Browsing by Author "Cuzick, Jack"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Cervical screening by visual inspection, HPV testing, liquid-based and conventional cytology in Amazonian Peru
    (WILEY, 2007) Almonte, Maribel; Ferreccio, Catterina; Winkler, Jennifer L.; Cuzick, Jack; Tsu, Vivien; Robles, Sylvia; Takahashi, Rina; Sasieni, Peter
    Cervical cancer is an important public health problem in many developing countries, where cytology screening has been ineffective. We compared four tests to identify the most appropriate for screening in countries with limited resources. Nineteen midwives screened 5,435 women with visual inspection (VIA) and collected cervical samples for HPV testing, liquid-based cytology (LBC) and conventional cytology (CC). If VIA was positive, a doctor performed magnified VIA. CC was read locally, LBC was read in Lima and HPV testing was done in London. Women with a positive screening test were offered colposcopy or cryotherapy (with biopsy). Inadequacy rates were 5% and 11% for LBC and CC respectively, and less than 0.1% for VIA and HPV. One thousand eight hundred eightyone women (84% of 2,236) accepted colposcopy/cryotherapy: 79 had carcinoma in situ or cancer (CIS+), 27 had severe- and 42 moderate-dysplasia on histology. We estimated a further 6.5 cases of CIS+ in women without a biopsy. Sensitivity for CIS+ (specificity for less than moderate dysplasia) was 41.2% (76.7%) for VIA,95.8% (89.3%) for HPV, 80.3% (83.7%) for LBC, and 42.5% (98.7%) for CC. Sensitivities for moderate dysplasia or worse were better for VIA (54.9%) and less favourable for HPV and cytology. In this setting, VIA and CC missed the majority of high-grade disease. Overall, HPV testing performed best. VIA gives immediate results, but will require investment in regular training and supervision. Further work is needed to determine whether screened-posilive women should all be treated or triaged with a more specific test. (c) 2007 Wiley-Liss, Inc.
  • Thumbnail Image
    Item
    Risk Factors for High-Risk Human Papillomavirus Infection and Cofactors for High-Grade Cervical Disease in Peru
    (BMJ PUBLISHING GROUP, 2011) Almonte, Maribel; Ferreccio, Catterina; Gonzales, Miguel; Delgado, Jose Manuel; Buckley, C. Hilary; Luciani, Silvana; Robles, Sylvia C.; Winkler, Jennifer L.; Tsu, Vivien D.; Jeronimo, Jose; Cuzick, Jack; Sasieni, Peter
    Objective: To evaluate the association between potential risk factors for high-risk human papillomavirus (HR-HPV) infection and cofactors for cervical intraepithelial lesions grade 2 or worse (CIN2+) in women attending cervical screening in Amazonian Peru.
  • Thumbnail Image
    Item
    Visual Inspection after Acetic Acid (VIA) Is Highly Heterogeneous in Primary Cervical Screening in Amazonian Peru
    (2015) Almonte, Maribel; Ferreccio Readi, Catterina; Luciani, Silvana; Gonzales, Miguel; Delgado, José M.; Santos, Carlos; Álvarez, Manuel; Cuzick, Jack; Sasieni, Peter