Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study

Corresponding author. E-mail address: ramirezt@iarc.who.int (A.T. Ramírez).

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Main Author: Ramírez, Arianis Tatiana (author)
Other Authors: Valls, Joan (author), Baena, Armando (author), Rojas, Freddy David (author), Ramírez, Katherine (author), Álvarez, Rodrigo (author), Cristaldo, Carmen (author), Henríquez, Odessa (author), Moreno, Adrián (author), Colque Reynaga, Daysi (author), González Palma, Hans (author), Robinson, Isabel (author), Hernández, Diana Carolina (author), Bardales, Rosa (author), Cardinal, Lucía (author), Salgado, Yuly (author), Martínez, Sandra (author), González, Emmanuel (author), Guillén, Diego (author), Fleider, Laura (author), Tatti, Silvio (author), Villagra, Verónica (author), Venegas, Gino (author), Cruz Valdez, Aurelio (author), Valencia, Marleny (author), Rodríguez, Guillermo (author), Terán, Carolina (author), Picconi, María Alejandra (author), Ferrera, Annabelle (author), Kasamatsu, Elena Satiko (author), Mendoza Torres, Laura Patricia (author), Calderón, Alejandro (author), Luciani, Silvana (author), Broutet, Nathalie (author), Darragh, Teresa M. (author), Almonte, Maribel (author), Herrero, Rolando (author)
Format: article
Language:English
Published: 2023
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Online Access:https://doi.org/10.1016/j.lana.2023.100593
http://hdl.handle.net/20.500.14066/4423
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author Ramírez, Arianis Tatiana
author2 Valls, Joan
Baena, Armando
Rojas, Freddy David
Ramírez, Katherine
Álvarez, Rodrigo
Cristaldo, Carmen
Henríquez, Odessa
Moreno, Adrián
Colque Reynaga, Daysi
González Palma, Hans
Robinson, Isabel
Hernández, Diana Carolina
Bardales, Rosa
Cardinal, Lucía
Salgado, Yuly
Martínez, Sandra
González, Emmanuel
Guillén, Diego
Fleider, Laura
Tatti, Silvio
Villagra, Verónica
Venegas, Gino
Cruz Valdez, Aurelio
Valencia, Marleny
Rodríguez, Guillermo
Terán, Carolina
Picconi, María Alejandra
Ferrera, Annabelle
Kasamatsu, Elena Satiko
Mendoza Torres, Laura Patricia
Calderón, Alejandro
Luciani, Silvana
Broutet, Nathalie
Darragh, Teresa M.
Almonte, Maribel
Herrero, Rolando
author2_role author
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author_browse Almonte, Maribel
Baena, Armando
Bardales, Rosa
Broutet, Nathalie
Calderón, Alejandro
Cardinal, Lucía
Colque Reynaga, Daysi
Cristaldo, Carmen
Cruz Valdez, Aurelio
Darragh, Teresa M.
Ferrera, Annabelle
Fleider, Laura
González Palma, Hans
González, Emmanuel
Guillén, Diego
Henríquez, Odessa
Hernández, Diana Carolina
Herrero, Rolando
Kasamatsu, Elena Satiko
Luciani, Silvana
Martínez, Sandra
Mendoza Torres, Laura Patricia
Moreno, Adrián
Picconi, María Alejandra
Ramírez, Arianis Tatiana
Ramírez, Katherine
Robinson, Isabel
Rodríguez, Guillermo
Rojas, Freddy David
Salgado, Yuly
Tatti, Silvio
Terán, Carolina
Valencia, Marleny
Valls, Joan
Venegas, Gino
Villagra, Verónica
Álvarez, Rodrigo
author_facet Ramírez, Arianis Tatiana
Valls, Joan
Baena, Armando
Rojas, Freddy David
Ramírez, Katherine
Álvarez, Rodrigo
Cristaldo, Carmen
Henríquez, Odessa
Moreno, Adrián
Colque Reynaga, Daysi
González Palma, Hans
Robinson, Isabel
Hernández, Diana Carolina
Bardales, Rosa
Cardinal, Lucía
Salgado, Yuly
Martínez, Sandra
González, Emmanuel
Guillén, Diego
Fleider, Laura
Tatti, Silvio
Villagra, Verónica
Venegas, Gino
Cruz Valdez, Aurelio
Valencia, Marleny
Rodríguez, Guillermo
Terán, Carolina
Picconi, María Alejandra
Ferrera, Annabelle
Kasamatsu, Elena Satiko
Mendoza Torres, Laura Patricia
Calderón, Alejandro
Luciani, Silvana
Broutet, Nathalie
Darragh, Teresa M.
Almonte, Maribel
Herrero, Rolando
author_role author
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dc.contributor.other.es.fl_str_mv Universidad Nacional de Asunción. Instituto de Investigaciones en Ciencias de la Salud
dc.creator.none.fl_str_mv Ramírez, Arianis Tatiana
Valls, Joan
Baena, Armando
Rojas, Freddy David
Ramírez, Katherine
Álvarez, Rodrigo
Cristaldo, Carmen
Henríquez, Odessa
Moreno, Adrián
Colque Reynaga, Daysi
González Palma, Hans
Robinson, Isabel
Hernández, Diana Carolina
Bardales, Rosa
Cardinal, Lucía
Salgado, Yuly
Martínez, Sandra
González, Emmanuel
Guillén, Diego
Fleider, Laura
Tatti, Silvio
Villagra, Verónica
Venegas, Gino
Cruz Valdez, Aurelio
Valencia, Marleny
Rodríguez, Guillermo
Terán, Carolina
Picconi, María Alejandra
Ferrera, Annabelle
Kasamatsu, Elena Satiko
Mendoza Torres, Laura Patricia
Calderón, Alejandro
Luciani, Silvana
Broutet, Nathalie
Darragh, Teresa M.
Almonte, Maribel
Herrero, Rolando
dc.date.accessioned.none.fl_str_mv 2024-07-10T20:53:48Z
dc.date.available.none.fl_str_mv 2024-07-10T20:53:48Z
dc.date.issued.none.fl_str_mv 2023-09-20
dc.format.extent.es.fl_str_mv 11 páginas
dc.identifier.citation.en.fl_str_mv Ramírez, A. T., Valls, J., Baena, A., Rojas, F. D., Ramírez, K., Álvarez, R., Cristaldo, C., Henríquez, O., Moreno, A., Reynaga, D. C., Palma, H. G., Robinson, I., Hernández, D. C., Bardales, R., Cardinal, L., Salgado, Y., Martínez, S., González, E., Guillén, D., Fleider, L., … ESTAMPA Study Group. (2023). Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study. The Lancet Regional Health Americas, 26, Artículo 100593. https://doi.org/10.1016/j.lana.2023.100593
dc.identifier.doi.es.fl_str_mv 10.1016/j.lana.2023.100593
dc.identifier.essn.es.fl_str_mv 2667-193X
dc.identifier.other.es.fl_str_mv https://doi.org/10.1016/j.lana.2023.100593
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.14066/4423
dc.language.iso.es.fl_str_mv eng
dc.publisher.es.fl_str_mv The Lancet
dc.relation.projectCONACYT.es.fl_str_mv 14-INV-036
PINV18-256
dc.rights.*.fl_str_mv Attribution-NonCommercial-NoDerivs 3.0 Intergovernmental Organization
dc.rights.accessRights.es.fl_str_mv info:eu-repo/semantics/openAccess
dc.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/3.0/igo/
dc.subject.classification.es.fl_str_mv 7. Salud
7.2. Abarca desde medicina preventiva, incluyendo todos los aspectos de tratamientos médicos y quirúrgicos, tanto para individuos como para grupos, y las provisiones de hospitales y cuidado domiciliario, medicina social e investigación pediátrica y geriátrica
dc.subject.ocde.es.fl_str_mv 3. Ciencias Médicas y de la Salud
3.3. Ciencias de la Salud (salud pública, medicina social, higiene, enfermería, epidemiología)
dc.subject.other.es.fl_str_mv América Latina
Citología
Colposcopía
Detección precoz del cáncer
Displasia del cuello del útero
Infecciones por papillomavirus
Neoplasias del cuello uterino
Tamizaje masivo
Virus del Papiloma Humano
Latin America
Cytology
Colposcopy
Early detection of cancer
Uterine cervical dysplasia
Papillomavirus infections
Uterine cervical neoplasms
Mass screening
Human Papillomavirus Viruses
dc.title.es.fl_str_mv Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study
dc.type.es.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
description Corresponding author. E-mail address: ramirezt@iarc.who.int (A.T. Ramírez).
eu_rights_str_mv openAccess
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identifier_str_mv Ramírez, A. T., Valls, J., Baena, A., Rojas, F. D., Ramírez, K., Álvarez, R., Cristaldo, C., Henríquez, O., Moreno, A., Reynaga, D. C., Palma, H. G., Robinson, I., Hernández, D. C., Bardales, R., Cardinal, L., Salgado, Y., Martínez, S., González, E., Guillén, D., Fleider, L., … ESTAMPA Study Group. (2023). Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study. The Lancet Regional Health Americas, 26, Artículo 100593. https://doi.org/10.1016/j.lana.2023.100593
10.1016/j.lana.2023.100593
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publishDate 2023
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repository.mail.fl_str_mv repositorio.institucional@conacyt.gov.py
repository.name.fl_str_mv Repositorio Institucional CONACYT
repository_id_str
rights_invalid_str_mv Attribution-NonCommercial-NoDerivs 3.0 Intergovernmental Organization
http://creativecommons.org/licenses/by-nc-nd/3.0/igo/
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Instituto de Investigaciones en Ciencias de la Salud2024-07-10T20:53:48Z2024-07-10T20:53:48Z2023-09-20Ramírez, A. T., Valls, J., Baena, A., Rojas, F. D., Ramírez, K., Álvarez, R., Cristaldo, C., Henríquez, O., Moreno, A., Reynaga, D. C., Palma, H. G., Robinson, I., Hernández, D. C., Bardales, R., Cardinal, L., Salgado, Y., Martínez, S., González, E., Guillén, D., Fleider, L., … ESTAMPA Study Group. (2023). Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study. The Lancet Regional Health Americas, 26, Artículo 100593. https://doi.org/10.1016/j.lana.2023.100593https://doi.org/10.1016/j.lana.2023.100593http://hdl.handle.net/20.500.14066/442310.1016/j.lana.2023.1005932667-193XCorresponding author. E-mail address: ramirezt@iarc.who.int (A.T. Ramírez).Artículo científico premiado con una Mención Honorífica por el Premio Nacional de Ciencias de la edición 2024, otorgado por la Honorable Cámara de Senadores del Congreso Nacional de la República del Paraguay.Background. Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30–64 years participating in the ESTAMPA study. Methods. Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings. 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0–53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3–96.7). Specificity was 96.5% (95% CI: 96.3–96.7) using cytology and 88.7% (95% CI: 88.3–89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%–100% and 83.6–90.8%, respectively). Interpretation. The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America.Consejo Nacional de Ciencia y TecnologíaPrograma Paraguayo para el Desarrollo de la Ciencia y Tecnología. Proyectos de investigación y desarrollo11 páginasengThe LancetAttribution-NonCommercial-NoDerivs 3.0 Intergovernmental Organizationhttp://creativecommons.org/licenses/by-nc-nd/3.0/igo/info:eu-repo/semantics/openAccess© 2023 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND IGO license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/).7. Salud7.2. Abarca desde medicina preventiva, incluyendo todos los aspectos de tratamientos médicos y quirúrgicos, tanto para individuos como para grupos, y las provisiones de hospitales y cuidado domiciliario, medicina social e investigación pediátrica y geriátricaAmérica LatinaCitologíaColposcopíaDetección precoz del cáncerDisplasia del cuello del úteroInfecciones por papillomavirusNeoplasias del cuello uterinoTamizaje masivoVirus del Papiloma HumanoLatin AmericaCytologyColposcopyEarly detection of cancerUterine cervical dysplasiaPapillomavirus infectionsUterine cervical neoplasmsMass screeningHuman Papillomavirus Viruses3. Ciencias Médicas y de la Salud3.3. Ciencias de la Salud (salud pública, medicina social, higiene, enfermería, epidemiología)Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA studyinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionThe Lancet Regional Health – Americas14-INV-036PINV18-25626Ramírez, Arianis TatianaValls, JoanBaena, ArmandoRojas, Freddy DavidRamírez, KatherineÁlvarez, RodrigoCristaldo, CarmenHenríquez, OdessaMoreno, AdriánColque Reynaga, DaysiGonzález Palma, HansRobinson, IsabelHernández, Diana CarolinaBardales, RosaCardinal, LucíaSalgado, YulyMartínez, SandraGonzález, EmmanuelGuillén, DiegoFleider, LauraTatti, SilvioVillagra, VerónicaVenegas, GinoCruz Valdez, AurelioValencia, MarlenyRodríguez, GuillermoTerán, CarolinaPicconi, María AlejandraFerrera, AnnabelleKasamatsu, Elena SatikoMendoza Torres, Laura PatriciaCalderón, AlejandroLuciani, SilvanaBroutet, NathalieDarragh, Teresa M.Almonte, MaribelHerrero, RolandoORIGINALPerformance of cervical cytology and HPV testing.pdfPerformance of cervical cytology and HPV testing.pdfArtículo científicoapplication/pdf374812http://repositorio.conacyt.gov.py/bitstream/20.500.14066/4423/1/Performance%20of%20cervical%20cytology%20and%20HPV%20testing.pdfa30a6762d9d0dc21e25c477566e26040MD51Appendix A. Supplementary data.docxAppendix A. Supplementary data.docxMaterial Suplementarioapplication/vnd.openxmlformats-officedocument.wordprocessingml.document33808http://repositorio.conacyt.gov.py/bitstream/20.500.14066/4423/5/Appendix%20A.%20Supplementary%20data.docx65dd1e1eb2c1559fe0dfa92ffccd30eeMD55CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8805http://repositorio.conacyt.gov.py/bitstream/20.500.14066/4423/2/license_rdf4460e5956bc1d1639be9ae6146a50347MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-81698http://repositorio.conacyt.gov.py/bitstream/20.500.14066/4423/3/license.txt858b22fda432bd774e469302988c1974MD53THUMBNAILPerformance of cervical cytology and HPV testing.jpgPerformance of cervical cytology and HPV testing.jpgVista de primera página de artículo científicoimage/jpeg934739http://repositorio.conacyt.gov.py/bitstream/20.500.14066/4423/4/Performance%20of%20cervical%20cytology%20and%20HPV%20testing.jpg42772fa2d7e492de8e65dd74b794ab98MD54TEXTPerformance of cervical cytology and HPV testing.pdf.txtPerformance of cervical cytology and HPV testing.pdf.txtExtracted texttext/plain55277http://repositorio.conacyt.gov.py/bitstream/20.500.14066/4423/6/Performance%20of%20cervical%20cytology%20and%20HPV%20testing.pdf.txtc416ddd255c6119ee1b6674d4fd4565cMD5620.500.14066/4423oai:repositorio.conacyt.gov.py:20.500.14066/44232026-02-12 19:30:37.431Repositorio Institucional CONACYTrepositorio.institucional@conacyt.gov.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
spellingShingle Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study
Ramírez, Arianis Tatiana
7. Salud
7.2. Abarca desde medicina preventiva, incluyendo todos los aspectos de tratamientos médicos y quirúrgicos, tanto para individuos como para grupos, y las provisiones de hospitales y cuidado domiciliario, medicina social e investigación pediátrica y geriátrica
América Latina
Citología
Colposcopía
Detección precoz del cáncer
Displasia del cuello del útero
Infecciones por papillomavirus
Neoplasias del cuello uterino
Tamizaje masivo
Virus del Papiloma Humano
Latin America
Cytology
Colposcopy
Early detection of cancer
Uterine cervical dysplasia
Papillomavirus infections
Uterine cervical neoplasms
Mass screening
Human Papillomavirus Viruses
3. Ciencias Médicas y de la Salud
3.3. Ciencias de la Salud (salud pública, medicina social, higiene, enfermería, epidemiología)
status_str publishedVersion
title Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study
title_full Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study
title_fullStr Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study
title_full_unstemmed Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study
title_short Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study
title_sort Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America : an analysis within the ESTAMPA study
topic 7. Salud
7.2. Abarca desde medicina preventiva, incluyendo todos los aspectos de tratamientos médicos y quirúrgicos, tanto para individuos como para grupos, y las provisiones de hospitales y cuidado domiciliario, medicina social e investigación pediátrica y geriátrica
América Latina
Citología
Colposcopía
Detección precoz del cáncer
Displasia del cuello del útero
Infecciones por papillomavirus
Neoplasias del cuello uterino
Tamizaje masivo
Virus del Papiloma Humano
Latin America
Cytology
Colposcopy
Early detection of cancer
Uterine cervical dysplasia
Papillomavirus infections
Uterine cervical neoplasms
Mass screening
Human Papillomavirus Viruses
3. Ciencias Médicas y de la Salud
3.3. Ciencias de la Salud (salud pública, medicina social, higiene, enfermería, epidemiología)
url https://doi.org/10.1016/j.lana.2023.100593
http://hdl.handle.net/20.500.14066/4423