Cervical Cancer and Screening Procedures

Cervical cancer is one of the major health risks for women. This type of cancer is usually caused by the high-risk human papillomavirus (HPV). Due to the persistence of the infection and the growing prevalence of cervical cancer caused by HPV, screening procedures have been established to be able to identify and diagnose the health threats at the early stages and address them accordingly. This paper provides a review of two recent articles focused on the evaluation of the effectiveness of the screening procedures for cervical cancer that focus on a similar issue but approach it in different manners.

The first article reviewed for this paper is titled “Primary cervical cancer screening with human papillomavirus: End of study results from the ATHENA study using HPV as the first-line screening test”, its authors, Wright et al. (2015) stated that according to ATHENA, the cobas HPV test was recognized as the primary screening approach for women of 25 years of age or older. The main objective of the research was to report the end-of-study results that reflected the screening results on a large sample of women who underwent cytology and hrHPV testing procedures and evaluate whether or not the primary HPV screening approach was as effective as the hybrid screening strategy that involved cytology (for the women of 25 to 29 years) and cotesting for the women older than 30.

The present research reported the results of the follow-up phase that lasted for 3 years with annuals examinations and collection of the cervical specimens for HPV testing and cytology (Wright et al., 2015). The women whose lab results showed abnormal cytology had a colposcopy with ECCs and biopsies. In the cases when the subjects had CIN 2+ diagnosed, they were excluded from the follow-up. The findings of the study showed that the effectiveness of the primary HPV screening approach equaled that of the hybrid screening strategy that involved cytology (for the women of 25 to 29 years) and cotesting for the women older than 30 (Wright et al., 2015).

The second article reviewed for this paper is titled “Use of primary high-risk human papillomavirus testing for cervical cancer screening: Interim clinical guidance”. It was written by Huh et al. (2015) and had the primary objective to evaluate the data from the FDA registration study in order to establish the advantages and disadvantages of the recommended hrHPV testing strategy and inform the health care delivering professionals about the challenges they may face investing into this approach. The group of reviewers included thirteen experts who represented very respectful and influential healthcare organizations such as the American Society for Colposcopy and Cervical Pathology, the American Cancer Society, the American College of Obstetricians and Gynecologists, the Society of Gynecologic Oncology, to name a few (Huh et al., 2015).

The authors specified that the type of screening under review is rather sensitive; however, the primary challenge that concerns it is the applied evaluation strategy and the frequency of testing (Huh et al., 2015). The researchers concluded that compared to the screening based on cytology only, hrHPV testing was similarly effective and sensitive and could be relied on as an approach alternative to cytology and cotesting. In addition, the researchers pointed out the need for the further investigation of such aspects as the potential impact of the increased number of colposcopies performed on women younger than 25 years of age and the correlation between the screening and the rates of actual cancer prevention (Huh et al., 2015).

Comparison and Contrast

The two studies under review focused on the type of primary HPV screening strategy that was established by ATHENA and attempted to evaluate its effectiveness and the potential challenges it may carry for the health care providers choosing to go with this strategy. In other words, it is possible to state that the two works explore the same issue, and this is the first similarity between them. At the same time, the methods and approaches used by the authors are very different, even though they pursue similar goals.

In particular, the study by Wright et al. (2015) follows quantitative design and relies on the statistical analysis (verification bias adjusted (VBA) estimates of absolute risk of CIN2+ or CIN3+ for the primary stage of the research) and Kaplan–Meier method and the VBA risk estimates for each year for the establishment of cumulative risk during the 3-year follow-up period. In addition, when it comes to the confidence intervals for the cumulative risk, they were estimated with the help of the bootstrap method (Wright et al., 2015). The numerical results of the calculations were presented in several detailed tables and appendixes. Moreover, since the sample of participants was very large (over 42 thousand women), and many participants were excluded at different stages of the research due to diverse reasons, a diagram was presented for the readers to comprehend the processes according to which the number of participants changed and what health outcomes were observed in the sample at various stages.

To compare, in the second study, the authors relied on the qualitative methods of evaluation. The research was done in a form of a literature review where thirteen experts representing some of the most influential healthcare organizations in the United States explored a sample of relevant studies that were accessed using MEDLINE database and located via search focusing on such keywords as “cervical cancer”, “HPV”, “human papillomavirus”, “screening,” and “tests” (Huh et al., 2015). Further, a selection of eleven articles that were found to be relevant and significant was reviewed by the authors (each article was studied by at least three professionals). The major research questions the experts sought to answer were: “1) Is hrHPV testing for primary screening as safe and effective as cytology-based screening? and 2) Can primary hrHPV screening be considered as an alternative to current US cervical cancer screening methods?” (Huh et al., 2015, p. 179). In fact, one of the studies processed and reviewed in the Article 2 was Article 1. In that way, the authors of the first study conducted a practical screening research that took several years and involved tens of thousands of participants, the authors of the second article take a theoretic approach and review a number of practical research articles summarizing their findings. As a result, the second study represents the findings based on a much larger sample that includes the sample of the first study.

Conclusion

To conclude, focusing on the similar issue – the effectiveness of the primary HPV screening compared to the other testing approaches such as cotesting and cytology, the authors of the two studies chose very different approaches. That way, the research by Wright et al. presents quantitative analysis of statistical data collected from a large sample over several years, whereas the article by Huh et al. is a qualitative literature review that processed the findings of the studies such as that of Wright at al. in order to sum up the results.

References

Huh, W., Ault, K., Chelmow, D., Davey, D., Goulart, R., & Garcia, F.,… Einstein, M.

H. (2015). Use of primary high-risk human papillomavirus testing for cervical cancer screening. Obstetrics & Gynecology, 136(2), 178–182. Web.

Wright, T., Stoler, M., Behrens, C., Sharma, A., Zhang, G., & Wright, T. (2015).

Primary cervical cancer screening with human papillomavirus: End of study results from the ATHENA study using HPV as the first-line screening test. Gynecologic Oncology, 136(2), 189-197. http://dx.doi.org/10.1016/j.ygyno.2014.11.076