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Preventive Medicine Jun 2024The fight against cervical cancer requires effective screening together with optimal and on-time treatment along the care continuum. We examined the impact of cervical...
OBJECTIVE
The fight against cervical cancer requires effective screening together with optimal and on-time treatment along the care continuum. We examined the impact of cervical cancer testing and treatment guidelines on testing practices, and follow-up adherence to guidelines.
METHODS
Data from Estonian electronic health records and healthcare provision claims for 50,702 women was used. The annual rates of PAP tests, HPV tests and colposcopies during two guideline periods (2nd version 2012-2014 vs 3rd version 2016-2019) were compared. To assess the adherence to guidelines, the subjects were classified as adherent, over- or undertested based on the timing of the appropriate follow-up test.
RESULTS
The number of PAP tests decreased and HPV tests increased during the 3rd guideline period (p < 0.01). During the 3rd guideline period, among 21-29-year-old women, the adherence to guidelines ranged from 38.7% (44.4…50.1) for ASC-US to 73.4% (62.6…84.3) for HSIL and among 30-59-year-old from 49.0% (45.9…52.2) for ASC-US to 65.7% (58.8…72.7) for ASCH. The highest rate of undertested women was for ASC-US (21-29y: 25.7%; 30-59y: 21.9%). The rates of over-tested women remained below 12% for all cervical pathologies observed. There were 55.2% (95% CI 49.7…60.8) of 21-24-year-olds and 57.1% (95% CI 53.6…60.6) of 25-29-year-old women who received HPV test not adherent to guidelines.
CONCLUSIONS
Our findings highlighted some shortcomings in guideline adherence, especially among women under 30. The insights gained from this study help to improve the quality of care and, thus, reduce cervical cancer incidence and mortality.
Topics: Humans; Female; Uterine Cervical Neoplasms; Cross-Sectional Studies; Guideline Adherence; Adult; Electronic Health Records; Middle Aged; Early Detection of Cancer; Papanicolaou Test; Vaginal Smears; Estonia; Colposcopy; Papillomavirus Infections; Mass Screening
PubMed: 38701952
DOI: 10.1016/j.ypmed.2024.107982 -
The New Microbiologica May 2024Human papilloma virus (HPV) is the most common sexually transmitted viral agent in the world and the most common cause of cervical cancer. HPV prevalence and genotype...
Human papilloma virus (HPV) is the most common sexually transmitted viral agent in the world and the most common cause of cervical cancer. HPV prevalence and genotype distribution vary by region and demographic data. In a province in the south of Turkey that constantly receives immigration, we aimed to determine the prevalence of high-risk HPV (HR-HPV) genotypes, evaluate the compatibility between cervical Pap smear cytology results patients and HR-HPVs, and make an up-to-date contribution to the elucidation of epidemiological data. In this single-centre study, a total of 12,641 women aged 18 and over were evaluated retrospectively from January 2019 to July 2022. HPV detection and genotyping were analysed by the PCR method. Bethesda scoring was used for Pap smear cytological evaluation. The overall prevalence of HR-HPV was 12.6% (12.7% in Turkish women, 11.2% in foreign women). Among the typed HPVs that were detected, HPV-16 (31%) was found first, followed by HPV-18 (8%). The prevalence of HR-HPV was higher in women with abnormal cytology (977/1762, 55.4%) than in women with normal cytology (620/10879, 5.7%) (p<0.001). Turkey doesn't yet have a national HPV immunisation program. We think that determining the specific regional frequency of other HR-HPVs separately will be useful in the follow-up of the natural course of the type-specific infection and in vaccine studies in the future.
Topics: Humans; Female; Turkey; Adult; Papillomavirus Infections; Papillomaviridae; Middle Aged; Genotype; Emigrants and Immigrants; Young Adult; Retrospective Studies; Adolescent; Cervix Uteri; Prevalence; Aged; Vaginal Smears; Papanicolaou Test; Uterine Cervical Neoplasms; Human Papillomavirus Viruses
PubMed: 38700888
DOI: No ID Found -
Cureus Apr 2024The human papillomavirus (HPV) belongs to the Papillomavirus family and is considered a non-enveloped virus. HPV affects individuals by causing both benign and malignant... (Review)
Review
The human papillomavirus (HPV) belongs to the Papillomavirus family and is considered a non-enveloped virus. HPV affects individuals by causing both benign and malignant lesions. We aim to define HPV and its important characteristics, explain the relation between HPVs and cervical cancer, review its prevalence among Saudi women and their awareness of screening and prevention of cervical cancer, and focus on the importance of HPV vaccination. The persistence of HPV infection is the most important risk factor for the development of cervical cancer. HPVs cannot be cultured, and the identification of the virus is dependent on a variety of techniques, including immunology, serology, and molecular biology. Cervical cancer is the fourth most prevalent form of cancer in women worldwide, while it is considered the 12th type of cancer that affects Saudi women. Unfortunately, many studies have shown a lack of awareness regarding HPV infection, screening, and vaccination among the Saudi population in general, as well as among Saudi healthcare professionals. The HPV vaccine has a potent role in preventing people from getting infected with the virus, despite some previous clinical trials assessing the outcomes of therapeutic HPV vaccinations showing unsatisfactory results. While there is no doubt about the benefits of vaccines and their role in reducing the incidence of HPV infectious diseases, there are discrepancies in the evaluation of the safety of the HPV vaccine. In conclusion, HPV is an essential etiology of cervical cancer, and the expansion of public awareness about protective methods and threat factors associated with HPV infection is highly important.
PubMed: 38699134
DOI: 10.7759/cureus.57432 -
Iranian Journal of Public Health Jan 2024Cervical cancer occupies a significant place in the overall structure of morbidity and mortality in developing countries. We focused on the sexual health and use of...
BACKGROUND
Cervical cancer occupies a significant place in the overall structure of morbidity and mortality in developing countries. We focused on the sexual health and use of cervical cancer screening among the female working population of reproductive age in Central Serbia.
METHODS
The research was conducted as a cross-sectional study, according to the methodology Stepwise approach to noncommunicable disease risk factor surveillance WHO. The study population consisted of 1182 female working population aged 18-49 years, living on the territory of Central Serbia. The method of simple random sampling was utilized in the research itself. An anonymous standardized questionnaire was used as a research tool.
RESULTS
During the first sexual intercourse, 38.9% of the participants reported not having used any of the contraceptives, whereas 74.5% of the participants reported not having used them during their last sexual intercourse and 26.1% of the respondents reported not having had a single Pap smear in their lifetime. The multivariate logistic regression analysis singled out the following factors in women who reported not having done a Pap smear in their lifetime as the most significant ones: age - the youngest age group (OR = 3.30, CI = 1.80-6.04), unemployment (OR = 2.87, CI = 0.07-3.40), women who had never been married or had never been in a common-law marriage (OR = 2.55, CI = 1.40-4.66) and individuals with a medium education level (OR = 2.63, CI = 1.67-4.14).
CONCLUSION
In Serbia, all the activities should be directed towards increasing the levels of awareness and knowledge on sexual health and cervical cancer screening services.
PubMed: 38694863
DOI: 10.18502/ijph.v53i1.14696 -
Annals of Medicine and Surgery (2012) May 2024Since today cervical cancers are growing, there is an increasing need to use screening and examination methods. Meanwhile, liquid-based Pap smear test is a common...
BACKGROUND
Since today cervical cancers are growing, there is an increasing need to use screening and examination methods. Meanwhile, liquid-based Pap smear test is a common screening method for women, which is widely applied today. Studies have found that use of lubricant gel in this test can affect the pathology and cytology results. Accordingly, the authors intended to evaluate the effect of use of lubricant gel on the Pap smear test results.
METHODS
This study was of single-blind clinical trial, the study population consisted of candidate patients for screening in terms of cervical pathology, for whom liquid-based Pap smear was done. In this study, 506 patients participated, divided into two groups of 253. One group used lubricant gel during the Pap smear, while the other group underwent this test without lubricant. The data were analyzed by SPSS 21.
RESULTS
The study results indicated that once the two groups were compared in terms of age, interval of menstruation time and intercourse time from the sampling, no significant relationship was found between the two groups (>0.05). It was also found that use of lubricant did not affect the cytology and pathology results of patients (>0.05).
CONCLUSION
The use of lubricant gel in patients can reduce pain in patients during examination and testing, but does not affect the cytological and pathological results of patients.
PubMed: 38694378
DOI: 10.1097/MS9.0000000000001803 -
Annals of Medicine and Surgery (2012) May 2024In Palestine, cervical cancer is the third most common gynaecological cancer, exhibiting higher mortality rates compared to regional counterparts. Late-stage diagnosis...
BACKGROUND
In Palestine, cervical cancer is the third most common gynaecological cancer, exhibiting higher mortality rates compared to regional counterparts. Late-stage diagnosis and limited awareness contribute to this disparity. This study aims to assess the awareness of Palestinian medical students regarding cervical cancer prevention.
METHODS
A questionnaire-based survey involving 532 medical students from various Palestinian universities was conducted between October 2023 and December 2023. The survey encompassed closed-ended quantitative and demographic questions distributed through social media.
RESULTS
The study was carried out on a group of 532 medical students (66.3% women and 33.6% men), (average age 21.7 years). Most students (77.7%) knew that the main risk factor for cervical cancer was human papillomavirus (HPV) infection. Participants doing the internship had the greatest knowledge, whereas students from the first year had the poorest knowledge about the main risk factors for cancer of the cervix. Only about half, 50.2% of all students, knew that in Palestine, there is no screening program. 84.4% of students correctly indicated that the cervical cancer screening test is a pap smear test. 41.4% of respondents knew that microscopic evaluation of the exfoliated cells from the vaginal part of the cervix is the screening test for cervical cancer which is used. Only about half of the students (45.1%) knew that there were no specific early symptoms of cervical cancer.
CONCLUSIONS
This study highlights the need for enhanced education, particularly regarding screening program awareness, among Palestinian medical students. Addressing these knowledge gaps is crucial for effective preventive strategies.
PubMed: 38694304
DOI: 10.1097/MS9.0000000000001935 -
BMC Women's Health Apr 2024Uganda has approximately 1.2 million people aged 15-64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of... (Comparative Study)
Comparative Study
Association between HIV Serostatus and premalignant cervical lesions among women attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda: a comparative cross-sectional study.
BACKGROUND
Uganda has approximately 1.2 million people aged 15-64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of premalignant cervical lesions among HIV-positive women than among HIV-negative women. Additionally, HIV-infected women are more likely to have human papilloma virus (HPV) infection progress to cancer than women not infected with HIV. We determined the prevalence of premalignant cervical lesions and their association with HIV infection among women attending a cervical cancer screening clinic at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.
METHODS
We conducted a comparative cross-sectional study of 210 women aged 22-65 years living with HIV and 210 women not living with HIV who were systematically enrolled from March 2022 to May 2022. Participants were subjected to a structured interviewer-administered questionnaire to obtain their demographic and clinical data. Additionally, Papanicolaou smears were obtained for microscopy to observe premalignant cervical lesions. Multivariate logistic regression was performed to determine the association between HIV status and premalignant cervical lesions.
RESULTS
The overall prevalence of premalignant cervical lesions in the study population was 17% (n = 72; 95% C.I: 14.1-21.4), with 23% (n = 47; 95% C.I: 17.8-29.5) in women living with HIV and 12% (n = 25; 95% C.I: 8.2-17.1) in women not living with HIV (p < 0.003). The most common premalignant cervical lesions identified were low-grade squamous intraepithelial lesions (LSIL) in both women living with HIV (74.5%; n = 35) and women not living with HIV (80%; n = 20). HIV infection was significantly associated with premalignant lesions (aOR: 2.37, 95% CI: 1.27-4.42; p = 0.007).
CONCLUSION
Premalignant cervical lesions, particularly LSILs, were more common in HIV-positive women than in HIV-negative women, highlighting the need to strengthen the integration of cervical cancer prevention strategies into HIV care programs.
Topics: Humans; Female; Adult; Cross-Sectional Studies; Uganda; Uterine Cervical Neoplasms; Middle Aged; Young Adult; Early Detection of Cancer; HIV Infections; Prevalence; Precancerous Conditions; Aged; Papanicolaou Test; Tertiary Care Centers; HIV Seropositivity; Uterine Cervical Dysplasia; Papillomavirus Infections; Vaginal Smears
PubMed: 38678278
DOI: 10.1186/s12905-024-03108-w -
Journal of Personalized Medicine Apr 2024Preeclampsia is a progressive multi-systemic disorder characterized by proteinuria, critical organ damage, and new-onset hypertension. It can be further complicated by...
Increased Complement Activation and Decreased ADAMTS13 Activity Are Associated with Genetic Susceptibility in Patients with Preeclampsia/HELLP Syndrome Compared to Healthy Pregnancies: An Observational Case-Controlled Study.
Preeclampsia is a progressive multi-systemic disorder characterized by proteinuria, critical organ damage, and new-onset hypertension. It can be further complicated by HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), resulting in critical liver or renal damage, disseminated coagulation, and grand mal seizures. This study aimed to examine the involvement of ADAMTS13, von Willebrand, and the complement system in the pathogenesis of preeclampsia/HELLP syndrome. We studied 30 Caucasian preeclamptic pregnant women and a control group of 15 healthy pregnancies. Genetic sequencing of ADAMTS13 and complement regulatory genes (MiniSeq System, Illumina) was performed. The modified Ham test was used to check for complement activation, ADAMTS13 activity, von Willebrand antigen (vWFAg) levels, and soluble C5b-9 levels were measured. Patients with preeclampsia had a decreased ADAMTS13 activity and increased C5b-9 levels. The vWFAg was significantly correlated with ADAMTS13 activity (r = 0.497, = 0.003). Risk-factor variants were found in the genes of ADAMTS13, C3, thrombomodulin, CFB, CFH, MBL2, and, finally, MASP2. A portion of pregnant women with preeclampsia showed a decline in ADAMTS13 activity, correlated with vWFAg levels. These patients also exhibited an elevated complement activation and high-risk genetic variants in regulatory genes. Further research is needed to determine if these factors can serve as reliable biomarkers.
PubMed: 38673014
DOI: 10.3390/jpm14040387 -
Infectious Agents and Cancer Apr 2024A study coordinated by Groesbeck Parham and Mark Schiffman describes a novel approach to single-visit, point-of-care cervical screening and triage for low and middle...
A study coordinated by Groesbeck Parham and Mark Schiffman describes a novel approach to single-visit, point-of-care cervical screening and triage for low and middle income countries (LMICs) that uses an HPV screening test that is not affordable in LMICs combined with a triage test that is not available at the point of care. Pap smears are feasible, affordable, and well-suited for single-visit, point-of-care cervical screening and triage in LMICs. Research into a discredited cervical screening test, funded by the US National Cancer Institute, contributed to at least 500,000 preventable cervical cancer deaths by delaying implementation of Pap screening throughout India for 18 years. Researchers should no longer delay implementation of Pap screening in LMICs pending research into novel screening approaches. Instead, researchers should prioritize cervical screening approaches that will save as many lives as quickly as possible in LMICs. To that end, Parham et al. should implement good-quality, single-visit, point-of-care Pap smear screening in LMICs until better-quality, single-visit, point-of-care HPV screening becomes widely affordable in LMICs.
PubMed: 38671517
DOI: 10.1186/s13027-024-00576-5 -
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