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« Back to Contents CERVICAL CANCER

LiFE re

Literature for ENYGO

Cervical pre-invasive disease (diagnosis, management)

Editor Geanina Dragnea Screening

Descriptive summary A systematic review compared test accuracy of the HPV test, cytolo-
gy, and unaided visual inspection with acetic acid (VIA) to detect CIN
Risk factors 2+. Despite large differences in sensitivity between tests, absolute
differences in missed diagnoses were small. Differences in specifici-
Multiple HPV infections were not associated with increased risk for ty may lead to overtreatment as demonstrated for assessment with
high-risk cervical lesions compared to the women infected with a VIA instead of the cervical smear (58 more per 1000 women) [6].
single HPV genotype. This finding is suggestive of possible interge-
notypic competition or a more effective immune response triggered A retrospective study concluded that cytology+hrHPV co-testing
by multiple infections. Further studies in larger, more diverse cohorts remains the best strategy for detecting CIN2+ lesions, with
are needed [1]. a false-negative rate of only 1.2 %. The false-negative rates for
hrHPV and Pap smears were 8.7 % and 9.1 %, respectively [7].
Mitra et al. reported that a high diversity of vaginal microbiomes
and low levels of Lactobacillus spp. (community state type-CST IV) A Swedish population-based cohort study showed that atypical glan-
to be associated with increasing CIN severity. Vaginal microbiota dular cells (AGC) during cervical screening is associated with a high
diversity may be involved in regulating viral persistence and disease and persistent risk of cervical cancer for up to 15 years (cumulative
progression [2]. incidence of 2.6 % at 15.5 years), particularly for cervical adenocar-
cinoma and women at age 30-39. Management of AGC seems to
Pathogenesis have been suboptimal in preventing cervical cancer. The current
Swedish guidelines recommend immediate histology assessment
A post-hoc analysis of the ATHENA study was performed to and subsequent treatment for women with AGC (similar to HSIL
determine whether true HPV negative cervical lesions CIN2+ occur management). This is likely to be insufficient, and a more aggressive
and whether they have clinical relevance. Of 55 CIN2+ women, 23 assessment strategy, including both an additional histology test in
cases were negative by all HPV tests (11 CIN3/ACIS lesions). Further one year and close long-term surveillance, could be considered to
analysis with tissue PCR did not identify any true CIN3/ACIS not find the precursor lesions in time, with particular attention given to
attributable to HPV (4 were positive for HPV types not considered women aged 30-39 [8].
oncogenic, 2 were positive for oncogenic genotypes and 1 was
indeterminate) [3].

Vaccination

Prophylactic

The protective effect of HPV vaccination (quadrivalent vaccine)
against CIN2+ was evaluated in a population-based study on
1,333,691 Swedish girls aged 13-29. Greater effectiveness was ob-
served in younger age groups, with 75 % for those vaccinated before
age 17, and 46 % and 22 % for those vaccinated at ages 17-19, and
at ages 20-29, respectively [4].

Therapeutic

A randomised study on 1,711 women (18-25 years old) with hrHPV
infection and 311 who underwent treatment for CIN and received
HPV-16/18 vaccination (versus Hepatitis A vaccine) found that there
was no evidence for a vaccine effect on the fate of detectable HPV
infections; the vaccination does not protect against infections/lesi-
ons post-treatment [5].

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International Journal of Gynecological Cancer, Volume 26, Supplement #1 Page 34