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PloS One 2023In Brazil, during the pandemic caused by COVID-19, screening for breast and cervical cancers was postponed or interrupted due to the prevailing health conditions. These...
In Brazil, during the pandemic caused by COVID-19, screening for breast and cervical cancers was postponed or interrupted due to the prevailing health conditions. These neoplasms, however, are responsible for high morbidity and mortality among women in Brazil and have a major impact on the quality of life of this population and public health. Thus, this study aims to evaluate the epidemiological behavior of hospitalization for cervical and breast cancer in Brazilian women, as well as the trend of screening tests of breast and cervical cancer in the years 2010 to 2022 according to the regions of Brazil. This is ecological research of time series, based on secondary data obtained from information systems of the country, about hospital admissions for breast and cervical cancer and screening methods used for these tumors. The data were analyzed in the Joinpoint Regression Program, to obtain the linear regression and temporal analysis of the variables. As a result, between 2010 and 2022, the rates of mammography varied from 36 to 71 exams, while in the pap smear, the variations were 126 and 226 cytopathological exams per 1000 women. Hospitalizations for these cancers peaked in 2019, with 48 hospitalizations for cervical cancer per 100,000 women and 147 hospitalizations for breast cancer for the same population. For both, in the pandemic years, between 2020 and 2022, there is a decrease in Brazil and in all its regions. As for the tracking of these diseases, it was observed that the performance of mammograms and preventive tests showed a similar behavior, in which there is a higher supply of these tests until 2019 and a drop during the pandemic period. This leads to the conclusion that even though Brazil has several policies for the screening of these diseases, there is still instability in the offering of these tests and that there was instability in this area during the pandemic.
Topics: Female; Humans; Uterine Cervical Neoplasms; Vaginal Smears; Brazil; Quality of Life; Mass Screening; Early Detection of Cancer; Breast Neoplasms; Mammography; Hospitalization
PubMed: 37883452
DOI: 10.1371/journal.pone.0278011 -
Computational and Mathematical Methods... 2023Image processing has enabled faster and more accurate image classification. It has been of great benefit to the health industry. Manually examining medical images like...
Image processing has enabled faster and more accurate image classification. It has been of great benefit to the health industry. Manually examining medical images like MRI and X-rays can be very time-consuming, more prone to human error, and way more costly. One such examination is the Pap smear exam, where the cervical cells are examined in laboratory settings to distinguish healthy cervical cells from abnormal cells, thus indicating early signs of cervical cancer. In this paper, we propose a convolutional neural network- (CNN-) based cervical cell classification using the publicly available SIPaKMeD dataset having five cell categories: superficial-intermediate, parabasal, koilocytotic, metaplastic, and dyskeratotic. CNN distinguishes between healthy cervical cells, cells with precancerous abnormalities, and benign cells. Pap smear images were segmented, and a deep CNN using four convolutional layers was applied to the augmented images of cervical cells obtained from Pap smear slides. A simple yet efficient CNN is proposed that yields an accuracy of 0.9113% and can be successfully used to classify cervical cells. A simple architecture that yields a reasonably good accuracy can increase the speed of diagnosis and decrease the response time, reducing the computation cost. Future researchers can build upon this model to improve the model's accuracy to get a faster and more accurate prediction.
Topics: Female; Humans; Papanicolaou Test; Uterine Cervical Neoplasms; Privacy; Cervix Uteri; Neural Networks, Computer
PubMed: 37455684
DOI: 10.1155/2023/9676206 -
Journal of Lower Genital Tract Disease Jan 2024A follow-up of women 50 years or older with concomitant positive high-risk human papillomavirus (HPV) genotypes other than 16 and 18 (hrHPVO) and negative Pap test...
OBJECTIVE
A follow-up of women 50 years or older with concomitant positive high-risk human papillomavirus (HPV) genotypes other than 16 and 18 (hrHPVO) and negative Pap test (NILMPap) was conducted to better understand the implications of hrHPVO positivity on potential risk of developing significant high-grade lesions.
MATERIAL AND METHODS
A retrospective review of 2014 cytology data of patients with co-testing (Pap test and HPV DNA) identified 85 women 50 years or older with NILMPap and hrHPVO+.
RESULTS
Most patients (63) had repeat co-testing on next follow-up. Of these, 41 patients with persistent hrHPVO+ status, 3 developed cervical intraepithelial neoplasia 2 (CIN2), and 1 CIN3. Nineteen patients were followed with biopsies. Of these, 7 biopsies were abnormal, 5 of which showed low-grade (CIN1) and 2 high-grade (CIN3) histology; none progressed on further follow-up. Three patients were followed with Pap test only, all had NILMPap, and none progressed on further follow-up. In summary, of the 85 patients, 26 developed abnormal histology during follow-up, 6 of whom had high-grade histology (CIN2 and CIN3, 3 each).The 5-year risk of CIN1+ in this cohort was 43.8% and for CIN2+ was 12.3%. The risk of abnormal histology did not differ significantly by prior history of Pap tests, histology, and/or HPV results.
CONCLUSIONS
A persistent positivity for hrHPVO indicated higher likelihood to develop a lesion, and this risk was not reduced for patients 50 and older compared with the published screening population risk.
Topics: Humans; Female; Papanicolaou Test; Uterine Cervical Neoplasms; Follow-Up Studies; Papillomavirus Infections; Uterine Cervical Dysplasia; Genotype; Human Papillomavirus Viruses; Papillomaviridae; Vaginal Smears
PubMed: 37906566
DOI: 10.1097/LGT.0000000000000772 -
The European Journal of General Practice Dec 2023Cancer preventive services (gynaecological cancer screening, colon cancer screening) and cardiometabolic screening are recommended by guidelines to individuals. People...
BACKGROUND
Cancer preventive services (gynaecological cancer screening, colon cancer screening) and cardiometabolic screening are recommended by guidelines to individuals. People with diabetes were less likely to receive them than those without diabetes in some studies.
OBJECTIVES
To analyse differences in the coverage of preventive services in people with diabetes compared to non-diabetic individuals and in people with diabetes according to sex and household income.
METHODS
We analysed data collected from the European Health Interview Survey 2013-2015, including individuals aged 40-74 ( = 179,318), 15,172 with diabetes from 29 countries. The income of a household (HHI) was described in quintiles. The relationship between the coverage of preventive services (cardiometabolic, vaccination, cancer screening) and sociodemographic characteristics was analysed with multiple logistic regression.
RESULTS
Women comprised 53.8% of the total and 40% were 60-74 years. People with diabetes compared to those without diabetes had higher reported coverage of cardiometabolic screening (98.4% vs. 90.0% in cholesterol measurement; 97.0% vs. 93.6% in blood pressure measurement), colorectal cancer screening (27.1% vs. 24.6%) but lower coverage of gynaecological cancer screening (mammography: 29.2% vs. 33.5%, pap smear test: 28.3% vs. 37.9%). Among diabetic patients, women were less likely to receive cholesterol screening (OR = 0.81; 95% CI: 0.72-0.91) and colon cancer screening (OR = 0.79; 95% CI: 0.73-0.86) compared to men. Being affluent was positively associated with receiving cardiometabolic screening and mammography in diabetic patients.
CONCLUSION
People with diabetes reported higher coverage of preventive services except gynaecological cancer screening. Disparities were found in diabetes among women and less affluent individuals.
Topics: Male; Humans; Female; Diabetes Mellitus; Health Surveys; Cholesterol; Colonic Neoplasms; Cardiovascular Diseases; Mass Screening; Income
PubMed: 36661248
DOI: 10.1080/13814788.2022.2159941 -
Acta Cytologica Jun 2024Extrauterine malignancies in cervical samples are rarely seen. It is important to differentiate these cells from those of primary uterine malignancies to determine...
INTRODUCTION
Extrauterine malignancies in cervical samples are rarely seen. It is important to differentiate these cells from those of primary uterine malignancies to determine appropriate line of further investigations and management. Literature on these lesions is limited largely restricted to case reports. The aim of the present study was to study the spectrum and cytomorphological features of extrauterine malignancies in cervical Pap smears.
MATERIALS AND METHODS
It is a retrospective and descriptive study conducted in Department of Cytopathology from January 2019 to July 2023. All cases of extrauterine malignancies with available cytology material were included in this study. All cases of primary uterine malignancies, i.e., uterine corpus or cervix confirmed by clinical, radiological, and histopathological examination were excluded.
RESULTS
104 out of 11,674 cytology Pap smears were those of extrauterine malignancy. Diagnosis of extrauterine malignancy was given in 47.1% cases, 30.9% were reported as positive for malignancy without giving the possibility of an extrauterine origin, and 22.0% were reported as atypical glandular cells only. In 56 cases where Pap smear was the first investigation which led to the diagnosis. Most common extrauterine malignancy was adenocarcinoma principally from ovarian, colorectal, and vaginal origin. Other epithelial malignancies noted were urothelial carcinoma and invasive breast carcinoma. Among non-epithelial malignancies, we reported vaginal mucosal melanoma, cutaneous melanoma, acute leukaemia, and anaplastic large cell lymphoma.
CONCLUSION
High index of suspicion, presence of squamous and glandular elements with no atypical features, and occasional clusters of cells with marked atypia and usually no necrosis in the background are helpful cytomorphological clues to raise suspicion for extrauterine malignancy. Correlation with serology, radiology, and immunocytochemistry can help in reaching final diagnosis.
PubMed: 38952122
DOI: 10.1159/000539508 -
Viruses Aug 2023Cervical cancer screening typically involves a Pap smear combined with high-risk human papillomavirus (hr-HPV) detection. Women with hr-HPV positivity but normal...
Cervical cancer screening typically involves a Pap smear combined with high-risk human papillomavirus (hr-HPV) detection. Women with hr-HPV positivity but normal cytology, as well as those with precancerous abnormal cytology, such as low-grade squamous intraepithelial lesions (LSIL) and high-grade SIL (HSIL), are referred for colposcopy and histology examination to identify abnormal lesions, such as cervical intraepithelial neoplasia (CIN) and cervical cancer. However, in order to enhance the accuracy of detection, bioinformatics analysis of a microarray database was performed, which identified cg01009664, a methylation marker of the thyrotropin-releasing hormone (TRH). Consequently, a real-time PCR assay was developed to distinguish CIN2+ (CIN2, CIN3, and cervical cancer) from CIN2- (CIN1 and normal cervical epithelia). The real-time PCR assay utilized specific primers targeting methylated cg01009664 sites, whereas an unmethylated reaction was used to check the DNA quality. A cut-off value for the methylated reaction of Ct < 33 was established, resulting in improved precision in identifying CIN2+. In the first cohort group, the assay demonstrated a sensitivity of 93.7% and a specificity of 98.6%. In the cytology samples identified as atypical squamous cells of undetermined significance (ASC-US) and LSIL, the sensitivity and specificity for detecting CIN2+ were 95.0% and 98.9%, respectively. However, when self-collected samples from women with confirmed histology were tested, the sensitivity for CIN2+ detection dropped to 49.15%, while maintaining a specificity of 100%. Notably, the use of clinician-collected samples increased the sensitivity of TRH methylation testing. TRH methylation analysis can effectively identify women who require referral for colposcopy examinations, aiding in the detection of CIN2+.
PubMed: 37766209
DOI: 10.3390/v15091802 -
Gynecology and Minimally Invasive... 2024[This corrects the article on p. 77 in vol. 12, PMID: 37416097.].
[This corrects the article on p. 77 in vol. 12, PMID: 37416097.].
PubMed: 38487606
DOI: 10.4103/gmit.gmit_21_24 -
Heliyon Nov 2023This research presents a novel approach for cervical cancer detection and segmentation using tissue images with multiple cells. The study employs a novel deep learning...
This research presents a novel approach for cervical cancer detection and segmentation using tissue images with multiple cells. The study employs a novel deep learning architecture based on Mask Region-Based Convolutional Neural Network (RCNN) and statistical analysis. This new architecture enables us to achieve a high percentage of detection and pix-to-pix area segmentation. A mean Average Precision (mAP) higher than 60% for 3-class and 5-class was achieved. In addition, higher F1-scores of 70% for 3-class and 5-class were obtained. This investigation is a collaborative work, where a medical consultant collected the samples from the Papanicolaou (Pap) Smear examination and labeled the cells presented to the liquid-based cytology (LBC). Furthermore, the online available benchmark data set, , was also utilized. Additionally, sample images from the data set were also labeled by the trained medical consultant for comparison. The proposed scheme automatically generates a full report for a medical consultant to identify the location of the malicious cells in the given images and expedite the diagnosis and treatment process.
PubMed: 37964829
DOI: 10.1016/j.heliyon.2023.e21388 -
Pain Aug 2023The pain experienced during Pap tests is a crucial gap in reducing cervical cancer burden. This study sought to investigate whether adding a nonpainful step at the end... (Randomized Controlled Trial)
Randomized Controlled Trial
The pain experienced during Pap tests is a crucial gap in reducing cervical cancer burden. This study sought to investigate whether adding a nonpainful step at the end of Pap tests helps women recall less pain. We conducted a randomized controlled trial on women aged 30 to 70 years at a cervical cancer screening center. A nonpainful step was added at the end of Pap test in the modified Pap group. The outcomes included recalled pain after Pap smear screening, real-time pain, and 1-year willingness to receive further Pap tests. Among 266 subjects in the intention-to-treat analysis, the modified Pap group (n = 133) experienced lower 5-minute recalled pain than the traditional Pap group on a 1 to 5 numeric scale (mean [SD], 1.50 [0.77] vs 2.02 [1.12]; P < 0.001) and a 0 to 10 visual analog scale (2.12 [1.79] vs 3.12 [2.23]; P < 0.001). In exploratory subgroup analyses, the association between the modified Pap test and reduced 5-minute recalled pain was not affected by predicted pain, demographic, or socioeconomic characteristics, but it was more apparent in postmenopausal women. Consistently, the modified Pap test attenuated 1-year recalled pain on both pain scales. Furthermore, the modified Pap test increased 1-year willingness grade to receive further Pap tests (adjusted β [SE], 2.11 [0.27]; P < 0.001). In conclusion, adding a nonpainful step at the end of Pap smear screening reduces on-site and long-term recalled pain and strengthens willingness to undergo subsequent Pap tests regularly. The modified Pap test contributes to cervical cancer screening participation.
Topics: Female; Humans; Papanicolaou Test; Vaginal Smears; Uterine Cervical Neoplasms; Early Detection of Cancer; Pain Management; Mass Screening
PubMed: 37043729
DOI: 10.1097/j.pain.0000000000002897 -
EBioMedicine Aug 2023The incidence of endometrial cancer is increasing worldwide. While delays in diagnosis reduce survival, case molecular misclassification might be associated with under-...
BACKGROUND
The incidence of endometrial cancer is increasing worldwide. While delays in diagnosis reduce survival, case molecular misclassification might be associated with under- and over-treatment. The objective of this study was to evaluate genetic alterations to detect and molecularly classify cases of endometrial cancer using non-invasive samples.
METHODS
Consecutive patients with incident endometrial cancer (N = 139) and controls (N = 107) from a recent Spanish case-control study were included in this analysis. Overall, 339 cervicovaginal samples (out of which 228 were clinician-collected and 111 were self-collected) were analysed using a test based on next-generation sequencing (NGS), which targets 47 genes. Immunohistochemical markers were evaluated in 133 tumour samples. A total of 159 samples were used to train the detection algorithm and 180 samples were used for validation.
FINDINGS
Overall, 73% (N = 94 out of 129 clinician-collected samples, and N = 66 out of 90 self-collected samples) of endometrial cancer cases had detectable mutations in clinician-collected and self-collected samples, while the specificity was 80% (79/99) for clinician-collected samples and 90% (19/21) for self-collected samples. The molecular classifications obtained using tumour samples and non-invasive gynaecologic samples in our study showed moderate-to-good agreement. The molecular classification of cases of endometrial cancer into four groups using NGS of both clinician-collected and self-collected cervicovaginal samples yielded significant differences in disease-free survival. The cases with mutations in POLE had an excellent prognosis, whereas the cases with TP53 mutations had the poorest clinical outcome, which is consistent with the data on tumour samples.
INTERPRETATION
This study classified endometrial cancer cases into four molecular groups based on the analysis of cervicovaginal samples that showed significant differences in disease-free survival. The molecular classification of endometrial cancer in non-invasive samples may improve patient care and survival by indicating the early need for aggressive surgery, as well as reducing referrals to highly specialized hospitals in cancers with good prognosis. Validation in independent sets will confirm the potential for molecular classification in non-invasive samples.
FUNDING
This study was funded by a competitive grant from Instituto de Salud Carlos III through the projects PI19/01835, PI23/00790, and FI20/00031, CIBERESP CB06/02/0073 and CIBERONC CB16/12/00231, CB16/12/00234 (Co-funded by European Regional Development Fund. ERDF: A way to build Europe). Samples and data were provided by Biobank HUB-ICO-IDIBELL, integrated into the Spanish Biobank Network, and funded by the Instituto de Salud Carlos III (PT20/00171) and by Xarxa de Bancs de Tumors de Catalunya (XBTC) sponsored by Pla Director d'Oncologia de Catalunya. This work was supported in part by the AECC, Grupos estables (GCTRA18014MATI). It also counts with the support of the Secretariat for Universities and Research of the Department of Business and Knowledge of the Generalitat de Catalunya, and grants to support the activities of research groups 2021SGR01354 and 2021SGR1112.
Topics: Female; Humans; Case-Control Studies; Endometrial Neoplasms; Mutation; Prognosis; Europe
PubMed: 37480623
DOI: 10.1016/j.ebiom.2023.104716