Desai Kanan T, Ajenifuja Kayode O, Banjo Adekunbiola, Adepiti Clement A, Novetsky Akiva, Sebag Cathy, Einstein Mark H, Oyinloye Temitope, Litwin Tamara R, Horning Matt, Olanrewaju Fatai Olatunde, Oripelaye Mufutau Muphy, Afolabi Esther, Odujoko Oluwole O, Castle Philip E, Antani Sameer, Wilson Ben, Hu Liming, Mehanian Courosh, Demarco Maria, Gage Julia C, Xue Zhiyun, Long Leonard R, Cheung Li, Egemen Didem, Wentzensen Nicolas, Schiffman Mark
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, USA.
Oak Ridge Institute of Science and Education, Oak Ridge, USA.
Infect Agent Cancer. 2020 Oct 14;15:60. doi: 10.1186/s13027-020-00324-5. eCollection 2020.
Accelerated global control of cervical cancer would require primary prevention with human papillomavirus (HPV) vaccination in addition to novel screening program strategies that are simple, inexpensive, and effective. We present the feasibility and outcome of a community-based HPV self-sampled screening program.
In Ile Ife, Nigeria, 9406 women aged 30-49 years collected vaginal self-samples, which were tested for HPV in the local study laboratory using Hybrid Capture-2 (HC2) (Qiagen). HPV-positive women were referred to the colposcopy clinic. Gynecologist colposcopic impression dictated immediate management; biopsies were taken when definite acetowhitening was present to produce a histopathologic reference standard of precancer (and to determine final clinical management). Retrospective linkage to the medical records identified 442 of 9406 women living with HIV (WLWH).
With self-sampling, it was possible to screen more than 100 women per day per clinic. Following an audio-visual presentation and in-person instructions, overall acceptability of self-sampling was very high (81.2% women preferring self-sampling over clinician collection). HPV positivity was found in 17.3% of women. Intensive follow-up contributed to 85.9% attendance at the colposcopy clinic. Of those referred, 8.2% were initially treated with thermal ablation and 5.6% with large loop excision of transformation zone (LLETZ). Full visibility of the squamocolumnar junction, necessary for optimal visual triage and ablation, declined from 68.5% at age 30 to 35.4% at age 49. CIN2+ and CIN3+ (CIN- Cervical intraepithelial neoplasia), including five cancers, were identified by histology in 5.9 and 3.2% of the HPV-positive women, respectively (0.9 and 0.5% of the total screening population), leading to additional treatment as indicated. The prevalences of HPV infection and CIN2+ were substantially higher (40.5 and 2.5%, respectively) among WLWH. Colposcopic impression led to over- and under-treatment compared to the histopathology reference standard.
A cervical cancer screening program using self-sampled HPV testing, with colposcopic immediate management of women positive for HPV, proved feasible in Nigeria. Based on the collected specimens and images, we are now evaluating the use of a combination of partial HPV typing and automated visual evaluation (AVE) of cervical images to improve the accuracy of the screening program.
要加快全球宫颈癌防控，除了采用简单、廉价且有效的新型筛查项目策略外，还需要通过人乳头瘤病毒（HPV）疫苗接种进行一级预防。我们介绍了一项基于社区的HPV自我采样筛查项目的可行性和结果。
在尼日利亚伊费岛，9406名30至49岁的女性自行采集阴道样本，并在当地研究实验室使用杂交捕获-2（HC2）（Qiagen公司）检测HPV。HPV阳性的女性被转诊至阴道镜诊所。妇科医生的阴道镜诊断决定即时治疗方案；出现明确醋酸白变时进行活检，以建立癌前病变的组织病理学参考标准（并确定最终临床治疗方案）。通过与医疗记录的回顾性关联，在9406名女性中确定了442名感染艾滋病毒的女性（HIV感染者）。
通过自我采样，每个诊所每天可以筛查100多名女性。经过视听演示和现场指导，自我采样的总体接受度非常高（81.2%的女性更喜欢自我采样而非临床医生采集）。17.3%的女性HPV检测呈阳性。强化随访使阴道镜诊所的就诊率达到85.9%。在被转诊的女性中，8.2%最初接受了热消融治疗，5.6%接受了转化区大环形切除术（LLETZ）。鳞状柱状交界的完全可视性是最佳视觉分诊和消融所必需的，从30岁时的68.5%下降到49岁时的35.4%。通过组织学检查，分别在5.9%和3.2%的HPV阳性女性中发现了2级及以上宫颈上皮内瘤变（CIN2+）和3级及以上宫颈上皮内瘤变（CIN3+）（包括5例癌症）（占总筛查人群的0.9%和0.5%），并根据需要进行了额外治疗。HIV感染者中HPV感染率和CIN2+的患病率显著更高（分别为40.5%和2.5%）。与组织病理学参考标准相比，阴道镜诊断导致了过度治疗和治疗不足。
在尼日利亚，一项使用自我采样HPV检测的宫颈癌筛查项目，对HPV阳性女性进行阴道镜即时治疗，证明是可行的。基于收集的标本和图像，我们目前正在评估结合部分HPV分型和宫颈图像自动视觉评估（AVE）来提高筛查项目的准确性。
