Adino Tesfahun Tsegaye

Performance of the Alinity m HR HPV assay on self-collected vaginal samples compared to clinician-collected cervical samples

Human papillomavirus (HPV) testing using self-collected samples could increase cervical cancer screening among never screened or underscreened populations. This study aimed to evaluate the concordance between self-collected and clinician-collected samples using the Alinity m high risk (HR) HPV extended genotyping assay. Self-collected vaginal samples and clinician-collected cervical samples were obtained from 25 to 69-year-old women who had visits for cervical cancer screening, colposcopy, follow up pap test, and/or treatment of cervical dysplasia at the George Washington University Hospital in Washington DC and Sarasota Memorial Health Care System and their affiliates in Florida. Extended genotyping based on the Alinity m HR HPV assay was performed on stored residual samples and the agreement between clinician- and self-collected HPV test results was assessed using positive percent agreement and Cohen's kappa values. There were 294 participants who provided paired self and clinician-collected samples. The overall prevalence of any HR-HPV was 26 %(76/293) for clinician-collected samples and 27 %(79/291) for self-collected samples. The positive percent agreement between clinician- and self-collected samples for any HR-HPV was 78 %, and the Cohen's Kappa value was 0.83(95 %CI:0.76,0.91). For specific HPV genotypes, the positive percent agreement ranged from 72 % for HPV16-79 % for other HR-HPV group A (HPV31/33/52/58); and the Kappa value ranged from 0.83(95 %CI:0.68,0.98) for HPV16-0.87(95 %CI:0.77,0.97) for other HR-HPV group A. There was a strong test concordance between self-collected and clinician-collected samples using the Alinity m HR HPV assay. Self-collected samples tested with the Alinity m HR HPV assays can be considered an alternative to clinician-collected primary HPV testing.

Racial and ethnic differences in HPV-related cancer incidence in the United States, 2001-2020

Abstract Background Human papillomavirus (HPV) causes cervical cancer and a proportion of oropharyngeal, vulvar, vaginal, penile, and anal cancers. Evaluating racial and ethnic heterogeneity by anatomic site will identify populations with the highest cancer incidence rates (IRs) and help to optimize available prevention strategies. Methods Using the 2001-2020 US Cancer Statistics database, we estimated age-standardized IRs of cervical carcinoma, oropharyngeal, anal, vaginal, vulvar, and penile squamous cell carcinomas (SCCs) by race and ethnicity. We examined changes over time by comparing IRs in 2016-2020 with 2001-2005. Results Between 2001 and 2020, 750 897 HPV-related cancers occurred among 6.17 billion total person-years, with 61% (n = 455 475) in females. Among females, the highest IRs of oropharyngeal (1.6/100 000 person-years), vulvar (2.3/100 000 person-years), and anal (2.1/100 000 person-years) SCC were among White females. The highest IR for vaginal SCC (0.6/100 000 person-years) was among Black females and for cervical carcinoma (10.0/100 000 person-years) among Hispanic females. Among males, the highest IR for oropharyngeal SCC (8.0/100 000 person-years) was among White males, penile SCC (1.3/100 000 person-years) among Hispanic males, and anal SCC (1.5/100 000 person-years) among Black males. From 2001-2005 to 2016-2020, for most racial and ethnic groups, both in terms of absolute incidence, and proportion of the total HPV-related cancer burden, cervical carcinoma and vaginal SCC rates decreased, vulvar and anal SCC increased, and there was no clear pattern in oropharyngeal and penile SCC rates. Conclusion For all cancer types, there were disparate racial and ethnic patterns by anatomic site likely caused by a constellation of factors, including access to preventive care and site-specific HPV prevalence.

Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State

Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI. We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women. CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.

Association of Maternal Cervical Cancer Screening Adherence with Adolescent HPV Vaccination Among Adolescent-Mother Pairs

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.

Race‐specific temporal trends of HPV ‐related cancers in South Africa: An analysis of the South African National Cancer Registry, 2011–2022

Abstract Evaluating trends in HPV‐related cancer rates by race is essential for identifying high‐risk populations and improving prevention efforts. Using 2011–2022 South African National Cancer Registry data, we analyzed age‐standardized incidence rates by race and sex across three periods (2011–2014, 2015–2018, 2019–2022) using linear regression. Significant increases were observed for oropharyngeal squamous cell carcinoma (SCC) among White females ( p  &lt; .01), vulvar SCC among Asian ( p  &lt; .01) and Black ( p  = .02) females, and anal SCC among Colored females and Black males ( p  &lt; .01). Cervical carcinoma rates remained stable for most racial groups, except for the annual trends showing a 1.9% increase per year (95% CI = 1.0, 2.7) among White females. These findings suggest rising incidence rates for some HPV‐related cancers across racial groups in South Africa. Further research is needed to explore the constellation of risk factors contributing to these trends and to guide targeted interventions.

Modeling HPV Self-Sampling Impact on Cervical Cancer in East African Immigrants

Cervical cancer screening uptake among East African immigrants in the U.S. is low. Offering self-collected samples for human papillomavirus (HPV) testing increases screening coverage among underserved populations, but the potential impact on cervical cancer incidence and mortality is understudied. A Markov cohort state-transition model was used to predict the impact of primary HPV screening with self-sampling on cervical cancer incidence and mortality among East African immigrant women in Washington state. The model estimated cervical cancer cases and deaths for a hypothetical cohort from ages 25 to 80 years under alternative screening, diagnostic colposcopy and treatment scenarios. Base case scenarios compared primary HPV testing by clinician-sampling exclusively (standard of care) with self-sampling exclusively, assuming higher screening coverage (70% vs 63%) but lower colposcopy adherence with self-sampling (67% vs 83%) with equal treatment coverage of 85%, based on Washington state patient data. Sensitivity analyses with varied coverages, and also the combinations of the 2 strategies were evaluated. The model was developed and fitted between 2022 and 2024. In the base case scenario, an exclusive self-sampling strategy results in 4% higher cervical cancer incidence and mortality compared to the standard of care. Self-sampling results in lower cancer incidence and mortality if colposcopy adherence is raised to the level of the standard of care and/or if coverage is increased beyond 90%. In scenarios combining clinician- with self-sampling, the benefits of reaching more women with self-sampling are attenuated if more than 34% of screening is done by self-sampling. Self-sampling has the potential to improve cervical cancer prevention for underserved populations. The impact of the strategy can be enhanced with stronger linkage to follow-up care.