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Le Touquet – Paris-Plage, France

Monsonego J.,Institute of the Cervix | Cortes J.,Spanish Society of Obstetrics and Gynaecology | Pereira Da Silva D.,Portuguese Institute of Oncology in Coimbra | Jorge A.-F.,Portuguese Institute of Oncology in Coimbra | Klein P.,Vision Critical
Gynecologie Obstetrique Fertilite | Year: 2012

Objectives: The availability of information on HPV and Pap tests has increased dramatically with the introduction of national HPV vaccination programs. But data on the effectiveness of this information is limited. However, our desire is to reduce patient anxiety and promote better delivery of information. Patients and methods: Therefore a questionnaire-based cohort study was conducted to investigate women's experience with the announcement of an abnormal Pap smear result, then the ensuing events, as well as their practitioner's management. This article focuses on the French experience, underpinned by comparative data with Spain and Portugal. Results: It shows that, face with stress reactions and patient's anxiety, the level of information from the medical profession is still seen as inadequate, while the Internet as an information source has its limitations and dangers. The close entourage is most relied on, which supports the need for better public information. Discussion and conclusion: Uniformity and standardization of information strategies is not yet on European time. © 2012 Elsevier Masson SAS. Source

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. Source

Arbyn M.,Scientific Institute of Public Health | De Sanjose S.,Institute Catala dOncologia | De Sanjose S.,CIBER ISCIII | Saraiya M.,Centers for Disease Control and Prevention | And 15 more authors.
International Journal of Cancer | Year: 2012

The EUROGIN 2011 roadmap reviews the current burden of human papillomavirus (HPV)-related morbidity, as well as the evidence and potential practice recommendations regarding primary and secondary prevention and treatment of cancers and other disease associated with HPV infection. HPV infection causes ∼600,000 cases of cancer of the cervix, vulva, vagina, anus and oropharynx annually, as well as benign diseases such as genital warts and recurrent respiratory papillomatosis. Whereas the incidence of cervical cancer has been decreasing over recent decades, the incidence of anal and oropharyngeal carcinoma, for which there are no effective screening programs, has been rising over the last couple of decades. Randomized trials have demonstrated improved efficacy of HPV-based compared to cytology-based cervical cancer screening. Defining the best algorithms to triage HPV-positive women, age ranges and screening intervals are priorities for pooled analyses and further research, whereas feasibility questions can be addressed through screening programs. HPV vaccination will reduce the burden of cervical precancer and probably also of invasive cervical and other HPV-related disease in women. Recent trials demonstrated that prophylactic vaccination also protects against anogenital HPV infection, anogenital intraepithelial lesions and warts associated with vaccine types, in males; and anal HPV infection and anal intraepithelial neoplasia in MSM. HPV-related oropharyngeal cancer could be treated less aggressively because of better survival compared to cancers of the oropharynx unrelated to HPV. Key findings in the field of cervical cancer prevention should now be translated in cost-effective strategies, following an organized approach integrating primary and secondary prevention, according to scientific evidence but adapted to the local situation with particular attention to regions with the highest burden of disease. Copyright © 2012 UICC. Source

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. Source

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. Source

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