Related videosMejorando la educación en tecnología, Christian Van Der Henst at TEDxUFM
Curso de Programación Básica gratis | Platzi
You signed in with another tab or window. Reload to refresh your session. You signed out in another tab or window. Press h to open a hovercard with more details.
Our results suggest that self- and clinician-collected HPV testing could be used in CC prevention programs, as an effective complement or substitute for the Pap test. This paper is available too at: Key words: Palabras clave: Cervical cancer CC is a major public health problem in Mexico, and in many other developing countries. Over the past 25 years CC mortality rates have remained stable, fluctuating little from The incidence of invasive CC in Mexico is also estimated to be one of the highest in the world.
One of the explanations for the low coverage of the Mexican CCSP is the limited utilization and acceptability of the Pap test due to cultural and institutional barriers.
Other reasons include: Although the efficacy of the Pap test has never been evaluated in a randomized trial, it is the primary tool for the screening of cervical neoplasia around the world. The decline in the number of advanced lesions and in the mortality rate for patients with CC that has occurred in the last 40 years has mainly been attributed to the introduction of this screening test.
This is probably related to an increase in the incidence of sexually transmitted diseases, including infection with certain types of human papillomavirus HPV16 which may have occurred years ago. Also important is the fact that in some developed countries with well screened populations, CC mortality rates have stabilized and large reductions in mortality are not expected.
One possible option is the use of HPV testing as an alternative to, or in conjunction with, the Pap test. Genital HPV infection is the most common sexually transmitted viral infection.
Some of the possible uses of HPV testing include: The higher costs that may be associated with HPV testing are likely to be offset by the savings in the direct and indirect costs of Pap testing and Colposcopy services, and by allowing longer screening intervals for HPV DNA negative women.
On its own or in conjunction with cytology, there are a number of possibilities for incorporating HPV testing at different ages and at different screening intervals. Studies that have modeled different HPV screening strategies using various values for prevalence, sensitivity, and probability of progression indicate that it may be effective and cost-effective. The highest rates of HPV infection have consistently been found in sexually active women under the age of This observation tends to be true even after adjusting for factors such as lifetime number of sexual partners.
This information could have important implications in terms of the optimal age range for an HPV-based screening strategy. The process by which an HPV infection progresses to carcinogenesis is not yet fully understood.
Most HPV infections occur early in a person's sexual life, the overwhelming majority of infections are cleared by the host immune system, and persistent infection is strongly related to neoplasia.
Studies suggest that infection with high-risk types of HPV and older age are associated with persistence. Certain behaviors such as smoking, hormonal exposure e.
All participants also underwent a pelvic examination that involved collecting a cervical sample for the Pap smear, and a clinician-collected cervical specimen CS for HPV testing. A specialized HPV lab was set up and validated at INSP with the help of Digene technicians, and the samples were tested according to the manufacturer's instructions. During the recruitment visit, all participants were interviewed by female staff using a standard IMSS registration form.
In addition, during the initial recruitment visit a randomly selected subsample of 1 participants were interviewed to collect additional information about their demographic data; obstetric, family planning and sexual history; risk factors for HPV and CC; knowledge and use of the CCSP; experience and acceptance of the Pap and HPV tests; patient costs of screening; and willingness to pay to reduce risk of CC.
There are few studies that have examined the cost-effectiveness of HPV testing as compared to the Pap. A recent review of 2 papers that address the role of HPV testing for CC screening found that the existing modeling studies are inadequate for assessing cost-effectiveness.
A recent study by Mandelblatt et al. The use of HPV testing alone and in combination with the Pap test was compared to screening with the Pap test on its own. This study used published estimates of costs and effectiveness to create their model.
The researchers who conducted this study used data from a South African screening study, a national survey, fee schedules, and published literature, to create their model.
The study reports that when all strategies are compared simultaneously, HPV testing every three years is the most cost-effective option. These two studies provide important information about the cost-effectiveness of HPV testing for CC screening.
Also, previous studies have not examined the potential use of different test combinations. Of particular importance are the reference populations that have been used for these studies; most have focused on the use of HPV testing in women who are attending colposcopy.