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Revista Brasileira de Epidemiologia =... 2023To estimate prevalence, assess trends and identify factors associated with non-performance of Pap smears among postpartum women residing in Rio Grande, Southern Brazil.
OBJECTIVE
To estimate prevalence, assess trends and identify factors associated with non-performance of Pap smears among postpartum women residing in Rio Grande, Southern Brazil.
METHODS
Between 01/01 and 12/31 of 2007, 2010, 2013, 2016 and 2019, previously trained interviewers applied a single standardized questionnaire at the hospital to all postpartum women residing in this municipality. It was investigated from the planning of pregnancy to the immediate postpartum period. The outcome consisted of not performing a Pap smear in the last three years. The chi-square test was used to compare proportions and assess trends, and Poisson regression with robust variance adjustment in the multivariate analysis. The measure of effect was the prevalence ratio (PR).
RESULTS
Although 80% of the 12,415 study participants had performed at least six prenatal consultations, 43.0% (95%CI 42.1-43.9%) had not been screened in the period. This proportion ranged from 64.0% (62.1-65.8%) to 27.9% (26.1-29.6%). The adjusted analysis showed a higher PR for not performing Pap smears among younger puerperal women, living without a partner, with black skin color, lower schooling, and family income, who did not have paid work during pregnancy or planned pregnancy, who attended fewer prenatal consultations. smoked during pregnancy and were not being treated for any illness.
CONCLUSION
Despite the improvement in coverage, the observed rate of non-performance of Pap smears is still high. Women most likely to have cervical cancer were those who had the highest PR for not having this test.
Topics: Female; Humans; Pregnancy; Brazil; Cross-Sectional Studies; Income; Papanicolaou Test; Pregnant Women; Socioeconomic Factors; Uterine Cervical Neoplasms; Prevalence; Postpartum Period
PubMed: 37436328
DOI: 10.1590/1980-549720230032 -
Heliyon Nov 2023Cervical cancer is the second most commonly seen cancer in women. It affects the cervix portion of the vagina. The most preferred diagnostic test required for screening...
Cervical cancer is the second most commonly seen cancer in women. It affects the cervix portion of the vagina. The most preferred diagnostic test required for screening for cervical cancer is the pap smear test. Pap smear is a time-consuming test as it requires detailed analysis by expert cytologists. Cytologists can screen around 100 to 1000 slides depending upon the availability of advanced equipment. It requires substantial time and effort to carefully examine each slide, identify and classify cells, and make accurate diagnoses. Prolonged periods of visual inspection can increase the likelihood of human errors, such as overlooking abnormalities or misclassifying cells. The sheer volume of slides to be screened can exacerbate fatigue and impact diagnostic accuracy. Due to this reason Artificial intelligence (AI) based computer-aided diagnosis system for the classification and detection of pap smear images is needed. There are some AI-based solutions proposed in the literature, still, an effective and accurate system is under research. In this paper, we implement a state-of-the-art object detection model with a newly available CRIC dataset which follows the Bethesda system for nomenclature. Object detection models implemented are YOLOv5 which uses the CSPNet backbone, Faster R-CNN which has Region Proposal Network (RPN) and Detectron2 framework created by Facebook AI Research (FAIR) Group. ResNext model is implemented among the available models from Detectron2. The CRIC dataset is preprocessed and augmented using Roboflow tool. The performance measures of Average Precision and mean Average precision over the Intersection over Union (IoU) are used to evaluate the effectiveness of the models. The models performed better for two classes namely Normal and Abnormal compared to six classes from the Bethesda system. The highest mean Average Precision (mAP) is observed on the augmented dataset for YOLOv5 models for binary classification with 83 % mAP with IoU in the range of 0.50-0.95.
PubMed: 38058644
DOI: 10.1016/j.heliyon.2023.e22324 -
Journal of Gynecologic Oncology May 2024This study aims to investigate the implementation rate and influencing factors of confirmatory tests for women with abnormal cervical cytology results in the Korean...
OBJECTIVE
This study aims to investigate the implementation rate and influencing factors of confirmatory tests for women with abnormal cervical cytology results in the Korean nationwide cervical cancer screening program.
METHODS
The National Health Insurance Service (NHIS) database was utilized to identify all Korean women who have participated in the Korean nationwide cervical cancer screening program from January 2011 and December 2021 using the NHIS database. Multiple logistic regression analysis was performed to estimate the multivariate odds ratio and evaluate the patients' characteristics.
RESULTS
The rate of abnormal Papanicolaou (Pap) smears showed an initial increase from 2011 to 2015 and subsequently reached a plateau after 2016. When examining specific subcategories, cases of atypical squamous cells of undetermined significance (ASC-US) increased from 28,546 cases (1.1%) in 2011 to 62,850 cases (1.7%) in 2021. In contrast, cases of HSIL and SCC declined from 3,535 cases (0.14%) to 2,763 cases (0.07%) and from 383 cases (0.01%) to 179 cases (0.005%), respectively. Furthermore, the implementation rate of confirmatory tests for women with abnormal cytology increased from 8,865 cases (21.0%) in 2011 to 39,045 cases (51.2%) in 2021. Regarding the specific subcategory of ASC-US, the number of confirmatory tests exhibited a substantial increase from 4,101 cases (14.4%) in 2011 to 30,482 cases (48.5%) in 2021. For SCC, there was no significant change, with 216 cases (56.4%) in 2011 and 102 cases (57.0%) in 2021. The implementation rate of confirmatory tests was found to be significantly associated with results of abnormal Pap smear, age, and residence. Notably, economic status did not emerge as a significant factor affecting the likelihood of undergoing confirmatory tests.
CONCLUSIONS
The severity of abnormal Pap smear results is a reliable indicator of the probability of undergoing a confirmatory test. Additional endeavors are required to improve the implementation rate among women who have received abnormal Pap smear results.
Topics: Humans; Female; Papanicolaou Test; Adult; Uterine Cervical Neoplasms; Middle Aged; Republic of Korea; National Health Programs; Early Detection of Cancer; Vaginal Smears; Aged; Atypical Squamous Cells of the Cervix; Databases, Factual; Young Adult; Uterine Cervical Dysplasia
PubMed: 38130135
DOI: 10.3802/jgo.2024.35.e26 -
Cureus Mar 2024To determine the role of geminin as a tool for differentiating various types of cervical intraepithelial neoplasia (CIN) and cervical carcinoma (CC).
AIM
To determine the role of geminin as a tool for differentiating various types of cervical intraepithelial neoplasia (CIN) and cervical carcinoma (CC).
METHODS
Seventy women newly diagnosed with CIN or CC undergoing cervical biopsy were included; their clinical profile, human papilloma virus (HPV) positivity, and colposcopy findings were noted, and biopsy tissue was analyzed for geminin content.
RESULTS
On geminin immunohistochemistry, 100% of women with CIN3 and 96.29% of women with CC had geminin two plus or more. When analyzed as ordinal variables, there was a significant correlation (spearman's rho 0.35, p 0.01) between geminin and biopsy results (CIN1, CIN2, CIN3, and CC).
CONCLUSIONS
Screening tests for cervical cancer, like conventional pap smears, liquid-based pap smears, and triaging with HPV, have limitations. It is important to be able to differentiate between high-grade lesions, invasive cancer, and low-grade lesions. The detection of geminin in these cells may aid in the confirmation of the diagnosis and ensure adequate treatment. Cervical intraepithelial lesions and carcinoma cervix demonstrated a correlation between increased geminin expression in CIN1 vs. CC and CIN2 vs. CC. Geminin may be a potential surrogate marker for higher-grade cervical lesions, and further research is needed to corroborate evidence in this direction.
PubMed: 38659554
DOI: 10.7759/cureus.56864 -
BMJ Open Jan 2024Although Pap smear (PS) is considered the best standard in detecting cervical cancer, adherence to timely and regular PS is often lower than global standards in...
OBJECTIVE
Although Pap smear (PS) is considered the best standard in detecting cervical cancer, adherence to timely and regular PS is often lower than global standards in developing countries. Thus, the present study aimed to identify barriers and facilitators of adherence to cervical cancer screening in Mashhad, Iran.
DESIGN
A qualitative content analysis was done from July to December 2022 using semistructured in-depth interviews.
SETTING
The study was conducted in health centres in Mashhad, Iran.
PARTICIPANTS
A sample of 36 married women aged 18-70 years was selected using a purposive sampling, with maximum diversity.
RESULTS
The mean age of participants was 42.8±7.6 years. Among all, 66.7% had the PS test at least once; only 8.3% regularly had the test. The qualitative content analysis led to the extraction of four major themes: (1) individual challenges, (2) environmental limitations, (3) individual motivators, and (4) supportive and efficient environments. The most significant barriers were psychological stress, unhealthy attitudes, insufficient information, cultural issues and insufficient healthcare services. Facilitators included an active and efficient healthcare system, advice and support of important others, and positive emotions and individual beliefs.
CONCLUSIONS
Participants' perceptions showed that the main factors influencing the PS testing were supportive environments, individual motivators, individual challenges and environmental limitations. To encourage women to take the PS and reduce barriers, it may be necessary to revise current health system policies, promote individual and public awareness, reduce psychological stress and correct negative beliefs and attitudes.
Topics: Female; Humans; Adult; Middle Aged; Early Detection of Cancer; Uterine Cervical Neoplasms; Papanicolaou Test; Health Policy; Perception
PubMed: 38191254
DOI: 10.1136/bmjopen-2023-072954 -
Diagnostics (Basel, Switzerland) Aug 2023One of the most widespread health issues affecting women is cervical cancer. Early detection of cervical cancer through improved screening strategies will reduce...
One of the most widespread health issues affecting women is cervical cancer. Early detection of cervical cancer through improved screening strategies will reduce cervical cancer-related morbidity and mortality rates worldwide. Using a Pap smear image is a novel method for detecting cervical cancer. Previous studies have focused on whole Pap smear images or extracted nuclei to detect cervical cancer. In this paper, we compared three scenarios of the entire cell, cytoplasm region, or nucleus region only into seven classes of cervical cancer. After applying image augmentation to solve imbalanced data problems, automated features are extracted using three pre-trained convolutional neural networks: AlexNet, DarkNet 19, and NasNet. There are twenty-one features as a result of these scenario combinations. The most important features are split into ten features by the principal component analysis, which reduces the dimensionality. This study employs feature weighting to create an efficient computer-aided cervical cancer diagnosis system. The optimization procedure uses the new evolutionary algorithms known as Ant lion optimization (ALO) and particle swarm optimization (PSO). Finally, two types of machine learning algorithms, support vector machine classifier, and random forest classifier, have been used in this paper to perform classification jobs. With a 99.5% accuracy rate for seven classes using the PSO algorithm, the SVM classifier outperformed the RF, which had a 98.9% accuracy rate in the same region. Our outcome is superior to other studies that used seven classes because of this focus on the tissues rather than just the nucleus. This method will aid physicians in diagnosing precancerous and early-stage cervical cancer by depending on the tissues, rather than on the nucleus. The result can be enhanced using a significant amount of data.
PubMed: 37685299
DOI: 10.3390/diagnostics13172762 -
BMC Women's Health Nov 2023Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by...
INTRODUCTION
Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria.
METHODS
Longitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions.
RESULTS
We included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care.
CONCLUSIONS
Overall, we found that COVID-19 pandemic mitigation efforts significantly influenced women's ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations.
Topics: Female; Humans; Uterine Cervical Neoplasms; HIV Infections; Vaginal Smears; Early Detection of Cancer; Nigeria; Pandemics; COVID-19; Papanicolaou Test; Mass Screening
PubMed: 38037005
DOI: 10.1186/s12905-023-02782-6 -
BMC Primary Care Aug 2023The aims of the "médecin traitant" or referring physician (RP) reform, introduced in France in 2004, were to improve the organisation and quality of care and to allow...
BACKGROUND
The aims of the "médecin traitant" or referring physician (RP) reform, introduced in France in 2004, were to improve the organisation and quality of care and to allow for greater equity, particularly in terms of prevention. The objective of our study was to evaluate the effect of having a declared RP on the uptake of screening for breast and cervical cancers, and to explore the mechanisms involved.
METHODS
We used an existing dataset of 1,072,289 women, which combines data from the Health Insurance information systems, with census data. We built multivariable logistic regression models to study the effect of having a RP on the uptake of mammography and pap smear, adjusted for age, socio-economic level, health status and healthcare provision. We secondarily added to this model the variable "having consulted a General Practitioner (GP) within the year". Finally, we evaluated the interaction between the effect of having a referring physician and the area of residence (metropolitan/urban/rural).
RESULTS
Patients who had a declared RP had a significantly higher uptake of mammography and pap smear than those who did not. The strength of the association was particularly important in very urban areas. The effect of having visited a GP seemed to explain a part of the correlation between having a RP and uptake of screening.
CONCLUSIONS
Lower rates of gynaecological screening among women without an RP compared to those with an RP may partly reflect a specific behaviour pattern in women less adherent to the health care system. However, this result also shows the importance of the RP, who assumes the key role of relaying public health information in a more personalised and adapted way.
Topics: Humans; Female; Early Detection of Cancer; Cross-Sectional Studies; Uterine Cervical Neoplasms; General Practitioners; France
PubMed: 37644404
DOI: 10.1186/s12875-023-02122-5 -
Journal of Cancer Policy Dec 2023Eastern Europe and Central Asia (EECA) countries have higher cervical and breast cancer mortality rates and later stage at diagnosis compared with the rest of WHO...
BACKGROUND
Eastern Europe and Central Asia (EECA) countries have higher cervical and breast cancer mortality rates and later stage at diagnosis compared with the rest of WHO European Region. The aim was to explore current early detection practices including "dispensarization" for breast and cervix cancer in the region.
METHODS
A questionnaire survey on early detection practices for breast and cervix cancer was sent to collaborators in 11 countries, differentiating services in the primary health setting, and population-based programs. Responses were received from Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation (Arkhangelsk, Samara and Tomsk regions), Tajikistan, Ukraine, and Uzbekistan.
RESULTS
All countries but Georgia, Kyrgyzstan, and the Russian Federation had opportunistic screening by clinical breast exam within "dispensarization" program. Mammography screening programs, commonly starting from age 40, were introduced or piloted in eight of nine countries, organized at national oncology or screening centres in Armenia, Belarus and Georgia, and within primary care in others. Six countries had "dispensarization" program for cervix cancer, mostly starting from the age 18, with smears stained either by Romanowsky-Giemsa alone (Belarus, Tajikistan and Ukraine), or alternating with Papanicolaou (Kazakhstan and the Russian Federation). In parallel, screening programs using Papanicolaou or HPV test were introduced in seven countries and organized within primary care.
CONCLUSION
Our study documents that parallel screening systems for both breast and cervix cancers, as well as departures from evidence-based practices are widespread across the EECA. Within the framework of the WHO Initiatives, existing opportunistic screening should be replaced by population-based programs that include quality assurance and control.
Topics: Female; Humans; Adult; Adolescent; Uterine Cervical Neoplasms; Early Detection of Cancer; Europe, Eastern; Asia, Central; Russia
PubMed: 37544479
DOI: 10.1016/j.jcpo.2023.100436 -
Factors related to knowledge, attitudes, and behaviors regarding cervical cancer among Yemeni women.BMC Cancer Jun 2024Cervical cancer (CxCa), although preventable, is still among the most prevalent cancers in women. Mortality from this cancer is high, especially in low-income countries...
BACKGROUND
Cervical cancer (CxCa), although preventable, is still among the most prevalent cancers in women. Mortality from this cancer is high, especially in low-income countries where preventive strategies are often lacking. We studied the knowledge, attitudes, and practices regarding CxCa among Yemeni women.
METHODS
This cross-sectional study was conducted in 2019 among 399 women in five major hospitals in Sanaa, the capital city of Yemen. Data were collected through face-to-face interviews using structured questionnaires. We used logistic regression models to analyze the likelihood of hearing about CxCa, believing that CxCa is treatable and preventable, awareness of the Pap smear test, and ever having this test, in relation to participant's age, education level, working outside the household, and family history of CxCa.
RESULTS
Only 66.7% of the women had heard of CxCa. Women with higher education, working outside the household, and with a family history of CxCa were more likely to be aware of CxCa. Working outside the household was the only variable related to a higher likelihood of knowing that CxCa is a treatable and preventable. Furthermore, women with a family history of CxCa were more likely to have knowledge about Pap smear test and were more likely to have Pap smear test in the past.
CONCLUSION
This study identified a low awareness of CxCa and its prevention among Yemeni women. In order to reduce the burden of CxCa in Yemen and save women's lives, it is necessary to raise women's awareness of this disease, especially among those with lower education and those not involved in work outside their homes.
Topics: Humans; Female; Uterine Cervical Neoplasms; Health Knowledge, Attitudes, Practice; Yemen; Cross-Sectional Studies; Adult; Middle Aged; Papanicolaou Test; Young Adult; Surveys and Questionnaires; Vaginal Smears; Aged
PubMed: 38844917
DOI: 10.1186/s12885-024-12435-y