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In this article, Lab Insights summarises the key takeaways from AOGIN 2024. The bi-annual conference was held in Seoul, South Korea, this year, with the theme “Empowering Women, Together against Cervical Cancer”.

In the 14th meeting of the Asia-Oceania Research Organisation in Genital Infection and Neoplasia (AOGIN 2022), distinguished speakers from around the world gathered to talk about human papillomavirus (HPV) and the several cancers it can cause, the most notable among them being cervical cancer. Read more on the highlights at the link below:

In 2020, the WHO announced its goal of eliminating cervical cancer by 2030. Its ‘90-70-90’ target was to ensure that 90% of girls would be fully vaccinated against HPV by 15 years old; 70% of women would be screened with a high-performance test by age 35 and again by 45; and 90% of women identified with cervical disease would receive treatment.

To track efforts and measure the progress of this goal, the Asia-Pacific Economic Cooperation (APEC) Health Working Group recently released its Status Report on Cervical Cancer Elimination in the APAC Region. Read more on the key takeaways at the link below:

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Cervical cancer is the second most common cancer affecting women, with incidence and mortality rates on the rise. Women in the APAC region are more heavily affected by cervical cancer due to factors including inadequate or inaccessible screening and vaccination programmes and socioeconomic causes including stigma and lack of awareness.

In this whitepaper, the burden of women’s cancer (breast and cervical) were examined across 6 APAC countries. Using a benchmarking scorecard, the research examines and compares the quality of policies and programmes to tackle cancer based on recommendations set by the World Health Organisation (WHO). The following regional opportunities for improvement were identified:

1. Countries must demonstrate greater political will and leadership, and implement and update national elimination plans and strategies to align with WHO targets for cervical and breast cancer
2. Enhance performance tracking by building immunisation, screening and patient outcome registries for cervical and breast cancer
3. Focus on primary prevention by rolling out national immunisation programmes (HPV immunisation for cervical cancer) and secondary prevention by rolling out organised population-based national screening programmes (for both cervical and breast cancer)
4. Referral and treatment pathways for patients should be clear and well defined
5. Governments should prioritise women’s cancers as key policy areas to achieve national targets for immunisation, screening and treatment
6. Governments and global funding bodies should devise and implement effective and sustainable funding models
7. Services and programmes should be patient-centric and tailored to needs of affected populations in different settings
8. Consider integrated, holistic approaches to tackle resource and capacity challenges

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This WHO and HRP guideline is designed to help countries make faster progress, more equitably, on the screening and treatment of cervical cancer. It includes some important shifts in WHO’s recommended approaches to cervical screening, and includes a total of 23 recommendations and 7 good practice statements.

• Among the 23 recommendations, 6 are identical for both the general population of women and for women living with HIV and 12 are different and specific for each population.
• Among the 7 good practice statements, 3 are identical for both the general population of women and for women living with HIV and 2 are different and specific for each population.

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The Enduring Consensus Cervical Cancer Screening and Management Guidelines (Enduring Guidelines) effort is a standing committee of 19 organizations including medical professional societies, patient advocacy groups, and federal agencies, to continuously evaluate new technologies and approaches to cervical cancer screening, management, and surveillance.

In this study, the committee aimed to develop recommendations for dual stain (DS) testing with CINtec PLUS Cytology for use of DS to triage high-risk human papillomavirus (HPV)-positive results. Colposcopy was recommended for individuals testing DS-positive, for triage of positive HPV results from screening with primary HPV testing (with or without genotyping) or with cytology cotesting.

Find out more about the ASCCP Enduring Guideline Process.

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The incidence of AFP-negative HCC is increasing worldwide, particularly HCCs of nonviral etiology, such as MASLD/MASH. A high percentage of patients with MASLD/MASH-related HCC are positive for PIVKA-II, even those who are negative for AFP[1]. Higher levels of AFP-L3 have also been reported in cases of MASLD/MASH-related HCC [2]. Thus, the role of PIVKA-II and AFP-L3 measurements in HCC surveillance and diagnosis of AFP-negative HCCs has become more important.
This article by Prof Masatoshi Kudo details the importance of testing all 3 biomarkers, AFP, AFP-L3, and PIVKA-II, in HCC surveillance and management. He also discusses new algorithms, such as GALAD and GAAD, which incorporate these biomarkers have been useful in countries where access to imaging is limited.

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The recently published Chinese standards for the diagnosis and treatment of primary liver cancer [1] mention various screening strategies, including abdominal ultrasonography (US), serological tests such as alpha-fetoprotein (AFP) and protein induced by vitamin K absence/antagonist-II (PIVKA-II).

However, combined screening strategies may be associated with increased costs. The Chinese guidelines [2] highlight that there is a lack of health economic evaluations and evidence on the cost–effectiveness of different liver cancer screening strategies.

This study aims to compare the cost-effectiveness of seven screening strategies:

1. US
2. AFP
3. PIVKA-II
4. AFP+US
5. AFP+PIVKA-II
6. GAAD
7. GAAD+US

This was done by developing a health economic model from the Chinese healthcare system perspective to identify the most cost-effective strategy for early detection of liver cancer in patients with chronic hepatitis B in China.