Incidence Of Cervical Intraepithelial Neoplasia Research Articles

The Incidence of Cervical Intraepithelial Neoplasia or Cervical Cancer in Women Referred With Postcoital Bleeding.

The incidence of cervical cancer among patients with postcoital bleeding (PCB) was the primary objective of this study. Furthermore, the proportion of cervical intraepithelial neoplasia requiring treatment and the correlation between PCB and the presence of high-risk human papillomavirus (HPV) was determined. Lastly, the study aimed to identify risk factors among the referred women. A retrospective cohort study was conducted at a university hospital in Denmark between January 1, 2017 and December 31, 2019. Women referred with PCB were identified with the ICD diagnosis codes "DN930 Postcoital and contact bleeding" and "DN930B Contact bleeding." Demographic and paraclinical data were extracted from the journals and the supportive systems: Patoweb and the Danish Microbiology Database. A total of 789 women were included in this study, with only 0.25% (n = 2) diagnosed with cervical cancer and 2.5% (n = 20) diagnosed with cervical intraepithelial neoplasia II-III and adenocarcinoma in situ. Human papillomavirus testing was only conducted in a minority of cases, and a low incidence of high-risk human papilloma virus was detected in the 22 cases, n = 5. A very low incidence of cervical cancer and high-grade cervical intraepithelial neoplasia reported among women referred with PCB. Prognostic factors as body mass index, smoking, and HPV vaccination status may predict the risk of cervical cancer. Selection criteria like primary testing for hrHPV and cytology as cotests before referral to colposcopy may reduce the number of unnecessary colposcopies.

Incidence of pre-neoplastic and neoplastic lesions of the cervix before and after the COVID-19 pandemic

ObjectiveThe COVID-19 pandemic had significant effects on healthcare systems worldwide, including the disruption of routine screening programs for cervical cancer. This study aimed to compare the incidence of cervical intra-epithelial...

Epidemiological features of the incidence of cervical intraepithelial neoplasia in the modern megapolis

Background. Information on the incidence of cervical intraepithelial neoplasia (CIN) is relevant for planning and evaluating the effectiveness of medical care at the stage of secondary prevention of cervical cancer. Aim. To analyze the incidence of CIN and benign diseases of the cervix: erosion and ectropion, leukoplakia, polyp, according to medical organizations in Yekaterinburg in 2013–2019. Materials and methods. A descriptive epidemiological study of the incidence of cervical pathology in the population of women in Yekaterinburg in 2013–2019 was conducted. The forms of Federal Statistical Observation No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”, in terms of erosion and ectropion, and data from the city’s women’s consultations on the number of cases of CIN, leukoplakia and cervical polyp were examined. Information on the number of female population of the city from Sverdlovskstat was used. Results. The primary incidence of CIN increased throughout the follow-up period. The indicator increased by 1.7 times compared to 2013 (p < 0.001) in 2016, it had a maximum value in 2019 – 215.5 per 100 thousand women and was 3.2 times more than in 2013 (p < 0.001). The dynamics of the primary incidence of other types of cervical pathology: ectropion, leukoplakia and cervical polyp, was characterized by the absence of significant changes (p > 0.05) in 2013–2019. The increase in the overall incidence of CIN was registered from 2014 to 2019 in comparison with 2013 (p < 0.001). The indicator of the overall incidence of CIN in 2019 was 2.1 times higher than in 2013 (p < 0.001). Conclusions. The growth of primary and total incidence of CIN in the population of Yekaterinburg women noted since the beginning of the XXI century continued in 2013–2019. The primary incidence rate of CIN had the maximum value in 2019. The increase in the incidence of CIN is associated with the natural spread of the disease, accessibility and improvement in the quality of medical care.

Human polyomavirus BKPyV and JCPyV serostatus has no impact on women´s human papillomavirus infection outcome.

Polyomaviruses have both structural and functional similarities with papillomaviruses. Accordingly, their role in human papillomavirus (HPV) associated malignancies has been studied with conflicting results. Our goal was to disclose any association between BK (BKPyV) and/or JC (JCPyV) polyomavirus serology and HPV data derived from Finnish women (327) in a 6-year prospective follow-up. Glutathione S-transferase fusion-protein-capture (ELISA) in combination with fluorescent bead technology was used to analyze antibodies to BKPyV and JCPyV. In the longitudinal setting, BKPyV or JCPyV serostatus was related to i) oral- and ii) genital low (LR)- and high risk (HR) HPV DNA detection, iii) HPV16 persistence at both these sites, iv) results of the Pap (Papanicolaou) smear taken at baseline, and v) development of incident CIN (cervical intraepithelial neoplasia) during the follow-up. Being BKPyV or JCPyV seropositive was not significantly associated with HPV seropositivity to either LR- or HR-genotypes, genital- or oral HPV DNA positivity, persistence of genital- or oral HPV16 infection, grade of Pap smear, or development of incident CIN. Thus, the present study could not provide any confirmation to the concept that co-infections by HPyV and HPV have interactions that impact on the clinical manifestations or outcomes of HPV infections either in the genital tract or in the oral mucosa.

Cervical intraepithelial neoplasia in non-16/18 high-risk human papilloma virus positive/cytology negative women: An alternative approach in poor resource areas.

Because the specific prevalence and carcinogenesis of non-16/18 high-risk (hr) Human Papillomavirus (HPV) is not fully understood, we designed a study with aim of evaluating the risk of high-grade cervical intraepithelial neoplasia (CIN) in non-16/18 hr-HPV positive/cytology negative cases and assessing the distribution of non-16/18 hr-HPV subtypes. This cross-sectional study was conducted on 138 non-16/18 hr-HPV positive/cytology negative women, who were referred to the gynecologic oncology clinic of Yas hospital, affiliated with Tehran University of Medical Sciences, January 2021 to 2022. Among the detected types, HPV 31 was the most frequent type. 63 cases underwent biopsy as indicated based on colposcopic examination with acetic acid 3% application among which 34 had normal results. In the remaining 29 cases, 25 had insignificant findings. CIN2 was reported in 2 cases, one with HPV 31, 45, 58, and the other with HPV 58. CIN3 was also detected in 2 cases, one with HPV 31 and the other with HPV 35, 45. The overall incidence of high-grade CIN was 2.8%. A statistically significant (P-value=0.046) difference was detected between patients with high-grade CIN compared with the others regarding the Hookah usage. The risk of CIN among non-16/18 hr-HPV positive/cytology negative cases is noticeably low. Based on ASCCP guidelines return testing at 1 year without immediate colposcopy seems sufficient; however, because of many reasons doing immediate colposcopy rather than 1-year follow-up may be a more accessible approach in resource poor, low-income countries such as ours.

Pap Smear and Colposcopic Examination of the Cervix in Pelvic Inflammatory Disease and other Gynaecological Conditions: A Prospective Analytical Study

Introduction: Pap smear and colposcopy are commonly done procedures in gynaecology practice. The Pap test is a low-cost, straight forward, and widely used tool for detecting cervical cancer and preinvasive cervical abnormalities. Colposcopy is also widely used to detect Cervical Intraepithelial Neoplasia (CIN) to guide cervical biopsy sites with clinical symptoms of suspected cervical diseases. Aim: To evaluate the diagnostic implications of Pap smear and colposcopy in inflammatory cellular changes and to estimate the incidence of Cervical Intraepithelial Neoplasia (CIN)/invasive carcinoma in the study population through biopsy. Materials and Methods: This prospective analytical study was conducted at JNU Medical College, Jaipur, India, where Pelvic Inflammatory Disease (PID), and other gynecology Out Patient Department (OPD) patients without any previous diagnosis of cervical malignancy, were included in the study. A total of 150 study patients, underwent Pap smear and colposcopic examination with biopsy as the gold standard. Descriptive analysis of data was done using means and standard deviation for continuous variables and nominal variables as frequencies. The Chi-square test was applied to categorical variables to find out the association and Receiver Operating Characteristic (ROC) analysis was done to predict the diagnostic ability of Pap smear, and colposcopy in cervical pathology. Results: The mean age of the patient population was 36±3 years. The mean age at first coitus and marriage of all the women were 18.9±2.7 years and 19.5±3.4 years, respectively. Twenty (13.3%) and 5 (3.3%) cases were reported as CIN and carcinoma, respectively after colposcopic biopsy. Pap smear results showed a sensitivity of 87.7% and a specificity of 78.2%. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 72.8% and 68.7%, respectively. Sensitivity of the colposcopic report was 89.4% and the specificity was 98.8%. The PPV is 96.6% and NPV is 82.3% for colposcopic report. Conclusion: This study suggested that PID and gynaecology OPD patients can be better targeted with a good opportunity for screening the potential premalignant changes in the cervix by using Pap smear and colposcopy.

The incidence of cervical intraepithelial neoplasia and its correlation with the results of histopathological examination in the female population of the Podlaskie Voivodeship

<br>Introduction: Cervical cancer was the seventh most common malignant tumor among women in the Podlaskie Voivodeship in 2016. The development of this cancer is preceded by the occurrence of cervical intraepithelial neoplasia (CIN). Pap smear is still the basic method of secondary prevention of cervical cancer. If the result of the Pap test is positive, further diagnosis is necessary (colposcopy, histopathological examination).</br> <br>Aim: The aim of the study was to assess the incidence of intraepithelial cervical lesions and its correlation with the results of histopathological examination in the female population of the Podlaskie Voivodeship.</br> <br>Material and methods: 51,136 Pap smear tests were analyzed (retrospectively). The tests were performed in the Podlaskie Voivodeship from January 2012 to December 2019. Of this group, 134 patients had a histopathological examination. The results of both studies were compared.</br> <br>Results: Among the cytological tests performed in private offices, incorrect results accounted for 1.35%. The value is two times lower than in the case of tests carried out in the prevention program in Podlaskie Voivodeship. The results were consistent in 77% of patients diagnosed with HSIL and in 35% of patients diagnosed with LSIL.</br> <br>Conclusions: The obtained congruence of cytological and histopathological results is comparable to the data in the literature. The creation of a central registry of pap smears would be helpful in the quality monitoring and the number of abnormal results.</br>

Efficacy of prophylactic human papillomavirus vaccines on cervical cancer among the Asian population: A meta-analysis.

We conducted a meta-analysis to assess the efficacy of prophylactic human papillomavirus (HPV) vaccines against cervical cancer precursors and HPV persistent infection among Asian populations. Randomized controlled clinical trials conducted in Asian countries were identified from three electronic databases (PubMed, EMBASE and the Cochrane Library). Publication retrieval was performed on September 1, 2022 and only those written in English were included. The data were analyzed with Cochrane Review Manager (version 5.3) and Stata/SE (15.1). Effect sizes were presented as risk ratios (RRs) and 95% confidence intervals (CIs). Ten articles were considered in the meta-analysis, without significant heterogeneity among them. The fixed-effect RRs and 95% CIs for cervical intraepithelial neoplasia grade 1 (CIN1+) and CIN2+ were 0.10 (0.05-0.21) and 0.11 (0.04-0.27), respectively. Positive effect of HPV vaccination on 6- and 12-month persistent infection were observed, with the respective pooled RRs of 0.05 (95% CI: 0.03-0.09) and 0.09 (95% CI: 0.05-0.15). HPV vaccination has a positive effect on the incidence of cytological abnormalities associated with HPV 16/18 (RR, 0.13; 95% CI (0.09-0.20)). Positive effects of HPV vaccination were also observed for HPV 16- and 18-specific immunogenicity (RR, 235.02; 95% CI (82.77-667.31) and RR, 98.24; 95% CI (50.36-191.67), respectively). Females receiving an initial vaccination showed significant decreased incidences of cervical intraepithelial neoplasia, HPV persistent infection and cytological abnormalities and a significantly higher antibody positive conversion rate compared with non-vaccination counterparts. Prophylactic HPV vaccines are highly efficacious in preventing cervical cancer in Asian females. The government should accelerate the processes of vaccine introduction and vaccination implementation by prioritizing them in public health policies, which should be helpful to enhance Asian females' awareness of receiving HPV vaccination volitionally.

Keeping up to date in a fast-paced world

Practice NursingVol. 33, No. Sup10 ImmunisationKeeping up to date in a fast-paced worldKelly NickallsKelly NickallsEditor, Practice NursingSearch for more papers by this authorKelly NickallsPublished Online:8 Oct 2022https://doi.org/10.12968/pnur.2022.33.Sup10.S4AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Falcaro M, Castañon A, Ndlela B, et al.. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021;398(10316):2084-2092. doi:https://doi.org/10.1016/S0140-6736(21)02178-4 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 October 2022Volume 33Issue Sup10ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Published online 8 October 2022 Published in print 1 October 2022 Information© MA Healthcare LimitedPDF download

Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra, India.

We are reporting (a) updated incidence of cervical intraepithelial neoplasia (CIN) among women who did not have colposcopic or histopathological disease at baseline and (b) disease outcomes among women treated for CIN and their follow-up HPV status; in a cohort of women living with HIV (WHIV). The median overall follow-up was 3.5 years (IQR 2.8-4.3). The incidence of any CIN and that of CIN 2 or worse disease was 16.7 and 7.0 per 1000 person-years of observation (PYO), respectively. Compared with women who were HPV negative at baseline, women who cleared HPV infection had 23.95 times increased risk of incident CIN 2 or worse lesions (95% CI 2.40-661.07). Women with persistent HPV infection had 138.18 times increased risk of CIN 2 or worse lesions (95% CI 20.30-3300.22). Complete disease regression was observed in 65.6% of the HPV positive women with high-grade CIN and were treated with thermal ablation but HPV persistence was seen in 44.8% of those with high-grade disease. Among those who did not have any disease at baseline and were also HPV negative, about 87% (95% CI 83.79-89.48) women remained HPV negative during consecutive HPV test/s with the median interval of 3.5 years. Long-term surveillance of WHIV treated for any CIN is necessary for the prevention of cervical cancer among them. Our study provides an early indication that the currently recommended screening interval of 3 to 5 years among WHIV may be extended to at least 5 years among HPV negative women. Increasing the screening interval can be cost saving and improve scalability among WHIV to support WHO's cervical cancer elimination initiative.

Problems with catch-up HPV vaccination after resumption of proactive recommendations.

We previously reported that the suspension of the proactive recommendation for human papillomavirus (HPV) vaccination in Japan led to an increase in infection rates and incidence of cytological abnormalities, 1 Sekine M Yamaguchi M Kudo R et al. Suspension of proactive recommendations for HPV vaccination has led to a significant increase in HPV infection rates in young Japanese women: real-world data. Lancet Reg Health West Pac. 2021; 16100300 PubMed Google Scholar , 2 Yagi A Ueda Y Ikeda S et al. The looming health hazard: a wave of HPV-related cancers in Japan is becoming a reality due to the continued suspension of the governmental recommendation of HPV vaccine. Lancet Reg Health West Pac. 2022; 18100327 PubMed Google Scholar and appealed for proactive recommendations to be reinstated. 3 Ueda Y Yagi A Ikeda S Enomoto T Kimura T Beyond resumption of the Japanese government's recommendation of the HPV vaccine. Lancet Oncol. 2018; 19: 1563-1564 Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar In response to our findings, the Japanese Ministry of Health, Labour, and Welfare resumed proactive recommendations for the HPV vaccine in April, 2022, and initiated catch-up vaccinations for women who might have missed the opportunity to receive the vaccine during the period when proactive recommendations were suspended. 4 Haruyama R Obara H Fujita N Japan resumes active recommendations of HPV vaccine after 8·5 years of suspension. Lancet Oncol. 2022; 23: 197-198 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar A large proportion of women in the target age group (17–25 years) in Japan's fiscal year 2022 will be eligible for the recommended catch-up vaccination (figure). 5 Nakagawa S Ueda Y Yagi A Ikeda S Hiramatsu K Kimura T Corrected human papillomavirus vaccination rates for each birth fiscal year in Japan. Cancer Sci. 2020; 111: 2156-2162 Crossref PubMed Scopus (24) Google Scholar To reduce the incidence of invasive cervical cancer in Japan, a catch-up vaccination programme with at least 50% coverage will be required. 6 Simms KT Hanley SJB Smith MA Keane A Canfell K Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study. Lancet Public Health. 2020; 5: e223-e234 Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar To date, England, Sweden, Denmark, and the USA have successfully implemented national catch-up HPV vaccination programmes. In these countries, catch-up vaccination has been reported to have substantially reduced the incidence of cervical precancer and invasive cancer. However, in England, low vaccination coverage among the catch-up generation has been reported. Coverage of three doses of the HPV vaccine was high for women who received the routine vaccination at age 12–13 years (80·9–88·0%), but lower for the catch-up cohorts (70·8–75·7% for age 14–16 years, and 38·9–48·1% for age 16–18 years). 7 Falcaro M Castañon A Ndlela B et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021; 398: 2084-2092 Summary Full Text Full Text PDF PubMed Scopus (116) Google Scholar Catch-up vaccination is challenging in Japan because no national HPV vaccine register exists, and immunisation histories are maintained individually by each municipality (approximately 1700) that has provided routine vaccinations. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar For example, if a woman who received the HPV vaccination at age 12–16 years in one municipality moves to a residential address in another municipality, it would not be possible to ascertain her vaccination history from the previous municipality. Thus, a woman who has received three doses of the HPV vaccine in one municipality would be advised to receive three more doses of the HPV vaccine if she moved to another municipality. Thus, the vaccination programme will rely on patient recall regarding personal vaccination history. In our previous study, 1230 women aged 20–22 years between fiscal year 2014 and fiscal year 2017 were asked in a questionnaire whether they had been vaccinated in the past. 140/308 (45·5%) of those who responded that they had not been vaccinated had received 1–3 doses of the vaccine. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar In our current analysis of 1778 women aged 20–26 years in fiscal year 2020 (appendix), 199/879 (22·6%) of those vaccinated reported that they had never been vaccinated. Recall of women who visited clinics with their parents at age 12–16 years and received the HPV vaccine was poor.

Primary HPV-DNA screening in women under 30 years of age: health technology assessment

RESUMEN AntecedentesA partir del 2014 en Colombia se incorporó la tamización primaria con prueba de Virus del Papiloma Humano (VPH) desde los 30 hasta los 65 años, cuando la prueba es positiva se hace triage con citología para remisión a colposcopia. Actualmente se discute la conveniencia de iniciar la tamización con prueba de ADN de VPH a partir de los 25 años. De esta manera, el objetivo de esta evaluación de tecnologías sanitarias es analizar la evidencia disponible en torno a la seguridad, efectividad, costo-efectividad, valores y preferencias, dilemas éticos y aspectos relacionados con la implementación para el contexto colombiano de la prueba ADN-VPH como estrategia de tamización cervical en mujeres menores de 30 años.Dominios a evaluar Eficacia clínica y seguridad 1. Tasa acumulada de neoplasia intraepitelial cervical (NIC) grado 2 o más avanzado luego de 2 rondas de tamización.2. Tasas acumuladas de cáncer invasor de cérvix luego de 2 rondas de tamización.3. Seguridad: remisión a colposcopia. Costo-efectividad Costo efectividad para Colombia. Otros dominios considerados Aspectos éticos asociados a la tamización cervical en mujeres menores de 30 años. Aspectos organizacionales y del individuo. Barreras y facilitadores relacionados con la implementación en el contexto colombiano de la tamización cervical en mujeres menores de 30 años.Métodos Evaluación de efectividad y seguridad clínica Se realizó una búsqueda sistemática de la literatura en MEDLINE, Embase y CENTRAL de revisiones sistemáticas y ensayos clínicos. Se calificó el cuerpo de la evidencia con la aproximación GRADE. Posteriormente, se convocó a un grupo interdisciplinario a una mesa de trabajo en donde se presentó la evidencia recuperada, dando paso a la discusión y a la construcción de las conclusiones, siguiendo los lineamientos de un consenso formal acorde a la metodología RAND/UCLA. Estudio económico Se hizo una búsqueda sistemática de la literatura de estudios que hubieran evaluado el costo-efectividad para Colombia.ResultadosDe 7.659 referencias recuperadas se incluyeron 8 estudios. Resultados clínicos Se realizó un análisis integrativo de 5 ensayos clínicos aleatorizados que cumplieron con los citerios de inclusión. Cuando se compara frente a la citología, la tamización primaria con ADN-VPH en mujeres menores de 30 años, podría asociarse con una mayor frecuencia de detección de lesiones NIC2+ durante la primera ronda de cribado (RR: 1,57; IC 95 %: 1,20 a 2,04; certeza en la evidencia baja), con una menor incidencia de NIC2+ (RR: 0,67; IC 95 %: 0,48 a 0,92; certeza en la evidencia baja) y se asocia con una menor frecuencia de carcinoma invasor al término del seguimiento (RR: 0,19; IC 95 %: 0,07 a 0,53; certeza en la evidencia alta). Resultados económicos Desde el punto de vista económico, la alternativa de ADN-VPH y triage con citología desde los 25 años quizás representa la alternativa más costo-efectiva para Colombia (razón costo-efectividad incremental $8.820.980 COP año 2013). Otras implicaciones Dos estudios sugieren que las barreras de implementación, atribuibles a circunstancias de intermediación, de orden público y de carácter geográfico, podrían ser solventadas por nuevas tecnologías o estrategias de cribado. Es importante considerar alternativas de forma de administración y de prestación de servicios para solventar algunas barreras de aceptabilidad y acceso. Todo programa de tamización cervical debe contemplar los principios éticos de no maleficencia, beneficencia, autonomía y equidad. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años.ConclusionesEl uso de la prueba ADN-VPH como estrategia de tamización en mujeres menores de 30 años es una intervención probablemente efectiva y costo-efectiva para Colombia. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años.

Successfully Pregnancy Outcome After LLETZ in Women with Cervical Intraepithelial Neoplasia: A Case Series

BACKGROUND: Human papillomavirus (HPV) has an important role in cervical cancer development and the incidence of cervical intraepithelial neoplasia (CIN) was 1.3–2.7/1000 pregnancies. The HPV and its treatments such as loop electrosurgical excisional procedure (LEEP) or large loop electrosurgical excisional procedure (LLETZ) have an association with poor obstetric outcomes. CASE REPORT: Here, we present four case studies of successful live birth after treatment of CIN. We reported that four patients had been performed LLETZ, with abnormal colposcopy results and liquidbased cytology results were one ASCUS, one ASCH, and two HSIL. The histopathology results were one CIN 1, one CIN 2, and two CIN 3. There was a higher rate of pregnancy for treated women than untreated women. The higher the CIN grades, the more prevalence of cesarean section rate. CONCLUSION: The HPV testing or cotesting at 3-year intervals is recommended after treatment due to the sensitivity of HPV testing. Although pregnancy could delay the progression of precancerous lesions, it is recommended to follow the individualized algorithm in the ASCCP guideline to reduce the risk of cervical cancer progression.

The relationship between hormonal contraception and cervical dysplasia/cancer controlling for human papillomavirus infection: A systematic review

ObjectiveStudies on the effect of long-term use of combined oral contraceptives (COCs) on cervical dysplasia and/or cancer risk have been inconsistent. Less is known about the effects of other forms of hormonal contraception (HC). We examine whether HC use increases the risk of incident cervical intraepithelial neoplasia (CIN) 2, 3 and/or cancer after accounting for preexisting human papillomavirus (HPV) infection. Study DesignSystematic review of prospective studies on HC use as risk factor for cervical dysplasia with HPV infection documented prior to outcome assessment including PubMed and EMBASE records between January 2000 and February 2020 (Prospero #CRD42019130725). ResultsAmong nine eligible studies, seven described recency and type of HC use and therefore comprise the primary analysis; two studies limit comparisons to ever versus never use and are summarized separately. All seven studies explored the relationship between oral contraceptive (OC) use and cervical dysplasia/cancer incidence: two found increased risk (adjusted odds ratio, aOR = 1.5–2.7), one found no association but decreased risk when restricted to women with persistent HPV (adjusted hazard ratio = 0.5), and four found no association. None of the seven studies differentiated between COC and progestin-only pills (POPs) by use recency or duration. The only study that included injectable progestin-only contraception (DMPA) found increased CIN3 incidence among current versus never users (aOR = 1.6). The one study that included Norplant found no association. Two studies included intrauterine device (IUD) use, but did not differentiate between hormonal and copper IUDs, and found no association. ConclusionWe found no consistent evidence that OC use is associated with increased risk for cervical dysplasia/cancer after controlling for HPV infection. There were too few studies of progestin-only injectables, implants or IUDs to assess their effect on cervical dysplasia/cancer risk. ImplicationsUse of single self-reported HC measures and insufficient distinction by hormonal constituent cloud our understanding of whether some HCs increase risk for cervical cancer. Methodologically rigorous studies with distinct HCs measured as time-varying exposures are needed to inform cervical cancer prevention efforts and improve our understanding of cervical cancer etiology.

The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study

Human papillomavirus (HPV) immunisation with a bivalent vaccine (Cervarix) was introduced in England, UK, in Sept 1, 2008: routine vaccination was offered to girls aged 12-13 years with a catch-up programme for females aged 14-18 years in 2008-10. We quantified the early effect of this immunisation programme on cervical cancer and cervical carcinoma in situ, namely grade 3 cervical intraepithelial neoplasia (CIN3), registrations. In this observational study, we used an extension of the age-period-cohort Poisson model to estimate the relative risk of cervical cancer in three vaccinated cohorts compared with earlier cohorts that were not eligible for HPV vaccination. Data from a population-based cancer registry were extracted on Jan 26, 2021, and were assessed for diagnoses of cervical cancer and CIN3 from Jan 1, 2006 to June 30, 2019 in women aged 20-64 years and who were a resident in England. We used three vaccinated cohorts to account for differences in the school year in which the vaccine was offered and its national coverage. Adjustment for confounding was made using information on changes in cervical screening policy and historical events that affected cervical cancer incidence. Results were compared across models with different adjustments for confounders. We used data from a total of 13·7 million-years of follow-up of women aged 20 years to younger than 30 years. The estimated relative reduction in cervical cancer rates by age at vaccine offer were 34% (95% CI 25-41) for age 16-18 years (school year 12-13), 62% (52-71) for age 14-16 years (school year 10-11), and 87% (72-94) for age 12-13 years (school year 8), compared with the reference unvaccinated cohort. The corresponding risk reductions for CIN3 were 39% (95% CI 36-41) for those offered at age 16-18 years, 75% (72-77) for age 14-16 years, and 97% (96-98) for age 12-13 years. These results remained similar across models. We estimated that by June 30, 2019 there had been 448 (339-556) fewer than expected cervical cancers and 17 235 (15 919-18 552) fewer than expected cases of CIN3 in vaccinated cohorts in England. We observed a substantial reduction in cervical cancer and incidence of CIN3 in young women after the introduction of the HPV immunisation programme in England, especially in individuals who were offered the vaccine at age 12-13 years. The HPV immunisation programme has successfully almost eliminated cervical cancer in women born since Sept 1, 1995. Cancer Research UK.

Human Papillomavirus Vaccine Impact on Cervical Precancers in a Low-Vaccination Population

Demonstrating human papillomavirus vaccine impact is critical for informing guidelines to increase vaccination and decrease human papillomavirus‒related outcomes, particularly in states with suboptimal vaccination coverage, such as Tennessee. This study examines the trends in high-grade cervical lesion incidence among Tennessee Medicaid-enrolled women aged 18-39 years and the subset of women who were screened for cervical cancer. Using a validated claims-based model to identify incident cervical intraepithelial neoplasia Grades 2 or 3 or adenocarcinoma in situ events, annual age group‒specific incidence rates from Tennessee Medicaid billing data, 2008-2018, were calculated. Significant trends were determined by Joinpoint. Analyses were conducted in 2020. From 2008 to 2018, high-grade cervical lesion incidence significantly declined in women aged 18-20 years (average annual percentage change= -31.9, 95% CI= -38.6, -24.6), 21-24 years (average annual percentage change= -12.9, 95% CI= -22.3, -2.4), and 25-29 years (average annual percentage change= -6.4, 95% CI= -8.1, -4.6). Among screened women, rates significantly declined for ages 18-20 years (average annual percentage change= -20.3, 95% CI= -25.3, -15.0), 21-24 years (average annual percentage change= -10.2, 95% CI= -12.6, -7.8), and 25-29 years (average annual percentage change= -2.6, 95% CI= -3.9, -1.2). Trends from 2008 to 2018 were stable for older age groups (30-34 and 35-39 years). Results show reductions in high-grade cervical lesion incidence among ages most likely to have benefited from the human papillomavirus vaccine. Declines among young, screened women suggest causes other than reduction in screening. Evidence of vaccine impact in populations with low-vaccination coverage, such as Tennessee, is promising.

A nationwide birth year-by-year analysis of effectiveness of HPV vaccine in Japan.

In Japan, the age‐adjusted incidence of cervical cancer has been increasing constantly and rapidly among younger women. We set out to accurately confirm the effectiveness of the HPV vaccine in Japan. Data were collected for women born in the fiscal year (FY) 1990 to 1997, who became eligible for their 20‐y‐old cervical cancer screening between the FY 2010 to 2017. The adjusted incidence of cervical intraepithelial neoplasia (CIN)1+ in women born in FY 1990 to 1993, that is those who reached the national vaccination target age prior to the introduction of publicly subsidized HPV vaccinations, referred here after as “the pre‐introduction generation”, was 1.42% (242/17 040). The incidence in the “vaccination generation” (women born in FY 1994 to 1997, that is those who were heavily vaccinated as a group when they were of the nationally targeted age of 13‐16) was 1.66% (135/8020). There was no significant difference between these incidence rates. However, our FY birth year‐by‐year analysis revealed that the incidence of CIN1+ was obviously lower than that predicted based on just the trend for CIN1+ seen in the pre‐introduction generation. Our analysis revealed that the incidence of CIN3+ was obviously lower in the vaccination generation than in the pre‐introduction generation (P = .0008). The incidence of CIN was already tending to increase in both the pre‐introduction and vaccination generations. The changes in CIN incidence by individual birth FY must be examined to accurately determine the actual effects of the HPV vaccine for reducing mild cervical lesions.

Colposcopic Evaluation of Clinically Unhealthy Cervix

Cervical cancer is the commonest malignancy found amongst Bangladeshi women and the third most common cancer in the world. New cases of invasive cervical cancer are diagnosed over 5,00,000 annually worldwide. For Cervical Intra-Epithelial Neoplasia (CIN) and for invasive cancer of the uterine cervix, Papanicolaou’s (Pap) smear is the primary screening tool. The Pap smear accuracy, which was recently assumed found to be 80% to 95% for detecting CIN and early invasive cancer, was questioned. Colposcopy and directed biopsy are needed to clarify the clinically unhealthy cervix in women. This study was conducted to evaluate the role of colposcopy in identifying. The aim of the study was to assess the role of colposcopy of the unhealthy cervix to localize the lesions and to obtain biopsies from the selected areas. This prospective observational study conducted from January 2016 to December 2016 in the Department of Obstetrics and Gynaecology, Sikder Medical College, Dhaka including 104 patients who were aged between 25-65 years with clinically unhealthy cervix, were exposed to a colposcopic evaluation. All the patients underwent colposcopic-directed biopsies. The biopsies were taken from the act white areas and the iodine negative areas. Among 104 patients, 49 (47.1%) were in the age group of 25-34 years. In the parity, 97 (93.3%) 0-4 child, 61 (58.7%) were married before 18 years of age. 17 (16.35%) had normal colposcopic findings. The colposcopic evaluation and the guided biopsy were successful in detecting abnormalities in 26 out of 31 cases. The incidence of CIN 1 and CIN2, 3 were found colposcopically and histologically 33.65%, 24.04%, and 11.54%, respectively. In the present study, the sensitivity of colposcopy was 83.33%. Both the neoplastic and the non-neo-plastic ones, colposcopy was found to be useful in understanding the morphology of the cervical lesions and this would very helpful in planning their management in the future.

Japan's Ongoing Crisis on HPV Vaccination.

The Japanese government suspended proactive recommendations for the HPV vaccine in June 2013. The suspension is now in its seventh year, despite all the data pointing to the safety of the HPV vaccine. We reported a high vaccine effectiveness in the group of women vaccinated before their first intercourse (93.9%). The prevalence of cross-protected types of HPV 31/45/52 was also lower in the vaccinated group, and the vaccine effectiveness was 67.7%. Furthermore, prevalence of HPV16, 31 and 52 infection rates in the vaccinated group were obviously lower than that in the unvaccinated group, and no one had HPV18 or 45 infection in the vaccinated group. The addition of a cross-protective effect toward HPV types 31/45/52 to HPV types 16/18, which is the direct target of the bivalent HPV vaccine, may possibly prevent around 82% of invasive cervical cancer cases in Japan. With regard to the preventive effect of histological abnormalities, we also reported significant reduction in incidence of cervical intraepithelial neoplasia (CIN)3 or worse. Thus, the efficacy of the vaccine has been demonstrated for precancerous disease, and the diverse symptoms after HPV vaccination are likely functional somatic. For the future of Japanese girls, there is a need to resume the proactive recommendation of HPV vaccination and for immediate action to be taken by the Japanese government.

Socio-demographic Characteristics and Incidence of CIN of Uterine Cervix among VIA Positive Women attended at a Tertiary Care Hospital in Dhaka City

Background: Women in different socio-demographic are presented with VIA positivity.
 Objective: The purpose of the present study was to see the socio-demographic characteristics and incidence of CIN of uterine cervix among of VIA positive women.
 Methodology: This cross sectional study was conducted in the Department Of Pathology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of July 2007 to June 2008 for one (01) year. Patients who were colposcopically positive for cervical intraepithelial neoplasia and early invasive carcinoma or patients who are colposcopically negative but clinically suspicious for cervical neoplasia were included in this study. The clinical history was obtained by taking history with particular attention to age, age at marriage, parity, history of contraceptives, abnormal per vaginal discharge and post coital bleeding. The cervix was examined on naked eye by Cusco’s speculum to see whether it was healthy or not. Then it was examined by the colposcope after applying 3.0 to 5.0% acetic acid and colposcopic findings were collected. VIA positive cases were underwent colposcopy guided LEEP biopsy.
 Result: A total of 63 patients of different age group were recruited for this study. The mean with SD of age of this study population was 34.6±9.59 years. In this study, 41(65%) cases were diagnosed as cervical intraepithelial neoplasia (CIN). Incidence of CIN-I was 10 cases in age group 20 to 29 years. Most of the cases were in 30 to 39 (18 cases) years age group. Among 20 cases of high grade lesion (CIN-II/III) 9(45%) cases were in lower class, 8(40%) cases were in middle class and 3(15%) cases in upper class. Conclusion: In conclusion majority of the women were middle aged reproductive age group who are mostly in the lower class of socioeconomic class.
 Journal of Current and Advance Medical Research 2020;7(1): 7-11