Marcel Zwahlen

Autoprélèvement HPV et dépistage du cancer du col utérin

Carcinogenic human papillomavirus (HPV) infections cause the majority of cervical cancers (CC). While vaccination represents primary prevention, screening remains essential. HPV testing, more sensitive than cytology, is recommended as the primary method in some European countries. Among women aged ≥ 30 years, HPV selfsampling improves access to screening and can increase coverage of underscreened populations by up to 2.5-fold; several countries have adopted this approach. In Switzerland, where screening is opportunistic and only cytology is reimbursed, 30 % of women remain under-or unscreened. Introducing HPV self-sampling for underscreened women could contribute to the goals set by the World Health Organization. This review provides an overview of the situation in Switzerland and Europe regarding CC screening.

Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study

Objective To determine the spectrum of cancers in adolescents and young adults (AYAs) living with and without HIV in South Africa. Design Cross-sectional study with cancer records provided by the National Cancer Registry (NCR) and HIV records from the National Health Laboratory Service (NHLS). Setting and participants The NHLS is the largest provider of pathology services in the South African public sector. The NCR is a division of the NHLS. We included AYAs (aged 10–24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8479). HIV status was obtained through record linkages and text mining. Primary and secondary outcomes We determined the spectrum of cancers by HIV status in AYAs. We used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex, ethnicity and calendar period. We imputed (post hoc) the HIV status for AYA with unknown HIV status. Results 8479 AYAs were diagnosed with cancer, HIV status was known for 45% (n=3812). Of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi’s sarcoma (adjusted OR (aOR) 218, 95% CI 89.9 to 530), cervical cancer (aOR 2.18, 95% CI 1.23 to 3.89), non-Hodgkin’s lymphoma (aOR 2.12, 95% CI 1.69 to 2.66) and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27 to 5.86) than AYAs without HIV. About 44% (n=1062) of AYAs with HIV-related cancers had not been tested for HIV. Conclusions Targeted HIV testing for AYAs diagnosed with cancer, followed by immediate start of antiretroviral therapy, screening for cervical precancer and vaccination against human papilloma virus is needed to decrease cancer burden in AYAs living with HIV in South Africa.