New Aspects and an Artificial Intelligence Approach for the Detection of Cervical Abnormalities

The COVID-19 pandemic has challenged health systems worldwide by decreasing their reserves and effectiveness. In this changing landscape, the urge for reallocation of financial and human resources represents a top priority. In screening, effectiveness and efficiency are most relevant. In the quest against cervical cancer, numerous molecular ancillary techniques detecting HPV DNA or mRNA or other related biomarkers complement morphological assessment by the Papanicolaou test. However, no technique is perfect as sensitivity increases at the cost of specificity. Various approaches try to resolve this issue by incorporating several examination results, such as artificial intelligence are proposed. In this study, 1,258 cases with a complete result dataset for cytology, HPV DNA, HPV mRNA, and p16 were used to evaluate the performance of a self-organizing map (SOM), an unsupervised artificial neural network. The results of the SOM application were encouraging since it is capable of producing maps discriminating the necessary tests and has improved performance.

Fatores que interferem na não adesão de mulheres ao teste de Papanicolaou: revisão integrativa

Objetivo: Identificar os fatores que interferem na não adesão de mulheres ao Teste de Papanicolaou. Métodos: Trata-se de uma revisão integrativa, realizada de forma pareada nas bases de dados CINAHL, LILACS, MEDLINE e na biblioteca virtual Scielo, entre maio e agosto de 2021 por meio dos Descritores em Saúde Women, Papanicolaou Test Uterine Cervical Neoplasms e Risk Factors, cruzados pelo operador booleano and. Selecionaram-se 19 artigos para amostra final. Resultados: Diversos fatores foram identificados como preditivos à não adesão do Teste de Papanicolaou, dentre eles: baixa renda, escolaridade, faixa etária, falta de conhecimento sobre o teste, não possuir companheiro, uso de tabaco, álcool e outras drogas, vergonha ou medo do procedimento, acreditar estar bem de saúde, dificuldade de acesso aos serviços e falta de integralidade da assistência prestada. Considerações finais: Percebe-se que os fatores associados à não adesão do Teste de Papanicolaou remetem a presença de iniquidades sociais e raciais, fatores individuais, condições e oferta dos serviços de saúde deficiente, além da cobertura insuficiente da realização do teste; sendo necessário, portanto, realizar ações educativas para sensibilizar a população sobre a importância de realizar o exame para a detecção precoce, tratamento oportuno da doença e realização de busca ativa.

Women’s knowledge, awareness and prevention of cervical cancer and infection from HPV in Greece

Background Cervical cancer prevention can be obtained by regular screening with Papanicolaou test. However, in recent years HPV DNA test and mRNA HPV test are available for the screening for cervical cancer. The HPV vaccine helps protect against HPV- related cancers. Our aim was to investigate the beliefs and knowledge of women living in a city in northwestern Thessaly, Greece, regarding the prevention of cervical cancer. Methods A cross sectional study was conducted among 119 women, 18-65 years old and living in Trikala, Greece. They completed a 45-item self-administered questionnaire, investigating their knowledge, perceptions, and behaviors regarding the prevention of cervical cancer, the infection with HPV, the Papanicolaou test and vaccination. Furthermore, associations between knowledge and behaviors as well as with various demographic factors were explored. Results Most of the women had at least university education (77%). More than 90% declared to visit an obstetrician-gynecologist at least once a year and 68.4% regularly have a Pap smear once a year. 95.8% were aware of the importance of a Pap smear and 82% declared a positive attitude regarding HPV vaccination. Higher knowledge regarding examination and vaccination, was associated with marital status (married) (p = 0.002) and educational level (higher educational level) (p = 0.001). Conclusions The majority of women in our sample know why they should do the Pap test; however, they need to be further informed with additional details about the diagnostic test. Although most of the women were aware about the importance of testing, one third of them were not regularly tested for cervical cancer detection or had lacked knowledge about vaccination. Key messages A high percentage of women is aware about the benefits of cervical cancer screening. However, information campaigns and establishment of national screening programs are required to facilitate the access to such programs for all women.

Examining Sexual Orientation Differences in the Utilization of the Human Papillomavirus Vaccine, Human Papillomavirus Test, and Cervical Papanicolaou Test in Allegheny County, Pennsylvania

Despite sexual minorities' (SMs) increased risk for contracting human papillomavirus (HPV) and developing related cancers compared to their heterosexual peers, we know little about SM disparities in uptake of HPV vaccines and routine screenings. Therefore, this study examined sexuality differences in HPV preventive interventions and related screenings. From 2015 to 2016, Pennsylvania's Allegheny County Health Department commissioned a health survey of 9,026 adults in their catchment area using probability-based sampling. Multivariable models tested differences by sexual identity separately for cisgender men and women (heterosexual versus gay/lesbian, bisexual, and other) for lifetime receipt of HPV vaccine and number of HPV vaccines. Among women, we examined sexuality differences in HPV and cervical Pap tests, adjusting for age, race/ethnicity, education, marital status, and income. No differences in prevention utilization emerged when comparing heterosexual women to all SM women. However, exploratory analyses comparing heterosexual women to subgroups of SM women found lesbians had higher odds (adjusted odds ratio [AOR] = 5.27; 95% confidence interval [CI] = 1.15–24.09) of never receiving an HPV vaccine. Women who reported their sexuality as “other” had higher odds (AOR = 5.65; 95% CI = 1.03–31.02) of never receiving a cervical Pap test compared to heterosexual women. “Other” women had higher odds (AOR = 19.80; 95% CI = 1.64–239.16) of never receiving a cervical Pap test when compared to heterosexual women receiving one within the recommended screening guidelines. SM men's utilization was not significantly different from heterosexual men, though vaccination uptake for both groups was low. These findings highlight the need for additional public health surveillance to understand cancer prevention utilization among this underserved population.

Liquid Biopsy in Cervical Cancer: Hopes and Pitfalls

Cervical cancer (CC) is the fourth most common cancer in women worldwide, with about 90% of cancer-related deaths occurring in developing countries. The geographical influence on disease evolution reflects differences in the prevalence of human papilloma virus (HPV) infection, which is the main cause of CC, as well as in the access and quality of services for CC prevention and diagnosis. At present, the most diffused screening and diagnostic tools for CC are Papanicolaou test and the more sensitive HPV-DNA test, even if both methods require gynecological practices whose acceptance relies on the woman’s cultural and religious background. An alternative (or complimentary) tool for CC screening, diagnosis, and follow-up might be represented by liquid biopsy. Here, we summarize the main methodologies developed in this context, including circulating tumor cell detection and isolation, cell tumor DNA sequencing, coding and non-coding RNA detection, and exosomal miRNA identification. Moreover, the pros and cons of each method are discussed, and their potential applications in diagnosis and prognosis of CC, as well as their role in treatment monitoring, are explored. In conclusion, it is evident that despite many advances obtained in this field, further effort is needed to validate and standardize the proposed methodologies before any clinical use.

Connaissances, attitudes et croyances concernant le dépistage du cancer du col utérin dans le District d’Ajumako-Enyan-Essiam au Ghana

L’étude a été menée dans le district d’Ajumako-Eyan-Essiam (AEED) et visait à évaluer les connaissances, attitudes et croyances des femmes relativement au dépistage du cancer du col utérin. Au Ghana, ce cancer vient au deuxième rang des causes de cancer gynécologique. Dans les études et la pratique clinique effectuées auprès de femmes atteintes de cancer du col utérin, le diagnostic précoce, le traitement et la prévention du cancer sont largement influencés par leurs connaissances et leurs attitudes envers le dépistage. À ce jour, on ne dispose pas d’étude sur ces perceptions chez les femmes dans le district d’AEED. Un devis transversal quantitatif a été utilisé avec une analyse statistique descriptive de données provenant de 240 femmes. Les résultats ont révélé que 61,3 % d’entre elles ne savaient pas quel organe était touché lors d’un cancer du col utérin ou à quel intervalle un suivi était nécessaire après un résultat de test Pap normal; il y aurait donc des lacunes dans les connaissances. Au total, 36 % croyaient que le test de Papanicolaou (test Pap) était effectué une fois pour toutes, et 57,1 % pensaient qu’il était dispendieux, ce qui limite la participation au dépistage. Par peur de l’inconnu, beaucoup de répondantes avaient refusé le dépistage (48,8 %) alors que d’autres croyaient qu’elles n’étaient pas à risque (65,8 %). De plus, bon nombre de femmes (46,7 %) pensaient qu’il n’y avait pas de traitement contre le cancer du col. En conclusion, les connaissances fausses et inadéquates de ces femmes ont influencé leurs attitudes envers le dépistage du cancer.

Can mystery patients evaluate the quality of cervical cancer screenings? A pilot study in Bolivia

Objective This pilot study assesses the feasibility of using mystery patients to evaluate cervical cancer screenings provided to women in rural Bolivia. Methods We developed a protocol with local officials and adapted and pre-tested a debriefing tool. Eight mystery patients with existing appointments at four purposively selected rural facilities were recruited and trained. An interviewer debriefed patients after their screenings, and entered responses into a spreadsheet for analysis. Ques- tionnaire response frequencies and missing observations were presented. Results All patients completed screening and debriefing. On average, 93% of the questions were completed, with non-responses largely due to questions that were irrelevant to the screening venue. Responses revealed problems with confidentiality and dignity, minimal exam explanations or health education, inconsistencies across health facilities in Papanicolaou test availability, and problems in delivering and receiving test results. Conclusion Our findings suggest that the mystery patient method can be useful in evaluating the quality of cervical cancer screening and the delivery of test results in rural Bolivia.