Browsing by Author "Almonte, Maribel"

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    Assessing participation of women in a cervical cancer screening program in Peru
    (PAN AMER HEALTH ORGANIZATION, 2009) Robles, Sylvia C.; Ferreccio, Catterina; Tsu, Vivien; Winkler, Jenny; Almonte, Maribel; Bingham, Allison; Lewis, Merle; Sasieni, Peter
    Objective. To assess systemic and individual factors influencing participation of women in a screening program for cervical cancer.
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    Cervical screening by visual inspection, HPV testing, liquid-based and conventional cytology in Amazonian Peru
    (WILEY, 2007) Almonte, Maribel; Ferreccio, Catterina; Winkler, Jennifer L.; Cuzick, Jack; Tsu, Vivien; Robles, Sylvia; Takahashi, Rina; Sasieni, Peter
    Cervical cancer is an important public health problem in many developing countries, where cytology screening has been ineffective. We compared four tests to identify the most appropriate for screening in countries with limited resources. Nineteen midwives screened 5,435 women with visual inspection (VIA) and collected cervical samples for HPV testing, liquid-based cytology (LBC) and conventional cytology (CC). If VIA was positive, a doctor performed magnified VIA. CC was read locally, LBC was read in Lima and HPV testing was done in London. Women with a positive screening test were offered colposcopy or cryotherapy (with biopsy). Inadequacy rates were 5% and 11% for LBC and CC respectively, and less than 0.1% for VIA and HPV. One thousand eight hundred eightyone women (84% of 2,236) accepted colposcopy/cryotherapy: 79 had carcinoma in situ or cancer (CIS+), 27 had severe- and 42 moderate-dysplasia on histology. We estimated a further 6.5 cases of CIS+ in women without a biopsy. Sensitivity for CIS+ (specificity for less than moderate dysplasia) was 41.2% (76.7%) for VIA,95.8% (89.3%) for HPV, 80.3% (83.7%) for LBC, and 42.5% (98.7%) for CC. Sensitivities for moderate dysplasia or worse were better for VIA (54.9%) and less favourable for HPV and cytology. In this setting, VIA and CC missed the majority of high-grade disease. Overall, HPV testing performed best. VIA gives immediate results, but will require investment in regular training and supervision. Further work is needed to determine whether screened-posilive women should all be treated or triaged with a more specific test. (c) 2007 Wiley-Liss, Inc.
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    New Approaches to Cervical Cancer Screening in Latin America and the Caribbean
    (ELSEVIER SCI LTD, 2008) Herrero, Rolando; Ferreccio, Catterina; Salmeron, Jorge; Almonte, Maribel; Ines Sanchez, Gloria; Lazcano Ponce, Eduardo; Jeronimo, Jose
    Cervical cancer remains an important public health problem in the Latin America and Caribbean region (LAC), with an expected significant increase in disease burden in the next decades as a result of population ageing. Prophylactic human papillomavirus (HPV) vaccine is currently unaffordable in LAC countries, However, even if vaccination was implemented, an additional two decades will be required to observe its impact on HPV related disease and cancer. With some exceptions, cytology-based screening programs have been largely ineffective to control the problem in the region, and there is a need for new approaches to the organization of screening and for use of newly developed techniques. Several research groups in LAC have conducted research on new screening methods, some of which are summarized in this paper. A recommendation to reorganize screening programs is presented considering visual inspection for very low resource areas, improvement of cytology where it is operating successfully and HPV DNA testing followed by visual inspection with acetic acid (VIA) or cytology as soon as this method becomes technically and economically sustainable. This could be facilitated by the incorporation of new, low-cost HPV DNA testing methods and the use of self-collected vaginal specimens for selected groups of the population. An important requisite for screening based on HPV testing will be the quality assurance of the laboratory and the technique by validation and certification measures. (C) 2008 Elsevier Ltd. All rights reserved.
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    Risk Factors for High-Risk Human Papillomavirus Infection and Cofactors for High-Grade Cervical Disease in Peru
    (BMJ PUBLISHING GROUP, 2011) Almonte, Maribel; Ferreccio, Catterina; Gonzales, Miguel; Delgado, Jose Manuel; Buckley, C. Hilary; Luciani, Silvana; Robles, Sylvia C.; Winkler, Jennifer L.; Tsu, Vivien D.; Jeronimo, Jose; Cuzick, Jack; Sasieni, Peter
    Objective: To evaluate the association between potential risk factors for high-risk human papillomavirus (HR-HPV) infection and cofactors for cervical intraepithelial lesions grade 2 or worse (CIN2+) in women attending cervical screening in Amazonian Peru.
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    Visual Inspection after Acetic Acid (VIA) Is Highly Heterogeneous in Primary Cervical Screening in Amazonian Peru
    (2015) Almonte, Maribel; Ferreccio Readi, Catterina; Luciani, Silvana; Gonzales, Miguel; Delgado, José M.; Santos, Carlos; Álvarez, Manuel; Cuzick, Jack; Sasieni, Peter