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利用7型人乳头瘤病毒mRNA E6/E7检测对自我采集样本进行宫颈癌筛查:来自墨西哥的多中心见解

Enhancing Cervical Cancer Screening with 7-Type HPV mRNA E6/E7 Testing on Self-Collected Samples: Multicentric Insights from Mexico.

作者信息

Flores Carlos Eduardo Aranda, Falang Bente Marie, Gómez-Laguna Laura, Gutiérrez Guillermo Gómez, León Jorge Miguel Ortiz, Uribe Miguel, Cruz Omar, Sørbye Sveinung Wergeland

机构信息

Oncology Service, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México 06720, Mexico.

PreTect AS, 3490 Klokkarstua, Norway.

出版信息

Cancers (Basel). 2024 Jul 8;16(13):2485. doi: 10.3390/cancers16132485.

Abstract

Cervical cancer remains a significant public health issue, particularly in regions with low screening uptake. This study evaluates the effectiveness of self-sampling and the 7-type HPV mRNA E6/E7 test in improving cervical cancer screening outcomes among a referral population in Mexico. A cohort of 418 Mexican women aged 25 to 65, referred for colposcopy and biopsy due to abnormal cytology results (ASC-US+), participated in this study. Self-samples were analyzed using both the 14-type HPV DNA test and the 7-type HPV mRNA E6/E7 test. The study assessed the sensitivity, specificity, positive predictive value (PPV), and the necessity of colposcopies to detect CIN3+ lesions. Participant acceptability of self-sampling was also evaluated through a questionnaire. The 7-type HPV mRNA E6/E7 test demonstrated equivalent sensitivity but significantly higher specificity (77.0%) and PPV for CIN3+ detection compared to the 14-type HPV DNA test (specificity: 45.8%, < 0.001). The use of the HPV mRNA test as a triage tool reduced the number of colposcopies needed per CIN3+ case detected from 16.6 to 7.6 ( < 0.001). Self-sampling was highly accepted among participants, with the majority reporting confidence in performing the procedure, minimal discomfort, and willingness to undertake self-sampling at home. Self-sampling combined with the 7-type HPV mRNA E6/E7 testing offers a promising strategy to enhance cervical cancer screening by improving accessibility and ensuring precise diagnostics. Implementing these app roaches could lead to a significant reduction in cervical cancer morbidity and mortality, especially in underserved populations. Future research should focus on the long-term impact of integrating these methods into national screening programs and explore the cost-effectiveness of widespread implementation.

摘要

宫颈癌仍然是一个重大的公共卫生问题,尤其是在筛查参与率较低的地区。本研究评估了自我采样和7型人乳头瘤病毒mRNA E6/E7检测在改善墨西哥转诊人群宫颈癌筛查结果方面的有效性。一组418名年龄在25至65岁之间、因细胞学结果异常(非典型鳞状细胞意义不明确及以上)而被转诊进行阴道镜检查和活检的墨西哥女性参与了本研究。自我采样样本同时采用14型人乳头瘤病毒DNA检测和7型人乳头瘤病毒mRNA E6/E7检测进行分析。该研究评估了检测CIN3+病变的敏感性、特异性、阳性预测值以及阴道镜检查的必要性。还通过问卷调查评估了参与者对自我采样的接受度。与14型人乳头瘤病毒DNA检测相比,7型人乳头瘤病毒mRNA E6/E7检测在检测CIN3+时显示出相当的敏感性,但特异性(77.0%)和阳性预测值显著更高(14型人乳头瘤病毒DNA检测特异性:45.8%,P<0.001)。将人乳头瘤病毒mRNA检测用作分流工具,使每例检测到的CIN3+病例所需的阴道镜检查次数从16.6次减少到7.6次(P<0.001)。自我采样在参与者中得到了高度认可,大多数人表示对进行该操作有信心,不适感最小,并且愿意在家中进行自我采样。自我采样结合7型人乳头瘤病毒mRNA E6/E7检测提供了一种有前景的策略,可通过提高可及性并确保精确诊断来加强宫颈癌筛查。实施这些方法可能会显著降低宫颈癌的发病率和死亡率,尤其是在服务不足的人群中。未来的研究应关注将这些方法纳入国家筛查计划的长期影响,并探索广泛实施的成本效益。

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