Risk of HPV-16/18 Infections and Associated Cervical Abnormalities in Women Seropositive for Naturally Acquired Antibodies: Pooled Analysis Based on Control Arms of Two Large Clinical Trials.

Background: Studies on the role of antibodies produced after infection with human papillomavirus 18 (HPV-18) and subsequent protection from HPV-18 infection have been conflicting, mainly due to inadequate sample size. Methods: We pooled data from the control arms of the Costa Rica Vaccine Trial and the PATRICIA trial. Using Poisson regression we compared the risk of newly detected 1-time HPV-18 infection, HPV-18 1-year persistent infection (12MPI), and HPV-18-associated atypical squamous cells of undetermined significance or greater (ASC-US+) lesions between HPV-18 seropositive and seronegative women. Results: High HPV-18 antibodies at enrollment was associated with reduced subsequent HPV-18 detection (P trend = 0.001; relative rate [RR] = 0.69; 95% confidence interval [CI], 0.47-1.01 for the third quartile; RR = 0.63; 95% CI, 0.43-0.94 for the fourth quartile, compared to seronegative). The risk of 12MPI showed a decreasing trend with increasing antibodies (P trend = 0.06; RR = 0.72; 95% CI, 0.29-1.77; RR = 0.42; 95% CI, 0.13-1.32 for the third and fourth quartiles, respectively). Lastly, we observed a significant decreased risk of HPV-18 ASC-US+ with increasing antibody (P trend = 0.01; RR = 0.46; 95% CI, 0.21-0.97 for the fourth quartile). We also observed a significant decreased risk of HPV-16 infection, 12MPI, and ASC-US+ with increasing HPV-16 antibody level. Conclusions: High HPV-18 naturally acquired antibodies were associated with partial protection from future HPV-18 infections and associated lesions. Clinical Trials Registration: NCT00128661 and NCT001226810.

ASCCP Colposcopy Standards: How Do We Perform Colposcopy? Implications for Establishing Standards.

OBJECTIVES: The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. Working group 3 defined colposcopy procedure guidelines for minimum and comprehensive colposcopy practice and evaluated the use of colposcopy adjuncts. MATERIALS AND METHODS: The working group performed a systematic literature review to identify best practices in colposcopy methodology and to evaluate the use of available colposcopy adjuncts. The literature provided little evidence to support specific elements of the procedure. The working group, therefore, implemented a national survey of current and recent ASCCP members to evaluate common elements of the colposcopy examination. The findings of this survey were modified by expert consensus from the ASCCP Colposcopy Standards Committee members to create guidelines for performing colposcopy. The draft recommendations were posted online for public comment and presented at an open session of the International Federation for Cervical Pathology and Colposcopy 2017 World Congress for further comment. All comments were considered in the development of final recommendations. RESULTS: Minimum and comprehensive colposcopy practice guidelines were developed. These guidelines represent recommended practice in all parts of the examination including the following: precolposcopy evaluation, performing the procedure, documentation of findings, biopsy practice, and postprocedure follow-up. CONCLUSIONS: These guidelines are intended to serve as a guide to standardize colposcopy across the United States.

Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States.

The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based colposcopy, colposcopy procedures, and colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect colposcopy performance, updates to some of the current recommendations may be necessary in the future.

Desing and methods of a population-based natural history study of cervical neoplasia in a rural province of Costa Rica: the Guanacaste Project / Diseño y métodos usados en un estudio poblacional sobre la historia natural de las neoplasias de cuello uterino en una provincia rural de Costa Rica: el Proyecto de Guanacaste

En el presente trabajo se describe la fase de reclutamiento de un estudio poblacional sobre la historia natural de las neoplasias de cuello uterino en Guanacaste, provincia rural costarricense donde las tasas de cáncer cervicouterino invasor son invariablemente altas. Las metas principales del estudio son investigar el papel que desempeñan la infección por el virus del papiloma humano (VPH) y sus cofactores en la etiología de las neoplasias cervicouterinas de alto grado, y evaluar las nuevas tecnologías empleadas en el tamizaje del cáncer cervical. Para empezar se seleccionó una muestra aleatoria de segmentos censuales y, con la ayuda de trabajadores de acción comunitaria del Ministerio de Salud de Costa Rica, se hizo un recuento de todas las habitantes de 18 años de edad o mayores. De las 10 738 mujeres que cumplían con los requisitos para participar, 10 049 (93,6%) fueron entrevistadas después de haber dado su consentimiento informado por escrito. Después de la entrevista sobre los factores de riesgo del cáncer cervicouterino, se hizo un examen pélvico a las mujeres que dijeron haber tenido actividad sexual. El examen pélvico incluyó la determinación del pH vaginal y la obtención de células para análisis citológico mediante tres técnicas distintas. También se obtuvieron células cervicales para determinar la presencia y cantidad de ADN de 16 tipos de VPH diferentes y se tomaron dos fotografías del cérvix que fueron interpretadas en un local distinto por un experto en colposcopia. Por último, se sacaron muestras de sangre para hacer ensayos inmunológicos y determinaciones de micronutrientes. Las mujeres con un diagnóstico citológico anormal o un cervigrama positivo, más una muestra del grupo en general, fueron remitidas para hacerles colposcopia y se tomaron biopsias cuando se observaron lesiones. El tamizaje con fines de reclutamiento servirá de base para un estudio de prevalencia de casos y controles, y las integrantes de la cohorte sin enfermedad avanzada tendrán un seguimiento activo a intervalos mínimos de un año, con el propósito de estudiar la historia natural de la infección por VPH y los orígenes de las lesiones escamosas intraepiteliales de alto grado. Se describe en detalle la operación de campo y se hace especial alusión a la realización de estudios de este tipo en países en desarrollo. También se presentan datos descriptivos sobre la prevalencia de la enfermedad y la exposición a diversos factores de riesgo

This paper reports on the enrollment phase of a population-based natural history study of cervical neoplasia in Guanacaste, a rural province of Costa Rica with consistently high rates of invasive cervical cancer. The main goals of the study are to investigate the role of human papillomavirus (HPV) infection and its co-factors in the etiology of high-grade cervical neoplasia, and to evaluate new cervical cancer screening technologies. To begin, a random sample of censal segments was selected and enumeration of all resident women 18 years of age and over was conducted with the aid of outreach workers of the Costa Rican Ministry of Health. Of the 10 738 women who were eligible to participate, 10 049 (93.6%) were interviewed after giving written informed consent. After the interview on cervical cancer risk factors was administered, a pelvic examination was performed on those women who reported previous sexual activity. The pelvic examination included a vaginal pH determination and collection of cervical cells for cytologic diagnosis using three different techniques. Additional cervical cells were collected for determination of the presence and amount of DNA from 16 different types of HPV, and two photographic images of the cervix were taken and interpreted offsite by an expert colposcopist. Finally, blood samples were collected for immunologic and micronutrient assays. Women with any abnormal cytologic diagnosis or a positive Cervigram, as well as a sample of the whole group, were referred for colposcopy, and biopsies were taken when lesions were observed. The enrollment screening will serve as the basis for a prevalent case-control study, and the members of the cohort free from serious disease will be followed actively, at intervals of no more than a year, to study the natural history of HPV infection and the origins of high-grade squamous intraepithelial lesions (HSIL). Details of the field operation are outlined, with particular reference to the realization of this kind of study in developing countries. Descriptive data on the prevalence of disease and exposure to various risk factors are also presented.