Trends in the Prevalence of Cervical Intraepithelial Neoplasia Grade 3 in the District of Florence, Italy

1995 ◽  
Vol 81 (5) ◽  
pp. 330-333 ◽  
Author(s):  
Silvia Cecchini ◽  
Stefano Ciatto ◽  
Marco Zappa ◽  
Annibale Biggeri
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Poisson Regression ◽  
Precancerous Lesions ◽  
Age Groups ◽  
Pap Test ◽  
Intraepithelial Neoplasia ◽  
Birth Cohorts ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Detection Rates

Aims and background The objective of this study was to investigate the detection rate of cervical intraepithelial neoplasia grade III (CIN 3) in previously unscreened women, in order to reveal trends over time in the prevalence of CIN 3 in the District of Florence, where a population-based screening for cervical cancer has been going on since 1973. Study design We considered the women, recorded in the computerized archives of CSPO, who had had no pap test for at least 10 years. Trends of CIN 3 (histologically proven) were analyzed within age groups; the effect of age, cohort and period were considered by means of a Poisson regression model. Results A total of 648 cases of histologically proven CIN 3 were detected in the study period. The detection rates of CIN 3 increased steadly within age groups over birth cohort and calendar period simultaneously. The Poisson regression analysis showed that only the model with age + time trend was statistically significant. Conclusions Although several biases should be taken into account, the analysis seemed to indicate a real increase in CIN 3 prevalence. An increase in frequency of precancerous lesions for cervical cancer in more recent birth cohorts supports the need to keep screening coverage and efficiency as high as possible.

scholarly journals The risk of cervical cancer after cervical intraepithelial neoplasia grade 3: A population-based cohort study with 80,442 women

2020 ◽  
Vol 157 (1) ◽  
pp. 195-201
Author(s):  
Diede L. Loopik ◽  
Joanna IntHout ◽  
Renée M.F. Ebisch ◽  
Willem J.G. Melchers ◽  
Leon F.A.G. Massuger ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cohort Study ◽  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Population Based ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Grade 3

scholarly journals Is Primary HPV with Secondary p16/Ki67 Dual-Stain an Alternative HSIL-Risk Detection Strategy in Cervical Cancer Screening for Women under 30 Years?

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2012
Author(s):  
Martyna Trzeszcz ◽  
Maciej Mazurec ◽  
Robert Jach ◽  
Karolina Mazurec ◽  
Zofia Jach ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Age Groups ◽  
Intraepithelial Neoplasia ◽  
Screening Strategy ◽  
Screening Tests ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Predictive Values ◽  
Age Range

Recently, cervical cancer rates elevation has been noted in women aged 20–39 years in regions with a very high human development index (HDI). The onset of cancer elevation rates is observed in the age range of 25–29 years, which should necessitate effective precancer screening in younger age groups, including those <25 years. From 30.066 liquid-based screening tests results (n = 30.066), 3849 liquid-based cytology, 1321 high-risk human papillomavirus (HRHPV) and 316 p16/Ki67 performed in women <30 years were selected. Performance characteristics were calculated for three screening models: primary HRHPV with p16/Ki67 triage, primary cytology with reflex HPV and primary cytology alone. Primary HRHPV with p16/Ki67 triage was significantly more sensitive in high-grade squamous intraepithelial lesion quantified with cervical intraepithelial neoplasia grade 2 or worse [HSIL(CIN2+)] detection than cytology with reflex HRHPV and cytology alone (83.3% vs. 70.8%/45.8%) and had significantly higher diagnostic predictive values (PPV:29.4%/21.3%/22.9%; NPV:91.7%/82.9%/82.2%, respectively at CIN2+ threshold). The number of colposcopies per HSIL(CIN2+) detection indices was 3.4, 4.7 and 4.4, respectively. Primary HPV testing in women <30 years with p16/Ki67 triage of HPV-positive cases might be an effective cervical cancer screening strategy for HSIL(CIN2+) detection with superior diagnostic performance when compared with primary cytology-based models. Women <25 years might also benefit from an introduction to a more sensitive screening approach.

scholarly journals Histological outcomes in HPV-screened elderly women in Denmark

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246902
Author(s):  
Gry St-Martin ◽  
Petra Hall Viborg ◽  
Ane Birgitte Telén Andersen ◽  
Berit Andersen ◽  
Jette Christensen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Elderly Women ◽  
Management Strategies ◽  
Age Groups ◽  
Intraepithelial Neoplasia ◽  
Birth Cohorts ◽  
Hpv Test ◽  
Region Of Residence

Introduction Danish women exit cervical cancer screening at age 65 years, but 23% of cervical cancer cases occur beyond this age. In addition, due to gradual implementation of cervical cancer screening, older women are underscreened by today´s standards. A one-time screening with HPV test was therefore offered to Danish women born before 1948. Methods Register based study reporting histology diagnoses and conizations in women found HPV positive in the one-time screening. Number and proportion of women with severe or non-severe histology results were calculated for screened and HPV-positive women by age group or region of residence. Number of women with biopsy and/or conization per case of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) or CIN3+ were also calculated by age groups and region. Results 4,479 (4.1% of screened women) had positive HPV test. 94% of these had one or more additional tests. 2,785 (62%) of HPV-positive women had histology results, and conization was performed in 1,076 (24% of HPV-positive and 1% of all screened women). HPV positivity and CIN3+ detection varied little between regions, but the proportions of HPV positive women undergoing histology varied between regions from 40% to 86% and the proportion with conization from 13% to 36%. Correspondingly, the number of histologies and conizations per CIN3+ detected varied from 5.9 to 11.2 and 1.8 to 4.7, respectively. In total, 514 CIN2+ (0.47% of screened women, 11% of HPV-positive) and 337 CIN3+ (0.31% of screened women, 7.5% of HPV-positive) were diagnosed, including 37 cervical cancer cases. Discussion HPV screening of insufficiently screened birth cohorts can potentially prevent morbidity and mortality from cervical cancer but longer follow-up is needed to see if cancer incidence declines in the screened women in the coming years. Management strategies differed among regions which influenced the proportions undergoing biopsy/conization.

scholarly journals Toward Cervical Cancer Elimination: Evaluation of Access to Diagnostic Services After Referral to a Specialist Gynecologist Clinic at a Major Referral Hospital in Kisumu, Kenya

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 35-35
Author(s):  
Chemtai Mungo ◽  
Jackton Omoto ◽  
Stephen Gwer ◽  
Akwabi Wameyo ◽  
Muruka Kays ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Database Systems ◽  
Referral Hospital ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Tertiary Referral Hospital ◽  
Financial Barriers ◽  
Incidence And Mortality ◽  
Suspicious Lesions

PURPOSE Women in low- and middle-income countries bear a disproportionate burden of cervical cancer incidence and mortality. WHO recommends screening with visual inspection with acetic acid (VIA), followed by treatment in a screen-and-treat approach. We evaluate access to diagnostic services after referral for VIA-positive or suspicious lesions to a gynecologist-led colposcopy clinic at a major government referral and teaching hospital in Kisumu, Kenya. METHODS Data on women who were referred for colposcopy at a gynecologist clinic at the Jaramogi Oginga Odinga Teaching and Referral Hospital with positive VIA from referral clinics from 2014 to 2017 were abstracted. We determined the proportion of referred women screening positive after colposcopy-based screening by a gynecologist, the proportion accessing diagnostic biopsy, and histologic results after positive or suspicious lesions. Treatment ascertainment is ongoing. RESULTS Four hundred five women were evaluated after referral for positive VIA screening or suspicious lesions. Mean age was 40.2 years and mean parity was 4 children, with 53% of women self-reporting positive HIV status. Two hundred thirty-three referred women (57.5%) were found to have positive or suspicious lesions after colposcopy-based screening by a gynecologist. Of these women, 147 (63%) had a biopsy performed and results were available for 110 patients (74.8%). Eighty-six women did not receive biopsy, despite positive colposcopy, primarily because of associated costs or lack of supplies. Among women with biopsy results, 25 (22.7%) were benign, 18 (16.4%) had cervical intraepithelial neoplasia grade 1, 9 (8.2%) had cervical intraepithelial neoplasia grade 2 and 3, 57 (51.8%) had squamous cell carcinoma, and 1 (0.9%) had nondiagnostic results. CONCLUSION While drawing from observational, paper-based clinical data with incomplete records, our evaluation demonstrates significant challenges in the cervical cancer prevention cascade at a tertiary referral hospital. This calls for strengthening the ability of facilities to adequately evaluate at-risk women, remove financial barriers, and invest in database systems to facilitate evaluation.

scholarly journals Primary cervical screening with high risk human papillomavirus testing: observational study

BMJ ◽  
2019 ◽  
pp. l240 ◽  
Author(s):  
Matejka Rebolj ◽  
Janet Rimmer ◽  
Karin Denton ◽  
John Tidy ◽  
Christopher Mathews ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
High Risk ◽  
Observational Study ◽  
Cervical Intraepithelial Neoplasia ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Liquid Based Cytology ◽  
Grade 3

AbstractObjectiveTo provide the first report on the main outcomes from the prevalence and incidence rounds of a large pilot of routine primary high risk human papillomavirus (hrHPV) testing in England, compared with contemporaneous primary liquid based cytology screening.DesignObservational study.SettingThe English Cervical Screening Programme.Participants578 547 women undergoing cervical screening in primary care between May 2013 and December 2014, with follow-up until May 2017; 183 970 (32%) were screened with hrHPV testing.InterventionsRoutine cervical screening with hrHPV testing with liquid based cytology triage and two early recalls for women who were hrHPV positive and cytology negative, following the national screening age and interval recommendations.Main outcome measuresFrequency of referral for a colposcopy; adherence to early recall; and relative detection of cervical intraepithelial neoplasia grade 2 or worse from hrHPV testing compared with liquid based cytology in two consecutive screening rounds.ResultsBaseline hrHPV testing and early recall required approximately 80% more colposcopies, (adjusted odds ratio 1.77, 95% confidence interval 1.73 to 1.82), but detected substantially more cervical intraepithelial neoplasia than liquid based cytology (1.49 for cervical intraepithelial neoplasia grade 2 or worse, 1.43 to 1.55; 1.44 for cervical intraepithelial neoplasia grade 3 or worse, 1.36 to 1.51) and for cervical cancer (1.27, 0.99 to 1.63). Attendance at early recall and colposcopy referral were 80% and 95%, respectively. At the incidence screen, the 33 506 women screened with hrHPV testing had substantially less cervical intraepithelial neoplasia grade 3 or worse than the 77 017 women screened with liquid based cytology (0.14, 0.09 to 0.23).ConclusionsIn England, routine primary hrHPV screening increased the detection of cervical intraepithelial neoplasia grade 3 or worse and cervical cancer by approximately 40% and 30%, respectively, compared with liquid based cytology. The very low incidence of cervical intraepithelial neoplasia grade 3 or worse after three years supports extending the screening interval.

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