Institute of the Cervix

Courcelles-lès-Lens, France

Institute of the Cervix

Courcelles-lès-Lens, France
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Nicol A.F.,Instituto Oswaldo Cruz | Monsonego J.,Institute of the Cervix
Future Virology | Year: 2012

Eurogin 2012, held in Prague, Czech Republic, 8-11 July 2012 spotlighted the major contributions over the years made by researchers throughout the world and provided a forum for an exchange of information. The present summary included HPV-associated cervical, anogenital, head and neck, and skin cancers, and prevention strategies including screening and HPV vaccination. This article contains the highlights of more than 335 lectures presented at the conference. The meeting attracted 1486 delegates from 83 different countries. EUROGIN is one of the largest forums worldwide for health professionals from all over the world interested in HPV infection and related diseases. All the references cited are from the abstract book of Eurogin 2012. For more details and abstracts, see the conference website at www.eurogin.com/2012. © 2012 Future Medicine Ltd.


Arbyn M.,Scientific Institute of Public Health | Roelens J.,Scientific Institute of Public Health | Cuschieri K.,Royal Infirmary | Cuzick J.,Queen Mary, University of London | And 6 more authors.
International Journal of Cancer | Year: 2013

Testing for DNA of 13 high-risk HPV types with the Hybrid Capture 2 (HC2) test has consistently been shown to perform better in triage of women with cervical cytology results showing atypical squamous cells of undetermined significance (ASC-US) but often not in triage of low-grade squamous intraepithelial lesions (LSIL) detected in cervical cancer screening. In a meta-analysis, we compared the accuracy of the APTIMA HPV test, which identifies RNA of 14 high-risk HPV types, to HC2 for the triage of women with ASC-US or LSIL. Literature search-targeted studies where the accuracy of APTIMA HPV and HC2 for detection of underlying CIN2/3+ was assessed concomitantly including verification of all cases of ASC-US and LSIL. HSROC (Hierarchical Summary ROC) curve regression was used to compute the pooled absolute and relative sensitivity and specificity. Eight studies, comprising 1,839 ASC-US and 1,887 LSIL cases, were retrieved. The pooled sensitivity and specificity of APTIMA to triage ASC-US to detect underlying CIN3 or worse was 96.2% (95% CI = 91.7-98.3%) and 54.9% (95% CI = 43.5-65.9%), respectively. APTIMA and HC2 showed similar pooled sensitivity; however, the specificity of the former was significantly higher (ratio: 1.19; 95% CI = 1.08-1.31 for CIN2+). The pooled sensitivity and specificity of APTIMA to triage LSIL were 96.7% (95% CI = 91.4-98.9%) and 38.7% (95% CI = 30.5-47.6%) for CIN3+. APTIMA was as sensitive as HC2 but more specific (ratio: 1.35; 95% CI = 1.11-1.66). Results were similar for detection of CIN2 or worse. In both triage of ASC-US and LSIL, APTIMA is as sensitive but more specific than HC2 for detecting cervical precancer. Copyright © 2012 UICC.


Monsonego J.,Institute of the Cervix | Hudgens M.G.,University of North Carolina at Chapel Hill | Zerat L.,Laboratoire Lavergne | Zerat J.-C.,Laboratoire Lavergne | And 2 more authors.
Gynecologic Oncology | Year: 2012

Objective: New commercial HPV RNA assays require further validation studies in population-based cervical cancer screening settings. To assess the performance of (FDA-approved) APTIMA® HPV Assay (AHPV), Hybrid Capture 2 (HC2), in-house PCR genotyping, and ThinPrep LBC in population-based screening, stratified by three histological gold standards. Study design: A multi-center trial in 5006 women undergoing routine screening in France was designed to compare the absolute and relative risks of diagnosing CIN3 + and CIN2 + lesions by different diagnostic tests. Results: Reproducibility between the primary and second pathology reading was excellent for CIN3 + and CIN2 + endpoints (Cohen's kappa 0.948 and 0.854). Absolute risks (PPV) of different tests (AHPV, HC2, PCR genotyping, LBC) in diagnosing CIN2 + (15-20%) and CIN3 + (4-6%) were similar for the first, second, and consensus pathology readings. The relative risks of diagnosing these lesions by the four tests were also similar when the first, second or third pathology readings were employed. AHPV had the highest absolute risk of both histological endpoints, and detects 5% to 15% more CIN3 + and CIN2 + lesions, respectively, than LBC. Compared with HC2 assay, the relative risk of AHPV is 24% to 29% higher, with a significant difference in CIN2 + detection. With LBC as reference, AHPV had the best sensitivity/specificity balance measured by AUC (area under ROC curve) comparison test (significant for CIN2 +), and the colposcopy referral rate (9.2%) comparable to that of LBC (8.7%). Conclusions: These data corroborate the suitability of AHPV for the primary cervical cancer screening. © 2012 Elsevier Inc. All rights reserved.


Monsonego J.,Institute of the Cervix | Hudgens M.G.,University of North Carolina at Chapel Hill | Zerat L.,Laboratoire Lavergne | Zerat J.-C.,Laboratoire Lavergne | And 4 more authors.
International Journal of Cancer | Year: 2011

The APTIMA® HPV Assay (AHPV) allows detection of 14 high-risk human papillomavirus (HPV) RNA types in cervical specimens. Until present, the assay has been compared to HPV DNA tests only in triage settings. Herein, we compare AHPV with a DNA assay (Hybrid Capture® 2; HC2) and liquid-based cytology (LBC; using PreservCyt® ThinPrep liquid Pap) in a screening setting (French APTIMA screening evaluation [FASE] study). Women (N = 5,006) aged 20-65 were screened by gynecologists in 17 private practices in Paris, France. One cervical specimen was collected and tested with LBC, AHPV and HC2 assays. Women were referred to colposcopy if they were ASC-US+ in LBC or HPV positive in either HPV assay. To control for verification bias, a random group (14%) with normal LBC and dually HPV negative tests underwent colposcopy. Data from 4,429 women were analyzed. Sensitivity, specificity and predictive values were calculated for the three tests. AHPV and HC2 were highly sensitive for CIN2+ (92.0% and 96.7%) and CIN3+ (95.7% and 95.3%) detection and much more sensitive than LBC (69.1% for CIN2+ and 73.3% for CIN3+). Specificity of AHPV was higher than that of HC2, but similar to that of LBC (p < 0.001). Combining LBC with either HPV test slightly increased sensitivity but compromised specificity. AHPV assay is both specific and sensitive for the detection of high-grade precancerous lesions and may be considered as an option for routine cervical cancer screening for women over 20 years of age. Copyright © 2010 UICC.


Monsonego J.,Institute of the Cervix | Cortes J.,Spanish Society of Obstetrics and Gynaecology | Greppe C.,Sahlgrenska University Hospital | Hampl M.,Universitatsklinikum Dusseldorf | And 2 more authors.
Vaccine | Year: 2010

Cervical cancer is a leading cause of cancer-related deaths worldwide. The causal role of human papillomavirus (HPV) infection in the pathogenesis of cervical cancer has prompted the development of vaccines against HPV. The highest risk of HPV infection is in women aged 16-25 years. Almost all young adult women can benefit from HPV vaccination. There is strong epidemiological and clinical support for vaccination programmes that target sexually active women in this age group to prevent HPV infection, and thus avert the development of HPV-related disease. Furthermore, the implementation of HPV vaccination programmes may benefit the development or awareness of cervical cancer prevention strategies and ultimately reduce the burden of cervical cancer and improve cervical cancer control. © 2010 Elsevier Ltd.


Monsonego J.,Institute of the Cervix | Cortes J.,Spanish Society of Obstetrics and Gynaecology | da Silva D.P.,Portuguese Institute of Oncology in Coimbra | Jorge A.F.,Portuguese Institute of Oncology in Coimbra | Klein P.,Vision Critical
BMC Women's Health | Year: 2011

Background: Extensive information on cervical cancer is currently available. Its effectiveness in reducing anxiety in women receiving abnormal Pap tests is not clear. We investigated current practices of communicating abnormal Pap results to evaluate women's reactions and determine the sources of information they use subsequently.Methods: A self-administered questionnaire-based study was performed in 1475 women in France, Spain and Portugal who had received an abnormal Pap smear result in the 12 months prior to completing the questionnaire. Questions covered methods of communication of the result, emotional reactions, support received (from the physician and entourage), and information sources, using pre-specified check box options and rating scales. Data were analyzed by country.Results: Pap test results were mostly communicated by phone to Spanish women (76%), while physician letters were common in France (59%) and Portugal (36%). Frequent reactions were anxiety, panic and stress, which were less common in Spanish women than their French and Portuguese counterparts. After discussing with their physician, half of the participants were worried, despite rating highly the psychological support received. Over 90% of women in each country discussed their results with family or friends. Partners provided a high level of support. Overall, the abnormal diagnosis and consequences had a low to medium impact on daily, professional and family life and their relationships with their partner. Impact was higher in Spanish women than the French or Portuguese. Information on the diagnosis and its treatment was rated average, and nearly 80% of participants wanted more information, notably French women. Preferred sources were the physician and the Internet.Conclusions: Women expressed a strong wish for more information about cervical cancer and other HPV-related diseases, and that their physician play a major role in its provision and in support. There was a heavy reliance on the close entourage and the Internet for information, highlighting the need for dissemination of accurate material. Differences between countries suggest information management strategies may need to be tailored to different geographical regions. © 2011 Monsonego et al; licensee BioMed Central Ltd.


Giuliano A.R.,H. Lee Moffitt Cancer Center and Research Institute | Nyitray A.G.,University of Houston | Kreimer A.R.,U.S. National Institutes of Health | Pierce Campbell C.M.,H. Lee Moffitt Cancer Center and Research Institute | And 4 more authors.
International Journal of Cancer | Year: 2014

Human papillomaviruses (HPVs) cause cancer at multiple anatomic sites in men and women, including cervical, oropharyngeal, anal, vulvar and vaginal cancers in women and oropharyngeal, anal and penile cancers in men. In this EUROGIN 2014 roadmap, differences in HPV-related cancer and infection burden by gender and anatomic site are reviewed. The proportion of cancers attributable to HPV varies by anatomic site, with nearly 100% of cervical, 88% of anal and <50% of lower genital tract and oropharyngeal cancers attributable to HPV, depending on world region and prevalence of tobacco use. Often, mirroring cancer incidence rates, HPV prevalence and infection natural history varies by gender and anatomic site of infection. Oral HPV infection is rare and significantly differs by gender; yet, HPV-related cancer incidence at this site is several-fold higher than at either the anal canal or the penile epithelium. HPV seroprevalence is significantly higher among women compared to men, likely explaining the differences in age-specific HPV prevalence and incidence patterns observed by gender. Correspondingly, among heterosexual partners, HPV transmission appears higher from women to men. More research is needed to characterize HPV natural history at each anatomic site where HPV causes cancer in men and women, information that is critical to inform the basic science of HPV natural history and the development of future infection and cancer prevention efforts. © 2014 UICC.


Monsonego J.,Institute of the Cervix
Endocrine Development | Year: 2012

This report addresses several areas including the progress made toward global implementation of currently licensed human papillomavirus (HPV) vaccines, and monitoring impact of HPV vaccination programs that can be implemented within developed and less-developed countries. For the sake of completeness, a short update on the evolution of HPV testing in primary screening programs at present and after HPV vaccine introduction has also been included. Copyright © 2012 S. Karger AG, Basel.


PubMed | Institute of the Cervix
Type: Comparative Study | Journal: International journal of cancer | Year: 2011

The APTIMA HPV Assay (AHPV) allows detection of 14 high-risk human papillomavirus (HPV) RNA types in cervical specimens. Until present, the assay has been compared to HPV DNA tests only in triage settings. Herein, we compare AHPV with a DNA assay (Hybrid Capture 2; HC2) and liquid-based cytology (LBC; using PreservCyt ThinPrep liquid Pap) in a screening setting (French APTIMA screening evaluation [FASE] study). Women (N = 5,006) aged 20-65 were screened by gynecologists in 17 private practices in Paris, France. One cervical specimen was collected and tested with LBC, AHPV and HC2 assays. Women were referred to colposcopy if they were ASC-US+ in LBC or HPV positive in either HPV assay. To control for verification bias, a random group (14%) with normal LBC and dually HPV negative tests underwent colposcopy. Data from 4,429 women were analyzed. Sensitivity, specificity and predictive values were calculated for the three tests. AHPV and HC2 were highly sensitive for CIN2+ (92.0% and 96.7%) and CIN3+ (95.7% and 95.3%) detection and much more sensitive than LBC (69.1% for CIN2+ and 73.3% for CIN3+). Specificity of AHPV was higher than that of HC2, but similar to that of LBC (p < 0.001). Combining LBC with either HPV test slightly increased sensitivity but compromised specificity. AHPV assay is both specific and sensitive for the detection of high-grade precancerous lesions and may be considered as an option for routine cervical cancer screening for women over 20 years of age.


New commercial HPV RNA assays require further validation studies in population-based cervical cancer screening settings. To assess the performance of (FDA-approved) APTIMA HPV Assay (AHPV), Hybrid Capture 2 (HC2), in-house PCR genotyping, and ThinPrep LBC in population-based screening, stratified by three histological gold standards.A multi-center trial in 5006 women undergoing routine screening in France was designed to compare the absolute and relative risks of diagnosing CIN3+ and CIN2+ lesions by different diagnostic tests.Reproducibility between the primary and second pathology reading was excellent for CIN3+ and CIN2+ endpoints (Cohens kappa 0.948 and 0.854). Absolute risks (PPV) of different tests (AHPV, HC2, PCR genotyping, LBC) in diagnosing CIN2+ (15-20%) and CIN3+ (4-6%) were similar for the first, second, and consensus pathology readings. The relative risks of diagnosing these lesions by the four tests were also similar when the first, second or third pathology readings were employed. AHPV had the highest absolute risk of both histological endpoints, and detects 5% to 15% more CIN3+ and CIN2+ lesions, respectively, than LBC. Compared with HC2 assay, the relative risk of AHPV is 24% to 29% higher, with a significant difference in CIN2+ detection. With LBC as reference, AHPV had the best sensitivity/specificity balance measured by AUC (area under ROC curve) comparison test (significant for CIN2+), and the colposcopy referral rate (9.2%) comparable to that of LBC (8.7%).These data corroborate the suitability of AHPV for the primary cervical cancer screening.

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