Pap Smear Research Articles

Features of the course of external genital endometriosis due to cervical pathology

Background. In modern literature, there is a limited number of publications devoted to the characteristics of the course of endometriosis in patients with cervical diseases (CD), the choice of management tactics for cervical diseases and the prevention of relapses of these diseases.Objective. To analyze clinical, anamnestic and laboratory data in patients of reproductive age with a combination of benign cervical diseases and external genital endometriosis.Materials and methods. A retrospective cohort study was conducted that included 100 women of reproductive age with external genital endometriosis. The main group consisted of 56 patients with a combination of benign cervical diseases and external genital endometriosis. The comparison group consisted of 44 patients with external genital endometriosis without cervical cancer. An assessment was made of clinical and anamnestic data, the results of a cytological examination of a cervical smear, extended colposcopy and the level of hormones AMH, FSH, estradiol, performed by enzyme immunoassay on days 2-5 of the menstrual cycle. Statistical analysis was carried out using the SPSS Statistics 26.0 program.Results. External genital endometriosis in 56% of cases is associated with benign cervical diseases, in the structure of which non-inflammatory diseases predominate (63%). Inflammatory diseases of the cervix were observed in 16% of patients, and combined pathology of the cervix was observed in 21% of women with external genital endometriosis. The presence of concomitant cervical pathology in 83.3% of cases is accompanied by endometriosis-associated infertility, this is significantly more common than in patients with inflammatory (22.2%) and non-inflammatory (42.9%) cervical diseases, p < 0.05. Surgical treatment of endometriosis did not lead to pregnancy within one year after surgery in any planning patient with concomitant cervical pathology (0/11); this figure in women with non-inflammatory cervical diseases was 14.3% (4/32), whereas in 75.0% (3/4) with inflammatory diseases of the cervix, pregnancy occurred within a year after surgery, p<0.05. In turn, the presence of inflammatory cervical diseases was associated with a significantly lower level of AMH (1.4±0.5 ng/ml) compared to patients with non-inflammatory cervical diseases (3.0±0.4 ng/ml) and combined cervical cancer pathology (3.4±0.5 ng/ml), p<0.017. A significant decrease in ovarian reserve in the future can also lead to impaired fertility in this category of patients.Conclusion. The results of the study indicate the need for a comprehensive assessment of the condition of the cervix in patients with genital endometriosis, including a thorough history taking, cytological examination and extended colposcopy in combination with determination of HPV virus carriage. Timely measures for the diagnosis and treatment of cervical diseases in patients with endometriosis-associated infertility will improve fertility rates in this category of patients.

Abstract A116: Cervical cancer awareness, knowledge, and attitudes in young adult students on a Northern California college campus

Abstract Cervical cancer is the fourth most common gynecological malignancy in women worldwide. Human papillomavirus (HPV) is the primary cause of cervical cancer, with increased risk associated with select serotypes HPV 16 and 18. This study assesses cervical cancer awareness, knowledge of HPV, and attitudes towards vaccination among a convenience sample of San Francisco State University (SFSU) students. Despite the availability of effective HPV vaccines and associated cervical cancer prevention, vaccine uptake remains relatively low which may be due to various factors, including lack of awareness and vaccine knowledge. A convenience sample survey assessing cervical cancer awareness, behaviors and attitudes about HPV vaccine was administered to students on the San Francisco State University campus. The data was collected anonymously, via QR code. Participants received a $10 Target gift card. At completion of the survey, a 5x7 information card about Cervical Cancer and HPV vaccines, developed by and for college students, was distributed to participants. A total of 100 students completed the survey. Participants average age was 23-24 years old; 60% of participants identified as female; 34% as male. The vast majority of participants were aware of cervical cancer. Among 60 female respondents, 25 (42%) reported having had a pap smear, but a larger proportion had not. Of the female participants over age 21 years old, 12 out of 62 had never had a pap smear. 39% of respondents were not aware of the HPV vaccine and its relationship to cervical cancer prevention. There was a large difference in HPV vaccine awareness by gender and age. Of the 60 female respondents, 20 had reported being unaware of the HPV vaccine, while 17 of the 34 male respondents also reported being unaware. At completion of the survey, two-thirds of respondents reported a plan to receive a pap smear as recommended. 16% said they will not, and 21% were unsure. Our survey set out to understand the distribution of knowledge, awareness, attitudes and behaviors about cervical cancer and HPV vaccination on the SF State college campus. We found that most students on our campus are aware of cervical cancer. However, a small proportion of participants eligible for pap smears have yet to undergo the procedure. Our research also revealed that there is a lack of understanding regarding the importance of HPV vaccination, with significant differences in awareness by gender and age. This study underscores the need for targeted educational initiatives on cervical cancer awareness, knowledge, and attitudes towards HPV and its vaccine. To improve awareness and preventive actions, we can; increase the efforts to educate the public about the importance of HPV vaccinations and regular Pap smears and improve access to vaccination and screening services. Addressing gaps in knowledge and negative impressions of HPV vaccine can lead to the ultimate eradication of CC as we know it. Citation Format: Elissa I. Sanders, Kim F. Rhoads, Suzana Beyene. Cervical cancer awareness, knowledge, and attitudes in young adult students on a Northern California college campus [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 A116.

Abstract A117: Cervical cancer screening rates among older Hispanic women living in Texas: results using the BRFSS 2018, 2020, and 2022 survey data

Abstract Background: Despite cancer risk increasing with age, older women are less likely to be up-to- date with cervical cancer screening (CCS). CCS is recommended up-to 65 years, absent history of abnormal results. CCS rates are significantly lower among Hispanic women, despite higher cervical cancer incidence and mortality rates compared to non-Hispanic white women. In Texas, women older than 50 years have lower odds of timely pap testing. We examined CCS rates among older Hispanic women in Texas using data from the Behavioral Risk Factor Surveillance System. Methods: Our sample included 5,291 self-identified Hispanic women, ages 50-64. Outcome: receipt of pap smear within the last 3 years following the U.S. Preventive Services Task Force guidelines at the time each survey was conducted (years: 2018, 2020 and 2022). Descriptive analysis and chi-square tests were used to examine the proportion of women who reported receiving CCS within the recommended timeframe. Results: Only 63.75% (mean age = 56.4) reported getting a pap smear. Significant decreases were found among women who had a pap smear from 87.03% in 2018, 71.95% in 2020, and 43.24% in 2022 (p=0.00). Additional analyses will be conducted to test relationships with sociodemographic and healthcare variables. Conclusion: Older Hispanic women in Texas represented in this dataset are far from the 2030 Healthy People goal of 79% CCS. Decreases in CCS rates are possibly due to the COVID-19 pandemic impact on healthcare access. As the US population ages, research is needed to identify the potential systemic barriers this group is confronting to access preventive cancer care. Citation Format: Coralia Vázquez-Otero, Bilikisu Elewonibi, Adaobi Ankwe, Rhonda BeLue. Cervical cancer screening rates among older Hispanic women living in Texas: results using the BRFSS 2018, 2020, and 2022 survey data [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 A117.

Abstract C177: Increasing cervical cancer screening among women living with HIV (WLWH) in Jamaica

Abstract Background: Cervical cancer (CCA) is the third most common cancer and the third leading cause of cancer deaths among women in Jamaica. Although human papilloma virus (HPV), the primary risk factor for CCA, has a prevalence of 54% among sexually active Jamaican women, HPV vaccination uptake is low, and CCA is often diagnosed at advanced stages due to inadequate screening. Women comprise 50% of persons living with HIV in Jamaica and are about six times more likely to develop cervical cancer than women without HIV. However, despite national guidelines requiring annual screenings, a national audit found that fewer than one-third of eligible WLWH underwent a Pap smear in the past year. Objective: We aimed to address gaps in CCA screening among WLWH attending four large HIV treatment sites in Jamaica through programmatic and operational support integrated into HIV care. Method: Working through the UCSF Jamaica Country Programme, funded by PEPFAR, clinical advisors completed site reviews to identify gaps in the CCA screening process. Critical gaps identified at the four sites included insufficient supplies (speculums, slides, cytology brushes, fixative, Pap smear jackets, and bed rolls), limited provider knowledge, delays in sample processing, and the delayed return of results from the national public health lab. From January 2023 to May 2024, our team provided technical assistance and resources for sample collection, private laboratory testing, delivery of samples, and collection and review of results. Results: Cervical cancer modules were integrated into an ongoing clinical management training series that reached 33 clinicians across multiple sessions. With supportive supervision, the sites strengthened patient notification and sample transportation, that facilitated appointment adherence, timely sample delivery, and prompt collection of results. Clinical advisors further supported site teams to identify abnormal results and ensure timely and appropriate follow-up diagnostic tests and treatment referrals. This intervention supported 656 eligible WLWH to complete Pap smears, with 614 timely results returned to the sites by May 2024. Conclusion: Targeted programmatic interventions can increase CCA screening by improving the availability of Pap supplies, clinic workflow, and operational efficiency within HIV care clinics thereby reaching a population at high risk for CCA. Technical and financial support from donors can be expanded to explore clinic-based models for improving and integrating HPV screening and vaccine uptake among vulnerable WLWH. The impact of these interventions can be tested through quality improvement and implementation science frameworks. Citation Format: Sharlene T Beckford Jarrett, Sasha-Kaye Blackwood, Kimlin Tam Ashing, Kamelia Bryan, Tyrone O Ellis, Jeffrey Edwards, Willi McFarland, Nicola Skyers. Increasing cervical cancer screening among women living with HIV (WLWH) in Jamaica [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 C177.

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.

Abstract A126: Cancer screening trends in Louisiana’s sexual gender minority population

Abstract Cancer screenings in Louisiana (LA) have been consistently lower than the national average. Sexual and gender minorities (SGM) are more likely to be non-compliant with cancer screening guidelines and consistently do not meet cancer screening recommendations. This study compares compliance to cervical, breast, and colorectal cancer (CRC) screening guidelines over time between SGM and the non-SGM population in LA. Data were obtained from the LA 2014, 2016, 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System (BRFSS). The sample was divided into gay (including lesbian, gay, bisexual, or other sexual orientation other than straight) and straight. Three primary outcomes of interest were used to measure breast, cervical, and CRC cancer screening adherence based on the U.S. Preventive Services Task Force (USPSTF) screening recommendation at the time of each survey. Descriptive analysis and chi-square tests were conducted using sample weights. CRC had the lowest compliance rate in the entire population and across sexual orientation groups. Twenty-five percent of both populations had never received any CRC screening test. Comparatively, 3.6% of straight and 5.3% of gay populations had never received a mammogram while 6.6% of straight and 13.6% of the population had never received a pap smear. Significant improvements in compliance to breast, cervical, and CRC cancer screenings guidelines was observed among those who identified as straight over the survey years until 2020. Decreases in screening compliance were observed in this population from 2020 to 2022, likely due to the effects of the COVID pandemic. Screening compliance in those who identified as gay showed more variation over time in all three cancers. Screening compliance for CRC and cervical cancer were at its highest in 2016, declined to its lowest point in 2020, but increased in 2022. In 2016, there was a significant decline in breast cancer screening compliance in this population to the lowest ever observed in both groups. The initial increases in colorectal and cervical cancer screening observed from 2014 to 2016 among the gay population may be attributed to significant decreases in uninsured rates following the passage of the Affordable Care Act. Additionally, this population saw increased access to the private insurance market following the Obergefell decision and the Marriage Equality Act of 2015, which extended employer-sponsored coverage to same-sex couples. While breast cancer screenings declined from 2014-2016 in the gay population, there was a sharp increase from 2016 to 2018, which aligns with the 2016 expansion of Medicaid in Louisiana. Despite increases in access to insurance coverage, SGM individuals report being in fair or poor health and having negative experiences with healthcare providers at higher rates than their non-SGM counterparts. More research is needed to understand the healthcare landscape and experiences of SGM Louisianans. This will help to inform targeted interventions to increase screenings and improve cancer outcomes among this population. Citation Format: Bilikisu Elewonibi, Carleigh Baudoin, Ashely Fenton. Cancer screening trends in Louisiana’s sexual gender minority population [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 A126.

Abstract B113: Cervical cancer stigma in the Caribbean: Implications for prevention

Abstract Background: Cervical cancer is still a major threat in the Caribbean region. Stigma may be a contributor to low screening and HPV vaccination practices, but it has been understudied in the region. The study aims to assess stigma among a Caribbean non- patient population in Jamaica, Grenada and Trinidad and Tobago. Methods: A cross-sectional study involving 1207 participants was conducted using a trans-created Cancer Stigma Scale for the Caribbean context and additional measures on cervical cancer and HPV vaccine knowledge and beliefs were added. Cancer stigma was assessed across six sub-domains Severity, Personal Responsibility, Awkwardness, Avoidance, Policy Opposition and Financial Discrimination. The data were collected online between October 2022 and March 2023. Descriptive statistics for characteristics of socio- demographic and variables associated with cancer stigma were run. ANOVA tests compared factor scores with multi categorised variables using SPSS. Results: Levels of cancer stigma were low but varied across the six domains with the severity domain showing high scores (40.1%-77.4%). The majority of the participants disagreed with banks refusing to give loans to people with cancer (85.1%). Under policy opposition (93.0%) agreed that more government funding should be spent on cancer care and treatment. Social rejection was significantly higher in Grenada when compared to both Jamaica and Trinidad and Tobago. More than a third of the participants (35.6%) agreed that the fear of family reaction and rejection may discourage women from getting a further diagnosis after an abnormal Pap smear. Younger participants showed less stigma than older participants. Those aged 18-25 also differed from those aged 26-35 and 56-65 for the factors of Policy Opposition and Severity respectively. In all cases the older age group had higher mean scores. Social impact factors of shame and social rejection are predictors of cancer stigma with p < 0.001 and p = 0.050 respectively. Married/cohabiting individuals had more negative responses than divorced persons across all three factors of Shame, Social Rejection and Social Isolation. The majority of our participants were female 81.4% and fell between the ages of 18-35 years (56.8%). Discussion: Cancer stigma is understudied in the Americas. Our results show that cancer stigma varies by several important factors including stigma domain, and participant demographics e.g. age and gender. The findings indicate that interventions and educational efforts targeting cancer stigma ought to be included in cancer prevention and control efforts. Targeted evidenced-based strategies for reducing stigma include featuring cancer survivors especially prominent survivors like celebrities, and employing mass media public health campaigns. A reduction in cancer stigma may lead to increased prevention, screening, and treatment of cervical cancer. Citation Format: Diadrey-Anne Sealy, Kamilah Thomas- Purcell, Althea Bailey, Gaole Song, Kimlin Ashing. Cervical cancer stigma in the Caribbean: Implications for prevention [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 B113.

HUMAN PAPILLOMAVIRUS, CLINICAL, DERMATOLOGICAL AND GYNECOLOGICAL APPROACH

Introduction: Human papillomavirus (HPV) infection is associated with a wide range of cutaneous and mucosal manifestations. The spectrum of HPV ranges from inapparent infections, through multiple benign clinical presentations, including cutaneous and mucosal disease, to malignant and premalignant conditions. Cervical cancer is the fourth cancer with the highest incidence in women in the world, being the second cause of cancer death in women between 15 and 44 years of age, one of the risk factors for this cancer is the human papillomavirus. Objective: to detail the current information related to human papillomavirus, description, etiology, epidemiology, pathophysiology, anamnesis, physical examination, evaluation, treatment, differential diagnosis, prognosis, prevention and complications taking into account a clinical, dermatological and gynecological approach. Methodology: a total of 27 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 18 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: human papillomavirus, HPV, dermatosis, warts, infection, papanicolau, tumor virus infections. Results: HPV has been associated with the development of laryngeal, mouth, lung and anogenital cancers. Subtypes 6 and 11 are low risk and are usually associated with the formation of condylomas and low-grade precancerous lesions. Subtypes 16 and 18 are high-risk and are responsible for high-grade intraepithelial lesions that progress to malignant neoplasia. There are more than 180 HPV subtypes.The prevalence of genital HPV in adults aged 18-59 years is about 45.2% in males and 39.9% in females. The prevalence of high oncogenic risk HPV genotypes is 2.26%; (95%CI: 1.75-2.78), with the most common genotype being 16 (28.89%). Cervical cancer screening with cytology has significantly reduced the incidence and mortality of this type of cancer in developed countries, despite the fact that its sensitivity for detecting CIN2+ is around 66%. Conclusions: it is of remarkable importance to know the human papillomavirus outlook, especially because it is linked to a number of underlying clinical manifestations both benign, premalignant and malignant conditions. The authors recommend prevention, especially suggesting that boys and girls be vaccinated against HPV starting at 11 to 12 years of age, in addition to the other measures outlined in the article. It is important to understand that HPV alone does not cause cancer, but requires triggering factors such as smoking, folate deficiency, exposure to ultraviolet light, immunosuppression and pregnancy. Individuals with cutaneous warts have numerous treatment alternatives available, including surgical removal, cryotherapy, irritant or immunomodulatory drugs, and laser removal. KEY WORDS: HPV, infection, pap smear, warts.

Effect of Cancer Information Overload and Cancer Worry on Women’s Attitudes Towards Cervical Cancer and Pap Smear Screening: A Cross-Sectional Study

Effect of Cancer Information Overload and Cancer Worry on Women’s Attitudes Towards Cervical Cancer and Pap Smear Screening: A Cross-Sectional Study

Cervical Cancer Screening and Prevention Uptake in Females with Autism Spectrum Disorder.

This study reports on uptake rates of cervical cancer prevention and screening in a clinically-referred cohort of adolescent and adult females with autism spectrum disorder (ASD). Females with ASD (11-65years) were invited to participate in an online survey to report on uptake of the human papillomavirus (HPV) vaccination and cervical cancer screening. Participants also provided demographic and clinical information. Chi-square statistical analysis was utilized to examine the relationship between categorical variables and receipt of cervical cancer prevention and screening. Forty-one out of 73 (56%) of adolescent (11-17years) and 51/108 (47%) of adult (≥ 18years) females with ASD reported having received at least one dose of the HPV vaccine. Only 30/73 (41%) and 37/108 (34%) of adolescents and adults respectively, were fully vaccinated (≥ 2 doses). Language impairment was the only clinical factor found to be associated with non-receipt of the HPV vaccine. Thirty-one out of 82 (38%) adult females (≥ 21years) with ASD had received at least one pap smear. Language impairment, intellectual disability, non-independent living, and lower level of education were all associated with not receiving a pap smear. Females with ASD are vulnerable to invasive cervical cancer disease due to low uptake rates of the HPV vaccine and routine pap smear screening.

Cervical cytology abnormalities and associated genotype patterns of High-Risk HPV Infection in Women of Tripura, North-East India: A Hospital-Based Study.

The current study explored HPV prevalence and age variation in cervical samples of different cytological categories and HPV types from women seeking gynecological care in Tripura, northeast India. Pap smears, cervical tissues, and HPV/DNA specimens were collected from gynecological outpatient departments (OPD) or in-house patients and were screened for HPV16, HPV18, and other HPV types by PCR. Finally, logistic regression was performed to find the association between epidemiologic factors and HPV infection in women of different cytological grades. About 90% of HPV-screened women were found to be HPV positive. HPV16 was most common in HPV-positive women (53.27%), followed by HPV16/18 co-infection (26.17%). HPV16 or HPV18 was most frequent (86.45%) compared to others (13.55%). Among the confirmed cytological tests 68.83% showed normal cytology and 37.17% showed atypical abrasions. Among the abnormal cytology participants, 94.37% were HPV-positive, and 42.25% had cervical cancer. The prevalence of HPV increased with cytological abnormalities (p < 0.01). Abnormal cytological lesions increased with age (p trend = 0.017). Among all epidemiologic factors studied, parity was strongly associated with overall HPV infection, regardless of cytological status. Observed very high frequency of HPV infection in the current study, warrants further investigations.

Penyuluhan Pentingnya Vaksin HPV untuk Mencegah Kanker Serviks Sedini mungkin di Kabupaten Takalar

Cervical cancer is one of the most common types of cancer in the female genital organs caused by human papillomavirus (HPV), and preventive measures are highly recommended rather than curative measures. Prevention efforts are still poorly understood, so education is needed to increase vaccination coverage. The aim of this service is to increase participants' understanding of cancer vaccines. This method was used to discuss with partners at SDN Pusat No. 1 Patalasang District. Takalar, and students and teachers participate. Participants' knowledge was assessed through pre-test and post-test. The test result in front of 6 teachers and 15 students was 71.4, increasing to 98.2 at the time of the test. All service participants were satisfied with the implementation of the service because they felt the information was very useful and they needed it. All participants feel the benefits of using the services. Participants hope to continue this service in the future with free pap smears and vaccinations. It can be concluded that advice on cancer prevention and vaccination increased participants' understanding from 71.4 to 98.2 and was highly appreciated by the participants.

Human Papillomavirus, Cervical Intraepithelial Neoplasia, and Quantitative Blood Loss at Delivery.

Studies using estimated blood loss show the association of either human papillomavirus (HPV) or cervical intraepithelial neoplasia (CIN) with postpartum hemorrhage (PPH). We study the association of HPV or CIN with either blood loss or PPH as measured by the more precise measure of quantitative blood loss (QBL). We retrospectively studied 2,334 peripartum women with a documented Pap smear prior to de- livery. The main predictor variable had categories for HPV and CIN as compared to normal cytology. Covariates included demographics, medical/surgical history, and pregnancy variables. Model 1 included the whole sample. Model 2 included only those with an operative vaginal delivery or a cesarean delivery. Outcome measures were QBL and PPH measured by QBL. We found in model 1 that those HPV positive and those with CIN were each not significantly associated with QBL. In model 2, those HPV positive were significantly associated with increased QBL (B = 0.11, SE = 0.05, p = 0.047), while CIN was not significantly associated with QBL. In model 1, those HPV positive and those with CIN were each not significantly associated with PPH. In model 2, those HPV positive were significantly associated with increased odds for PPH (OR:11.03, 9% CI:1.77, 68.74, p = 0.01) while CIN was not significantly associated with PPH. In conclusion, the presence of HPV was positively associated with an increase in the QBL and PPH at time of delivery for those with operative vaginal and cesarean deliveries. We suggest that clinicians take HPV results of Pap smears into consideration when considering a patient's risk of PPH.

The vaginal microbiome of transgender men receiving gender-affirming hormonal therapy in comparison to that of cisgender women

The vaginal microbiome of trans men and menopausal women is suspected to be similar due to a lack of estrogen leading to the absence of lactobacilli. However, data are scarce. We performed an analysis of the vaginal microbiome of trans men (n = 25) in comparison to that of menopausal (n = 25) and premenopausal women (n = 25). The vaginal microbiome of trans men and menopausal women showed a higher alpha diversity than that of premenopausal women. Various beta diversity indices (e.g., Bray‒Curtis (Un-)Weigthed Unifrac), showed significant differences in community composition between trans men and premenopausal (p < 0.001) and menopausal women (p < 0.001). The vaginal microbiome of trans men is characterized by a loss of Lactobacillus and an increase in bacteria associated with the intestinal flora (e.g., Campylobacter, Anaerococcus, Dialister, Prevotella). The abundance of Dialister and Prevotella decreased with the length of hormonal therapy in trans men. The Nugent score, Pap smear and HPV status did not differ between the study groups. The vaginal microbiome of trans men differs from that of premenopausal women but shows similarities to that of menopausal women. The duration of hormonal therapy in trans men may have important impacts on the vaginal microbiome and thus possibly on the risk for STIs.

Classification of cervical cells from the Pap smear image using the RES_DCGAN data augmentation and ResNet50V2 with self-attention architecture

AbstractCervical cancer is a type of cancer in which abnormal cell growth occurs on the surface lining of the cervix. In this study, we propose a novel residual deep convolutional generative adversarial network (RES_DCGAN) for data augmentation and ResNet50V2 self-attention method to classify cervical cells, to improve the generalizability and performance of the model. The proposed method involves adding residual blocks in the generator of the DCGAN to enhance data flow and generate higher-quality images. Subsequently, a self-attention mechanism is incorporated at the top of the pre-trained models to allow the model to focus more on significant features of the input data. To evaluate our approach, we utilized the Pomeranian and SIPaKMeD cervical cell imaging datasets. The results demonstrate superior performance, achieving an accuracy of 98% with Xception and 96.4% with ResNet50V2 on the Pomeranian dataset. Additionally, DenseNet121 with self-attention achieved accuracies of 92% and 95% in multiclass and binary classification, respectively, using the SIPaKMeD dataset. In conclusion, our RES_DCGAN-based data augmentation and pre-trained with self-attention model yields a promising result in the classification of cervical cancer cells.

Demonstrating the staining ability of &lt;i&gt;Zingiber officinale&lt;/i&gt; and &lt;i&gt;Curcuma longa&lt;/i&gt; as replacement to Eosin Y in EA50

Nicholas Papanicolaou developed the Pap stain, a combination of three major stains used for cervical smears. Eosin-Azure (EA50), one of these stains, includes Eosin Y, Light Green SF, and Bismarck brown. This study explores the use of Curcuma longa extract as a substitute for Eosin Y in EA50. Cervical smears from premenopausal women were collected and stained using both the standard Papanicolaou stain and a modified version where Eosin Y was replaced with Curcuma longa extract. The modified stain's effectiveness was assessed based on the quality of staining of superficial cells. The modified stain (T.A- extract) successfully stained and highlighted superficial cells, while the Zingiber officinale extract (Z.A) performed poorly in staining the nuclei and cytoplasm. The staining ability of the Curcuma longa extract was found to be 100% comparable to the traditional Papanicolaou stain. Staining aims to clearly demonstrate cellular components for diagnostic purposes, and many existing stains are long-established but require modifications for better application. Using local alternatives can enhance availability and affordability. Curcuma longa is readily available and, based on our findings, can effectively replace Eosin Y in Eosin-Azure stains. Further research into the dye components of herbal products and their staining capabilities could lead to cost-effective, locally sourced alternatives to imported stains.

Cervical stump leiomyomata after supracervical hysterectomy; a case report with review of literature

BackgroundDespite being a highly debated issue, subtotal or supracervical hysterectomy (SCH) is still considered a safe and effective treatment for women with benign gynecological lesions. Benign and malignant cervical diseases have been reported after SCH, with fibroids being the most frequently diagnosed lesions in the excised cervical stump. Recurrence of cervical disease after SCH usually presents with vaginal bleeding, pelvic mass, or abdominal pain; moreover, it may necessitate reoperation and resection of the cervical stump or trachelectomy. Trachelectomy is known to be a difficult surgical procedure that may be associated with significant intra- and post-operative morbidity.Case presentationWe presented here a case of a 41-year-old nulliparous woman with a pelvic mass related to the cervical stump presented 2 years after subtotal hysterectomy, performed due to interactable abnormal uterine bleeding, which was attributed to a multiple fibroid uterus. Six years ago, she complained of pelvic pain, excessive vaginal discharge, and spotting. A transvaginal sonography and magnetic resonance imaging with contrast were performed, which revealed a 10.2 × 7.6 × 6.5 cm heterogeneous pelvic mass with irregular borders and marked vascularity on color Doppler. Surgical exploration and resection of the mass with cervical stump excision were performed. Histopathology confirmed the diagnosis of cervical stump multiple benign leiomyomata with no atypical features.ConclusionRecurrence or De novo development of leiomyomata and other cervical lesions might occur after supracervical or subtotal hysterectomy; thus, thorough pre-operative counseling for women requesting a SCH regarding the pros and cons of the procedure compared with total hysterectomy should be optimized. Meticulous follow-up, including the continuation of routine cervical cytological smears, is mandatory for patients with a retained cervix.

George N. Papanicolaou (1883-1962): The Pioneer of Cytology and Early Cancer Detection.

George N. Papanicolaou (1883-1962) is recognized as a pioneer in cytology and early cancer detection, whose groundbreaking work revolutionized women's healthcare. His development of the Pap smear, a simple yet powerful screening tool, dramatically improved the early diagnosis of cervical cancer, leading to a significant reduction in mortality rates and saving millions of lives worldwide. Born in Greece and extensively trained in medicine and biology, Papanicolaou conducted meticulous research at Cornell University, laying the foundation for modern preventive medicine. This historical vignette explores Papanicolaou's life, transformative achievements, and the innovative processes he championed. By examining his enduring contributions, we highlight his profound impact on public health and medical practice, which continues to inspire and guide healthcare professionals across generations.

An Artificial Neural Network Prediction Model of Depressive Symptoms among Women with Abnormal Papanicolaou Smear Results before and after Diagnostic Procedures.

(1) Background: Cervical screening and additional diagnostic procedures often lead to depression. This research aimed to develop a prediction model for depression in women who received an abnormal Papanicolaou screening test, prior to and following the diagnostic procedures. (2) Methods: The study included women who had a positive Papanicolaou screening test (N = 172) and attended the Clinical Center of Kragujevac in Serbia for additional diagnostic procedures (colposcopy/biopsy/endocervical curettage). Women filled out a sociodemographic survey and the Center for Epidemiologic Studies Depression questionnaire (CES-D scale) before and after diagnostic procedures. A prediction model was built with multilayer perceptron neural networks. (3) Results: A correlation-based filter method of feature selection indicated four variables that correlated with depression both prior to and following the diagnostic procedures-anxiety, depression, worry, and concern about health consequences. In addition, the use of sedatives and a history of both induced and spontaneous abortion correlated with pre-diagnostic depression. Important attributes for predicting post-diagnostic depression were scores for the domains 'Tension/discomfort' and 'Embarrassment' and depression in personal medical history. The accuracy of the pre-diagnostic procedures model was 70.6%, and the area under the receiver operating characteristic curve (AUROC) was 0.668. The model for post-diagnostic depression prediction showed an accuracy of 70.6%, and an AUROC = 0.836. (4) Conclusions: This study helps provide means to predict the occurrence of depression in women with an abnormal Papanicolaou screening result prior to and following diagnostic procedures, which can aid healthcare professionals in successfully providing timely psychological support to those women who are referred to further diagnostics.

Economic Evaluation of Cervical Cancer Screening by HPV DNA, VIA, and Pap smear Methods in Indonesia.

Cervical cancer occurs 80% in developing country including Indonesia and take place in the first rank of incidence rate and third rank in mortality rate in Asian Pacific. Natural history of cervical cancer gives a potential to get accurate screening method. Cervical cancer screening m in Indonesia use VIA and Pap smear method for women in age range 30 to 50 years old. Recently, HPV DNA test has been recommended in international and national policy as primary screening method for cervical cancer. This research aims to asses cost-effectiveness and economic implications of specific cervical cancer screening modalities. Cost-effectiveness analysis was conducted from societal perspective. Cost data was collected from four hospitals in Indonesia. Direct medical costs were derived from discussions with an expert panel and hospital billing data, aligning with current practice guidelines. Direct and indirect non-medical costs were estimated from patient interviews. Effectiveness data for the screening methods were extracted from a systematic review of existing literature. Markov model design was used for cost-effectiveness analysis. Budget impact analysis used healthcare perspective method from its billing for cervical cancer patients. Cervical cancer screening costs are calculated using direct medical, non-medical, and indirect expenses. Regarding to cost-effective analysis by incremental cost-effective ratio (ICER), pap smear for every 3 and 5 years is more cost-effective than VIA. HPV DNA also has the potential to be cost-effective. The budget impact analysis investigates scenarios, with a focus on negotiation-based cost reductions for HPV DNA testing. Controlling HPV DNA tariffs at USD 8.76 proves cost-effective. In conclusion, pap smear is the most cost-effective modality, while HPV DNA has the potential to be cost-effective by reducing the unit cost. Despite favorable outcomes, challenges in implementation suggest a phased approach for resource equalization before full deployment.