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The Precision Medicine Approach in Oncology
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
In the UK, cervical, breast, and bowel cancer screens are carried out routinely through the NHS. For cervical cancer, screening (based primarily on microscopy of scraped cells, and in some cases on the presence of HPV virus) is offered every 3 years from age 25 to 49, and every five years from age 50 to 64. For women over 65 it is offered only to women who have recently had abnormal test results. For breast cancer, an X-ray screen (e.g., a mammogram) that can identify tumors when they are too small to detect manually is offered to women aged 50–70 every 3 years. The NHS is in the process of extending this program as a trial to some women aged 47–73. The main risk with breast cancer screening is that it sometimes picks up small tumors that may not be causing any symptoms, and that may not become life threatening. This can lead to unnecessary extra tests and treatment which may be highly invasive. The NHS also offers a screen for bowel cancer. In some areas of the UK, healthy individuals reaching 55 are invited for a one-off flexible sigmoidoscopy or “flexisig” bowel screening. From the age of 60–74, individuals are invited to carry out a home test (supplied by postal delivery) every 2 years which is based on the detection of occult blood in stool samples. This screen is also available to those over 75 but has to be requested.
Sexually transmitted infections in adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Oncogenic HPV serotypes are strongly associated with cervical dysplasia and anogenital and oropharyngeal cancers. In adolescents, cervical cancer is extremely rare. Mild cervical dysplasia is common following HPV infection but resolves spontaneously in the vast majority of cases.27 Cervical cancer screening therefore is not recommended until 21 years of age in immunocompetent women, nor is there a defined role for routine HPV testing. Screening should begin with the onset of sexual activity in HIV-infected or immunocompromised adolescents.
Screening
Published in William Bonnez, Guide to Genital HPV Diseases and Prevention, 2019
Effective screening techniques require detection of a pre-malignant state. The paradigm of cervical cancer screening with use of cervical cytology (Pap smear) is the prime example of such a system. Prior to the advent of cervical cytology, the initial surveys in the United States from the late 1940’s reported approximately 33 cases of cervical cancer per 100,000 Caucasian women. In countries where widespread screening is practiced using cervical cytology, this number has decreased to about 4 per 100,000. Nowadays, cervical cytology is often supplemented by HPV DNA testing.
Advancing cervical cancer diagnosis and screening with spectroscopy and machine learning
Published in Expert Review of Molecular Diagnostics, 2023
Carlos A. Meza Ramirez, Michael Greenop, Yasser A. Almoshawah, Pierre L. Martin Hirsch, Ihtesham U. Rehman
Persistent human papillomavirus (HPV), especially the high-risk HPV-16 and HPV-18, is known to be essential for cervical cancer to occur [10]. Risk factors for HPV include smoking, HIV, low socioeconomic level, multiple sexual partners, and because HPV is a sexually transmitted infection, sexual intercourse before the age of 16 [10]. The current approach to cervical cancer screening is a Pap smear test, an invasive procedure causing lowered participation [8]. Further diagnosis can be carried out by white light colposcopy with a sensitivity of ~ 96% but a specificity of ~ 48% [11]. A biopsy is the gold standard for diagnosis but is further invasive and can be impractical for patients with several suspicious lesions [11]. Developing new approaches could provide improvements in the overall accuracy of cervical cancer diagnosis, as well as a more accessible sample collection.
The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS
Published in Annals of Medicine, 2022
Y. Tong, E. Orang’o, M. Nakalembe, P. Tonui, P. Itsura, K. Muthoka, M. Titus, S. Kiptoo, A. Mwangi, J. Ong’echa, R. Tonui, B. Odongo, C. Mpamani, B. Rosen, A. Moormann, S. Cu-Uvin, J. A. Bailey, C. I. Oduor, A. Ermel, C. Yiannoutsos, B. Musick, E. Sang, A. Ngeresa, G. Banturaki, A. Kiragga, J. Zhang, Y. Song, S. Chintala, R. Katzenellenbogen, P. Loehrer, D. R. Brown
The need for cost-effective screening approaches for cervical cancer prevention in low-income countries has led to widespread use of visual assessment of the cervix following the application of 5% acetic acid, a test known as visual inspection with acetic acid, or VIA [27–32]. Although relatively inexpensive, VIA has only modest sensitivity (∼60 to 70%) and specificity (∼50%) for detection of cervical intraepithelial neoplasia (CIN), which may be pre-invasive lesions [29]. Despite these limitations, VIA is likely to be better than no screening of any kind. Cervical cancer screening is done in wealthy countries in clinics using clinician-obtained samples with cytological testing (Pap smear) or/and molecular methods (testing for HR-HPV). Development of advanced methods for cervical cancer screening has been slow in low-income countries due to the need for infrastructure, training, and high costs. Thus, it is critical we move beyond VIA and that more sensitive and specific biomarkers of early disease and progression are identified, particularly those that may be specific including markers in women infected with HIV.
The pattern of human papillomavirus infection and genotypes among Nigerian women from 1999 to 2019: a systematic review
Published in Annals of Medicine, 2021
Anthony Uchenna Emeribe, Idris Nasir Abdullahi, Maisie Henrietta Etukudo, Idongesit Kokoabasi Isong, Anthony Ogbonna Emeribe, Justin Onyebuchi Nwofe, Chikodi Modesta Umeozuru, Buhari Isa Shuaib, Odunayo Rahmat Oyetola Ajagbe, Amos Dangana, Bibiana Nonye Egenti, Peter Elisha Ghamba
Moreover, as a measure for ensuring early cervical cancer diagnosis, the use of screening tools such as cost-effective cervical screening through visual inspection with acetic acid and/or Lugol’s iodine, or detection of high-risk HPV types [40] could reduce the high burden of cervical cancer morbidity and mortality in Nigeria. The current WHO recommendations on cervical cancer screening are based on age of women. However, data from studies used for this systematic review revealed that the prevalence of HPV infection was similar within the three-age group and was not significantly associated with age. A dissimilar study accounted the effect of age on HPV prevalence in Africa [41]. The outcome of some other reports revealed the HPV infection prevalence increases inversely with age in younger females unlike the older counterparts where there is either an increase, a plateau or a decrease. This is not similar with a study that observed no influence of age on HPV prevalence [42].