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Frontiers in Oncology 2024Few articles have focused on the cytological misinterpretation of high-grade squamous intraepithelial lesion (HSIL). Due to estrogen deficiency, cervical epithelial...
BACKGROUND
Few articles have focused on the cytological misinterpretation of high-grade squamous intraepithelial lesion (HSIL). Due to estrogen deficiency, cervical epithelial cells in postmenopausal women tend to show atrophic change that looks like HSIL on Papanicolaou-stained cytology slides, resulting in a higher rate of cytological misinterpretation. P16 immunocytochemical staining (P16 cytology) can effectively differentiate diseased cells from normal atrophic ones with less dependence on cell morphology.
OBJECTIVE
To evaluate the role of P16 cytology in differentiating cytology HSIL from benign atrophy in women aged 50 years and above.
METHODS
Included in this analysis were women in a cervical cancer screening project conducted in central China who tested positive for high-risk human papillomavirus (hr-HPV) and returned back for triage with complete data of primary HPV testing, liquid-based cytology (LBC) analysis, P16 immuno-stained cytology interpretation, and pathology diagnosis. The included patients were grouped by age: ≥50 (1,127 cases) and <50 years (1,430 cases). The accuracy of LBC and P16 cytology in the detection of pathology ≥HSIL was compared between the two groups, and the role of P16 immuno-stain in differentiating benign cervical lesions from cytology ≥HSIL was further analyzed.
RESULTS
One hundred sixty-seven women (14.8%; 167/1,127) in the ≥50 group and 255 (17.8%, 255/1,430) in the <50 group were pathologically diagnosed as HSIL (Path-HSIL). LBC [≥Atypical Squamous Cell Of Undetermined Significance (ASCUS)] and P16 cytology (positive) respectively detected 63.9% (163/255) and 90.2% (230/255) of the Path-≥HSIL cases in the <50 group and 74.3% (124/167) and 93.4% (124/167) of the Path-≥HSIL cases in the ≥50 group. LBC matched with pathology in 105 (41.2%) of the 255 Path-≥HSIL cases in the <50 group and 93 (55.7%) of the 167 Path-≥HSIL cases in the ≥50 group. There were five in the <50 group and 14 in the ≥50 group that were Path-≤LSIL cases, which were interpreted by LBC as HSIL, but negative in P16 cytology.
CONCLUSION
P16 cytology facilitates differentiation of Path-≤LSIL from LBC-≥HSIL for women 50 years of age and above. It can be used in the lower-resource areas, where qualified cytologists are insufficient, as the secondary screening test for women aged ≥50 to avoid unnecessary biopsies and misinterpretation of LBC primary or secondary screening.
PubMed: 38863645
DOI: 10.3389/fonc.2024.1332172 -
BMC Primary Care Jun 2024Preconceptual care aiming to improve health is influenced by various factors including health literacy. Considering the importance and necessity of high quality...
BACKGROUND AND AIM
Preconceptual care aiming to improve health is influenced by various factors including health literacy. Considering the importance and necessity of high quality preconceptual care, this study aimed to determine the relationship between health literacy and receiving components of preconceptual care prior to pregnancy.
METHODS
This cross-sectional study included 693 participants with pregnancies of less than 14 weeks gestation referred to health centers and gynecologists in Shiraz city, Iran. Multi-stage sampling was done from May 2021 to February 2022 in 18 comprehensive urban health centers and 20 gynecology offices via proportional allocation method. The data collection tool comprised a questionnaire consisting of 3 parts: (1) individual and fertility characteristics, (2) information related to the components of preconceptual care and (3) health literacy for Iranian adults. This was completed by individual participants via the self-reporting method.
RESULTS
The majority of participants were between 30 and 34 years old. They also identified as women with a university education and were predominantly unemployed. The mean health literacy of participants was 76.81%. Health literacy obtained the highest mean score in the dimension of 'understanding' and the lowest mean score in the dimension of 'access'. The frequency of preconceptual counseling, folic acid supplement consumption, exercise, blood testing, dental visits, genetic counseling, Pap smear testing and rubella, diphtheria, and hepatitis vaccinations prior to pregnancy was 66.8%, 53.8%, 45.6%, 71.86%, 44.44%, 12%, 53.4%, 10.83%, respectively. Many (> 64%) received preconceptual care at specialist gynecology offices. Results demonstrated that health literacy had a statistically significant relationship with preconceptual care, folic acid consumption, exercise and dental care, (p < 0.001), along with blood testing and Pap smear testing (p < 0.05).
CONCLUSION
Overall, our results demonstrate that despite health literacy being optimal, uptakes of some components of preconceptual care are low. As such, it will be important to further raise awareness of the importance of preconceptual care for people prior to pregnancy as a priority in health promotion and education.
Topics: Humans; Female; Cross-Sectional Studies; Health Literacy; Pregnancy; Adult; Preconception Care; Iran; Young Adult; Surveys and Questionnaires; Health Knowledge, Attitudes, Practice
PubMed: 38862877
DOI: 10.1186/s12875-024-02467-5 -
Diagnostic Cytopathology Jun 2024The World Health Organization (WHO) reporting system for pancreaticobiliary cytopathology was released to internationalize the reporting, assisting in correct diagnosis...
BACKGROUND
The World Health Organization (WHO) reporting system for pancreaticobiliary cytopathology was released to internationalize the reporting, assisting in correct diagnosis and patient treatment with significant revisions from the previous Papanicolaou Society of Cytopathology (PSC) system. The "neoplastic: benign" and "neoplastic: other" categories have mostly been superseded by two new ones: "pancreatic neoplasia-low-grade" (PaN-low) and "pancreatic neoplasia-high-grade" (PaN-high), which classify intermediate neoplastic lesions based on cytological atypia. We aim to assess the reproducibility and risk of malignancy (ROM) for reporting pancreaticobiliary cytopathology by the WHO system in comparison with the PSC system.
MATERIALS AND METHODS
A retrospective study by reviewing archival slides sent for pancreaticobiliary cytological evaluation from June 2021 to June 2023, by two pathologists blinded to each other's findings. Absolute ROM was determined by histopathology/cell block study/clinical follow-up (minimum 6 months)/overtly malignant imaging/metastasis.
RESULTS
A total of 332 cases from 329 patients met the inclusion criteria, comprising pancreatic, gallbladder, and biliary lesions. The median patient age was 54 years (range, 14-86 years). The overall sensitivity of the test is 74.9% specificity is 93.2%, positive predictive value of 96.8%, negative predictive value of 57.6%, and a diagnostic accuracy of 81.8%. The absolute ROM for each site in all categories was comparable with that of the published data from the WHO system.
CONCLUSION
Our study highlights the reliability of the WHO system for guiding clinical decision-making and patient management in the context of pancreaticobiliary. However, continual efforts among pathologists are essential to maintain consistent accuracy in cytological interpretations.
PubMed: 38860686
DOI: 10.1002/dc.25367 -
Cureus May 2024Background Cervical cancer ranks among the top five cancers in India, with human papillomavirus (HPV) types 16 and 18 causing up to 70% of related lesions. HPV...
A Study to Assess the Impact of Education on the Knowledge and Attitude Toward Cervical Cancer and HPV (Human Papillomavirus) Vaccination Among Female Healthcare Students.
Background Cervical cancer ranks among the top five cancers in India, with human papillomavirus (HPV) types 16 and 18 causing up to 70% of related lesions. HPV infection, acquired through various routes, poses risks for both men and women, especially in the age group of 16 to 25 years. Effective prevention is possible through HPV vaccination, with Cervarix and Gardasil approved for use in India. Despite its proven efficacy, HPV vaccine use remains minimal. This study aims to evaluate awareness, willingness, and barriers among female healthcare students while assessing the impact of a health education program on their knowledge and attitude. Methods The present study is an educational interventional study conducted on 489 female students in the healthcare sector in the age group of 19-25 years. Two questionnaires (pre-lecture and post-lecture) were used. After the pre-lecture questionnaire, a session on cervical cancer and vaccine education was delivered by the subject expert. Afterward, the post-lecture questionnaire was given and the impact of session was analyzed using various statistical tools. Result A total of 489 students across MBBS (Bachelor of Medicine, Bachelor of Surgery), BAMS (Bachelor of Ayurvedic Medicine and Surgery), BHMS (Bachelor of Homoeopathic Medicine and Surgery), paramedical, and nursing courses participated in the study. Prior to the lecture, knowledge regarding cervical cancer and vaccines was generally low across subgroups, witnessing improvements ranging from 60% to 100% in various questionnaire sections post-education. Understanding of the importance of a Pap smear (Papanicolaou test) increased significantly from 21% to 79% after the educational session. The most preferred measure to boost coverage was the inclusion of the HPV vaccine in the National Immunization Schedule, with lack of awareness identified as the most significant barrier. Conclusion An educational session not only enhances knowledge but also boosts willingness for cervical cancer vaccination. Inclusion of the vaccine in the National Immunization Schedule not only increases acceptability but also indirectly raises awareness.
PubMed: 38854271
DOI: 10.7759/cureus.59856 -
Heliyon Jun 2024Cervical cancer is caused by changes in the cervix that lead to precancerous cells and eventually progress to cancer. Human papillomavirus (HPV) infections are the...
Cervical cancer is caused by changes in the cervix that lead to precancerous cells and eventually progress to cancer. Human papillomavirus (HPV) infections are the primary cause of cervical cancer. Early detection of HPV is crucial in preventing cervical cancer, and regular screening for HPV infection can identify cell changes before they develop into cancer. While Pap smear tests are reliable for cervical cancer screening, they are critical, expensive, and labor-intensive. Therefore, researchers are focusing on identifying blood-based biomarkers using biosensors for cervical cancer screening. HPV strains 16, 45, and 18 are common culprits in cervical cancer. This study aimed to develop an HPV-16 DNA biosensor on a zeolite-iron oxide (zeolite-IO) modified interdigitated electrode (IDE) sensor. The DNA probe was immobilized on the IDE through amine-modified zeolite-IO, enhancing the hybridization of the target and DNA probe. The detection limit of the DNA-DNA duplex was found to be 7.5 pM with an R value of 0.9868. Additionally, control experiments with single and triple mismatched sequences showed no increase in current responses, and the identification of target DNA in a serum-spiked sample indicated specific and selective target identification.
PubMed: 38845893
DOI: 10.1016/j.heliyon.2024.e31851 -
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 -
Schizophrenia Bulletin Jun 2024In the United States, women with schizophrenia face challenges in receiving gynecologic care, but little is known about how cervical cancer screening rates vary across...
BACKGROUND AND HYPOTHESIS
In the United States, women with schizophrenia face challenges in receiving gynecologic care, but little is known about how cervical cancer screening rates vary across time or states in a publicly insured population. We hypothesized that women Medicaid beneficiaries with schizophrenia would be less likely to receive cervical cancer screening across the United States compared with a control population, and that women with schizophrenia and other markers of vulnerability would be least likely to receive screening.
STUDY DESIGN
This retrospective cohort study used US Medicaid administrative data from across 44 states between 2002 and 2012 and examined differences in cervical cancer screening test rates among 283 950 female Medicaid beneficiaries with schizophrenia and a frequency-matched control group without serious mental illness, matched on age and race/ethnicity. Among women with schizophrenia, multivariable logistic regression estimated the odds of receiving cervical cancer screening using individual sociodemographics, comorbid conditions, and health care service utilization.
STUDY RESULTS
Compared to the control group, women with schizophrenia were less likely to receive cervical cancer screening (OR = 0.76; 95% CI 0.75-0.77). Among women with schizophrenia, nonwhite populations, younger women, urban dwellers, those with substance use disorders, anxiety, and depression and those connected to primary care were more likely to complete screening.
CONCLUSIONS
Cervical cancer screening rates among US women Medicaid beneficiaries with schizophrenia were suboptimal. To address cervical cancer care disparities for this population, interventions are needed to prioritize women with schizophrenia who are less engaged with the health care system or who reside in rural areas.
PubMed: 38842724
DOI: 10.1093/schbul/sbae096 -
Archives of Medical Research Jun 2024To inform the implementation of Human Papillomavirus Self-Sampling (HPV-SS) in the workplace, we assessed the perspectives of healthcare professionals and managers on...
AIM
To inform the implementation of Human Papillomavirus Self-Sampling (HPV-SS) in the workplace, we assessed the perspectives of healthcare professionals and managers on the benefits, barriers, and opportunities for improvement of a pilot program.
METHODS
A qualitative descriptive study based on in-depth telephone interviews was conducted between June and August 2023. Data were analyzed through inductive thematic analysis. Fifteen health professionals from different companies and fifteen managers from the Mexican Institute of Social Security (IMSS) were interviewed.
RESULTS
Participants identified several benefits of the HPV-SS, including ease of use, privacy, convenience, affordability, reduced workplace absences, and promotion of a prevention culture. However, there were also individual and organizational barriers to program implementation. The former consisted of women's concerns about collecting a reliable sample or injuring themselves, lack of confidence in the HPV test, fear of positive results, and discomfort caused by the brush used to collect the sample. Organizational barriers included failure to follow up on positive test results, lack of knowledge of program indicators, perceived negative impact on the established Pap smear cervical cancer screening indicator, and the lack of government regulations supporting HPV testing. To improve the program, participants suggested disseminating information through mass media campaigns and social networks, providing companies with additional support from IMSS preventive staff, extending the work hours of IMSS Family Medicine clinics, and training IMSS health staff on the follow-up of women with HPV test results.
CONCLUSIONS
The study findings suggest potential areas for improvement in HPV-SS programs.
Topics: Humans; Female; Qualitative Research; Papillomavirus Infections; Workplace; Adult; Health Personnel; Mexico; Uterine Cervical Neoplasms; Middle Aged; Specimen Handling; Male; Early Detection of Cancer; Papillomaviridae
PubMed: 38823184
DOI: 10.1016/j.arcmed.2024.103009 -
PloS One 2024Cervical cancer is the second leading cause of cancer death among Ethiopian women. This study aimed to assess the influence of the health system on access to cervical...
BACKGROUND
Cervical cancer is the second leading cause of cancer death among Ethiopian women. This study aimed to assess the influence of the health system on access to cervical cancer prevention, screening, and treatment services at public health centers in Addis Ababa, Ethiopia.
METHODS
This study used a cross-sectional survey design and collected data from 51 randomly selected public health centers in Addis Ababa. Open Data Kit was used to administer a semi-structured questionnaire on Android tablets, and SPSS version 26 was used to analyze the descriptive data.
RESULTS
In the study conducted at 51 health centers, cervical cancer prevention and control services achieved 61% HPV vaccination for girls, 79% for cervical cancer awareness messages, 80% for precancer lesion treatment, and 71% for cervical screening of women. All health centers were performing cervical screening mostly through visual inspection with acetic acid due to the inconsistent availability of HPV DNA tests and the lack of Pap smear tests. In 94% of health centers, adequate human resources were available. However, only 78% of nurses, 75% of midwives, 35% of health officers, and 49% of health extension workers received cervical cancer training in the 24 months preceding the study. Women had provider choices in only 65% of health centers, and 86% of the centers lacked electronic health records. In 41% of the health centers, the waiting time was 30 minutes or longer. About 88% and 90% of the facilities lacked audio and video cervical cancer messages, respectively.
CONCLUSION
This study revealed that the annual cervical cancer screening achievement was on track to fulfill the WHO's 90-70-90 targets by 2030. We recommend that decision-makers prioritize increasing HPV vaccination rates, enhancing messaging, reducing wait times, and implementing electronic health records to improve access to cervical cancer services in Addis Ababa.
Topics: Humans; Female; Uterine Cervical Neoplasms; Ethiopia; Early Detection of Cancer; Adult; Cross-Sectional Studies; Health Services Accessibility; Middle Aged; Young Adult; Adolescent; Public Health; Papillomavirus Vaccines; Surveys and Questionnaires; Papillomavirus Infections
PubMed: 38820249
DOI: 10.1371/journal.pone.0300152 -
Cancer Epidemiology, Biomarkers &... May 2024Cervical cancer (CC) presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national...
BACKGROUND
Cervical cancer (CC) presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing CC screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of CC among Nepalese women.
METHODS
Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (WHO-STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30-69 years, were used. Respondents were asked if they had undergone CC testing through VIA, Pap smear, or HPV test ever or in the past five years. The slope index of inequality (SII) and relative concentration index (RCI) were used to measure socioeconomic and education-based disparities in CC test uptake.
RESULTS
Only 7.1% (95% CI: 5.1-9.9) Nepalese women had ever undergone CC testing, while 5.1% (95% CI: 3.4-7.5) tested within the last five years. The ever uptake of CC testing was 5.1 percentage points higher (SII: 5.1, 95% CI: -0.1 to 10.2) among women from richest compared to poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII: 13.9, 95% CI: 5.8 to 21.9).
CONCLUSIONS
Less than one in ten women in Nepal had a CC testing, primarily favoring higher educated and wealthier individuals.
IMPACT
Targeted early detection and CC screening interventions are necessary to address these disparities and improve access and uptake.
PubMed: 38820125
DOI: 10.1158/1055-9965.EPI-24-0037