HPV genotype profile in a Norwegian cohort with ASC-US and LSIL cytology with three year cumulative risk of high grade cervical neoplasia.

OBJECTIVE: To explore the HPVgenotype profile in Norwegian women with ASC-US/LSIL cytology and the subsequent risk of high-grade cervical neoplasia (CIN 3+). METHODS: In this observational study delayed triage of ASC-US/LSIL of 6058 women were included from 2005 to 2010. High-risk HPV detection with Hybrid Capture 2 (HC2) was used and the HC2+ cases were genotyped with in-house nmPCR. Women were followed-up for histologically confirmed CIN3+ within three years of index HPV test by linkage to the screening databases at the Cancer Registry of Norway. RESULTS: HC2 was positive in 45% (2756/6058) of the women. Within 3years CIN3+ was diagnosed in 26% of women<34year and in 15%≥34year. HC2 was positive at index in 94% of CIN3+ cases and negative in 64 cases including three women with cervical carcinomas. Women<34years with single infections of HPV 16, 35, 58 or 33 or multiple infections including HPV 16, 52, 33 or 31 were associated with highest proportions of CIN 3+. Older women with single infection with HPV 16, 33, 31 or 35 or multiple infections including HPV 16, 33, 31 or 18/39 were more likely to develop CIN 3+. CONCLUSIONS: HPV 16 and HPV 33 at baseline both as single or multiple infections, were associated with the highest risk for CIN3+. Among older women, all 13 high-risk genotypes as single infection were associated with >20% risk of CIN3+. Further studies are necessary to risk stratify the individual genotypes to reduce the number of colposcopies in Norway.

CIN 2/3 and cervical cancer in an organised screening programme after an unsatisfactory or a normal Pap smear: a seven-year prospective study of the Norwegian population-based screening programme.

OBJECTIVES: To estimate the risk of cervical intraepithelial neoplasia (CIN) 2/3 and invasive cervical cancer (ICC) in an organised screening programme after an unsatisfactory or a normal Pap smear. SETTING: A seven-year prospective cohort study of the Norwegian population-based co-ordinated screening programme based on the actual diagnostic and screening procedures performed. Observations of 526,661 women with a normal index Pap smear and 21,405 women with an unsatisfactory index Pap smear were made during 3.26 million women-years. METHODS: The risk of being diagnosed with CIN 2/3 or ICC was calculated by logistic regression for the first two years of follow-up. The hazard of being diagnosed with CIN 2/3 or ICC for the women who were not diagnosed during the two first years was estimated by non-parametrical survival regression. RESULTS: After two years of follow-up, 0.2% of the women were diagnosed with CIN 2/3 and 0.01% with ICC after a normal Pap smear. An unsatisfactory Pap smear indicated a 1.6-4.0 times higher risk of harbouring a CIN 2/3 or ICC compared to women with a normal Pap smear. No increased risk of ICC was found during long-term follow-up for the 70% of the women with an unsatisfactory Pap smear who were returned to ordinary screening. Prior series of low-grade Pap smears followed by a normal Pap were associated with an increased risk of CIN 2/3 and ICC. CONCLUSIONS: An unsatisfactory Pap smear indicates a risk of harbouring CIN II/III or ICC. Repeated Pap smears are adequate as a follow-up of an unsatisfactory Pap smear. Women with repeated series of equivocal/LSIL Pap smears followed by a normal Pap should be considered at high risk.

The cervical cancer screening programme in Norway, 1992-2000: changes in Pap smear coverage and incidence of cervical cancer.

OBJECTIVES: Changes in the incidence of cervical cancer were studied to assess the impact of the Norwegian coordinated cervical cancer screening programme introduced in 1995. Attention was given as to whether recommendation letters sent to women without a screen in the previous 3 years could be an alternative to a conventional screening programme that invites women irrespectively of their spontaneous screening. SETTING: A population based, nationwide, screening programme in which women of 25 to 69 are recommended to have a conventional Pap smear every 3 years. METHODS: The impact of the screening programme was assessed indirectly by comparing trends in invasive cervical cancer, changes in coverage, and changes in interval between Pap smears in the 3 year period (1992-4) before screening with the two first screening rounds (1995-7 and 1998-2000). All Pap smears taken from women of all ages were included, a total of 4 744 967 Pap smears from more than 1.4 million women. Further, the impact was assessed directly by logistic regression by comparing the screening results of women recruited for the programme with women who had regularly had Pap smears. RESULTS: In the last 2 years studied, the incidence of invasive cancer was 22% lower than in the period before the programme. The proportion of women who had a Pap smear was higher after the implementation of the coordinated screening programme. The number of smears taken was less as the interval after a normal smear was greater. The newly recruited women had a threefold risk of having a high grade precursor and a 20-fold higher risk of cancer than the women who had had regular smears. CONCLUSIONS: The coordinated screening programme provides a low cost way of increasing the coverage of the female population, and consequently has reduced the rate of invasive cervical cancer.

Comparison of information on occupation and lifestyle habits obtained from European man-made vitreous fibre production workers and their relatives.

BACKGROUND: Studies of the aetiology of fatal diseases often rely on data obtained from relatives, which can cause loss of precision and introduce bias. We assessed the quality of such information on demographics, occupation, smoking and alcohol habits. METHODS: We compared contemporary interviews, based on a structured questionnaire, with male workers from the man-made vitreous fibre production industry in four European countries and their relatives. The participation rate was 63% (74 pairs of workers and relatives). RESULTS: Only minor differences in the ability to answer the questions appeared among workers and relatives, except for specific occupational questions. There was moderate to excellent agreement for demographics, residential and work history (kappa or intraclass correlation range: 0.44-0.98). For smoking habits, beer and wine consumption the agreement was good to excellent (range: 0.59-0.99). In particular, number of different residential areas, jobs, industries, and duration of wine drinking were significantly underreported by the relatives. No general determinant for reduced agreement appeared. CONCLUSIONS: In general, the quality of information obtained from relatives appeared good. However, information on specific occupational exposures may be improved by supplementing the information from relatives with details obtained from colleagues, occupational hygiene experts or occupation-exposure matrices.

[Mass screening for cervical cancer. Experiences after 25 years of voluntary screening and 2 years of organized screening]. / Masseundersøkelsen for livmorhalskreft. Erfaringer etter 25 år med villscreening og to års organisert screening.

In 1990 the Norwegian Ministry of Health and Social Services initiated an organised screening programme for cervical cancer, the main goal of which is to reduce the incidence of and mortality from cervical cancer in Norway. All women aged between 25-69 years are offered screening every third year. In the first three years of the programme, all voluntary screening was reported to The Cancer Registry of Norway. This showed that a high number of smear tests were carried out on young women, against a low rate of smear tests on older women. Since January 1995 invitations have been sent to all women aged between 25-69 years, where there is no record of a smear test having been done in the last three years. Results so far show that the number of women who have had a smear test done in the last three years is increasing in the older age groups. A total of 2.6 million smears have been recorded. Approximately 90% of the smears were normal, only 1.7% showing signs of dysplasia. All pathological smears will be followed up with a reminder either from the laboratories or The Cancer Registry.

Mass screening for cervical cancer in Norway: evaluation of the pilot project.

The Norwegian Department of Health and Social Affairs initiated a national screening program for cervical cancer in 1990, with all women aged 25 to 70 years to be offered cervical screening every three years. During the first three years of the program (November 1991-October 1994), all spontaneous cervical cytology in Norway was recorded at the Norwegian Cancer Registry. In addition, women in the counties of Vestfold and Sør-Trøndelag were invited individually to be screened. The aim of the present study was principally to evaluate the organization aspects of a nationwide, population-based screening program for cervical cancer in Norway. Special attention was paid to the coverage, the attendance rate, and the cytologic findings in the two-county study area. A total of 1,581,379 Pap smears were recorded from November 1991 to October 1994. Most smears were taken from women under age 30 years (31.7 percent). About 25 percent of the women aged 25 to 29 years had more than one normal smear. In the study area, a coverage of about 71 percent in the age group 25 to 69 years was achieved. The pilot project also has shown that it is possible to recruit elderly women into screening. However, no difference was noted between the study and the reference area with regard to findings per smear of precursor lesions (CIN 3, modified SNOMED coding system). The experiences from three years of recording and the implementation of the pilot project have provided useful guidelines for the national screening which began in January 1995.

Second primary cancers in patients with carcinoma in situ of the uterine cervix. The Norwegian experience 1970-1992.

Multiple primary cancers in the same individual occur rarely. Consequently, a large number of cancer patients have to be followed for long periods to obtain adequate information about their risk of subsequent tumour development. Studies of multiple malignancies are of interest, since they may provide information on common or opposite risk factors. In the present study, the risk of second primary cancers following carcinoma in situ of the uterine cervix diagnosed in Norway in the period 1970-1992 was examined and quantified. Altogether, 37,001 patients with carcinoma in situ were followed from the date of diagnosis until 31 December 1992. The follow-up period was divided into 5-year intervals. The results were expressed as standardized incidence ratios (SIR = O/E), and their 95% confidence intervals were given. A total of 1,037 second primary cancers in 989 individuals were identified. There was no overall excess of second primary cancers. However, there were differences depending on the site: cancers of the oesophagus, nose, nasal cavities, trachea, bronchus, lung, vulva, vagina, bladder and other urinary organs, and other skin cancers, excluding basal-cell carcinoma, occurred more frequently. A lower risk than expected was noted for cancer of the cervix uteri and cancer of the corpus uteri. There was a rising trend with time in the observed/expected ratio for cancer of urinary organs. In the group of patients evaluated, the likelihood of subsequent tumour development was no greater than in the general female population. Nevertheless, cancer sites of higher and of lower risk than expected were identified among the carcinoma-in situ patients.

Cervical mass screening in Norway--510,000 smears a year.

In 1990 the Norwegian Department of Health and Social Affairs decided to start a national screening program for cervical cancer. All women aged 25 to 70 years are offered cervical screening every 3 years. The mass screening is organized and run by a central unit, comprising the Cancer Registry of Norway and the National Health Screening Service. For the first 3 years, all spontaneous cervical screening in Norway is recorded in a central, computerized register. In addition, a pilot project has been implemented in two counties to evaluate the organizational aspects of the screening program. A total of 509,641 cervical smears were recorded during the first year of registration. The test frequency was highest in the age group 20 to 29 years (28.4%), while relatively few tests were performed on women in the age group 60 to 69 years (6.6%). The majority of smears (88.6%) had normal tissue morphology, whereas 2.9% displayed different cytological abnormalities. Human papillomavirus (HPV) changes and mild (CIN 1) and moderate (CIN 2) dysplasia had the highest smear rate in women under 40 years. Malignant cellular changes had the highest rate in older age groups. The imbalance in the age distribution of smears and the confinement of cytological abnormalities to the youngest and the oldest age groups support the wide target age range of the screening program.

[Mass screening for cervical cancer. A one-year registration of cervical cytological tests]. / Masseundersøkelsen for livmorhalskreft. Ett års registrering av cervixcytologiske prøver.

In 1990 the Norwegian Ministry of Health and Social Affairs decided to start an organised screening programme for cervical cancer. All women aged 25-70 years will be offered screening every three years. During the first three years of the programme, all spontaneous screening in Norway is to be reported to a central unit located at the Cancer Registry of Norway. A pilot project has been implemented in the counties of Sør-Trøndelag and Vestfold to evaluate the organisational aspects of the screening programme. A total of 509,641 smears were recorded during the first year of recording. The majority of smears were taken from women below 50 years. Most smears (88.6%) had normal tissue morphology, while 2.9% displayed various cellular changes. Smears from younger women showed the highest rate of Human papillomavirus (HPV) changes and mild (CIN 1) and moderate (CIN 2) dysplasias, whereas the rated malignant cellular changes was highest in the older age groups. The findings support the wide age range of the target group.

Incidence, survival and mortality in cervical cancer in Norway, 1956-1990.

Long-term trends in incidence, survival and mortality were examined in women with squamous cell carcinoma and adenocarcinoma of the uterine cervix, diagnosed in Norway in the 35-year period 1956-1990. During the 1970s the number of cervical smears increased substantially in Norway, although no organised screening programme was introduced. Special attention was paid to the time period 1971-1990 to evaluate the effect of the extensive spontaneous screening. In addition, the prognostic importance of clinical stage and age was explored. In the squamous cell carcinoma patients the incidence rate peaked in the time period 1971-1975, since when there has been a decrease. In the adenocarcinoma patients the incidence rate rose through the years 1976-1990. Also, the proportion of adenocarcinomas increased in this time period. The mortality rates in both histological types declined modestly through the years 1966-1990. A more favourable stage distribution was noted among the squamous cell carcinomas (P = 0.00), but not among the adenocarcinomas, when comparing the two diagnostic periods 1971-1975 and 1981-1985. The multivariate analysis (GLIM) revealed that stage was the most important prognostic factor in both histological types (P = 0.00). In the squamous cell carcinoma patients the relative rate increased (P = 0.04) in the last period. There was a tendency towards a poorer prognosis in younger women in this group, but age did not prove to be an important prognostic factor (P = 0.08).