Tag: Cervical Cancer

Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses

hrHPV testing with an appropriate assay offers a promising new strategy that could increase population coverage substantially

What is already known on this topic

  • Tests performed on self samples are less sensitive and less specific than tests performed on clinician samples when using a high-risk human papillomavirus (hrHPV) assay based on signal amplification
  • Response rates for hrHPV testing are higher for self sampling kits than for conventional invitations

What this study adds

  • Tests performed on self samples are similarly sensitive and slightly less specific than tests performed on clinician samples when using a hrHPV assay based on polymerase chain reaction
  • Response rates for hrHPV testing continue to be higher for self sampling kits than for conventional invitations

2018 Study Abstract

Objective
To evaluate the diagnostic accuracy of high-risk human papillomavirus (hrHPV) assays on self samples and the efficacy of self sampling strategies to reach underscreened women.

Design
Updated meta-analysis.

Data sources
Medline (PubMed), Embase, and CENTRAL from 1 January 2013 to 15 April 2018 (accuracy review), and 1 January 2014 to 15 April 2018 (participation review).

Review methods
Accuracy review: hrHPV assay on a vaginal self sample and a clinician sample; and verification of the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by colposcopy and biopsy in all enrolled women or in women with positive tests. Participation review: study population included women who were irregularly or never screened; women in the self sampling arm (intervention arm) were invited to collect a self sample for hrHPV testing; women in the control arm were invited or reminded to undergo a screening test on a clinician sample; participation in both arms was documented; and a population minimum of 400 women.

Results
56 accuracy studies and 25 participation trials were included. hrHPV assays based on polymerase chain reaction were as sensitive on self samples as on clinician samples to detect CIN2+ or CIN3+ (pooled ratio 0.99, 95% confidence interval 0.97 to 1.02). However, hrHPV assays based on signal amplification were less sensitive on self samples (pooled ratio 0.85, 95% confidence interval 0.80 to 0.89). The specificity to exclude CIN2+ was 2% or 4% lower on self samples than on clinician samples, for hrHPV assays based on polymerase chain reaction or signal amplification, respectively. Mailing self sample kits to the woman’s home address generated higher response rates to have a sample taken by a clinician than invitation or reminder letters (pooled relative participation in intention-to-treat-analysis of 2.33, 95% confidence interval 1.86 to 2.91). Opt-in strategies where women had to request a self sampling kit were generally not more effective than invitation letters (relative participation of 1.22, 95% confidence interval 0.93 to 1.61). Direct offer of self sampling devices to women in communities that were underscreened generated high participation rates (>75%). Substantial interstudy heterogeneity was noted (I2>95%).

Conclusions
When used with hrHPV assays based on polymerase chain reaction, testing on self samples was similarly accurate as on clinician samples. Offering self sampling kits generally is more effective in reaching underscreened women than sending invitations. However, since response rates are highly variable among settings, pilots should be set up before regional or national roll out of self sampling strategies.

Whereas accuracy of new combinations of assays and self sampling devices can be evaluated in a diagnostic setting, acceptance and participation should be shown locally in a screening setting before general roll out.

Cancer of the cervix uteri

Half a million new cases of cervical cancer are added each year

Abstract

Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.

Reference.

FIGO Cancer Report 2018

Presention of the management of gynecological cancers

The FIGO Committee for Gynecologic Oncology is pleased to present the third edition of the FIGO Cancer Report. Since 2012, this report has been presented triennially in the current format, which aims to present the state of the art management of gynecological cancers in our endeavor to ensure women worldwide receive an acceptable standard of care. The excellent readership of the previous edition encouraged us to produce an updated edition. A series of carefully reviewed and presented articles covers each of the gynecologic cancers. Chapters on pathology, targeted therapy, psychosexual health, and end‐of‐life care have been updated. New chapters have been added on surgical anatomy in gynecologic oncology, essential surgical skills for gynecologic oncologists, enhanced recovery after surgery, role of imaging in endometrial cancer, and cancer in pregnancy. This edition is Open Access to ensure wide dissemination. The 2015 edition of the Cancer Report was translated into Portuguese and Spanish, and the 2018 edition will also be translated to ensure greater readership.

Undeniably, this does not do away with the need for data. The situational analysis done during the tenure of the previous committee had indicated the need to position dedicated data entry managers to get good quality data from low‐ and middle‐income countries (LMICs). However, this project could not find funding. It is apparent that in these days of widespread internet use and mobile health, new methods will have to be found. The Committee initiated a survey to understand changing practices, the results of which will be presented at the XXII FIGO World Congress, held in Rio de Janeiro, Brazil, October 14–19, 2018. It is hoped that increased use of these techniques will bring more insights.

In the last three years, FIGO Gynecologic Oncology Committee members have been actively engaged in organizing and participating in several educational activities including conferences, workshops, and training programs in various countries. They have developed educational aids including handbooks and slide sets. An e‐learning course in collaboration with the Catalan Institute of Oncology (ICO) has been implemented. Cadaver training programs have been initiated for skills development in open and laparoscopic surgery. A smartphone mobile application (free to download and use ofline) for staging and resource‐based management of gynecologic cancers was developed in collaboration with the International Atomic Energy Agency (IAEA).

One of the major objectives of the Committee has been to work with governments to inform policy regarding the implementation of the HPV vaccine program. Members have been engaged in advising various governments during this period. The Committee has collaborated with international and nongovernmental organizations to support this cause in different regions.

By far one of the most challenging tasks undertaken by the Committee was the revision of the staging of cervical cancer. Hitherto staged by clinical methods only, it was insensitive to the advances in technology that had improved the quality of imaging and brought in minimally invasive surgery to facilitate access. However, being a disease largely confined to LMICs, there was widespread belief that a revision would not be applicable where it was needed most. Various rounds of discussions, extensive literature review, interaction, face‐to‐face meetings with the major gynecologic oncology societies internationally, in collaboration with the International Union for Cancer Control (UICC) and the American Joint Commission on Cancer (AJCC), finally resolved the impasse and the 2018 revision now allows the use of imaging and pathology in a way that can be practiced at all levels of resources. The revised staging has been endorsed by the FIGO Executive Board and will be published in the International Journal of Gynecology and Obstetrics (IJGO).

The members of the FIGO Committee for Gynecologic Oncology during this term were: Neerja Bhatla (Chair), India; Kanishka Karunaratne (Co‐Chair), Sri Lanka; Lynette Denny (Immediate Past Chair), South Africa; Seija Grenman (Vice President FIGO, Ex officio member), Finland; Jonathan Berek, USA; Mauricio Cuello Fredes, Chile; Sean Kehoe, UK; Ikuo Konishi, Japan; Alexander Olawaiye, USA; Jaime Prat, Spain; Rengaswamy Sankaranarayanan, France.

Going forward, the Committee will continue its work on FIGO staging, the next cancer to be updated will be cancer of the vulva. FIGO also hopes to work closely with WHO in response to the call for elimination of cervical cancer. Collaboration with the International Agency for Research on Cancer (IARC) will help to gain insights on incidence and survival statistics from different regions to understand the inequities and direct our efforts to promote appropriate education and skills training as we work together to lessen the burden of gynecologic cancers.

Reference. FIGO Cancer Report 2018.

Condom use in prevention of Human Papillomavirus infections and cervical neoplasia

Systematic review of longitudinal studies, 2014

HPV and cancer : the condom is much more effective than the vaccine in preventing cancer, including when dysplasias are already present. As a bonus, remember that the condom protects against a whole lot of other unpleasant infections or dangers…

Abstract

Objectives
Based on cross-sectional studies, the data on protection from Human Papillomavirus (HPV) infections related to using male condoms appear inconsistent. Longitudinal studies are more informative for this purpose. We undertook a systematic review of longitudinal studies on the effectiveness of male condoms in preventing HPV infection and cervical neoplasia.

Methods
We searched PubMed using MeSH terms for articles published until May 2013. Articles were included if they studied a change in non-immunocompromized women’s cervical HPV infection or cervical lesion status along with the frequency of condom use.

Results
In total, 384 abstracts were retrieved. Eight studies reported in 10 articles met the inclusion criteria for the final review. Four studies showed a statistically significantly protective effect of consistent condom use on HPV infection and on regression of cervical neoplasia. In the remaining four studies, a protective effect was also observed for these outcomes, although it was not statistically significant.

Conclusions
Consistent condom use appears to offer a relatively good protection from HPV infections and associated cervical neoplasia. Advice to use condoms might be used as an additional instrument to prevent unnecessary colposcopies and neoplasia treatments in cervical screening, and to reduce the risk of cervical cancer.

POLE-mutated clear cell cervical cancer associated with in-utero diethylstilbestrol exposure

Gynecologic Oncology Reports, Volume 28, Pages 15-17, May 2019

2019 Study Highlights

  • We report a POLE-mutated clear cell cervical cancer associated with in-utero DES.
  • Tumor exhibited increased tumor infiltrating lymphocytes and PD-L1 expression.
  • Patient remains in remission for ≥4 years after standard therapy.
  • POLE mutation confers a phenotype of higher immunogenicity and improved outcome.

Abstract

We report an extraordinary case of a woman, exposed to diethylstilbestrol in utero, who developed clear cell adenocarcinoma of the cervix with a concurrent polymerase-Ɛ (POLE) somatic mutation. The tumor exhibited the classic phenotypic characteristics of POLE-mutated tumors originating from other organs (e.g. the uterus or the colon) including increased tumor infiltrating lymphocytes and high PD-L1 expression and has remained in remission since completion of primary therapy for >4 years. This case highlights the importance of next generation sequencing in unraveling the biology of rare tumors and supports that the presence of a POLE mutation and the associated ultramutated state confers a unique phenotype of higher immunogenicity and possibly improved prognosis in a tissue-agnostic manner, i.e. regardless of the type of cancer where the POLE mutation is present. Image credit bioinfo.

DES DiEthylStilbestrol Resources

Screening for Cervical Cancer – US Preventive Services Task Force Recommendation Statement

New Cervical Cancer Screening Guidelines: What You Need to Know

Some women have a new option for cervical cancer screening — and it doesn’t necessarily involve a Pap test — according to updated guidelines from a government-appointed panel of experts, livescience reports.

Key Points

  • Women under age 21 should not be screened for cervical cancer.
  • Women ages 21 to 29 should undergo screening every three years using a Pap test, also called “cervical cytology.” (HPV testing isn’t recommended for women ages 21 to 29 because, in this age group, HPV infection is common and is often cleared by the immune system.)
  • Women over age 65 do not need to be screened for cervical cancer if they are up to date on their screening, their tests in the previous 10 years were negative and they don’t have other risk factors for cervical cancer.

Abstract

Importance
The number of deaths from cervical cancer in the United States has decreased substantially since the implementation of widespread cervical cancer screening and has declined from 2.8 to 2.3 deaths per 100 000 women from 2000 to 2015.

Objective
To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for cervical cancer.

Evidence Review
The USPSTF reviewed the evidence on screening for cervical cancer, with a focus on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus (hrHPV) testing alone or hrHPV and cytology together (cotesting) compared with cervical cytology alone. The USPSTF also commissioned a decision analysis model to evaluate the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies.

Findings
Screening with cervical cytology alone, primary hrHPV testing alone, or cotesting can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality. The harms of screening for cervical cancer in women aged 30 to 65 years are moderate. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone in women aged 21 to 29 years substantially outweigh the harms. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with both tests (cotesting) in women aged 30 to 65 years outweigh the harms. Screening women older than 65 years who have had adequate prior screening and women younger than 21 years does not provide significant benefit. Screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer provides no benefit. The USPSTF concludes with moderate to high certainty that screening women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, screening women younger than 21 years, and screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer does not result in a positive net benefit.

Conclusions and Recommendation
The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. (A recommendation) The USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years. (A recommendation) The USPSTF recommends against screening for cervical cancer in women younger than 21 years. (D recommendation) The USPSTF recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. (D recommendation) The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer.

Recommendations of Others

… “Women at increased risk of cervical cancer (ie, women with a history of cervical cancer, a compromised immune system, or diethylstilbestrol exposure) may need to be screened more often.” …

Reference. US Preventive Services Task Force, August 21, 2018.

Gardasil alert, imminent risk of unnecessary and sometimes dangerous HPV vaccination for girls and boys

Gardasil : the anticancer vaccination that increases the risk of cervical cancer in young women

Reference. Written by Gérard Delépine, MD, Orthopaedic Surgeon/Oncologist/statistician, July 23, 2018.

Open letter to parliamentarians, and to all citizens.

BE CAREFUL. While many doctors, foreign and French, citizens, patients sometimes victims, have been trying to inform for many years about the uselessness and the risks of the HPV vaccine, a new offensive of the pharmaceutical lobbies led again some MPs to try to introduce laws to make it a compulsory vaccination, already probably the most widespread in the world.

We have analysed the benefit-risk of this vaccine originally intended for women, but boys are likely to be targeted as well and denounced several times its uselessness coupled with its risks. both in women and in men. The time spent since FDA’s marketing authorization in June 2006 only adds new arguments against this vaccination, the strongest of which is the increase in the number of cervical cancers in the vaccinated population. which should encourage these countries to follow the example of Japan and Austria and to delete the recommendation.

Attention, some MPs want to impose a vaccination that can increase the risk of cervical cancer, as proven by international publications of national cancer registries.

ANALYSIS OF THE PROPOSED LAW WHICH MAY MAKE GARDASIL COMPULSORY

The preamble to the bill is based on the usual arguments of pharmaceutical companies widely disseminated by the media and their comfortably paid experts.

This preamble certainly recalls some indisputable true facts: there are more than one hundred HPV strains, the vaccines possibly protect against infection by the 4 to 9 strains included in the vaccine (only 2 to 5% of the 200 known strains ), against genital warts and some dysplasia’s without specifying that there is no evidence that it protects against cancer.

It is extremely disturbing to read in the presentation of opinion justifying the proposed law a number of known untruths:

« There are more than one hundred and twenty kinds of human papillomavirus (HPV), and fifteen are considered to be at high risk because they can cause cancers including HPV 16 and 18 causing 70% of infections. » But this only demonstrates a statistical correlation between presence of HPV and cancer, without anyone being so far able to demonstrate a direct CAUSALITY link.

« There are effective HPV vaccines. Current vaccines offer effective vaccination against 70% of carcinogenic HPV, and a new vaccine will soon increase this rate to 90%. » But, what do MPs mean by efficiency? the vaccine is effective on the infections of strains targeted by the vaccine (only 4 to 9 of the nearly 200 listed strains) but there is no evidence that it can prevent invasive cancer let alone avoid death by this cancer.

Citing Australia as a vaccine success story: « In Australia, where 80% of women and 75% of men are vaccinated, cases of HPV lesions have almost disappeared ». But, this statement is outrageous, as the following presentation will show you, because in this highly vaccinated country the number of cervical cancers (and other cancers attributed to HPV) continue to increase.

They also deny the risk of serious side effects that have led to protests in many countries (Denmark, Ireland, Japan, Colombia) and legal complaints from doctors against the EMA.

WHAT SHOULD IT EXPLAIN TO PARLIAMENTARIANS?

The regular smear (every three years) better guarantees early detection of cervical cancer.

In France, HPV infection is not a real public health problem in 2018, neither for women nor for men. In women, since smear screening has been used, the annual number of deaths from cervical cancer is consistently less than 1000 in France, and the women who die are almost exclusively those who have not been screened.

Diagnosis of HPV papillomavirus infection detected by systematic sampling should be avoided! Positive results often lead to unnecessary examination and very early conisation (biopsy) which is often useless.

The <1000 deaths per year from cervical cancer could all have been prevented by screening, Compare this with lung cancer (23,000 deaths), breast cancer (11,883 deaths), or prostate cancer (8,207 deaths) [15] .

Whilst efficacy of smear screening is proven, HPV vaccination not been proven to prevent a single invasive cervical cancer. The cancer registry records even suggest that this vaccine is sometimes likely to increase the risk.

INSTEAD OF REDUCING THE NUMBER OF CERVICAL CANCERS, IT INCREASES SOMETIMES

Curiously, the MPs who signed the bill do not talk about the proven results of the vaccine on the risk of invasive cancer of the cervix, its only official justification.

Instead of reducing the risk of invasive cancer of the cervix, HPV vaccines keep it at a high level or increase it!

After 12 years of use and more than 200 million girls vaccinated worldwide for a total bill of nearly $100 billion paid directly or indirectly by citizens , we can indeed draw a balance of effectiveness of vaccination in two ways:

  1. By examining the evolution of the incidence (annual frequency of new cases per 100,000 women) of the invasive cancer of the cervix in each country, before and after vaccination, a method already validated in 2003.
  2. World Standardised Rates: gross Incidence reported as « Standard World Population » to correct possible biases related to the demographic characteristics of each country.

The evolution of the incidence of cervical cancer before and after vaccination with Gardasil can be traced in a perfectly reliable way in the national cancer registries controlled and published by the ministries of health of the concerned countries.

 

Australia, according to the Australian Institute of Health and Welfare, the incidence of cervical cancer declined by almost 50%, from 12(/100,000) in 1995 to 7 in 2004 (before the vaccination campaign). Mortality also improved, thanks to smear screening and treatment. However, since the vaccination campaign started in 2007, there has been no further decrease in either incidence or mortality. In 2017, the incidence of cervical cancer is estimated at 7.1 and cervical cancer mortality has increased by almost 15% from 1.7 in 2014 to 2 in 2017. And our MPs quote Australian efficiency!

The Australian Ministry of Health estimates the number of new cases of cervical cancer is 912 in 2017 and 930 in 2018. Claiming, like our MPs, that « cases of HPV lesions have almost disappeared » in Australia is therefore not correct. One cannot imagine that these MPs lie voluntarily, so we can conclude that they are poorly informed and that they should have checked themselves the information provided by the experts related to laboratories before distributing this « fake news ».

Great Britain, according to Cancer Research UK, the Office of National Statistics (ONS), the incidence of cervical cancer had decreased (thanks to smear screening) from 12.4 in 1995 to 9.27 in 2004. But since vaccination, there is no longer any evidence of improvement, nor on the incidence stagnating from 9.3 in 2006 to 9.6 in 2015 nor on the mortality remaining at 3.

Canada. According to the Canadian Cancer Society, the incidence of cervical cancer has decreased (through screening) from 18 in 1972 to 8.1 in 2008. But since vaccination, there has been no further progress on incidence stagnating at 8.3 in 2017.

United States, according to the National Cancer Institute’s SEER cancer statistics review, the incidence of cervical cancer reduced from 14.8 in 1975 to 6.66 in 2007. But since vaccination, there has been no decrease in the incidence of cervical cancer reached 6.68 in 2015 .

Norway, according to the Cancer Registry of Norway, Oslo: before vaccination, the standardized incidence had fallen sharply thanks to smear screening from 24 in 1965 to 7 in 2004. But since the vaccination, it goes up to 13.9 in 2014 and 14.9 in 2015.

Sweden, according to the National Kvalitetsregister for Cervix Cancer prevention (NKCx ): before the vaccination campaign, the incidence of cervical cancer had decreased (thanks to screening) from 18 in 1967 to 7 in 2006. The worldwide standardized incidence of cervical cancer has increased significantly since vaccination rising to 10.3 in 2012 and 11.5 in 2015. This increase is almost exclusively due to the increase in the incidence of invasive cancer among women aged 23 to 49, which has reached more than 50% since 2006 (11 in 2006 versus 17 in 2015), whereas it is those who have the highest vaccination coverage rate (85%).

Thus, in countries whose populations have access to smear screening, it has led to a considerable reduction in the incidence of cervical cancer (from 40 to 60%). In contrast, the introduction of vaccination has not reduced the incidence or mortality of cervical cancer. Contrary to what is promised by laboratory-related physicians and by many global health authorities, vaccination campaigns have even been followed by an increase in the incidence of cancer.

France, with low levels of HPV vaccination, can serve as a control country. According to Public Health France, the incidence of cervical cancer in mainland France has steadily decreased from 15 in 1995 to 7.5 in 2007, 6.7 in 2012 and 6 in 2017. This decrease in incidence was accompanied by a decrease in mortality from 5 in 1980 to 1.8 in 2012 and 1.7 in 2017. France, with low use of Gardasil, has a much more satisfactory evolution for both incidence and mortality than that of the countries cited as example by the MPs who want to impose vaccination.

Comparison of recent standardized incidences with vaccination coverage rates.

Immunization advocates claim that a high vaccination coverage rate reduces the risk of invasive cancer of the cervix. Yet the comparison of incidence and mortality rates with vaccine coverage rates shows the opposite:

Australia, HPV vaccination coverage exceeds 85% , but in 2017 the incidence of cervical cancer is 7 and the mortality is 2

Great Britain, despite vaccination coverage exceeding 80%, the incidence in 2015 was 9.6 and mortality 3

Sweden the vaccination coverage rate is close to 75% but the incidence 2015 reaches 11.5.

USA, in 2017 the vaccination coverage rate is 60% for a cervical cancer incidence of 6.8 and a specific mortality at 2.3.

France , in 2017, HPV vaccination coverage is very low (around 15% ) for a cervical cancer incidence of 6 and a specific mortality of 1.7

In countries with high immunization coverage, the incidence of invasive cancers and mortality are therefore higher than in France, and compulsory immunisation proposed by some MPs would eliminate this French paradox that protects our children!

 

The harmful side-effects are difficult to deny

In their preamble, the MPs deny that Gardasil can lead (as any treatment) to complications while Japan, Austria and Denmark have stopped promoting this vaccination after serious complications, sometimes even fatal and that families suffering from these vaccines organized public demonstrations in several countries of the world (Japan, Colombia, Ireland), and that Danish doctors lodged a complaint against the European Medicines Agency (EMA), which refused to answer the questions they asked. after the notification of severe neurological events not listed in the EMA registers.

In France, several lawsuits are in progress.

« Among the most frequently mentioned by the victims defended by M pathologies e Coubris include multiple sclerosis, lupus, disseminated acute encephalomyelitis (inflammation of the central nervous system) and myofasciitis macrophages (a disease that results in pain muscle and chronic fatigue) ». A parliamentary commission of inquiry which could hear experts, citizens and independent associations of laboratories, having, from near or far, no link of interest with laboratories, would be a first step to enlighten Parliament.

IN CONCLUSION, the benefit-risk balance is not in favour of vaccination, let alone compulsory.

A compulsory health measure should not be based on faith in vaccination or hidden conflicts of interest, but on proven facts, verifiable by every citizen. However, the facts established by the official records of cancer registries show that HPV vaccination does not protect against invasive cancer of the cervix but seems rather to maintain its frequency at a high level, and sometimes even increase it.

Let us fight against this bill that threatens our children, by informing everyone, our MP, our senator, our elected officials, that no one may be unaware.

Only this work of proximity of each citizen this summer, will be able to avoid this new catastrophe of return which could be the anti-HPV vaccination, as it has been and still is the obligation of vaccination against hepatitis B.

Let’s apply the precautionary principle! Let us respect the right of every human being to informed choice/consent for medical interventions!

Could HPV vaccination play a role in the increase in the incidence of cervical cancer ?

Increased incidence of cervical cancer in Sweden : Possible link with HPV vaccination

Recently, when the Swedish media discussed the increase in the incidence of cervical cancer, the health authorities were unable to explain the increase.

2018 Study Abstract

The Centre for Cervical Cancer Prevention in Sweden has noted in its annual report a substantial increase in the incidence of invasive cervical cancer, especially during the two years 2014 and 2015. I have sub-grouped the data according to age, using the same statistical database of the National Board of Health and Welfare as used by the authors of the above-mentioned report. The increase in the incidence of cervical cancer was shown to be most prominent among women 20–49 years of age while no apparent increase was observed among women above 50. The FDA has noted in the clinical trials referred to it for marketing approval that women exposed to the human papilloma virus (HPV) prior to vaccination had an increase in premalignant cell changes compared with placebo controls. I discuss the possibility that HPV vaccination could play a role in the increase in the incidence of cervical cancer by causing instead of preventing cervical cancer disease in women previously exposed to HPV. A time relationship exists between the start of vaccination and the increase in the incidence of cervical cancer. The HPV vaccines were approved in 2006 and 2007, respectively and most young girls started to be vaccinated during 2012–2013.

Featured image credit ijme shows increase in incidence of cervical cancer among younger women (<50 years) as compared with women ≥50 years. The data shows the number of cases/100,000 women from 2006 to 2015.

The IUD (intrauterine device) would reduce the risk of cervical cancer

Intrauterine Device Use and Cervical Cancer Risk : A Systematic Review and Meta-analysis

A study shows that the possibility of developing cervical cancer could be reduced by a third by wearing the IUD. Image credit @magicmaman_com.

2017 Study Abstract

OBJECTIVE
To estimate the association between use of an intrauterine device (IUD) and risk of cervical cancer by subjecting existing data to critical review, quantitative synthesis, and interpretation.

DATA SOURCES
We searched PubMed, Web of Science, ClinicalTrials.gov, and catalogs of scientific meetings and abstracts, theses, and dissertations queried from inception through July 2016.

METHODS OF STUDY SELECTION
Examination of abstracts from 225 reports identified 34 studies with individual-level measures of use of an IUD and incident cervical cancer. By critically assessing the full text of these reports, independent reviewers identified 17 studies conducted without recognized sources of systematic error, of which 16 could be harmonized for meta-analysis.

TABULATION, INTEGRATION, AND RESULTS
Point and interval estimates of the association between use of an IUD and incident cervical cancer were extracted from original reports into a structured database along with key features of study design and implementation. A random-effects meta-analysis was implemented to quantitatively synthesize extracted estimates and assess likely influence of publication bias, residual confounding, heterogeneity of true effect size, and human papillomavirus prevalence and cervical cancer incidence in source populations. Women who used an IUD experienced less cervical cancer (summary odds ratio 0.64, 95% CI 0.53–0.77). Neither confounding by recognized risk factors nor publication bias seems a plausible explanation for the apparent protective effect, which may be stronger in populations with higher cervical cancer incidence.

CONCLUSION
Invasive cervical cancer may be approximately one third less frequent in women who have used an IUD. This possible noncontraceptive benefit could be most beneficial in populations with severely limited access to screening and concomitantly high cervical cancer incidence.

USPSTF Draft Recommendation Statement Cervical Cancer : Screening

The US Preventive Services Task Force has New Draft Guidance for Cervical Cancer Screening

These recommendations do NOT apply to women with in utero exposure to diethylstilbestrol or women who have a compromised immune system (e.g., women living with HIV).

The major change from the US Preventive Services Task Force (USPSTF) 2012 recommendation is that testing for high-risk strains of human papillomavirus (hrHPV) alone is now recommended as an alternative to cytology or Papanicolaou (Pap) screening alone beginning at age 30 years; cotesting is no longer recommended.

As in the 2012 recommendation, the USPSTF continues to recommend that women aged 21 to 29 years undergo Pap screening every 3 years.

The USPSTF recommend against screening in women younger than age 21 years because there is adequate evidence that regardless of sexual history, screening younger women does not reduce cervical cancer incidence or mortality.

The USPSTF also continues to give a thumbs down to screening in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, as well as in women who have had a hysterectomy and their cervix removed and do not have a history of a high-grade precancerous lesions or cervical cancer.

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