Changes In Cervical Cells Research Articles

The importance of combined HPV and CINtec® PLUS genotyping testing for p16 in women with cervical squamous cell carcinoma.

Immunohistochemistry (IHC) for p16INK4A (p16) is a reliable surrogate test for the presence of a high-risk, potentially transformative human papillomavirus (HPV) infection in precursor and malignant lesions of the cervix. The purpose of this study was to evaluate changes in cervical cells caused by persistent HPV infection, by IHC (p16 protein) by comparison with HPV genotyping. The study included female patients aged between 26 and 57 years who presented to a public hospital, with complaints related to the genital area, namely vaginal bleeding and dyspareunia. After selecting the patients, samples were subjected to cytological testing and IHC for p16 and for the determination of HPV types. The relationship between HPV status and p16 status was statistically significant (p=0.0001), of the 41 patients, 53.7% were HPV positive, respectively 56.1% were p16 positive, the agreement relationship between the two indicators was very high (weighted kappa: 0.951). The clinical performance of CINtec® PLUS triage for p16 shows a high positive predictive value (PPV) and a high negative predictive value (NPV) of 95.7% and 100%, respectively, as regards HPV. The p16 marker (CINtec® PLUS) can be used as a prognostic biomarker and provides clinical usefulness through increased sensitivity (Se) and specificity (Sp) in the triage of women at risk of developing precancerous lesions, compared to cytology that is based on morphology, but has a rather low Se and high Sp, while HPV testing is very sensitive but slightly more specific.

Influence of sexually transmitted infections on the cervical cytological abnormalities among Iranian women: A cross-sectional study.

Sexually transmitted infections (STIs) are one of the world's most severe health challenges. The existence of STIs such as human papillomavirus (HPV) might cause cervical cell changes leading to cervical cancer. This study aims to assess the association of STIs with cervical cytological abnormalities and genital warts among women in northeastern Iran. This cross-sectional study was carried out on 190 women referred to the central laboratory of Academic Center for Education, Culture, and Research, Mashhad, Iran from March to July 2022. The presence of genital infections caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Herpes simplex viruses (1 and 2) were assessed using the real-time polymerase chain reaction method. HPV genital infection was detected based on the principles of reverse hybridization, and cellular changes in the cervix were examined by the liquid-based cytology technique. The mean age of participants was 35.33 8.9 yr. 34 different HPV genotypes were detected in all HPV-positive cases, and the most common genotype was low-risk HPV6. No significant association was found between STIs and cervical cytology abnormalities. The prevalence rates of sexually transmitted pathogens among HPV-positive and HPV-negative individuals were 10.9 and 1.6%, respectively. The frequency of genital warts was significantly higher in cases with multiple infections of high- and low-risk HPV genotypes. High percentages of the participants with non-HPV STIs and HPV infection had normal cervical cytology. It is advised to use STIs and HPV diagnostic tests along with cytology examinations for cervical cancer screening.

The Prevalence of HPV and non-HPV STIs Among Iranian Women and Assessment of the HPV/non-HPV STIs Co-infection on Cervical Cell Changes

The Prevalence of HPV and non-HPV STIs Among Iranian Women and Assessment of the HPV/non-HPV STIs Co-infection on Cervical Cell Changes

Understanding HPV and cervical screening

Cervical cancer is preventable and curable. Sarah Butler and Yvonne Wilkinson explain how the cervical screening programme has changed from a cytology based test to HPV primary screening Screening for human papillomavirus is now the primary test for cervical screening in England, Wales and Scotland. Cervical screening for those individuals with a cervix routinely occurs every 3 years for those aged 25–49 (24½ in England) and every 5 years for those aged 50–64. Over 99.7% of cervical cancers are caused by human papillomavirus. Cervical cancer is preventable and curable; primary HPV screening can detect early changes in cervical cells allowing for effective monitoring and treatment.

The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women

ObjectiveCervical cancer is considered treatable as long as it is detected early and managed effectively. Pap smear test is a screening tool that plays an important role in the early detection, prevention and can prevent any early cervical cell changes from becoming cancer. This study aims to survey the effect of educational programs based on beliefs, subjective norms, and perceived behavior control on doing the pap-smear test in a sample of Iranian women.Materials and methodsThis experimental interventional study was performed on 300 women admitted to Fasa City, Fars Province, Iran health centers in 2018–2019. A questionnaire consisting of demographic information, knowledge, Health Belief Model, and Theory of Planned Behavior constructs were used to measure on doing of Pap smear test in women before and after 6 months’ educational intervention.ResultsThe results revealed that 6 months after the intervention, 108 women (72%) in the experimental group and only 9 women (6%) in the control group received the Pap smear test.ConclusionsThe current research results revealed that education based on the combination of the health Belief model and theory of planned behavior might be promoting participation and an increasing rate of receiving Pap smear tests in women.

Enhancing the Knowledge of Cervical Cancer Screening among Female Nursing Students: An Interventional Educational Program

Background: Cervical cancer is a growing health risk facing women worldwide with the human papillomavirus (HPV) as the primary underlying cause. Pap smear is a simple screening test that can detect early changes in cervical cells, which might develop into cancer cells. Raising awareness of cervical cancer prevention has a significant impact on decreasing the burden of the disease. The aim of the study is to assess female nursing students' knowledge on early detection and screening of cervical cancer, and to determine the effectiveness of an educational program. Methods: A quasi-experimental research design (one group for pre- and post-tests) was utilized with a convenience sample of 130 female nursing students in one of the nursing colleges in Saudi Arabia. The study’s educational intervention included information about anatomy of genital tract and the importance of regular check-ups. The pre- and post-tests were applied to identify changes after intervention measures. Results: The mean age of the participants were 21.32 years (SD: 1.34). The findings revealed a significant improvement of post-test students’ knowledge in all items related to risk factors, signs and symptoms, occurrence, identification of HPV as causative agent, vaccination against HPV, and finally Pap smear for early detection and screening of cervical cancer. Conclusion: The study results support implementing educational intervention to improve nursing students' knowledge and awareness about cervical cancer prevention. Furthermore, it is imperative that cervical cancer awareness education modules should be developed and integrated within the nursing curriculum. Further studies with large sample size are recommended to increase generalization of the results. 
 Key words: cervical cancer, education program, primary prevention, nursing students, Saudi Arabia

Precancerous lesions of the cervix and its determinants among Ethiopian women: Systematic review and meta-analysis.

IntroductionPrecancerous lesions of the cervix are changes in cervical cells that make them more likely to develop into cancer. Understanding the prevalence and determinants of the precancerous lesions of the cervix among women helps to take an action like vaccination programs, improving screening coverage, and close management and follow-up which could decrease the morbidity and mortality caused by cervical cancer.Materials and methodsThe international databases, PubMed/MEDLINE, Web of Science, EMBASE, CINAHL, Google Scholar, Science Direct and Cochrane Library and unpublished reports were systematically searched. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was employed to analyse the data. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity between the studies. A random-effect model was computed to estimate the pooled prevalence of precancerous lesions of the cervix in Ethiopia. Determinants of the precancerous lesion of cervix (early initiation of sexual intercourse, multiple sexual partners, and history of sexually transmitted infection) were analysed.ResultsThirteen studies fulfilled the inclusion criteria and included in the meta-analysis. The I2 test result showed high heterogeneity (I2, 93.2%, p = <0.001). Using the random effect analysis, the pooled prevalence of precancerous lesions of the cervix among women in Ethiopia was 14.21% (95% CI (10.49, 17.94). After adjusting of publication bias using trim-and-fill method, the pooled prevalence was 9.43% (95% CI (5.23, 13.62). Women who had multiple sexual partners in their lifetime (OR:2.67 CI: 1.49,4.79) and had a history of sexually transmitted infections (OR:6.22 CI: 2.99,12.92) were more likely to have a precancerous lesion of the cervix.ConclusionThe pooled prevalence of the precancerous lesions of the cervix among Ethiopian women was 9.43%. It was associated with having multiple sexual partners and a history of sexually transmitted infections.

Physical status of human papillomavirus in the prognosis of recurrence of low-grade and-high-grade cervical intraepithelial lesions

The study included 168 patients with precancerous cervical lesions 37 with low-grade squamous intraepithelial lesions (LSIL), 131 with high-grade squamous intraepithelial lesions (HSIL), and 150 women, who had not abnormal cervical cell changes. All patients underwent full colposcopy assessment, cytological/histological examination, molecular detection and genotyping of high-risk human papillomavirus. Viral load and physical status of HPV-16 DNA was evaluated in cases of mono-infection (n=208). The prevalence of virus-positive cases among the patients with LSIL/NSIL and healthy women was 78.5 and 50.7 %, respectively. The frequency of recurrence in patients with LSIL and HSIL was found to be determined by the physical status of HPV-16. A significant difference in episomal, mixed and integrated forms of HPV-16 between patients with LSIL/HSIL and patients without abnormal cervical cell changes was found (p=0.0002).

The introduction of the HPV primary screening programme

Screening for Human Papilloma Virus is to be included as a primary test in the English cervical screening programme. Aine Kothari outlines the background behind this decision as well as the benefits for patients and healthcare professionals Women aged 25-49 (24½ in England) are invited for cervical screening (previously referred to as a smear test) every three years and screening is undertaken every five years in women aged 50-64. Cervical screening can detect early changes in cervical cells, which if left undetected and untreated could lead to cancer of cervix. 99.9% of cervical cancers are caused by Human Papilloma Virus (HPV). Plans are in place to implement HPV primary screening into the cervical screening programme. HPV primary screening involves testing all cervical samples for HPV and undertaking cytology only on samples that are HPV positive. The decision to implement HPV primary screening in the cervical screening programme follows on from the report of the ARTISTIC Trial. This article discusses the background to the introduction of HPV primary screening.

Gynaecological morbidities and health seeking behaviour of aged tribal women in Trivandrum district, Kerala, India

Background: Gynaecological morbidities is any condition, disease or dysfunction of the reproductive system that is not associated with pregnancy which include reproductive tract infections, cervical cell changes, prolapse, urinary tract infection, back pain due to osteoporosis. The community based prevalence of gynaecological morbidities are influenced by demographic, social, cultural and behavioural factors. Geriatric gynaecological problem especially in tribal population has not received adequate attention in India. It is a fact that, health seeking behaviour forms an important component in formulating health programs as successful interventions depends on the accessibility and acceptability ,both of which relates to social factors. The objective of this study was to assess the gynaecological morbidities of aged (>60 years) tribal women in Trivandrum district living in various settlement areas and also to study their health seeking behavior. Methods: 11 panchayats were selected where the density of tribal population was high, and using cluster sampling method, a sample size of119 was arrived at, and these many women were included in this study out of the total of 2362 aged tribal women residing in Trivandrum. 12 camps were conducted in settlement areas during the period of one year of study. Socio-demographic, general health, and gynaecological examination was conducted and findings noted in a proforma. Results: 47.1% women had one or more coexistent gynaecological morbidities. 16% had clinical evidence of vaginitis, 9.2% had urinary tract infection, 12.6% had prolapse of some degree, 3.4% had cervical lesions. 80% of tribal women belonged to low socio economic status. 74.8% tribal women were anaemic. However around 80% had health seeking behaviour. The rest did not seek because of inaccessibility or shyness to discuss gynaecological morbidities. Conclusions: Aged trial women harbour considerable gynaecological morbidities. Inspite of having a very high level of health seeking behaviour it was noted in the current study that the prevalence of anaemia was very high. Therefore there is an urgent need to further improve health facilities and health care in these areas.

Influence of the Host Factors on Human Papillomavirus Infection and Vaccine Efficacy

Human papillomavirus (HPV) is associated with cervical cell changes, genital warts, recurrent respiratory papillomatosis, laryngeal papillomatosis, head and neck cancer, and cervical cancer. Two commercial HPV vaccines have successfully been made available in the clinical field. This review covers the progress of cervical disease by understanding the nature of HPV infection, as well as the relationship between the host factors and HPV vaccine effectiveness. Among these host factors, microbiota has been revealed to influence the development and function of both the innate and adaptive immune systems. Therefore, the composition of the microbiome may ultimately affect vaccine efficacy. Understating the relationship between host factors and HPV infection/vaccine efficacy may prove to be useful in earlier diagnosis, as well as disease prophylaxis.

Cervical Cancer Screening in Nepal

Cervical cancer screening is a process using the Pap smear to identify precancerous and potentially precancerous changes in cervical cells and tissue. Cervical cancer acts as the biggest killer and most preventable cancer in Nepalese women. This paper tries to give a brief overview of cervical cancer screening program in Nepal. Various published and unpublished literatures were obtained and reviewed from international journals, local newspapers and books. All literatures were systematically reviewed and analyzed. Human papilloma virus (HPV) infection is chiefly the reason for cervical cancer. In majority cases, early exposure to sexual intercourse, multiple sex partners and addiction are considered as risk factor. In Developing country like Nepal, screening for cervical cancers is not easily available to people at risk. A vaccine is available which reduces the risk of HPV. The vaccine will be effective if received before the onset of sexual activities 9-13 years. Cervical cancer screening program has many difficulties in terms of limited medical services, difficult geographical terrain creating difficulties in delivering health services. Special programs needs to be designed and delivered to population focusing on reducing burden of cervical cancer. DOI: http://dx.doi.org/10.3126/hprospect.v12i1.8723 Health Prospect: Journal of Public Health Vol.12(1) 2013: 18-20

Women's perspectives on illness when being screened for cervical cancer

BackgroundIn Greenland, the incidence of cervical cancer caused by human papillomavirus (HPV) is 25 per 100,000 women; 2.5 times the Danish rate. In Greenland, the disease is most frequent among women aged 30–40. Systematic screening can identify women with cervical cell changes, which if untreated may cause cervical cancer. In 2007, less than 40% of eligible women in Greenland participated in screening.ObjectiveTo examine Greenlandic women's perception of disease, their understanding of the connection between HPV and cervical cancer, and the knowledge that they deem necessary to decide whether to participate in cervical cancer screening.Study designThe methods used to perform this research were 2 focus-group interviews with 5 Danish-speaking women and 2 individual interviews with Greenlandic-speaking women. The analysis involved a phenomenological-hermeneutic approach with 3 levels of analysis: naive reading, structural analysis and critical interpretation.ResultsThese revealed that women were unprepared for screening results showing cervical cell changes, since they had no symptoms. When diagnosed, participants believed that they had early-stage cancer, leading to feelings of vulnerability and an increased need to care for themselves. Later on, an understanding of HPV as the basis for diagnosis and the realization that disease might not be accompanied by symptoms developed. The outcome for participants was a life experience, which they used to encourage others to participate in screening and to suggest ways that information about screening and HPV might reach a wider Greenlandic population.ConclusionWomen living through the process of cervical disease, treatment and follow-up develop knowledge about HPV, cervical cell changes, cervical disease and their connection, which, if used to inform cervical screening programmes, will improve the quality of information about HPV, cervical cancer and screening participation. This includes that verbal and written information given at the point of screening and diagnosis needs to be complemented by visual imagery.

Women in the limelight: a varied issue

Women in the limelight: a varied issue

Unsupervised segmentation and classification of cervical cell images

The Pap smear test is a manual screening procedure that is used to detect precancerous changes in cervical cells based on color and shape properties of their nuclei and cytoplasms. Automating this procedure is still an open problem due to the complexities of cell structures. In this paper, we propose an unsupervised approach for the segmentation and classification of cervical cells. The segmentation process involves automatic thresholding to separate the cell regions from the background, a multi-scale hierarchical segmentation algorithm to partition these regions based on homogeneity and circularity, and a binary classifier to finalize the separation of nuclei from cytoplasm within the cell regions. Classification is posed as a grouping problem by ranking the cells based on their feature characteristics modeling abnormality degrees. The proposed procedure constructs a tree using hierarchical clustering, and then arranges the cells in a linear order by using an optimal leaf ordering algorithm that maximizes the similarity of adjacent leaves without any requirement for training examples or parameter adjustment. Performance evaluation using two data sets show the effectiveness of the proposed approach in images having inconsistent staining, poor contrast, and overlapping cells.

Is mass cytological cancer screening possible worldwide?

Our answer is yes, but with appropriate tools.Although preventable, cervical cancer is still, second to the breast cancer, major killer of women from malignant diseases worldwide. The outreach for preventive cytological screening is less than 10% in the most of the developing counties. Screening for risk factors such as HPV have contributed, but still not sufficiently.At EB 2004, we presented for the first time our proprietary, biomarker‐based MarkPap® platform technology. The biomarker is cytoplasmic expression of genetic changes in cervical cells during transformation from normal to pre‐malignant (dysplastic) and malignant. At subsequent EB meetings, we presented further developments of this technology from manual to semi‐automated, to diagnosis at distance‐telecytopathology (both digital and wireless), including home self‐collection. Most recently, we made self‐collection kit. With all these small devices, a low‐trained technician at the POC in remote sites, can process the specimen with customer‐friendly MarkPap® kit, locate suspicious cells by the biomarker and transmit microscopic images of those cells via MarkPap® Digital networking system to expert sites for instant diagnosis. Our recent testing with China and India proved that this concept is feasible.Consequently, development of low‐cost devices for mass cervical cancer screening for developing countries is warranted. .

Attention focus, trait anxiety and pain perception in patients undergoing colposcopy

Few studies have compared the relative efficacy of attention-focus strategies in reducing clinical pain. Colposcopy, a medical diagnostic examination performed to identify premalignant cervical cell changes, elicits both anxiety and pain in patients, while allowing little or no behavioural control over the event. Employing a multi-group experimental design, the present study sought to investigate how different types of attention-focus strategies impacted upon pain perception, state anxiety and affect, in a sample of 123 colposcopy patients. Patients were randomly assigned to one of three groups: sensory focusing, active distraction and undirected control. Psychometric measures of pre-colposcopy pain expectancy and dispositional trait anxiety were also taken, in order to assess whether these factors further contributed to outcomes. Overall, when controlling for pain expectancy and trait anxiety, self-reported pain intensity, sensory pain and affective pain did not differ across groups. Further, there were no significant between-group differences in colposcopy-related state anxiety or affect. However, pre-colposcopy psychometric measures were found to be predictive of a range of outcomes. Pre-colposcopy pain expectancy, but not trait anxiety, was found to be positively related to colposcopy-related pain. It was further demonstrated that heightened state anxiety following colposcopy was due to experienced pain and pain unpleasantness, rather than to aspects of the pre-colposcopy prediction of pain. The results have implications for management of acute clinical pain.

A review of prophylactic human papillomavirus vaccines: Recommendations and monitoring in the US

It has been estimated that genital human papillomavirus (HPV) is the most common sexually transmitted infection in the US. Nononcogenic types, such as HPV type 6 (HPV-6) and HPV-11, can cause benign or low-grade cervical cell changes, genital warts, and recurrent respiratory papillomatosis. Oncogenic types can cause cervical and other anogenital cancers; oncogenic HPV types are detected in 99% of cervical cancers worldwide. A quadrivalent HPV vaccine to prevent HPV-6, HPV-11, HPV-16, and HPV-18 was licensed for use in the US in June 2006 and an application for Food and Drug Administration licensure was submitted for a bivalent HPV vaccine to prevent HPV-16 and HPV-18 in March 2007. Currently in the US, the quadrivalent HPV vaccine is recommended for routine immunization of girls aged 11 and 12 years, and catch-up immunization is recommended through age 26 years. Monitoring the impact of prophylactic HPV vaccines will be useful for understanding the population level impact of vaccination. In this report, the authors provide a brief review of the epidemiology of HPV infection and an overview of prophylactic HPV vaccines and postvaccine licensure monitoring.

Gene Identification by cDNA Arrays in HPV-Positive Cervical Cancer

One of the most frequent malignancies in women worldwide is carcinoma of the uterine cervix. High-risk human papillomavirus (HPV) infection is considered the most important etiological factor of uterine cervical cancer. Our aim was to identify novel cellular genes that could potentially act as predictive molecular markers for human cervical cancer by means of cDNA arrays. We used cDNA arrays to examine the expression profiles of six cell lines derived from human cervical cancer, three HPV+ tumor samples and three normal (HPV-) epithelium tissues. Data normalization was performed and the top overexpressed genes were obtained. Hierarchical cluster was performed and, to validate some of the differentially expressed genes between normal and carcinogenic samples, semi-quantitative RT-PCR, in situ hybridization and immunohistochemistry were performed in tissue samples. Four genes were demonstrated to be consistently overexpressed in invasive cervical cancer biopsies; three novel genes not previously related to cervical cancer: MMP10, Lamc2 and Claudin 1. Moreover, overexpression of IL6 and VEGF was corroborated. The identification of characteristic molecular changes in cervical cells by carcinogenesis and HPV infection can lead to a better understanding of cervical cancer. cDNA arrays are beginning to provide new possible molecular markers for prognosis and diagnosis. This technology could eventually help to elucidate the biological differences of the particular mechanisms associated with each different HPV-type infection and those with a poor prognosis.

A Community Study of Gynecological and Related Morbidities in Rural Egypt

This study assesses the prevalence of gynecological and related morbidity conditions in a rural Egyptian community. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women. For gynecological morbidities, genital prolapse was diagnosed in 56 percent, reproductive tract infections in 52 percent, and abnormal cervical cell changes in 11 percent of the women. For related morbidities, anemia was present in 63 percent of the women, followed by obesity (43 percent), hypertension (18 percent), and urinary tract infection (14 percent). Regression analysis of risk factors demonstrated the contribution of social conditions and medical factors to these diseases. Reproductive tract infections were shown to occur more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload showed significant associations with related morbidity conditions. This evidence challenges national health programs to go beyond safe motherhood, child survival, and family planning in its services to women, and to consider the social context of health as well.