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 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 High-risk HPV genotypes and cervical lesions association in postmenopausal women

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Ana Rita Fernandes Miranda da Costa ◽  
Cláudia Sousa ◽  
Erica Isidoro ◽  
Regina Silva ◽  
Cristiana Mourato
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Postmenopausal Women ◽  
Age Groups ◽  
Low Grade ◽  
High Grade ◽  
Cervical Lesions ◽  
Intraepithelial Lesion ◽  
The Bethesda System ◽  
High Risk Hpv

Abstract Background Persistent infection by high-risk Human Papillomavirus (hrHPV) are the major cause of cervical cancer. Studies report disparities in the incidence of infection and the various genotypes of this virus in different age groups, suggesting a higher frequency of hrHPV in young women and low-risk subtypes being predominant in older women. This study aimed to investigate the incidence and distribution of hrHPV genotypes in postmenopausal women as well as the correlation with the cytological findings. Methods 16 859 women, aged 50–64 years, performed cervical cancer screening test in Friuri Venezia Giulia region, Italy. The infection was evaluated by the Polymerase Chain Reaction methodology and the positive samples were evaluated by Liquid Based Cytology according to the Bethesda System from 2014. A statistical analysis was performed to study the molecular and cytological data of this population. Results hrHPV infection were found in 5.8% of the women and 78.3% of these were caused by hrHPV other than HPV16 and HPV18 (). Also, 65.7% of the positive samples were negative for intraepithelial lesion or malignancy while low grade squamous intraepithelial lesion was the most frequent (22.4%). There was an increase in the number of high-grade intraepithelial lesions in the presence of HPV16 compared to that recorded when this genotype was absent (20.8% vs. 8.5%). No cervical cancers were detected. Conclusions Infection with hrHPV is uncommon in postmenopausal women and it is mostly caused by subtypes less associated with the development of cervical cancer. Yet, HPV16 infection triggers the development of high-grade lesions.

scholarly journals Visual techniques for cervical cancer screening in Colombia

Biomédica ◽  
2019 ◽  
Vol 39 (1) ◽  
pp. 65-74
Author(s):  
Óscar Gamboa ◽  
Mauricio González ◽  
Jairo Bonilla ◽  
Joaquín Luna ◽  
Raul Murillo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
False Positive ◽  
Gold Standard ◽  
Visual Inspection ◽  
Low Grade ◽  
High Grade ◽  
Detection Rates ◽  
Lower Detection

Introduction: Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic cervical lesions.Objectives: To determine the rates of cervical intraepithelial neoplasia grade 2 or more and of false positives for colposcopy and direct visual inspection.Materials and methods: Women aged 25-59 underwent direct visual inspection with acetic acid (VIA), Lugol’s iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for all positive tests. Using histology as the gold standard, detection and false positive rates were compared for VIA, VIA-VILI, and colposcopy (two thresholds). Sensitivity and false positive ratios with the corresponding 95% confidence intervals were estimated.Results: We included 5,011 women in the analysis and we obtained 602 biopsies. Positivity rates for colposcopy high-grade and low-grade diagnosis were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed a significantly lower detection rate than colposcopy with low-grade diagnosis as the threshold (SR=0.72; 95% CI 0.57-0.91), and significantly lower false positive rate (FPR=0.70; 95% CI 0.65-0.76). No differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups, false positive rates for VIA and VIA-VILI were significantly higher than colposcopy.Conclusions: Detection rates for VIA-VILI similar to colposcopy low-grade threshold represent a chance to reduce cervical cancer mortality through see-and-treat approaches among women with limited access to health care. Lower detection rates suggest reviewing high-grade colposcopy findings as the threshold for biopsy in certain settings.

29. WHAT DO ANAL CYTOLOGY RESULTS MEAN?

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 296
Author(s):  
R. Hillman
Keyword(s):  
Anal Cancer ◽  
Screening Program ◽  
Cervical Screening ◽  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Screening Programs ◽  
Anal Dysplasia ◽  
Anal Swab

Background: Between 1970 and 2000 in Australia, anal cancer rates have increased over fourfold. Furthermore, the prevalence rate of anal cancer in MSM is approximately 35 cases/100�000, comparable to that of cervical cancer in women prior to the introduction of the national cervical screening program. These observations have led to calls for the introduction of targeted anal cytological screening program for MSMs. Our study examined the effectiveness of anal cytological testing in detecting histologically proven high grade anal intraepithelial neoplasia (HGAIN, also known as AIN2 & 3). Methods: A retrospective case note review of people attending an anal dysplasia clinic from July 2002 to May 2007 was performed. Cytological results of anal swabs were compared to results of biopsies obtained through high resolution anoscopy. Results: 436 anal cytological results were identified. Of these, 5% were unsatisfactory, 51% showed low grade changes and 44% showed high grade changes. 185 cases were then paired with corresponding histological results. Analysing the data from the perspective of diagnosing histologically proven HGAIN, anal swab cytological abnormalities revealed a sensitivity of 54% and specificity of 90% for the most recent cytological test and 83% and 39% respectively, when analysed according to most serious cytological result ever. Conclusions: Our sensitivities of 54-83% and specificities of 39-90% are consistent with those found with cervical cytology, but emphasize the need for caution in their interpretation. However, before any anal cytological screening programs are introduced, it is important to also establish that treatment of any high grade anal dysplasia detected by such screening is of value in preventing progression to cancer.

Liquid-Based Cytology: Evaluation of Effectiveness, Cost-Effectiveness, and Application to Present Practice

2004 ◽  
Vol 2 (6) ◽  
pp. 597-611 ◽  
Author(s):  
J. Thomas Cox
Keyword(s):  
Cost Effectiveness ◽  
Cervical Screening ◽  
Pap Test ◽  
Representative Specimen ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Split Sample ◽  
Intraepithelial Lesion ◽  
Liquid Based Cytology

This article reviews the data available as of 2004 on the effectiveness and cost-effectiveness of cervical screening with the two available cytologic methods, the conventional Papanicolaou (Pap; CP) smear and liquid-based cytology (LBC), and discusses the application of LBC to current practice. The majority of LBC studies are on the ThinPrep Pap Test (CYTYC, Boxsborough, MA) and the remainder are on SurePath (TriPath, Burlington, NC), which was previously known as AutoCyte Prep. LBC identified more low-grade squamous intraepithelial lesion (LSIL) Pap test results compared with paired conventional cytology in 17 of 21 ThinPrep and 9 of 12 SurePath “split-sample” studies considered to fulfill the criteria for inclusion in the British NHS Health Technology Assessment (HTA) evaluation of cervical cytology. In four of the six recent ThinPrep and one of two SurePath split-sample studies, more high-grade squamous intraepithelial lesion-positive (HSIL+) results were identified by LBC than by CP. All 15 “direct-to vial studies” meeting HTA criteria reported more LSIL+ results for LBC compared with CP, and all eight of the direct-to-vial studies reporting HSIL+ results separately showed increased detection of high-grade cytology interpretations. Fifteen studies met the criteria for evaluating sensitivity and specificity. Aggregate sensitivity for the CP was 71.5% and for LBC was 80.1%. Indirect comparisons of the two LBC methods did not detect a difference in sensitivity, and a meta-analysis of the six studies comparing specificity between CP and LBC found no difference. Other capabilities of LBC are improved specimen adequacy and the ability to do ancillary testing out of the liquid-based vial. In cost-effective analyses based on models of disease natural history and/or the clinical effectiveness of each screening modality, screening with CP was always dominated by screening with LBC. Primary cervical screening guidelines issued by the American Cancer Society in 2002 recommend repeating the cytology biannually if liquid-based and annually if conventional. The gain in sensitivity, apparent cost-effectiveness, and advantage of having a representative specimen for ancillary testing, support the use of LBC.

Cervical screening, high-grade squamous lesions, and cervical cancer in illicit drug users

2013 ◽  
Vol 24 (7) ◽  
pp. 1449-1457 ◽  
Author(s):  
Anne Kricker ◽  
Lucinda Burns ◽  
Chris Goumas ◽  
Bruce K. Armstrong
Keyword(s):  
Cervical Cancer ◽  
Drug Users ◽  
Illicit Drug ◽  
Cervical Screening ◽  
High Grade ◽  
Illicit Drug Users

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

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