Cervical Cancer Screening - Science topic

I'm not an expert in systematic reviews and metaanalysis

I suggest to you Prof. Vera Afreixo of Aveiro University, Portugal

Although an old question, this link can help for the next seekers after me

Hi Veerabhadrappa,

Several publications show that while either VIA or VILI is as (or more) sensitive but less specific than Pap smear, either VIA or VILI is more cost-effective. A study has shown that among women with CD4+ count <350, VILI had a significantly decreased specificity (66.2%) compared to VIA (83.9%, p = 0.02). Nevertheless, VIA and VILI had similar diagnostic accuracy and rates of CIN2+ detection among HIV-infected women. See

Warren

Methods for Average-Risk Asymptomatic Women.

Age 21 to 29: Every 3 years with cytology (Pap testing), regardless of age of onset of sexual activity or other risk factors.

Age 30 to 65: Every 5 years with HPV co-test (Pap + HPV test) OR every 3 years with cytology.

Women over the age of 65 or those with surgical intervention in which they have no cervix do not need ongoing screening.

Thank you all for the added information

Three specimen types has been used to the cervical screening: liquid based cytology, urine samples or self-taken swabs. The paper Kavanagh et al. BMC Infectious Diseases 2013, 13:519, http://www.biomedcentral.com/1471-2334/13/519 will give more details about prevalence and genotyping for HPV.

If we use FIGO staging, it clearly states that any distant metastasis means stage IVB. SO, ovarian metastasis is IVB. 

If we use TNM, then of course M1

How did you determine the 50% value? Was it purely based on PCR, or did you quantify the DNA using some other method?

If you have access to a NanoDrop or other spectrophotometer, you can estimate the quantity and purity of DNA. 

A fluorescence based assay, such as Qubit, is good for more accurate quantification of your extract. 

Great issue. I have had several colleagues researching in areas such as drug use or teenagers living on the street  where verbal consent is used.  My colleagues claim that the paper consent is more appropriate as anything  written is regarded with suspicion. In addition, the consent is a 'rolling process' in the sense that should the person disclose something that the researcher feels may be compromising, then the consent is renewed , allowing the interviewee to revoke such disclosure . This is particularly important if they name someone else involved in an illegal activity. 

Agree, it is complex and related to screening vs opportunistic presentation and resources available. In a resource-poor environment the question is even harder to answer because of the lack of healthcare professionals.

In rich countires HPV testing only at the age of 30 with reflex cytology if positive is the probably the way forward, although it is important to have a strategy for younger women.

We must inform women

Murat,

as Nadia and Nelson already said it, yes, high risk HPV is seen more frequently in cervical cancers than low risk counterparts.

About the cut-off level of low-risk to high-risk: the main difference between the two types is the presence (low) or not (high) of transcription factor E2, a protein that suppresses E6 and E7 (the main oncoproteins) expression. High-risk HPVs often lose E2 during viral DNA integration into host genome. See attached file for more details.

regards.

I think that the best way is combination of PAP smear (ecto- and endo-cervical) and Colposcopy.

I always get my HPV antibody testing done by PPD so I recommend you contact them for how to get access.

VIA is simple cost effective method of developing countries like India,for developed country HC2 HPV testing is better.

see also the very recent piece in PLOS comp biol for some general advice for creating figures: http://www.ploscompbiol.org/article/info%3Adoi%2F10.1371%2Fjournal.pcbi.1003833

Thank you Margaret Mckenzie, I have taken a look at the abstracts of two recent publication of Dr Jerome Belinson and there been helpful. I found out that I share the same line of thought as the studies reported and am working at getting the full papers although my institution does not have subscription to those journals. If it is possible to share these papers I will glad to have them.

Relying on the government to protect your privacy is like asking a peeping tom to install your window blinds (John Perry Barlow)

The trials of the vaccines, and more important the follow up studies in field use in various countries show that risk of harm is very small (unless you know of studies that I am unaware of). However, so far the outcome studies of cancer reduction are not long enough to be confident about how effective the vaccine will be: 70%? 90%? 98%? At what level would you say we can stop cervical screening? In particular, the trials and population cohort studies cannot yet show the long term effect in the peak age group for the cancer: 40-60. Until we know that, it is difficult to recommend cutting down on cervical screening: a preventive activity that we know works. Further, if the vaccine reduces minor abnormalities, LSIL, HSIL ASCUS that are found on screening but mostly resolve without treatment, it will reduce the harms that arise when colposcopists feel obliged to treat these, and thereby cause cervical damage that may lead to pregnancy complications. We already know that the vaccine reduces these abnormalities in the younger age groups, so gives us greater confidence not to screen young women under 25. Thus at present, the vaccine should reduce the harms of screening, and in the distant future we will know how well it reduces cancer.