28 November 2011
An analysis of HPV primary screening trials suggests that cut-off values for the HC2 test could be safely increased to 10rlu. False positive results would be greatly reduced without significantly compromising sensitivity.
10 March 2011Up to £775 million of government funding is to be made available over the next five years for research aimed at delivering benefits to NHS patients.
5 March 2011"The logical and inevitable move to HPV-based cervical cancer prevention strategies will require longer screening intervals that will disrupt current gynecologic and cytology laboratory practices built on frequent screening."
17 January 2011Academy of Medical Sciences press release.
28 December 2010Hot on the heels of the MAVARIC trial showing no benefit of automation-assisted cervical cytology, a large RCT from Finland involving more than half a million cases has reached the same conclusion.
26 December 2010An analysis of over 50,000 slides pre- and post-conversion to liquid based cytology shows that rapid prescreening by LBC is significantly more sensitive for detecting cervical abnormalities (58.7 vs. 68.7%, p<0.001) than conventional cytology.
12 December 2010Reporting rates for glandular neoplasia in 464,754 cervical samples reported at six UK laboratories in 12-month periods before and after the implementation of SurepathTM LBC processing are compared. The introduction of LBC processing is seen to have resulted in a significant increase in the detection rate for endocervical glandular neoplasia while maintaining high levels of reporting specificity.
11 December 2010MAVARIC was a randomised controlled trial designed to investigate the utility of automation-assisted reading of cervical cytology slides.
18 November 2010A study published in the International Journal of Cancer, an HPV RNA assay provided a better combination of sensitivity and specificity than HPV DNA- or cytology-based tests for cervical cancer screening.
14 November 2010A pooled analysis of primary HPV testing in over 30,000 women from 17 studies across China, concludes that HPV testing is significantly more sensitivie for the detection of CIN3 or worse than either cytology or visual inspection with acetic acid. By adopting a cutoff point for HPV positivity of 10pg/ml for women under the age of 35, instead of the manufacturer's recommendation of 1-2pg/ml, specificity was increased and a high sensitivity was maintained.
29 October 2010A massive multinational study reported in Lancet Oncology has shown that HPV types 16, 18, 45, 33, 31, 52, 58, and 35 account for 91% of all cases of cervical cancer. It is likely that the next generation of cervical cancer vaccines will specifically include each of the 8 HPV types noted in this paper, since this will cover 90% of the cases of cervix cancer.
28 October 2010Conventional cytology apparently! Human papillomavirus testing and liquid-based cytology increases costs, but not effectiveness, compared with traditional approaches, according to a paper in the current issue of Obstet Gynecol
28 October 2010The use of p16INK4a immunohistochemistry significantly improves the accuracy of grading CIN lesions by a single pathologist, equalling an expert consensus diagnosis.
21 October 2010A randomized trial in a resource-limited setting has shown that an HPV test-and-treat policy is more effective than visual inspection-and-treat in reducing the incidence of high grade CIN.
20 September 2010A randomised study from Finland comparing automation-assisted screening and conventional cytology hs shown no difference in cervical cancer risk between the two groups after six years of follow up. The authors suggest that both methods are valid for screening.
26 August 2010Controversy has arisen over the potential impact on cervical cancer rates of reduced screening in a population vaccinated against HPV. A recent modeling study reported in The Lancet Infectious Diseases suggests that introduction of the vaccine is unlikely to lead to an increased incidence of cervical cancer as a result of diminished screening.
26 August 2010This study challenges the claim that LBC improves the sensitivity for detection of CIN2+ compared with conventional cytology. A random sample of 818 LBC cases originally reported in the NTCC trial were blindly reviewed by three international cytology exerts.There was no significant difference between the accuracy of the experts and the original interpreters.
24 August 2010Existing data on HPV type-specific risk is derived largely from unscreened populations. A case control study in a screened UK population indicates a considerable risk of subsequent invasive cervical cancer in women infected with HPV 16 and 18, particularly in women over 40.
21 August 2010A FISH assay comprised of chromosomal probes 8q24 and 3q26 to cervical cytology specimens confirms the positive correlation between increasing dysplasia and copy gains and shows promise as a marker in cervical disease progression.
7 August 2010A study from India has shown that HPV DNA can be effectively detected using a simple and inexpensive paper smear method for the dry collection of cervical specimens.
5 August 2010A prospective study in which colposcopically guided cervical biopsies and cone excision were performed in a single procedure, the sensitivity and specificity of biopsies for detecting CIN2+ were 66.2% and 95.0%, respectively. While the positive predictive value was 98.5%, the negative predictive value was only 35.5%. So, cervical biopsies are reliable for confirming cytologically detected high grade disease but are relatively poor at excluding it.
23 July 2010An analysis of the Icelandic cervical screening programme concludes that, in the HPV vaccine era:
23 July 2010FUTURE (Females United To Unilaterally Reduce Endo-ectocervical disease) was a randomized controlled trial studying the efficacy of the quadrivalent HPV vaccine Gardasil. The trial involved nearly 18000 women in 24 countries. The vaccine provided sustained protection (>95%) against low grade lesions attributable to vaccine HPV types (6, 11, 16, and 18) and a substantial reduction in the burden of these diseases through 42 months of follow-up. Protection against all low grade lesions (regardless of HPV type) was also sgnificant (30%, 75% and 48% for cervical, vulval and vaginal lesions, respectively).
21 July 2010A paper in Cancer Cytopathology describes a new automated technology in which cytology slides are consecutively scanned for morphological changes and genetic changes in the detection of lung cancer. The authors suggest its utility for mass screening.
18 July 2010An analysis of over 5000 cervical cytology samples and biopsies has confirmed the high prevalence of HPV 16 and/or 18 across multiple sites in England. This promises a high impact from HPV immunisation in due course.
12 July 2010"When significant discrepancies exist between colposcopy, cytology and histopathology, then MDT discussion seems pertinent as MDT discussion can lead to the avoidance of over-treatment. To improve timeliness of treatment, MDT meetings should occur at least monthly. The results of each case discussion should be recorded in the patient case notes, the minutes of each meeting should be circulated to all MDT members and a letter describing MDT recommendations must be sent to the colposcopist responsible for patient care."
12 July 2010"On the basis of our results, it would be considered acceptable to manage women [with borderline glandular cells] under 35 years of age with normal and satisfactory colposcopy conservatively. In women above 35 years of age, we would recommend a diagnostic 'large loop excision of the transformation zone' procedure, irrespective of the colposcopic findings"
12 July 2010HPV testing for cervical screening has been found to be over 50 per cent more sensitive than cytology in a community-based study in Mexico. This is the largest HPV primary screening study ever to be performed in a Latin American country and points to the readiness of HPV testing for large-scale implementation in Mexico.
29 April 2010Reporting in this week's BMJ, a Finnish randomized controlled trial has confirmed the superior sensitivity of HPV testing compared with conventional cytology for cervical screening. These results are consistent with most of those previously reported.
18 April 2010Summary of commentary from: Arbyn M, Martin-Hirsch P, Wentzensen N. HPV-based triage of women showing a cervical cytology result of borderline or mild dyskaryosis. BJOG 2010117:641–644.
14 April 2010A comparison of the sensitivity of the ThinPrep Imaging (TPI) system and conventional cytology for the detection of cellular abnormalities has given mixed results. TPI gave improved detection rates for low grade abnormalities but not for high grade.
14 April 2010This publication is a critical review of four types of studies looking at screening and cervical cancer. In brief:
14 March 2010PROHTECT (protection by offering HPV testing on cervicovaginal specimens trial) is a cohort study within the setting of the Dutch population based cervical screening programme to assess the feasibility and efficacy of offering cervicovaginal lavage self sampling for high risk HPV testing to women who do not attend the regular screening programme.
4 March 2010The latest results from NTCC are reported in the current issue of Lancet Oncology. Briefly, HPV-based screening is more effective than cytology in preventing invasive cervical cancer, by detecting persistent high-grade lesions earlier and providing a longer low-risk period. However, in younger women, HPV screening leads to over-diagnosis of regressive CIN2. The report is accompanied by a freely accessible editorial.
4 March 201082% of HPV positive cervical cancers in Scotland are caused by HPV types 16 and/or 18. The authors conclude that "A significant reduction in ICC in Scotland should be achieved through the HPV immunisation programme."
24 February 2010According to an Australian study reported in this week's BMJ, the use of HPV triage to resolve borderline cervical cytology is better for women’s psychosocial health than repeat smear testing.
20 February 2010Fluorescence in situ hybridization (FISH) has been successfully applied to liquid-based cytology preparations to analyse the amplification of the human telomerase gene (TERC) in normal and abnormal cervical samples. The results showed a significant association betwen gene expression levels and grade of abnormality, thus providing a potentially useful prognostic marker.
28 January 2010A modelling study has predicted a 63% reduction in invasive cancer, a 51% reduction in CIN3 and a 27% reduction in cytological abnormalities by 2025 in the UK, provided that HPV vaccine uptake reaches 80%. Wales and Scotland can expect earlier benefits in cytological abnormality rates than England, due to the earlier starting age for screening in these countries.
21 January 2010Numerous studies have shown that HPV testing is good at detecting abnormalities in women with low-grade tests and can reduce the number who need to be referred for treatment, especially in the over 35s. However, a recent publication in BJOG seems to cast doubt over the presumed benefits of HPV testing as a means of triage for low grade cytological abnormalities.
21 January 2010Latest results from the Italian NTCC randomized controlled trial:
7 December 2009Results from this latest randomised controlled trial support the use of HPV DNA testing with cytology triage in primary cervical screening for women aged 35 years or older.
5 December 2009Six-year follow-up results reported in The Lancet show that the bivalent HPV vaccine Cervarix shows sustained efficacy when targeted at young girls before they become sexually active. Vaccine efficacy against incident infection with HPV-16/18 was 95%, and against 12-month persistent infection was 100%. Vaccine efficacy against CIN2+ was 100% for lesions associated with HPV-16/18, and 72% for lesions independent of HPV type.
26 November 2009Results in a nutshell
30 October 2009A large randomised controlled trial in the Netherlands indicates that liquid-based cytology does not perform better than conventional Pap tests in terms of relative sensitivity and PPV for detection of cervical cancer precursors.
30 October 2009Management decisions for cervical abnormalities are currently based on a combination of cytological, colposcopic, and histological diagnoses. These decision processes are formalised in algorithms that narrow down the clinical management options to a single course of action. As new technologies and new tests come on line the algorithm approach will beome ever more complex and eventually unworkable. A research group in Bethesda is developing a computer-based risk assessment tool that will enable far more accurate and evidence-based clinical decision making in cervical screening programmes of the future.
26 October 2009This useful resource of recent research papers covering the NHS breast, cervical, colorectal and prostate cancer management programmes is available at the link below.
5 September 2009A group of Australian researchers have unambiguously demonstrated the presence of high-risk HPV in the cells of breast cancer specimens, thus offering the exciting possibility that at least some breast cancers may be prevented by HPV vaccination.
1 August 2009A population based cohort study from Costa Rica has shown that women who test positive for hrHPV at enrolment and after about one year (i.e. positive/positive) have a three year cumulative incidence of CIN2+ significantly higher (17.0%, CI 12.1%-22.0%) than those who tested negative/positive (3.4%, CI 0.1%-6.8%), positive/negative (1.2%, CI 0.2%- 2.5%), and negative/negative (0.5%, CI 0.1%-0.9%).
1 August 2009This is the conclusion from a large case-control study from the UK, reported in this week''s BMJ.
1 August 2009Three separate papers in this week''s BMJ report the long awaited results from the TOMBOLA trial (Trial of the Management of Borderline and Other Low Grade Abnormalities). Collectively the papers reach three main conclusions:
9 July 2009This week The Lancet reports the final results of the worlds largest trial of a cervical cancer vaccine - PApilloma TRIal against Cancer In young Adults (PATRICIA). The study, involving 18,644 women, confirmed that Cervarix is highly effective at protecting against the two most common cervical cancer-causing HPV types, 16 and 18. The study also showed that the vaccine provides cross-protection against HPV types 31, 33 and 45. and effectively protects against CIN2+ associated with HPV-16/18 and non-vaccine oncogenic HPV types.
21 June 2009Results from the ARTISTIC trial have shown that over two screening rounds the addition of HPV testing to liquid based cytology does not improve detection rates of high grade CIN. In the first round of screening HPV testing did result in higher detection rates but by the second round there was an unexpected fall in the number of cases of CIN detected.
2 June 2009The quadrivalent HPV vaccine is efficacious in women aged 24—45 years not previously infected with vaccine HPV types. This is the conclusion from a randomised trial reported in the current issue of The Lancet.
31 May 2009The May 20th issue of the Journal of the National Cancer Institute reports a study in which mice and rabbits immunized with a multimeric-L2 protein HPV vaccine had robust antibody responses and were protected from infection with HPV16 four months after vaccination.The authors claim that clinical studies in humans are now warranted to assess the safety and immunogenicity of multitype L2 vaccines.
13 May 2009A new study in the British Journal of Cancer found that screening continues to identify abnormalities in over-50s, even if the screening tests they had in their 40s came back clear. Lead author Dr Roger Blanks revealed that nearly two thirds of serious pre-cancerous ''CIN 3'' abnormalities currently detected in over-50s would be undetected if screening for this age group was halted.
27 April 2009In an attempt to answer the age-old question of the age at which it is safe to cease cervical screening, researchers in the Netherlands and Denmark have studied the incidence of cervical cancer following a number of negative smears at different ages.
24 April 2009Women treated for CIN are at an increased risk of subsequent mortality, according to a retrospective cohort study from Finland. Interestingly, women who had delivered post-treatment tended to have decreased overall mortality. However, the mortality rate was significantly increased for women who had subsequent preterm delivery.
22 April 2009The HPV vaccine Cervarix, currently being issued in the UK, has been shown to be very stable upon long-term storage at 2-8 degrees, with or without transient exposure to higher temperatures (up to 37 degrees C). This will be welcome news for under-resourced countries where cold storage facilities may be limited.
2 April 2009This week''s NEJM reports on a landmark randomized clinical trial from India, involving over 130,000 women. The trial clearly demonstrated that a single HPV test between the age of 30 and 59 dramatically reduced the incidence of, and mortality from, cervical cancer within 8 years. The reduction was far greater than a single conventional cytology test or visual inspection of the cervix with acetic acid (VIA). HPV testing was the most objective and reproducible of all cervical screening tests and was less demanding in terms of training and quality assurance.
1 March 2009A Dutch team has demonstrated that combining hrHPV testing with cytology following treatment for CIN improves clinical outcome and reduces overall costs compared with the current standard of cytology alone.
22 February 2009After 5 years of combined cytology and HPV testing in a large general screening population of women aged 30 and older, only 3.99% of cotests had normal cytology and were hrHPV positive. The concerns about excessive HPV positivity among women aged 30 years and older are therefore not borne out.
14 February 2009A report in the current issue of Diagnostic Cytopathology (13th Feb 2009) suggests the use of hrHPV testing for triaging abnormal cytology in post-trachelectomy specimens. Of 9 patients studied, 4 had intermittent or persistent abnormal cytology following trachelectomy. All patients with abnormal cytology went on to have benign biopsies, giving a false abnormal rate of 44%. A strong case for hrHPV testing in these patients then.
14 January 2009This week''s Journal Of the National Cancer Institute carries an article reporting from the intervention arm of SWEDESCREEN - a population-based randomized trial of HPV DNA testing as a cervical screening strategy.
23 December 2008New evidence from the ALTS trial suggests that 40% of CIN 2 will regress over 2 years, but CIN 2 caused by HPV-16 may be less likely to regress than CIN 2 caused by other high-risk-HPV genotypes.
22 December 2008Currently in the US less than 25 percent of the target population has received an HPV vaccination, far below the target needed to maximize the vaccine’s potential public health benefit.
19 December 2008Quote from the report of the second phase of the Independent review of NHS Pathology services in England:
9 December 2008After more than 380,000 HPV vaccine doses given in Australian schools since 2007, only three schoolgirls were found to have probable hypersensitivity to the quadrivalent vaccine, Gardasil. Read the full paper for free in this week''s BMJ.
5 December 2008A fascinating insight into the link between social deprivation and cancer in England:
4 December 2008Results of three statistical models presented at the European Research Organisation on Genital Infection and Neoplasia (EUROGIN) annual meeting suggest that women vaccinated with the HPV vaccine Cervarix could look forward to a prolonged immune response against hpv 16 and 18 for at least 20 years.
29 November 2008HPV prevalence data are needed for two reasons: assessment of the impact of prophylactic HPV vaccination and to help inform future screening strategies. This research provides such data for the South Wales area. Curiously, HPV type 31 is more common than type 18 in this part of the world.
14 November 2008Cytologists have long pondered the potential use of cytology for the early diagnosis of oral cancer. However, oral cytology has always suffered from poor sensitivity and specificity, largely because of the difficulty in obtained adequate specimens. Interest has recently been revived due to the introduction of a cytobrush for cell collection as well as a computer-assisted analysis (Oral CDx®). as described in this review paper in the Journal of Oral Pathology & Medicine.
27 October 2008Automated detection of genetic abnormalities combined with sputum cytology is a sensitive predictor of lung cancer, according to a study reported in the journal Modern Pathology.
26 October 2008A pilot study reported in the journal Radiology has shown that a new imaging technology (diffusion-weighted magnetic resonance imaging) can identify small cervical tumours, reducing the need for radical surgery in Stage Ia and Ib1 Disease.
26 October 2008Combining cytology with HPV testing improves the sensitivity of screening, but how often does it need to be repeated? A European study in the BMJ suggests that 6 years is probably a safe interval, and that HPV testing alone may suffice. Among ~25,000 women tested in 6 countries, the rate of CIN3+ at 6 years was only 0.27% in those who were HPV-negative at baseline compared with 0.97% in those who were cytology-negative. Combining the two tests made little difference.
17 October 2008The number of cells required for LBC samples to be deemed adequate remains the subject of debate. There is a risk that samples may be described as negative when they are really inadequate and that abnormalities could therefore be missed.
7 October 2008That''s the conclusion from a substudy of the NTCC HPV screening trial in this week''s The Lancet Oncology.