CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(03): 264-271
DOI: 10.1055/s-0041-1739314
Original Article
Lower Genital Tract Diseases

Cervical Cancer Screening with HPV Testing: Updates on the Recommendation

Rastreamento do câncer do colo de útero com teste de HPV: Atualizações na recomendação
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
› Author Affiliations

Abstract

The present update is a reassessment of the 2018 ‘Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil’ (Zeferino et al.)[9], according to the changes observed in new international guidelines and knowledge updates. The most relevant and recent guidelines were assessed. Questions regarding the clinical practice were formulated, and the answers considered the perspective of the public and private sectors of the Brazilian health system. The review addressed risk-based strategies regarding age to start and stop screening, the use of cytology and colposcopy to support management decisions, treatment, follow-up strategies, and screening in specific groups, including vaccinated women. The update aims to improve the prevention of cervical cancer and to reduce overtreatment and the misuse of HPV testing.

Resumo

Esta atualização é uma reavaliação das “Recomendações para o uso de testes de DNA-HPV no rastreamento do câncer do colo do útero no Brasil” (Zeferino et al., 2018),[9] de acordo com as mudanças observadas nas novas recomendações internacionais, além das atualizações no conhecimento. As recomendações mais relevantes e recentes foram avaliadas. Questões referentes à prática clínica foram formuladas, e as respostas consideraram a perspectiva do sistema de saúde brasileiro, tanto público quanto privado. Esta revisão abrange estratégias baseadas em risco sobre idade para início e término de rastreamento, o uso da citologia e colposcopia para apoiar as condutas, tratamento, estratégias de seguimento, e rastreamento em grupos específicos, incluindo mulheres vacinadas. Esta atualização tem o objetivo de melhorar as estratégias de prevenção do câncer do colo de útero e reduzir o supertratamento e o uso incorreto dos testes de HPV.



Publication History

Received: 11 June 2021

Accepted: 14 October 2021

Article published online:
15 February 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors. Eur J Cancer 2013; 49 (15) 3262-3273 DOI: 10.1016/j.ejca.2013.04.024.
  • 2 Vale DB, Sauvaget C, Muwonge R, Thuler LC, Basu P, Zeferino LC. et al. Level of human development is associated with cervical cancer stage at diagnosis. J Obstet Gynaecol 2019; 39 (01) 86-90 DOI: 10.1080/01443615.2018.1463976.
  • 3 Vale DB, Sauvaget C, Muwonge R, Ferlay J, Zeferino LC, Murillo R. et al. Disparities in time trends of cervical cancer mortality rates in Brazil. Cancer Causes Control 2016; 27 (07) 889-896 DOI: 10.1007/s10552-016-0766-x.
  • 4 Pan American Health Organization. A Global Strategy for elimination of cervical cancer [Internet]. 2020 [cited 2020 Sep 14]. Available from: https://www.paho.org/en/towards-healthier-generations-free-diseases/global-strategy-elimination-cervical-cancer
  • 5 Vale DB, Teixeira JC, Bragança JF, Derchain S, Sarian LO, Zeferino LC. Elimination of cervical cancer in low- and middle-income countries: Inequality of access and fragile healthcare systems. Int J Gynaecol Obstet 2021; 152 (01) 7-11 DOI: 10.1002/ijgo.13458.
  • 6 Ronco G, Dillner J, Elfström KM, Tunesi S, Snijders PJ, Arbyn M. et al; International HPV screening working group. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 2014; 383 (9916): 524-532 DOI: 10.1016/S0140-6736(13)62218-7.
  • 7 Koliopoulos G, Nyaga VN, Santesso N, Bryant A, Martin-Hirsch PP, Mustafa RA. et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev 2017; 8 (08) CD008587 DOI: 10.1002/14651858.CD008587.pub2.
  • 8 Ministério da Saúde, Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes brasileiras para o rastreamento do câncer do colo do útero. 2a ed.. Rio de Janeiro: INCA; 2016
  • 9 Zeferino LC, Bastos JB, Vale DBAPD, Zanine RM, Melo YL, Primo WQ. et al. Recomendações para o uso de testes de DNA-HPV no rastreamento do câncer do colo do útero no Brasil. Rev Bras Ginecol Obstet 2018; 40 (06) 360-368 DOI: 10.1055/s-0038-1657754.
  • 10 Cancer Council Australia. National Cervical Screening Program: guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding [Internet]. Sydney: Cancer Council Australia; 2020. [cited 2021 Mar 24]. Available from: https://wiki.cancer.org.au/australia/Guidelines:Cervical_cancer/Screening
  • 11 Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F. et al; 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020; 24 (02) 102-131 DOI: 10.1097/LGT.0000000000000525.
  • 12 Practice Bulletin No. 157: Cervical Cancer Screening and Prevention. Obstet Gynecol 2016; 127 (01) e1-e20 DOI: 10.1097/AOG.0000000000001263.
  • 13 Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A. et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin 2020; 70 (05) 321-346 DOI: 10.3322/caac.21628.
  • 14 Kyrgiou M, Arbyn M, Bergeron C, Bosch FX, Dillner J, Jit M. et al. Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC). Br J Cancer 2020; 123 (04) 510-517 DOI: 10.1038/s41416-020-0920-9.
  • 15 Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW. et al; US Preventive Services Task Force. Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2018; 320 (07) 674-686 DOI: 10.1001/jama.2018.10897.
  • 16 World Health Organization. Comprehensive cervical cancer control: a guide to essential practice. Geneva: WHO; 2014
  • 17 Fujiwara K, Monk B, Devouassoux-Shisheboran M. Adenocarcinoma of the uterine cervix: why is it different?. Curr Oncol Rep 2014; 16 (12) 416 DOI: 10.1007/s11912-014-0416-y.
  • 18 Vale DB, Bragança JF, Zeferino LC. ‘Missing Adenocarcinomas’: Are They a Real Problem in Cervical Cancer Screening in Brazil?. Rev Bras Ginecol Obstet 2019; 41 (10) 579-580 DOI: 10.1055/s-0039-1698772.
  • 19 Nogueira-Rodrigues A, Ferreira CG, Bergmann A, de Aguiar SS, Thuler LC. Comparison of adenocarcinoma (ACA) and squamous cell carcinoma (SCC) of the uterine cervix in a sub-optimally screened cohort: a population-based epidemiologic study of 51,842 women in Brazil. Gynecol Oncol 2014; 135 (02) 292-296 DOI: 10.1016/j.ygyno.2014.08.014.
  • 20 Diaz M, Moriña D, Rodríguez-Salés V, Ibáñez R, Espinás JA, de Sanjosé S. Moving towards an organized cervical cancer screening: costs and impact. Eur J Public Health 2018; 28 (06) 1132-1138 DOI: 10.1093/eurpub/cky061.
  • 21 Jansen E, Naber SK, Aitken CA, de Koning HJ, van Ballegooijen M, de Kok I. Cost-effectiveness of HPV-based cervical screening based on first year results in the Netherlands: a modelling study. BJOG 2021; 128 (03) 573-582 DOI: 10.1111/1471-0528.16400.
  • 22 Burger EA, Ortendahl JD, Sy S, Kristiansen IS, Kim JJ. Cost-effectiveness of cervical cancer screening with primary human papillomavirus testing in Norway. Br J Cancer 2012; 106 (09) 1571-1578 DOI: 10.1038/bjc.2012.94.
  • 23 Huh WK, Ault KA, Chelmow D, Davey DD, Goulart RA, Garcia FA. et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Gynecol Oncol 2015; 136 (02) 178-182 DOI: 10.1016/j.ygyno.2014.12.022.
  • 24 Vale DB, Silva MT, Discacciati MG, Polegatto I, Teixeira JC, Zeferino LC. Is the HPV-test more cost-effective than cytology in cervical cancer screening? An economic analysis from a middle-income country. PLoS One 2021; 16 (05) e0251688 DOI: 10.1371/journal.pone.0251688.
  • 25 Katki HA, Kinney WK, Fetterman B, Lorey T, Poitras NE, Cheung L. et al. Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol 2011; 12 (07) 663-672 DOI: 10.1016/S1470-2045(11)70145-0.
  • 26 Gage JC, Schiffman M, Katki HA, Castle PE, Fetterman B, Wentzensen N. et al. Reassurance against future risk of precancer and cancer conferred by a negative human papillomavirus test. J Natl Cancer Inst 2014; 106 (08) dju153 DOI: 10.1093/jnci/dju153.
  • 27 Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G. et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine 2012; 30 (Suppl. 05) F88-F99 DOI: 10.1016/j.vaccine.2012.06.095.
  • 28 Bhatla N, Singhal S. Primary HPV screening for cervical cancer. Best Pract Res Clin Obstet Gynaecol 2020; 65: 98-108 DOI: 10.1016/j.bpobgyn.2020.02.008.
  • 29 Egemen D, Cheung LC, Chen X, Demarco M, Perkins RB, Kinney W. et al. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. J Low Genit Tract Dis 2020; 24 (02) 132-143 DOI: 10.1097/LGT.0000000000000529.
  • 30 Schiffman M, Doorbar J, Wentzensen N, de Sanjosé S, Fakhry C, Monk BJ. et al. Carcinogenic human papillomavirus infection. Nat Rev Dis Primers 2016; 2: 16086 DOI: 10.1038/nrdp.2016.86.
  • 31 Castanon A, Leung VM, Landy R, Lim AW, Sasieni P. Characteristics and screening history of women diagnosed with cervical cancer aged 20-29 years. Br J Cancer 2013; 109 (01) 35-41 DOI: 10.1038/bjc.2013.322.
  • 32 Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hirsch P. et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ 2016; 354: i3633 DOI: 10.1136/bmj.i3633.
  • 33 Vale DB, Westin MC, Zeferino LC. High-grade squamous intraepithelial lesion in women aged <30 years has a prevalence pattern resembling low-grade squamous intraepithelial lesion. Cancer Cytopathol 2013; 121 (10) 576-581 DOI: 10.1002/cncy.21312.
  • 34 Hopman EH, Voorhorst FJ, Kenemans P, Meyer CJ, Helmerhorst TJ. Observer agreement on interpreting colposcopic images of CIN. Gynecol Oncol 1995; 58 (02) 206-209 DOI: 10.1006/gyno.1995.1212.
  • 35 Massad, Stewart L, Jeronimo Jose, Schiffman Mark. e National Institutes of Health/American Society for Colposcopy and Cervical Pathology (NIH/ASCCP) Research Group. “Interobserver Agreement in the Assessment of Components of Colposcopic Grading”. Obstetrics and Gynecology 111, n°6 (junho de 2008): 1279-1284 https://doi.org/10.1097/AOG.0b013e31816baed1
  • 36 Ebisch RM, Rovers MM, Bosgraaf RP, van der Pluijm-Schouten HW, Melchers WJ, van den Akker PA. et al. Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis. BJOG 2016; 123 (01) 59-66 DOI: 10.1111/1471-0528.13530.
  • 37 Silver MI, Andrews J, Cooper CK, Gage JC, Gold MA, Khan MJ. et al. Risk of cervical intraepithelial neoplasia 2 or worse by cytology, human papillomavirus 16/18, and colposcopy impression: a systematic review and meta-analysis. Obstet Gynecol 2018; 132 (03) 725-735 DOI: 10.1097/AOG.0000000000002812.
  • 38 Castle PE, Kinney WK, Xue X, Cheung LC, Gage JC, Zhao FH. et al. Effect of several negative rounds of human papillomavirus and cytology co-testing on safety against cervical cancer: an observational cohort study. Ann Intern Med 2018; 168 (01) 20-29 DOI: 10.7326/M17-1609.
  • 39 Dhar JP, Kmak D, Bhan R, Pishorodi L, Ager J, Sokol RJ. Abnormal cervicovaginal cytology in women with lupus: a retrospective cohort study. Gynecol Oncol 2001; 82 (01) 4-6 DOI: 10.1006/gyno.2001.6207.
  • 40 ter Haar-van Eck SA, Rischen-Vos J, Chadha-Ajwani S, Huikeshoven FJ. The incidence of cervical intraepithelial neoplasia among women with renal transplant in relation to cyclosporine. Br J Obstet Gynaecol 1995; 102 (01) 58-61 DOI: 10.1111/j.1471-0528.1995.tb09027.x.
  • 41 Reusser NM, Downing C, Guidry J, Tyring SK. HPV carcinomas in immunocompromised patients. J Clin Med 2015; 4 (02) 260-281 DOI: 10.3390/jcm4020260.
  • 42 Benard VB, Castle PE, Jenison SA, Hunt WC, Kim JJ, Cuzick J. et al; New Mexico HPV Pap Registry Steering Committee. Population-based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era. JAMA Oncol 2017; 3 (06) 833-837 DOI: 10.1001/jamaoncol.2016.3609.
  • 43 Rosenblum HG, Lewis RM, Gargano JW, Querec TD, Unger ER, Markowitz LE. Declines in prevalence of human papillomavirus vaccine-type infection among females after introduction of vaccine - United States, 2003-2018. MMWR Morb Mortal Wkly Rep 2021; 70 (12) 415-420 DOI: 10.15585/mmwr.mm7012a2.
  • 44 Bruni L, Diaz M, Barrionuevo-Rosas L, Herrero R, Bray F, Bosch FX. et al. Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. Lancet Glob Health 2016; 4 (07) e453-e463 DOI: 10.1016/S2214-109X(16)30099-7.
  • 45 Faisal-Cury A, Levy RB, Tourinho MF, Grangeiro A, Eluf-Neto J. Vaccination coverage rates and predictors of HPV vaccination among eligible and non-eligible female adolescents at the Brazilian HPV vaccination public program. BMC Public Health 2020; 20 (01) 458 DOI: 10.1186/s12889-020-08561-4.
  • 46 Agénor M, Pérez AE, Peitzmeier SM, Borrero S. Racial/ethnic disparities in human papillomavirus vaccination initiation and completion among U.S. women in the post-Affordable Care Act era. Ethn Health 2020; 25 (03) 393-407 DOI: 10.1080/13557858.2018.1427703.
  • 47 Kops NL, Hohenberger GF, Bessel M, Correia Horvath JD, Domingues C, Kalume Maranhão AG. et al. Knowledge about HPV and vaccination among young adult men and women: Results of a national survey. Papillomavirus Res 2019; 7: 123-128 DOI: 10.1016/j.pvr.2019.03.003.