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Cancers
Special Issues
Prevention & Screening in Cervical Cancer
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Prevention & Screening in Cervical Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Causes, Screening and Diagnosis".

Deadline for manuscript submissions: closed (30 September 2020) | Viewed by 19998

Special Issue Editors

Dr. Raj Naik

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Guest Editor
Queen Elizabeth Hospital, Gateshead, UK
Interests: gynaecological oncology; cervical cancer
Special Issues, Collections and Topics in MDPI journals
Dr. Pierre Martin-Hirsch

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Guest Editor
Department of Gynaecological Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
Interests: adjunctive technologies; screening in cervical pre-cancer; HPV vaccines & prevention
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Evangelos Paraskevaidis

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Guest Editor
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ioannina, 45110 Ioannin, Greece
Interests: gynaecological cancers; human pappilomavirus (HPV); HPV vaccination; cervical cancer; cervical intraepithelian neoplasia (CIN); cervical screening; colposcopy
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Maria Kyrgiou

E-Mail Website
Guest Editor
1. Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
2. Imperial College Healthcare NHS Trust, London W2 1NY, UK
Interests: gynaecological cancers; human pappilomavirus (HPV); HPV vaccination; cervical cancer; cervical intraepithelian neoplasia (CIN); cervical screening; ovarian cancer; endometrial cancer; microbiome; epigenetics; organoids
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cervical cancer continues to be the fourth most frequent cancer in women with an estimated 570,000 new cases in 2018 representing 6.6% of all female cancers. Approximately 90% of deaths from cervical cancer occur in low- and middle-income countries. The high mortality rate from cervical cancer globally could be reduced through a comprehensive approach that includes prevention, early diagnosis, effective screening and treatment programs.

Cervical pre-cancer screening and more recently HPV vaccination have been major corner-stones in the prevention of cervix cancers in the developed world. The full impact of these strategies is yet to be realized with the potential to eradicate the scourge of this disease that increasingly affects younger women.

With so much which was once considered research now becoming standard clinical practices and in keeping with the “bench to clinic” concept and the explosion of personalized medicine we, the Guest Editors, are delighted to bring to you this Special Themed Edition of the journal “Cancers” focusing specifically on prevention and screening in cervical cancer.

Dr. Raj Naik
Prof. Pierre Martin-Hirsch
Prof. Evangelos Paraskevaides
Dr. Maria Kyrgiou
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cervix cancer
  • screening
  • colposcopy
  • HPV testing
  • HPV vaccination

Published Papers (6 papers)

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Research

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12 pages, 1236 KiB  
Article
Fostering Prevention of Cervical Cancer by a Correct Diagnosis of Precursors: A Structured Case-Based Colposcopy Course in Finland, Norway and UK
by Forsell Sabrina, Kalliala Ilkka, Halttunen-Nieminen Mervi, Redman Charles, Leeson Simon, Tropé Ameli, Moss Esther, Kyrgiou Maria, Pyörälä Eeva and Nieminen Pekka
Cancers 2020, 12(11), 3201; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers12113201 - 30 Oct 2020
Cited by 4 | Viewed by 1995
Abstract
High-quality colposcopy is essential in cervical cancer prevention. We performed a multicentre prospective interventional pilot-study, evaluating the effect of a six-hour case-based colposcopy course on short- and long-term learning of colposcopy-related knowledge, diagnostic accuracy levels and confidence. We recruited 213 colposcopists participating in [...] Read more.
High-quality colposcopy is essential in cervical cancer prevention. We performed a multicentre prospective interventional pilot-study, evaluating the effect of a six-hour case-based colposcopy course on short- and long-term learning of colposcopy-related knowledge, diagnostic accuracy levels and confidence. We recruited 213 colposcopists participating in three European Federation of Colposcopy (EFC) basic colposcopy courses (Finland, Norway, UK). The study consisted of three tests with identical content performed before, after and 2 months after the course, including ten colposcopic images, ten patient cases and scales for marking confidence in the answers. Outcome measures where mean scores in correct case-management, diagnosis (including high-grade lesion recognition), transformation-zone recognition and confidence in answers. Results were compared between the three tests and stratified according to experience. Mean test scores improved after the course for all participants. The increase was highest for beginners. Confidence in answers improved and the number of colposcopists showing high confidence with low scores decreased. A structured case-based course improves skills and confidence especially for inexperienced colposcopists; however, trainers should be aware of the risk of overconfidence. To complement theoretical training, further hands-on training including high-quality feedback is recommended. Conclusions drawn from long-term learning are limited due to the low participation in the follow-up test. Full article
(This article belongs to the Special Issue Prevention & Screening in Cervical Cancer)
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9 pages, 849 KiB  
Article
Survival from Cervical Cancer Diagnosed Aged 20–29 Years by Age at First Invitation to Screening in England: Population-Based Study
by Alejandra Castanon, Daniela Tataru and Peter Sasieni
Cancers 2020, 12(8), 2079; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers12082079 - 28 Jul 2020
Cited by 4 | Viewed by 2966
Abstract
Age at which women are first invited to attend cervical screening in England has changed twice: in 2004, women under 25 years were no longer invited; and in 2012, first invitations were sent six months earlier (at age 24.5 years). Concomitantly, a dramatic [...] Read more.
Age at which women are first invited to attend cervical screening in England has changed twice: in 2004, women under 25 years were no longer invited; and in 2012, first invitations were sent six months earlier (at age 24.5 years). Concomitantly, a dramatic increase in screen-detected cervical cancer was observed, and their survival had not been documented. Diagnoses of invasive cervical cancer at ages 20–29 years in 2006–2016 in England were followed until the end of 2018 for deaths. We estimated 8-year overall survival (OS) by International Federation of Gynecology and Obstetrics (FIGO) stage and age at first screening invitation. Overall and relative survival for stage IA cervical cancer for women diagnosed aged 20–29 years in England (n = 1905) was excellent at 99.8% (95% confidence intervals (CI): 99.4–99.9%) and 100% (95% CI: 99.7–100.1%), respectively. OS for stage IB cervical cancer (n = 1101) was 90.4% (95% CI: 88.3–92.2%). Survival from stage IB was worse for women diagnosed age 20–24 years compared to those diagnosed 25–29 years at diagnosis (p < 0.0001), but no difference was observed by age at first invitation for screening, p = 0.8575. OS for stage II (65.5%, 95% CI: 60.2–72.0%) and stage III+ (36.6%, 95% CI 28.4–44.7%) were poorer. Survival from stage I cervical cancer in young women in England is excellent: mortality in women with stage IA cancer is akin to that of the general population regardless of age at first invitation to screening. Full article
(This article belongs to the Special Issue Prevention & Screening in Cervical Cancer)
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12 pages, 429 KiB  
Article
Role of Colposcopy after Treatment for Cervical Intraepithelial Neoplasia
by Annu Heinonen, Maija Jakobsson, Mari Kiviharju, Seppo Virtanen, Karoliina Aro, Maria Kyrgiou, Pekka Nieminen and Ilkka Kalliala
Cancers 2020, 12(6), 1683; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers12061683 - 24 Jun 2020
Cited by 3 | Viewed by 3638
Abstract
Colposcopy is often used in follow-up after treatment for cervical intraepithelial neoplasia (CIN) despite its marked inter-observer variability and low sensitivity. Our objective was to assess the role of colposcopy in post-treatment follow-up in comparison to hrHPV (high-risk human papillomavirus) testing, cytology, and [...] Read more.
Colposcopy is often used in follow-up after treatment for cervical intraepithelial neoplasia (CIN) despite its marked inter-observer variability and low sensitivity. Our objective was to assess the role of colposcopy in post-treatment follow-up in comparison to hrHPV (high-risk human papillomavirus) testing, cytology, and cone margin status. Altogether, 419 women treated for histological high-grade lesion (HSIL) with large loop excision of the transformation zone (LLETZ) attended colposcopy with cytology and hrHPV test at six months. Follow-up for recurrence of HSIL continued for 24 months. Colposcopy was considered positive if colposcopic impression was recorded as high grade and cytology if HSIL, ASC-H (atypical squamous cells, cannot exclude HSIL), or AGC-FN (atypical glandular cells, favor neoplasia) were present. Overall, 10 (10/419, 2.4%) recurrent HSIL cases were detected, 5 at 6 months and 5 at 12 months. Colposcopic impression was recorded at 407/419 6-month visits and was positive for 11/407 (2.7%). None of them had recurrent lesions, resulting in 0% sensitivity and 97% specificity for colposcopy. Sensitivity for the hrHPV test at 6 months was 100% and specificity 85%, for cytology 40% and 99%, and for margin status at treatment 60% and 82%, respectively. While the hrHPV test is highly sensitive in predicting recurrence after local treatment for CIN, colposcopy in an unselected population is not useful in follow-up after treatment of CIN. Full article
(This article belongs to the Special Issue Prevention & Screening in Cervical Cancer)
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16 pages, 270 KiB  
Article
National Policies to Prevent and Manage Cervical Cancer in East African Countries: A Policy Mapping Analysis
by Diana Wangeshi Njuguna, Nour Mahrouseh, Dede Onisoyonivosekume and Orsolya Varga
Cancers 2020, 12(6), 1520; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers12061520 - 10 Jun 2020
Cited by 8 | Viewed by 3963
Abstract
Policy mapping is used to provide evidence on effective interventions and highlight the necessary refinements of health policies. The goal of this work is to carry out legal mapping to identify and assess health policies for the prevention and management of cervical cancer [...] Read more.
Policy mapping is used to provide evidence on effective interventions and highlight the necessary refinements of health policies. The goal of this work is to carry out legal mapping to identify and assess health policies for the prevention and management of cervical cancer in East African countries. Cervical cancer, as a largely preventable disease, is the cause of most cancer deaths among women in East African countries. Legal documents were searched uniformly from government websites, national cancer institute sites, and international and national legal databases, then the data were analyzed using the Nvivo12 software package. The sample of 24 documents includes policies, plans, guidelines, acts, and strategies from 12 East African countries. The emerging themes were screening, prevention, diagnosis, treatment, challenges, and mitigation efforts. A few binding policies, a significant discrepancy to international standards in at least four countries, patchy screening registries, and a lack of prophylactic vaccination against human papillomavirus incorporation into national immunization schedules are the main findings. This paper underlies the role of law in health and the need for transparent legal and regulatory tools to achieve a further reduction in cervical cancer mortality in East African countries. Full article
(This article belongs to the Special Issue Prevention & Screening in Cervical Cancer)
12 pages, 1848 KiB  
Article
The Clinical Impact of Low-Volume Lymph Nodal Metastases in Early-Stage Cervical Cancer: The Senticol 1 and Senticol 2 Trials
by Benedetta Guani, Vincent Balaya, Laurent Magaud, Fabrice Lecuru and Patrice Mathevet
Cancers 2020, 12(5), 1061; https://doi.org/10.3390/cancers12051061 - 25 Apr 2020
Cited by 25 | Viewed by 3152
Abstract
Background: With the development of the sentinel node technique in early-stage cervical cancer, it is imperative to define the clinical significance of micrometastases (MICs) and isolated tumor cells (ITCs). Methods: We included all patients who participated in the Senticol 1 and Senticol 2 [...] Read more.
Background: With the development of the sentinel node technique in early-stage cervical cancer, it is imperative to define the clinical significance of micrometastases (MICs) and isolated tumor cells (ITCs). Methods: We included all patients who participated in the Senticol 1 and Senticol 2 studies. We analyzed the factors associated with the presence of low-volume metastasis, the oncological outcomes of patients with MIC and ITC and the correlation of recurrences and risk factors. Results: Twenty-four patients (7.5%) had low-volume metastasis. The risk factors associated with the presence of low-volume metastasis were a higher stage (p = 0.02) and major stromal invasion (p = 0.01) in the univariate analysis. The maximum specificity and sensitivity were found at a cutoff of 8 mm of stromal invasion. In multivariate analysis, the higher stage (p = 0.02) and the positive lymphovascular space invasion (p = 0.02) were significantly associated with the MIC and ITC. Patients with low-volume metastasis had similar disease-free survival (DFS) (92.7%) to node-negative patients (93.6%). The addition of adjuvant treatment in presence of low-volume metastasis did not modify the DFS. Conclusions: These results confirm our previous analysis of Senticol 1: the presence of low-volume metastasis did not decrease the DFS in early-stage cervical cancer patients. Full article
(This article belongs to the Special Issue Prevention & Screening in Cervical Cancer)
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15 pages, 284 KiB  
Review
Urine HPV in the Context of Genital and Cervical Cancer Screening—An Update of Current Literature
by Alexandros Daponte, George Michail, Athina-Ioanna Daponte, Nikoletta Daponte and George Valasoulis
Cancers 2021, 13(7), 1640; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13071640 - 01 Apr 2021
Cited by 25 | Viewed by 3495
Abstract
Within the previous decades, following the widespread implementation of HPV-related biomarkers and computerization in liquid-based cytology, screening for lower genital tract malignancies has been optimized in several parts of the world. Many organized anogenital cancer prevention systems have reached a point at which [...] Read more.
Within the previous decades, following the widespread implementation of HPV-related biomarkers and computerization in liquid-based cytology, screening for lower genital tract malignancies has been optimized in several parts of the world. Many organized anogenital cancer prevention systems have reached a point at which efficacy is more a matter of population coverage and less of available infrastructures. Meanwhile, self-sampling modalities in which biologic material (vaginal secretions, urine, etc.) is obtained by the individual and not the clinician and subsequently undergoes examination for HPV biomarkers enjoy appreciating acceptance. Bygone the initial skepticism that vaginal or urine HPV represents “passenger” transient infections, extensive scientific work has been conducted to optimize high-risk HPV (hrHPV) detection from this “novel” biologic material. Nowadays, several state-of-the-art meta-analyses have illustrated that self-sampling techniques involving urine self-sampling represent a feasible alternative strategy with potentially enhanced population coverage possessing excellent performance and sensitivity. Recently published scientific work focusing on urine HPV was reviewed, and after a critical appraisal, the following points should be considered in the clinical application of hrHPV urine measurements; (i) use of first-void urine (FVU) and purpose-designed collection devices; (ii) using a preservation medium to avoid human/HPV DNA degradation during extraction and storage; (iii) using polymerase chain reaction (PCR) based assays, ideally with genotyping capabilities; (iv) processing of a sufficient volume of whole urine; and (v) the use of an analytically sensitive HPV test/recovery of cell-free HPV DNA in addition to cell-associated DNA. Full article
(This article belongs to the Special Issue Prevention & Screening in Cervical Cancer)
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