PDF(Pubmed)
Abstract：
Cervical cancer remains a significant public health issue, particularly in regions with low screening uptake. This study evaluates the effectiveness of self-sampling and the 7-type HPV mRNA E6/E7 test in improving cervical cancer screening outcomes among a referral population in Mexico. A cohort of 418 Mexican women aged 25 to 65, referred for colposcopy and biopsy due to abnormal cytology results (ASC-US+), participated in this study. Self-samples were analyzed using both the 14-type HPV DNA test and the 7-type HPV mRNA E6/E7 test. The study assessed the sensitivity, specificity, positive predictive value (PPV), and the necessity of colposcopies to detect CIN3+ lesions. Participant acceptability of self-sampling was also evaluated through a questionnaire. The 7-type HPV mRNA E6/E7 test demonstrated equivalent sensitivity but significantly higher specificity (77.0%) and PPV for CIN3+ detection compared to the 14-type HPV DNA test (specificity: 45.8%, p < 0.001). The use of the HPV mRNA test as a triage tool reduced the number of colposcopies needed per CIN3+ case detected from 16.6 to 7.6 (p < 0.001). Self-sampling was highly accepted among participants, with the majority reporting confidence in performing the procedure, minimal discomfort, and willingness to undertake self-sampling at home. Self-sampling combined with the 7-type HPV mRNA E6/E7 testing offers a promising strategy to enhance cervical cancer screening by improving accessibility and ensuring precise diagnostics. Implementing these app roaches could lead to a significant reduction in cervical cancer morbidity and mortality, especially in underserved populations. Future research should focus on the long-term impact of integrating these methods into national screening programs and explore the cost-effectiveness of widespread implementation.
摘要：
宫颈癌仍然是一个重要的公共卫生问题，特别是在低筛选吸收的地区。这项研究评估了自采样和7型HPVmRNAE6/E7测试在改善墨西哥转诊人群中宫颈癌筛查结果中的有效性。一组418名年龄在25至65岁之间的墨西哥女性，由于细胞学结果异常（ASC-US）而进行阴道镜检查和活检，参与了这项研究。使用14型HPVDNA测试和7型HPVmRNAE6/E7测试分析自身样品。这项研究评估了敏感性，特异性，阳性预测值(PPV)，以及阴道镜检查检测CIN3+病变的必要性。还通过问卷评估了参与者对自我抽样的可接受性。与14型HPVDNA检测相比，7型HPVmRNAE6/E7检测显示出同等的灵敏度，但对CIN3+检测的特异性（77.0％）和PPV（特异性：45.8％，p<0.001)。使用HPVmRNA测试作为分类工具将检测到的perCIN3+病例所需的阴道镜数量从16.6减少到7.6(p<0.001)。自我抽样在参与者中被高度接受，大多数人报告对执行该程序充满信心，最小的不适，并愿意在家进行自我抽样。自采样结合7型HPVmRNAE6/E7检测提供了一种有希望的策略，通过改善可及性和确保精确的诊断来增强宫颈癌筛查。实施这些应用程序蟑螂可以显着降低宫颈癌的发病率和死亡率，尤其是在服务不足的人群中。未来的研究应侧重于将这些方法纳入国家筛查计划的长期影响，并探索广泛实施的成本效益。
