer and cancer for women testing HPV-negative for many years. Analyses have also been conducted in support of the recent U.S. Preventive Services Task Force guidelines that show that primary HPV screening achieves the greatest balance of benefits and harms compared with other strategies. An added benefit of primary HPV testing is the ability to conduct it from self-collected samples, which is critical for extending coverage among hard-to-reach individuals and could provide a safe and effective alternative to in-person screening visits during the COVID-19 pandemic.See related article by Liang et al., p. 474.


Subject(s)
Alphapapillomavirus , COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Humans , Mass Screening , Pandemics , Papanicolaou Test , Papillomaviridae , Papillomavirus Infections/diagnosis , Reproducibility of Results , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears
18.
Talanta ; 227: 122154, 2021 May 15.
Article in English | MEDLINE | ID: covidwho-1078200

ABSTRACT

Infectious diseases caused by viruses such as SARS-CoV-2 and HPV have greatly endangered human health. The nucleic acid detection is essential for the early diagnosis of diseases. Here, we propose a method called PLCR (PfAgo coupled with modified Ligase Chain Reaction for nucleic acid detection) which utilizes PfAgo to only use DNA guides longer than 14-mer to specifically cleave DNA and LCR to precisely distinguish single-base mismatch. PLCR can detect DNA or RNA without PCR at attomolar sensitivities, distinguish single base mutation between the genome of wild type SARS-CoV-2 and its mutant spike D614G, effectively distinguish the novel coronavirus from other coronaviruses and finally achieve multiplexed detection in 70 min. Additionally, LCR products can be directly used as DNA guides without additional input guides to simplify primer design. With desirable sensitivity, specificity and simplicity, the method can be extended for detecting other pathogenic microorganisms.


Subject(s)
Argonaute Proteins/chemistry , DNA, Viral/analysis , Ligase Chain Reaction/methods , Pyrococcus furiosus/enzymology , RNA, Viral/analysis , Alphapapillomavirus/chemistry , Alphapapillomavirus/isolation & purification , COVID-19/diagnosis , DNA, Viral/chemistry , Humans , Limit of Detection , Mutation , Papillomavirus Infections/diagnosis , RNA, Viral/chemistry , SARS-CoV-2/chemistry , SARS-CoV-2/isolation & purification , Sensitivity and Specificity , Spike Glycoprotein, Coronavirus/genetics
19.
Br J Cancer ; 124(8): 1361-1365, 2021 04.
Article in English | MEDLINE | ID: covidwho-1072147

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disrupted cervical cancer screening services. Assuming increases to screening capacity are unrealistic, we propose two recovery strategies: one extends the screening interval by 6 months for all and the other extends the interval by 36/60 months, but only for women who have already missed being screened. METHODS: Using routine statistics from England we estimate the number of women affected by delays to screening. We used published research to estimate the proportion of screening age women with high-grade cervical intraepithelial neoplasia and progression rates to cancer. Under two recovery scenarios, we estimate the impact of COVID-19 on cervical cancer over one screening cycle (3 years at ages 25-49 and 5 years at ages 50-64 years). The duration of disruption in both scenarios is 6 months. In the first scenario, 10.7 million women have their screening interval extended by 6 months. In the second, 1.5 million women (those due to be screened during the disruption) miss one screening cycle, but most women have no delay. RESULTS: Both scenarios result in similar numbers of excess cervical cancers: 630 vs. 632 (both 4.3 per 100,000 women in the population). However, the scenario in which some women miss one screening cycle creates inequalities-they would have much higher rates of excess cancer: 41.5 per 100,000 delayed for screened women compared to those with a 6-month delay (5.9 per 100,000). CONCLUSION: To ensure equity for those affected by COVID-19 related screening delays additional screening capacity will need to be paired with prioritising the screening of overdue women.


Subject(s)
COVID-19/diagnosis , Early Detection of Cancer , Papillomavirus Infections/diagnosis , Uterine Cervical Neoplasms/diagnosis , Adult , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Colposcopy/methods , England/epidemiology , Female , Humans , Middle Aged , Pandemics , Papillomaviridae/pathogenicity , Papillomavirus Infections/complications , Papillomavirus Infections/epidemiology , Papillomavirus Infections/virology , Pregnancy , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity , Uterine Cervical Neoplasms/complications , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/virology , Vaginal Smears/methods
20.
Cancer Epidemiol Biomarkers Prev ; 30(2): 245-247, 2021 02.
Article in English | MEDLINE | ID: covidwho-1066965

ABSTRACT

Self-sampling is poised to be a disruptor for cervical screening. So far, cancer screening has been a causality of COVID-19; however, the opposite may transpire for self-sampling. Self-sampling enables socially distanced cervical screening with an outreach that extends to underserved populations. As evidence mounts that self-sampling is noninferior to clinician-taken samples, the focus for self-sampling is now as a primary screening option for all women. Now, we have evidence from a modeling study (using Australia as an exemplar) to suggest that program effectiveness with primary self-sampling would be better than the current program, even if sensitivity is lower. Regulatory issues, suitable triage strategies, and clear communication about self-sampling are hurdles yet to be overcome. Nevertheless, existing evidence coupled with COVID-19 could be the tipping point for wider introduction of self-sampling.See related article by Smith et al., p. 268.


Subject(s)
COVID-19 , Papillomaviridae , Papillomavirus Infections , Uterine Cervical Neoplasms , Australia , Early Detection of Cancer , Female , Humans , Mass Screening , Papillomavirus Infections/diagnosis , SARS-CoV-2 , Specimen Handling , Uterine Cervical Neoplasms/diagnosis
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