Cervical cancer studies on prevention and treatment
Author
Summary, in English
Cervical cancer is the fourth most common reason for cancer death amongst women worldwide, with 500 000 new cases every year. Most of these women live in developing countries. Cervical screening programs can reduce the incidence by 50%, but are not common in the developing world. In Sweden there are approximately 400 new cases of cervical cancer yearly, despite the existence of a screening program.
Cervical cancer and dysplastic lesions in the cervix are caused by infection by the Human Papilloma Virus, mainly HPV 16 and 18. An alternative to cytological screening is screening for HPV DNA.
The aim of this thesis was to analyze the screening history of women with cervical cancer, to find new techniques to screen women for cervical cancer, and to find out why some women do not attend screening. Furthermore, standard treatment for early cervical cancer is surgery including lymph node mapping, and patients have adverse effects from lymphadenectomies, so if a sentinel node procedure is accurate, it would be of value for the women.
Of the population of cervical cancer patients diagnosed in the years 2009-2010, one third of the women were over 60 years of age, and one fourth were over 65. The women that followed the screening program had a better prognosis compared to women above the screening age (Hazard Ratio (HR) =5.3 95% CI 2.4-12.0, p<0.001). All the women whose cancer was identified via the screening program were alive at the median follow-up (36 months). This contrasted with the women that had symptoms, where 68 of 98 patients were alive at the median follow-up (p<0.0001).The vaginal self-sampling device that we validated showed good agreement with HPV analysis of liquid-based cytology (LBC) (kappa value 0.67 95% CI 0.53-0.81).
When 1000 women who had not taken a cytology sample for over nine years were offered self-sampling at home, 15% responded. In contrast, when 500 women were offered flexible and free open clinic appointments, 4.2% came. The most common reason for non-attending was “uncomfortable with vaginal examination”.
The sentinel node concept is safe when a sentinel node is identified on both sides, and the tumor is 2 cm or less. The negative predictive value was then 100%.
The conclusions are that since so many women develop their cervical cancer after screening age, it would be advisable with an exit test. This exit test should ideally be an HPV test. In the case of hr-HPV positivity, the women could be offered a reflex cytology test. To reduce the non-attendance rate for cervical cancer screening, vaginal self-sampling for HPV-DNA is a possible method to use. Since so many women seem to be non-attendant due to being uncomfortable with vaginal examination, a self-test could be an attractive alternative.
The final conclusion is that the sentinel node concept should be further investigated to make it possible to offer a sharp sentinel node for women with cervical cancer.
Cervical cancer and dysplastic lesions in the cervix are caused by infection by the Human Papilloma Virus, mainly HPV 16 and 18. An alternative to cytological screening is screening for HPV DNA.
The aim of this thesis was to analyze the screening history of women with cervical cancer, to find new techniques to screen women for cervical cancer, and to find out why some women do not attend screening. Furthermore, standard treatment for early cervical cancer is surgery including lymph node mapping, and patients have adverse effects from lymphadenectomies, so if a sentinel node procedure is accurate, it would be of value for the women.
Of the population of cervical cancer patients diagnosed in the years 2009-2010, one third of the women were over 60 years of age, and one fourth were over 65. The women that followed the screening program had a better prognosis compared to women above the screening age (Hazard Ratio (HR) =5.3 95% CI 2.4-12.0, p<0.001). All the women whose cancer was identified via the screening program were alive at the median follow-up (36 months). This contrasted with the women that had symptoms, where 68 of 98 patients were alive at the median follow-up (p<0.0001).The vaginal self-sampling device that we validated showed good agreement with HPV analysis of liquid-based cytology (LBC) (kappa value 0.67 95% CI 0.53-0.81).
When 1000 women who had not taken a cytology sample for over nine years were offered self-sampling at home, 15% responded. In contrast, when 500 women were offered flexible and free open clinic appointments, 4.2% came. The most common reason for non-attending was “uncomfortable with vaginal examination”.
The sentinel node concept is safe when a sentinel node is identified on both sides, and the tumor is 2 cm or less. The negative predictive value was then 100%.
The conclusions are that since so many women develop their cervical cancer after screening age, it would be advisable with an exit test. This exit test should ideally be an HPV test. In the case of hr-HPV positivity, the women could be offered a reflex cytology test. To reduce the non-attendance rate for cervical cancer screening, vaginal self-sampling for HPV-DNA is a possible method to use. Since so many women seem to be non-attendant due to being uncomfortable with vaginal examination, a self-test could be an attractive alternative.
The final conclusion is that the sentinel node concept should be further investigated to make it possible to offer a sharp sentinel node for women with cervical cancer.
Department/s
- Obstetrics and Gynaecology (Lund)
- BioCARE: Biomarkers in Cancer Medicine improving Health Care, Education and Innovation
Publishing year
2013
Language
Swedish
Publication/Series
Lund University Faculty of Medicine Doctoral Dissertation Series
Volume
2013:142
Full text
Document type
Dissertation
Publisher
Department of Obstetrics and Gynecology, Lund University
Topic
- Obstetrics, Gynecology and Reproductive Medicine
Keywords
- Cervical cancer
- human papilloma virus
- HPV
- screening
- HPV test
- self-sampling
- sentinel node
Status
Published
Supervisor
ISBN/ISSN/Other
- ISSN: 1652-8220
- ISBN: 978-91-87651-17-5
Defence date
13 December 2013
Defence time
09:00
Defence place
Kvinnoklinikens Föreläsningssal SUS Lund
Opponent
- Helga Salvesen (Professor)