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Cancer Cytopathology Jun 2024A cytologic diagnosis of atypical squamous cells, cannot exclude high-grade squamous lesion (ASC-H) poses a disproportionately high risk of cervical cancer development....
BACKGROUND
A cytologic diagnosis of atypical squamous cells, cannot exclude high-grade squamous lesion (ASC-H) poses a disproportionately high risk of cervical cancer development. The objective of this study was to analyze type-specific risks by mapping human papillomavirus (HPV) genotypes in ASC-H cytology.
METHODS
In total, 1,048,581 Papanicolaou tests that had ASC-H cytology were retrieved. Concurrent HPV genotyping using proprietary multiplex real-time (MRT) and polymerase chain reaction (PCR) HPV tests and histologic follow-up findings were analyzed.
RESULTS
Among 1678 patients who had ASC-H findings (0.16%), 1414 (84.3%) underwent concurrent HPV genotyping (MRT, 857; HPV PCR test, 557). The overall high-risk HPV (hrHPV)-positive rate was 84.4%. Of the 857 MRT cases, 63.9% were infected with a single hrHPV, and 24.4% had multiple genotypes. The most prevalent HPV types were HPV16/52/58/33/31. Lesions that were identified as cervical intraepithelial neoplasia 2 or worse (CIN2+) were detected in 498 of 906 cases (55.0%), including 81 cervical carcinomas (8.9%). The risk of CIN2+ for the composite group of HPV16/52/58/33/31-positive cases was 62.7%, representing 90.7% (264 of 291) of total CIN2+ lesions in ASC-H/hrHPV-positive cases by MRT. CIN2+ lesions were detected in 108 of 142 (76.1%) HPV16-positive and/or HPV18-positive women by the PCR the HPV test. Among 128 hrHPV-negative ASC-H cases by both methods, CIN2+ lesions were identified in 21 of 128 (16.4%), including five cervical carcinomas (3.9%). The sensitivity, specificity, positive predictive value, and negative predictive value for patients in the composite group with HPV16/52/58/33/31 were 88.0%, 40.8%, 62.7%, and 75.0%, respectively.
CONCLUSIONS
Papanicolaou tests classified as ASC-H are associated with a high CIN2+ rate and warrant colposcopy, regardless of HPV status. The extent to which the risk-stratification provided by comprehensive HPV genotyping can inform the management of ASC-H cytology remains to be explored.
PubMed: 38879864
DOI: 10.1002/cncy.22877 -
JAMA Network Open Jun 2024Little nationally representative research has examined Papanicolaou testing rates from before the pandemic in 2019 through the COVID-19 pandemic in 2022. Papanicolaou...
IMPORTANCE
Little nationally representative research has examined Papanicolaou testing rates from before the pandemic in 2019 through the COVID-19 pandemic in 2022. Papanicolaou testing rates among rural females are a concern as they have historically had lower screening rates than their urban counterparts.
OBJECTIVE
To examine the receipt of a Papanicolaou test in the past year among US females overall and females residing in rural and urban areas in 2019, 2020, and 2022.
DESIGN, SETTING, AND PARTICIPANTS
This repeated cross-sectional study used data from 3 years of the Health Information National Trends Survey (HINTS), a nationally representative survey that asks respondents about cancer screenings, sources of health information, and health and health care technologies. Study participants were females aged 21 to 65 years. Individuals who received a Papanicolaou test more than 1 to 3 years prior to a HINTS interview were excluded as they were likely not due for a Papanicolaou test.
EXPOSURES
Survey year (2019, 2020, and 2022) and rural or urban residence were the main exposure variables.
MAIN OUTCOMES AND MEASURES
Self-reported receipt of a Papanicolaou test within the past year.
RESULTS
Among the 188 243 531 (weighted; 3706 unweighted) females included in the analysis, 12.5% lived in rural areas and 87.5% in urban areas. Participants had a mean (SE) age of 43.7 (0.27) years and were of Hispanic (18.8%), non-Hispanic Asian (5.2%), non-Hispanic Black (12.2%), non-Hispanic White (59.6%), or non-Hispanic other (4.1%) race and ethnicity. In 2022, unadjusted past-year Papanicolaou testing rates were significantly lower among rural vs urban residents (48.6% [95% CI, 39.2%-58.1%] vs 64.0% [95% CI, 60.0%-68.0%]; P < .001). Adjusted odds of past-year Papanicolaou testing were lower in 2022 than 2019 (odds ratio, 0.70; 95% CI, 0.52-0.95; P = .02).
CONCLUSIONS AND RELEVANCE
This repeated cross-sectional study found that past-year Papanicolaou testing rates were lower in 2022 than 2019, pointing to a need to increase access to screenings to prevent an uptick in cervical cancer incidence. Rural-vs-urban differences in 2022 indicate a need to specifically target rural females.
Topics: Humans; Female; Uterine Cervical Neoplasms; Middle Aged; Adult; Early Detection of Cancer; Cross-Sectional Studies; Rural Population; Papanicolaou Test; Urban Population; Aged; United States; COVID-19; Young Adult; Vaginal Smears; SARS-CoV-2
PubMed: 38874926
DOI: 10.1001/jamanetworkopen.2024.17094 -
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