Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil

Zeferino, Luiz Carlos; Bastos, Joana Bragança; Vale, Diama Bhadra Andrade Peixoto do; Zanine, Rita Maria; Melo, Yara Lucia Mendes Furtado de; Primo, Walquíria Quida Salles Pereira; Corrêa, Flávia de Miranda; Val, Isabel Cristina Chulvis do; Russomano, Fábio

doi:10.1055/s-0038-1657754

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 40 (06) • June 2018 • https://doi.org/10.1055/s-0038-1657754 copy

Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil

Recomendações para o uso de testes de DNA-HPV no rastreamento do câncer do colo útero no Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Evidence-based clinical guidelines ensure best practice protocols are available in health care. There is a widespread use of human papillomavirus deoxyribonucleic acid (HPVDNA) tests in Brazil, regardless of the lack of official guidelines. On behalf of the Brazilian Association for the Lower Genital Tract Pathology and Colposcopy (ABPTGIC, in the Portuguese acronym), a team of reviewers searched for published evidence and developed a set of recommendations for the use of HPV-DNA tests in cervical cancer screening in Brazil. The product of this process was debated and consensus was sought by the participants. One concern of the authors was the inclusion of these tests in the assessment of women with cytologic atypia and women treated for cervical intraepithelial neoplasia (CIN). Testing for HPV is recommended in an organized screening scenario to identify women with precursor lesions or asymptomatic cervical cancer older than 30 years of age, and it can be performed every 5 years. It also has value after the cytology showing atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSILs) as a triage test for colposcopy, in the investigation of other cytological alterations when no abnormal findings are observed at colposcopy, seeking to exclude disease, or, further, after treatment of high-grade cervical intraepithelial neoplasia, to rule out residual disease.

Keywords:
screening; cervical neoplasms; DNA-HPV probes; cervical intraepithelial neoplasia; cytology

Certainty Level^* The United States Preventive Services Task Force (USPSTF) attributes a level of certainty based on the general nature of the evidence available to assess the net benefit of a preventive practice.3	Description
High	The available evidence usually includes consistent results from well-designed and well-conducted studies among the representative populations to which they apply. These studies assess the effects of the preventive practice on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.
Moderate	The available evidence is sufficient to establish the effects of the preventive practice on health outcomes, but confidence is limited by factors such as:• The number, size or quality of the individual studies• Inconsistency in the findings across individual studies• Limited generalizability of the findings to the routine practice• Lack of consistency in the chain of evidenceAs more information becomes available, the magnitude or direction of the observed effect may change, and this change may be large enough to alter the conclusion.
Low	The available evidence is insufficient to assess effects on health outcomes. The evidence is insufficient because of:• The limited number or size of the studies• Important flaws in the studies' designs or methods• Inconsistency in the findings across individual studies• Gaps in the chain of evidence• Findings not generalizable to the routine practice• Lack of information on important health outcomesMore information can allow estimates of the effects on health outcomes.

Grade	Definition^* The United States Preventive Services Task Force (USPSTF) defines certainty as the “likelihood that the USPSTF's assessment of the net benefit of a preventive practice is correct.” The net benefit is defined as the benefit minus the practice injury when implemented in a general population.2	Recommendations for practice
A	The practice is recommended. There is high certainty that the net benefit is substantial.	Offer or provide the practice.
B	The practice is recommended. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.	Offer or provide the practice.
C	The practice is not routinely recommended. There may be considerations that support the practice at an individual level. There is at least moderate certainty that the net benefit is small.	Offer or provide this service for selected patients depending on individual circumstances.
D	The practice is not recommended. There is moderate or high certainty that the practice has no net benefit, or that the damages outweigh the benefits.	Discourage the use of this practice.
I	The current evidence is insufficient to assess the balance between its benefits and harms. The evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.	Read the introductory text containing evidence obtained in the literature review that supports this recommendation. If the practice is offered, the patients should understand that there is uncertainty in the balance between benefits and harms.

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[1] Address for correspondence Fábio Russomano, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, da Fundação Oswaldo Cruz, Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ 22250-020, Brazil (e-mail: fabiorussomano@gmail.com).