‘Missing Adenocarcinomas’: Are They a Real Problem in Cervical Cancer Screening in Brazil? - Revista Brasileira de Ginecologia e Obstetrícia
Rev Bras Ginecol Obstet. 2019;41(10):579-580
Screening and human papillomavirus (HPV) vaccine are the most critical strategies for cervical cancer control. The impact of vaccine programs has not been fully demonstrated yet due to the long natural history of the neoplasia. Regions that have implemented organized screening had efficiently reduced their incidence and mortality rates. Even in Brazil, where screening is opportunist, the cervical cancer rate is going down, dropping to the fourth most common female cancer.
The acquired knowledge about the pathogenesis of cervical cancer has proved that HPV DNA test is more efficient than cytology in detecting precursor lesions and reducing the incidence of cervical cancer. In screening programs, the HPV DNA test anticipates the diagnosis with a higher sensitivity. The most robust evidence comes from the systematic review by Ronco et al, who analyzed four randomized trials that enrolled 176,464 women aged 20–64 years, who were randomly assigned to the HPV DNA intervention group or the cytology control group. The authors showed a benefit with the HPV DNA test for the detection of invasive squamous cell carcinoma (0.78, 0.49–1.25) that was even higher for adenocarcinoma (odds ratio [OR]: 0.31; 95% confidence interval [95%CI]: 0.14–0.69).
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Screening and human papillomavirus (HPV) vaccine are the most critical strategies for cervical cancer control. The impact of vaccine programs has not been fully demonstrated yet due to the long natural history of the neoplasia. Regions that have implemented organized screening had efficiently reduced their incidence and mortality rates. Even in Brazil, where screening is opportunist, the cervical cancer rate is going down, dropping to the fourth most common female cancer.
The acquired knowledge about the pathogenesis of cervical cancer has proved that HPV DNA test is more efficient than cytology in detecting precursor lesions and reducing the incidence of cervical cancer. In screening programs, the HPV DNA test anticipates the diagnosis with a higher sensitivity. The most robust evidence comes from the systematic review by Ronco et al, who analyzed four randomized trials that enrolled 176,464 women aged 20–64 years, who were randomly assigned to the HPV DNA intervention group or the cytology control group. The authors showed a benefit with the HPV DNA test for the detection of invasive squamous cell carcinoma (0.78, 0.49–1.25) that was even higher for adenocarcinoma (odds ratio [OR]: 0.31; 95% confidence interval [95%CI]: 0.14–0.69).
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