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BioMed Research International 2022Cervical cancer is a leading cause of mortality among women globally. Approaches to reduce cervical cancer incidence and mortality are "screen-and-treat," where positive...
BACKGROUND
Cervical cancer is a leading cause of mortality among women globally. Approaches to reduce cervical cancer incidence and mortality are "screen-and-treat," where positive primary test only is used in the treatment and "screen, triage and treat," where treatment is based on positive primary and triage tests with/without histological analysis.
OBJECTIVES
To determine cervical screening outcomes among HIV-infected and noninfected women using VIA, Pap smear, and HPV-PCR cervical screening methods and to determine the sensitivity, specificity, PPV and NPV of VIA, Pap smear, and HPV-PCR as primary test and sequential triage based on abnormal histopathology among HIV-infected and noninfected women. . This was a comparative cross-sectional study where women aged 18-46 years women underwent cervical screening and colposcopy-biopsy test as a positive-confirmatory test in the Referral Hospitals of Eastern Kenya.
RESULTS
A total of 317 (HIV negative: 156/317 (49.2%) and HIV positive: 161/317 (50.8%)) women were enrolled. Of these 81/317 (25.6%), 84/317 (26.5%), 96/317 (30.2%), and 78/122 (63.9%) participants had VIA, HPV DNA-PCR, Pap smear, and cervical histology positive results, respectively; average: 27.4% (HIV positive: 21.5%; HIV negative: 5.9%). Majority of women with LSIL [17/317 (5.4%)], HSIL [22/317 (6.9%)], invasive cancer [5/317 (1.6%)], cervicitis [45/317 (14.2%], and candidiasis 47/317 (14.8%) were HIV-infected ( < 0.001). 78/317 (24.6%) participants had positive histology test [ASCUS: 34/317 (10.7%) CIN1:17/317 (5.3%), CIN2: 16/317 (5.0%), CIN3:6/317 (1.9%), and ICC: 5/317 (1.6%)] ( > 0.001). A higher primary diagnostic accuracy was established by HPV DNA-PCR (sensitivity: 95.5%; specificity: 92.6%) than Pap smear and VIA test while in triage testing, high sensitivity was obtained by HPV DNA-PCR parallel testing with VIA test (92.6%) and Pap smear test (92.7%) and VIA cotesting with Pap smear (99.9%). HIV-infected women had increased specificity and reduced sensitivity and diagnostic accuracy by both primary and triage testing approaches. . Abnormal cervical screening outcome was high among HIV-infected than noninfected women. HIV-infected women had significantly high cases of cervical neoplastic changes. The diagnostic value of primary tests increased upon concurrent testing with other test methods hence reducing the number of women who would have been referred for biopsy.
CONCLUSION
High sensitivity and specificity in detection of CIN+ were established among HIV-infected than HIV noninfected women by HPV DNA-PCR and Pap smear than VIA test. HPV DNA-PCR test and Pap smear are more accurate in primary and sequential triage cervical screening based on abnormal histopathology outcomes among HIV-infected than noninfected women.
Topics: Cross-Sectional Studies; Early Detection of Cancer; Female; HIV Infections; Humans; Papanicolaou Test; Papillomaviridae; Papillomavirus Infections; Sensitivity and Specificity; Triage; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 36164451
DOI: 10.1155/2022/1930102 -
Asian Pacific Journal of Cancer... Oct 2020The aim of the study was to explore and describe perceptions of midwives on Papanicolaou (Pap smear) test during pregnancy.
PURPOSE
The aim of the study was to explore and describe perceptions of midwives on Papanicolaou (Pap smear) test during pregnancy.
METHODS
The study used qualitative, exploratory type of design. A probability purposive sampling was used to sample 12 registered midwives based in gynaecological units in a public hospital in Tshwane District, South Africa. Open-ended questionnaires, field notes, and audio tape were used to collect data. Data analysis process involved grouping and categorization into themes and sub-themes.
RESULTS
This study showed that majority of midwives lacked scientific knowledge behind Pap smear test during pregnancy. Some of the participants could relate with the test and verbalized that there may be complications such as bleeding, which may lead to miscarriage.
CONCLUSIONS
Findings showed that midwives were not performing Pap smear tests among pregnant women due lack of knowledge. This points out that Pap smear test is not prioritised as a secondary preventive tool at facility level. It is therefore recommended that refresher workshops be conducted at hospital level.
Topics: Adult; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Humans; Midwifery; Papanicolaou Test; Perception; Pregnancy; South Africa; Surveys and Questionnaires; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 33112565
DOI: 10.31557/APJCP.2020.21.10.3039 -
BMJ Open Feb 2022The objective of this cross-sectional study was to investigate the impact of socio-territorial characteristics on mammography and pap smear uptake according to the place...
OBJECTIVE
The objective of this cross-sectional study was to investigate the impact of socio-territorial characteristics on mammography and pap smear uptake according to the place of residence in the recommended age groups, and second outside the recommended age groups.
SETTING AND PARTICIPANTS
We used an existing dataset of 1 027 039 women which combines data from the Health Insurance information systems, with census data from Midi-Pyrénées, France.
PRIMARY AND SECONDARY OUTCOME MEASURES
Our outcome was, for each woman, the uptake of the pap smear and the uptake of the mammography during the year.
RESULTS
A social gradient of screening uptake was found in the recommended age groups. This gradient was stronger in large urban areas:(1) For mammography: decile 10 (the most deprived) vs 1 (the least deprived), adjusted OR 0.777, 95% CI (0.748 to 0.808) in large urban area; adjusted OR= 0.808 for decile 1 to 0.726 for decile 10 in other areas vs decile 1 in urban areas;(2) For pap smear: decile 10 vs 1 adjusted OR 0.66, 95%CI (0.642 to 0.679) in large urban areas; adjusted OR= 0.747 for decile 1 to 0.562 for decile 10 in other areas vs decile 1 in urban areas).Screening rates were globally higher in large urban areas.For mammography, the social and territorial disparities were higher outside the recommended age group.
CONCLUSIONS
Offering a universal approach to every woman, as it is often the case in nationally organised screening programmes, is likely to be insufficient to ensure real equity in access. Developing global dataset combining health data and diverse socioeconomic data, at individual and contextual levels, could enable a better understanding of the mechanisms involved in this social gradient, and therefore, the development of targeted territorial actions to improve equity of access to healthcare.
Topics: Breast Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Papanicolaou Test; Socioeconomic Factors; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 35193917
DOI: 10.1136/bmjopen-2021-055363 -
Computer Methods and Programs in... Oct 2023Cervical cancer affects around 0.5 million women per year, resulting in over 0.3 million fatalities. Therefore, repetitive screening for cervical cancer is of utmost...
BACKGROUND AND OBJECTIVES
Cervical cancer affects around 0.5 million women per year, resulting in over 0.3 million fatalities. Therefore, repetitive screening for cervical cancer is of utmost importance. Computer-assisted diagnosis is key for scaling up cervical cancer screening. Current recognition algorithms, however, perform poorly on the whole-slide image (WSI) analysis, fail to generalize for different staining methods and on uneven distribution for subtype imaging, and provide sub-optimal clinical-level interpretations. Herein, we developed CervixFormer-an end-to-end, multi-scale swin transformer-based adversarial ensemble learning framework to assess pre-cancerous and cancer-specific cervical malignant lesions on WSIs.
METHODS
The proposed framework consists of (1) a self-attention generative adversarial network (SAGAN) for generating synthetic images during patch-level training to address the class imbalanced problems; (2) a multi-scale transformer-based ensemble learning method for cell identification at various stages, including atypical squamous cells (ASC) and atypical squamous cells of undetermined significance (ASCUS), which have not been demonstrated in previous studies; and (3) a fusion model for concatenating ensemble-based results and producing final outcomes.
RESULTS
In the evaluation, the proposed method is first evaluated on a private dataset of 717 annotated samples from six classes, obtaining a high recall and precision of 0.940 and 0.934, respectively, in roughly 1.2 minutes. To further examine the generalizability of CervixFormer, we evaluated it on four independent, publicly available datasets, namely, the CRIC cervix, Mendeley LBC, SIPaKMeD Pap Smear, and Cervix93 Extended Depth of Field image datasets. CervixFormer obtained a fairly better performance on two-, three-, four-, and six-class classification of smear- and cell-level datasets. For clinical interpretation, we used GradCAM to visualize a coarse localization map, highlighting important regions in the WSI. Notably, CervixFormer extracts feature mostly from the cell nucleus and partially from the cytoplasm.
CONCLUSIONS
In comparison with the existing state-of-the-art benchmark methods, the CervixFormer outperforms them in terms of recall, accuracy, and computing time.
Topics: Female; Humans; Papanicolaou Test; Uterine Cervical Neoplasms; Early Detection of Cancer; Cervix Uteri; Diagnosis, Computer-Assisted
PubMed: 37451230
DOI: 10.1016/j.cmpb.2023.107718 -
Acta Cytologica 2017This editorial by Dr. Leopold G. Koss appeared in the January 1980 issue of Acta Cytologica. It addressed recent critical opinions in the general media on cervical... (Review)
Review
This editorial by Dr. Leopold G. Koss appeared in the January 1980 issue of Acta Cytologica. It addressed recent critical opinions in the general media on cervical screening and its costs. It marked the beginning of a more critical approach to cytology by the lay press, health care providers, and epidemiologists. It was also the first of a series of highly informative editorials by Dr. Koss that illustrated the critical issues of cytology during the 1980s. The elegance and clarity of his articles reflect the high standard of editorial writing in Acta Cytologica at this time. These articles are reviewed and excerpts are presented.
Topics: Early Detection of Cancer; Female; Humans; Mass Screening; Papanicolaou Test; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 28693015
DOI: 10.1159/000477653 -
Asian Pacific Journal of Cancer... 2016Despite the established role of the Pap smear test (PST) in prevention and early detection of cervical cancer, it is still rarely practiced in Sudan. Many challenges...
BACKGROUND
Despite the established role of the Pap smear test (PST) in prevention and early detection of cervical cancer, it is still rarely practiced in Sudan. Many challenges hinder the establishment of an effective cervical cancer screening program, including socio-cultural factors. Therefore, this study aimed to investigate the knowledge, attitudes and practices (KAP) of Sudanese women with regard to the Pap smear test and cervical cancer.
MATERIALS AND METHODS
A total of 500 married women aged 14 to 58 years were recruited from obstetric clinics, hospitals and universities in Khartoum in 2014. Data were collected using a standardized, pretested questionnaire that inquired socio-demographic characteristics and their KAP about cervical cancer and the PST.
RESULTS
More than 52% of participating women were above 30 years of age, and the majority (78.8%) were university degree holders. A total of 486 (97.2 %) of participants were resident in urban areas of Khartoum State. However about 48% of the respondents had never heard about PST, and only 15.8% of the participants had undergone a Pap smear test previously; 46.6% (233/500) knew that the human papilloma virus (HPV) was the causative agent, but only 39.2% (196/500) had heard about HPV vaccination, and only 11.4% (57/500) had received the vaccine. However 68% of the respondents agreed to do Pap smear if properly informed about the test and 75.4% of the respondents agreed to participate in a cervical cancer screening program.
CONCLUSIONS
Despite a high educational level, less than half of our participants had accurate knowledge about cervical cancer, HPV, and cervical cancer screening. Health education about cervical cancer, HPV and sexually transmitted infections and the role of PST in cervical cancer prevention are crucial when designing interventions aimed at improving cervical cancer screening for Sudanese women.
Topics: Adolescent; Adult; Cross-Sectional Studies; Early Detection of Cancer; Female; Follow-Up Studies; Health Education; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; Papanicolaou Test; Papillomaviridae; Papillomavirus Infections; Papillomavirus Vaccines; Prognosis; Sudan; Uterine Cervical Neoplasms; Vaccination; Vaginal Smears; Young Adult
PubMed: 26925654
DOI: 10.7314/apjcp.2016.17.2.625 -
Archives of Razi Institute Dec 2022The human papillomavirus (HPV) is a crucial but not the predominant cause of cervical cancer. This study aimed to identify gene expression in human papillomavirus using...
The human papillomavirus (HPV) is a crucial but not the predominant cause of cervical cancer. This study aimed to identify gene expression in human papillomavirus using a pap smear. A total of 120 serum samples, 60 samples were taken from infected females with papillomavirus and another 60 as healthy control. These samples were collected after pap smears were done. These women attended Al-Emam Hospital for delivery from March 1st, 2021, to February 28th, 2022. The levels of Pap-IgM and Pap-IgG were increasing among patients attacked by papilloma. The levels of viruses were higher than in levels than control groups, which was indicated by increases in the scores of mean and standard deviation (2.01±1.17, 0.11±0.02), (14.24±7.10, 0.4±0.17), respectively. Statistically, these differences between the levels of the studied groups were highly significant. The levels of the three markers Ca19.9, Ca125, and Ca15.3 were normal in levels among papilloma patients and the control group compared to the normal value of the three markers, which equaled N.V. (>37ng/ml). Statistically, these differences between the scores of the three markers, which were measured depending on mean and standard deviation, were highly significant. There is a low positive correlation between the levels of Pap-IgM (>1) with levels of Ca19.9 (>37) with (r=0.409**, =0.000), while there is a moderate association between the levels of Pap-IgM (>1) with Ca125 (>35ng/ml) and Ca15.3 (>37ng/ml) levels with (r=0.574**, 0.565**, =0.000, 0.000) respectively. Also, this table documents that there is a moderate positive correlation between the levels of Pap-IgG (>1) and the levels of the three tumor markers Ca19.9 (>37), Ca125 (>35), and Ca15.3 (>37) (r=0.521**, 0.592**, 0.647**). The gene expression was investigated in patients infected with Papillomaviruses compared to healthy controls using real-time PCR. The results showed a high Ct value for patients and controls with a high Ct value of templates, preoperational to the gene concentration.
Topics: Female; Humans; Human papillomavirus 16; Human Papillomavirus Viruses; Human T-lymphotropic virus 1; Immunoglobulin G; Immunoglobulin M; Papanicolaou Test; Papilloma; Papillomaviridae; Papillomavirus Infections; Vaginal Smears
PubMed: 37274879
DOI: 10.22092/ARI.2022.359292.2397 -
Journal of Gynecology Obstetrics and... Mar 2019Cervical polyps are benign neoplasms of the cervix and frequently asymptomatic; however, they may cause intermenstrual, postcoital, and postmenopausal bleeding. The...
Cervical polyps are benign neoplasms of the cervix and frequently asymptomatic; however, they may cause intermenstrual, postcoital, and postmenopausal bleeding. The excision of cervical polyps and necessity of endometrial sampling is remain controversial. The objective of our study was to determine the association between cervical polyps and smear and endometrial pathologies. 221 patients were included in the study and all patients data reviewed retrospectively. All patients were divided into two groups; 1. Premenopausal, 2. Postmenopausal. The groups were compared in terms of demographic information, histopathological results and polyp number and size. Also endometrial sampling results were divided; 1. premalignant-malignant group 2. benign group. There was a statistically significant difference between polyp size and premalignant and malignant endometrial pathologies in the postmenopausal patient group (p = 0.048 and p = 0.002). The cut-off value for polyp length was determined to be 19 mm and that for polyp volume was determined to be 2150 mm. The use of Pap smear screening before polypectomy can give information about malignancy potential of asymptomatic cervical polyps. However, if polyps sizes are length of >19 mm and volume of >2300 mm, especially in postmenopausal females endometrial sampling should be recommended.
Topics: Adult; Aged; Aged, 80 and over; Female; Gynecologic Surgical Procedures; Humans; Middle Aged; Papanicolaou Test; Polyps; Postmenopause; Premenopause; Retrospective Studies; Uterine Cervical Neoplasms
PubMed: 30660657
DOI: 10.1016/j.jogoh.2019.01.005 -
European Journal of Cancer Prevention :... Sep 2021Oral carcinoma and precancers are major public health challenges in India and other developing countries.
BACKGROUND
Oral carcinoma and precancers are major public health challenges in India and other developing countries.
OBJECTIVES
Aim of the study was to assess the associations of demographic characteristics, addictions, chief complaints of mouth/oral and clinical diagnosis by cytology smear and punch biopsy in early detection of oral premalignant and malignant lesions. Methods Study was designed on retrospective data of case files of CDC, CNCI, Kolkata, from patients attended from January 1996 to September 2016. History was taken, histopathology and Pap smear were performed. Descriptive statistical analysis, cross-tabulation and Pearson's Chi-square test were done.
RESULTS
Total participants (n = 692); 110 (15.9%) having history of swallowing betel leaf, nut lime, dokta, jarda, catecheu with an average of 11 years. Three hundred twenty-five (46.9%) had multiple addiction (cigarette/bidi/tobacco/all). Ninety-eight (12.1%), 99 (12.2%) and 68 (8.4%) were addicted to cigarette, bidi and chewing tobacco, respectively. Twenty-nine participants were addicted to alcohol; 18 (2.6%) and 11 (1.5%) took country and foreign alcohol correspondingly. Clinicians thoroughly examined lips (4.1%), buccal mucosa (27.3%), gingival (2.8%), tongue (23.1%), hard and soft palate (4.9%), mouth loor (5.2%) and other parts (32.3%); diagnosed participants as normal (22.8%)/benign (23.1%)/premalignant (39.1%)/malignant (14.8%). Smears confirmed 60, 131, 42, 9 and 8 cases as carcinoma, mild, moderate, severe dysplasia and inflammation, respectively. The punch biopsy identified 11 carcinomas, two severe, two moderate and seveeen mild dysplasia's. Chi-square test showed significant association between smear and examination (P = 0.022), diagnosis and examinations of the oral cancer patients (P = 0.0001).
CONCLUSION
The study provided strong evidence that betel leaf, chewing tobacco, smoking and alcohol are independent risk factors for oral cancer. Cytological smear and biopsy are cost-effective approaches for early detection.
Topics: Carcinoma; Female; Hospitals; Humans; Hyperplasia; India; Mouth Neoplasms; Papanicolaou Test; Precancerous Conditions; Retrospective Studies
PubMed: 33252366
DOI: 10.1097/CEJ.0000000000000640 -
African Journal of Reproductive Health Feb 2023Despite the lack of commercial sex activities as the localization has been shut down since 2014, former commercial sex workers (CSW) could be at risk for cervical...
Despite the lack of commercial sex activities as the localization has been shut down since 2014, former commercial sex workers (CSW) could be at risk for cervical cancer. Therefore, this study aimed to determine the prevalence of cervical cancer using early detection with Papanicolaou (Pap) smears in former CSW in this ex-localization area. This study was conducted with purposive sampling intended to be limited to former CSW and women who still live around this ex-localization area as a control group. This study included 76 women, 52.6% of whom were former CSW. Pap smear results showed no pre-cancerous lesions of the cervix in any of the participants. Comparisons between the CSW and control groups showed no differences in Pap smear results. Infection findings were found in 36.1% of CSW group. Early detection of human papillomavirus (HPV) DNA is necessary for identifying risk factors for cervical cancer in these populations.
Topics: Female; Humans; Uterine Cervical Neoplasms; Vaginal Smears; Sex Workers; Early Detection of Cancer; Papillomavirus Infections; Papanicolaou Test; Mass Screening
PubMed: 37584938
DOI: 10.29063/ajrh2023/v27i2.4