Low-grade Abnormalities Research Articles

‘Liver function tests’ on the intensive care unit: a prospective, observational study

To evaluate the prevalence, patterns and significance of deranged liver function tests (LFT) in critically ill patients. A prospective, observational data collection of the LFT [bilirubin, alanine aminotransferase (ALT), alkaline phosphatase (AKP), gamma glutaryl transferase (gammaGT)] and critical care parameters in all admissions to the general intensive care unit (ICU) of our institution. Prevalence of abnormal LFT on the day of ITU admission is described and the relationship of abnormal LFT to clinical events and 30-day mortality analysed. Of 263 first admissions without hepatobiliary disease, 61% demonstrated an abnormal LFT at the point of admission. The majority of abnormalities were less than twice the upper limit of normal. Episodes of ventilation, haemofiltration and hypotension during the first 48 h were associated with an abnormal ALT on day 3. The presence of an abnormal ALT [odds ratio 2.7 (1.2-6.0)], AKP [OR 2.8 (1.1-7.3)] or gammaGT [OR 3.9 (1.9-8.3)] was associated with an increased risk of death within 30 days of admission. When adjusted for APACHE II score, LFTs were not independent predictors of mortality. Low-grade abnormalities of LFT are a significant entity in critically ill patients and show an association with mortality outcomes and clinical events on ICU. They are likely to represent part of a spectrum of liver injury associated with critical illness and should not be disregarded.

Can 2009 herald a new era in preventing cervical cancers?

Can 2009 herald a new era in preventing cervical cancers?

Management of low‐grade cervical abnormalities detected at screening: which method do women prefer?

To establish whether women with low-grade abnormalities detected during screening for cervical cancer prefer to be managed by cytological surveillance or by immediate colposcopy. TOMBOLA (Trial of Management of Borderline and Other Low-grade Abnormal smears) is a randomized controlled trial comparing alternative management strategies following the screen-detection of low-grade cytological abnormalities. At exit, a sample of TOMBOLA women completed a questionnaire eliciting opinions on their management, contingent valuations (CV) of the management methods and preferences. Within-trial quality of life (EQ-5D) data collected for a sample of TOMBOLA women throughout their follow-up enabled the comparison of self-reported health at various time points, by management method. Once management had been initiated, self-reported health in the colposcopy arm rose relative to that in the surveillance arm, although the effect was short-term only. For the majority of women, the satisfaction ratings and the CV indicated approval of the management method to which they had been randomized. Of the minority manifesting a preference for the method which they had not experienced, relatively more would have preferred colposcopy than would have preferred surveillance. The findings must be interpreted in the light of sample bias with respect to preferences, whereby enthusiasm for colposcopy was probably over-represented amongst trial participants. The study suggests that neither of the management methods is preferred unequivocally; rather, individual women have individual preferences, although many would be indifferent between methods.

High-Grade Cervical Disease in Adolescents With HIV

Infection by genital types of human papillomavirus (HPV), carcinogenic HPV infection, and cervical cancer precursors all are more frequent in HIV-positive women. HPV infections are particularly common in young women. Young women with HIV are more likely than older subjects to have abnormal Pap test results and to develop incident Pap abnormalities. This study was planned to determine the frequency of high-grade squamous intraepithelial lesions (HSIL) and grade 2 or grade 3 cervical intraepithelial neoplasia (CIN 2,3) in 45 HIV-seropositive and 87 HIV-seronegative women aged 20 years or less. Colposcopy was recommended for all grades of epithelial abnormality. None of the 121 adolescents evaluated had either HSIL or CIN 2,3 when enrolled in this study. During a median follow-up interval of 2.6 years, 8 women (7%) developed high-grade disease. The incidence of HSIL/CIN 2,3 was 2.5 per 100 person-years. The figure was 4.8 per 100 person-years in HIV-seropositive women and 1.6 per 100 person-years in those who were HIV-seronegative. The relative risk was 3.1 with a 95% confidence interval of 0.76 to 12.74. None of the women developed cancer during the study. These findings indicate that, in young, HIV-seropositive women, rapid progression of cervical lesions to high-grade disease is unlikely. This would seem to dictate a policy of observation by cytology and colposcopy rather than preventive treatment of low-grade cervical abnormalities.

A Novel RUNX2 Mutation in Cleidocranial Dysplasia Patients

Cleidocranial dysplasia (CCD) is an autosomal-dominant heritable skeletal disease caused by heterozygous mutations in the RUNX2 gene. Here, the RUNX2 gene was analyzed within a CCD family from China, and a novel missense mutation (c. 475G --> C [p.G159R]) was identified. Normal and mutant RUNX2 expression vectors were then constructed and expressed transiently in NIH3T3 cells. Immunofluorescent staining and Western blotting showed that wild-type RUNX2 protein was localized exclusively in the nucleus; however, the mutant protein was found in both the nucleus and the cytoplasm, which demonstrated that transport of the RUNX2 mutant into the nucleus was disturbed by the G159R mutation. Therefore, we suggest that G159 is very important to promote RUNX2 nuclear localization. According to clinical analysis, the patient displays severe dysplasia of bones and relatively low-grade craniofacial abnormality, and we infer that G159 may be vital for normal skeletal development, other than control of tooth number. These findings confirm that mutations in the RUNX2 gene are associated with the pathogenesis of CCD across different ethnic backgrounds.

High-grade cervical disease in adolescents with HIV.

To estimate the risk of high-grade squamous intraepithelial lesions (HSIL) in adolescents with HIV. Review of cervical cytology and biopsy results from women aged 20 years and younger obtained within 3 years of enrollment in a prospective multicenter study. At enrollment, none of 132 adolescent participants (45 HIV seropositive and 87 seronegative) had HSIL or cervical intraepithelial neoplasia grade 2 or 3 (CIN 2,3). Eight (7%) of 123 women with follow-up developed high-grade disease after a median of 2.6 years of observation. The incidence of HSIL/CIN 2,3 was 2.7/100 person-years (4.8/100 person-years in HIV seropositive and 1.6/100 person-years in HIV seronegative women; relative risk = 3.1; 95% CI = 0.76-12.74; p =.13). No cancers were found in adolescents during the study. The low incidence of HSIL or CIN 2,3 in adolescents suggests that optimal management is careful observation rather than preventive treatment of low-grade abnormalities.

Prevalence of type-specific HPV infection by age and grade of cervical cytology: data from the ARTISTIC trial

Human papillomavirus (HPV) infection causes cervical cancer and premalignant dysplasia. Type-specific HPV prevalence data provide a basis for assessing the impact of HPV vaccination programmes on cervical cytology. We report high-risk HPV (HR-HPV) type-specific prevalence data in relation to cervical cytology for 24 510 women (age range: 20–64; mean age 40.2 years) recruited into the ARTISTIC trial, which is being conducted within the routine NHS Cervical Screening Programme in Greater Manchester. The most common HR-HPV types were HPV16, 18, 31, 51 and 52, which accounted for 60% of all HR-HPV types detected. There was a marked decline in the prevalence of HR-HPV infection with age, but the proportion due to each HPV type did not vary greatly with age. Multiple infections were common below the age of 30 years but less so between age 30 and 64 years. Catch-up vaccination of this sexually active cohort would be expected to reduce the number of women with moderate or worse cytology by 45%, but the number with borderline or mild cytology would fall by only 7%, giving an overall reduction of 12% in the number of women with abnormal cytology and 27% in the number with any HR-HPV infection. In the absence of broader cross-protection, the large majority of low-grade and many high-grade abnormalities may still occur in sexually active vaccinated women.

Molecular epidemiology and pathogenic potential of underdiagnosed human papillomavirus types

BackgroundHuman papillomavirus (HPV) tests are crucial diagnostic tools for the prevention of neoplastic lesions of the uterine cervix. However most commercial methods are designed to detect high-risk (HR) HPV types and a limited selection of low-risk ones, thus missing a fair number of intermediate/low-risk types. As a result, many HPV infections remain undiagnosed, generating distrust in virological diagnosis among gynaecologists, who continue to rely preferentially on cytological and colposcopic findings.ResultsIn this study, we tested 6,335 consecutive clinical samples, most of them from Italian patients with cytological abnormalities. The samples, collected in 2000–2007, were analyzed using PCR amplification of a 173–206 bp (depending on HPV type) conserved region in the L1 open reading frame, restriction endonuclease analysis and, where required, sequence analysis for type determination. Analysis of a smaller male sample and long term follow-up of a few female subjects was also performed. A total of 2,161 samples tested positive for HPV DNA (32.1%); 21.3% of them were mixed infections. Overall, 59 known and 2 unknown HPV types were detected. Their relative prevalence was calculated; notably, types not clearly identifiable using the most common commercial method accounted for 36% of infections. Clinical findings associated with the underdiagnosed types ranged from H-SIL to low-grade abnormalities, although none of these infections resulted in invasive cancer.ConclusionGiven the high prevalence of some underdiagnosed HPV types in the population (principally HPV53, HPV66, HPV84, and HPV87) and their frequent association with cytological abnormalities, techniques capable of detecting and typing them would prove extremely useful.

Correspondence between EQ-5D health state classifications and EQ VAS scores

BackgroundThe EQ-5D health-related quality of life instrument comprises a health state classification followed by a health evaluation using a visual analogue scale (VAS). The EQ-5D has been employed frequently in economic evaluations, yet the relationship between the two parts of the instrument remains ill-understood. In this paper, we examine the correspondence between VAS scores and health state classifications for a large sample, and identify variables which contribute to determining the VAS scores independently of the health states as classified.MethodsA UK trial of management of low-grade abnormalities detected on screening for cervical pre-cancer (TOMBOLA) provided EQ-5D data for over 3,000 women. Information on distress and multi-dimensional health locus of control had been collected using other instruments. A linear regression model was fitted, with VAS score as the dependent variable. Independent variables comprised EQ-5D health state classifications, distress, locus of control, and socio-demographic characteristics. Equivalent EQ-5D and distress data, collected at twelve months, were available for over 2,000 of the women, enabling us to predict changes in VAS score over time from changes in EQ-5D classification and distress.ResultsIn addition to EQ-5D health state classification, VAS score was influenced by the subject's perceived locus of control, and by her age, educational attainment, ethnic origin and smoking behaviour. Although the EQ-5D classification includes a distress dimension, the independent measure of distress was an additional determinant of VAS score. Changes in VAS score over time were explained by changes in both EQ-5D severities and distress. Women allocated to the experimental management arm of the trial reported an increase in VAS score, independently of any changes in health state and distress.ConclusionIn this sample, EQ VAS scores were predictable from the EQ-5D health state classification, although there also existed other group variables which contributed systematically and independently towards determining such scores. These variables comprised psychological disposition, socio-demographic factors such as age and education, clinically-important distress, and the clinical intervention itself.Trial registrationISRCTN34841617

Estimates for cervical abnormalities in Vanuatu

To use the Pap smear to establish a recent prevalence of cervical abnormalities within a select population in Vanuatu, a developing country. Cervical smears (n=907) were collected from Ni-Vanuatu women from both urban and rural islands within Vanuatu between August 2001 and September 2005. The prevalence of low-grade epithelial abnormalities for the total population was 2.9% and the prevalence of the high-grade epithelial abnormalities/cancer was 2.0%. There was a significant difference (p<0.05) in prevalence of high-grade epithelial abnormalities/cancer between the urban and rural populations sampled, with a higher prevalence in the urban population. The prevalence of pre-cancer and cancer in Vanuatu is high compared with Victorian (Australian) statistics yet comparable with other developing countries with no cervical screening programs available. This study will hopefully assist in future planning of women's health programs and relevant preventive strategies to combat cervical cancer in Vanuatu.

United Kingdom cervical cancer screening and the costs of time and travel

The aim of this study was to estimate the time and travel costs generated by women when attending for Papanicolaou (Pap) smear tests or colposcopy appointments in the United Kingdom, both absolutely and relative to the health service cost of the national cervical cancer screening programs. Data were obtained from questionnaires completed by two samples of women participating in a three-center trial of management of low-grade abnormalities detected by screening (n = 1,106 for Pap smears and n = 1,203 for colposcopy appointments). Women were 20 to 59 years of age and resident in Grampian or Tayside, Scotland, or Nottingham, England. Questionnaire data were supplemented with sociodemographic information previously collected at the time of recruitment to the trial. The mean total time and travel costs per attendance at a smear test and at a colposcopy appointment were estimated to be 9.2 pounds and 27.4 pounds, respectively, averaged across the three trial areas (valued at 2002 prices). Statistically significant intercenter disparities in time and travel costs were identified, particularly with respect to colposcopy appointments. For these, time and travel costs in Nottingham were substantially less than those in Grampian and Tayside (22.9 pounds, 30.2 pounds, and 32.1 pounds, respectively). Time and travel costs amount to 26 and 33 percent, approximately, over and above the direct health service costs of the English and Scottish screening programs, respectively. The time and travel costs associated with participation in the UK cervical cancer screening programs are substantial and are not spatially uniform across the country.

Overall, Postmenopausal Use of Combined Hormones Is Not Associated with Increased Risk of Cervical Cancer

Postmenopausal women who take hormones combining estrogen and progestin have cellular abnormalities detected in the cervix more frequently than nonusers of hormone therapy do, but the risk of precancerous lesions and cervical cancer does not differ between users and nonusers, according to a report based on six years of data from the Women’s Health Initiative.1 Unmarried women, particularly those who are sexually active, have a significantly elevated risk of developing precancerous abnormalities or cervical cancer. The Women’s Health Initiative enrolled nearly 200,000 postmenopausal women aged 50–79 in 1993–1998, of whom about 17,000 participated in a clinical trial of oral estrogen plus progestin. To be eligible for participation in the hormone trial, a woman had to have a uterus; have no history of breast, endometrial or nonmelanoma skin cancer; and have no history of other cancers within the past 10 years. Women who had ever had invasive cervical cancer were excluded from the analysis of cervical cytologic abnormalities. Participants who had a Pap smear at baseline or in the previous year that detected no abnormalities or only low-grade lesions (which are not precancerous) were randomly assigned to receive either combination hormone therapy or a placebo. The study protocol called for participants to have annual pelvic examinations including cervical smears; those with data at three and six years after enrollment (15,733 women) were included in the analysis. At baseline, 98% of women had normal Pap smear results, and 2% had abnormalities (most of which were low-grade). On average, women with normal results were significantly older than others (63 vs. 62 years) and had a lower waist-to-hip ratio; they had experienced menarche at an earlier age and had first given birth at a later age. The two groups did not differ with respect to other characteristics that may be risk factors for cervical cancer. In both groups, the majority of women were white, were married (or living as married) and had had at least some postsecondary education. Three-quarters of women had never used hormone therapy, and fewer than one in 10 were using it when they entered the study. Half had never smoked, and one in 10 were current smokers; two-thirds reported that they drank alcohol, and half of these said that they had no more than one drink a week. The majority of women had given birth. During follow-up, the annual incidence of any new cellular abnormality was significantly higher among women who had had an abnormal result at baseline (653 per 10,000 person-years) than among those who had not (146); the same was true for the incidence of high-grade (precancerous) lesions and cervical cancer. Women taking combined hormones had a significantly higher annual incidence of new abnormalities (179 per 10,000 person-years) than those in the placebo arm of the trial (130), and sexually active unmarried women had a higher incidence (20 per 10,000 person-years) than both unmarried women who were not sexually active (11) and married women (five). After identifying characteristics that were significantly related at the univariate level with the risk of any abnormalities during the follow-up period, the researchers conducted multivariate analyses to determine which ones had independent associations. According to these calculations, the risk of abnormal cervical smear results was significantly elevated among unmarried sexually active women (hazard ratio, 1.4), women who had been younger than 30 at first birth (1.7) and users of hormone therapy (1.4). Over the six years of follow-up, 54 women developed high-grade lesions or cervical cancer. Results of multivariate analyses identified only one significant predictor of this outcome: marital status and sexual activity. Unmarried women had a higher risk than married women of developing precancerous lesions or cancer; the elevation in risk was greater for those who were sexually active (hazard ratio, 3.5) than for those who were not (2.3). The researchers speculate that these findings reflect unmarried women’s increased chances of having new sexual partners and being exposed to human papillomavirus. However, the study did not gather sufficient information about women’s sexual history for a detailed examination of its relationship to the risk of high-grade abnormalities or cervical cancer. The researchers point out that their results “are generalizable to postmenopausal women who have recently had a normal cervical smear or a smear with low-grade abnormalities, but they are not applicable to postmenopausal women who have never been screened or have not recently been screened.” Despite the study’s limitations, the investigators conclude that “sexually active unmarried elderly women may benefit from continued cervical cancer screening.”

Human Papillomavirus testing for the management of low-grade cervical abnormalities in the UK—Influence of age and testing strategy

Background The results of the UK pilot studies were encouraging with respect to the introduction of Human Papillomavirus (HPV) testing as a means to improve the management of low-grade cytological abnormalities. However, several important unresolved issues related to HPV triage remain, two of which are: what type of HPV test should be used and what age group should be targeted. Objectives To perform an evaluation of two commercial HPV detection tests and to correlate disease persistence and clearance with age and HPV status by the two tests. Study design We performed an evaluation of two commercial HPV tests in a cross-sectional analysis of 322 cervical cytology specimens with low-grade abnormalities. A subset of these specimens were then examined longitudinally, in order to correlate disease persistence and clearance with age and HPV status by the two detection tests. Results The two tests performed similarly with respect to the longitudinal identification/prediction of high-grade cervical disease. Age did not appear to be a factor in determining which cases went on to manifest high-grade disease within 3 years of a low-grade result ( p = 0.678). Conclusions This study weakens the case for age-adjusted HPV triage of low-grade cervical abnormalities.

Reasons for participation and non-participation in a randomized controlled trial: postal questionnaire surveys of women eligible for TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears)

Better understanding of motivators for, and barriers to, participation in randomized controlled trials (RCTs) in different study populations and settings has the potential to improve participation of historically under-represented groups (eg, women) in future trials. To investigate reasons why women agreed, or declined, to participate in a RCT. In two postal questionnaire-based studies, we investigated women's reasons for participation or non-participation in TOMBOLA, a RCT comparing management policies for low-grade cervical abnormalities. Four-hundred and ninety-two TOMBOLA participants (response rate 56%) completed questionnaires on reasons for participation. One-hundred and thiry-seven women (38%) who declined TOMBOLA participation completed questionnaires on reasons for this. Eighty percent of women reported that one of their reasons for attending their TOMBOLA recruitment appointment was worries about their smear result. Ninety-four percent participated in the RCT because it was a worthwhile contribution to the cervical screening programme and other women; for 70% this was the most important reason. These proportions did not vary by socio-demographic factors. Thirty-two percent thought participation would result in better care. The most common reason for non-participation was preference for follow-up from the woman's GP. Logistical issues (eg, inconvenient appointments, travel time, arranging time off work or child-care) were commonly cited. Fourteen percent were too frightened to participate; this was unrelated to the grade of the recruitment smear. Response rates were not high, but there was little evidence of response bias. Structured questionnaires were used. Future research should address how best to deliver information to ensure different social groups appreciate potential benefits of RCT participation and provide reassurance regarding fears about participation. Simple strategies (eg, appealing to the altruism of potential participants or offering flexible recruitment clinic locations and times) might enhance RCT recruitment rates. This in turn would ensure best use of research resources thus bringing the greatest benefits to participants and the population.

Incidence of Cervical Cytological Abnormalities With Aging in the Women’s Health Initiative

To estimate the incidence of cytological abnormalities and cervical cancer and to determine the effect of oral estrogen and progestin on cervical cytology among postmenopausal women participating in a multi-institution clinical trial. The study was a longitudinal analysis of a prospective cohort of 16,608 postmenopausal women (aged 50-79 years) participating in the Women's Health Initiative (WHI) clinical trial of estrogen plus progestin. Eligible participants had a cervical smear within 1 year before randomization and at 3- and 6-year follow-ups. Outcomes measured were low-grade and high-grade squamous intraepithelial lesions (LSIL, HSIL) and cervical cancer at follow-up years 3 and 6. Of 15,733 eligible participants with a uterus, 7,663 were assigned to placebo and 8,070 to estrogen plus progestin. At baseline, 318 women (2%) had low-grade abnormalities on cervical cytology. The annual incidence rate of any new cytological abnormality in the estrogen plus progestin group was significantly higher than that in the placebo group (hazard ratio 1.4, 95% confidence interval [CI] 1.2-1.6). Independent risk factors for HSIL and cervical cancer over a 6-year follow-up (after stratifying for baseline cytologic abnormalities) included sexual activity in the past year while not being married or living as married (hazard ratio 3.5, 95% CI 1.5-8.3). Risk factors did not include age or use of estrogen plus progestin. Use of estrogen plus progestin was associated with increased incidence of any cytologic abnormality, although it had no impact on the incidence of HSIL or cervical cancer. Sexually active older women who are not married or living as married may benefit from continued cervical cancer screening. Clinicaltrials.gov, www.clinicaltrials.gov, NCT00000611.

Human Papillomavirus: Current Prevalence and Future Protection

Human Papillomavirus: Current Prevalence and Future Protection

Trial of management of borderline and other low-grade abnormal smears (TOMBOLA): Trial design

Cervical screening reduces the risk of cervical cancer by detecting and treating cervical intraepithelial neoplasia (CIN). The management of women with low-grade cervical abnormalities is controversial. Two management policies exist: repeat smears in primary care and colposcopy examination. It is not clear which of these is the more effective and efficient. There is also uncertainty as to the most effective and efficient management of women at colposcopy when an area of abnormality is seen on the cervix — immediate treatment or biopsy and selective recall for treatment if the biopsy result suggests this is necessary. The result of a human papillomavirus (HPV) test might assist in deciding the appropriate management of women with low-grade abnormalities. TOMBOLA, a pragmatic randomised-controlled trial set within the cervical screening programmes in Scotland and England, addresses these three areas of uncertainty. Almost four and a half thousand women aged 20–59 with a low-grade cervical abnormality have been recruited and randomised to either repeat smears or colposcopy examination. Women in the colposcopy arm of the trial are further randomised to a policy of either immediate treatment or biopsy and selective recall for treatment if they have an abnormal transformation zone. Women are followed up to an exit examination at 3 years. HPV testing is undertaken at recruitment and at the exit examination. The primary endpoint is cumulative incidence of CIN2/3. A range of other clinical, psychosocial and economic outcomes is being considered. This paper describes the design of the trial, and discusses the rationale underlying aspects of the design and the challenges faced in designing and implementing the trial.

Feasibility of Management of High-Grade Cervical Lesions in a Single Visit: A Randomized Controlled Trial

In this randomized, controlled trial, women from underserved neighborhoods who underwent cervical screening were either managed in the usual fashion and notified of their results with a recommendation for follow up at a later visit or treated in the same visit. Women in the “usual-care” group were dismissed after pelvic examination and Pap smear, and test results were mailed to them. If the smears were abnormal, they were contacted by phone and referred for additional evaluation either within the authors’ clinical system or to their primary care physician with a written copy of their test results. Follow-up information for usual-care patients with abnormal test results was obtained from the patient and from a review of medical records. Participants were told to return for a follow-up examination in 12 months. Women randomized to the “single-visit” group remained after the examination until the results of the cervical smear were known. If the findings were atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous epithelial lesion (LGSIL), the women were referred for additional evaluation as in the usual group. Patients whose smears were positive for high-grade squamous intraepithelial lesion (HGSIL), atypical glandular cells (AGUS), or carcinoma underwent immediate treatment with cervical loop electrosurgical procedure (LEEP). Neither colposcopy nor endocervical excision was performed; however, endometrial biopsies were taken in patients with AGUS. All LEEP patients were asked to return in 2 weeks and at 3 and 12 months for follow up. A total of 3521 women recruited from community health centers in primarily Latino neighborhoods participated in the study. One thousand seven hundred sixteen were randomly assigned to the single-visit group, and 1805 were assigned to the usual group. There was no difference in the rate of abnormal cervical smears (approximately 4% each) or in the rate of high-grade lesions (1%) between the two groups. Fourteen of 16 (88%) women with high-grade lesions in the single-visit group received definitive treatment compared with 10 of 19 (53%) women with a similar diagnosis in the usual-care group (P = .04). One of the two single-visit patients left before her results were known, and one refused treatment. Thirteen of 19 usual-care patients were evaluated with colposcopy within 6 months of the cervical screening, but only 10 were treated as recommended. Treatment and evaluation of low-grade abnormalities were similar for both groups of patients. Two patients, one in the single-visit group and one in the usual-care group, were found to have invasive cancer in the LEEP specimen. Thirty-six percent of patients in each treatment group returned for the follow-up Pap smear at 12 months. Among women with high-grade lesions, more patients in the single-visit group attended the 1-year examination (10 of 16, 63%) than did women in the usual-care group (4 of 19, 21%) (P = .02). The time each woman spent in the clinic was recorded. The mean time from registration to discharge was 2.8 hours for single-visit patients and 1.25 hours for usual-care patients. Responses on a patient questionnaire indicated that 76% of single-visit patients felt that the duration of the first visit was acceptable compared with 89% of those in the usual-care group (P < .001). Ninety-five percent of single-visit women would choose to have a single-visit screening again, and 67% of usual-care patients indicated they would have preferred to wait for results at the same visit.

Early integration of high copy HPV16 detectable in women with normal and low grade cervical cytology and histology

Background: Integration of human papillomavirus (HPV) DNA has been considered a late event in cervical carcinogenesis. However, integrated forms of HPV were recently detected in cancer precursor lesions using a...

Refining the Management of Low-Grade Cervical Abnormalities in the UK National Health Service and Defining the Potential for Human Papillomavirus Testing: A Commentary on Emerging Evidence

Refining the Management of Low-Grade Cervical Abnormalities in the UK National Health Service and Defining the Potential for Human Papillomavirus Testing: A Commentary on Emerging Evidence