Incidence Of Cervical Dysplasia Research Articles

Association Between Maternal Age and Postpartum Assessment of High-Grade Cervical Dysplasia Diagnosed in Pregnancy [ID 2683560

INTRODUCTION: The incidence of cervical dysplasia in pregnancy is expected to rise as patients delay childbearing. Historical studies have quoted high rates of postpartum regression of lesions diagnosed in pregnancy. We sought to evaluate the relationship between maternal age and postpartum progression, regression, and persistence of high-grade lesions. METHODS: This is a retrospective cohort study of patients with biopsy-proven high-grade dysplasia diagnosed during pregnancy from January 2013 to December 2022. Institutional review board approval was obtained. Only immunocompetent patients with postpartum pathology obtained within 1 year of delivery were included. Definitions based on postpartum pathology were as follows: regression as low-grade or resolved dysplasia, persistence as high-grade dysplasia, and progression as invasive cervical cancer. Results were stratified by maternal age (≤24, 25–29, 30–34, 35+) and data were analyzed using the Cochran–Armitage test. RESULTS: Among our cohort (N=286), 101 (35%) were diagnosed with CIN2, 181 (63%) with CIN3/CIS, and 4 (1%) with HSIL (not otherwise specified) on antepartum cervical biopsy. Average age was 28 (±4.2) years. Postpartum regression rate was 44% for patients aged 24 years or younger, 37% in ages 25–29, 33% in ages 30–34, and 33% in ages 35 or older (P=.174). Persistence was common (55%, 63%, 67%, and 64%, respectively) and apparent progression to cancer was rare, occurring in 1% of patients aged 24 years or younger and in 2.8% of patients 35 or older (P=.68). CONCLUSION: Persistence occurred in over half of patients, regardless of age. Our findings emphasize the importance of postpartum follow-up, and possible cervical excision, in patients with antepartum high-grade dysplasia.

Persistence and clearance of high-risk human papillomavirus and cervical dysplasia at 1year in women living with human immunodeficiency virus: a prospective cohort study.

Evaluate 1-year outcomes of cervical cancer screening and treatment using primary high-risk human papillomavirus (HPV) testing in women living with human immunodeficiency virus (HIV). Prospective cohort study. HIV treatment centre in Botswana. Women living with HIV. Participants underwent cervical cancer screening with high-risk HPV testing and triage evaluation at baseline and 1-year follow up. Excisional treatment was offered as indicated. Histopathology was the reference standard. Persistence, clearance and incidence of high-risk HPV infection; and persistence, progression, regression, cure and incidence of cervical dysplasia. Among 300 women screened at baseline, 237 attended follow up (79%). High-risk HPV positivity significantly decreased from 28% at baseline to 20% at 1year (P=0.02). High-risk HPV persistence was 46% and clearance was 54%; incidence was high at 9%. Prevalence of cervical intraepithelial neoplasia Grade 2 (CIN2) or higher was most common in participants with incident high-risk HPV (53%). CIN2 or higher was also common in those with persistent high-risk HPV (32%) and even in those who cleared high-risk HPV (30%). Of the high-risk HPV-positive participants at baseline with <CIN2, 40% progressed to CIN2 or higher at follow up. The high incidence of high-risk HPV and high-grade cervical dysplasia in women living with HIV after one round of high-risk HPV-based screening and treatment raises concern about the rate of progression of high-risk HPV infection to dysplasia. Persistent disease is common. Caution in spacing cervical cancer screening intervals using high-risk HPV testing in women living with HIV is warranted. High incidence and persistence of HPV and CIN2+ in women living with HIV 1year after screening and treatment.

Comparison of papanicolaou smear and human papillomavirus (HPV) test as cervical screening tools: can we rely on HPV test alone as a screening method? An 11-year retrospective experience at a single institution.

BackgroundThe decrease in incidence of cervical dysplasia and carcinoma has not been as dramatic as expected with the development of improved research tools and test methods. The human papillomavirus (HPV) test alone has been suggested for screening in some countries. The National Cancer Screening Project in Korea has applied Papanicolaou smears (Pap smears) as the screening method for cervical dysplasia and carcinoma. We evaluated the value of Pap smear and HPV testing as diagnostic screening tools in a single institution.MethodsPatients co-tested with HPV test and Pap smear simultaneously or within one month of each other were included in this study. Patients with only punch biopsy results were excluded because of sampling errors. A total of 999 cases were included, and the collected reports encompassed results of smear cytology, HPV subtypes, and histologic examinations.ResultsSensitivity and specificity of detecting high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC) were higher for Pap smears than for HPV tests (sensitivity, 97.14%; specificity, 85.58% for Pap smears; sensitivity, 88.32%; specificity, 54.92% for HPV tests). HPV tests and Pap smears did not differ greatly in detection of low-grade squamous intraepithelial lesion (85.35% for HPV test, 80.31% for Pap smears). When atypical glandular cells were noted on Pap smears, the likelihood for histologic diagnosis of adenocarcinoma following Pap smear was higher than that of high-risk HPV test results (18.8 and 1.53, respectively).ConclusionsPap smears were more useful than HPV tests in the diagnosis of HSIL, SCC, and glandular lesions.

Incidence of Cervical Dysplasia and Cervical Cancer in Patients Younger Than 25 Years in a Dysplasia Clinic

Incidence of Cervical Dysplasia and Cervical Cancer in Patients Younger Than 25 Years in a Dysplasia Clinic

Age and Ethnic Differences in the Occurrence of Cervical Dysplasia, Cervical Cancer, and Cervical Cancer Deaths in Suriname

Background: Updated information on the frequency of premalignant cervical lesions in Suriname is scant, while currently available data on the age and ethnic distribution of cervical dysplasia, cervical carcinoma, and cervical cancer deaths are inconsistent and conflicting. For these reasons, we assessed these topics using a retrospective cohort approach. Methods and Findings: Using secondary data, the incidence of cervical dysplasia (1995 - 2006) and cervical cancer (1980 - 2008), as well as cervical cancer mortality (1995 - 2010) was estimated and stratified per 10-year age groups and ethnic background. Data were evaluated for statistically significant differences using the Chi-square test and ANOVA, and expressed per 100,000 females per year. There were 2,554 records of dysplasia, 1, 117 for cervical carcinoma, and 283 for cervical cancer deaths during the indicated periods. The distribution of cervical dysplasia followed international patterns with a frequency of 1.7%for all lesions and for CIN1, CIN2 and CIN3/CIS of0.9, 0.5 and 0.3%, respectively. The average cervical cancer incidence was 24 per 100,000 women per year, and the average mortality rate was 10 per 100,000 women per year. The high-risk age groups for overall cervical dysplasia, cervical cancer, and mortality due to this disease were 30-49 (64-71%), 30-59 (60%), and 60-79 years (40%), respectively. Excess risk for cervical cancer and cervical cancer death was seen in Indigenous and Creole women. When compared to the other ethnic groups, Maroon women had the lowest cervical cancer incidence and mortality rates. Conclusions: Despite incomplete cancer registries, our data suggest that Suriname represents a high- risk country for cervical cancer; that current screening practices have a very limited impact on the incidence and mortality; and that high-risk groups are women aged 30-49 years and those of Indigenous and Creole background. These findings support the implementation of more targeted screening programs.

Novel methods to treat and prevent human papillomavirus infection

The human papillomavirus (HPV), a ubiquitous sexually transmitted virus, is the causative agent for cervical dysplasia and carcinoma worldwide. Current treatment methods primarily utilize ablative and excisional procedures to remove dysplastic, HPV-infected cervical tissue. However, these procedures require intensive cytopathological surveillance and carry inherent risks of bleeding, infection and possible future pregnancy complications. Development of an effective vaccine against HPV would dramatically reduce the need for costly cytological and histological surveillance. HPV represents an ideal candidate for vaccine development, and current research efforts in the realm of prophylactic and therapeutic vaccine design show great promise. A host of various vaccine techniques are currently being developed and tested and, if effective, will have a significant impact on the incidence of cervical dysplasia and carcinoma.

Cervical Dysplasia in Adolescents

Although the incidence of cervical dysplasia in adolescents is increasing, a paucity of data exists regarding the outcomes of adolescents with Pap test abnormalities. We determined the natural history and outcome of adolescents with low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL). A review of all women aged 18 years or younger with a cytologic diagnosis of LSIL or HSIL between 1997 and 2003 was performed. Follow-up cytologic and histologic samples were evaluated. The most significant abnormality was recorded for each patient. Rates of regression, persistence, and progression were calculated. A total of 646 adolescents were identified. Follow-up was available for 477 teenagers with LSIL and for 55 with HSIL. Among adolescents with LSIL, 146 (35%) had negative follow-up. Low-grade abnormalities (atypical squamous cells of undetermined significance, LSIL, and cervical intraepithelial neoplasia grade 1) were seen in 199 (47%), whereas high-grade abnormalities were documented in 77 (18%). After 36 months, 62% had regressed, whereas 31% had progressive dysplasia. For the HSIL cohort, negative follow-up was documented in 12 (21.8%) adolescents, and 15 (27.3%) had low-grade abnormalities, whereas more than one half (50.9%) were found to have a high-grade abnormality. At 36 months, 31% of HSIL subjects had progressed to cervical intraepithelial neoplasia 3. Adolescents with LSIL and HSIL cytology are at significant risk for progression to high-grade cervical abnormalities. The rate of development of high-grade cervical abnormalities in adolescents is similar to adults. Adolescents with cytologic abnormalities mandate close follow-up. II-3.

Cervical Dysplasia in Women Infected with the Human Immunodeficiency Virus (HIV): A Correlation with HIV Viral Load and CD4+ Count

Objectives. The incidence of cervical dysplasia and carcinoma is known to be increased in HIV-infected women. In addition, there is a positive correlation between HIV viral load (VL), CD4+ count, and opportunistic infections, as well as the incidence of various malignancies. This study compares HIV VL and CD4+ count with the presence of cervical dysplasia, as well as with the degree of severity of dysplasia.Methods. A retrospective chart review of 350 HIV-infected women with polymerase chain reaction (PCR) quantitation of viral load was performed to identify 82 women with biopsy-proven cervical dysplasia and 25 women without any significant cervical pathology. The highest plasma VL within a year of the patients' cervical pathology and corresponding CD4+ count was selected and compared with cervical pathology. Univariate and multivariate statistical analysis using Student's t test and logistic regression analysis was used to analyze the significance of other risk factors such as age, race, smoking history, history of illicit drug use, and prior sexually transmitted disease as well as of viral load and CD4+ count.Results. Of 82 cases of cervical dysplasia, 33 (40.24%) were mild (CIN I), 47 (57.32%) were either moderate or severe (CIN II–III) dysplasia, and 2 demonstrated invasive squamous cell carcinoma (2.44%). A significant statistical difference was found when comparing either HIV plasma VL or CD4+ T-cell counts with the presence of cervical dysplasia on biopsy (P < 0.005). However, only CD4+ count was identified as an independent risk factor for the presence of cervical dysplasia after multivariate analysis.Conclusion. In our population, there is a significant correlation between VL and CD4+ count and the presence of cervical dysplasia. However, VL does not appear to be an independent risk factor for cervical dysplasia in this population of HIV-infected women.

The association between abnormal cervical cytology and bacterial vaginosis

Objective: To determine the prevalence of cervical dysplasia in patients with atypical squamous cells of undetermined significance (ASCUS) Pap tests who have bacterial vaginosis (BV), compared with those without BV.Methods: This investigation was a prospective cohort study of 46 patients evaluated for ASCUS Pap tests. The prevalence of cervical dysplasia among women with BV, diagnosed by Gram stain using Nugent’s criteria, was compared with the prevalence of cervical dysplasia in women without BV.Results: Forty-one percent (19/46) of patients in the study had BV. Thirty-five percent (16/46) had cervical dysplasia. Among those with cervical dysplasia, 69% (11/16) had cervical intraepithelial neoplasia (CIN) 1, 25% (4/16) had CIN 2, and 6% (1/16) had CIN 3. An additional five patients had condyloma or human papillomavirus changes detected on cervical biopsy, increasing the percent of patients with an abnormality to 46% (21/46). Among women with BV, 5 of 19 (26%, 95% CI 0.06–0.46) had an abnormality on biopsy. In women without BV, 16 of 27 (59%, 95% CI 0.40–0.78) had an abnormality on biopsy. The relative risk of having an abnormal biopsy after an ASCUS Pap test if BV was absent, compared with if BV was present, was 2.27 (P <0.05). The ratio of low-grade dysplasia to high-grade dysplasia was similar in both groups.Conclusions: Women with ASCUS Pap tests have a significant risk of having cervical dysplasia, some of which will be high grade. Women without BV have more than twice the incidence of cervical dysplasia and abnormal cervical biopsies, compared with women with BV.

Results of clinically downstaging cervical cancer in a cytological screening programme.

The study was aimed at clinically downstaging cancer of the cervix during a cytological Screening Programme to find out whether such a strategy may help in yielding a large number of early cases of cancer. A cohort of 6,178 women with different cervical lesions were cytologically examined from April 1971 at Queen Mary's Hospital, Lucknow, India. The 8,718 asymptomatic women with healthy cervices were taken as controls. The incidence of cervical dysplasia and malignancy in the study group was found to be 11.2% and 1.9%, which was statistically highly significant compared to control values of 3.3% and 0.02%, respectively. Dysplastic smears were seen maximally in women whose cervix bled to the touch, and the rate of cervical cancer was high in women with suspicious cervix. Dysplastic smears were seen frequently in all age and parity groups, but malignancy was common in women of high age (over 30 years) and high parity (two and above). The incidence of three sexually transmitted diseases, namely Trichomonas vaginalis, Herpes simplex, and condyloma revealed highly significant values, especially in women whose cervix bled to the touch. The study highlights the strategy of clinically downstaging cervical cancer, which is very useful in detecting a large number of dysplasia and frank malignancy cases and also the presence of any associated sexually transmitted pathogens whose treatment would aid in restricting the rising incidence of the dreaded disease in this country.

Midwifery assessment of the well woman: The pap smear

As more women have their well woman gynecologic needs met by CNMs, the impact of the midwife's role as a coordinator of women's health care becomes clearly evident. Midwives must become experts in screening women of all ages for a variety of health care concems and they must be versed in many aspects of gynecologic care, beginning with the Pap smear. As the incidence of human papilloma virus has increased significantly in recent years, so has the incidence of cervical dysplasia. Understanding the epidemiologic factors for cervical dysplasia and the courses of therapy used are integral parts of comprehensive nurse-midwifery care.

Cytopathological changes in human cervix and endometrium following prolonged retention of copper-bearing intrauterine contraceptive devices.

Since 1971, cytological evaluation of cervical smears and endometrial aspirates was carried out in 604 women wearing CuT200 intrauterine contraceptive devices (IUDs) for periods ranging from 6 mo to 15 yr. No cases of cervical neoplasia or endometrial carcinoma were encountered, even after continuous use of the device for 15 years. Dysplastic cervical smears were, however, found in 45 postinsertional smears, and endometrial hyperplasia was detected in seven aspirates; in no cases was the dysplasia or hyperplasia higher than of moderate degree. Thirty-nine of the 45 women with postinsertional dysplastic smears were followed for 3-4 yr; in no case did the lesion progress to a higher grade or to frank malignancy. However, persistence and recurrence of dysplasia were seen in 10 women, necessitating removal of the IUDs. The incidence of cervical dysplasia and endometrial hyperplasia was found to be much higher when the IUDs had been changed than when the original devices were worn continuously. The rate of removal of IUDs because of persistent or recurring dysplasia was also much higher in the former group. Since no pregnancies were reported in any of the women wearing the original device for as long as 15 yr, we do not advocate the practice of changing the device at the end of 3 yr for maintaining contraceptive efficacy as recommended by the manufacturers; instead, we recommend the uninterrupted retention of the original device for periods not longer than 5 yr in view of occurrence of endometrial hyperplasia in two 6-yr wearers.

The role of routine outpatient cytological screening for early detection of carcinoma of the cervix in India.

Cytological evaluation of cervical smears has been carried out in 4,338 women attending the Gynecology and Obstetrics Department and Family Planning Clinic of Queen Mary's Hospital, Lucknow, India, since April 1971. The incidence of cervical dysplasia was found to be 4.6% (205 out of 4,338) in the series, while malignant smears were detected in 54 patients (1.2%). In five cases, malignant smears were encountered in women with apparently normal cervices, highlighting the advantage of exfoliative cytology in screening subjects without cervical pathology. The remaining 49 cases with malignant smears had lesions on the cervix that had been clinically diagnosed as carcinoma. The diagnosis of malignancy was confirmed by biopsy in all 54 cases showing malignant smears; however, in 10 cases clinically diagnosed as carcinoma of the cervix, and subsequently confirmed histologically, the diagnosis was missed by cytology, the smears being reported as inflammatory in seven and inadequate in three. Cytological evidence of herpes simplex infection was seen in the smears in 23 out of 54 cases of carcinoma, and trichomonal infection was present in 15, indicating some relationship of these infections with the development of neoplastic changes in the cervical epithelium. Eleven of the total 54 cases of carcinoma of the cervix were in the age group of 26-35 yr, and four were in subjects with only two children. This emphasizes the need for the routine cytologic screening of all child-bearing women with parities of two and above, regardless of their age, if any meaningful results are to be obtained in a cancer-screening program in India in view of the prevailing custom of early marriage.

Incidence and risk factors of cervical dysplasia among human immune deficiency virus positive and human immune deficiency virus negative women at Aminu Kano Teaching Hospital

Background: HIV infection is a risk factor for cervical cancer and both diseases are prevalent in Nigeria. HIV positive women are at greater risk of cervical dysplasia than HIV negative women which may be as a result of immunosupression, hence adding more burdens to their already worsening health condition. It has become relevant to screen these women early and refer for appropriate and effective therapeutic intervention. Objective: To compare the incidence and risk factors of cervical dysplasia among HIV positive and HIV negative women at Aminu Kano Teaching Hospital, Kano. Methods: This was a comparative cross sectional studyl, which involved HIV positive women attending HIV clinic and HIV negative women attending the gynecological clinic at Aminu Kano Teaching Hospital. A cohort of 150 consenting HIV- positive women not on HAART and 150 HIV- negative women, selected by systematic random sampling were sent for Pap smear examination. On the same day blood samples were taken from antecubital vein and sent for both CD4 count and viral load among the HIV positive group. A pretested questionnaire was administered to the women of both groups on same day to determine the presence or absence of risk factors of cervical dysplasia in them. The results obtained were recorded using proforma and analyses of risk factors of cervical dysplasia was done using Chi square test and Fisher exact test to compare variables between those with normal and abnormal smears and student t test to determine the relationship of lesions with CD4count and viral load among the HIV positive women. Results: The incidence of cervical dysplasia among HIV- positive women was 49 (32.7%) and was significantly higher than 12(8%) found among the HIV- negative. Age ≥ 35years and parity ≥5, early coitarche, multiple sexual partners, low-socioeconomic status, cigarette smoking did confer some risk of dysplasia however. This study also showed that among the HIV positive group, CD4 count was inversely associated with risk of cervical dysplasia and women with a CD4 count 500 cells/mm3. Conclusion: It Ais important to carryout cervical smear screening for HIV-positive women, especially those with a CD4 count