-
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 -
Acta Cytologica May 2024The earliest cytotechnologists are largely unknown. (Review)
Review
BACKGROUND
The earliest cytotechnologists are largely unknown.
SUMMARY
In 1943, the book "Diagnosis of Uterine Cancer by the Vaginal Smear" by Papanicolaou and Traut recognized several women who have largely faded from memory. While Mary Papanicolaou and Charlotte Street are familiar names, others like Alberta Kuder and Huldah Boerker, who inadvertently laid the groundwork for the field of Cytotechnology, remain obscure. There were also women like Christine Rassias and Adele Reboul who did not receive recognition. Notably, Mrs. Lady Mary G. Papanicolaou, despite her significant contributions both in the lab and at home since 1914, was not acknowledged in her husband's work until the publication of his Atlas in 1954.
KEY MESSAGE
These women set the benchmark for future Cytotechnologists, unknowingly shaping the profession as we know it today.
PubMed: 38815570
DOI: 10.1159/000539566 -
High frequency of alpha7-HPV in Colombian Caribbean coast women: cervical cancer screening analysis.BMC Infectious Diseases May 2024Cervical cancer (CC) is a significant global public health concern, particularly in developing countries such as Colombia. The main risk factor involves high-risk HPV...
BACKGROUND
Cervical cancer (CC) is a significant global public health concern, particularly in developing countries such as Colombia. The main risk factor involves high-risk HPV types (HR-HPV) infection, coupled with population-specific variables. The Caribbean region in Colombia lacks research on HR-HPV-type frequencies. Therefore, this study aims to establish the prevalence of type-specific HR-HPV and its association with sociodemographic factors among women undergoing cervical cytology screening.
METHODS
A cross-sectional study involving voluntary women who provided informed consent and completed a questionnaire capturing sociodemographic, clinical, and sexual behavior information was conducted. All participants underwent cervical cytology and molecular analysis. Generic HPV detection employed three simultaneous PCRs (GP5+/6+, MY09/11, and PU1R/2 M), and positive samples were genotyped using the Optiplex HPV Genotyping kit. The analysis encompassed the 12 types of high-risk HPV (HR-HPV-16,-18,-31,-33,-35,-39,-45,-51,-52,-56,-58, and - 59). Frequencies were reported based on geographic subregions within the Córdoba department, and disparities were made between single and multiple infections. Sociodemographic and clinical variables were subjected to ordinal logistic regression, with statistical significance at a p-value < 0.05. The statistical analyses utilized STATA 14® and R-Core Team-software.
RESULTS
We included 450 women, mean age 40 (SD±11.44). PCR analysis revealed 43% HPV-positive (n=192). GP5+/6+ detected the most positives at 26% (n=119), followed by PU1R/2 M at 22% (n = 100) and MY09/11 at 15% (n=69). Multiple infections occurred in 87.3% (n=142), primarily 2 to 4 types (47.37%, n=90). Dominant types were HPV-18 (15.6%, n=61), HPV-16 (14.9%, n=58), HPV-31 (13.0%, n = 51), and HPV-45 (11.5%, n=45). Logistic regression identified age above 60 as a risk for concurrent multiple types (OR=6.10; 95% CI 1.18-31.63). Menopause was protective (OR=0.31; 95% CI 0.11-0.89).
CONCLUSIONS
Our study reveals a notable prevalence of multiple (2-4) high-risk HPV infections among adult women engaged in CC detection initiatives. Predominantly, α7 species constitute the prevalent HR-viral types, with the Medio Sinú subregion showing elevated prevalence. Menopausal status confers protection against diverse HR-HPV infections. Nevertheless, advancing age, particularly beyond 60 years, is linked to an increased susceptibility to simultaneous infections by multiple HPV-types.
Topics: Humans; Female; Adult; Papillomavirus Infections; Colombia; Cross-Sectional Studies; Uterine Cervical Neoplasms; Middle Aged; Early Detection of Cancer; Prevalence; Papillomaviridae; Genotype; Young Adult; Risk Factors; Aged; Alphapapillomavirus; Caribbean Region
PubMed: 38811877
DOI: 10.1186/s12879-024-09410-0 -
Asian Pacific Journal of Cancer... May 2024The prevention of cervical cancer can be achieved by treating high-grade cervical precancerous lesions. Treatment options for cervical precancer include excisional... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Comparison of Sexual Function after Thermal Ablation Versus Loop Electrosurgical Excision Procedure (LEEP) for Cervical Intraepithelial Neoplasia (CIN 2 and 3): A Randomized Controlled Trial.
BACKGROUND
The prevention of cervical cancer can be achieved by treating high-grade cervical precancerous lesions. Treatment options for cervical precancer include excisional procedures, and ablation treatments. Despite the long pre-invasive course of the disease, literature addressing sexual function post-treatment for cervical pre-invasive lesions is scarce. This study aims to bridge this gap and assess the sexual function and the acceptability, efficacy, safety, and complications of loop electrosurgical excision procedure (LEEP) versus thermal ablation.
METHODS
The prospective open-label randomized controlled trial recruited women aged 22-55 with histologically confirmed Cervical Intraepithelial Neoplasia (CIN) 2 and 3 lesions. Participants were randomly allocated to either thermal ablation or LEEP. All cases were followed up with a Pap smear at three- and six-months post treatment. Sexual health assessments were conducted using a questionnaire at baseline and 3 months post-procedure. Secondary outcome measures included comparison of acceptability, pain, and side effects between the two treatment measures.
RESULTS
Out of 1356 screened cases, 60 were included in the study and randomized in two groups. The groups had similar baseline characteristics. Duration of LEEP was longer than thermal ablation (25.33 vs. 20.67 minutes), with higher pain reported 10 minutes post-procedure in the LEEP group. Three months post-procedure, both groups showed comparable acceptability and symptom relief. Sexual function parameters significantly improved in the thermal ablation group compared to LEEP, including satisfaction, desire, lubrication, flexibility, and ability to reach climax.
CONCLUSION
LEEP and thermal ablation are effective treatments for CIN with similar efficacy at 6 months. Thermal ablation demonstrated advantages in procedure time and post-procedural pain but exhibited varying effects on sexual function, improving satisfaction and desire. In contrast, LEEP showed a decrease in satisfaction and potential alterations in lubrication and flexibility. Larger-sample, longer-term studies are recommended for further insights.
Topics: Humans; Female; Electrosurgery; Adult; Uterine Cervical Dysplasia; Prospective Studies; Uterine Cervical Neoplasms; Middle Aged; Young Adult; Follow-Up Studies; Prognosis; Sexual Behavior; Sexual Dysfunction, Physiological; Ablation Techniques
PubMed: 38809642
DOI: 10.31557/APJCP.2024.25.5.1699 -
PloS One 2024Speculum lubrication may help to reduce the pain experienced during Pap-smear collection and hence increase uptake of cervical cancer screening and repeat testing, but... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Speculum lubrication may help to reduce the pain experienced during Pap-smear collection and hence increase uptake of cervical cancer screening and repeat testing, but there are fears of its interference with cytological results.
AIM
To determine and compare the adequacy of cervical cytology smears and the mean pain scores of women undergoing cervical cancer screening with or without speculum lubrication.
METHODS
This was a randomised controlled study of 132 women having cervical cancer screening at a tertiary hospital in Nigeria. Sixty-six participants were randomly assigned to the 'Gel' and 'No Gel' groups, respectively. Pap smears were collected from each participant with a lubricated speculum ('Gel group') or a non-lubricated speculum ('No Gel group'). The primary outcome measures were the proportion of women with unsatisfactory cervical cytology smears and the mean numeric rating scale pain scores, while the secondary outcome measures were the proportion of women who were willing to come for repeat testing and the cytological diagnosis of Pap-smear results.
RESULTS
The baseline socio-demographic variables were similar in both groups. There was no significant difference in the proportion of unsatisfactory cervical smear results between the two groups (13.6% vs. 21.2%, p = 0.359). However, the mean pain scores were significantly lower in the gel group than in the no gel group (45.04 vs. 87.96; p<0.001). An equal proportion of the participants in each group (90.9% vs. 90.9%; p > 0.999) were willing to come for repeat cervical smears in the future.
CONCLUSION
Speculum lubrication did not affect the adequacy of cervical smears but significantly reduced the pain experienced during pap smear collection. Also, it did not significantly affect the willingness to come for repeat cervical smears in the future.
TRIAL REGISTRATION
The trial was registered with the Pan-African Clinical Trial Registry with a unique identification and registration number: PACTR2020077533364675.
Topics: Humans; Female; Uterine Cervical Neoplasms; Vaginal Smears; Adult; Papanicolaou Test; Early Detection of Cancer; Middle Aged; Double-Blind Method; Lubrication; Surgical Instruments
PubMed: 38787830
DOI: 10.1371/journal.pone.0292207 -
Current Issues in Molecular Biology May 2024Human papilloma virus (HPV) infection and its progression still represent a great medical challenge worldwide. Clinical evidence has demonstrated the beneficial effects...
Human papilloma virus (HPV) infection and its progression still represent a great medical challenge worldwide. Clinical evidence has demonstrated the beneficial effects of polyhexamethylene biguanide (PHMB) on HPV clinical manifestations; however, evidence of the effect of this molecule on HPV viral load is still lacking. In this in vitro study, 13 ThinPrep Papanicolaou (Pap) tests were treated with a PHMB solution (0.10 g/100 mL) for 2 h. We observed no cytological changes but a significant reduction in the viral load of high-risk (HR) HPV after PHMB treatment, also revealing a dose-dependent antiviral effect. In addition, by stratifying the obtained results according to HR-HPV genotype, we observed a significant reduction in the viral load of HPV 16, P2 (56, 59, 66), 31, and P3 (35, 39, 68) and a strong decrease in the viral load of HPV 45, 52, and P1 (33, 58). Overall, 85% of the analyzed cervical cell samples exhibited an improvement in HPV viral load after PHMB exposure, while only 15% remain unchanged. For the first time, the data from this pilot study support the activity of PHMB on a specific phase of the HPV viral lifecycle, the one regarding the newly generated virions, reducing viral load and thus blocking the infection of other cervical cells.
PubMed: 38785561
DOI: 10.3390/cimb46050293 -
Journal of Cytology 2024Atypical glandular cells (AGCs) diagnosis on Pap (Papanicolaou) smears are uncommon and may represent various benign and malignant lesions.
BACKGROUND
Atypical glandular cells (AGCs) diagnosis on Pap (Papanicolaou) smears are uncommon and may represent various benign and malignant lesions.
OBJECTIVE
This study aims to report the incidence of AGC on Pap smear, to study the relationship of AGC with malignancy, and to determine cytomorphological features that help in predicting malignancy.
MATERIALS AND METHODS
Retrospective analytical study conducted in the Department of Oncopathology at Tertiary Cancer and Research Institute. In this retrospective study, we included cases diagnosed with AGC between July 2017 to July 2022. All slides were reviewed and subclassified according to the Bethesda 2014 classification system (TBS). The predetermined cytomorphological features observed in the smears were recorded. The follow-up histopathological diagnoses of the cases were retrieved. The significant cytomorphological and clinicopathological findings for malignancy were determined.
RESULTS
Pearson χ test with SPSS software version 22 to compare cytologic features of cases with benign and malignant follow-up. The significant cytomorphological features observed in neoplastic cases were cells in 3-dimensional clusters, nuclear overlapping, reniform nucleus, irregular nuclear membrane, increased nuclear size, single macronucleoli, engulfed neutrophils, and prominently vacuolated cytoplasm.
CONCLUSIONS
The diagnosis of AGC on cytology is associated with clinically significant lesions, and cytomorphologic parameters can be used to predict the benign and malignant outcome.
PubMed: 38779602
DOI: 10.4103/joc.joc_172_23 -
Cureus Apr 2024Background Anal Pap smears are imperative to screening for human papillomavirus (HPV)-associated anal squamous cell cancers, particularly in patients living with human...
Background Anal Pap smears are imperative to screening for human papillomavirus (HPV)-associated anal squamous cell cancers, particularly in patients living with human immunodeficiency virus (HIV) given a higher incidence of disease. Self-collection of specimens may be favored by patients and more feasible to collect, increasing screening. Methods This was a single-center observational cohort study at a single academic medical center Infectious Diseases clinic from October to December 2021. We aimed to improve compliance of anal Pap collection documentation of "self-collected" versus "physician-collected" as well as verify if self-collected specimens (SCS) were adequate for interpretation equivalent to physician-collected specimens (PCS). Additionally, we aimed to evaluate patient and provider satisfaction with self-collected anal Paps. Results Sixty anal Pap smears were available for evaluation. The rate of documentation of the collection method (self-collected vs. physician-collected) was 88% during the intervention. A total of 75% of patients opted for self-collection, and 35/45 (78%) of these samples were adequate for interpretation. There was no difference in the adequacy of specimen (the ability of a cytopathologist to interpret the specimen) between the SCS and PCS. Conclusion Limited prior data suggest self-collected anal Pap specimens are adequate for interpretation only slightly less often than PCS. In our small cohort, there was no statistically significant difference between collection methods. Satisfaction with self-collection of specimens was high for both patients and providers. Additional validation in more diverse/larger clinical settings may be helpful to support this practice.
PubMed: 38779240
DOI: 10.7759/cureus.58753 -
Journal of Mid-life Health 2024The present study was done to compare the visual inspection methods with Pap smear as a screening test for premalignant lesions of the cervix.
AIM AND OBJECTIVES
The present study was done to compare the visual inspection methods with Pap smear as a screening test for premalignant lesions of the cervix.
MATERIALS AND METHODS
The present observational prospective study was done at the Department of Obstetrics and Gynecology at Teerthanker Mahaveer Medical College and Research Center for 18 months. All study subjects were subjected to Papanicolaou smear, VIA, and VILI examination. If any of these tests were found positive, then a colposcopy and cervical biopsy were done.
RESULTS
The sensitivity of Pap, VIA, VILI, and colposcopy was 52.63%, 84.21%, 73.68%, and 84.21%, respectively. The specificity of Pap, VIA, VILI, and colposcopy was 60.0%, 80.0%, 60.0%, and 80.0%, respectively. The accuracy of Pap, VIA, VILI, and colposcopy was 54.17%, 83.33%, 70.83%, and 83.33%, respectively.
CONCLUSION
It is well known that VIA and VILI are very easy to carry out and apply. Even technically they do not cost much, consume less tax and can be applied to all the patients. Even the results are calculated in a faster manner which helps in chalking out the plan in an easy way.
PubMed: 38764929
DOI: 10.4103/jmh.jmh_201_23