HPV Testing In Polish POpulation-based Cervical Cancer Screening Program.

NCT ID: NCT04111835

Last Updated: 2024-02-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 33000 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-10-28
• Study Completion Date: 2023-12-31

Brief Summary

The HIPPO PROJECT is a randomized healthcare study nested in the OCCSP in Poland. This project will assess the performance of the new screening test (HR HPV test) before its implementation in Poland.

Detailed Description

The study assumes randomized assumption of 33,000 women aged 30-59 to cytology or HR HPV test in a 1:1 ratio with age stratification (three strata: 30-39, 40-49 and 50-59 years).

Patients are recruited by the Cervical Cancer Prevention Clinic at the Department of Cancer Prevention at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw (main centre) and 8 more sites from distant regions of Poland (Lublin, Masovian, Silesian, Swietokrzyskie and West Pomeranian Voivodeship). All sites are selected through a tendering process and have to fulfil several criteria for inclusion into the project (active participation in the OCCSP, being certified for HPV testing with the chosen clinically validated hrHPV DNA assays)to obtain results representative for the entire country.

Gynaecological clinics:

Lublin Voivodeship:

• Non-Public Health Care Department MED -SPEC in Zamosc
• Plus Clinic in Zamosc
• Medical Center - Diagnostic in Lukow

Masovian Voivodeship:

• Medical Center - Diagnostic Siedlce, Kleeberg Street 2 Minsk Mazowiecki, Dąbrówki Street 2 Lukow, Krynka Street 1C Nur, Drohiczyńska Street 8, Sterdyn, Lipowa Street 1A, 08-320 Sterdyn Zelechow, Piłsudskiego Street 34 Strachowka, Norwida Street 6A Wierzbno, Wierzbno Street 88 Latowicz, Nowowiejska Street 34, Wielgolas
• Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw
• St. John Paul II Mazovian Provincial Hospital in Siedlce

Silesian Voivodeship:

• Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw on Gliwice
• SUPRA-MED in Bielsko-Biała
• SUPRA-MED in Wilkowice
• Gynecology and Obstetrics Clinic "K na Żeromskiego" in Wodzisław Slaski
• Medical Center in Rybnik
• Non-public Health Care JARO in Wodzisław Slaski
• Non-public Health Care EVA in Lubliniec
• SIKORNIK Clinic in Gliwice

Swietokrzyskie Voivodeship:

• Holy Cross Cancer Centre in Kielce

West Pomeranian Voivodeship:

• Non-public Health Care MULTIMED Gynecology and Obstetrics in Koszalin Koszalin, Monte Casino Street 13 Koszalin, Sw. Wojciecha Street 1 Koszalin, Kolejowa Street 71 Koszalin, Lelewela Street7 Bedzino Street 18
• "Hospital in Szczecinek"

Cytological&molecular laboratories

• Maria Sklodowska-Curie National Research Institute of Oncology; Roentgen Street 5, Warsaw, Armii Krajowej Street 15, 44-102 Gliwice (branch in Gliwice),
• Holy Cross Cancer Centre; Prezydent Stefan Artwinski Street 3, 25-734 Kielce,
• Medical Center - Diagnostic; Niklowa Street 9, 08-110 Siedlce,
• ALAB Laboratories; Stępinska Street 22/30, 00-739 Warsaw,
• Non-public Health Care Center MEDITEST Medical Diagnostics; Bronislawy Street 14D, 70-533 Szczecin,
• Non-public Health Care MULTIMED Gynecology and Obstetrics; Monte Casino Street 13, 75-414 Koszalin,
• Non-Public Health Care Department of Pathomorphology ALFAMED. Edward Cwierz, Maciej Cwierz; Jana Kilinskiego Street 78, 22a-400 Zamosc,
• Femina. Medical Centre; Klodnicka Street 23, 40-703 Katowice.

Colposcopy clinics

• Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw
• Non-public Health Care Center MEDITEST Medical Diagnostics in Szczecin
• Maria Sklodowska-Curie National Research Institute of Oncology in Gliwice
• Non-public Health Care MULTIMED Gynecology and Obstetrics
• St. John Paul II Mazovian Provincial Hospital in Siedlce
• Femina. Medical Centre in Katowice
• Holy Cross Cancer Centre in Kielce
• Medical Center - Diagnostic in Siedlce
• Non-Public Health Care Department of Pathomorphology ALFAMED. Edward Cwierz, Maciej Cwierz in Zamosc

The primary endpoint is the detection rate (DR) of histologically confirmed CIN2 or higher in each screening arm and detection rate ratio (DRR) of CIN2+ in HPV test vs cytology arm in intention-to-treat (ITT) analysis. Secondary endpoints include detection rate ratio of CIN1+, CIN3+ (including adenocarcinoma in situ) and invasive CC in both ITT and per-protocol (PP) analysis, restricted to women who adhered to the foreseen follow-up.

Other outcome measures are: (1) distribution of women by the screening test results; (2) referral rate for colposcopy; (3) compliance with referral for colposcopy; (4) positive predictive value of referral for colposcopy calculated for each screening test and separately by histology results (no CIN, CIN1, CIN2, CIN3, AIS, CIN2+, CIN3+, invasive cancer (squamous/adenocarcinoma)); (5) DR of histologically confirmed CIN2+ in patients with hrHPV positive test, two NILM LBCs six months apart and a positive CINtePlus Cytology and/or Qiasure test; (6) DRR of histologically confirmed CIN2+ after CINtec® PLUS Cytology test vs. QIASURE methylation test; (7) yield of use of CINtec® PLUS Cytology test vs. QIASURE methylation test in terms of detection rate of histologically confirmed CIN2+.

Additionally, biobanking of cytological samples taken from patients participating in the HIPPO Project is planned in Maria Sklodowska-Curie National Research Institute of Oncology for the purpose of potential future restrospective analyses if new cervical cancer screening technologies emerge.

The study was approved by the Bioethics Committee of National Research Institute of Oncology (ID: 28/2019/1/2020).

Conditions

Cervical Cancer

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Conventional exfoliative cytology/LBC

According to current Polish guidelines:

ASC-US: repeat Pap testing in 6 months - current standard protocol

LSIL - repeat Pap testing in 6 months or refer for colposcopy (by the decision of cytologist) - current standard protocol

ASC-H and higher and all glandular lesions - refer for colposcopy - current standard protocol

Colposcopy-targeted biopsies will be taken in agreement with national guidelines.

If screening cytology is negative -> rescreening after 3 years.

Group Type: NO_INTERVENTION

No interventions assigned to this group

hrHPV molecular testing

hrHPV-positive - reflex LBC:

Abnormal reflex LBC (ASC-US or worse) -> colposcopy

Normal reflex LBC -> repeat LBC in 6 months

Positive - colposcopy

Negative -> The CINtec PLUS Cytology and The QIASURE methylation test

The CINtec PLUS Cytology Positive -> colposcopy Negative -> rescreen in 3 years

The QIASURE methylation test Positive -> colposcopy Negative -> rescreen in 3 years

Colposcopy-targeted biopsies will be taken in agreement with national guidelines.

HPV-negative - rescreen in 5 years

Group Type: EXPERIMENTAL

Offering an alternative cervical cancer screening method - hrHPV molecular testing.

Intervention Type: DIAGNOSTIC_TEST

Women randomized to this screening strategy group will take a hrHPV molecular test.

hrHPV-positive - reflex LBC:

Abnormal reflex LBC (ASC-US or worse) -> colposcopy

Normal reflex LBC -> repeat LBC in 6 months

Positive - colposcopy

Negative - rescreen in 3 years

HPV-negative - rescreen in 5 years

Interventions

Offering an alternative cervical cancer screening method - hrHPV molecular testing.

Women randomized to this screening strategy group will take a hrHPV molecular test.

hrHPV-positive - reflex LBC:

Abnormal reflex LBC (ASC-US or worse) -> colposcopy

Normal reflex LBC -> repeat LBC in 6 months

Positive - colposcopy

Negative - rescreen in 3 years

HPV-negative - rescreen in 5 years

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

Inclusion Criteria

-women aged 30-59 with no screening Pap test within the preceding three years in the OCCSP and women with risk factors entitled to annual screening based on information from the SIMP and not tested within preceding 12 months (based on information from the screening database SIMP)

Exclusion Criteria

-women with screening Pap test within the preceding three years in the OCCSP

• Minimum Eligible Age: 30 Years
• Maximum Eligible Age: 59 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

Ministry of Health, Poland

OTHER_GOV

Sponsor Role: collaborator

Maria Sklodowska-Curie National Research Institute of Oncology

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw

Warsaw, , Poland

Countries

Poland

References

Glinska P, Komerska K, Janik B, Olkowicz J, Jedrzejewska I, Macios A, Wieszczy P, Kaminski MF, Arbyn M, Nowakowski A. HPV testing in Polish population-based cervical cancer screening programme (HIPPO project)-study protocol of a randomised healthcare policy trial. BMC Cancer. 2023 Nov 17;23(1):1118. doi: 10.1186/s12885-023-11597-5.

Reference Type: DERIVED

PMID: 37978452 (View on PubMed)

Other Identifiers

28/2019/1/2020

Identifier Type: OTHER

Identifier Source: secondary_id

28/2019

Identifier Type: -

Identifier Source: org_study_id