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Barrison L, Hoskins E. Cervical cancer in a transgender man: lessons learnt to improve care. BMJ Case Rep 2024; 17:e258903. [PMID: 38508608 PMCID: PMC10952973 DOI: 10.1136/bcr-2023-258903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
We describe a case of rapid progression of cervical dysplasia to stage IVB cervical cancer in a previously healthy transgender young adult man on testosterone therapy. The cancer diagnosis came 7 months after routine pap smear showed low-grade dysplasia with high-risk human papillomavirus in preparation for gender-affirming hysterectomy/bilateral-salpingo-oophorectomy. After diagnosis, our patient faced unique challenges as a transgender man receiving gynecologic oncology care. This case highlights the challenges of and barriers to cervical cancer screening and treatment that transgender men confront. This case also considers whether gender-affirming testosterone therapy is associated with cervical cancer risk. We offer suggestions on how to improve cervical cancer screening and treatment for the transgender population.
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Affiliation(s)
- Lauren Barrison
- Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ebony Hoskins
- Gynecologic Oncology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Gynecologic Oncology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Mukhtar NF, Ng BK, Pauzi SHM, Wong YP, Hamizan MR, Lim PS, Isa NM. Abnormal Pap smear among pregnant women - Feasibility of opportunistic cervical screening. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100218. [PMID: 37575365 PMCID: PMC10413414 DOI: 10.1016/j.eurox.2023.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/11/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE The uptake of cervical cancer screening is poor, especially in developing countries. Thus, pregnancy represents a good opportunity to have the test done. The aim of this study is to determine the prevalence of abnormal Pap smear among pregnant women during their antenatal check-ups. STUDY DESIGN A prospective study involving five hundred and ninety-six women was recruited over a 1-year duration from 15th January 2018 until 14th January 2019 in a tertiary referral center, in Malaysia. Pap smears were performed on all consented pregnant women using liquid-based cytology and the results were obtained to evaluate the prevalence of abnormal Pap smear during pregnancy. Maternal risk factors associated with abnormal Pap smear were identified and the outcomes of abnormal Pap smear were followed up. RESULTS A total of 670 participants were approached and 596 participants agreed to participate, giving a response rate of 89.0 %. Therefore, 587 participants were available for analysis. There were nine unsatisfactory smears (1.5 %). The prevalence of premalignant lesions reported on p % ap smear was 0.8 %. Three respondents had atypical squamous cells of undetermined significance (ASCUS) (0.5 %) and two respondents had low-grade squamous intraepithelial lesions (LSIL) (0.3 %). Almost one-third (30.3 %) of respondents had an infection and 24 (4.1 %) smears were reported as reactive changes associated with inflammation. Respondents between the age of 20-30 years old had a significant association with an abnormal pre-cancerous smear (p = 0.000) as well as nulliparity (p = 0.0.40). There was no significant association between height, weight, BMI, sexual partner, age of first intercourse, smoking habit, history of sexually transmitted disease and history of abnormal Pap smear. CONCLUSION The prevalence of abnormal pre-cancerous smears during pregnancy is low. However, it is desirable to perform cervical screening as it provides an opportunity to no screening at all.
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Affiliation(s)
- Nur Farihan Mukhtar
- Department of Obstetrics and Gynaecology, Hospital Tuanku Fauziah, Jalan Tun Abd Razak, 01000 Kangar, Perlis, Malaysia
| | - Beng Kwang Ng
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Suria Hayati Md Pauzi
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Yin Ping Wong
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Mohammad Rafi’uddin Hamizan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Pei Shan Lim
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Nurismah Md Isa
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
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Magkana M, Mentzelopoulou P, Magkana E, Pampanos A, Daskalakis G, Domali E, Rodolakis A, Pappa K. The p16/ki-67 assay is a safe, effective and rapid approach to triage women with mild cervical lesions. PLoS One 2021; 16:e0253045. [PMID: 34115809 PMCID: PMC8195406 DOI: 10.1371/journal.pone.0253045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/27/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic accuracy and efficiency of p16/ki-67 dual stain in the identification of CIN2+ lesions, in Greek women with ASCUS or LSIL cytology. METHODS A total of 200 women, 20 to 60 years old, were enrolled in the study. All samples were cytologically evaluated and performed for p16/ki-67 and high-risk HPV (HR-HPV) test. All patients were referred to colposcopy for biopsy and histological evaluation. Three cervical cancer (CC) screening strategies were designed and the total direct medical costs of the procedures during our clinical trial were evaluated, from a healthcare perspective. RESULTS HPV 16 as expected was the most common HR-HPV type followed by HPV 31 and HPV 51. The risk for CIN2+ was significantly higher in HPV 16/18 positive cases. p16/ki-67 demonstrated a high sensitivity for CIN2+ identification in both ASCUS and LSIL groups (90.4% and 95%, respectively). HR-HPV test with sensitivity 52.3% and 65.5%, as well as colposcopy with sensitivity 14.3% and 36% respectively in ASCUS and LSIL group, showed inferior results compared to p16/ki-67. The specificity of p16/ki-67 for ASCUS and LSIL was 97.2% and 95.2% respectively, inferior only to colposcopy: 100% and 100%, lacking however statistical significance. HR-HPV test instead, presented the lowest specificity: 76.4% and 71.4% respectively in comparison to the other two methods. From a healthcare perspective, the costs and benefits of the tests implementation for the annual screening and triaging, in three CC screening strategies, were also calculated and discussed. CONCLUSIONS The results of the study indicate that p16/ki-67 is a safe and rapid assay that could be used to detect CIN2+ among women with mild cervical lesions, presenting both high sensitivity and specificity and could minimize the psychological and economic burden of HPV screening.
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Affiliation(s)
- Maria Magkana
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Cytology, "Alexandra" General Hospital, Athens, Greece
- * E-mail:
| | | | - Ekaterini Magkana
- Department of Cytology, "Alexandra" General Hospital, Athens, Greece
| | - Andreas Pampanos
- Department of Genetics, "Alexandra" General Hospital, Athens, Greece
| | - Georgios Daskalakis
- 1 Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ekaterini Domali
- 1 Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Rodolakis
- 1 Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Pappa
- 1 Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Cell and Gene Therapy Laboratory, Centre of Basic Research II, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
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Risk of Recurrence After Treatment for Cervical Intraepithelial Neoplasia 3 and Adenocarcinoma In Situ of the Cervix: Recurrence of CIN 3 and AIS of Cervix. J Low Genit Tract Dis 2021; 24:252-258. [PMID: 32384365 DOI: 10.1097/lgt.0000000000000542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate recurrence risk of cervical intraepithelial neoplasia (CIN) 3+ and adenocarcinoma in situ (AIS)+ in a large population cohort of women previously treated for CIN 3/AIS. METHODS Merging administrative databases with information on health services utilization and jurisdictional cancer registry, we identified all women undergoing treatment for CIN 3 or AIS from 2006 to 2010. Recurrence rate 1-5 years after treatment was defined as a biopsy finding of CIN 3/AIS or retreatment (loop electrosurgical excision procedure [LEEP], laser, cone, hysterectomy). Logistic regression was used to determine odds of recurrence. RESULTS A total of 15,177 women underwent treatment for CIN 3 (n = 14,668) and AIS (n = 509). The recurrence rate for 5 years was greater for AIS (9.0%) compared with CIN 3 (6.1%). In a multivariate analysis, increased risk of recurrence was shown for age older than 45 years (hazard ratio (HR) = 1.3, 95% CI = 1.1-1.6), AIS compared with CIN 3 (HR = 2.2, 95% CI = 1.5-3.5) first cytology after treatment showing high grade (HR = 12.4, 95% CI = 9.7-15.7), and no normal Pap smears after treatment (HR = 2.8, 95% CI = 2.2-3.7). There was no difference in recurrence risk with treatment type (cone vs LEEP: HR = 1.0, 95% CI = 0.8-1.2, and laser vs LEEP: HR = 1.1, 95% CI = 0.8-1.4) or number of procedures per year performed by physicians (<40 vs >40 procedures: HR = 1.1, 95% CI = 0.9-1.3). CONCLUSIONS Recurrence risk of CIN 3 and AIS is related to age, histology, and posttreatment cytology, which should assist with discharge planning from colposcopy. Definitive treatment with hysterectomy should be considered in women older than 45 years with additional risk factors for recurrence.
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Grotell LA, Bryson L, Florence AM, Fogel J. Postpartum Note Template Implementation Demonstrates Adherence to Recommended Counseling Guidelines. J Med Syst 2021; 45:14. [PMID: 33409663 DOI: 10.1007/s10916-020-01692-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Postpartum visits may provide patients with an inadequate amount of counseling on postpartum depression, birth spacing, healthy eating, exercise, or changes in sexual response and emotions. We created a template in our electronic health record (EHR) with the aid of our clinical informatics department to increased adherence with recommended counseling guidelines. We retrospectively reviewed the postpartum visits of 200 patients who had a delivery and received postpartum care. Patients were seen in a resident-run clinic: 100 visits occurred prior to implementation of the template, while 100 visits occurred post-implementation with use of the template. We observed for documentation of counseling on Pap smear, birth spacing, breastfeeding, contraception, depression, gestational diabetes mellitus, pre-eclampsia, and sleep/fatigue. Descriptive statistics of mean and standard deviation were used to describe the continuous variables. Frequency and percentage were used to describe the continuous variables. Analysis of variance compared the continuous variables. The Pearson chi-square test compared the categorical variables. In visits that occurred without use of the template, counseling was charted as low as 1.0% for birth spacing to as high as 86.0% for contraception. With use of the template, counseling was charted as 100% in all visits for each of the recommended counseling guidelines (all p < 0.001). In conclusion, an EHR template for documentation of postpartum visits is associated with resident adherence with recommended postpartum counseling guidelines. Managers in hospitals and clinical practices should consider incorporating OBGYN-specific EHR note templates to improve quality and increase adherence with recommended guidelines during postpartum visits.
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Affiliation(s)
- Lauren A Grotell
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, MD, USA
| | - Lennox Bryson
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, MD, USA
| | - Ashley M Florence
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, MD, USA
| | - Joshua Fogel
- Department of Obstetrics & Gynecology, Nassau University Medical Center, East Meadow, MD, USA. .,Department of Business Management, Brooklyn College of the City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA.
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Interactive Learning Modules With Visual Feedback Improve Resident Learning in Colposcopy. J Low Genit Tract Dis 2020; 24:215-220. [PMID: 32108121 DOI: 10.1097/lgt.0000000000000515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Accreditation Council for Graduate Medical Education and the Council on Resident Education in Obstetrics and Gynecology have milestones and/or competencies relating to colposcopy; however, the optimal way to reach these objectives is not proscribed and left to individual programs. Here, we aim to assess resident skill, confidence levels, perceived level of knowledge, and satisfaction with colposcopic training before and after implementation of a new interactive learning module with visual feedback. MATERIALS AND METHODS A new online educational intervention was developed by the author (E.L.N.) based on adult learning theory and introduced into our obstetrics and gynecology resident colposcopy curriculum in July 2014. We assessed performance on an objective competency examination administered at baseline and repeated after 6 months of our 24 residents.In addition, we assessed resident confidence levels, perceived level of knowledge, and satisfaction with training before and 6 months after intervention. RESULTS Scores on a national online examination improved after the intervention (p = .014). Significant improvements on the examination were seen in the sections of medical knowledge (p = .031) and management (p = .011). Residents' perceived knowledge increased significantly after the intervention (p = .030). CONCLUSIONS Learning outcomes improved after introduction of a novel teaching intervention.
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Phianpiset R, Ruengkhachorn I, Jareemit N, Ittiamornlert P, Chaopotong P, Hanamornroongruang S, Horthongkham N. ASCCP Risk-Based Colposcopy Recommendations Applied in Thai Women With Atypical Squamous Cells of Undetermined Significance or Low-Grade Squamous Intraepithelial Lesion Cytology. Obstet Gynecol 2020; 136:510-517. [PMID: 32769651 DOI: 10.1097/aog.0000000000003982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the proportion of cervical intraepithelial neoplasia (CIN) 2 or worse pathology among different risk strata according to the ASCCP when applied in women who had atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL) cervical cytology; to assess performance of colposcopy; and to assess the independent predictors for detected CIN 2 or worse pathology. METHODS This is a secondary analysis of a previous prospective study, which included Thai women with ASC-US or LSIL cytology who underwent high-risk human papillomavirus (HPV) testing and subsequent colposcopy with directed biopsy. Patients were classified as lowest-risk, intermediate-risk, or highest-risk based on cervical cytology, high-risk HPV testing, and colposcopic impression. The proportion of CIN 2 or worse pathology and associated prognostic factors were analyzed. RESULTS Of 697 women, 103 (14.8%), 573 (82.2%) and 21 (3%) were classified into lowest-risk, intermediate-risk, and highest-risk groups, respectively. The proportion of CIN 2 or worse pathology was 1%, 11.2%, and 61.9% in those same groups, respectively (P<.001). Colposcopy to detect CIN 2 or worse pathology had a sensitivity, specificity, positive predictive value, and negative predictive value of 98.7%, 18%, 13.2%, and 99.1%, respectively. Independent predictors for detecting CIN 2 or worse pathology were positive high-risk HPV, HPV 16/18 positivity, and high-grade colposcopic impression. CONCLUSION This study supports a no biopsy with follow-up strategy in the lowest-risk group, inconsistent with ASCCP recommendations, but is in alignment with a strategy of multiple targeted biopsies in the intermediate-risk and highest-risk groups.
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Affiliation(s)
- Rattiya Phianpiset
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Departments of Pathology and Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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An Update on Screening and Prevention for Breast and Gynecological Cancers in Average and High Risk Individuals. Am J Med Sci 2020; 360:489-510. [DOI: 10.1016/j.amjms.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 11/21/2022]
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Duan L, Du H, Belinson JL, Liu Z, Xiao A, Liu S, Zhao L, Wang C, Qu X, Wu R. Thermocoagulation versus cryotherapy for the treatment of cervical precancers. J Obstet Gynaecol Res 2020; 47:279-286. [PMID: 33089619 PMCID: PMC7820992 DOI: 10.1111/jog.14520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/04/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022]
Abstract
Aim To compare thermocoagulation and cryotherapy for treatment of high‐grade cervical intraepithelial neoplasia (CIN). Methods From May 2017 to May 2018, women with CIN2/3 were randomized to thermocoagulation or cryotherapy at Peking University Shenzhen Hospital. Follow‐up at 4 and 8 months included cytology and human papillomavirus (HPV) testing. Women who were HPV‐positive or had atypical squamous cells of undetermined significance or higher‐grade disease underwent colposcopy/biopsy. Results Among 149 women enrolled, 74 were randomized to thermocoagulation, and 75 to cryotherapy (excluded four were immediately referred for thermocoagulation due to large lesions). At follow‐up, there was no difference between the thermocoagulation and cryotherapy groups in HPV‐negative (4/8 months: 72.5%/86.2% vs 68.6%/80.6%) and pathology‐negative (97.1%/98.5% vs 94.3%/92.3%) rates (all P > 0.05). The cytology‐negative rate was similar for thermocoagulation and cryotherapy at 4 months (79.7% vs 78.9%, P > 0.05), but higher for thermocoagulation at 8 months (100% vs 88.7%, P < 0.05). No lesions were observed among the four referral women at follow‐up. As compared with cryotherapy, thermocoagulation was associated with shorter duration of treatment and less vaginal discharge, but higher pain during application and longer bleeding after treatment. Conclusion Thermocoagulation was as effective and safe as cryotherapy and might be easily applied to treat high‐grade cervical lesions.
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Affiliation(s)
- Lyufang Duan
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Hui Du
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Jerome L Belinson
- Preventive Oncology International, Cleveland Heights, Ohio, USA.,Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zhihong Liu
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Aimin Xiao
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Shuangyan Liu
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Liwei Zhao
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Chun Wang
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Xinfeng Qu
- Sanming Project of Medicine in Shenzhen Peking University, Shenzhen Hospital, Shenzhen, China
| | - Ruifang Wu
- Department of Gynecology and Obstetrics, Peking University Shenzhen Hospital, Shenzhen, China.,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
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Yang M, Li L, Jiang C, Qin X, Zhou M, Mao X, Xing H. Co-infection with trichomonas vaginalis increases the risk of cervical intraepithelial neoplasia grade 2-3 among HPV16 positive female: a large population-based study. BMC Infect Dis 2020; 20:642. [PMID: 32873233 PMCID: PMC7466445 DOI: 10.1186/s12879-020-05349-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
Background Evidence suggested that vaginal microbiome played a functional role in the progression of cervical lesions in female infected by HPV. This study aimed at evaluating the influence of common vaginal infection on the carcinogenicity of high risk HPV (hr-HPV). Methods From January 15, 2017 to December 31, 2017, 310,545 female aged at least 30 years old had been recruited for cervical cancer screening from 9 clinical research centers in Central China. All the recruited participants received hr-HPV genotyping for cervical cancer screening and vaginal microenvironment test by a high vaginal swab. Colposcopy-directed biopsy was recommended for female who were infected with HPV 16 and HPV 18, and other positive hr-HPV types through test had undertaken triage using liquid-based cytology, cases with the results ≥ ASCUS among them were referred to colposcopy directly, and cervical tissues were taken for pathology examination to make clear the presence or absence of other cervical lesions. Results Among 310,545 female, 6067 (1.95%) were tested with positive HPV 16 and HPV 18, 18,297 (5.89%) were tested with other positive hr-HPV genotypes, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and invasive cervical cancer (ICC) were detected in 861 cases, 377 cases, 423 cases, and 77 cases, respectively. Candida albicans and Gardnerella were not associated with the detection of cervical lesions. Positive trichomonas vaginitis (TV) was correlated with hr-HPV infection (p < 0.0001). Co-infection with TV increased the risk of CIN 1 among female infected with hr-HPV (OR 1.18, 95% CI: 1.42–2.31). Co-infection with TV increased the risk of CIN 2–3 among female infected with HPV 16 (OR 1.71, 95% CI: 1.16–2.53). Conclusions Co-infection of TV and HPV 16 is a significant factor for the detection of cervical lesions.
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Affiliation(s)
- Mei Yang
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Lin Li
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Chunfan Jiang
- Department of Pathology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Xiaomin Qin
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Min Zhou
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Xiaogang Mao
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Hui Xing
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China.
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Desravines N, Miele K, Carlson R, Chibwesha C, Rahangdale L. Topical therapies for the treatment of cervical intraepithelial neoplasia (CIN) 2-3: A narrative review. Gynecol Oncol Rep 2020; 33:100608. [PMID: 32685652 PMCID: PMC7356206 DOI: 10.1016/j.gore.2020.100608] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022] Open
Abstract
CIN management is currently surveillance or surgical therapy. This review describes current research on medical therapies. Imiquimod is the most studied with evidence of safety and efficacy. 5-Fluorouracil has also shown promise with two clinical trials showing efficacy as adjuvant and primary treatment. Antivirals therapies have produced mixed results with cidofovir showing the most potential. The data remains weak regarding hormonal, herbal and alternative therapies rending it difficult to draw conclusions. Current management of Cervical Intraepithelial Neoplasia (CIN), caused by high-risk human papillomavirus (hr-HPV), is based on surveillance and surgical therapy. Procedures carry potential risks such as preterm birth, and access remains limited throughout the world. However, there are no medical therapies recommended to promote the clearance of hr-HPV infection or CIN. Ultimately, even if less efficacious than excision procedures, medical therapies have the potential to decrease cervical cancer by eliminating barriers to treatment, such as access to treatment, or serving as an adjunct to surgical treatment in both high- and low-resource settings. This review describes current research on topical therapies with the potential for self-application for the treatment of HPV or CIN. Therapies included are immune-modulators, anti-proliferative medications, antivirals, hormones, and herbal/alternative therapies. Randomized trials of immune-modulating (imiquimod), anti-proliferative (5-fluorouracil), and anti-viral (cidofovir) therapies have had the most promising results. However, no option has sufficient clinical trial evidence to be recommended as treatment for CIN 2–3 and surgery remains the standard of care. The research described in this review serves as a guide for the development of future trials in the burgeoning arena of topical therapies for CIN 2–3.
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Affiliation(s)
- Nerlyne Desravines
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC, USA
| | - Kate Miele
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC, USA
| | - Rebecca Carlson
- University of North Carolina Health Sciences Library, Chapel Hill, NC, USA
| | - Carla Chibwesha
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC, USA.,South Africa University of the Witwatersrand, Clinical HIV Research Unit, Department of Internal Medicine, Johannesburg-Braamfontein, Gauteng, ZA, South Africa
| | - Lisa Rahangdale
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill, NC, USA.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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Wu L, Gong Y, Yan T, Zhang H. LINP1 promotes the progression of cervical cancer by scaffolding EZH2, LSD1, and DNMT1 to inhibit the expression of KLF2 and PRSS8. Biochem Cell Biol 2020; 98:591-599. [PMID: 32348690 DOI: 10.1139/bcb-2019-0446] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There is a growing body of evidence indicating that long non-coding RNAs (lncRNAs) are associated with a variety of cancers. LncRNA LINP1 has been shown to be a key factor in tumor malignancy. However, the role of LINP1 in cervical cancer (CC) it is unclear. In our research, we found that the levels of LINP1 were significantly elevated in CC tissues by comparison with adjacent normal tissue. Further, the expression level of LINP1 was upregulated in CC cells compared with healthy human cervical epithelial cell lines (HUCEC). Surprisingly, we found that downregulation of LINP1 significantly reduced the proliferation of CC cells and promoted apoptosis. Additionally, downregulation of LINP1 significantly decreased CC tumor growth in vivo. Further, we observed that LINP1 recruits EZH2, LSD1, and DNMT1, thereby reducing the expression of KLF2 and PRSS8. The results from our qRT-PCR analyses showed that silencing LINP1 uprgulated the expression of KLF2 and PRSS8 in CC cells. The results from our loss-of-function assays showed that upregulation of KLF2 and PRSS8 inhibits cell proliferation and boosts cell apoptosis in CC. We also found that inhibition of KLF2 and PRSS8 reversed the inhibitory effect on cell proliferation associated with silencing LINP1. In short, LINP1 facilitates the progression of CC by suppressing KLF2 and PRSS8, and thus could provide a promising target for CC therapy.
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Affiliation(s)
- Liuli Wu
- Medical College of Guizhou University, Guiyang 550025, Guizhou, P.R. China
| | - Yuan Gong
- Department of Gynaecology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou, P.R. China
| | - Ting Yan
- Department of Gynaecology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou, P.R. China
| | - Huimin Zhang
- Medical College of Guizhou University, Guiyang 550025, Guizhou, P.R. China.,Department of Gynaecology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou, P.R. China
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14
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Zhang Q, Dong B, Chen L, Lin T, Tong Y, Lin W, Lin H, Gao Y, Lin F, Sun P. Evaluation of PCR-Reverse Dot Blot Human Papillomavirus Genotyping Test in Predicting Residual/Recurrent CIN 2+ in Posttreatment Patients in China. Cancer Manag Res 2020; 12:2369-2379. [PMID: 32308477 PMCID: PMC7132552 DOI: 10.2147/cmar.s237490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/13/2020] [Indexed: 02/01/2023] Open
Abstract
Objective To assess the clinical value of the PCR-reverse dot blot human papillomavirus genotyping test during follow-up of patients with CIN grade 2 or worse (CIN 2+). Methods Four hundred patients with CIN 2+ receiving treatment from January 2008 to January 2017 were included in our study. Postoperative follow-up procedures comprised HPV examination and cervical cytology every 3–6 months for the first 2 years and then followed up every 6–12 months. A pathology examination was performed when there was a positive funding for HPV 16/18 or an abnormal ThinPrep cytology test (TCT) with or without positive for HR-HPV according to the American Society for Coloscopy and Cervical Pathology (ASCCP) guidelines. Results The median follow-up period was 27.10±12.47 months (ranging from 3 to 50 months). During follow-up, 12.00% (48/400) of the women developed residual/recurrent disease. The highest risk in CIN 2+ and CIN 3+ residual/recurrence was HPV-16/-18 (hazard ratio (HR)=12.898, 95% CI= 6.849–24.289; HR= 20.726, 95% CI= 9.64–44.562, respectively). Among the different follow-up methods, type-specific (TP) HR-HPV persistent infection showed the highest cumulative incidence risk (CIR) (84.62%, 95% CI=73.29–95.94) and HR (5.38, 95% CI= 2.596–11.149) during the 4-year follow-up period. At the CIN 2+ and CIN 3+ endpoints, TP-HPV testing had relatively high sensitivity (84.62%, 95% CI=73.29–95.94 and 89.28%, 95% CI= 77.83–100.00, respectively) and specificity (78.07%, 95% CI= 72.70–83.44 and 75.73%, 95% CI= 70.30–81.17, respectively). However, at the CIN 2+/CIN 3+ endpoint, TCT follow-up had a sensitivity of 60.42%/62.16% (95% CI=46.58–72.25/46.54–77.79) and specificity of 90.18%/88.72% (95% CI=86.95–93.41/85.35–92.10). Conclusion TP HR-HPV follow-up can provide a reliable and sensitive clinical reference for CIN 2+ postoperative patients.
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Affiliation(s)
- Qiaoyu Zhang
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Binhua Dong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Lihua Chen
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Tingting Lin
- Department of Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Yao Tong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Wenyu Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Haifeng Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yuqin Gao
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Fen Lin
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China.,Department of Gynecology, Fujian Provincial Maternity and Children's Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
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15
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Clinical Management of Anogenital Warts and Intraepithelial Neoplasia. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Abstract
Cervical cancer is by far the most common HPV-related disease. About 99.7% of cervical cancer cases are caused by persistent genital high-risk human papillomavirus (HPV) infection. Worldwide, cervical cancer is one of the most common cancer in women with an estimated 528,000 new cases reported in 2012. Most HPV infections clear spontaneously but persistent infection with the oncogenic or high-risk types may cause cancer of the oropharynx and anogenital regions. The virus usually infects the mucocutaneous epithelium and produces viral particles in matured epithelial cells and then causes a disruption in normal cell-cycle control and the promotion of uncontrolled cell division leading to the accumulation of genetic damage. There are currently two effective prophylactic vaccines against HPV infection, and these comprise of HPV types 16 and 18, and HPV types 6, 11, 16 and 18 virus-like particles. HPV testing in the secondary prevention of cervical cancer is clinically valuable in triaging low-grade cytological abnormalities and is also more sensitive than cytology as a primary screening. If these prevention strategies can be implemented in both developed and developing countries, many thousands of lives could be saved.
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Affiliation(s)
- Kehinde Sharafadeen Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
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17
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ACOG Committee Opinion No. 754: The Utility of and Indications for Routine Pelvic Examination. Obstet Gynecol 2019; 132:e174-e180. [PMID: 30247363 DOI: 10.1097/aog.0000000000002895] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The pelvic examination has long been considered a fundamental component of the well-woman visit, and many women and gynecologic care providers view this visit as an opportunity to discuss sexual and reproductive health issues. Traditionally, a pelvic examination is performed for asymptomatic women as a screening tool for gynecologic cancer, infection, and asymptomatic pelvic inflammatory disease; some obstetrician-gynecologists and patients consider it important in detecting subclinical disease, despite evidence to the contrary. Given changes in screening recommendations and the ability to screen for sexually transmitted infections using less-invasive methods, reevaluation of the role of the pelvic examination for asymptomatic, nonpregnant women is warranted. A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. It is recommended by the American College of Obstetricians and Gynecologists that pelvic examinations be performed when indicated by medical history or symptoms. Women with current or a history of cervical dysplasia, gynecologic malignancy, or in utero diethylstilbestrol exposure should be screened and managed according to guidelines specific to those gynecologic conditions. Based on the current limited data on potential benefits and harms and expert opinion, the decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician-gynecologist or other gynecologic care provider.
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18
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Abstract
Cervical cancer is by far the most common HPV-related disease. About 99.7% of cervical cancer cases are caused by persistent genital high-risk human papillomavirus (HPV) infection. Worldwide, cervical cancer is one of the most common cancers in women with an estimated 528,000 new cases reported in 2012. Most HPV infections clear spontaneously but persistent infection with the oncogenic or high-risk types may cause cancer of the oropharynx and anogenital regions. The virus usually infects the mucocutaneous epithelium and produces viral particles in matured epithelial cells and then causes a disruption in normal cell-cycle control and the promotion of uncontrolled cell division leading to the accumulation of genetic damage. There are currently two effective prophylactic vaccines against HPV infection, and these comprise of HPV types 16 and 18, and HPV types 6, 11, 16 and 18 virus-like particles. HPV testing in the secondary prevention of cervical cancer is clinically valuable in triaging low-grade cytological abnormalities and is also more sensitive than cytology as a primary screening. If these prevention strategies can be implemented in both developed and developing countries, many thousands of lives could be saved.
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Affiliation(s)
- Kehinde Sharafadeen Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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19
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Gu L, Hong Z, Gao H, Qiu L, Di W. Incidence of cervical high-grade squamous intraepithelial lesions and squamous cell carcinoma in women with high-risk human papillomavirus and normal cervical cytology: A retrospective analysis of 1858 cases stratified by age and human papillomavirus genotype. Cytopathology 2019; 30:419-425. [PMID: 31069857 DOI: 10.1111/cyt.12717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To retrospectively analyse the incidence of high-grade squamous intraepithelial lesions (HSILs) and squamous cell carcinoma (SCC) in women of different ages with high-risk (HR) human papillomavirus (HPV) but with normal cytology test results stratified by age and HPV genotype. METHODS In total, 1858 women with HR-HPV infection but with a normal smear who received a colposcopy and biopsy between 2015 and 2016 at our institution were included. The pathological results were retrospectively analysed after stratifying by age and HPV genotype. RESULTS Among the 1858 cases, the HSIL% in women aged 21-29 years (10.54%) was significantly different from that in women aged 40-49 years (19.85%; P < 0.05), whereas there was no significant difference in the HSIL% among women aged 21-29 years and those in the other age groups (P > 0.05). In total, 295 cases had single HPV16 infection. The HSIL% in patients with HPV16/18 infection was >15%, and the 40-49-year age group had the highest percentage at 48.48%. For other HR-HPV infections, the HSIL and SCC incidence rate was 10.41%, and there was no significant difference among the age groups; thus, women with other types of viral infections, regardless of age, should be referred to colposcopy. CONCLUSIONS Although HPV16 is the HPV with the highest risk, other HR-HPV infections can also cause a high percentage of HSILs and SCC in women with normal cytology. Therefore, it is necessary to refer HR-HPV-infected women aged ≥21 years for colposcopy in a timely manner to exclude potential cervical intraepithelial neoplasia and cervical cancer.
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Affiliation(s)
- Liying Gu
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zubei Hong
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hua Gao
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lihua Qiu
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wen Di
- Department of Obstetrics and Gynecology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.,State Key Laboratory of Oncogenes and Related Genes, School of Medicine, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
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20
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Goulding AN, Rahangdale L. Human Papillomavirus and Adverse Pregnancy Outcomes: An Opportunity for Prevention? J Womens Health (Larchmt) 2019; 28:565-567. [DOI: 10.1089/jwh.2018.7602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Alison N. Goulding
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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21
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Data on post-partum evaluation of women with abnormal cervical cytology in pregnancy. Data Brief 2018; 21:2405-2409. [PMID: 30547066 PMCID: PMC6282187 DOI: 10.1016/j.dib.2018.11.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022] Open
Abstract
During pregnancy, the only diagnosis that may alter management is invasive cancer. Thus, the primary aim of the cytological screening and subsequent colposcopy performed during pregnancy should be the exclusion of invasive cancer, “Practice Bulletin No. 140: management of abnormal cervical cancer screening test results and cervical cancer precursors,” (American College of Obstetricians and Gynecologists, 2013) [1]. However, the impact of the delivery on the regression of the cervical lesions is still debated. This data article concerns the post-partum evaluation of colposcopic patterns, cytological and histopathology findings in women diagnosed with abnormal cervical cytology in pregnancy, included in the paper entitled “Reliability of colposcopy during pregnancy” (Ciavattini et al., 2018). Data about the rates of persistence, progression and regression of CIN after delivery are reported.
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22
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Digital Colposcopy With Dynamic Spectral Imaging for Detection of Cervical Intraepithelial Neoplasia 2+ in Low-Grade Referrals: The IMPROVE-COLPO Study. J Low Genit Tract Dis 2018; 22:21-26. [PMID: 28953107 PMCID: PMC5768224 DOI: 10.1097/lgt.0000000000000353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a study of “real-world” practice, digital colposcopy with dynamic spectral imaging mapping increased the detection of women with high-grade CIN compared with standard colposcopy. Objective The aim of the study was to determine, in a wide “real-world” setting, whether digital colposcopy with adjunctive dynamic spectral imaging (DSI) mapping increases the detection of women with high-grade cervical intraepithelial neoplasia (CIN). Materials and Methods A multicenter, two-arm, observational, cross-sectional study that recruited women 21 years and older, having colposcopy after a low-grade abnormality screening result. The prospective arm collected outcomes of digital colposcopy with DSI used for identifying biopsy sites at the colposcopists' discretion. The retrospective control arm (number of subjects matched 1:1 per colposcopist) collected outcomes of standard colposcopy. The primary outcome was histopathological detection of women with CIN 2+ by colposcopic biopsy. Results The study included 1,788 women in the retrospective and 1,857 in the prospective arm from 39 US community-based clinics. Subject characteristics were comparable. A total of 71.6% of the women in the retrospective and 71.5% in the prospective arm underwent biopsy. The average number of biopsies increased from 1.032 (retrospective) to 1.256 (prospective). The yield of CIN 2+ patients was 7.21% in the retrospective and 9.48% in the prospective arm, a 2.27% difference (95% confidence interval = 0.47%–4.07%, p = .014) and 31.4% relative increase. The yield of CIN 3+ patients was 2.07% in the retrospective and 3.23% in the prospective arm, a 1.16% (95% confidence interval = 0.12%–2.24%, p = .031) absolute difference and 56.1% relative increase. The false-positive rates for biopsied patients were comparable (64.43% vs 62.04%, p = .139). Conclusions Digital colposcopy with the adjunctive DSI increased CIN 2+ and CIN 3+ detection in low-grade referrals compared with standard colposcopy, with a similar number of women undergoing biopsy.
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Jaishuen A, Jareemit N, Laiwejpithaya S, Viriyapak B, Benjapibal M, Horthongkham N. Comparison of Siriraj liquid-based solution and standard transport media for the detection of high-risk human papillomavirus in cervical specimens. J Med Virol 2018; 90:1793-1799. [PMID: 29995342 DOI: 10.1002/jmv.25259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 06/08/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the performance of Siriraj liquid-based solution for human papillomavirus (HPV) DNA testing compared with standard transport media. METHODS This cross-sectional study enrolled 217 women aged 30 years or older who attended for cervical cancer screening or had abnormal cervical cytology, or were diagnosed with cervical cancer at the Department of Obstetrics-Gynecology, Siriraj Hospital from March 2015 to January 2016. We excluded patients with a history of any cervical procedures, hysterectomy, or previous treatment with pelvic irradiation or chemotherapy. Two cervical specimens were collected from each participant. The standard Cervi-Collect Specimen Collection Kit was used to preserve the first sample, and Siriraj liquid-based solution was used for the second one. All samples were sent for HPV DNA testing using the same standard high-risk HPV assay. HPV test results were recorded and statistically analyzed. RESULTS The results showed agreement between standard transport media and Siriraj liquid-based solution for HPV DNA testing, at a kappa value of 0.935 (P < 0.001). We found no discorrelation for the detection of HPV 16, which accounts for approximately 50% of cervical cancers. The relative sensitivity of Siriraj liquid-based solution and standard transport media in patients with high-grade cervical intraepithelial neoplasia or worse (CIN2+) is 98% (50/51). The relative specificity of Siriraj liquid-based solution and standard transport media in patients with non-CIN2+ is 98.1% (102/104). CONCLUSION Siriraj liquid-based solution showed almost perfect agreement with the standard transport media for HPV DNA testing. This solution, costing 2 to 3 times less than the commercially available standard media, may be an alternative option for HPV DNA testing.
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Affiliation(s)
- Atthapon Jaishuen
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nida Jareemit
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somsak Laiwejpithaya
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Boonlert Viriyapak
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mongkol Benjapibal
- Department of Obstetrics-Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Navin Horthongkham
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Onuma T, Tajima K, Sato K, Hattori K, Fukuda S, Tsuji T, Yoshida Y. Clinical significance of atypical squamous cells of undetermined significance after treatment for cervical intraepithelial grade 3 neoplasia: A retrospective single-center cohort study. Mol Clin Oncol 2017; 7:1032-1038. [PMID: 29285369 DOI: 10.3892/mco.2017.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/28/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the clinical significance of atypical squamous cells of undetermined significance (ASC-US) following cervical conization for cervical intraepithelial neoplasia (CIN) grade 3. This study was a retrospective cohort analysis. The medical records of women treated with conization for CIN 2-3 were reviewed and 142 patients with CIN 3 who had been diagnosed using the conization specimens were selected. The mean follow-up period after conization was 41.8 months. Cytological abnormalities after conization were observed in 19.0% of the patients and consisted of ASC-US (13.4%) and worse than low-grade squamous intraepithelial lesion (LSIL; 5.6%). Recurrence was defined as a diagnosis worse than CIN 2, and the recurrence rate was 29.6% among patients with abnormal cytology. The recurrence rate was 15.7% in the ASC-US group and 71.4% in the worse than LSIL group. There was no significant difference in the time of initial identification of abnormal cytology after treatment between the worse than LSIL and the ASC-US groups (P=0.054). However, the ASC-US group had a significantly better cumulative recurrence-free rate compared with the worse than LSIL group (P<0.05). Women with ASC-US following treatment for CIN appear to be at a relatively high risk. Regarding the risk stratification of women following treatment for CIN, if surveillance cytology shows ASC-US, immediate colposcopy is recommended, along with long-term follow-up.
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Affiliation(s)
- Toshimichi Onuma
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan.,Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Kimihisa Tajima
- Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Kumiko Sato
- Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Katsushige Hattori
- Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Shin Fukuda
- Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Takahiro Tsuji
- Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
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25
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Mrayan L, Alnuaimi K, Abujilban S, Abuidhail J. Exploring Jordanian women's experience of first pelvic examination. Appl Nurs Res 2017; 38:159-162. [PMID: 29241510 DOI: 10.1016/j.apnr.2017.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 09/24/2017] [Accepted: 10/15/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Lina Mrayan
- Department on Maternal, Child and Family Health Nursing, Faculty of Nursing, Hashemite University, Room 2086, P.O. Box 150459, Zarqa 13115, Jordan.
| | - Karimeh Alnuaimi
- Department on Maternal, Child and Midwifery, Faculty of Nursing and Midwifery, Jordan University of Science and Technology, Irbid 13115, Jordan
| | - Sanaa Abujilban
- Department on Maternal, Child and Family Health Nursing, Faculty of Nursing, Hashemite University, Room 2090, P.O. Box 150459, Zarqa 13115, Jordan
| | - Jamila Abuidhail
- Department on Maternal, Child and Family Health Nursing, Faculty of Nursing, Hashemite University, Room 5359, P.O. Box 150459, Zarqa 13115, Jordan.
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DeNardis SA, Lavin PT, Livingston J, Salter WR, James-Patrick N, Papagiannakis E, Olson CG, Weinberg L. Increased detection of precancerous cervical lesions with adjunctive dynamic spectral imaging. Int J Womens Health 2017; 9:717-725. [PMID: 29033612 PMCID: PMC5628669 DOI: 10.2147/ijwh.s144577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective To validate, in US community-based colposcopy clinics, previous reports of increased detection of high-grade cervical intraepithelial neoplasia (CIN2+) with biopsies selected using dynamic spectral imaging (DSI) mapping after standard colposcopy. Study design Cross-sectional observational study of 26 colposcopists across nine clinics recruiting consecutive colposcopy patients. Standard assessment with biopsy selections was completed before seeing the DSI map which was subsequently interpreted and used for additional biopsies per clinical judgment. Primary measure was the number of women with CIN2+ detected by DSI-assisted biopsies, over those detected by standard colposcopy biopsies. Results A total of 887 women were recruited. After exclusions, 881 women and 1,189 biopsies were analyzed. Standard biopsy detected 78 women with CIN2+ and DSI-assisted biopsies another 34, increasing the detection rate from 8.85% to 12.71% (p=0.00016). This was achieved with 16.16% of DSI-assisted biopsies finding CIN2+ compared to 13.24% for the preceding standard biopsies. For secondary specificity analysis, 431 women had only <CIN2 in standard biopsy/ies, a 48.92% rate, while 131 women who underwent no standard biopsy/ies had DSI-assisted biopsy/ies which were all <CIN2, a 35.22% rate (p<0.0001). Conclusion The largest study, to date, of DSI used in colposcopy confirms previously reported increased detection of CIN2+, across multiple US community-based clinics. Based on the improved efficiency of the DSI-assisted biopsies, this increase suggests an improved diagnostic capacity achieved with DSI and cannot be explained solely by the taking of additional biopsies.
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Affiliation(s)
- Sara A DeNardis
- Department of Obstetrics/Gynecology, University of Central Florida, Orlando, FL, USA
| | - Philip T Lavin
- Boston Biostatistics Research Foundation, Framingham, MA, USA
| | | | | | | | | | | | - Lori Weinberg
- Department of Obstetrics/Gynecology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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Deshmukh AA, Chiao EY, Cantor SB, Stier EA, Goldstone SE, Nyitray AG, Wilkin T, Wang X, Chhatwal J. Management of precancerous anal intraepithelial lesions in human immunodeficiency virus-positive men who have sex with men: Clinical effectiveness and cost-effectiveness. Cancer 2017; 123:4709-4719. [PMID: 28950043 DOI: 10.1002/cncr.31035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/05/2017] [Accepted: 05/15/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) are at disproportionately high risk for anal cancer. There is no definitive approach to the management of high-grade squamous intraepithelial lesions (HSIL), which are precursors of anal cancer, and evidence suggests that posttreatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves HSIL treatment effectiveness. The objectives of this study were to evaluate the optimal HSIL management strategy with respect to clinical effectiveness and cost-effectiveness and to identify the optimal age for initiating HSIL management. METHODS A decision analytic model of the natural history of anal carcinoma and HSIL management strategies was constructed for HIV-positive MSM who were 27 years old or older. The model was informed by the Surveillance, Epidemiology, and End Results-Medicare database and published studies. Outcomes included the lifetime cost, life expectancy, quality-adjusted life expectancy, cumulative risk of cancer and cancer-related deaths, and cost-effectiveness from a societal perspective. RESULTS Active monitoring was the most effective approach in patients 29 years or younger; thereafter, HSIL treatment plus adjuvant qHPV vaccination became most effective. When cost-effectiveness was considered (ie, an incremental cost-effectiveness ratio [ICER] < $100,000/quality-adjusted life-year), do nothing was cost-effective until the age of 38 years, and HSIL treatment plus adjuvant qHPV vaccination was cost-effective beyond the age of 38 years (95% confidence interval, 34-43 years). The ICER decreased as the age at HSIL management increased. Outcomes were sensitive to the rate of HSIL regression or progression and the cost of high-resolution anoscopy and biopsy. CONCLUSIONS The management of HSIL in HIV-positive MSM who are 38 years old or older with treatment plus adjuvant qHPV vaccination is likely to be cost-effective. The conservative approach of no treatment is likely to be cost-effective in younger patients. Cancer 2017;123:4709-4719. © 2017 American Cancer Society.
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Affiliation(s)
- Ashish A Deshmukh
- College of Public Health and Health Professions, Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | - Elizabeth Y Chiao
- Section of Infectious Disease, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth A Stier
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Alan G Nyitray
- Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Timothy Wilkin
- Division of Infectious Diseases, Weil Cornell Medicine, New York, New York
| | - Xiaojie Wang
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, Florida
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, Massachusetts
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Vegunta S, Files JA, Wasson MN. Screening Women at High Risk for Cervical Cancer: Special Groups of Women Who Require More Frequent Screening. Mayo Clin Proc 2017; 92:1272-1277. [PMID: 28778260 DOI: 10.1016/j.mayocp.2017.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 01/20/2023]
Abstract
The updated cervical cancer screening guidelines recommend that women at average risk who have negative screening results undergo cervical cytological testing every 3 to 5 years. These recommendations do not pertain to women at high risk for cervical cancer. This article reviews recommendations for cervical cancer screening in women at high risk.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ.
| | | | - Megan N Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, AZ
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Abstract
The incidence of cervical cancer in the United States has decreased more than 50% in the past 30 years because of widespread screening. In 1975, the rate was 14.8 per 100,000 women. By 2011, it decreased to 6.7 per 100,000 women. Mortality from the disease has undergone a similar decrease from 5.55 per 100,000 women in 1975 to 2.3 per 100,000 women in 2011 (1). The American Cancer Society (ACS) estimated that there would be 12,900 new cases of cervical cancer in the United States in 2015, with 4,100 deaths from the disease (2). Cervical cancer is much more common worldwide, particularly in countries without screening programs, with an estimated 527,624 new cases of the disease and 265,672 resultant deaths each year (3). When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed (4, 5).New technologies for cervical cancer screening continue to evolve, as do recommendations for managing the results. In addition, there are different risk-benefit considerations for women at different ages, as reflected in age-specific screening recommendations. In 2011, the ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) updated their joint guidelines for cervical cancer screening (6), as did the U.S. Preventive Services Task Force (USPSTF) (7). Subsequently, in 2015, ASCCP and the Society of Gynecologic Oncology (SGO) issued interim guidance for the use of a human papillomavirus (HPV) test for primary screening for cervical cancer that was approved in 2014 by the U.S. Food and Drug Administration (FDA) (8). The purpose of this document is to provide a review of the best available evidence regarding the prevention and early detection of cervical cancer.
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Recognition and Therapeutic Options for Malignancy of the Cervix and Uterus. Obstet Gynecol Clin North Am 2017; 44:195-206. [DOI: 10.1016/j.ogc.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Leal SM, Gulley ML. Current and Emerging Molecular Tests for Human Papillomavirus-Related Neoplasia in the Genomic Era. J Mol Diagn 2017; 19:366-377. [PMID: 28325688 PMCID: PMC5417044 DOI: 10.1016/j.jmoldx.2017.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022] Open
Abstract
Laboratory tests have a key role in preventing human papillomavirus (HPV)-driven carcinomas and in guiding therapeutic interventions. An understanding of the virology, immunology, and carcinogenesis of HPV is essential for choosing appropriate diagnostic test modalities and developing new and even more effective cancer prevention strategies. HPV infects basal epithelial cells on multiple surfaces and induces carcinoma primarily in the cervix and the oropharynx. HPV types are stratified as high risk or low risk based on their carcinogenic potential. During oncogenesis, HPV interferes with cell cycle regulation and incites DNA damage responses that thwart apoptosis and enable mutations to accumulate. Such mutations are an adverse effect of innate and adaptive antiviral immune responses that up-regulate DNA-editing enzymes, with natural selection of cells having a chromosomally integrated viral genome lacking expression of viral proteins targeted by the immune system. Infected cancers share a similar mutation signature, reflecting the effect of apolipoprotein B mRNA-editing catalytic polypeptide enzyme DNA-editing enzymes. It is feasible that genomic tests for characteristic mutations or methylation signatures, along with tests for dysregulated HPV gene expression, add value in predicting behavior of premalignant lesions. Furthermore, these tumor markers in cell-free DNA of plasma or body fluids may one day assist in early detection or monitoring cancer burden during treatment.
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Affiliation(s)
- Sixto M Leal
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Margaret L Gulley
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Clinical Utility of Molecular Biomarkers in Cervical Squamous Intraepithelial Lesions in a Young Adult Population. J Low Genit Tract Dis 2016; 20:26-30. [PMID: 26579841 DOI: 10.1097/lgt.0000000000000163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although human papillomavirus (HPV) infection is necessary for cervical squamous intraepithelial lesion (SIL/CIN) and cancer to develop, exposure to HPV is not predictive of which women will develop SIL/CIN and cancer. This study examines mRNA expression of several potential biomarkers in exfoliated cervical cells collected from college-aged women. MATERIALS AND METHODS Freshman female students were recruited into the Carolina Women's Care Study, which was designed to prospectively evaluate factors that contribute to persistent HPV infections. One component of this study was to extract mRNA from exfoliated cervical cells. In this study, mRNA expression of Frizzled (FZD), growth differentiating factor 15, interleukin 1 beta (IL1β), and N-cadherin was assessed through real-time polymerase chain reaction. Statistical analysis was performed with a Student t test; all results were standardized with glyceraldehyde 3-phosphate dehydrogenase. RESULTS Fifty samples were selected that reflected the demographics of the Carolina Women's Care Study participants. IL1β mRNA expression was 9.4-fold higher in cervical cells from women with abnormal Pap tests (p = .0018); low-grade squamous intraepithelial lesion had 12.7-fold higher expression than negatives (p = .0011). The FZD mRNA expression was 5.7-fold higher in CIN 2 as compared with CIN 1 (p = .0041) and 8.5-fold higher compared with cytology/pathology negative (p = .0014). Other differences in mRNA expression showed trends but not reaching statistical significance for each condition. CONCLUSIONS It seems that several biomarkers involved in the cytokine/inflammatory pathway (IL1β), cell adhesion pathway (N-cadherin), growth factor (growth differentiating factor 15), and Wingless (WNT) signaling pathway (FZD) may be potential biomarkers in conjunction with the Pap test and HPV that help predict which women are at highest risk for developing CIN 3 and cervical cancer.
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Abstract
Recent changes in cervical cancer screening and management guidelines reflect our evolving knowledge about cervical carcinogenesis. In the pursuit of precision, however, decision-making has become complicated. We provide an overview of cervical cancer screening with a focus on what clinicians can do to maximize screening benefits while minimizing screening harms. The approach relies on categorizing women at each step in the screening process by their estimated risk of high-grade precancerous lesions and cervical cancer. Current screening guidelines are designed to find a reasonable balance between benefits and harms by recommending less screening in most women. Current management guidelines are designed to assure consistent decisions regarding referral to colposcopy. After initial colposcopy, we outline three major management options based on risk assessment. For treatment, we recommend ablational procedures when appropriate because they are similarly effective, less costly, and potentially safer than excisional procedures. We advise caution in adopting new screening strategies until they demonstrate cost-effective patient-centered improvements compared with current strategies. Clinicians can maximize their effect on cervical cancer prevention by being attentive to guidelines, assuring that women have access to appropriate human papillomavirus vaccination and providing low-cost, high-quality screening and treatment.
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Walker AJ, Benrubi ID, Ward KK. Care of survivors of gynecologic cancers. World J Obstet Gynecol 2016; 5:140-149. [DOI: 10.5317/wjog.v5.i2.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/16/2015] [Accepted: 02/24/2016] [Indexed: 02/05/2023] Open
Abstract
The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunting in a busy general gynecology practice. This paper intends to review the literature and suggest management of these women for the general gynecologist.
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Nghiem VT, Davies KR, Beck JR, Follen M, Cantor SB. Overtreatment and Cost-Effectiveness of the See-and-Treat Strategy for Managing Cervical Precancer. Cancer Epidemiol Biomarkers Prev 2016; 25:807-14. [PMID: 26929242 DOI: 10.1158/1055-9965.epi-15-1044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/15/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND See-and-treat using loop electrosurgical excision procedure (LEEP) has been recommended as an alternative in managing high-grade cervical squamous intraepithelial lesions, but existing literature lacks evidence of the strategy's cost-effectiveness. We evaluated the overtreatment and cost-effectiveness of the see-and-treat strategy compared with usual care. METHODS We modeled a hypothetical cohort of 40-year-old females who had not been screened for cervical cancer and followed them through their lifetimes using a Markov model. From a U.S. health-system perspective, the analysis was conducted in 2012 dollars and measured effectiveness in quality-adjusted life-years (QALY). We estimated incremental cost-effectiveness ratios (ICER) using a willingness-to-pay threshold of $50,000/QALY. The robustness of the see-and-treat strategy's cost-effectiveness and its overtreatment rates were further examined in various sensitivity analyses. RESULTS In the base-case, the see-and-treat strategy yielded an ICER of $70,774/QALY compared with usual care. For most scenarios in the deterministic sensitivity analysis, this strategy had ICERs larger than $50,000/QALY, and its cost-effectiveness was sensitive to the disutility of LEEP treatment and biopsy-directed treatment adherence under usual care. Probabilistic sensitivity analysis showed that the see-and-treat strategy had a 50.1% chance to be cost-effective. It had an average overtreatment rate of 7.1% and a 78.8% chance to have its overtreatment rate lower than the 10% threshold. CONCLUSION The see-and-treat strategy induced an acceptable overtreatment rate. Its cost-effectiveness, compared with usual care, was indiscriminating at the chosen willingness-to-pay threshold but much improved when the threshold increased. IMPACT The see-and-treat strategy was reasonable for particular settings, that is, those with low treatment adherence. Cancer Epidemiol Biomarkers Prev; 25(5); 807-14. ©2016 AACR.
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Affiliation(s)
- Van T Nghiem
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, Texas. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kalatu R Davies
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Robert Beck
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Michele Follen
- Department of Obstetrics & Gynecology, Brookdale University Hospital & Medical Center, Brooklyn, New York
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Nitschmann C, May T, Mirkovic J, Feldman S. Screening History Among Women with Invasive Cervical Cancer in an Academic Medical Center: Will We Miss Cancers Following Updated Guidelines? J Womens Health (Larchmt) 2016; 25:826-31. [PMID: 26859535 DOI: 10.1089/jwh.2015.5394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Updated guidelines for the screening and management of cervical cancer in the United States recommend starting Papanicolaou (Pap) testing at age 21 and screening less frequently with less aggressive management for abnormalities. We sought to examine updated Pap test screening guidelines and how they may affect the detection of invasive cervical cancer, especially among women <30 years of age. MATERIALS AND METHODS Patients diagnosed at Brigham and Women's Hospital with invasive cervical cancer between 2002 and 2012 were retrospectively identified. Prior screening history was obtained and patients were divided into two groups based on age <30 years or age ≥30 years. The two groups were then compared with respect to demographics, pathological findings, and time to diagnosis. RESULTS A total of 288 patients with invasive cervical carcinoma were identified. Among these patients, 109 had adequate information on prior screening history. Invasive adenocarcinoma (IAC) was diagnosed in 37 (33.94%) patients, whereas 64 (58.72%) patients were diagnosed with invasive squamous cell carcinoma (ISCC). The remaining eight patients were diagnosed with other types of cancers of the cervix. A total of 13 patients were younger than 30 while 96 patients were 30 or older. The mean time from normal Pap to diagnosis of IAC was 15 months in patients younger than 30 years of age compared to 56 months in patients aged 30 and older (p < 0.001). The mean time from normal Pap to diagnosis of ISCC was 38 months in patients younger than 30 years of age and 82 months in patients aged 30 and older (p = 0.018). CONCLUSION In this small retrospective study, updated Pap test screening guidelines would not have missed invasive cancer on average among screened women age 30 and older. However, young patients aged 21-29 years may be at increased risk of developing IAC of the cervix between the recommended screening intervals.
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Affiliation(s)
- Caroline Nitschmann
- 1 Department of Obstetrics and Gynecology, Division of Gynecologic Surgery , Mayo Clinic, Rochester, Minnesota
| | - Taymaa May
- 2 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Princess Margaret Cancer Center , Toronto, Canada
| | - Jelena Mirkovic
- 3 Department of Pathology, Brigham and Women's Hospital , Boston, Massachusetts
| | - Sarah Feldman
- 4 Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute , Boston, Massachusetts
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Pierce KJ, Currens HS, Tafe LJ, Tsongalis GJ, Padmanabhan V. An analysis of human papillomavirus testing and endocervical component on pap tests: A pilot study using the Roche Cobas(®) assay. Diagn Cytopathol 2016; 44:280-2. [PMID: 26801205 DOI: 10.1002/dc.23436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/11/2015] [Accepted: 01/06/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION HPV is known to have a predilection for infecting the transformation zone (TZ). Endocervical cells (EC) on a Pap test (PT) indicate that the cervical TZ has been sampled. Earlier repeat testing of women lacking EC is of little value in further detecting disease, thus a sample without EC is not necessarily inadequate. Both HPV testing and PT can be performed using a single sample; however, few studies have investigated the relationship between HPV results and TZ sampling. MATERIALS AND METHODS Specimens were collected following the ThinPrep(®) liquid-based PT protocol. The Roche Cobas(®) HPV test was performed on post-aliquot samples. Data was collected retrospectively on 500 patients: 250 consecutive cases of EC- and 250 of EC+ on PT. To maintain uniformity, we included only cases diagnosed as negative (NILM). We compared HPV test results within each category. As a positive control, five consecutive cases each of LSIL and HSIL were also reviewed. RESULTS Of NILM cases, 11 of 250 EC+ cases and 14 of 250 EC- cases were positive for hrHPV. HPV 16 was present in 5 of 11 EC + cases and in 1 of 14 EC- cases. Of LSIL cases, 1 of 5 EC+ cases was positive for hrHPV, and 2 of 5 EC- cases were positive for hrHPV. Of HSIL cases, 5 of 5 EC+ cases were hrHPV+. In the time period studied, only one case of EC- HSIL was found, which was positive for hrHPV. DISCUSSION Although our study did not prove a significant correlation between HPV testing results and EC on PT, more EC+ PTs were positive for HPV16 compared to EC- PTs. The absence of EC on PT does not appear to warrant re-testing for HPV infection, though larger studies are required to determine the significance of low HPV 16 in PT without EC. Diagn. Cytopathol. 2016;44:280-282. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Laura J Tafe
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Frey HA, Conner SN. Treatment of cervical dysplasia and the risk of preterm birth: understanding the association. Am J Obstet Gynecol 2015; 213:445-6. [PMID: 26410203 DOI: 10.1016/j.ajog.2015.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/05/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Heather A Frey
- Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus, OH.
| | - Shayna N Conner
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO
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Haugsdal ML, Ryan GL. HPV and Cervical Dysplasia in Adolescents: A Progressive March Toward Prevention. J Pediatr Adolesc Gynecol 2015; 28:127-31. [PMID: 25532683 DOI: 10.1016/j.jpag.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 12/19/2022]
Abstract
Cervical cancer caused by infection with the human papillomavirus is the second most common malignancy among women worldwide. Over the course of the past century our understanding of the virus and the disease has expanded exponentially through landmark studies and pioneers of academic medicine. It has all led to the current evidence-based guidelines for prevention of cervical dysplasia and invasive carcinoma in adolescent females that will significantly lessen morbidity and mortality and may eradicate the disease completely. Unfortunately, the greatest challenge to this may be overcoming common misunderstandings and other barriers to compliance with these guidelines among practitioners, patients, and the general public.
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Affiliation(s)
- Michael L Haugsdal
- University of Iowa Carver College of Medicine, Department of Obstetrics & Gynecology, Iowa City, IA
| | - Ginny L Ryan
- University of Iowa Carver College of Medicine, Department of Obstetrics & Gynecology, Iowa City, IA.
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Gabzdyl E, Engstrom JL, McFarlin BL. Health Care Workers' Beliefs and Practices Around Pap Screening for Adolescents Seeking Contraception. Nurs Womens Health 2015; 19:216-223. [PMID: 26058904 DOI: 10.1111/1751-486x.12203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Adolescents often avoid seeing a health care provider to obtain contraception because they do not want to undergo a pelvic exam and Pap screening for fear of stress, pain or embarrassment. The purpose of this quality improvement project was to study health care workers, attitudes and beliefs about Pap screening and to educate them on the latest evidence-based guidelines, with the hope of ultimately decreasing unnecessary screening. Results showed a modest reduction in the frequency of Pap screening; however, many adolescents continued to undergo unnecessary Pap screening. The reluctance of health care workers to change their practice demonstrates the need for better methods of translating evidence-based guidelines into practice.
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ACOG Committee Opinion no. 598: Committee on Adolescent Health Care: The initial reproductive health visit. Obstet Gynecol 2015; 123:1143-1147. [PMID: 24785880 DOI: 10.1097/01.aog.0000446826.46833.c0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: The initial visit for screening and the provision of reproductive preventive health care services and guidance should take place between the ages of 13 years and 15 years. The initial reproductive health visit provides an excellent opportunity for the obstetrician-gynecologist to start a patient-physician relationship, build trust, and counsel patients and parents regarding healthy behavior while dispelling myths and fears. The scope of the initial reproductive health visit will depend on the individual's need, medical history, physical and emotional development, and the level of care she is receiving from other health care providers. A general exam, a visual breast exam, and external pelvic examination may be indicated. However, an internal pelvic examination generally is unnecessary during the initial reproductive health visit, but may be appropriate if issues or problems are discovered in the medical history. Health care providers and office staff should be familiar with state and local statutes regarding the rights of minors to consent to health care services and the federal and state laws that affect confidentiality.
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Monsonego J, Cox JT, Behrens C, Sandri M, Franco EL, Yap PS, Huh W. Prevalence of high-risk human papilloma virus genotypes and associated risk of cervical precancerous lesions in a large U.S. screening population: data from the ATHENA trial. Gynecol Oncol 2015; 137:47-54. [PMID: 25667973 DOI: 10.1016/j.ygyno.2015.01.551] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/31/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We assessed the age-related prevalence of high risk human papillomavirus (HR-HPV) genotypes and the genotype-associated risk for high-grade cervical intraepithelial neoplasia (CIN) in a large U.S. screening population. METHODS A total of 40,901 women aged ≥25 years were screened with liquid-based cytology and HPV testing in the ATHENA (Addressing the Need for Advanced HPV Diagnostics) trial. Genotyping was performed using the LINEAR ARRAY HPV Genotyping Test. RESULTS HPV16 was the most prevalent genotype in all age groups, ranging from 3.5% to 0.8% in women aged 25-29 and ≥50 years, respectively. The next most prevalent genotypes were HPV52, HPV31 and HPV18. In the overall population, HPV16 conferred the greatest absolute risk of ≥CIN3 both in women aged 25-29 and ≥30 years (14.2% and 15.1%, respectively) followed by HPV31 (8.0% and 7.9%), HPV52 (6.7% and 4.4%) and HPV18 (2.7% and 9.0%). Similar trends were seen in women with negative cytology. The percent positivity increased markedly with disease progression for HPV16 and HPV18 which were responsible for 45.6% and 8.4% of ≥CIN3, respectively. Of note, HPV 18 was responsible for 50% of adenocarcinoma in situ (AIS) and 50% of invasive cancer cases. CONCLUSIONS HPV16 played a major role in the development of ≥CIN3 irrespective of age, supporting the identification of HPV16 in primary screening for all women. Identification of HPV18 is also warranted, given its significant contribution to AIS and cancer. Identification of non-16/18 genotypes as a pool should provide sufficient information for screening.
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Affiliation(s)
| | - J Thomas Cox
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | | | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Poh-Sin Yap
- Roche Molecular Systems, Pleasanton, CA, USA
| | - Warner Huh
- University of Alabama, Birmingham, AL, USA
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Montella JM, Pelegano JF. Improving the Rate of Colposcopy in an Urban Population of Patients With Known Abnormal Pap Smears. Am J Med Qual 2015; 31:233-9. [PMID: 25614512 DOI: 10.1177/1062860614568648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This project was designed to improve the colposcopy rate in an urban patient population with known abnormal Pap smears within 75 days of the test to rapidly identify and treat premalignant lesions. Using Plan-Do-Study-Act cycles, Lean techniques, and the electronic health record, the authors created a protocol to verify all Pap smears, then created a process whereby a phone-triage team contacted patients with abnormal Pap smears to educate them and schedule colposcopy. As a result, 100% of Pap smears were verified, compared with 95% prior to plan implementation. The mean time from Pap to colposcopy was 38.5 days, with 85% of patients having colposcopy performed after plan implementation, compared with 50% prior-a 70% improvement. If patients with medical contraindications were excluded, the percentage rose to 91%-an 82% improvement. Patient and provider satisfaction improved, staff and provider workload did not increase, and there was the potential for substantial economic savings.
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Affiliation(s)
- Joseph M Montella
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - James F Pelegano
- Jefferson School of Population Health of Thomas Jefferson University, Philadelphia, PA
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Wright TC, Stoler MH, Behrens CM, Sharma A, Zhang G, Wright TL. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol 2015; 136:189-97. [PMID: 25579108 DOI: 10.1016/j.ygyno.2014.11.076] [Citation(s) in RCA: 403] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/21/2014] [Accepted: 11/22/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES ATHENA evaluated the cobas HPV Test as the primary screen for cervical cancer in women ≥25years. This reports the 3-year end-of-study results comparing the performance of HPV primary screening to different screening and triage combinations. METHODS 42,209 women ≥25years were enrolled and had cytology and hrHPV testing. Women with abnormal cytology (≥atypical squamous cells of undetermined significance) and those HPV positive were referred to colposcopy. Women not reaching the study endpoint of CIN2+ entered the 3-year follow-up phase. RESULTS 3-year CIR of CIN3+ in cytology-negative women was 0.8% (95% CI; 0.5-1.1%), 0.3% (95% CI 0.1-0.7%) in HPV-negative women, and 0.3% (95% CI; 0.1-0.6%) in cytology and HPV negative women. The sensitivity for CIN3+ of cytology was 47.8% (95% CI; 41.6-54.1%) compared to 61.7% (95% CI; 56.0-67.5%) for the hybrid strategy (cytology if 25-29years and cotesting with cytology and HPV if ≥30years) and 76.1% (95% CI; 70.3-81.8%) for HPV primary. The specificity for CIN3+ was 97.1% (95% CI; 96.9-97.2%), 94.6% (95% CI; 94.4-94.8%), and 93.5% (95% CI; 93.3-93.8%) for cytology, hybrid strategy, and HPV primary, respectively. Although HPV primary detects significantly more cases of CIN3+ in women ≥25years than either cytology or hybrid strategy, it requires significantly more colposcopies. However, the number of colposcopies required to detect a single CIN3+ is the same as for the hybrid strategy. CONCLUSIONS HPV primary screening in women ≥25years is as effective as a hybrid screening strategy that uses cytology if 25-29years and cotesting if ≥30years. However, HPV primary screening requires less screening tests.
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Affiliation(s)
- Thomas C Wright
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA.
| | - Mark H Stoler
- Department of Pathology, University of Virginia, Charlottesville, VA, USA.
| | | | - Abha Sharma
- Roche Molecular Systems, Pleasanton, CA, USA.
| | - Guili Zhang
- Roche Molecular Systems, Pleasanton, CA, USA.
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Hillemanns P, Einstein MH, Iversen OE. Topical hexaminolevulinate photodynamic therapy for the treatment of persistent human papilloma virus infections and cervical intraepithelial neoplasia. Expert Opin Investig Drugs 2014; 24:273-81. [PMID: 25514095 DOI: 10.1517/13543784.2015.990150] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Current treatments for high-grade cervical intraepithelial neoplasia (CIN2/3) are mainly excisional procedures, which are associated with significant side effects and pose risks for future pregnancies. An effective and safe therapy is needed to reduce the requirement for surgical interventions in women of reproductive age. AREAS COVERED This review looks at the pharmacokinetic and clinical data for topical hexaminolevulinate (HAL) photodynamic therapy (PDT), which is currently entering late phase clinical trials for high-grade CIN. The authors include published studies in patients and volunteers but laboratory and animal studies have been excluded as have studies on other porphyrins such as Photofrin, 5-aminolevulinic acid, methyl aminolevulinate and studies reporting other clinical applications for HAL. EXPERT OPINION Topical HAL PDT has potential as a non-surgical tissue-preserving treatment for CIN and persistent oncogenic human papilloma virus infections. HAL PDT selectively treats the entire epithelial sheet, without the tissue destruction seen in excisional procedures. The authors believe that this treatment could replace surgery in a large proportion of patients. It would be of particular value to the high percentage of women who are interested in future child-bearing. If the treatment is approved, it is very likely that physicians will want to use this treatment, as many patients will be keen to consider a non-surgical option.
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Affiliation(s)
- Peter Hillemanns
- Hannover Medical School, Department of Obstetrics and Gynaecology , Hannover , Germany +49 511 532 6144 ; +49 511 532 6145 ;
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Aderibigbe O. Response to publication entitled: High-risk human papillomavirus at entry to prenatal care and risk of preeclampsia, McDonnold et al. Am J Obstet Gynecol 2014; 211:572. [PMID: 24858199 DOI: 10.1016/j.ajog.2014.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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Gage JC, Katki HA, Schiffman M, Castle PE, Fetterman B, Poitras NE, Lorey T, Cheung LC, Behrens C, Sharma A, Zhao FH, Cuzick J, Yang ZH, Kinney WK. The low risk of precancer after a screening result of human papillomavirus-negative/atypical squamous cells of undetermined significance papanicolaou and implications for clinical management. Cancer Cytopathol 2014; 122:842-50. [PMID: 25045058 DOI: 10.1002/cncy.21463] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Different US practice guidelines have conflicting recommendations for when women should return after a screening result of human papillomavirus (HPV)-negative with an equivocal Papanicolaou (Pap) result of atypical squamous cells of undetermined significance (ASC-US) (ie, return in either 3 or 5 years). One way to determine management is to compare the risk of precancer/cancer after an HPV-negative/ASC-US result with the risks after other negative screening results. For example, if the risk after an HPV-negative/ASC-US result was similar to the risk after a negative Pap test, a 3-year return would be preferred because guidelines agree that women with negative Pap test results should return in 3 years. Alternatively, if the risk after an HPV-negative/ASC-US result is similar to that after a cotest-negative result (HPV negative/Pap test negative), a 5-year return would be preferred because guidelines agree that women testing cotest negative should return in 5 years. METHODS The authors compared risks of cervical intraepithelial neoplasia of grade 3 or higher (CIN3+) and cervical cancer among women aged 30 years to 64 years at Kaiser Permanente Northern California with the following test results from 2003 through 2012: 17,191 women testing HPV negative/ASC-US; 980,268 women testing Pap test negative (regardless of HPV result); and 892,882 women testing cotest negative. RESULTS The 5-year CIN3+ and cancer risks after an HPV-negative/ASC-US result were closer to the risks after a negative Pap test result (CIN3+: 0.48% vs 0.31% [P =.0019]; and cancer: 0.043% vs 0.031% [P =.4]) than after a negative cotest (CIN3+: 0.48% vs 0.11% [P<.0001]; and cancer: 0.043% vs 0.014% [P =.016]). CONCLUSIONS Women testing HPV negative/ASC-US were found to have precancer/cancer risks that were more closely aligned with women with negative Pap test results, suggesting that women testing HPV negative/ASC-US should be managed similarly to women testing negative on Pap tests with a 3-year return for screening.
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Affiliation(s)
- Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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Pritham UA, Brigdon A, Jones M. Understanding factors related to women's adherence to colposcopy. Nurs Womens Health 2014; 18:402-12. [PMID: 25316540 DOI: 10.1111/1751-486x.12148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early detection can prevent death from cervical cancer, but success is dependent on women with abnormal cytology attending follow-up procedures, including colposcopy. Factors that influence adherence to colposcopy include age, race, education, socioeconomic status, smoking, chemical dependence, intimate partner violence and anxiety. Comprehension of abnormal Pap smear results and knowledge of current treatment guidelines and follow-up is important in the prevention of cervical cancer. Understanding factors that could inhibit adherence to colposcopy will allow for tailored communication and individualized treatment to prevent colposcopy default. Implementation of colposcopy clinics with designated nurses to track and monitor adherence could help.
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Diagnosis and Management of Precancerous Cervical Lesions. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommends that human papillomavirus (HPV) vaccination routinely be targeted to females and males aged 11 years or 12 years as part of the adolescent immunization platform to help reduce the incidence of anogenital cancers and genital warts associated with HPV infection. The quadrivalent HPV vaccine is approved for use in males and females, whereas the bivalent HPV vaccine is approved for use only in females. For those not vaccinated at the target age, catch-up vaccination is recommended up to age 26 years. The American College of Obstetricians and Gynecologists endorses these recommendations. Although obstetrician-gynecologists are not likely to care for many patients in the initial HPV vaccination target group, they have the opportunity to educate mothers about the importance of vaccinating their children at the recommended age and are critical to vaccinating adolescent girls and young women during the catch-up period. Obstetrician-gynecologists should advise patients and parents that HPV vaccines are most effective in preventing genital cancers when administered before the onset of sexual activity. However, sexually active individuals can receive some benefit from the vaccination because exposure to all HPV types prevented by the vaccines is unlikely in persons aged 13 years through 26 years. Although HPV vaccination in pregnancy is not recommended, neither is routine pregnancy testing before vaccination. Lactating women can receive either HPV vaccine. The need for ongoing cervical cytology screening should be emphasized in all women aged 21 years and older, even those who received HPV vaccination before the onset of sexual activity.
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