Abnormal Pap Test Research Articles

Comparison of Urine and Cervical Samples for Genotyping Via HPV DNA Test

<i>Background</i>: Human papillomavirus (HPV) is a key factor in cervical cancer development. This study aimed to compare the efficacy of urine and cervical samples for HPV genotyping, evaluating their diagnostic performance in detecting high-risk HPV genotypes. <i>Methods</i>: This comparative cross-sectional study conducted over one year at the Department of Gynaecological Oncology, BSMMU, Dhaka, the study enrolled 74 women aged 30-60 years with positive visual inspection with acetic acid (VIA) results or abnormal Pap test findings. Urine samples (20 ml) and cervical samples were collected from each participant. The samples were analyzed using multiplex real-time PCR to amplify high-risk HPV types (16, 18, and others). DNA was extracted using the Qiagen viral DNA extraction kit. Sensitivity and specificity of HPV detection in urine samples were compared to cervical sampling, the gold standard. Data were analyzed with SPSS 22.0, and agreement was assessed using the Kappa index. <i>Result</i>: Cervical samples detected HPV in 17.56% of participants, while urine samples identified HPV in 5.40%. The agreement between urine and cervical samples was moderate, with a kappa value of 0.743. Among 74 cases, 5 cases were detected as HPV 16 and HR (co-injection) in both cervical and urine sample, 2 cases as HPV 16 in both cervical and urine samples, 2 cases as only HR type in both cervical and urine sample. The kendall’s correlation of agreement was 0.361 and a significance of 0.002. <i>Conclusion</i>: Cervical samples are more reliable for HPV detection compared to urine samples, though urine testing shows high sensitivity.

Prevalence of cervical dysplastic lesions in cervical smears from Baghdad city: a single centre study.

To assess the association of demographic and clinical features of patients with clinicopathological markers in cases of abnormal Pap smear. The retrospective study was conducted from July 2020 to June 2021 at Al-Elwiya Maternity Teaching Hospital, Baghdad, Iraq, and comprised data from January 2019 to June 2020 of women who underwent Pap-smear. Data was retrieved for patients' age, marital status, smoking status, clinical symptoms at presentation, findings of clinical and cytological examinations, as well as follow-up or human papillomavirus testing data where applicable. Data was analysed using SPSS 26. Of the 560 women with mean age 40.42±10.211 years, 26(4.6%) were attending the hospital for routine check-ups/screening, and 12(2.1%) for follow-up screening with previous abnormal Pap-tests, while the rest had been referred for medical consultation. The most common diagnosis was negative for intraepithelial lesion or malignancy 403(72%) Cervical epithelial abnormalities were seen in 136(24.3%) cases, and, of them, 12(8.8%) returned for follow-up. Epithelial abnormalities had a significant association with age, clinical presentation, and clinical examination results (p<0.05), while it had a non-significant relation with marital and smoking statuses (p>0.05). The majority of subjects were referred cases, with routine cervical screening being <5%. Increasing public awareness about the importance of cervical screening and follow-up is essential.

Abstract C175: Implementing cervical cancer screening services in women living with HIV in Trinidad and Tobago

Abstract Background: Women constitute 50% of people living with HIV, and cervical cancer (CCA) is among the top cancers for incidence and mortality, in the Caribbean. Women living with HIV (WLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. There is a pressing need for clinic-based CCA prevention in WLWH. Objective: A preliminary quality improvement evaluation of pilot CCA screening (Pap smear) targeting WLWH in Trinidad and Tobago from July 2020 to September 2021. Methodology: The electronic health information system from a large clinic was used to abstract Pap testing data. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: A total of 242 WLWH attended the women's clinic (WHC) from July 2020 to September 2021. The average age was 41.2 (age range: 20-72). Most (78.9%) reported sexual activity initiation between 15-29 years old, and 2 in 3 (66.1%) had sexual activity in the last 12 months. Among our participants, 67.8% were Afro-Caribbean, 20.7% were Mixed, and 5.8% were East Indian. The majority of WLWH completed at least secondary education (69.8%). Almost half were single (49.6%), and 59.5% were employed/self-employed. Additionally, 11.6% of patients reported a family history of CCA. The WHC provided Pap test to 91.7% of WLWH, 69.3% had normal Pap test results, 9.2% had abnormal Pap test results, and 0.4% were diagnosed with CCA in situ. Additionally, 8.6% found infections including Candida Albicans, Actinomyces, and Trichomoniasis. For those with abnormal Pap tests, timely follow-up care was provided to prevent further illnesses and cervical dysplasia. WLWH with cervical cancer in situ were scheduled/referred to treatments to prevent CCA progression. Discussion: A women’s clinic approach to CCA screening was successful in providing Pap tests and promoting timely diagnostic and therapeutic care to prevent CCA. We thus recommend an implementation and dissemination science approach to create strategies for adopting, implementing, sustaining and disseminating clinic-based CCA screening and HPV-related cancer prevention to reduce cancer-related morbidity and mortality among WLWH. Citation Format: Jonathan Edwards, Gaole Song, Selena Todd, Tessa Galindo, Sharon Soyer, Gregory Boyce, Kamilah Thomas-Purcell, Jarrett Sharlene, Diadrey-Ann Sealy, Kathy-Ann Pate-Robinson, Kimlin Ashing, Jeffrey Edwards, Nyla Lyons. Implementing cervical cancer screening services in women living with HIV in Trinidad and Tobago [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C175.

Timing of Colposcopy and Risk of Cervical Cancer

(Abstracted from Obstet Gynecol 2023;142:1125–1134) Recommended testing for cervical cancer includes colposcopy after abnormal Pap or human papillomavirus (HPV) test results. This method is designed to diagnose cervical cancers early and to additionally detect precancerous tissue before it becomes cancerous.

Chatbot-interfaced and cognitive-affective barrier-driven messages to improve colposcopy adherence after abnormal Pap test results in underserved urban women: A feasibility pilot study.

Challenges in ensuring adherence to colposcopy and follow-up recommendations, particularly within underserved communities, hinder the delivery of appropriate care. Informed by our established evidence-based program, we sought to assess the feasibility and acceptability of a novel cognitive-affective intervention delivered through a Chatbot interface, aimed to enhance colposcopy adherence within an urban inner-city population. We developed the evidence-based intervention, CervixChat, to address comprehension of colposcopy's purpose, human papillomavirus (HPV) understanding, cancer-related fatalistic beliefs, procedural concerns, and disease progression, offered in both English and Spanish. Females aged 21-65, with colposcopy appointments at an urban OBGYN clinic, were invited to participate. Enrolled patients experienced real-time counseling messages tailored via a Chatbot-driven barriers assessment, dispatched via text one week before their scheduled colposcopy. Cognitive-affective measures were assessed at baseline and through a 1-month follow-up. Participants also engaged in a brief post-intervention satisfaction survey and interview to capture their acceptance and feedback on the intervention. The primary endpoints encompassed study adherence (CervixChat response rate and follow-up survey rate) and self-evaluated intervention acceptability, with predefined feasibility benchmarks of at least 70% adherence and 80% satisfaction. Among 48 eligible women scheduled for colposcopies, 27 (56.3%) agreed, consented, and completed baseline assessments. Participants had an average age of 34 years, with 14 (52%) identifying as non-Hispanic White. Of these, 21 (77.8%) engaged with the CervixChat intervention via mobile phones. Impressively, 26 participants (96.3%) attended their diagnostic colposcopy within the specified timeframe. Moreover, 22 (81.5%) completed the follow-up survey and a brief interview. Barriers assessment revealed notable encodings in the Affect and Values/Goals domains, highlighting concerns and understanding around HPV, as well as its impact on body image and sexual matters. Persistent and relatively high intrusive thoughts and lowered risk perceptions regarding cervical cancer were reported over time, unaffected by the intervention. Post-intervention evaluations documented high satisfaction and perceived usefulness, with recommendations for incorporating additional practical and educational content. Our findings underscore the robust satisfaction and practicality of the CervixChat intervention among a diverse underserved population. Moving forward, our next step involves evaluating the intervention's efficacy through a Sequential Multiple Assignment Randomized Trial (SMART) design. Enhanced by personalized health coaching, we aim to further bolster women's risk perception, address intrusive thoughts, and streamline resources to effectively improve colposcopy screening attendance.

Psychological Distress in Women With Abnormal Pap Smear Results Attending Cervical Cancer Screening.

Women often experience psychological distress upon receipt of an abnormal Pap test result. This study aimed to evaluate psychological distress and its correlates among women who received an abnormal Pap screening test result. A cross-sectional study was performed in a cohort of 172 consecutive women who had attended screening for cervical cancer and who received abnormal Pap smear results and underwent additional diagnostic procedures (colposcopy/biopsy/endocervical curettage). The participants filled out a questionnaire on sociodemographic variables and the Cervical Dysplasia Distress Questionnaire. Multivariate linear regression was used for the analysis of the data. For multiple comparisons, the Bonferroni correction was applied to adjust the level of significance. In women who received an abnormal Pap smear result, the independent correlate of higher psychological distress (by Cervical Dysplasia Distress Questionnaire score) before diagnostic procedures was lower satisfaction with information/support received from other people ( p = .002). Correlates of psychological distress in women older than 40 years with abnormal Pap smear were anxiety ( p = .042) and worry about having cervical cancer, general health and having sex ( p = .044). The authors' findings could enable control of factors predictive of psychological distress in women who received a positive Pap smear screening test before undergoing diagnostic procedures, primarily via active provision of targeted information.

Demonstrating a Statistically Significant Association Between Anal High-Grade Squamous Intraepithelial Lesion and Positive OncoE6 Anal Test in Men Who Have Sex With Men and Are Living With HIV.

The aim of the study is to determine whether a positive OncoE6 Anal Test result has statistically significant higher odds of being associated with high-grade squamous intraepithelial lesion (HSIL) and to calculate sensitivity and specificity of this test for predicting HSIL in adult men who have sex with men and are living with HIV (MSMLWH). Men living with HIV 18 years or older having ≥atypical squamous cells of undetermined significance-grade anal cytology results were eligible to enroll in this cross-sectional study. Anal samples were collected just before the high-resolution anoscopy procedure. OncoE6 Anal Test results were compared with histology, the reference standard. Sensitivity, specificity, and odds ratio were calculated using HSIL as the threshold. Two hundred seventy-seven consented MSMLWH were enrolled between June 2017 and January 2022. Of these, 219 (79.1%) had biopsies obtained and histology performed; 81 of 219 participants (37%) had 1 or more biopsies with HSIL results while the remaining 138 of 219 (63%) had only low-grade squamous intraepithelial lesion or were negative for dysplasia. Anal samples from 7 participants (8.6%, 7/81) with HSIL and 3 (2.2%, 3/138) with low-grade squamous intraepithelial lesion had positive OncoE6 Anal Test results. Odds of having HSIL were 4.26 times higher among participants testing positive for HPV16/HPV18 E6 oncoprotein(s) (OR = 4.26, 95% CI = 1.07-16.95, p = .04). The OncoE6 Anal Test demonstrated excellent specificity, 97.83% (93.78-99.55), but poor sensitivity, 8.64% (3.55-17.0). In this highest-risk population for anal cancer, one could combine the OncoE6 Anal Test, having excellent specificity, with the anal Pap test, having higher sensitivity. Patients found having both an abnormal anal Pap and positive OncoE6 Anal Test result could be triaged for rapid scheduling of their high-resolution anoscopy.

Abstract 1978: Community Genomic Health Promotion Program evaluates precision DNA methylation biomarkers for use in self-testing and collection kits in urine, to increase cervical cancer screening rates among Latina women

Abstract Cervical cancer incidence is 32% higher among Latina women in the United States (US) and 78% higher among women in Puerto Rico compared to non-Latina White (NLW) women, yet it is largely preventable through screening. Latina women with public insurance or uninsured are significantly less likely to have had a Pap test, undergo fewer Pap and high-Risk Human Papilloma Virus (HPV) testing than NLW and Black women, and are less likely than women of other races/ethnicities to return for recommended follow-up after an abnormal Pap test. Utilizing the PRECEDE-PROCEED model, Community Based Participatory Research strategies and the NIH I-Corps hypothesis-driven research method of customer discovery, we implemented the Community Genomic Health Promotion Program in Federally Qualified Health Centers to evaluate cervical cancer screening needs in six rural municipalities in Puerto Rico. We recently validated in clinical liquid cytology samples that the CervicalMethDx test, a precision DNA methylation test, can identify HPV positive women most likely to be diagnosed with Cervical Intraepithelial Neoplasia (CIN) grades 2 and 3. We hypothesized that a molecular pathology test which identifies advanced premalignant cervical lesions in urine, can be distributed by commercial channels targeting populations with low screening rates. The CervicalMethDx quantitative Methylation Specific PCR (qMSP) test was used to quantify ZNF516, FKBP6 and INTS1 promoter DNA methylation in well-characterized, discarded, liquid cytology clinical samples from Puerto Rico. We then tested the CervicalMethDx test concordance on paired cytobrush (n=82) and urine samples (n=82) from Chile. The CervicalMethDx test correctly classified 86% of discarded liquid cytology clinical samples from HPV-positive women, when comparing DNA methylation in CIN2/CIN3 samples (n=47) to samples with a cervical pathology diagnosis of No Intraepithelial Lesions or Malignancy (n=18), with 83% Sensitivity, 94% Specificity, Area Under the Curve (AUC) of 0.88, and 98% positive predictive value (PPV). The concordance of the CervicalMethDx test in paired brush and urine samples was moderate (rho=0.45). The Wilcoxon signed-rank test showed no statistically significant differences for the CervicalMethDx test in paired brush and urine samples (p=0.14) These encouraging preliminary results show the successful identification of advanced premalignant cervical lesions in liquid cytology media and urine samples from Latina women. The data suggests that urine should be explored as a biofluid for cervical cancer screening. Future research may lead to expanded screening options, enabling women with low access to health care (public insurance or uninsured) to collect a specimen at home, and either send it to a testing facility or perform the test at home. Citation Format: Carmen Ili, Priscilla Brebi, Jaime López, Fernando T. Zamunér, Ana Purcell-Wiltz, Amanda García-Negrón, Keilyn Vale-Lassalle, Keerthana Gosala, Mirla Otero-García, Camila Rivero-Maldonado, Teresa Torres-Rivera, Adriana Pérez-Vicente, Ashley Ramos-López, David Sidransky, Mariana Brait, Rafael E. Guerrero-Preston. Community Genomic Health Promotion Program evaluates precision DNA methylation biomarkers for use in self-testing and collection kits in urine, to increase cervical cancer screening rates among Latina women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1978.

Prediction and Detection of Cervical Malignancy Using Machine Learning Models.

Human papillomavirus and other predicting factors are responsible causing cervical cancer, and early prediction and diagnosis is the solution for preventing this condition. The objective is to find out and analyze the predictors of cervical cancer and to study the issues of unbalanced datasets using various Machine Learning (ML) algorithm-based models. A multi-stage sampling strategy was used to recruit 501 samples for the study. The educational intervention was the video-assisted counseling which is consisted of two educational methods: a documentary film and face-to- face interaction with women followed by reminders. Following the collection of baseline data from these subjects, they were encouraged to undergo Pap smear screening. Women having abnormal Pap tests were sent for biopsy. Machine learning classification methods such as Decision Tree (DT), Random Forest (RF), Logistic Regression (LR), Multi-layer Perceptron (MLP) and Naive Bayes(NB) were used to evaluate the unbalanced input and target datasets. Merely 398 women out of 501 showed an interest to participate in the study, but only 298 stated a willingness for cervical screening. Atypical malignant cells were discovered on the cervix of 26 women who had abnormal pap tests. These women had guided for further tests, such as a cervical biopsy, and seven women had been diagnosed with cervical cancer. LR in models 1, 2, and 4 showed 88% to 94% sensitivity with 84% to 89% accuracy, respectively for cervical cancer prediction, whereas DT in models 3, 5, and 6 algorithms exhibited 83% to 84% sensitivity with 84% to 88% accuracy, respectively. The NB and LR algorithms produced the highest area under the ROC curve for testing dataset, but all models performed similarly for training data. In current study , Logistic Regression and Decision Tree algorithms were identified as the best-performed ML algorithm classifiers to detect the significant predictors.

Sociodemographic Determinants in Cervical Cancer Screening Among the Underserved West Texas Women.

Pap smear screenings are associated with a 60% reduction in cervical cancer rates for women over the age of 40 years. West Texas presents a challenge for cervical cancer screening as demonstrated by some of the highest incidence and mortality rates of any region in Texas. This study examined the role of socioeconomic and sociodemographic factors in the nonadherence of underserved/uninsured women treated by Access to Breast and Cervical Cancer Care for West Texas (ABC24WT) in three regions with the goal of identifying barriers to screening and higher risk groups. ABC24WT Program database was queried from November 1, 2018, to June 1, 2021, for sociodemographic variables, screening history, and screening results to identify high-risk groups for outreach. Independent samples t-test, Pearson's chi square test, and logistic regression were used to detect significant relationships between variables. There were 1,998 women from the ABC24WT Program included in the study. The program's rates of abnormal pap tests were 21.5% (Council of Government 1 [COG-1]), 8.1% (Council of Government 2 [COG-2]), and 9.6% (Council of Government 7 [COG-7]), all much higher than the nation's average of 5%. Women without recent cervical screening (5 or more years) represented 31.8% (n = 183) of COG-1, 40.3% (n = 132) of COG-2, and 49.5% (n = 61) of COG-7. In addition, a lower baseline adherence rate was noted in women with reduced incomes (<$600 per month per person) than those with higher incomes (p = 0.008). Non-Hispanic women were two times more likely to "no-show" screening appointments than Hispanic women (odds ratio [OR] = 2.01, 95% confidence interval [CI] 1.31-3.08). However, Hispanic women required two times more colposcopies and biopsies (OR = 2.08, 95% CI 1.05-4.13). Hispanic race and poverty represent a high-risk category for cervical cancer and form an important target for community outreach in West Texas.

Genotype heterogeneity of high-risk human papillomavirus infection in Ethiopia.

Cervical cancer is a vaccine-preventable sexually transmitted disease. In the year 2020, there were an estimated 604,000 new cases and 342,000 deaths worldwide. Although its incidence is global, it is much higher in sub-Saharan African countries. In Ethiopia, there is a scarcity of data about the prevalence of high-risk HPV infection and its association with cytological profiles. Therefore, this study was conducted to fill this information gap. A hospital-based cross-sectional study was conducted from April 26 to August 28, 2021, and enrolled 901 sexually active women. Socio-demographic and other relevant bio-behavioral and clinical data were collected using a standardized questionnaire. Visual inspection with acetic acid [VIA] was done as an initial screening method for cervical cancer. The cervical swab was then collected using L-Shaped FLOQSwabs in eNAT nucleic acid preservation and transportation medium. A Pap test was done to determine the cytological profile. Nucleic acid was extracted using STARMag 96 ProPrep Kit on SEEPREP32. A Real-time multiplex assay was performed to amplify and detect the HPV L1 gene used for genotyping. The data were entered into Epi data version 3.1 software and exported to STATA version 14 for analysis. A total of 901 (age range from 30 to 60 years, mean age = 34.8 years, and SD± 5.8) women were screened for cervical cancer using VIA and 832 women had a valid co-testing (Pap test and HPV DNA testing) results for further process. The overall prevalence of hr HPV infection was 13.1%. Out of 832 women, 88% of them had normal and 12% had abnormal Pap test results. The proportion of high risk HPV was significantly higher among women with abnormal cytology (X 2 = 688.446, p < 0.001) and younger age (X 2 = 15.3408, p = 0.018). Among 110 women with hr HPV, 14 genotypes (HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68) were identified while HPV-16, -31, -52, -58, and -35 genotypes were highly prevalent. The high risk HPV infection continues to be a significant public health problem among women 30-35 years old. The presence of high-risk HPV irrespective of genotypes is highly correlated with cervical cell abnormalities. Genotype heterogeneity is observed suggesting the importance of periodic geospatial genotyping surveillance for vaccine effectiveness.

Prevalence of Precancerous Cervical Lesions among Nonvaccinated Kazakhstani Women: The National Tertiary Care Hospital Screening Data (2018).

At the present time, cervical cancer remains the fourth most prevalent cancer among women worldwide. Most cervical cancer cases are attributed to high-risk human papillomavirus (HPV) infection. Because the natural history of cervical cancer takes decades, the disease could be prevented if premalignant conditions are identified and appropriately managed. The aim of this study is to identify the prevalence of precancerous lesions among non-vaccinated women attending the national tertiary care hospital in Kazakhstan. This was a retrospective study of the cervical cancer screening database (2018) from the national tertiary care hospital in Kazakhstan. Records of 6682 patients, who had cervical cytology tests by Papanicolaou (Pap test), were analyzed. Out of the revised cases, 249 patients had abnormal cervical cytology reports. The Pap test was performed using liquid-based cytology (LBC). The data were analyzed using the statistical software STATA 16. A p-value of less than 0.05 was considered statistically significant. In this retrospective analysis of 6682 patients' records, we found 3.73% (249 patients) out of all Pap tests performed in 2018 were abnormal. The prevalence of high-grade squamous intraepithelial lesion (HSIL) was high at 19.28%, and the proportion of atypical squamous cells of undetermined significance (ASCUS) and atypical squamous cells (ASCs-H) was 18.47%, while low-grade squamous intraepithelial lesion (LSIL) were identified in 62.25% of the cases. Almost 25% of the women included in the study had concurrent lower and upper genital tract infections. Although the overall rate of abnormal Pap test results was not high, the study shows the elevated prevalence of HSIL. It calls the attention of local policymakers and gynecology specialists and requires immediate actions to improve the prophylactic measures to decrease morbidity and mortality from cervical cancer in Kazakhstan.

Cervicovaginal cytology, HPV testing and vaginal flora in transmasculine persons receiving testosterone.

Testosterone is one of the strategies that transmasculine persons can elect in order to align physical traits to their gender identity. Previous studies have shown morphologic changes in the genital tract associated with testosterone. Here, we aim to evaluate cervicovaginal cytology specimens (Pap tests) and high-risk HPV (HR-HPV) testing from transmasculine individuals receiving testosterone. This is a retrospective cohort of 61 transmasculine individuals receiving testosterone from 2013 to 2021. Cytologic diagnoses from 65 Pap tests were correlated with HPV status and histologic follow-up and compared with the institutional data and a cohort of cisgender women with atrophic changes. The median age was 28 years and median time of testosterone use was 3 years. Transmasculine persons showed significantly higher rates of HSIL (2%) and unsatisfactory (16%) when compared with the institutional data and atrophic cohort of cisgender women. After reviewing slides of 46 cases, additional findings were noted: atrophy was present in 87%, glycogenated cells were seen in 30%, and Lactobacilli were substantially decreased in 89%. Among 32 available HPV tests, 19% were positive for HR-HPV and 81% were negative. On histologic follow-up, all HR-HPV-positive cases with abnormal cytology showed HSIL, while none of the HPV-negative cases revealed HSIL. Our study cohort demonstrated a high percentage of abnormal Pap tests in transmasculine persons receiving testosterone. Testosterone seems to induce changes in squamous cells and shifts in vaginal flora. HR-HPV testing can be a useful adjunct in the workup of abnormal Pap tests from transmasculine individuals.

Racial and ethnic disparities associated with abnormal cervical cancer screening follow-up (391)

Objectives: There have been significant advances in cervical cancer screening since the implementation of Pap testing, with an initial decrease in incidence and mortality. Unfortunately, during the last decade, there has been a plateau in the incidence and mortality associated with cervical cancer. One of the areas largely contributing to this plateau is the low rate of follow-up with abnormal cervical cancer screening. The objective of this study was to determine whether race affects patient adherence to follow-up for colposcopy after abnormal cervical cancer screening. Methods: This retrospective chart review included randomly selected women from patients presenting to our colposcopy clinic from January 2019 to December 2019. Inclusion criteria included females aged ≥21 years old and appropriate referral for colposcopy. Patients were grouped into three categories: 1) ADHERENT to follow-up if they came to their scheduled appointment; 2) DELAYED if they presented more than three months from their original referral (usually missing 1-3 appointments); and 3) NOT ADHERENT if they did not show for their appointment after referral. Analysis was performed using SPSS v.26. Results: A total of 312 women met the inclusion criteria for the study. The majority of women were Black (65.2%), followed by non-Hispanic White (20.0%) and Latinx (14.8%). Overall, 39.1% of women were ADHERENT, 18.6% were DELAYED, and 42.3% were NOT ADHERENT. There was a significant difference between race/ethnic- ity and timing of follow-up (p=0.04). Black patients were more likely to be NOT ADHERENT for their appointment (45.6%; p=0.03), and Latinx and Black patients were the most likely to be DELAYED (21.7% and 20.3%; p=0.04) than White patients. A Black woman presenting for care would follow-up 80.0% of the time for further evaluation or treatment. Patients with private insurance were more likely to be ADHERENT for care compared with uninsured patients (77.8 vs 27.6%, p=0.001). Conclusions: There are large gaps in adequate follow-up after an abnormal Pap test across race/ethnicity; however, adherence to follow-up is lower in Black patients despite their screening rates being higher than non-Hispanic White patients. Moreover, a quarter of Latinx and Black women presented in a delayed fashion. Culturally relevant assessments and interventions are needed to understand these gaps in care. Objectives: There have been significant advances in cervical cancer screening since the implementation of Pap testing, with an initial decrease in incidence and mortality. Unfortunately, during the last decade, there has been a plateau in the incidence and mortality associated with cervical cancer. One of the areas largely contributing to this plateau is the low rate of follow-up with abnormal cervical cancer screening. The objective of this study was to determine whether race affects patient adherence to follow-up for colposcopy after abnormal cervical cancer screening. Methods: This retrospective chart review included randomly selected women from patients presenting to our colposcopy clinic from January 2019 to December 2019. Inclusion criteria included females aged ≥21 years old and appropriate referral for colposcopy. Patients were grouped into three categories: 1) ADHERENT to follow-up if they came to their scheduled appointment; 2) DELAYED if they presented more than three months from their original referral (usually missing 1-3 appointments); and 3) NOT ADHERENT if they did not show for their appointment after referral. Analysis was performed using SPSS v.26. Results: A total of 312 women met the inclusion criteria for the study. The majority of women were Black (65.2%), followed by non-Hispanic White (20.0%) and Latinx (14.8%). Overall, 39.1% of women were ADHERENT, 18.6% were DELAYED, and 42.3% were NOT ADHERENT. There was a significant difference between race/ethnic- ity and timing of follow-up (p=0.04). Black patients were more likely to be NOT ADHERENT for their appointment (45.6%; p=0.03), and Latinx and Black patients were the most likely to be DELAYED (21.7% and 20.3%; p=0.04) than White patients. A Black woman presenting for care would follow-up 80.0% of the time for further evaluation or treatment. Patients with private insurance were more likely to be ADHERENT for care compared with uninsured patients (77.8 vs 27.6%, p=0.001). Conclusions: There are large gaps in adequate follow-up after an abnormal Pap test across race/ethnicity; however, adherence to follow-up is lower in Black patients despite their screening rates being higher than non-Hispanic White patients. Moreover, a quarter of Latinx and Black women presented in a delayed fashion. Culturally relevant assessments and interventions are needed to understand these gaps in care.

Increased disparities in cervical cancer screening associated with the COVID-19 pandemic (436)

Objectives: To evaluate the impact of the COVID-19 pandemic on women’s preventative healthcare with regards to cervical cancer screening.Methods: This retrospective chart review evaluated a randomized selection of women scheduled to present to a single referral-based colposcopy clinic from February 2020-January 2021 (COVID group) compared to those scheduled the year prior (pre-COVID group). Inclusion criteria included females aged >21 years, with an appropriate referral for colposcopy. Patients were grouped into three categories: (1) ADHERENT to follow-up if they came to their scheduled appointment; (2) DELAYED if they presented more than three months from their original referral (usually missing 1-3 appointments); and (3) NOT ADHERENT if they did not show for their appointment after referral. Analysis was performed using SPSS v.26.Results: A total of 312 women met the inclusion criteria for the study and were randomly selected; 237 in the pre-COVID group and 77 in the COVID group. During the study period of February 2020-January 2021, our institution saw a 39.5% decrease in patients presenting for their scheduled colposcopy appointment. Within the COVID group, 71.2% were NOT ADHERENT or DELAYED in their care compared with 57.4% in the pre-COVID group (p=0.0001). There were no major differences in race, age, or Pap abnormality between the groups. The majority of women were Black (65.2%) followed by non-Hispanic Whites (20.0%) and Latinx (14.8%). In the pre-COVID group, Black women were more likely to be NOT ADHERENT (45.6%; p=0.02), and Hispanic women had the highest rate of DELAYED presentation (28.1%; p=0.01). In the COVID group, all races and ethnicities had a higher percentage of being NOT ADHERENT (Black 47.7%, White 61.5%, and Hispanic 42.9%) compared with the pre-COVID group (Black 46.6%, White 35.6%, and Hispanic 15.6%). Overall, 81.8% of Black women were either DELAYED or NOT ADHERENT during COVID compared with 61.5% and 50.0% of White and Hispanic women, respectively (p<0.001).Conclusions: In general, there is a concerning gap in care with women who do not follow-up for treatment after having an abnormal Pap test. The COVID-19 pandemic had a substantial effect on women’s access to care with regards to all races and ethnicities in this study, where nearly two-thirds of women were DELAYED or NOT ADHERENT to care. However, the greatest difference was seen with Black women who were adherent less than 20% of the time. Moving forward, it is crucial to provide a culturally relevant assessment of barriers to care and targeted interventions to narrow the gap and reach these women who were lost to care.

Impact of primary care provider teaching on knowledge of colposcopy for women newly diagnosed with abnormal cervical cytology (422)

Impact of primary care provider teaching on knowledge of colposcopy for women newly diagnosed with abnormal cervical cytology (422)

New Screening Strategy Combining Anal Papanicolaou and Human Papillomavirus Tests for Human Papillomavirus-Related Anal Cancer: A Prospective, Single-Center Study.

The objective of this study was to evaluate the performance of a combined approach of liquid-based anal cytology and human papillomavirus (HPV) testing in predicting patients who should undergo high-resolution anoscopy for the early detection of anal cancer and anal intraepithelial neoplasia (AIN)-2+. We conducted a prospective single-center quality improvement study. We consecutively enrolled men who had sex with men (MSM) attending our sexually transmitted disease clinic to undergo anal Papanicolaou (Pap) and HPV tests. All patients with an abnormal anal Pap test result and/or positive HPV test result underwent high-resolution anoscopy. We enrolled 217 MSM, 80 HIV-positive patients, and 137 HIV-negative patients. Cytology showed a sensitivity of 100%, a specificity of 64.1%, an accuracy of 66.7%, a positive predictive value (PPV) of 15.7%, and a negative predictive value (NPV) of 100% for the detection of AIN-2+. The high-risk (HR)-HPV test showed sensitivity, specificity, accuracy, PPV, and NPV of 100%, 36.4%, 40%, 9.4%, and 100%, respectively. The combination of abnormal cytology with identification of infection by at least 1 HR-HPV strain on the HPV test had a sensitivity of 100%, a specificity of 73%, an accuracy of 74.6%, a PPV of 19.1%, and an NPV of 100%. Anal HR-HPV testing, complementary to cytology, improves the diagnostic accuracy of screening for anal cancer.

Online Education Improves Clinicians’ Knowledge and Competence Related to Advances in Cervical Cancer Screening [A44

INTRODUCTION: Women who test positive on primary screening tests for human papillomavirus (HPV) infection are triaged with Pap to determine whether a colposcopy is needed. The diagnostic variability of Paps may lead to missed diagnosis. Clinicians would benefit from education that will provide expert guidance on best-practice triage strategies for women who test HPV-positive. METHODS: The educational initiative consisted of an online video-based continuing medical education (CME) discussion among three experts, with synchronized slides. Intervention included pre/post study assessment, and McNemar tests (P&lt; .05 level) determined statistical significance. Learners who improved (answered ≥1 questions correctly pre-education than post) were identified. Data are reported from 1/11/2021-10/17/2021. RESULTS: The analysis set consisted of obstetrician-gynecologists (ob-gyns) (n=1,086) and primary care providers (PCPs) (n=296). Pre- vs. post-education decisions demonstrated significant improvement (P&lt;.001) in knowledge and competence related to the following for HPV positive women (pre% vs. post%): Knowledge regarding the limitations of traditional cytology methods: 20% of ob-gyns improved (36% pre, 48% post, P&lt;.001); 21% of PCPs improved (28% pre, 41% post, P&lt;.001). Knowledge regarding newer methodologies to triage women with abnormal screening results: 41% of ob-gyns improved (31% pre, 67% post, P&lt;.001); 33% of PCPs improved (24% pre, 49%,P&lt;.001). Competence related to follow-up care: 21% of ob-gyns (16% pre, 30% post, P&lt;.001); 11% of PCPs improved (18% pre, 24% post; P&lt;.05). CONCLUSION: The intervention demonstrates improvements and highlights the role of online video-based CME discussion in improving knowledge and competence related to clinicians’ ability to triage women who are HPV positive or have an abnormal Pap test. Additional gaps were identified for future education.

Utility of routine cytology in detecting asymptomatic cervical cancer recurrence.

The objective of this study was to examine the utility of routine cervical cytology after cervical cancer treatment. We performed a retrospective study from 2004 to 2020, which identified 581 cervical cancer patients. Of the 581 patients, 233 were included in the analysis. The remaining 348 were excluded because of failure to enter the surveillance period, loss to follow-up, or treatment at an outside facility. The continuous data were summarized using the median and interquartile range for non-normally distributed data. The categorical data were summarized using frequencies and proportions. Comparisons between the categorical data were performed using the Fisher exact test. Of the 233 included patients, 78 (33.5%) had had ≥1 abnormal Papanicolaou (Pap) test during surveillance. Of these 78 patients, 22 (28.2%) underwent biopsy, with all biopsies negative for malignancy. Local recurrence was identified in 15 patients. Of these 15 patients, 14 (93.3%) were symptomatic at diagnosis, 7 (46.7%) had had visible disease on the physical examination, and 6 (40.0%) had normal cytology findings throughout surveillance. Only 1 case of local, asymptomatic cervical cancer recurrence was detected by Pap test alone. A subset analysis was performed to compare the rate of abnormal Pap tests between the radiation therapy and non-radiation therapy groups. Of the 233 patients, 154 (66.1%) underwent primary radiation therapy, 64 (41.6%) of whom had abnormal cytology during surveillance. Of 82 patients who did not undergo radiation therapy, only 14 (17.1%) had had abnormal cytology (P &lt; 0.01). None of the patients in either group had underlying recurrent disease at the time of abnormal cytology. The results of our study show that routine Pap tests have limited clinical utility in the surveillance of cervical cancer recurrence. Consideration should be given to removing routine cytology from the surveillance recommendations.

Papanicolaou Test in Women with Abnormal Bacteriologic Exam Results

Abstract The normal vaginal flora is complex and includes various organisms, many of them conditioned pathogens. The vaginal microbiome is controlled by estrogens that is why a major difference it encountered between pre-menopausal and menopausal women. Bacterial vaginosis was associated with inflammatory changes on Papanicolaou (PAP) smears and chronic inflammation may eventually tead to potentially precancerous and cancerous processes of the cervix. We asses the importance of PAP test and early discovery of vaginal infections because bacterial vaginosis has been associated with inflammatory changes on PAP smears. Materials and metods: Were analysed 50 patients with bacteriologic exam and PAP smear, from ambulatory (Polyclinic Constanța). Bacteriological exam was performed on smears stained Gram from vaginal secretion, collected during the same ginecological examination when PAP smears were collected. The PAP smear was conventional PAP. Samples were obtained by cervical brushing. Results and discussions: These patients were aged between 21 and 64 year and were examined for various symptoms. The patients were classified in pre-menopausal 35% and post-menopausal 65%.The result of the bacteriologic exam showed normal flora (absence of infection) in 44% of cases and abnormal vaginal flora in 56% of the cases. The predominant pathology was bacterial vaginosis with non-specific flora (Gram positive coci and Gram negative bacilli, absence of lactobacilli) in 38% of cases. Candida infection was present in 12% of the cases and Trichomonas vaginalis and Actynomices in 3% of the cases each. Conclusions The majority of patients with bacterial vaginosis (Candida, Trichomonas,Actinomyces) had Pap tests negative for intraepithelial lesion or malignancies NILM or NILM and cellular changes associated with inflammation. There may be infectious causes of abnormal Pap tests other than HPV.