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.

scholarly journals Kanker serviks dan gen Fas-promoter-670

2019 ◽  
Vol 2 (3) ◽  
pp. 90-91
Author(s):  
ML Edy Parwanto
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cervical Intraepithelial Neoplasia ◽  
Incidence Rate ◽  
Invasive Cervical Cancer ◽  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion

Kanker serviks merupakan keganasan pada serviks. Jenis kanker tersebut terjadi pada perempuan dan masih menjadi masalah di Indonesia. Indonesia merupakan negara urutan ke 4 di Asia Tenggara dengan insiden kanker serviks terbesar setelah Kamboja, Myanmar dan Thailand. Berdasar data statistik tahun 2012, tingkat insidensi (incidence rate) kanker serviks di Indonesia 17 per 100.000 perempuan per tahun.(1) Telah terbukti bahwa penyebab primer terjadinya kanker serviks yaitu virus papilloma atau yang lebih dikenal dengan istilah “human papillomavirus (HPV)”. Terdapat beberapa jenis serotype HPV, tetapi tidak semua jenis serotype bersifat progesif menjadikan kanker serviks. Salah satu serotype yang bersifat progesif menjadikan kanker serviks yaitu HPV serotype 16. HPV serotype 16 mampu mengubah sel epitel squamosa serviks (cervical-squamous-epithelial cells=CSEC) normal menjadi lesi intraepitelial squamosa tingkat rendah (low-grade squamous intraepithelial lesion=LSIL) atau neoplasia intraepitel serviks (cervical intraepithelial neoplasia=CIN) 1. Selanjutnya, LSIL atau CIN 1 berkembang menjadi lesi intraepitelial squamosa tingkat tinggi (high-grade squamous intraepithelial lesion=HSIL) atau CIN 2, dan akhirnya menjadi kanker serviks yang invasif (invasive cervical cancer=CIN3).(2)

scholarly journals Aboriginal women have a higher risk of cervical abnormalities at screening; South Australia, 1993–2016

2018 ◽  
Vol 26 (2) ◽  
pp. 104-112
Author(s):  
Ming Li ◽  
David Roder ◽  
Lisa J Whop ◽  
Abbey Diaz ◽  
Peter D Baade ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Relative Risk ◽  
Confidence Interval ◽  
Cervical Screening ◽  
South Australia ◽  
Low Grade ◽  
High Grade ◽  
Mixed Effect ◽  
Aboriginal Women ◽  
Cytological Abnormality

Objective Cervical cancer mortality has halved in Australia since the national cervical screening program began in 1991, but elevated mortality rates persist for Aboriginal and Torres Strait Islander women (referred to as Aboriginal women in this report). We investigated differences by Aboriginal status in abnormality rates predicted by cervical cytology and confirmed by histological diagnoses among screened women. Methods Using record linkage between cervical screening registry and public hospital records in South Australia, we obtained Aboriginal status of women aged 20–69 for 1993–2016 (this was not recorded by the registry). Differences in cytological abnormalities were investigated by Aboriginal status, using relative risk ratios from mixed effect multinomial logistic regression modelling. Odds ratios were calculated for histological high grade results for Aboriginal compared with non-Aboriginal women. Results Of 1,676,141 linkable cytology tests, 5.8% were abnormal. Abnormal results were more common for women who were younger, never married, and living in a major city or socioeconomically disadvantaged area. After adjusting for these factors and numbers of screening episodes, the relative risk of a low grade cytological abnormality compared with a normal test was 14% (95% confidence interval 5–24%) higher, and the relative risk of a high grade cytological abnormality was 61% (95% confidence interval 44–79%) higher, for Aboriginal women. The adjusted odds ratio of a histological high grade was 76% (95% confidence interval 46–113%) higher. Conclusions Ensuring that screen-detected abnormalities are followed up in a timely way by culturally acceptable services is important for reducing differences in cervical cancer rates between Aboriginal and non-Aboriginal women.

scholarly journals Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out

2009 ◽  
Vol 127 (5) ◽  
pp. 283-287 ◽  
Author(s):  
Andréa Cytryn ◽  
Fábio Bastos Russomano ◽  
Maria José de Camargo ◽  
Lucília Maria Gama Zardo ◽  
Nilza Maria Sobral Rebelo Horta ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Prevalence Ratio ◽  
Intraepithelial Neoplasia ◽  
Uterine Cervical Cancer ◽  
High Grade ◽  
Cross Sectional ◽  
Squamous Cells ◽  
Bethesda System ◽  
Undetermined Significance

CONTEXT AND OBJECTIVE: The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. DESIGN AND SETTING: Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. METHODS: ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard. RESULTS: The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases. CONCLUSION: The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.

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.

scholarly journals Silent High Grade Cervical Intraepithelial Neoplasia Diagnosis of Atypical Smear between Conventional and Liquid Based Papanicolaou Smear in Suburban Area of Thailand

2018 ◽  
Vol 3 (3) ◽  
pp. 47
Author(s):  
Paweena Phaliwong ◽  
Piyawan Pariyawateekul ◽  
Nathaya Khuakoonratt ◽  
Worrawan Sirichai ◽  
Kornkarn Bhamarapravatana ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Medical Records ◽  
Menopausal Status ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Squamous Cells ◽  
The Mean ◽  
Cytology Result ◽  
Undetermined Significance

Objectives: To evaluate the prevalence of silent high grade cervical intraepithelial neoplasia diagnose in atypical squamous cells of undetermined significance (ASC-US) in cytology result between conventional (CPP) and liquid-based cervical cytology (LBP) methods to suggest the proper management for Thai women.Methods: This retrospective study was conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand between January 2011 and December 2016. Medical records of 28,564 patients who attended for cervical cancer screening were reviewed. Prevalence of silent high grade cervical intraepithelial neoplasia (CIN) in atypical squamous cells of undetermined significance (ASC-US) cytology result was determinedResults: During the study period, 28,564 cases were enrolled. There were 22,552 and 6,012 of CPP and LBP cases, respectively. A total of 644 cases of ASC-US cytology were enrolled. In women with ASC-US in cytology, the mean age was younger than women with negative screening cytology group and approximately 70% were in pre-menopausal status. Prevalence of high grade cervical intraepithelial neoplasia in ASC-US cytology from CPP and LBP were 9.5 and 11.9%, respectively. Ten percent (23/248) of atypical glandular cytology pattern was cancer. One-quarter of them was endometrial cancer.Conclusion: Silent high grade cervical intraepithelial neoplasia in ASC-US cytology and the rate of cancer in atypical glandular cytology pattern were high. We recommended colposcopy for women who had the cervical cytological report as atypical squamous and glandular cytology pattern.

Adjunctive Human Papillomavirus Testing in the 2-Year Follow-up of Women With Low-Grade Cervical Cytologic Abnormalities: A Randomized Trial and Economic Evaluation

2003 ◽  
Vol 127 (9) ◽  
pp. 1169-1175 ◽  
Author(s):  
Alice Lytwyn ◽  
John W. Sellors ◽  
James B. Mahony ◽  
Dean Daya ◽  
William Chapman ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Cervical Intraepithelial Neoplasia ◽  
Pap Test ◽  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Hpv Testing ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion

Abstract Context.—Although human papillomavirus (HPV) testing may aid in managing low-grade abnormality on screening cervical cytology, patient compliance with repeat testing programs requires consideration. Objectives.—To determine effectiveness and costs of repeated Papanicolaou (Pap) test and oncogenic HPV testing for detecting cervical intraepithelial neoplasia 2 or 3. Design.—We conducted a randomized controlled trial of combined Pap test and cervical HPV testing by Hybrid Capture 1 test compared with Pap test alone; tests were performed every 6 months for up to 2 years. The study end point was colposcopic examination performed on all women at 2 years, or earlier if an HPV test was positive or if a Pap test showed high-grade squamous intraepithelial lesion. Setting.—Sixty-six community family practices. Participants.—Two hundred fifty-seven women with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion on screening cervical cytology. Main Outcome Measures.—Detection of histologically confirmed cervical intraepithelial neoplasia 2 or 3, fully allocated costs, and loss to follow-up. Results.—Combined Pap test and HPV testing detected 11 (100%) of 11 cases of cervical intraepithelial neoplasia 2/3, whereas Pap test alone detected 7 (63.6%) of these 11 cases (P = .14); corresponding specificities were 39 (46.4%) of 84 and 45 (71.4%) of 63 (P = .005). The cost-effectiveness ratio was Can $4456 per additional case of high-grade cervical intraepithelial neoplasia. Sixty-nine (26.8%) of the 257 women (24.6% combined group vs 29.1% Pap test only group, P = .41) defaulted from testing or from colposcopy when referred with an abnormal result. Conclusions.—Combined testing was more costly but may detect more cases of cervical intraepithelial neoplasia 2/3 than Pap test alone. However, poor adherence limits usefulness of a management strategy that requires repeated follow-up.

scholarly journals Clinical effectiveness of VIA and colposcopy based management of cervical intraepithelial neoplasia

2015 ◽  
Vol 47 (1-2) ◽  
pp. 16-20
Author(s):  
Zannatul Ferdous Jesmin ◽  
Afroza Khanam ◽  
Eti Saha ◽  
Md Mokter Hossain
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Screening Program ◽  
Precancerous Lesion ◽  
Intraepithelial Neoplasia ◽  
Post Treatment ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
Cin Iii

Cervical cancer develops from early precancerous lesion known as cervical intraepithelial neoplasia (CIN). Khulna Medical college Hospital provides primary screening for preventing cervical cancer and a secondary referral centre for management of CIN by colposcopy. Primary objective of this study was to do an audit between January 2012 to February 2014 to update clinical efficacy of colposcopy based diagnosis, treatment and follow up of 510 CIN cases and also to document any shortcomings in existing services and suggestion for early rectification. Colposcopic findings in our study group were: 309(60.6%) cases were CIN-1, 124 (24.3%) cases was CIN II, and 49 (9.6%) cases were CIN III. Suspicious of invasive lesion was in 7 (1.4%) abnormal looking cervix and biopsy was done in 21(4.1%). Treatment procedure was done with individualization of cases and options were cold coagulation, Loop electrosurgical excision procedure (LEEP), hysterectomy, biopsy and post treatment follow up. Histopathological diagnosis was documented in 387 cases, where CINI was found in 161 (31.6%), CIN II in 92 (18%), CIN III in 26 (5.1%), non specific Inflammatory cervicitis in 87(17.1%), Squamous cell carcinoma in 15(2.9%), abnormalities consistent with koilocytic atypia in 6 (12%) and reports missed in 123 (24.1%). Cases results showed Positive predictive value (PPV) of 53% and 68% respectively for low grade (CIN I) and high grade lesion (CIN II, III). 481 patient were eligible for post treatment follow up but only 99 (20.5%) patient came and among them 74 (74.7%) were colposcopically negative, 25 (25.2%) had residual CIN and Risk Ratio (RR) was 0.25. Colposcopy is gold standard for diagnosis of CIN but our screening program is opportunistic and far way from population based. Histopathological correlation were often inaccurate with colposcopic diagnosis in practice and about one third case reports were missed. Majority of women did not complete follow up protocol. Residual or recurrent CIN lesion in dropped out cases would be a concern in near future. DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22557 Bang Med J (Khulna) 2014; 47 : 16-20

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