Abstract Pre-adolescent girls (9–15 years) have the option of receiving a two dose HPV vaccine series at either a six month or one year interval to provide protection from HPV 16, the most prevalent ...type associated with cervical cancers, as well as several other less prevalent types. This series of vaccinations is highly likely to protect her from HPV infection until she enters the routine screening program, whether that be primary HPV testing or a combination of HPV testing and cytology. The two dose program has been recommended by the World Health Organization (WHO) since 2015. For women 15 years and older, the three dose vaccine schedule is still recommended. The past ten years of Gardasil use has provided evidence of reduced HPV 16/18 infections in countries where there has been high coverage. Gardasil9 has replaced Gardasil. Gardasil9 has the same rapid anti-HPV 18 and HPV45 titer loss as Gardasil did. Cervarix remains equivalent to Gardasil9 in the prevention of HPV infections and precancers of any HPV type; Cervarix also has demonstrated sustained high antibody titers for at least 10 years. One dose of Cervarix provides protection against HPV 16/18 infection with robust antibody titers well above natural infection titers. This may offer the easiest and most cost effective vaccination program over time, especially in low and lower middle income countries. Cervical cancer screening must continue to control cancer incidence over the upcoming decades. Future studies of prophylactic HPV vaccines, as defined by the WHO, must demonstrate protection against six month type specific persistent infections, not actual cervical cancer precursor disease endpoints, such as cervical intraepithelial neoplasia grade 3 (CIN 3) or adenocarcinoma in situ (AIS). This simplifies and makes less expensive future comparative studies between existing and new generic vaccines.
Between 1990 and 1995, Finland reached a cervical cancer incidence of fewer than four cases per 100 000 women through organised screening; nonetheless, a subsequent decrease in participation in ...screening among women aged 30–35 years led to an increased incidence within a 5-year timeframe.4 Cytology as a primary screen has been replaced by primary human papillomavirus (HPV) cervical screening, which has a 70% greater protection against invasive cervical cancer than cytology.5 The efficacy of the HPV vaccines against persistent HPV16 and 18 infections is well established,6,7 and vaccines have been assumed to be 100% effective for lifelong protection against certain HPV-associated cervical cancers in modelling studies that have informed the WHO cervical cancer elimination programmes.8 10-year follow-up results of antibody titres and clinical efficacy against HPV-associated cervical intra-epithelial neoplasias of grade 3 or higher have shown continued high efficacy,9,10 but with declining antibody titres over time measured through different assays. The WHO cervical cancer elimination plan can still work, with modifications. Because the bivalent HPV vaccine meets the model's assumptions for efficacy and longevity, worldwide implementation of this vaccine could be emphasised. The models themselves show that implementing primary HPV screening once or twice in a lifetime brings the model to a maximum reduction of cervical cancer incidence much earlier in the 100-year time frame of the model than the vaccination-only plans.8 The WHO 90-70-90 plan calls for 90% of girls to be HPV vaccinated before age 15 years, presumably with a two-dose vaccine schedule12 instead of the three-dose schedule on which efficacy data have been established.
Men who have sex with men (MSM) account for most new HIV diagnoses in the US. Annual HIV testing is recommended for sexually active MSM if HIV status is negative or unknown. Our primary study aim was ...to determine annual HIV screening rates in primary care across multiple years for HIV-negative MSM to estimate compliance with guidelines. A secondary exploratory endpoint was to document rates for non-MSM in primary care.
We conducted a three-year retrospective cohort study, analyzing data from electronic medical records of HIV-negative men aged 18 to 45 years in primary care at a large academic health system using inferential and logistic regression modeling.
Of 17,841 men, 730 (4.1%) indicated that they had a male partner during the study period. MSM were screened at higher rates annually than non-MSM (about 38% vs. 9%, p<0.001). Younger patients (p-value<0.001) and patients with an internal medicine primary care provider (p-value<0.001) were more likely to have an HIV test ordered in both groups. For all categories of race and self-reported illegal drug use, MSM patients had higher odds of HIV test orders than non-MSM patients. Race and drug use did not have a significant effect on HIV orders in the MSM group. Among non-MSM, Black patients had higher odds of being tested than both White and Asian patients regardless of drug use.
While MSM are screened for HIV at higher rates than non-MSM, overall screening rates remain lower than desired, particularly for older patients and patients with a family medicine or pediatric PCP. Targeted interventions to improve HIV screening rates for MSM in primary care are discussed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cervarix
®
and Gardasil
®
are two prophylactic HPV vaccines designed primarily for cervical cancer prevention. Cervarix is effective against HPV-16, -18, -31, -33 and -45, the five most common ...cancer-causing types, including most causes of adenocarcinoma for which we cannot screen adequately. Gardasil is effective against HPV-16, 18 and 31, three common squamous cell cancer-causing types. In addition, Gardasil is effective against HPV-6 and -11, causes of genital warts and respiratory papillomatosis. The most important determinant of vaccine impact to reduce cervical cancer is its duration of efficacy. To date, Cervarix's efficacy is proven for 6.4 years and Gardasil's for 5 years.
eLife has published a special issue containing articles that examine how cancer prevention, control, care and survivorship were impacted by the COVID-19 pandemic.
IMPORTANCE: Colorectal cancer is the second leading cause of cancer death in the United States. In 2016, an estimated 134 000 persons will be diagnosed with the disease, and about 49 000 will die ...from it. Colorectal cancer is most frequently diagnosed among adults aged 65 to 74 years; the median age at death from colorectal cancer is 73 years. OBJECTIVE: To update the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer. EVIDENCE REVIEW: The USPSTF reviewed the evidence on the effectiveness of screening with colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multitargeted stool DNA test, and the methylated SEPT9 DNA test in reducing the incidence of and mortality from colorectal cancer or all-cause mortality; the harms of these screening tests; and the test performance characteristics of these tests for detecting adenomatous polyps, advanced adenomas based on size, or both, as well as colorectal cancer. The USPSTF also commissioned a comparative modeling study to provide information on optimal starting and stopping ages and screening intervals across the different available screening methods. FINDINGS: The USPSTF concludes with high certainty that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit. Multiple screening strategies are available to choose from, with different levels of evidence to support their effectiveness, as well as unique advantages and limitations, although there are no empirical data to demonstrate that any of the reviewed strategies provide a greater net benefit. Screening for colorectal cancer is a substantially underused preventive health strategy in the United States. CONCLUSIONS AND RECOMMENDATIONS: The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation). The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history (C recommendation).
Lay Summary
During the coronavirus disease 2019 (COVID‐19) pandemic, cancer screening decreased precipitously; home screening for colorectal cancer diminished less than that for colonoscopy and ...breast and cervical cancer screening.
The authors have highlighted approaches for home cancer screening in addition to telemedicine.
During the coronavirus disease 2019 (COVID‐19) pandemic, cancer screening has decreased precipitously. Nevertheless, home screening for colorectal cancer appears to have diminished less than colonoscopy and breast cancer and cervical cancer screening in a large, academic midwestern medical center. Based on these findings, the current study highlights the promise for increasing home cancer screening in addition to telemedicine.
Cervical cancer prevention becomes more efficient Harper, Diane M.; Rozek, Laura S.
International journal of cancer,
1 February 2022, 2022-02-01, 2022-02-00, 20220201, Letnik:
150, Številka:
3
Journal Article
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