• No results found

Cervical screening with primary HPV

N/A
N/A
Protected

Academic year: 2021

Share "Cervical screening with primary HPV"

Copied!
2
0
0

Loading.... (view fulltext now)

Full text

(1)

Cervical screening with primary HPV

– from research to clinical effectiveness

av

Lovisa Bergengren

Akademisk avhandling

Avhandling för medicine doktorsexamen i medicinsk vetenskap med inriktning kirurgi,

som kommer att försvaras offentligt fredagen den 15 maj 2020 kl. 09.00, Hörsal C1 , X-huset Universitetssjukhuset Örebro

Opponent: Professor Matts Olovsson Institutionen för kvinnors och barns hälsa

Uppsala universitet

Örebro universitet

Institutionen för medicinska vetenskaper 701 82 ÖREBRO

(2)

Abstract

Lovisa Bergengren (2020): Cervical screening with primary HPV – from research to clinical effectiveness. Örebro Studies in Medicine 209. Organized cervical screening has greatly reduced the incidence of cervical can-cer where implemented. Human papilloma virus (HPV) is the cause of can- cer-vical cancer, and in later years, convincing evidence has led to cercer-vical screening with HPV as the primary method being implemented around the world. The overall aim of this thesis is to improve cervical screening, with focus on HPV screening.

Papers I–III were performed with focus on postmenopausal women. Women aged, 55–59 years, excluded from the screening with a normal cy-tology cervical sample were found to have a high-risk HPV (hrHPV) prev-alence of 5.5% in paper II. In a follow-up sample, 56% (71/126) had a persistent infection with the same genotype. Nineteen per cent of the women had dysplasia, where the majority of the high-grade squamous intraepithe-lial lesions (HSILs) were associated with HPV types other than HPV 16/18.

Women 55-59 has a lower attendance rate in the study region, and since self-sample has been proven to increase attendance, paper I was performed to compare self-sample and professionally collected samples in these post-menopausal women. The concordance between the sampling methods was 83%, and both tests detected all histological HSILs. When including a study with older women (aged 70 years) in paper III, 23% of histological HSILs were found in hrHPV-positive women.

Paper IV is a scientific evaluation of an implemented HPV-based screen-ing programme, comparscreen-ing clinical effectiveness and cost with cytology screening. More HSIL+ were detected in the new programme but at a higher cost than the old cytology-based programme. The screening visits for sam-pling accounted for two thirds of the costs.

Altogether, the results indicate the importance of having a negative HPV test before exiting screening. Data also present the necessity to find bi-omarkers that are more specific than cytology and HPV 16/18 for triaging women with hrHPV to further follow-up, both among postmenopausal women and other age groups when screening with HPV, since many women without HSIL are coming for clinical follow-up and treatment. Extending the screening interval between hrHPV-negative tests as well as implementing self-sampling to a greater extent can be important changes, since two thirds of the costs in the programme come from screening visits for sampling.

Keywords: cervical cancer, screening, human papillomavirus (HPV), HPV

prevalence, HPV genotypes, precancerous lesion, HSIL, self-sampling, postmenopausal women, health economy

Lovisa Bergengren, School of Health and Medical Sciences.

References

Related documents

To study the prevalence of genital HPV infection in the female population women with cervical cancer, cervical intraepithelial neoplasia (CIN), HPV signs and

She is responsible for the cervical screening programme in the Region of Örebro County; is the process leader of cervical screening in RCC Uppsala-Örebro and represents the region

By using registers from the National Cervical Screening Register (NKCx) and Swedish Population Register, women participating in the screening programme in the Region of Örebro

The overall aim of this thesis is to contribute to preventing cervical cancer by focusing attention on non-attendees, assessing interventions to increase participation in

Lack of knowledge (1a) Women’ knowledge about cervical cancer before they were be diagnosis: patients with cervical cancer are poorly informed of the disease, symptoms, risk

There were basically used: The European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) , the Cervix Cancer Module (QLQ-CX24),

Kumakech, Edward (2015): Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV) and Cervical Cancer Prevention in Uganda: Prevalence, Risk factors, Benefits and Challenges

Methods: We compared both the presence and the viral load of high-risk HPV types 16, 18, 31, 33, 39, 45, 52, 58, and 67 in relation to clinical data from patients with