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Abstract Cervical cancer screening in Brazil is opportunistic, based on cytology and offered for women aged 25–64 years, with low coverage (30%) and 70% of cancer diagnoses done in advanced stages, without impact on mortality. The current study reports 5-year first-round results of a population-based DNA-HPV testing screening program in a Brazilian city, which intended to be a model for transition to a more efficient program. Program flowchart is simple and current, indicating repetition of a negative test after five years. The first-round (October 2017-September 2022) screened 20,551 women by DNA-HPV testing with 58.7% coverage and 99.4% compliance with the program's targeted age range. Coverage increases to 77.8% when excluding the ‘pandemic period’. The DNA-HPV testing was 87.2% negative with 6.2% colposcopy referrals and 84.8% colposcopies performed. A total of 258 high-grade precursor lesions and 29 cervical cancers (mean age = 41.4 years, 83% Stage I) were detected. As a reference, 41,387 cytology tests from the previous program (2012–2016) detected 36 cervical cancers (mean age = 52.0 years, p = 0.0005), with 67% in advanced stages (p

Abstract Background The causal relationship between high-risk (hr) HPV infection and precancerous lesions or cervical cancer has led to the development of strategies to increase screening performance and prevent this cancer. The increased sensitivity of DNA-HPV testing compared to cervical cytology favors DNA-HPV testing as a primary screening test. Cervical cancer screening in Brazil is opportunistic, and this cancer remains a considerable health problem with a high proportion of diagnoses in advanced stages. This paper aims to describe the design and implementation of the Cervical Cancer Screening Program with primary DNA-HPV testing (CCSP-HPV) planned for Indaiatuba City (SP), Brazil; the strategies to achieve higher population coverage; and a study protocol for cost-effectiveness analyses. Methods The CCSP-HPV was designed based on successful guidelines that replaced cervical cytology-based screening by the DNA-HPV test performed at 5-year intervals. The screening will be performed for the female population aged 25-64 years cared for by the public health system and aim to reach 80% coverage after completing the first round. The chosen DNA-HPV test detects 14 hr-HPV types and genotypes HPV-16 and 18. All women with a negative test will be reassessed after five years. Women showing a positive test for HPV-16 and/or 18 will be referred for colposcopy. Those showing the other 12 hr-HPV types will be tested by cytology, and if any abnormality is detected, they will also be referred for colposcopy. The histopathologic evaluation will be reviewed by a pathologist panel and aided by p16 immunohistochemistry. A cost-effectiveness analysis will be performed by a Markov model comparing the cost of the new program and the screening performed by conventional cytology five years prior (2011–2016). Discussion The new screening program is considered a breakthrough for public health regarding cervical cancer, which is the third leading cause of cancer death among Brazilian women. Achieving at least 80% coverage will have the possibility to change this scenario. The proposed program will provide a modern cervical cancer screening method for women, and information about cost-effectiveness will help other similar places support the decision of implementing cervical cancer screening using the DNA-HPV test.

Summary: Background: Cervical cancer is a preventable disease, and the Brazilian screening is opportunistic and has low impact. The current study evaluated an initiative to organize screening using DNA–HPV testing as a replacement for cytology. Methods: This demonstration study examined information from 16 384 DNA–HPV tests for screening in women aged 25–64 years from Indaiatuba city between October 2017–March 2020. The comparison was 20 284 women screened using cytology between October 2014–March 2017. The flowchart indicates the repetition of a negative test in five years. HPV16- and/or HPV18-positive tests and the 12 pooled high–risk HPV-positive tests with abnormal liquid–based cytology were referred for colposcopy. If cytology was negative, the HPV test was repeated in 12 months. The analyses evaluated coverage, age–group compliance, and cancer detected. Findings: After 30 months, the coverage projection was greater than 80%. The age compliance for the HPV test was 99.25%, compared to 78.0% in the cytology program. The HPV test program showed 86.8% negative tests and 6.3% colposcopy referrals, with 78% colposcopies performed. The HPV testing program detected 21 women with cervical cancer with a mean age of 39.6 years, and 67% of cancers were early–stage compared to 12 cervical cancer cases detected by cytological screening (p=0.0284) with a mean age of 49.3 years (p=0.0158), and one case of early–stage (p=0.0014). Interpretation: Organizing cervical cancer screening using DNA–HPV testing demonstrated high coverage and age compliance in a real–life scenario, and it had an immediate impact on cervical cancer detection at an early–stage. Funding: University of Campinas, Indaiatuba City, and Roche Diagnostics.

Abstract Background A Brazilian guideline on cervical cancer screening was released in 2011. The objective was to verify changes in screening indicators around this period. Methods An audit study which sample was all screening tests performed by the public health system of Campinas city from 2010 to 2016. Variables were absolute tests numbers, excess tests, intervals and results, by age. For trend analysis was used Cochran-Armitage × 2 and linear regression. Results Were carried out 62,925 tests in 2010 and 43,523 tests in 2016, a tendency at a reduction (P = 0.001). Excess tests were higher than 50% over the years, with a tendency at a reduction (P

Introduction: The expansion of cytological screening programs for cervical cancer leads to an increase in the proportion of both adenocarcinomas and diagnoses in young women with reproductive intention. Conservative treatment is not fully established. Objective: to report the conservative management and follow-up difficulties of a real case of microinvasive cervical adenocarcinoma in a young woman. Case report: This is a case report of a 23-yearold patient with stage IA1 microinvasive cervical adenocarcinoma related to HPV18. The patient was vaccinated against HPV 16/18 at 16 years of age and conservatively treated. She became pregnant during follow-up with a favorable outcome. Conclusion: We discuss the difficulties and uncertainties regarding follow-up and opportunity for hysterectomy, emphasizing the need for a multidisciplinary approach to make a balanced decision between conservative treatment and oncological safety, as well as mitigate follow-up difficulties in real life.

OBJETIVO: Avaliar o uso da laparoscopia como método diagnóstico e terapêutico na abordagem inicial de tumores anexiais em população de risco para malignidade, bem como fatores clínicos associados à falha do método e conversão para laparotomia, e comparar taxas de complicação com pacientes cuja abordagem inicial se deu por laparotomia. MÉTODOS: Estudo prospectivo com 210 mulheres com exames de imagem prévios constando tumor anexial, das quais 133 foram incluídas. Destas, 45 foram submetidas à laparoscopia e 88, à laparotomia. Catorze das 45 cirurgias iniciadas por laparoscopia foram convertidas a laparotomia no intraoperatório. Foi avaliado se idade, índice de massa corporal (IMC), número de cirurgias abdominais prévias, CA-125, índice de risco de malignidade (IRM), diâmetro do tumor, duração da cirurgia e número de complicações cirúrgicas diferiram entre os grupos laparoscopia, laparoscopia com conversão à laparotomia e laparotomia. Foi também avaliado o motivo reportado pelos cirurgiões como falha da laparoscopia e a razão da conversão para laparotomia. RESULTADOS: A taxa de tumores malignos neste estudo foi de 30%. Houve diferença nos valores de CA-125, IRM e diâmetro do tumor entre os grupos laparoscopia e laparotomia. A duração da cirurgia foi maior no grupo de laparoscopias convertidas à laparotomia, porém as taxas de complicação cirúrgica foram semelhantes entre os grupos e, quando isolados os tumores benignos, as taxas de complicação cirúrgica da laparoscopia se mostraram inferiores à laparotomia. Dentre os fatores em estudo, apenas o tamanho do tumor esteve relacionado à conversão para laparotomia. CONCLUSÃO: Este estudo sugere que a abordagem inicial de pacientes com tumores anexiais de risco para malignidade é segura e não aumenta as taxas de complicação, mesmo em pacientes que necessitem de conversão para laparotomia; entretanto, nos casos de dúvida, é preciso avaliar a necessidade de consultar ginecologistas com experiência em laparoscopia avançada e no tratamento de câncer. O tamanho do tumor esteve relacionado à conversão para laparotomia.

OBJETIVO: avaliar o desempenho da citologia oncológica (CO), de captura híbrida II (CH II) e da inspeção visual com ácido acético na detecção de lesões pré-neoplásicas e neoplásicas cervicais. MÉTODOS: 2281 mulheres foram submetidas a exame clínico além da coleta de material para citologia, para CH II para detecção de DNA-HPV. Foi feita a inspeção visual do colo após aplicação do ácido acético a 5% (IVA). As mulheres com pelo menos um exame positivo eram convocadas para colposcopia, que também foi realizada em 420 mulheres com todos os exames normais. O desempenho dos testes foi calculado utilizando como padrão ouro a colposcopia com ou sem biopsia. RESULTADOS: a CO foi anormal em 209 mulheres (9,2%); a CH II foi positiva em 399 (17,5%) e em 249 (10,9%) foram encontradas alterações na IVA. Entre as 2281 mulheres avaliadas, 671 (29,4%) apresentaram pelo menos um resultado de exame positivo, embora apenas 82 (3,6%) apresentassem doença confirmada histologicamente (50 NIC1, 20 NIC2, sete NIC3 e cinco carcinomas invasores). As sensibilidades da IVA e da CH II foram semelhantes e significativamente maiores que a da CO. A especificidade da CO foi maior que a da IVA e da CH II. Nos casos com resultado de CO negativo, a IVA apresentou melhor desempenho comparada à CH II. CONCLUSÃO: o desempenho da CO associada à IVA foi melhor que o da CO associada à CH II e do que o da CO isolada.OBJECTIVE: to evaluate the performance of Pap smear, hybrid capture II (HC II), and visual inspection with acetic acid in the detection of pre-invasive and invasive cervical lesions. METHODS: a total of 2281 women were submitted to a clinical exam, including Pap smear, HC II for HPV DNA detection and visual inspection with 5% acetic acid (VIA). When at least one of the tests was positive, colposcopy was performed and targeted biopsies were taken from suspicious lesions. Colposcopy was also performed in 420 women with negative results. Test performance was evaluated, using colposcopy as the gold standard, with or without biopsy. RESULTS: Pap smear, VIA and HC II were positive in 9.2, 10.9 and 17.5% of all women screened, respectively. Although at least one positive test was found in 671 women (29.4%), only 82 (3.6%) presented histologically confirmed disease (50 NIC1, 20 NIC2, 7 NIC3, and 5 invasive carcinoma). VIA and HC II sensitivities were similar and significantly higher than Pap smear. Pap smear showed better specificity than VIA and than HC II. In women with a negative Pap smear result, VIA showed better performance than HC II. CONCLUSION: Pap smear combined with VIA performed better than Pap smear combined with HC II or than Pap smear alone.