The impact of microinvasive cancer of the cervix on women during follow-up

2008 ◽  
Vol 18 (6) ◽  
pp. 1289-1293 ◽  
Author(s):  
M. Cairns ◽  
N. M. Gray ◽  
M. E. Cruickshank
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Cervical Screening ◽  
Depression Scale ◽  
Intraepithelial Neoplasia ◽  
Postal Questionnaire ◽  
Depression Score ◽  
High Grade ◽  
The Impact

The psychologic and psychosexual sequelae of cervical screening and disease are well recognized but most research has focused on women with cervical intraepithelial neoplasia (CIN) or women with early (stage IB) to advanced cervical cancer. There has been little work looking at women with microinvasive cancer as a unique clinical identity. Many of these women have a similar diagnostic, treatment, and follow-up pathway to those with high-grade CIN. This could result in unrecognized and ongoing health concerns. We report on a questionnaire-based case–control study, comparing the concerns of women with microinvasive cervical cancer with those of women with high-grade CIN. Women with microinvasive cancer and controls with CIN2/3 diagnosed between 2000 and 2006, from a geographically defined population, were recruited and invited to complete a postal questionnaire consisting of the Hospital Anxiety and Depression Scale (HADS) and the Process Outcome Specific Measure (POSM). Twenty-eight women diagnosed with microinvasive cancer were identified and 18 participated (response rate 64%). Fifty-eight controls were matched by age and year of treatment with 26 responding (45%). About 18% of women with microinvasive cancer had a HADS depression score of 8 or more, compared to 12% of those with CIN (P= not significant). The HADS anxiety score of 8 or more occurred in 35% of each group. There were no significant differences in terms of POSM results for sexual activity, fertility, and developing cervical cancer in the future between cases and controls. We did not find a difference between women with a previous diagnosis of microinvasive cancer and those with high-grade CIN, in terms of ongoing concerns during their follow-up. We did not identify any additional concerns for women with microinvasive cancer in the care provided in the colposcopy service.

High-grade cervical abnormalities and screening intervals in New South Wales, Australia

2008 ◽  
Vol 15 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Suzanne Schindeler ◽  
Stephen Morrell ◽  
Yeqin Zuo ◽  
Deborah Baker
Keyword(s):  
Cervical Cancer ◽  
New South ◽  
Cervical Screening ◽  
New South Wales ◽  
Pap Test ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Screening Interval ◽  
South Wales ◽  
Screening Intervals

Objectives This study aims to determine the association of two versus three year screening intervals with the likelihood of detection of a high-grade cervical abnormality and cervical cancer. Methods Data were obtained from the New South Wales (NSW) Papanicolaou (Pap) Test Register (PTR) and NSW Central Cancer Registry (CCR). Subjects were human papillomavirus (HPV) unvaccinated women aged 20-69 years who had a minimum of two Pap tests with a negative result at their first recorded Pap test (n = 1,213,295). Logistic regression was used to determine the association between screening interval and the likelihood of: (1) a cytological prediction of high-grade abnormality, defined as cervical intraepithelial neoplasia (CIN) 2 or greater; (2) a histologically confirmed high-grade abnormality; (3) a cytological prediction of cervical cancer and (4) a confirmed diagnosis of cervical cancer, controlling for potential confounders of age and socioeconomic status (SES) of area of residence. Results For each year increase in the screening interval, the odds of a histologically confirmed high-grade abnormality increased significantly in women aged 20-29 years (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.20-1.28) and in women aged 30-49 years (OR 1.11, 95% CI 1.06-1.16), but not in women aged 50-69 years (OR 1.08, 95% CI 0.89-1.32). Similar results were observed for cytologically detected high-grade abnormalities. The screening interval was significantly and positively associated with a cytological prediction of cervical cancer (OR 1.40, 95% CI 1.28-1.54) and a confirmed cervical cancer diagnosis (OR 1.66, 95% CI 1.33-2.07) in women aged 20-69 years. We estimate that if the screening interval were increased from two to three years, and the number of women participating in triennial screening participation was the same as for biennial participation in NSW, then 267 (95% CI 186-347) extra cases of high-grade abnormalities would be detected annually by cytology and 225 extra cases (95% CI 160-291) confirmed by histology, mostly confined to women aged 20-49 years. Equivalently, 2.3 (95% CI 1.8-2.8) and 1.9 (95% CI 1.5-2.4) extra cases of high-grade cytology and histology, respectively, would be expected per 1000 women with initially negative cytology if the screening interval were extended from two to three years. Conclusion Increasing the cervical screening interval from two to three years would be expected to significantly increase the odds of detection of a high-grade abnormality for NSW women aged 20-49 years and cervical cancer for NSW women aged 20-69 years. Accordingly, our study provides evidence in support of retaining the recommended cervical screening interval at two years for HPV unvaccinated, well women.

scholarly journals A CASE OF CERVICAL INTRAEPITHELIAL NEOPLASIA - MANAGEMENT THROUGH AYURVEDA

2021 ◽  
Vol 9 (12) ◽  
pp. 3143-3150
Author(s):  
Deepthi. G. B ◽  
Gayathri Bhat. N.V
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Disease Incidence ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Treatment Modalities ◽  
Low Grade ◽  
Disease Manifestation ◽  
Mild Dysplasia

Introduction – Cervical cancer is the 2nd most leading prevalent cancer in India. There are an estimated 123,000 new cases of cervical cancer in India every year with 67,000 deaths in women alone. Cervical cancer in Recent studies shows that screening of cervical cancer reduces the disease incidence and disease mortality by 50%. Low- grade squamous intraepithelial lesion (LSIL) is a common abnormal result on a Pap smear cervical test. It’s also known as mild dysplasia. Methodology – Here is a case report of a patient aged 26yrs with complaints of white discharge per vagina with severe itching, on routine cervical screening investigations found to have Low grade squamous intraepithelial neoplasms. She was treated with Ayurvedic sthanika chikitsa (Local therapies) such as Yoni prakshalana (Vaginal douching), and Yoni pichu (Vaginal tamponing) for 7 days along with shaman chikitsa. Later PAP smear was repeated after 1 month of follow up and found to have negative for intraepithelial neoplasia. And there was relief in the symptoms following treatment. Results- In this case, there was a relief of symptoms and on follow up when Pap smear was repeated, there was negative for intraepithelial neoplasia. Ayurvedic treatment modalities such as Sthanika chikitsa which includes yoni prakshalana and Yoni Pichu are the line of treatment for various gynecological problems and help in reducing mortality and morbidity caused due to cervical cancer in India. Discussion- Here Low-grade squamous Intraepithelial neoplasia can be considered as the Sanchaya avastha and hence diagnosing the disease in its Sanchaya avastha i.e mild dysplasia, is important. During Sanchaya avastha there is localized neoplastic changes of cervical cells and there is Manifestation of Low-grade Intraepithelial Neo- plasia. In the later stages of Kriyakala (Stages of disease manifestation) the neoplasia turns into metastasis and further differentiation occurs which Manifests all the symptoms of Cervical Cancer. Hence treatment modalities such as Yoni prakshalana and yoni pichu helps in preventing later conditions such as cervical cancer. Keywords: Cervical Cancer, LSIL, Ayurveda, Sanchaya

Insulin-like growth factor II mRNA binding protein 3 (IMP3) expression in cervical intraepithelial neoplasia and its relationship with HIV-infection status

Sexual Health ◽  
2015 ◽  
Vol 12 (1) ◽  
pp. 22 ◽  
Author(s):  
Alessandro Del Gobbo ◽  
Emanuela Bonoldi ◽  
Fulvia Milena Cribiù ◽  
Ilaria Franceschetti ◽  
Caterina Matinato ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Growth Factor ◽  
Protein Expression ◽  
Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
High Grade ◽  
Mrna Binding Protein ◽  
Mrna Binding ◽  
Hiv Negative

Background Cervical cancer is preventable through screening, and HIV treatment guidelines recommend that all HIV-infected women receive cervical cancer twice during the year after HIV diagnosis and annually thereafter. Different immunohistochemical markers have been studied to highlight cervical intraepithelial lesions of low and high grade, the most widely used being p16. Recent studies have shown that insulin-like growth factor mRNA binding protein 3 (IMP3) plays a role in the development of invasive squamous cell carcinoma from cervical dysplasia, both in histology and in liquid-based cytology. Methods: We evaluated the clinical significance of the immunohistochemical expression of IMP3 and p16 in histological samples of cervical intraepithelial neoplasia from 56 samples of HIV-positive and 30 samples of HIV-negative patients. Results: A significant difference was found in IMP3 and p16 protein expression between HIV-positive and HIV-negative specimens. All cases of HIV-positive low grade squamous intraepithelial neoplasia (L-SIL) with IMP3 expression progressed in high grade (H)-SIL. However, the HIV-positive patients with IMP3-negative L-SIL remained stable or had a negative follow up. The L-SIL of HIV-negative patients with IMP3 protein expression had an uneventful follow up. IMP3-positive H-SIL recurred with low- or high-grade dysplasia during follow up after conisation in both populations. All IMP3-negative L-SIL and H-SIL had negative pap tests at follow up. Conclusions: In HIV-positive cases, IMP3 showed a higher sensitivity than p16 in identifying patients at risk of progression and recurrence.

scholarly journals HPV Detection Methods

2007 ◽  
Vol 23 (4) ◽  
pp. 273-281 ◽  
Author(s):  
Antoinette A. T. P. Brink ◽  
Peter J. F. Snijders ◽  
Chris J. L. M. Meijer
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
High Risk ◽  
Cervical Intraepithelial Neoplasia ◽  
Causal Relation ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Detection Methods ◽  
High Grade ◽  
Cervical Lesions

Given the causal relation between a persistent high-risk human papillomavirus (hrHPV) infection and the development of high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer, hrHPV testing has been advocated in addition to cytology for the detection of clinically relevant cervical lesions. HrHPV testing is thought to improve cervical screening algorithms, the management of women with cytologically equivocal smears, and the management of women treated for high grade CIN. In this chapter we discuss different methods for HPV detection and genotyping and their respective applications.

scholarly journals Evaluation of Visual and Cytology Screening in Preventing Cervical Intraepithelial Neoplasia and Cervical Cancer in Namibia

2021 ◽  
Author(s):  
Riana Pick ◽  
Koffi Kouame ◽  
Sylvester Rodgers Moyo ◽  
Yapo Guillaume Aboua
Keyword(s):  
Cervical Cancer ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Increased Risk ◽  
Health Objectives ◽  
The Impact ◽  
Intraepithelial Lesions ◽  
Diagnostic Outcomes ◽  
Cytology Screening

Abstract An estimated 851 340 women in Namibia are at risk of human papilloma viral (HPV) infection that may cause cervical cancer. Visual screening with acetic acid (VIA) and cryotherapy have been proven highly effective. However, data associating with the impact of cervical cancer screening programmes lack. This study evaluated visual and cytology screening in preventing cervical intraepithelial lesions (CIN) and cervical cancer in Namibia. Findings showed that women with HPV, cervicitis, koilocytosis and atypia are at an increased risk of testing positive for VIA. Older women, particularly with HIV are more likely to be diagnosed with squamous cell carcinoma (SCC). VIA procedure seems to be viable in screening, although colposcopy in patient follow-up in the Namibian context should be revised and used with positive HR-HPV results. Screening modalities incorporating HPV testing for different ages and risk populations (e.g. HIV positive, autoimmune disease) is recommended. Screening uptake can further be improved by interventions that adopt a model which uses previous diagnostic outcomes, women’s health objectives, up-to-date knowledge and practice relevant to national context.

scholarly journals Safety and Prognostic Impacts of Ovarian Preservation during Radical Hysterectomy for Early-Stage Adenocarcinoma and Adenosquamous Cervical Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Arisa Theplib ◽  
Jitti Hanprasertpong ◽  
Kittinun Leetanaporn
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Pelvic Lymphadenectomy ◽  
Ovarian Metastasis ◽  
Ovarian Preservation ◽  
Oncological Outcomes ◽  
The Difference ◽  
The Impact

Objective. To identify the incidence of ovarian metastasis and the impact of ovarian preservation on oncological outcomes for early-stage adenocarcinoma and adenosquamous cervical cancer. Methods. 281 patients with stages IA2-IB1 adenocarcinoma and adenosquamous cervical cancer who underwent radical hysterectomy with pelvic lymphadenectomy (RHND) were included in the study. The incidence of ovarian metastasis was evaluated from 173 patients who underwent oophorectomy during RHND. Subgroup analysis was performed for patients less than 50 years (196 of 281 patients) who were classified into two groups, ovarian preservation and nonovarian preservation groups. 5-year recurrence-free survival (5-yr RFS) and 5-year overall survival (5-yr OS) were evaluated and compared between these groups. Results. There was no evidence of ovarian metastasis, synchronous ovarian cancer, or ovarian recurrence during follow-up. In patients less than 50 years of age, there were no statistically significant differences in the 5-yr RFS ( P = 0.363 ), or 5-yr OS ( P = 0.974 ) between the ovarian preservation and nonovarian preservation groups. In Kaplan–Meier analysis, the ovarian preservation group seemed to have a slightly better OS in long-term follow-up (after 15 years); however, the difference was not statistically significant. Conclusions. Ovarian preservation was safe in adenocarcinoma and adenosquamous cervical cancer stages IA2-B1. However, the impact of ovarian preservation on oncological outcomes needs to be further investigated.

Effects of Implementing the Dual Papanicolaou Test Interpretation of ASC-H and LSIL Following Bethesda 2014

2020 ◽  
Vol 154 (4) ◽  
pp. 553-558
Author(s):  
Abha Goyal ◽  
Ami P Patel ◽  
Thomas L Dilcher ◽  
Susan A Alperstein
Keyword(s):  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Papanicolaou Test ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Hpv Test ◽  
Intraepithelial Lesion ◽  
The Impact

Abstract Objectives To evaluate the impact of implementing the dual interpretation of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and low-grade squamous intraepithelial lesion (LSIL) after the Bethesda System 2014 and to compare it with other indeterminate interpretations. Methods Rates of high-risk human papillomavirus (HPV) positivity and histologic follow-up and the proportion of women with high-grade squamous intraepithelial lesion on histologic follow-up were compared for the combined interpretation of ASC-H and LSIL (ASCHL) and the categories of LSIL, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) and ASC-H. Results The percentage of ASCHL HPV-positive cases (86.0%) was similar to that of LSIL-H but significantly higher in comparison to that of ASC-H. The rates of cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) and CIN 3+ for ASCHL (29.6% and 3.6%, respectively) were similar to those of LSIL-H and ASC-H. When stratified by HPV test results, the proportions of patients with CIN 2+ and CIN 3+ remained statistically similar to those with ASCHL and with LSIL-H and ASC-H. Conclusions Considering the similar risks of CIN 2+ and CIN 3+ for ASCHL and ASC-H, having a separate category of ASCHL for reporting cervical cytology appears to be redundant.

scholarly journals The impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland: reducing the gap

2017 ◽  
Vol 71 (10) ◽  
pp. 954-960 ◽  
Author(s):  
Ross L Cameron ◽  
Kimberley Kavanagh ◽  
D Cameron Watt ◽  
Chris Robertson ◽  
Kate Cuschieri ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Relative Risk ◽  
Cervical Intraepithelial Neoplasia ◽  
Hpv Vaccine ◽  
Intraepithelial Neoplasia ◽  
Incidence Rates ◽  
Vaccine Uptake ◽  
Low Grade ◽  
High Grade ◽  
The Impact

BackgroundCervical cancer disproportionately affects women from lower socioeconomic backgrounds. A human papillomavirus (HPV) vaccination programme was introduced in Scotland in 2008 with uptake being lower and inequitable in a catch-up cohort run for the first three years of the programme compared with the routine programme. The socioeconomic differences in vaccine uptake have the potential to further increase the inequality gap in regards to cervical disease.MethodsVaccination status was linked to demographic, cytological and colposcopic data, which are routinely collected by the Scottish HPV surveillance system. Incidence rates and relative risk of cervical intraepithelial neoplasia (CIN) 1, 2 and 3 in unvaccinated and vaccinated women were stratified by birth year and deprivation status using Poisson regression.ResultsWomen who received three doses of HPV vaccine have significantly decreased risk of CIN 1, 2 and 3. Vaccine effectiveness was greater in those women from the most deprived backgrounds against CIN 2 and 3 lesions. Compared with the most deprived, unvaccinated women, the relative risk of CIN 3 in fully vaccinated women in the same deprivation group was 0.29 (95% CI 0.2 to 0.43) compared with 0.62 (95% CI 0.4 to 0.97) in vaccinated women in the least-deprived group.ConclusionsThe HPV vaccine is associated with significant reductions in both low-grade and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most-deprived women. These data are welcoming and allay the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland.

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