Abnormal Pap Test Research Articles

Abnormal pap tests among women living in a Hispanic migrant farmworker community: A narrative of health literacy.

This study explored narrative responses following abnormal Pap tests among Hispanic migrant farmworkers ( N = 18; ages 22-50 years) via in-depth interviews in Florida. Qualitative analyses utilized health literacy domains (obtain/process/understand/communicate) as a conceptual framework. Participants described how they (1) obtained information about getting a Pap test, (2) processed positive and negative reactions following results, (3) understood results and recommended health-promoting behaviors, and (4) communicated and received social support. Women had disparate reactions and understanding following an abnormal Pap result. Health literacy was a meaningful conceptual framework to understand assets and gaps among women receiving an abnormal Pap test result. Future interventions should incorporate health literacy domains and facilitate patient-provider communications and social support to assist women in decision-making and health-promoting behaviors, ultimately decreasing cancer disparities.

Sexual Orientation and Sexual and Reproductive Health among African American Sexual Minority Women in the U.S. South

BackgroundResearch on the sexual and reproductive health of sexual minority women, especially those of color, is limited. MethodsUsing multivariable Poisson regression, we estimated risk ratios for the association between two dimensions of sexual orientation (sexual identity and sexual behavior) and five sexual and reproductive health indicators (pregnancy, contraceptive use, human immunodeficiency virus [HIV] testing, Pap test use, and sexual assault) among African American sexual minority women in the U.S. South (n = 165). ResultsLesbians were less likely than bisexual women to have ever been pregnant (risk ratio [RR], 0.64; 95% confidence interval [CI], 0.48–0.85), ever received an HIV test (RR, 0.88; 95% CI, 0.80–0.96), obtained a Pap test in the last 3 years (RR, 0.75; 95% CI, 0.61–0.91), and had an abnormal Pap test result in their lifetime (RR, 0.42; 95% CI, 0.24–0.75). Women with only female past-year sexual partners were less likely than women with male and female past-year sexual partners to have ever been pregnant (RR, 0.58; 95% CI, 0.43–0.78), ever received an HIV test (RR, 0.87; 95% CI, 0.79–0.96), obtained a Pap test in the last 3 years (RR, 0.82; 95% CI, 0.67–0.99), and had an abnormal Pap test result in their lifetime (RR, 0.55; 95% CI, 0.32–0.94). Contraceptive use, receiving an abnormal Pap test result at the time of the study visit, and experiencing sexual assault did not differ by sexual identity or behavior. ConclusionsSeveral sexual and reproductive health indicators varied in relation to sexual identity and sexual behavior among Southern African American sexual minority women. Interventions that facilitate access to sexual and reproductive health services and are tailored to the unique needs of sexual orientation subgroups of sexual minority women are needed.

Challenges to Pap Smear Follow-up among Women in the Criminal Justice System.

Women involved in the United States criminal justice system face a variety of challenges in maintaining their health. Histories of sexual abuse, early initiation of sex, and substance abuse are reflected in more negative reproductive health outcomes, including cervical cancer, than those found among non-incarcerated women. Little is known about how to close this health gap. The present study assessed what incarcerated women perceived to be facilitators and inhibitors of obtaining recommended follow-up for abnormal Pap tests. In-depth individual interviews were conducted with 44 women in an urban county jail about experiences with Pap tests and how they followed-up on abnormal results. We analyzed data using the process of thematic content analysis. Four themes were found, Pap test abnormality as an all-inclusive phrase for women's health problems, unstable lives, the structural challenges of money, and competing demands. Women with criminal justice histories have numerous and complex challenges in following-up abnormal Pap test results, as well as other health problems. Understanding the context around the follow-up for abnormal Pap tests in this population may increase providers' ability to help women effectively obtain cancer prevention care that can be life-saving, as well as to more effectively provide care for other health problems.

Primary Care Physicians' Adherence to Expert Recommendations for Cervical Cancer Screening and Prevention in the Context of Human Papillomavirus Vaccination.

Expert recommendations do not recommend using Papanicolaou (Pap) or human papillomavirus (HPV) test results to determine whether unvaccinated women should receive HPV vaccine, nor do they recommend using vaccine receipt to inform cervical cancer screening practices. This study characterizes physicians' HPV vaccine recommendations and practices in the context of HPV and Pap testing. We surveyed family physicians and obstetrician-gynecologists randomly selected from the American Medical Association Masterfile in 2011 (n = 574). Physicians used a 5-point scale (never to always) to report the frequency of (1) using HPV testing results to decide whether to recommend HPV vaccine, and (2) recommending HPV vaccination to women (≤26 years) who had an abnormal Pap test. Physicians also reported (3) intention to change Pap screening frequency for vaccinated women. Across both specialties, 80% correctly reported rarely or never using HPV testing results to guide vaccine recommendations; 66% often or always recommended vaccination to patients with an abnormal Pap result; and 77% did not plan to change Pap screening frequency for vaccinated women. About 41% reported recommendation-consistent practices with all 3 measures. In multivariable analysis, obstetrician-gynecologist specialty and private practice type were associated with higher average overall adherence to recommendations. Contrary to expert recommendations, a considerable minority of physicians reported recommending HPV vaccination based on HPV and Pap test results. If these clinical practices persist, many young adult women will not realize the benefits of HPV vaccination. Additional efforts are needed to ensure all young women are screened and vaccinated appropriately.

Abnormal Vaginal Pap Test Results After Hysterectomy in Human Immunodeficiency Virus-Infected Women.

To evaluate the prevalence of abnormal vaginal cytology and vaginal intraepithelial neoplasia (VAIN) and vaginal cancer in human immunodeficiency virus (HIV)-infected women with no history of abnormal cytologic screening who had a hysterectomy for conditions other than cervical dysplasia and cancer and to explore the risk factors associated with VAIN and vaginal cancer. A retrospective cohort study was performed identifying 238 women between January 2000 and January 2015 with a history of HIV, previous hysterectomy, and no previous abnormal Pap test results. Medical records from patients with both HIV and a history of hysterectomy were reviewed from Thomas Street Health Center and Northwest Community Health Center. Among 238 women, 164 (69%) had normal Pap test results, 12 (5%) had results showing atypical cells of undermined significance and human papillomavirus-positive, 55 (23.1%) had results showing low-grade squamous intraepithelial lesion, and seven (2.9%) had results showing high-grade squamous intraepithelial lesion. No demographic risk factor was associated with abnormal Pap test results after hysterectomy. Median follow-up time for the Pap test was 16 years. Of those who underwent vaginal biopsies for abnormal Pap test results, 15 (28%) had normal results, 23 (43%) had VAIN 1, nine (16%) had VAIN 2, and seven (13%) had VAIN 3. No patients had invasive vaginal cancer. More than 30% of HIV-infected women who had no prehysterectomy history of abnormal Pap test results had abnormal vaginal Pap test results. Among those who had vaginal biopsies, 29% had VAIN 2 or 3, suggesting that Pap testing posthysterectomy in the HIV population may be indicated.

Genotyping for Human Papillomavirus (HPV) 16/18/52/58 Has a Higher Performance than HPV16/18 Genotyping in Triaging Women with Positive High-risk HPV Test in Northern Thailand.

BackgroundTesting for high-risk human papillomavirus DNA (HPV test) has gained increasing acceptance as an alternative method to cytology in cervical cancer screening. Compared to cytology, HPV test has a higher sensitivity for the detection of histologic high-grade squamous intraepithelial lesion or worse (HSIL+), but this could lead to a large colposcopy burden. Genotyping for HPV16/18 has been recommended in triaging HPV-positive women. This study was aimed to evaluate the screening performance of HPV testing and the role of genotyping triage in Northern Thailand.MethodsA population-based cervical screening program was performed in Chiang Mai (Northern Thailand) using cytology (conventional Pap test) and HPV test (Hybrid Capture 2). Women who had abnormal cytology or were HPV-positive were referred for colposcopy. Cervical samples from these women were genotyped using the Linear Array assay.ResultsOf 5,456 women, 2.0% had abnormal Pap test results and 6.5% tested positive with Hybrid Capture 2. Of 5,433 women eligible for analysis, 355 with any positive test had histologic confirmation and 57 of these had histologic HSIL+. The sensitivity for histologic HSIL+ detection was 64.9% for Pap test and 100% for Hybrid Capture 2, but the ratio of colposcopy per detection of each HSIL+ was more than two-fold higher with Hybrid Capture 2 than Pap test (5.9 versus 2.8). Genotyping results were available in 316 samples. HPV52, HPV16, and HPV58 were the three most common genotypes among women with histologic HSIL+. Performance of genotyping triage using HPV16/18/52/58 was superior to that of HPV16/18, with a higher sensitivity (85.7% versus 28.6%) and negative predictive value (94.2% versus 83.9%).ConclusionsIn Northern Thailand, HPV testing with genotyping triage shows better screening performance than cervical cytology alone. In this region, the addition of genotyping for HPV52/58 to HPV16/18 is deemed necessary in triaging women with positive HPV test.

Associations of an abnormal Pap test result with attitudes and beliefs relevant to cervical cancer: a study of rural Appalachian women.

To compare women who recall being informed of an abnormal Pap to those not having this experience relative to attitudes and beliefs pertaining to screening for cervical cancer. Four hundred women were recruited from eight rural Appalachian counties, in 2013 and 2014. Women completed a paper-and-pencil survey after providing written informed consent. Bivariate associations and age-adjusted associations were calculated between the self-reported experience of being told of an abnormal Pap test result and eight attitudes/beliefs relative to the prevention of cervical cancer. Data analyses were performed in 2014. The mean age was 40.2years (range 30-64years). Eighteen women chose not to answer the question asking about ever having an abnormal Pap test result, leaving n=382. Of the 382 women who did answer, 122 (30.6%) indicated having an abnormal Pap test result and the remaining 260 (65.2%) indicated never having this experience. With the exception of one item assessing knowledge that HPV is the cause of cervical cancer, between-group differences in attitudes, beliefs, and intent to have a Pap test the next time one is due were not observed. Although we hypothesized that women ever having an abnormal Pap test may have actively sought to learn more about cervical cancer and its prevention, findings suggest that this is not the case. Informing women of an abnormal result could be coupled with a high-intensity counseling designed to improve attitudes and beliefs relative to women's role in protecting themselves from cervical cancer.

Role of cervical cytology in surveillance after radical trachelectomy for cervical cancer

ObjectiveThere are currently no standard guidelines on the use of Papanicolaou (Pap) tests for surveillance after radical trachelectomy for cervical cancer. The goal of this study was to determine the usefulness of Pap tests in routine surveillance after radical trachelectomy for cervical cancer. MethodsCervical cancer patients who underwent radical trachelectomy from January 2004 through October 2015 and subsequently had at least one Pap test were retrospectively identified. Demographic and clinical characteristics were described and compared between patients with and without at least one abnormal Pap test. The Kaplan-Meier method was used to estimate time to first abnormal Pap test. ResultsForty-one patients met inclusion criteria. Of these, 30 (73%) had at least one year in which more than one Pap test per year was obtained. Twenty-four (59%) had at least one abnormal Pap test. Of 238 total Pap tests collected, 44 (18%) were abnormal. The most common abnormality was ASCUS (52%, n=23). Other findings included LSIL (20%, n=9), HSIL (2%, n=1), and AGUS (25%, n=11). Median time from radical trachelectomy to first abnormal Pap test was 17.2months (range, 11.8–86.3). No patient had disease recurrence. Surgery type (laparoscopic, open, or robotic), trachelectomy specimen size, histology, device for stenosis prevention (pediatric Foley catheter or Smit Sleeve), and cerclage placement were not significant predictors of an abnormal Pap test. ConclusionsThe rate of abnormal Pap tests after radical trachelectomy is high; however, the clinical significance of such abnormalities appears limited. The routine use of cervical cytology as surveillance after radical trachelectomy does not appear to substantially impact management decisions.

Digital holographic microscopy as screening tool for cervical cancer preliminary study.

The liquid-based cytology Papanicolaou (Pap) test has gradually replaced the conventional Pap test, as it seems to be more efficient, in part because it uses computer assistance. However, Pap test diagnoses are still subjective and are cost-consuming or time-consuming. The authors describe a new digital holographic microscopy instrument and accompanying software. This technology provides an instantaneous, 3-dimensional image reconstruction of cells directly from the uterine cervical sample vial. Analyses were performed using the proprietary digital holographic microscopy (DHM) instrument, computer, and software. Residual materials from 3 randomly chosen laboratories were analyzed and subjected to DHM, and the sensitivity and specificity of DHM were calculated for the detection neoplasia. In 41 specimens that yielded normal Pap test results, 1333 cells were analyzed using DHM; and, in 30 specimens that yielded abnormal Pap test results, 494 cells were analyzed using DHM. Available histologic correlation was as follows: 4 histologic samples were diagnosed as grade 1 cervical intraepithelial neoplasia (corresponding to 2 cytologic diagnoses of low-grade squamous intraepithelial lesion and 2 cytologic diagnoses of atypical squamous cells of undetermined significance), 4 histologic samples were diagnosed as grade 3 cervical intraepithelial neoplasia (corresponding to 2 cytologic diagnoses of low-grade squamous intraepithelial lesion and 2 cytologic diagnosis of atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion), and 11 lesions were diagnosed as benign. Receiver operating characteristic curve analysis indicated that the best criteria were the nuclear-to-cytoplasmic ratio (area under the curve, 0.88; 95% confidence interval, 0.68-1.00) and the greatest nuclear dimension (area under the curve, 0.85; 95% confidence interval, 0.66-1.00). This preliminary study demonstrated for the first time that the DHM technique is suitable for the processing of gynecologic cervical samples. Nevertheless, DHM criteria and parameters could be better defined. Hopefully, holographic analysis will be performed automatically and will provide an instantaneous, cost-effective diagnosis from a closed vial with the preservation of all cellular material. Cancer Cytopathol 2016;124:573-80. © 2016 American Cancer Society.

Abnormal Vaginal Pap Test After Hysterectomy in Human Immunodeficiency Virus-Infected Women.

To evaluate the prevalence of abnormal vaginal cytology and vaginal intraepithelial neoplasia (VAIN) and vaginal cancer in human immunodeficiency virus (HIV)-infected women with no history of abnormal cytologic screening who had a hysterectomy for conditions other than cervical dysplasia and cancer; and to explore the risk factors associated with VAIN and vaginal cancer. A retrospective cohort study was performed identifying 238 women between January 2000 to January 2015 with a history of HIV, previous hysterectomy, and no previous abnormal Pap tests. Medical records from patients with both HIV and history of hysterectomy were reviewed from Thomas Street Health Center and Northwest Community Health Center. Among 238 women, 164(69%) had normal Pap test results, 12(5%) had results showing atypical cells of undermined significance and human papillomavirus-positive, 55(23.1%) had results showing low-grade squamous intraepithelial lesion, and 7(2.9%) had results showing high-grade squamous intraepithelial lesion. No demographic risk factor was associated with abnormal Pap test after hysterectomy. Median follow-up time for the Pap test was 16 years. Of those who underwent vaginal biopsies for an abnormal Pap test, 15(28%) were normal, 23(43%) were VAIN1, 9(16%) were VAIN2, and 7(13%) were VAIN3. No patients had invasive vaginal cancer. Over 30% of HIV-infected women who had no pre-hysterectomy history of an abnormal Pap test had abnormal vaginal Pap tests. Among those who had vaginal biopsies, 29% had VAIN2 or VAIN3, suggesting that Pap tests post-hysterectomy in the HIV population may be indicated.

Diagnostic Impacts of Serum CA-125 Levels, Pap Smear Evaluation, and Endometrial Sampling in Women with Endometrial Clear Cell Carcinoma

Background: Endometrial clear cell carcinoma (ECCC) is a rare variant of endometrial cancer with an unfavorable prognosis. The aim of this study was to determine the relationships, if any, between preoperative serum cancer antigen 125 (CA-125) levels, the last Papanicolaou (Pap) smear, the results of endometrial biopsy and tumor histology, and disease-stage according to permanent histopathology. Materials and Methods: The data of 26 women with ECCC were collected from their medical records to compare demographics, preoperative serum CA-125 levels, Pap test results, histological diagnosis of the endometrial biopsy, and tumor histology, as well as the disease stage according to permanent histopathology. Results: The mean age at diagnosis was 64.0 years. There were 17 (65.3%) women with pure ECCC and 8 (30.7%) women with a mixed histology. Stage III-IV disease was diagnosed in 12 (46.2%) women and occurred more frequently in pure ECCC (n = 11, 91.7%). CA-125 values were significantly higher in advanced stage disease. Cytological evaluation indicated the presence of 71.4% (10/14) cytological abnormalities in pure ECCC. The overall sensitivity of endometrial sampling for the detection of malignancy was 92.3% (24/26), whereas the accurate diagnosis of ECCC was only 34.7% (8/23) with the Pipelle sampler. Conclusion: Pap test abnormalities are frequent in ECCC. Although it is less accurate in the diagnosis of ECCC than in the detection of malignancy, endometrial sampling is still the main procedure for the diagnosis of ECCC. Higher preoperative CA-125 concentrations imply the presence of advanced stage ECCC.

High-resolution microendoscopy: a point-of-care diagnostic for cervical dysplasia in low-resource settings.

Cervical cancer is the third leading cause of cancer-related death among women in low-to-middle income countries. Pap testing and pathological services are difficult to implement under these settings. Alternative techniques for the diagnosis of cervical precancer in these settings are needed to reduce the burden of the disease. The objective of this study was to evaluate the diagnostic accuracy of a low-cost, high-resolution microendoscope imaging system in identifying precancerous lesions of the cervix in vivo. A retrospective study of 59 patients undergoing colposcopy for an abnormal Pap test was performed at Hospital de Câncer de Barretos in Brazil. All patients underwent colposcopy as per standard of care, and acetowhite lesions were recorded. High-resolution microendoscopy (HRME) images were obtained from one colposcopically normal region and from all lesions observed on colposcopy. Biopsies of abnormal areas were obtained and reviewed by three independent, blinded pathologists and compared with HRME findings. The mean nuclear area and the median nuclear eccentricity were calculated from HRME images acquired from each site. A diagnostic algorithm to distinguish histopathologically diagnosed cervical intraepithelial neoplasias of grade 2 or more severe lesions (high grade) from less severe lesions (low grade) was developed using these parameters. A test of trend was used to analyze the relationship between HRME positivity and severity of histopathogical diagnosis. Fisher's exact test was used to analyze differences in HRME positivity between high-grade and low-grade lesions. Evaluable images were obtained from 108 of 143 discrete sites. Of these, 71 sites were colposcopically normal or low grade according to histopathology and 37 were diagnosed as high grade on the basis of histopathology. Using the mean nuclear area and the median nuclear eccentricity, HRME images from 59 colposcopically abnormal sites were classified as high grade or low grade with 92% sensitivity and 77% specificity compared with histopathological findings. Increasing HRME positivity showed a significant trend with increasing severity of diagnosis (Ptrend<0.001). We found a strong association (P<0.001) between HRME positivity and a histopathological diagnosis of cervical intraepithelial neoplasia of grade 2 or higher. HRME demonstrated an accurate in-situ diagnosis of high-grade dysplasia. In low-resource settings in which colposcopy and histopathology services are severely limited or unavailable, HRME may provide a low-cost, accurate method for diagnosis of cervical precancer without the need for biopsy, allowing for a single 'screen-and-treat' approach.

Abstract C17: Racial/ethnic variation in psychological distress following an abnormal Pap test

Abstract Introduction: While racial/ethnic disparities in cervical cancer incidence are mostly attributed to screening test utilization, lower rates of adherence to diagnostic and clinical follow-up after an abnormal Pap test may contribute to the higher cervical cancer mortality among racial/ethnic minorities. Psychological distress is a known contributor to non-adherence to diagnostic and therapeutic follow-up. The objective of this analysis is to explore racial/ethnic differences in distress following an abnormal Pap. Methods: Data were collected as part of a clinical trial to evaluate emerging optical technologies for the diagnosis of cervical dysplasia. Participants were non-pregnant women, age ≥18 years, with a recent abnormal Pap test and were recruited at one of the participating colposcopy clinics. Participants answered questionnaires before and after their colposcopy procedure. Distress regarding the abnormal Pap was assessed using the Cervical Dysplasia Distress Questionnaire (CDDQ). The CDDQ measures multiple domains of distress, including those related to the colposcopy procedure (i.e., Tension and Discomfort, Embarrassment), as well as those related to having a positive screening test for cervical cancer (i.e., Health Consequences, Sexual/Reproductive Consequences). Additional items assessed participants' fear of cancer. Subscale scores range from 1 to 4, with higher scores indicating higher levels of distress. Linear regression models were built to assess the differences in distress scores among Hispanic, non-Hispanic black, and non-Hispanic white women after controlling for age and education (Model 1) and age, education, trait anxiety and depression (Model 2). Trait anxiety and depression were respectively measured using the State-Trait Anxiety Inventory for Adults and the Center for Epidemiologic Studies Depression (CESD) scale. Results: Eighty-five Hispanic, 55 non-Hispanic black, and 86 non-Hispanic white women were included in these analyses. After controlling for age and education, there were statistically significant differences by race/ethnicity in distress scores, particularly for the domains of health consequences (p=0.02) and cancer worry (p = 0.014). In both domains, scores were highest among Hispanic women, compared to non-Hispanic black and non-Hispanic white women (mean health consequences scores = 2.45, 2.02, and 2.16, respectively; mean cancer worry scores = 2.02, 1.62, and 1.75, respectively). Furthermore, these racial/ethnic differences in domain-specific distress remained statistically significant after controlling for differences in underlying depression and trait anxiety. Discussion: Our results suggest that there are racial/ethnic differences in levels of distress following an abnormal Pap test, particularly related to concerns over health consequences and fear of cancer. Distress scores in these domains were significantly greater among Hispanic women compared to non-Hispanic blacks and non-Hispanic whites. Hispanic women may be more likely to perceive that their abnormal Pap test will have long-term health consequences and develop into cancer. Clinical and ancillary health professionals who communicate Pap test results to Hispanic patients should reinforce messages to address unrealistic fears about disease and alleviate distress. Citation Format: Jane R. Montealegre, Michael E. Scheurer, Eileen H. Shinn, Thelma Carrillo, Zuber Mulla, Michele Follen, Karen Basen-Engquist. Racial/ethnic variation in psychological distress following an abnormal Pap test. [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 C17.

Abstract B67: Increasing access to cancer prevention and early detection screenings among racial/ethnic minorities: An innovative same-day result model

Abstract Purpose: Cervical cancer is detected among more than 12,000 women, annually. Some age groups are affected disproportionately, at nearly 25% higher rates of new cases than other women. Following recommended pap screening guidelines, cervical cancer can essentially be eliminated. Likewise, when breast cancer is detected at earlier stages the greater the likelihood of 5-year survival, 98%. The See, Test &amp; Treat® Houston screening model provides free breast and cervical cancer screenings with same-day results to communities identified as underserved. Methods: Through a multidisciplinary volunteer collaboration, this novel screening model targeted medically underserved women between ages 21-65 with 1) breast and cervical cancer screenings, 2) same-day results, 3) health education counseling, 4) and the connection to follow-up care in a culturally and linguistically competent setting at no cost to the women served. Results: Over 750 women attended the free special screening programs over a 3-year period. Of those that participated, 673 women who had never or rarely been screened received a pelvic and breast examination and a Pap test through the program. Of these women, 55 had abnormal Pap tests and 28 of these underwent same day colposcopy and 9 completed a LEEP. Seventy-six mammograms were performed. Two Breast Fine Needle Aspirations were provided on-site for women with a palpable breast mass. Four breast malignancies were detected. The population served were predominately minorities, low income, uninsured or under-insured, and between 40-49 years. Conclusions: Findings suggest that additional dissemination of same-day screen, result and treat models are promising to reach demographics most affected by breast and cervical cancer disparities. As health seeking behavior plays a pivotal role in the outcome of any disease, including a health education component in all screening programs can continue to promote proactive preventive screening seeking behaviors and better provision of culturally-sensitive community screening programs. Citation Format: Jameisha B. Brown. Increasing access to cancer prevention and early detection screenings among racial/ethnic minorities: An innovative same-day result model. [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 B67.

Abstract IA12: Addressing cervical cancer disparities in Appalachia: From biology to policy

Abstract IA12: Addressing cervical cancer disparities in Appalachia: From biology to policy

Abstract PR06: Racial/ethnic variation in the prevalence of vaccine-preventable human papillomavirus genotypes

Abstract Introduction: The bi- and quadrivalent human papillomavirus (HPV) vaccines that have been on the market for ≥ 9 years protect against high-risk HPV types 16 and 18, the two HPV genotypes causally associated with ≥ 70% of cervical cancers. The recent nonavalent vaccine, which became commercially available in 2014, additionally protects against high-risk types 31, 33, 45, 52, and 58. The quadri- and nonavalent vaccines also protect against low-risk HPV types 6 and 11, which cause genital warts. The objective of this analysis is to compare the prevalence of vaccine-preventable HPV genotypes among non-Hispanic white, non-Hispanic black, Hispanic, and Asian women and determine the risk of cervical dysplasia (CIN2+) associated with the genotypes covered by each of the vaccines. Methods: Patients in this analysis represent a subset of those participating in a clinical trial to evaluate new optical technologies for the diagnosis of cervical dysplasia. Trial participants were non-pregnant women, age ≥18 years, with a recent abnormal Pap test and were recruited at participating colposcopy clinics in Houston, El Paso, and Vancouver. As part of the parent trial, a subset of participants provided a biopsy and a cervical swab. Histologic diagnosis was based on biopsies and evaluated by a certified pathologist to represent the histology of the most severe biopsy. HPV genotyping was conducted using the Roche Linear Array. Prevalent HPV types were grouped according to their inclusion in each of the vaccines: bivalent (16, 18), quadrivalent (16, 18, 6, 11), and nonavalent (16, 18, 31, 33, 45, 52, 58, 6, 11). Women were considered to be potentially protected by a particular vaccine if all or some (in the case of multiple infections) type-specific infections were covered by the vaccine. Results for the bi- and quadrivalent vaccines were grouped given the small number of women additionally protected by the quadri- versus bivalent vaccine. Results: The sample for this analysis (n= 419) is comprised of 206 non-Hispanic white, 39 non-Hispanic Black, 142 Hispanic, and 32 Asian women. The prevalence of HPV genotypes covered by the bi- and quadrivalent vaccines was significantly greater among non-Hispanic white (38.3%) and Asian women (37.5%) compared to non-Hispanic black (15.4%) and Hispanic women (19.7%). The increase in the proportion of women potentially protected by the nonavalent vaccine versus the bi-/quadrivalent vaccine was highest among non-Hispanic blacks (33.3% increase) followed by Hispanics (18.3% increase). However, the prevalence of HPV genotypes not covered by any vaccine was also highest among these racial/ethnic groups. Specifically, 42.3% and 35.9% of Hispanic and non-Hispanic black women, respectively, had ≥ 1 genotype not covered by any vaccine, compared to 24.3% and 15.6% among non-Hispanic white and Asian women, respectively. Non-vaccine HPV types were primarily high-risk (68%). Among women with a CIN2+ diagnosis, 37.3% had genotypes included in the bi/quadrivalent vaccine and an additional 46.7% had genotypes included in the nonavalent (but not the bi/quadrivalent) vaccine. However, 16.0% of CIN2+ diagnoses occurred among women with HPV genotypes not covered by any vaccine. Conclusions: Our data suggest racial/ethnic differences in the proportion of women protected by the new nonavalent HPV vaccine. In particular, non-Hispanic black and Hispanic women had the greatest prevalence of HPV types covered by the nonavalent but not the bi-/quadrivalent vaccines. Nonetheless, a large proportion of women from these racial/ethnic groups were infected with genotypes not covered by any vaccine. While HPV 16 and 18 are known to cause most cervical cancers, non-vaccine genotypes were associated with 16% of CIN2+ histology, a diagnosis often requiring significant therapeutic intervention. This abstract is also presented as Poster C38. Citation Format: Indu Varier, Jane R. Montealegre, Christina M. Gutierrez, Laura M. Dillon, Martial Guillaud, Karen A. Storthz, Michele Follen, Andrew G. Sikora, Michael E. Scheurer. Racial/ethnic variation in the prevalence of vaccine-preventable human papillomavirus genotypes. [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 PR06.

Providers' practice, recommendations and beliefs about HPV vaccination and their adherence to guidelines about the use of HPV testing, 2007 to 2010

Human papillomavirus (HPV) vaccines prevent cervical pre-cancer lesion and can potentially reduce abnormal Papanicolaou (Pap) results among vaccinated females. However, current U.S. cervical screening guidelines recommend no change in screening initiation and frequency based on vaccination status. We examined providers' practices and beliefs about HPV vaccination to evaluate their adherence to guidelines. We used 4-year data (2007–2010) from two nationally representative samples totaling 2119 primary-care providers from the Cervical Cancer Screening Supplement to the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Providers in each survey were stratified to obstetrician/gynecologist (OB/GYNs) and non-OB/GYNs. Descriptive statistics and chi-square tests were performed to assess differences between providers' types in each survey. Approximately 60% of providers believed that HPV vaccination will result in fewer abnormal Pap tests and fewer referrals to colposcopy and over 92% would not change their cervical cancer screening practices for fully vaccinated females. NAMCS OB/GYNs were more likely (p<0.05) than non-OB/GYNs to rarely/never use the number of sexual partners to determine who gets the HPV vaccine (68.4% vs. 59.1%), more likely to recommend the vaccine to females with history of abnormal Pap (79.6% vs. 68.4%) and to females with a history of HPV positive test result (75.3% vs. 62.8%). Consistent with guidelines, most providers would not change cervical cancer screening practices based on patients' vaccination history. However, some providers used inappropriate tests for making vaccination decisions. Improving HPV vaccine knowledge and recommendations for its use is warranted to implement a successful vaccine program.

Patient-provider communication with HIV-positive women about abnormal Pap test results

ABSTRACTIn this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%, n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19–10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55–14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH’s health literacy as an intermediate step to improving patient–provider communication among WLH. Lay sources of cancer information for WLH warrant further study.

Clinical Utility of Molecular Biomarkers in Cervical Squamous Intraepithelial Lesions in a Young Adult Population.

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. 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. 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. 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.

Abnormal uterine cervical cytology in a large tertiary hospital in Bangkok metropolis: Prevalence, management, and outcomes.

To determine the prevalence of abnormal cervical cytology, management, and association with clinical significant histopathology including cervical intraepithelial neoplasia II or adenocarcinoma in situ and more severe lesions. Women with abnormal cervical cytology from January 2005 to December 2009 were identified from the archives of Department of Anatomical Pathology and Department of Obstetrics and Gynecology. Demographic data, type of abnormal cytology, management, and their associated histopathology were collected. During the study period: 2533/54,179 women (4.7%) had abnormal cervical Pap test. Squamous lesions were more common than glandular lesions: 2309 (4.3%) compared to 224 (0.4%). Atypical squamous cell (ASC) was most commonly found (1449 or 2.7%), whereas low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intra-epithelial lesion (HSIL), or squamous cell carcinoma (SCC) were found in 648 (1.2%) and 212 (0.4%), respectively. Among abnormal glandular cytology, atypical glandular cell (AGC) was most commonly found (199 women or 0.4%) whereas adenocarcinoma and endometrial cell in woman aged >40 year were found in only 14 (0.02%) and 11 women (0.02%), respectively. Majority (77.3%) underwent further investigations. We found that 13.0% of ASC, 20.3% of LSIL, and 78.7% of HSIL and SCC had clinical significant histopathology. In glandular abnormalities: 14.9% of AGC, 33.3% of women aged >40 years with endometrial cell, and 66.7% of adenocarcinoma were histologically proven to be of clinical significant. ASC was the most common abnormal cervical cytology. Cytology abnormalities of HSIL and SCC had the highest association with clinical significant histopathology.