Current limits of cervical cancer prevention in the Czech republic

Czech version

Authors: J. Sláma
Authors‘ workplace: Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc.
Published in: Ceska Gynekol 2017; 82(6): 482-486

Overview

Objective:
Cervical cancer represents disease with an unique possibilities of prevention. Despite this fact, it´s still detected excessive number of new cases and deaths annualy in our country. The aim of this work was to identify major limits of cervical cancer prevention in the Czech republic.

Design:
Review article.

Setting:
Department of Obstetrics and Gynecology, General University Hospital and 1st Medical Faculty, Charles University, Prague.

Materials and methods:
The main limit of primary and secondary prevention of cervical cancer is low participation rate of target population. Limits of screening include also inadequate age stratification of examination visits and usage of tests with a limited sensitivity.

Results:
Combination of prophylactic vaccination in HPV-naive population with screening based on HPV DNA testing with selective genotyping are the strategies showing high efficacy, sensitivity and long-term negative predictive value. Essential requirement is as high as possible participation of young girls in national vaccination program and adult women in screening program.

Conclusions:
It cannot be expected further improvement of current results if primary and secondary prevention programs remain unchanged. Necessary steps comprise rising of public education about advantages of vaccination and legislative changes in screening program.

Keywords:
HPV test, cervical cancer, screening, vaccination

Sources

1. Andrae, B., Kemetli, L., Sparén, P., et al. Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst, 2008, 7, 100(9), p. 622–629.

2. European Centre for Disease Prevention and Control. Introduction of HPV vaccines in EU countries – an update. Stockholm: ECDC, 2012.

3. Katki, HA., Kinney, WK., Fetterman, B., et al. Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol, 2011, 12(7), p. 663–672.

4. Khan, MJ., Castle, PE., Lorincz, AT., et al. The elevated 10-years risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst, 2005, 20, 97(14), p. 1072–1079.

5. Leyden, WA., Manos, MM., Geiger, AM., et al. Cervical cancer in women with comprehensive health care access: attributable factors in the screening process. J Natl Cancer Inst, 2005, 4, 97(9), p. 675–683.

6. Madzima, TR., Vahabi, M., Lofters, A. Emerging role of HPV self-sampling in cervical cancer screening for hard-to-reach women: Focused literature review. Can Fam Physician, 2017, 63(8), p. 597–601.

7. Quinn, M., Babb, P., Jones, J., Allen, E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ, 1999, 3, 318(7188), p. 904–908.

8. Whitlock, EP., Vesco, KK., Eder, M., et al. Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med, 2011, 15, 155(10), p. 687–697, W214-5.

9. Wright, TC. Jr, Behrens, CM., Ranger-Moore, J., et al. Triaging HPV-positive women with p16/Ki-67 dual-stained cytology: Results from a sub-study nested into the ATHENA trial. Gynecol Oncol, 2017, 144(1), p. 51–56.

10. Wright, TC., Stoler, MH., Behrens, CM., et al. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol, 2015, 136(2), p. 189–197.

11. www.svod.cz