Eur J Gynaecol Oncol
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Eur J Gynaecol Oncol · Jan 2008
Clinical TrialPrognostic significance of high-risk HPV persistence after laser CO2 conization for high-grade CIN: a prospective clinical study.
To estimate the persistence rate of high-risk HPV DNA (HR-HPV DNA) in a population treated totally by laser CO2 conization for high-grade cervical intraepithelial neoplasia (HG-CIN), and to examine if this persistence might be considered an independent risk factor for relapsing disease. ⋯ Although able to reach a low recurrence rate of HG-CIN, laser CO2 conization does not remove HPV infection completely from the cervix with a case of persistence in every five treated patients. In our experience this persistence in itself represents an independent risk factor for developing relapsing disease and constitutes the basis to introduce HPV testing even in the follow-up of patients treated for HG-CIN by laser CO2 conization.
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Eur J Gynaecol Oncol · Jan 2008
Multicenter StudyNew concepts on risk factors of HPV and novel screening strategies for cervical cancer precursors.
During the past several years, this author has been engaged in coordinating two major multicentre trials testing optional screening tools for cervical cancer (CC) in low-resource settings both in East Europe and in Latin America. These international trials include the NIS (New Independent States of the former Soviet Union) cohort (n = 3,187 women) and the LAMS (Latin American Screening) study (n = 12,114 women). In both studies, a sizeable cohort of women (887 and 1,011, respectively) have been prospectively followed-up to assess the natural history of high-risk human papillomavirus (HR-HPV) infections and the role of implicated risk factors as potential predictors of disease outcome (acquisition, persistence and clearance). ⋯ Both the NIS cohort and LAMS study have significantly contributed to solving several of the open issues in the natural history of HR-HPV infections, including their risk factors, covariates necessary in cervical carcinogenesis as well as in sorting out the optional screening strategies in low-resource settings and for women in different age groups. In the long run, it is most likely that the cost-effectiveness will be the decisive factor for which screening tests will be selected. Needless to reiterate that screening for cervical cancer precursors will be mandatory until the foreseeable future, even in this emerging era of prophylactic HPV vaccination.