scholarly journals Colposcopy in evaluation of suspected cervical cancer: a prospective, observational study

Author(s):  
Ashwini Sudhir Desai ◽  
Shruti Panchbudhe

Background: Cervical cancer is the fourth most frequent cancer in women according to World Health Organization. In India the incidence is approximately 1 in 53 compared with 1 in 100 women in more developed regions of the world. Cervical cancer is eminently preventable by early detection using various screening tests like Pap smear, colposcopy, HPV testing. In this study we aim to evaluate the use of colposcopy in early detection of cervical cancer and also assess risk factors for the same. Primary objective was to study the correlation between colposcopic findings and histopathological analysis with a secondary objective to assess risk factors for development of cervical neoplasia.Methods: The study was carried over a period of 2 years (October 2016 to October 2018) with a sample size of 60 in the department of obstetrics and gynecology at tertiary care centre. Participants who fit the inclusion criteria were included in the study after taking a written and informed consent. The colposcopy findings were correlated with the histopathological findings of the cervical biopsy that was undertaken.Results: Colposcopy impression had sensitivity of 93.8% in predicting the histopathology, specificity was 77.3%, positive predictive value was 60%, negative predictive value was 9% and the diagnostic accuracy was 81.7%. On analyzing the risk factors, it was found that the odds of malignant histopathology were 0.55 times decreasing with each unit increase in age (at first intercourse) (p value<0.05).Conclusions: Colposcopy gives immediate and accurate results and its value as a diagnostic test is undisputable.  The sensitivity of colposcopy is high and hence in high risk population or remote places where women do not turn for regular screening tests, colposcopy can be used primarily as the screening test.

2021 ◽  
Vol 3 (1) ◽  
pp. 47
Author(s):  
Elsani P. L. Rapar ◽  
Maria K. Sambuaga ◽  
Meilany F. Durry

Abstract: The incidence and mortality rates of cervical cancer in developing countries are relatively high compared to developed countries. The main risk factor for cervical cancer is high risk human papilloma virus (HPV) infection, such as types 16 and 18. Types of high-risk HPV expresses oncoproteins E6 and E7 which play an essential role in the pathogenesis of cervical carcinoma through inhibition of the activity of gene group expression products that play a role in suppressing tumor growth, such as p53 and pRB. This process will cause morphological changes in the squamous epithelium from precancerous lesions to cancer. The development of squamous epithelial cell cancer can be prevented through screening tests in order to detect cervical cancer early. This study was aimed to obtain the oncogenesis, morphology, and early detection modality of cervical carcinoma. This was a literature review study using three databases, as follows: ClinicalKey, PubMed, and Google Scholar. The results explained that p53 and pRB suppression by high-risk HPV oncoproteins E6 and E7 played an important role in the pathogenesis of cervical carcinoma. The most common histological type is squamous cell carcinoma. Screening tests such as visual inspection with acetic acid (VIA), Pap smears and HPV DNA have an important role as modalities for early detection of malignancy. More specifically VIA and Pap smears are suitable for Indonesia which is a developing country, especially when implemented in peripheral areas.Keywords: oncogenesis; morphological changes; early detection; cervical carcinoma  Abstrak: Insidens dan mortalitas kanker serviks di negara berkembang relatif tinggi dibandingkan negara maju. Faktor risiko utama dari kanker serviks adalah infeksi human papilloma virus (HPV) risiko tinggi yaitu tipe 16 dan 18. HPV tipe risiko tinggi mengekspresikan onkoprotein E6 dan E7, yang berperan penting dalam patogenesis karsinoma serviks melalui inhibisi terhadap aktivitas produk-produk ekspresi kelompok gen yang berperan dalam menekan pertumbuhan tumor, seperti p53 dan pRB. Proses ini akan menyebabkan perubahan morfologik pada epitel skuamosa mulai dari lesi prakanker sampai kanker. Perkembangan kanker sel epitel skuamosa dapat dicegah melalui pemeriksaan skrining guna mendeteksi dini kanker serviks. Penelitian ini bertujuan untuk mengetahui onkogenesis, morfologi, dan modalitas deteksi dini karsinoma serviks. Jenis penelitian ialah literature review menggunakan tiga basis data yaitu ClinicalKey, PubMed, dan Google Scholar. Hasil penelitian mendapatkan bahwa penekanan p53 dan pRB oleh onkoprotein HPV risiko tinggi E6 dan E7 sangat berperan penting dalam patogenesis karsinoma serviks. Tipe histologik tersering ialah tipe karsinoma sel skuamosa. Pemeriksaan skrining seperti pemeriksaan inspeksi visual dengan asam asetat (IVA), Pap smear dan HPV DNA memiliki peran penting sebagai modalitas deteksi dini keganasan. Lebih khusus IVA dan Pap smear cocok untuk negara Indonesia yang merupakan negara berkembang, terutama bila diimplementasikan di daerah perifer.Kata kunci: onkogenesis; perubahan morfologik; deteksi dini; karsinoma serviks


Author(s):  
Ike Nurrochmawati ◽  
◽  
Ambar Dwi Retnoningrum ◽  
Remita Yuli Kusumaningrum ◽  
◽  
...  

Background: Cervical cancer is the fourth most prevalent cancer in women. Pap smear and visual inspection acetic acid (VIA) are essential screening tests to early detect cervical cancer. However, the use of screening tests remained low among women of reproductive age in Nganjuk district, East Java. This study aimed to determine the effectiveness of health education using flip chart and video on knowledge about early detection of cervical cancer among women of reproductive age in Nganjuk district, East Java. Subjects and Method: A randomized control trial conducted in Rejoso, Nganjuk, East Java, from October to November 2019. A sample of 120 women of reproductive age was randomized into two groups: (1) Experiment group that received health education using a flip chart and video, and (2) Control group that received no intervention. The dependent variable was knowledge of early detection of cervical cancer. The independent variable was health education using a flip chart and video. The data were collected using questionnaire. The data were analyzed by independent t-test. Results: After the intervention, knowledge about early detection of cervical cancer in the experimental group (Mean= 80.40; SD= 10.54) was higher than the control group (Mean= 70.53; SD= 9.68), and it was statistically significant (p <0.001). Conclusion: Health education using a flip chart and video is effective in improving knowledge about early detection of cervical cancer among women of reproductive age. Keywords: early detection, cervical cancer, health education, women of reproductive age Correspondence: Ike Nurrochmawati. School of Health Sciences Satria Bhakti, Nganjuk. Jl. Panglima Sudirman VI, Nganjuk, East Java. Email: [email protected]. Mobile: +6282141578108. DOI: https://doi.org/10.26911/the7thicph.02.36


Author(s):  
Afolabi B. Abiodun ◽  
Aadewunmi O. Durodola ◽  
Mustapha A. Ajani ◽  
Isaac O. Amole ◽  
Adejoke D. Abiodun ◽  
...  

Background: Screening test for cervical cancer using visual inspection with acetic acid (VIA) has been advocated by World Health Organization as a suitable, low cost and feasible alternative modality for control of cervical cancer in resource-poor settings as compared to cytological and colposcopic screening. The need for reproducibility, accuracy and comparable efficacy will influence the acceptability of VIA as primary screening modalities for cervical cancer.Methods: A cross–sectional comparative study conducted at BUTH. Data were obtained from 318 consenting women aged 30–65 years using a systematic random sampling method and an interviewer–administered structured questionnaire. Pap smear samples were taken followed by visual inspection with acetic acid. Using Statistical Package for Social Sciences (SPSS) version 23.0, Frequencies were obtained and Chi-square test (X2) was used to compare rates and proportions with the level of statistical significance set at less than 0.05.Results: Positive results for premalignant cervical lesion was 1.3% and 4.1% for VIA and Pap smear respectively (X2=4.52; p=0.034). The sensitivity of VIA was 7.7% with positive predictive value of 25% while specificity was 99.0% with a negative predictive value of 96.2%. The prevalence of abnormal cervical lesion in the population studied was 4.1% (95% CI 2.2% – 6.9%).Conclusions: The detection rate for pre-cancerous lesions of the cervix using VIA was significantly lower than that of Pap smear in this study. There may be needed to exercise caution in adopting VIA as primary screening modality for cervical cancer.


2021 ◽  
Vol 2 (4) ◽  
pp. 1305-1320
Author(s):  
Hairudin La Patilaiya ◽  
Nursia Aja ◽  
Taufik Yunus

Background : Cervical cancer is one of the main problems in women's health in the world, including Indonesia. According to the 2018 Global Cancer Observatory from the World Health Organization (WHO), the most common cancer cases in Indonesia are breast cancer, which is 58,256 cases or 16.7% of the total 348,809 cancer cases. Cervical cancer (neck of the womb) is the second most common type of cancer in Indonesia, with 32,469 cases or 9.3% of the total cases. Objective: To determine the risk factors associated with early detection of cervical cancer using Visual Inspection with Acetic Acid (IVA) ) in women of childbearing age in the Work Area of the Ternate City Health Center for Siko Treatment. Methods: This research is a quantitative analytic study with a cross sectional design. Data collection was carried out from December 2020 to January 2021. The population was all patients who underwent examinations at the Maternal and Child Health Polyclinic (KIA) at the Siko Care Health Center in Ternate City as many as 227 patients and a sample of 145 female patients of childbearing age from January to September 2020. Techniques sampling is simple random sampling. Data analysis used univariate and bivariate with chi-square test. The research variable consists of the dependent variable, namely early detection of cervical cancer, while the independent variables are knowledge, husband's support, access to information and culture. Results: Shows that age (46.9%), knowledge of VIA (50.3%), attitude (55.2%), husband's support (52.4%), access to information (62.1%), culture (51.7%), Support Officer (48.3%), early detection of cervical cancer IVA method (55.2%), while the bivariate results include: Age (0.000, OR=19,011; CI=8.095-44,647), knowledge (0.001; OR=2.86; CI=1.563-18.367), attitude (0.000; OR=215.524 CI=53,456-868.955), husband's support (0.002; OR=1.448 CI=1.688-11.933), access to information (0.000; OR=2,294; CI=1,574-15,976), culture (0,003; OR=2,202 CI=1,648-10,717), health worker support (0,000; OR=27,111 CI;11,023-66,680). Conclusion: There is a relationship between knowledge, husband's support, access to information and culture with early detection of cervical cancer against the IVA method. Based on the results of the study, it is recommended that the relevant agencies, namely the Siko Health Center, always improve health education to the community, especially mothers and husbands regarding early detection of cervical cancer through various media tools including leaflets, posters, flipcharts and other media. Through this counseling, it is hoped that the community will be more interested and understand the material presented more quickly


Author(s):  
Ruksana Farooq ◽  
Azhar-un-Nisa Quraishi ◽  
Shahida Mohammad

Background: Cervical cancer is the most common genital cancer in India. In India alone,almost,130000 new cases occur with the death toll of 70000 everywhere. Objective of current study was correlation of pap smear with histopathological diagnosis.Methods: A retrospective study was conducted in tertiary care hospital in 130 sexually active women. Pap smears were taken and histopathological diagnosis was performed in all such patientsResults: From pap smear findings, out of 130 patients, maximum number of cases, 74 (56.9%) were categorized as. Out of epithelial cell abnormality, ASCUS was seen in 25 patients (10.2%), LSIL in 17 patients (13.1%), HSIL in 11 patients (8.5%). SCC was seen in 2 patients (1.5%) and adenocarcinoma in 1 patient (0.8%). From cervical biopsy reports, 51 cases(39.2%) were diagnosed as chronic cervicitis, 34 cases (26.2%) were diagnosed as chronic cervicitis with squamous metaplasia, CIN I in 31 patients (23.8%), CIN II in 8 patients (6.2%) and CIN III in 3 patients (2.3%), squamous cell carcinoma in 2 patients (1.5%) and adenocarcinoma in 1 patient (0.8%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pap smear test was 91.1%, 82.4%,73.2%, 94.6% and 85.4%, respectively.Conclusions: Pap smear has excellent correlation with histopathological diagnosis. Therefore it should be encouraged as effective tool for cervical cancer screening program to reduce incidence and mortality caused by cervical cancer. 


2021 ◽  
Vol 15 (5) ◽  
pp. 947-950
Author(s):  
Zertaj Kashif ◽  
Aman ur Rehman ◽  
Sonia Zafar Warriach ◽  
Muhammad Bilal Pasha ◽  
Zoya Khan ◽  
...  

Cervical cancer is the third most common cancer and the fourth dominant cause of cancer related death in women throughout the globe. Eighty percent of cases occur in the developing nations1,2. The extent of this cancer is tough to be evaluated in Pakistanbecause of differing insufficient epidemiological figures obtainable in small scale studies, dealing only reported limited number of cases which are not representative of its true burden3,4,5. As stated by World Health Organization, in 2002, the pervasiveness of cervical cancer in Pakistan was 9 in 100,000; in 2008 it jumped up to 19.5/100,000. Claimed by various studies, this cancer is among the list of first ten frequent cancers in Pakistan6,7,8,9. It is one of the most avoidable cancers nowadays and we have all the tools to eradicate it, still the number of lives lost due to cervical cancer is very high in Pakistan as it is an ignored ailment here in terms of screening, prevention and vaccination9. Economically developed countries who invested capitals for organized screening projects have made notable progress in reducing both occurrence and mortality due to this specific cancer10. The out of proportion load of cervical cancer in developing countries is largely attributable to scarcity of functional screening projects11. In our over 500 bedded teaching hospital with a well running gynecology outdoor, we do receive cervical biopsies positive for invasive malignancies but hardly receive any Pap smear tests in laboratory that prompted us to check for cervical cancer screening especially Pap smear test related awareness among our non-medical ladies.As the foundation of cervical cancer eradication is screening and prevention, each country and its regions must device an elimination plan that fits into its own culture and geographic landscape. Keywords: perception and understanding of existing screening tests, preventive measures, cervical cancer


2022 ◽  
Author(s):  
Gal Hershkovitz ◽  
Yifat Ochshorn ◽  
Nadav Michaan ◽  
Elisheva Fiszer ◽  
Dan Grisaru ◽  
...  

Abstract Background. To investigate whether knowledge regarding cervical cancer risk factors and Pap testing influence OB/GYN physicians’ compliance to cervical cancer screening and prevention.Methods. Female physicians working in the Tel Aviv Sourasky Medical Center were asked to complete an anonymous questionnaire assessing their knowledge of cervical cancer related factors, Pap testing and compliance with screening guidelines. Reported data was compared between resident and senior OB/GYN physicians and physicians from non-OB/GYN specialties.Results. 42 female OB/GYNs ( residents – 18, seniors- 24) and 80 female physicians of other specialties (“non-OB/GYNs”, residents -48, seniors -32) volunteered to participate in our study, with similar proportions of resident and senior participents between the two groups (p=0.0865). Generally, OB/GYNs were more knowledgable about cervical cancer prevention and risk factors compared to non-OB/GYNs. OB/GYN residents knew less about world health organization (WHO) recommendations for age at last Pap compared to senior OB/GYNs (answered correctly – 50% vs. 83%, respectively, p=0.04). They also knew less about the upper age for vaccine administration (answered correctly – 11% vs 50%, respectively, p=0.01). Even so, the majority of physician recommended Human Papillomavirus vaccination, in all groups compared. A similar proportion of OB/GYNs and non-OB/GYNs had performed a Pap smear in the last 3 years (OB/GYN – 75% non-OB/GYN – 83%, p=0.3). Of note, a higher percentage of residents, both OB/GYNs and non- OBGYNs were vaccinated against Human Papillomavirus compared to their senior counterparts (OB/GYNs -38.89% vs. 4.17%, p=0.013, non-OB/GYNs 50% vs. 12.5%, p=0.0007). Only half of OB/GYNs (residents – 50%, seniors –66.67%, p>0.99) initiated their Pap testing, similar to non-OB/GYNs. Human Papillomavirus vaccination was more prevalent among residents than among seniors, regardless of their specialty (OB/GYNs – 38.89% vs. 4.17%, p=0.013, non OB/GYN – 50% vs. 12.5%, p=0.0007) with a trend toward higher porportions of vaccinated physicians in non-OBGYNs.Conclusion. Female OB/GYNs’ knowledge of the importance of Pap test and their accessibility to Pap smear services, do not improve their compliance for Pap smear performance or Human Papillomavirus vaccination. Residents tend to have better general personal health habits out of their field of specialty.


2021 ◽  
Vol 12 (8) ◽  
pp. 144-148
Author(s):  
Anil Kumar Sirasagi ◽  
Arpitha K ◽  
Saara Neha ◽  
Pratima Manohar Pattar

Background: Cervical cancer in women is the second most common cancer and the commonest cause of mortality in developing countries. The introduction of Pap smear test changed the scenario of cervical cancer with an intense drop in the incidence and mortality due to invasive cervical cancer. Aims and Objective: To evaluate the patterns of cervical smear cytology and to correlate the cervical smear diagnosis with histopathological diagnosis and to assess the efficacy of Pap smears in diagnosing cervical lesions. Materials and Methods: This two-year retrospective study (January 2018 to December 2019) was done in the department of Pathology in a tertiary care hospital. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated considering histopathological diagnosis of cervical biopsy as the gold standard. Results: A total of 316 Pap smears were studied, out of which we selected 154 cases who also undergone biopsy or hysterectomy. Epithelial cell abnormalities (ECA) were found in 28 cases (18.2%). Among this the most common ECA was Atypical squamous cells of undetermined significance (ASCUS) seen in 10 cases (6.5%) followed by LSIL (5.2%), HSIL (3.2%) and SCC of cervix (3.2%). The overall correlation between cervical cytology and histopathology was found in 125 out of 154 cases (81.16%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pap smear was 90.57%, 62.50%, 95.41%, 43.47% and 87.66% respectively. Conclusion: Pap smear is a simple, safe, non-invasive and effective method for detection of lesions of the cervix and ECA. Hence, better awareness and periodical cytological screening programs can help in the early detection of malignant cervical lesions and thereby reducing the morbidity and mortality related to this malignancy.


Author(s):  
Abhishek Tandon ◽  
Snigdha Raja ◽  
Mangala M. Pai ◽  
B. Unnikrishnan ◽  
Tanuj Kanchan

Background: Carcinoma cervix is the second most common cancer in women worldwide, and the most common in India. In this study, the current knowledge of female undergraduates and faculty of health sciences regarding the various parameters like risk factors, symptoms, screening tests and vaccinations pertaining to cervical cancer was assessed.Methods: A cross-sectional, self-administered anonymous questionnaire-based survey was carried out, in a medical college in Mangalore, which included 260 staff and students. Non random sampling was done and the study was carried out only after gaining institutional Ethical community approval and written informed consent from the subjects.Results: Majority of the participants 185 (71.4%) were aware that cervical cancer is one of the most wide- spread gynecological cancers in Asia. The awareness of causative agents of cervical cancer was known to 53.9% of the undergraduates and 50% of the faculty members. 73% of the total study groups have heard of HPV and around 68% agreed that it was detectable. 71% of the study sample had heard about the Pap smear test and 42% have undergone the test. The questions pertaining to the preventive measures of cervical cancer had good faculty preponderance with 91.8% giving a positive response. 84.1% of the students and 79.5% of the faculty members knew that abnormal vaginal bleeding was a symptom.Conclusions: In this study an attempt has been made to study the correlates of knowledge of cervical cancer in a cohort which consisted of health care undergraduate and faculty. Majority of our study group was well aware of the various risk factors of cervical cancer and its preventable nature however awareness regarding the association between diets, multiple pregnancies and use of tobacco was poor.


Author(s):  
Rashmi Saxena ◽  
Alpana Agrawal ◽  
Neelima Agarwal ◽  
Manisha Gupta ◽  
Divya Shubham ◽  
...  

Background: Cervical cancer is the fourth most frequent cancer globally in women with an estimated 570,000 new cases and 311,000 deaths in 2018 representing 6.6% of all female cancers. To correlate the cytology, colposcopy and histopathology of cervical lesions in patients attending gynaecology OPD in a tertiary care centre, Ghaziabad.Methods: 208 women were enrolled from Gynaecology OPD of Santosh Medical College and Hospital, Ghaziabad, irrespective of their chief complaints. Women aged 19-80 years were included in the study group. Those with pregnancy and already diagnosed or treated with CIN, Cervical cancer or Cervical HPV infection were excluded from the study. PAP-smear was taken for all the patients followed by colposcopy without waiting for PAP-smear report. Cervical biopsy was taken from patients with abnormal colposcopic findings (90 patients).Results: Majority of women were in age group 30-39 years. 37.5% had unhealthy, 21.6% had hypertrophied cervix and only 9.1% had normal cervix. It was found that PAP -smear has a sensitivity of 33.33%, specificity of 92.59%, accuracy of 68.89%, positive predictive value of 75% and negative predictive value of 67.57%. Test parameters calculated for colposcopy revealed that it has sensitivity of 73.33%, specificity of 92%, PPV of 64.7%, NPV of 94.52% and accuracy of 88.89%.Conclusions: The results from the current study conclude that it is better to use cytology and colposcopy together as part of routine screening for cervical cancer rather than pap smear alone in order to detect maximum number of lesions.


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