Capacitação que salva vidas na Amazônia: Atualização no manejo de lesões precursoras do câncer de colo de útero

Our objective was to determine if a history of forced sex influenced the likelihood of meeting risk-appropriate cervical cancer (CC) screening guidelines among women in Appalachian Ohio. Methods: We used data collected from initial recruitment for Community Awareness Resources and Education (CARE) I projects 1 and 2. Women were randomly selected from 14 Ohio Appalachian clinics. Risk-appropriate guidelines were defined as having had a Pap smear within 13 months of study interview among high risk women and within 37 months of interview among low risk women. High risk was defined as meeting any of the following criteria: 5 or more sexual partners during their lifetime; intercourse before 18; a current smoker; diagnosis of an STI; or a sexual partner diagnosed with an STI. Low-risk women did not meet any of these criteria. Associations between meeting guidelines and patient characteristics were evaluated by calculating odds ratios (OR) and corresponding 95% confidence intervals (CI) using logistic mixed model regression, with clinic incorporated as a random effect. Significant factors were included in a multivariable regression model assessing the association between exposure to forced sex and meeting CC screening guidelines. Results: Of the 571 women in this study, 105 (18.4%) reported being forced to have sex, 456 (79.9%) did not report forced sex, and 10 (1.8%) refused to answer or didn't know. We observed significant crude associations between meeting risk-appropriate CC screening guidelines and potential confounders: socioeconomic status (low vs. intermediate: OR = 2.46, CI:1.48–4.09; low vs. high: OR = 2.78, CI:1.65–4.72), marital status (divorced/widowed/separated vs. married/member of couple: OR = 2.03, CI:1.90–6.92; divorced/widowed/separated vs. never married: OR = 3.63, CI:1.90–6.92), and smoking status (never vs. former: OR = 2.46, CI:0.32–0.84; never vs. current: OR = 0.51, CI:0.33–0.78). Adjusted for these factors and current age, women forced to have sex had significantly lower odds of being within screening guidelines (OR = 0.32, CI:0.20–0.53). Conclusions: Women exposed to forced sex have lower odds of meeting risk-appropriate CC screening guidelines. This population needs additional efforts to ensure adherence to CC screening guidelines.

Human Papillomavirus and Vaccination

Executive SummaryThe risk of cervical cancer (CC) among women immunosuppressed for a variety of reasons is well documented in the literature. Although there is improved organ function, quality of life and life expectancy gained through use of immunosuppressant therapy, there may be increased long-te

Sexually transmitted infection (STI) screening prevents complications and is cost-effective. Annual screening is recommended in sexually active women below 25 years and older women at increased risk. Cervical cancer (CC) screening guideline changes in 2009 and 2012 recommended less frequent screening, causing concern that STI screening would decrease. Pennsylvania Medicaid implemented a family planning program in 2007 which covered women's health services (including STI testing) for uninsured women. It is unclear how STI screening was affected by these countervailing forces. The main objective of this study was to assess STI screening before and after CC screening guideline changes and family planning program implementation, and to determine factors associated with STI screening. This study was an observational cross-sectional study of Pennsylvania Medicaid administrative claims from 2007 to 2013. Sixteen-year-old to 30-year-old women enrolled in Pennsylvania Medicaid. Annual STI screening, defined as receipt of ≥1 STI test in respective 1-year periods. Our population included 1,226,079 women-years for 467,143 women. STI screening increased by 48% between 2007 and 2011, and stabilized by 2013. Odds for STI screening were higher among black compared with white women [adjusted odds ratio (AOR), 2.56; 95% confidence interval (CI), 2.60-3.10]; Hispanic compared with non-Hispanic women (AOR, 1.42; 95% CI, 1.39-1.46); family planning program enrollees (AOR, 1.42; 95% CI, 1.40-1.45); and urban compared with rural residents (AOR, 1.05; 95% CI, 1.03-1.06). STI screening dramatically increased between 2007 and 2011. Potential reasons are family planning program implementation, increased urine/vaginal testing, and reporting improvements. It is reassuring that STI screening did not decrease despite CC screening guideline changes. Between 2011 and 2013, rates stabilized at 45% among all women and 60% among sexually active women below 25 years, suggesting opportunities for improvement.

Breast and cervical cancers are among the leading causes of female mortality. The reasons that make women adhere, or not, to screening guidelines are not only related to individual and health characteristics but are also placed in a wider social and cultural context. Social capital might facilitate the dissemination of relevant knowledge of and the adherence to cancer screening guidelines. This cross-sectional study explored the associations of individual-level social capital with breast and cervical cancer screening and the knowledge for the existence of relevant screening tests (Pap test and mammography) in the municipality of Gorgolaini, a rural area in Crete, Greece. A random sample of 131 of the 592 women of the 2001 electoral register were invited to participate in the study and 125 completed the Social Capital Questionnaire and two questions on self-reported health knowledge and behaviour (participation rate 95.4%). Women were eligible to participate if they were aged 35-75, had lived in the area for the last 10years and were of Greek origin. Multiple logistic regressions were performed to establish associations among each social capital factor (total, participation in the community, value of life, tolerance for diversity, feelings of safety, family/friends connections) and knowledge of and adherence to breast and cervical cancer screening guidelines after adjustment for confounders. Our results suggest that early detection of breast and cervical cancers may be facilitated when taking into account the social context of the population.

OBJECTIVE: The purpose of this study was to assess women's attitudes and preferences related to recent changes in cervical cancer screening guidelines. METHODS: We distributed 380 surveys in three university-based and community clinics. Study participants anonymously completed surveys, which included questions related to demographics, cervical cancer, screening practices, risk perception, and attitudes towards changing practices. RESULTS: Three hundred fifteen women agreed to participate (83%). Sixty percent (185/310) of the participants had some college education or higher and 12% (36/305) reported an occupation within the medical field. On average, participants answered 4.1 (SD=1.3) of the 8 knowledge questions correctly. Knowledge scores did not differ with age (Kruskal-Wallis test P=.899) or history of cervical dysplasia (Wilcoxon rank sum test P=.338) but significantly increased with education level (Kruskal-Wallis test P<.001). CONCLUSION: Even among a relatively highly educated population of women, participants had limited knowledge of cervical cancer and current screening guidelines. Many participants reported discomfort with less frequent screening intervals. This study supports the need for improvement in cervical cancer prevention education especially with regards to the new screening guidelines.

It is about to be published the second edition of the Brazilian Guidelines for Cervical Cancer Screening, as part of another publication of the Brazilian National Cancer Institute (Instituto Nacional de Câncer [Inca]). For the development of the document participated the members of the Collaborative Network for Qualification of Diagnosis and Treatment of Precursor Lesions of Cervical Cancer, of which are part: the Health Care Bureau of the Brazilian Ministry of Health, the Inca – National Institute of Cancer, the Brazilian National Institute of Women, Child and Adolescent Health (Instituto Nacional da Saude da Mulher, da Crianca e do Adolescente Fernandes Figueira [Fiocruz]), the Institute of Gynecology of the Universidade Federal do Rio de Janeiro (UFRJ) and the Brazilian Society of Lower Genital Tract Pathology and Colposcopy (Associacao Brasileira de Patologia do Trato Genital Inferior e Colposcopia), the member of the Committee of Experts on Strengthening of Prevention and Qualification actions of Diagnosis and Treatment of Cervical and Breast Cancers (Comite de Especialistas para o Fortalecimento das Acoes de Prevencao e Qualificacao do Diagnostico e Tratamento dos Cânceres do Colo do Utero e de Mama) (both created under Decree no 1.472/GM/MS, from June 24, 2011), and invited experts. They totaled more than 60 professionals directly involved in the women care for prevention and early detection of cervical cancer, including the presidency of the Brazilian Society of Cytopathology (Sociedade Brasileira de Citopatologia) and some of associates. The process involved review, discussion and search for consensus of the theoretical foundation and the recommendations on the first edition, in virtual meetings between August 2, 2013 and June 6, 2014. All meetings may be reviewed by accessing the links on the Guideline itself. The resulting texts were re-discussed and ratified in attendance workshop, held on 4 and 6 August 2014, in Rio de Janeiro, and submitted to public consultation. During the process, the contributions received were incorporated into the final text. Those which suggested using technology non-existing in the Unified Health System (Sistema Unico de Saude [SUS]) were excluded, since they depend on feasibility assessment of incorporation by the Ministry of Health before joining the recommendations for SUS. In its second edition, the Guidelines contain some updates compared to the previous: • the introductory text of each chapter, which presents the rationale for the recommendations was reviewed and updated; • new recommendations were incorporated and some had a clearer written; • flowcharts have been simplified; • a chapter of Complementary Topics was incorporated, in which some situations that can be faced in more than one cytological diagnosis are addressed; • the recommendations for women up to 20 years have been extended to up to 24 years; • the new international colposcopy terminology was used. Soon, the second edition of the Brazilian Guidelines for Cervical Cancer Screening will be published, and at that time we will make full disclosure. While we await the publication, we present in the current number of this journal, a review article that discusses the different screening strategies for cervical cancer that are being used in several countries.

Background: Early cancer detection is widely recommended to reduce cancer mortality, for cancer is most successfully treated during the early stage. In Maryland, only 44.6% of all cancers are detected at the early stage, which may partially account for the fact that blacks in Baltimore City experience significantly higher mortality rates related to breast, cervical, and colorectal cancers. Access to cancer screening and early detection services and early education are critical in reducing cancer mortality and disparities. Past studies have examined the factors that influence cancer-screening behaviors, however, few have directly assessed how the association between knowledge and behavioral intentions relative to cancer screening varies with age. Methods: The data was collected from the Advancing Community Outreach Study (March 2014-June 2015) conducted by the Johns Hopkins Center to Reduce Cancer Disparities in collaboration with community partners in Baltimore City. The data was obtained via convenience sampling at health fairs and community presentations, and study participants (n=294) responded to various questions to assess knowledge, attitudes, and behavioral intentions based on past and future communications with a health care provider about screening for breast, cervical, and colorectal cancers. Cancer knowledge focused on screening methods and National Cancer Institute's recommendations for screening. The primary outcome measure was defined by behavioral intentions indicated by the participant. Results: Preliminary analyses showed that the study population was 83.1% female and 88.5% black. Individuals were separated into three age groups (&amp;lt;50, 50-59, and &amp;gt;60 years of age) to examine the association between cancer screening knowledge and behaviors/intentions. Significant differences in knowledge of cervical cancer (p=0.030) and colorectal cancer (p&amp;lt;0.000) screening guidelines by age group were noted. Past actions related to getting cancer screening varied with age as well. After adjusting for differences in age, gender, and race, positive associations were found between knowledge of cervical cancer screening guidelines and past actions (OR, 3.4; 95% CI, 1.5-7.7) as well as between knowledge of colorectal cancer screening guidelines and past actions (OR, 4.2; 95% CI, 1.7-10.2). Stratifying by age groups indicated that individuals under 50 with knowledge of cervical cancer screening guidelines had higher odds of having positive intentions (OR, 3.6; 95% CI, 1.1-12.3) and positive past actions (OR, 11.1; 95% CI, 1.8-66.3). A positive association was also found in individuals over 60 with knowledge of colorectal cancer screening guidelines, for they had higher odds of both positive health intentions (OR, 5.2; 95% CI, 1.0-27.3) and past actions (OR, 6.7; 95% CI, 1.2-38.3). Knowledge of breast, cervical, and colorectal cancer screening methods was high across the study population (% individuals with correct knowledge &amp;gt;92.0 in all knowledge questions) and showed non-significant differences by age group. Conclusions: Study findings suggest that individuals closer in age to a specific cancer screening guideline demonstrate a positive association between cancer screening knowledge and behavioral intentions linked to obtaining cancer screening. The findings highlight the importance of increasing early and consistent education about cancer screenings to encourage early detection of cancer and to ultimately reduce the disparity in cancer mortality rates. Further research should be conducted to explore the additional factors that influence knowledge of cancer screening methods and guidelines and how that level of knowledge affects cancer screening behaviors. Citation Format: Anjani D. Kapadia, Ahmed Elmi, Lee Bone, Caryn Bell, Saad Tussaduq, Theron Scott, Olive Mbah, Adrian Dobs. The effect of knowledge on cancer screening intentions and behaviors among African Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B71.

Trichomonas vaginalis infection is one of the most prevalent curable STIs. Although treatments are available, T. vaginalis infections pose a significant challenge, especially in resource-limited regions, as the prevalence of this STI is often unknown. We aimed to determine the prevalence of Trichomonas vaginalis infection in women screened for cervical cancer precursor lesions in Botucatu in São Paulo, Brazil. We conducted a descriptive and retrospective study that included 23,735 women who attended the cervical cancer screening program at health units in 2019 and 2022. Clinical and sociodemographic data were collected from the cancer information system (SISCAN) and test requisition forms. Descriptive analysis was conducted, and comparisons were performed using the X2 Test and Student’s t-test (SigmaPlot version 13.0). The prevalence of T. vaginalis infection was 0.84% in 2019 and 0.57% in 2022. The mean age of patients with trichomoniasis was 42 (±11.2) years; 75% self-reported as white, 43% were married or in a stable relationship, and 40% had not completed primary education. Regarding the vaginal microbiota, only 15.3% of the cytology exams with infection by T. vaginalis showed a predominance of lactobacilli species, while inflammation was present in 82% of the smears. Cytological analysis revealed precursor lesions of cervical cancer in 0.05% of patients with trichomoniasis, including ASC, LSIL, and HSIL. The study showed a low prevalence of infection with T. vaginalis in low-risk women screened for precursor lesions of cervical cancer in Botucatu in São Paulo, Brazil.

To identify the 2022 recommendations made by ministries of health in the 13 countries and areas of South America for human papillomavirus (HPV) vaccination and cervical cancer screening. A systematic review of scientific literature and official documents was conducted between July 7 and October 17, 2022. The review included an initial search on official websites (e.g. ministries of health, national cancer institutes and health departments) of South American countries to identify current guidelines or recommendations for HPV vaccination and cervical cancer screening. Recommendations for HPV vaccination were found for 11 countries, with the exceptions of French Guiana and the Bolivarian Republic of Venezuela. Recommendations were found for cervical cancer screening in official documents from 11 countries, with the exceptions of the Bolivarian Republic of Venezuela, where one article was found that was not an official recommendation, and Suriname, for which no documents were found on websites or in other publications. A total of 12 countries use cytology to screen for cervical cancer. Four countries (Bolivia [Plurinational State of], Colombia, Guyana and Peru) use visual inspection with acetic acid and the screen-and-treat strategy. Six countries (Argentina, Chile, Colombia, Ecuador, Paraguay and Peru) are transitioning from cytology to HPV testing. No documents were found about a national HPV vaccination program in French Guiana and Venezuela, and no official guidelines for cervical cancer screening were found for Suriname and Venezuela; thus, it will be difficult to eliminate this public health problem in these countries. Countries in South America must update their guidelines for HPV vaccination and cervical cancer screening as new evidence emerges. Official websites with information about HPV vaccination and cervical cancer screening are important sources that can be accessed by health professionals and the population.

The purpose of this review was to examine new evidence since the authors' 2019 guidelines for cervical cancer (CC) screening in non-HIV immunocompromised persons and to provide updated recommendations based on literature review and expert opinion. In addition, human papillomavirus (HPV) vaccine efficacy in these populations was reviewed. A literature search was performed similar to the authors' previous publication but was conducted through March 2023. Risk of CC, squamous intraepithelial lesions, and HPV infection in those living with solid organ transplant (SOT), end-stage renal disease (ESRD), hematopoietic stem cell transplant (HSCT), and autoimmune diseases (AID), specifically systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD) with addition of multiple sclerosis (MS) were researched. This update also summarizes data available on newer disease-modifying therapies (DMTs) including monoclonal antibodies (MABs). The authors then made recommendations for HPV vaccine administration, and screening using either general population guidelines or increased surveillance, the latter based on following current recommendations for women living with HIV. Additionally, the literature search included antibody response to HPV vaccines and recommendations for their administration for these same conditions. Based on the reviewed risks, evidence continued to support those persons living with SOT, ESRD, HSCT, and SLE, whether on immunosuppressant therapy or not, had an increased risk of HPV, squamous intraepithelial lesions, and CC whereas there was weak evidence that those persons with IBD, RA, and MS not on immunosuppressants were at risk. Data on persons using DMT/MAB were conflicting. Data showed that patients on certain immunosuppressants had lower antibody titers following HPV vaccination. There were no studies on HPV vaccine efficacy. Following US Center for Disease Control and Prevention HIV Cervical cancer screening (CCS) guidelines is recommended for the following: SOT, ESRD, HSCT, and SLE whether on immunosuppressants or not, and IBD, RA, and MS on immunosuppressants. Shared decision-making about increased surveillance for IBD and RA not on immunosuppressants and persons on any DMT or MAB is reasonable based on conflicting data. Human papillomavirus vaccination should not change the recommendations for increased CC surveillance. A 3-dose series of the HPV vaccine is recommended for all age-eligible patients starting at 9 years of age, with catch-up to 26 years of age. Vaccination from age 27 up to age 45 years per Advisory Committee on Immunization Practices guidelines should be considered in shared decision-making. When possible, HPV vaccine series should be initiated and completed before SOT or initiation of DMT/MAB. For HSCT, the vaccine series should be readministered along with other childhood vaccines.

Patient knowledge and attitudes toward cervical cancer screening after the 2012 screening guidelines

This update expands the 2020 American Cancer Society (ACS) cervical cancer screening guideline for average‐risk women and individuals with a cervix who are at average risk, to include self‐collection for human papillomavirus (HPV) testing and revised guidance for exiting cervical cancer screening. Self‐collected vaginal specimens, a method of primary HPV testing, align with the ACS cervical cancer screening guideline. When clinician‐collected cervical specimens are used for HPV testing, repeat screening is recommended every 5 years for those with a negative test. For self‐collected vaginal specimens, the ACS endorses the following recommendations of the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee (of which it is a member): (1) primary HPV screening using clinician‐collected cervical specimens is preferred, and self‐collected vaginal specimens are acceptable for average‐risk individuals aged 25–65 years; and (2) repeat testing in 3 years is recommended after a negative result on a self‐collected HPV screening test. These recommendations apply only to combinations of collection devices and HPV assays approved by the US Food and Drug Administration for HPV testing in a clinical setting or at home. The rationale notes that the use of self‐collected vaginal specimens can overcome barriers to screening for many patients, but most patients who test HPV‐positive will require extra follow‐up steps, and data on long‐term, real‐world effectiveness are limited. For certain high‐risk individuals, clinician‐collected samples are still recommended. Furthermore, in response to high rates of cervical cancer among individuals older than 65 years and with poor implementation of current exiting screening criteria, ACS has amended the 2020 guideline to recommend HPV testing at ages 60 and 65 years, with the last HPV test at an age no younger than 65 years as a requisite to exiting screening. The revised recommendation states: To qualify for discontinuation of screening, the ACS recommends an average‐risk woman or an individual with a cervix at average risk have negative primary HPV tests (preferred) or negative co‐testing using HPV tests and cytology (acceptable) at ages 60 and 65 years. If primary HPV tests or co‐testing are not available, three consecutive negative cytology (Papanicolaou) tests at the recommended screening interval with the last test at age 65 years are acceptable. If self‐collected vaginal specimens are used for HPV testing, the 3‐year testing interval should be followed. Additional screening exit stipulations relate to women at higher risk because of prior abnormal test results or current immune suppression.

Cervical cancer screening programs and guidelines in low- and middle-income countries

Introducción: las neoplasias intraepiteliales cervicales (NIC) son lesiones precursoras del cáncer de cérvix. Aproximada-mente cada año se registran 527,600 nuevos casos, posicionándolo como el segundo cáncer más frecuente y la segunda causa mundial de muerte por cáncer en la mujer.&#x0D; Objetivo: determinar la incidencia de NIC en pacientes que acudieron a una Clínica de Patología de Cérvix de Santo Domingo, República Dominicana.&#x0D; Material y métodos: estudio retrospectivo, descriptivo y transversal en el cual se revisaron las historias médicas de 144 pacientes en riesgo de ser diagnosticadas con NIC durante el periodo.&#x0D; Resultados: la incidencia de NIC fue de 40.97 % (N=144). La NIC I fue el diagnóstico más frecuente con un 93.22 % (N=59), seguido 6.78 % con NIC II (N=59). Hubo una mayor frecuencia de NIC en las edades entre los 30 y 59 años (72.88 %, N=59). 62.71 % (N=59) presentó infección por virus del papiloma humano (VPH). La paridad en el 42.86 % (N=35) fue mayor de cuatro. 50 % (N=16) reportó como hábito tóxico el tabaquismo.&#x0D; Conclusiones: el diagnóstico de NIC predomina entre los 30 y 59 años, con una mayor frecuencia de NIC I. La infección por VPH, la paridad y el tabaquismo son factores que pudieran tener influencia sobre el desarrollo de la NIC.