Negative Pap Smears Research Articles

Anterior Vaginal Wall Suspension Procedure for Moderate Bladder and Uterine Prolapse as a Method of Uterine Preservation

We report our experience with anterior vaginal wall suspension for moderate anterior vaginal compartment prolapse and uterine descent less than stage 2. Data on patients who underwent anterior vaginal wall suspension with uterine preservation by hysteropexy and had a 1-year minimum followup were extracted from a long-term, prospective, institutional review board approved, surgical prolapse database. The indication for uterine preservation was uterine descent not beyond the distal third of the vagina with traction with the patient under anesthesia, and negative Pap smear and pelvic ultrasound preoperatively. The upper suture of the anterior vaginal wall suspension secures the cardinal ligament complex, allowing for uterine suspension once the suture is transferred suprapubically. Failure was defined as prolapse recurrence greater than stage 2 on physical examination or the need for reoperation for uterine descent. Outcome measures at serial intervals included validated questionnaires, physical examination, standing voiding cystourethrogram at 6 months postoperatively and complications. From May 1996 to March 2012, 52 of 739 patients met inclusion criteria. Mean followup was 55 months (range 12 to 175, median 44). Mean patient age was 62 years (range 38 to 81), mean body mass index was 26.7 kg/m(2) (range 18.3 to 49.4) and mean parity was 2.7. There were no transfusions or intraoperative complications. Overall 7 (13%) patients underwent subsequent hysterectomy foruterine prolapse recurrence at 7 months to 6 years postoperatively. The anterior vaginal wall suspension procedure offers a simple, mesh-free surgical alternative with acceptable long-term followup in patients with moderate uterine prolapse who wish for uterine preservation. However, patients should be appropriately counseled about the low risk of subsequent hysterectomy.

High‐grade cervical abnormalities and cervical cancer in women following a negative Pap smear with and without an endocervical component: A cohort study with 10 years of follow‐up

The proportion of Pap smears containing an endocervical component (ECC) has been declining in Australia. Given that ECC negative (ECC-) smears may be associated with reduced sensitivity, we undertook a retrospective cohort study to estimate rates of histologically confirmed high-grade cervical abnormality (HGA) and cancer in women with negative Pap smears with and without an ECC. Women 18-69 years with at least two Pap smears between 1 January 2001 and 31 December 2010 with the first smear in that period (index smear) showing no abnormality were eligible. Follow-up ended at date of the first abnormal smear, date of histological diagnosis, date of hysterectomy, date of death, or 31 December 2010, whichever came first. ECC status was treated as a time varying exposure. Follow-up was split at each smear after the index smear. Poisson regression was used to estimate adjusted incidence rates and incidence rate ratios (IRR) by ECC status. The incidence rate of histologically confirmed HGA was significantly lower following ECC- smears than after ECC+ smears (adjusted IRR: 0.69, 95%Confidence Interval (CI) 0.62-0.77), particularly at older ages (interaction between ECC status and age, p = 0.001). In contrast, the overall rate of invasive cancer was not significantly different after ECC- than after ECC+ smears (IRR: 1.27, 95%CI 0.90-1.77). In conclusion, women had a lower rate of confirmed HGA and no significant increase in the rate of invasive cervical cancer following ECC- smears. This study does not support differential (accelerated) follow-up in women with a negative smear without an endocervical component.

Comparison of Pap Smear and Colposcopy in Detection of Premalignant Lesions of Cervix

ABSTRACTObjectiveComparison of papanicolaou (pap) smear and colposcopy in detection of premalignant lesions of cervix.Materials and methodsA prospective clinical study was conducted in a tertiary care referral institute in 100 symptomatic, sexually active women of 20 to 60 years. All women were subjected to pap smear, colposcopy and cervical biopsy to confirm the diagnosis.ResultsOut of 49 positive on pap smear, 24 were true positives and 25 were false positives. Out of 51 negative pap smear findings, 45 were true negatives and 6 were false negatives. Thirty percent women had positive histopathology and colposcopic findings. Forty percent women had normal colposcopy with negative histopathology whereas 30% had positive colposcopic findings but negative histopathology. Nineteen percent of women with negative cytology were positive on colposcopy and histopathology.ConclusionPap smear had a sensitivity of 80% and a specificity of 64.29% with positive predictive value of 48.98% and negative predictive value of 88.24% while sensitivity and specificity of colposcopy were 100 and 57.14% respectively and positive predictive value and negative predictive value of colposcopy were found to be 50 and 100% respectively.How to cite this articleKohli B, Arya SB, Goel JK, Sinha M, Kar J, Tapasvi I. Comparison of Pap Smear and Colposcopy in Detection of Premalignant Lesions of Cervix. J South Asian Feder Menopause Soc 2014;2(1):5-8.

What Types Of Negative Pap Smears Tend To Be Flagged As Abnormal By Rapid Prescreening (RPS)?

What Types Of Negative Pap Smears Tend To Be Flagged As Abnormal By Rapid Prescreening (RPS)?

HPV L1 detection discriminates cervical precancer from transient HPV infection: a prospective international multicenter study

The benefits of cytology-based cervical cancer screening programs in reducing morbidity and mortality are well recognized. Especially, overtreatment of human papillomavirus (HPV) high-risk positive early dysplastic lesions may have a negative impact on reproductive outcomes for fertile women. To optimize the clinical management an objective standard is needed to distinguish precancer that requires treatment, from spontaneously resolving HPV infections. In the current study, we examined the prognostic relevance of HPV-L1 capsid protein analysis with Cytoactiv in an international prospective multicenter study including 908 HPV high-risk positive early dysplastic lesions (LSIL/HSIL) during a follow-up period of 54 months. The clinical end points of the study were histologically confirmed CIN3+ as progression, CIN1/2 for stable disease and repeated negative Pap smears as spontaneous clinical remission. The difference of the clinical outcome of HPV-L1-negative and HPV-L1-positive cases was statistically highly significant (P-value<0.0001) independent of the classification as mild dysplasia (LSIL) and moderate dysplasia (HSIL). Of the HPV-L1-negative HPV high-risk positive mild/moderate dysplasias 84% progressed to CIN3, as compared with only 20% of the HPV-L1-positive cases. The data from our study show that HPV-L1 detection allows to identify transient HPV infections and precancerous lesions within the group of HPV high-risk positive early dysplastic lesions. The high progression rate of HPV-L1-negative mild and moderate dysplasia emphasizes the precancerous nature of these lesions. A close follow-up with colposcopy and histological evaluation is advisable and removal of these lesions should be considered. The low malignant potential of HPV-L1-positive cases, however, indicates transient HPV infection, justifying a watch and wait strategy with cytological follow-up, thus preventing overtreatment especially for women in their reproductive age.

Screening History Preceding a Diagnosis of Cervical Cancer in Women Age 65 and Older

Abstract Objective To characterize the antecedent screening of women 65years of age and older diagnosed with cervical cancer. Methods Screening histories of women 65years of age and older who were diagnosed with cervical cancer between 2003 and 2008 were examined utilizing the organization's databases and the regional Cancer Registry. Stopping screening was recommended at age 65 for members who had either 3 consecutive negative Paps or a single negative Pap plus HPV test (cotest). Results From 2003 through 2008 there were 56 Kaiser Permanente Northern California members 65years of age and older diagnosed with cervical cancer. During the same time period there were 1,323,100 woman-years of membership in women age 65 and older. The risk of invasive cancer among women age 65 and older was 4.2/100,000/year in 2003–2008. 33 of 56 (59%) had one or more Pap smears prior to diagnosis. Of the 33, 14 women (25%) had 3 consecutive negative Pap smears prior to diagnosis. Three of 46,401 women with 1 or more negative cotests at age 65 and older were subsequently diagnosed with invasive cancer during 132,639 women-years of follow-up (2.3/100,000/year). Conclusions Most cervical cancers diagnosed at age 65 and older occur in women who have not met our criteria for stopping screening. A few cancers will continue to occur at age 65 and older despite multiple negative tests, as is true in other age groups. We currently have no evidence that these cancers would be prevented with continued screening at ages 65 and older.

Association between genital mycoplasma and cervical squamous cell atypia

Abstract Objectives To investigate the existence of an association between genital mycoplasma infections and cervical squamous cell atypia. Study design Prospective cross-sectional study. Setting Department of Obstetrics and Gynecology, in collaboration with the Clinical Pathology and Pathology Departments, Faculty of Medicine, Benha University, Egypt. Patients and methods Three-hundred women were scheduled into two equal groups. The control group included 150 women with negative Pap smear for cervical atypia. The study group included 150 women with cervical squamous cell atypia proved by Pap smear. Swabs obtained from endocervix and posterior vaginal fornix were subjected to culture for detection of genital mycoplasma using Mycoplasma IST2. Outcome measures were the rates of cervicovaginal infection with genital mycoplasma in both groups, and estimation of the co-occurrence of genital mycoplasma and cervical squamous cell atypia. Results Using Mycoplasma IST2 kit genital mycoplasmas were positive in (49.33% vs. 28.67%) of cases in study and control groups, respectively. Ureaplasma urealyticum was isolated more frequent than mycoplasma hominis and mixed mycoplasma infection. U. urealyticum colonization was demonstrated in women with HSIL (57.5%) significantly more frequent compared to women with LSIL (36.59%), ASCUS (30.43%), and with normal cytology (21.33%); P = 0.019. Conclusion Ureaplasma urealyticum was present significantly more often in women with cervical cytological atypia, suggesting the existence of an association between cervicovaginal infections with U. urealyticum and precancerous lesions of the uterine cervix.

Screening history preceding a diagnosis of cervical cancer in women age 65 and older

ObjectiveTo characterize the antecedent screening of women 65years of age and older diagnosed with cervical cancer. MethodsScreening histories of women 65years of age and older who were diagnosed with cervical cancer between 2003 and 2008 were examined utilizing the organization's databases and the regional Cancer Registry. Stopping screening was recommended at age 65 for members who had either 3 consecutive negative Paps or a single negative Pap plus HPV test (“cotest”). ResultsFrom 2003 through 2008 there were 56 Kaiser Permanente Northern California members 65years of age and older diagnosed with cervical cancer. During the same time period there were 1,323,100 woman-years of membership in women age 65 and older. The risk of invasive cancer among women age 65 and older was 4.2/100,000/year in 2003–2008. 33 of 56 (59%) had one or more Pap smears prior to diagnosis. Of the 33, 14 women (25%) had 3 consecutive negative Pap smears prior to diagnosis. Three of 46,401 women with 1 or more negative cotests at age 65 and older were subsequently diagnosed with invasive cancer during 132,639 women-years of follow-up (2.3/100,000/year). ConclusionsMost cervical cancers diagnosed at age 65 and older occur in women who have not met our criteria for stopping screening. A few cancers will continue to occur at age 65 and older despite multiple negative tests, as is true in other age groups. We currently have no evidence that these cancers would be prevented with continued screening at ages 65 and older.

Knowledge, Behavior and Beliefs Related to Cervical Cancer and Screening Among Turkish Women

The aims of this study were to explore Turkish women's knowledge, behavior and beliefs related to cervical cancer and screening. The study was performed in two cities in the East of Turkey between September 2009 and April 2010, with a sampling group of 387 women. Data were collected by means of an interview form with the Health Belief Model Scale for Cervical Cancer and Pap Smear Test - Turkish Version. Women in the research group were found to have poor knowledge, inadequate health behavior and low/medium level false beliefs regarding cervical cancer screening. There was relation between health beliefs and characteristics of women and particularly education (F = 10.80, p = 0.01). Similarly, it was found that Pap smear barriers were influenced by demographic characteristics and that women with low-level education (p = 0.001), divorced women (p = 0.05), women with low-income(p = 0.05), women who gave their first birth when they were 18 or younger (p = 0.05) and women not applying any contraceptive method at all (p = 0.01) were determined to have negative Pap smear barriers. Primarily the knowledge, attitudes and beliefs of women in the target group should be evaluated to increase their participation in cervical cancer screening and to prepare effective education strategies.

The prevalence of human papilloma virus infections according to Pap smear results in Jeju island

Objective We analyzed subtypes of human papilloma virus (HPV) infection in Papanicolaou (Pap) smear results of women in Jeju island, Korea. Methods We investigated the distribution of HPV subtypes according to Pap smear results among 635 women in Jeju island, Korea between October 2005 and October 2010. Results The most prevalent HPV subtypes were HPV 16, 52, 53, 58 in negative Pap smear result and HPV 16, 52, 31, 53, 66 in atypical squamous cell, HPV 52, 53, 56, 66 in low grade squamous intraepithelial lesion, HPV 16, 58, 52, 33, 33 in high grade squamous intraepithelial lesion/squamous cell carcinoma each other. The subtypes of HPV 16, 52, 53, 58, 31 were common in all women participated in study from Jeju island, Korea. And multiple infections were more common in women under 30 years of age than above age as previous study and the majority of HPV multiple infections were high risk types (94.5%). Conclusion This prevalence was some different from previous study of Korean other region, but more similar to Japanese study data. We think this result shows that Jeju island women maybe have the genetic, regional or environmental close relationship with Japanese because of close distance and culture irrespective of different national race.

Tobacco smoking and regression of low‐grade cervical abnormalities

The role of tobacco smoking in the multistage carcinogenesis at the cervix is not fully understood because of a paucity of prospective data. To assess the relationship between smoking and spontaneous regression of cervical precursor lesions, a total of 516 women with low-grade squamous intraepithelial lesion (LSIL) were monitored by cytology and colposcopy every 4 months. Probability of LSIL regression within 2 years was analyzed in relation to smoking behaviors, with regression defined as at least two consecutive negative Pap smears and normal colposcopy. Women's age, initial biopsy results, and human papillomavirus (HPV) genotypes were included in the multivariate models for adjustments. Our study subjects included 258 never-smokers and 258 smokers (179 current and 79 former smokers). During a mean follow-up time of 39.8 months, 320 lesions regressed to normal cytology. Probability of regression within 2 years was significantly lower in smokers than in never-smokers (55.0%vs 68.8%, P = 0.004). The risk of LSIL persistence increased with smoking intensity and duration and with younger age at starting smoking (P = 0.003, P < 0.001, and P = 0.03, respectively). Smokers had twice as high a risk of persistent HPV infection compared to never-smokers (odds ratio, 2.50; 95% confidence interval, 1.30-4.81; P = 0.006). In young women, passive smoking since childhood reduced probability of regression within 2 years (56.7%vs 85.9%, P < 0.001). Further adjustments for a wide range of cervical cancer risk factors did not change the findings. In conclusion, tobacco smoking may interfere with regression of cervical precursor lesions. Childhood exposure to second-hand smoke may increase a risk of persistent cervical abnormalities among young women.

Risk of CIN2 in Women With a Pap Test Without Endocervical Cells vs. Those With a Negative Pap Test With Endocervical Cells

To measure the risk of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in the 4.5 years following a negative Pap smear with adequate endocervical cells (ECC) (+) or absent/scarce ECC (-).A prospective, nonconcurrent study of the archives of 11 Italian population-based screening programs was conducted. Only 25-50-year-old women with a first negative Pap test were included.Women were classified as ECC+ or ECC- and followed for 4.5 years. The endpoint was the occurrence of a CIN2+ histologic diagnosis. Eligible subjects with negative Pap tests ECC+ and ECC- numbered 469,694 and 20,596, respectively. At least 1 subsequent test was available during follow-up for 335,763 and 11,972 subjects, and 691 and 13 CIN2+ lesions were observed, respectively. The risk of CIN2+ was 2.06 and 1.09 per 1,000 women over 4.5 years, and age-adjusted relative risk associated with ECC--was 0.55 (95% CI 0.28-1.06).Women with a negative Pap ECC--have a lower risk of CIN2+ than women with a negative Pap ECC+ and should repeat screening with frequency (3-5 years in Europe), independent of age.

Prevalence of high-risk human papillomavirus types 16 and 18 in healthy women with cytologically negative pap smear in Iran

Because human papillomavirus (HPV) is one of the causal factors in cervical cancer, understanding the epidemiology of this infection is an important step towards developing strategies for prevention. We evaluated the prevalence of high-risk human papillomavirus Types 16 and 18 in cervical samples from 402 healthy women with normal Pap smears by testing with type-specific primers in the polymerase chain reaction. Participants were seen at two gynecological clinics affiliated to the Shiraz University of Medical Sciences in Iran. The prevalence of positive HPV findings was 5.5%; high-risk HPV human papillomavirus Type 16 prevalence was 2% and no patient harbored HPV-18. The prevalence of HPV was 4.5% in younger age group and gradually increased to 20% in the 4 th decade. The prevalence of high-risk HPV was highest in the youngest women and gradually decreased with age. Overall, the prevalence of HPV in our population is low.

An epidemiological study to identify the risk factors with two different types of controls in high-grade cervical lesions including invasive cancer

A multidisciplinary study on pre-cancerous and early cancerous lesions of uterine cervix was carried out at our Institute from which the subjects (cases and one group of control) for the present study were selected with the objective to identify the possible risk factors related to high-grade cervical lesions including invasive cancer through an epidemiological study by selecting two different types of controls and to assess the feasibility whether the cancers of other organs could be taken as controls at the same time studying the risk factors associated with cervical cancer. One group of control was women with negative Pap smear and second group of control was the women with breast cancer but negative Pap smear. A total of 100 biopsy-proven cases of high-grade cervical intraepithelial lesions and Invasive cancer were recruited. The results of the study show that some of the risk factors associated with the cervical cancer get exaggerated when breast cancer cases were used as controls because risk factors of both cancers are opposite to each other. So it is concluded that in order to remove any bias, normal hospital controls or controls selected from multiple cancers should be taken to study the risk factors involved in cervical carcinogenesis.

Sentinel Pap smears in 261 invasive cervical cancer patients in Italy

Although cervical cytology screening has dramatically reduced its incidence, cervical cancer still occurs. The clinical history of 261 cervical cancer patients referred to the European Institute of Oncology between 1996 and 2006 was analysed in depth to better understand the difficulties in the diagnosis and prevention of this neoplasia in Italy. Data concerning anagraphical characteristics, tumour type and stage, Pap smear history, colposcopic and histologic data, treatment outcome were reviewed. Patients who had taken Pap smear in the 3-year time span preceding diagnosis were 199 and 55 (27.7%) of these smears were negative. A negative Pap smear was observed in 62.5% of the women with a cancer at stage IV or III. One hundred and seventy-two patients were symptomatic at diagnosis: 43 (25%) had a negative Pap smear in the 3 years preceding diagnosis while 54 (31.4%) had never done a Pap smear or had one taken more than 3 years before. Eighty-nine women were asymptomatic at the time of diagnosis; 13 patients (14.6%) had a negative Pap smear while 8 had no smear taken in the 3 years preceding diagnosis or no smear at all. The present retrospective investigation indicates that the screening system still has some critical points. Although multiple techniques and approaches have been proposed to improve the general performance of the system, prophylactic vaccination may dramatically limit the failures in an easier, and possibly more cost-effective way. We also stress that history taking and clinical examination are important tools to diagnose cervical cancers. However a clinical diagnosis requires experience, which, with the advent of more efficient screening system and prophylactic vaccination, many of the newer practising gynaecologists might lack.

Epidemiology and costs of cervical cancer screening and cervical dysplasia in Italy

BackgroundWe estimated the number of women undergoing cervical cancer screening annually in Italy, the rates of cervical abnormalities detected, and the costs of screening and management of abnormalities.MethodsThe annual number of screened women was estimated from National Health Interview data. Data from the Italian Group for Cervical Cancer Screening were used to estimate the number of positive, negative and unsatisfactory Pap smears. The incidence of CIN (cervical intra-epithelial neoplasia) was estimated from the Emilia Romagna Cancer Registry. Patterns of follow-up and treatment costs were estimated using a typical disease management approach based on national guidelines and data from the Italian Group for Cervical Cancer Screening. Treatment unit costs were obtained from Italian National Health Service and Hospital Information System of the Lazio Region.ResultsAn estimated 6.4 million women aged 25–69 years undergo screening annually in Italy (1.2 million and 5.2 million through organized and opportunistic screening programs, respectively). Approximately 2.4% of tests have positive findings. There are approximately 21,000 cases of CIN1 and 7,000–17,000 cases of CIN2/3. Estimated costs to the healthcare service amount to €158.5 million for screening and €22.9 million for the management of cervical abnormalities.ConclusionAlthough some cervical abnormalities might have been underestimated, the total annual cost of cervical cancer prevention in Italy is approximately €181.5 million, of which 87% is attributable to screening.

No increased risk for cervical cancer after a broader definition of a negative Pap smear

The definition of minimal relevant Pap smear abnormality is crucial for balancing the beneficial effects of screening (prevented mortality) with negative side-effects (the high positivity rate). After inflammation ceased to be defined as a borderline abnormal smear outcome in The Netherlands in 1996, the proportion of these smears dropped from 10% to less than 2%. Because this may have caused a loss in smear sensitivity, we analysed the changes in the incidence of cervical cancer after a negative Pap smear. All negative smears made at ages 30-64 in 1990-1995 (n = 1,546,252) and 1998-2006 (n = 3,552,716), registered in the national registry of histo- and cytopathology (PALGA), were followed for up to 9 years. During follow-up of the 1990-1995 smears, 377 women developed cervical cancer within 5,232,959 woman-years at risk, while during the follow-up of the 1998-2006 smears, 619 women developed cervical cancer within 11,210,675 woman-years at risk. The cumulative incidence after the definition change was not significantly higher than before: e.g. at 6 years, the cumulative incidence for smears made in 1990-1995 was 46 per 100,000 (95% CI: 41-52), and for smears in 1998-2006 was 48 per 100,000 (95% CI: 43-54), p = 0.59. The hazard ratio for 1998-2006 compared to 1990-1995 adjusted for age, number of previous negative smears and history of abnormalities was 0.90 (95% CI: 0.78-1.03). In The Netherlands, a setting with high-quality cytological screening, treating smears with only signs of inflammation as negative leads to a considerably lower positivity rate without increasing the risk for cervical cancer after a negative smear.

Atypical squamous cells and low squamous intraepithelial lesions in postmenopausal women: Implications for management

Objectives To determine whether the use of local Estrogen Replacement Therapy (ERT) affects the adequacy of colposcopic examination; to distinguish abnormal cervical smears secondary to hypoestrogenism from abnormal cervical smears due to true preneoplastic changes; and to suggest an effective management of atypical squamous cells of undeterminated significance (ASCUS) and low grade squamous intraepithelial lesion (L-SIL) in menopausal women. Study design Two-hundred fifty-four postmenopausal women with abnormal pap smears (L-SIL or ASCUS) underwent colposcopy and HPV DNA testing. All patients with positive colposcopy underwent punch biopsy, and all patients with positive histological findings underwent surgical treatment. Patients with negative colposcopy, both satisfactory [visible Squamo-Columnar Junction (SCJ)] and unsatisfactory, were treated with local estrogenic replacement therapy (ERT) for 3 months, and repeated colposcopy and pap smears. Patients with negative colposcopy and negative pap smears after ERT were included in a 6 months cytological and colposcopic follow-up. Patients with positive colposcopy underwent punch biopsy, if colposcopy was negative and cytology was positive, patients underwent endocervical curettage. Results One-hundred ninety-five had a diagnosis of ASCUS and 59 a diagnosis of L-SIL. At the first colposcopy, 39 patients showed a lesion and had an appropriate treatment. One-hundred eighty-eight in the ASCUS group and 27 in the L-SIL group had a negative colposcopy and were treated with local ERT. At first colposcopic examination, 37 of the 215 negative colposcopies resulted satisfactory and 178 of the 215 resulted unsatisfactory. After local ERT, 130 of the 178 patients had a satisfactory follow-up colposcopy. After ERT, 25 patients of 215 with initial abnormal CVS and negative colposcopy, required appropriate treatment. After ERT, 190 patients of 215 showed negative colposcopy and at cytologic follow-up showed 23 ASCUS and 167 normal CVS. Conclusions A correct diagnosis and an efficient treatment seem to be obtained with a short-time ERT followed by a short-time cytological and colposcopic follow-up. With a single course of local ERT it may be possible to distinguish between benign CVS mimicking atrophy and true preneoplastic changes. Estrogen therapy will often cause enough ectropion of the endocervical cells so that the entire SCJ can be visualized. Moreover, it may reduce the number of endocervical curettage or loop excision or cone procedure for women with inadequate colposcopic examination.

High HPV 16 Viral Load is Associated with Increased Cervical Dysplasia in Honduran Women

Cervical cancer is believed to have a co-factorial etiology in which high-risk human papillomavirus (HPV) infections are considered an essential factor and other elements play an ancillary role. Besides the importance of specific HPV genotypes, other viral cofactors as viral load may influence the progression likelihood. In this study the relationship between HPV 16 viral load with respect to the grade of cervical disease in Honduran women was investigated. A real-time PCR allowing quantification of both HPV 16 genome and beta-globin gene to normalize the measuring HPV 16 load in cervical cells was used. The data in 87 women with cervical dysplasia or cervical cancer and in 23 women with a negative Pap smear were evaluated. The highest average of HPV 16 viral load was detected in women with High Squamous Intraepithelial Lesions (HSIL). An increasing amount of HPV in higher cervical lesions was found, which could indicate a dose-response association between viral load and precancerous lesion grade.

Histoire cytologique des cancers du col utérin diagnostiqués en France en 2006

Objective After a significant decrease of the incidence of invasive cervical cancer with the practice of cytologic screening, the numbers remain the same nowadays. To explain the reasons for that, we performed a survey of the cases of invasive cervical cancer observed in France in 2006. Material and method A questionnaire about screening practice was sent to every member of the French Society of Colposcopy (SFCPCV) to fill out for every invasive cancer diagnosed in 2006. Results Five hundred and twenty-four cases were collected: 2/3 of them never had a pap smear or were under screened. Indeed 27% had a labelled normal smear in the last three years. Discussion and conclusion As many others, this study shows that the first risk factor remains the lack of screening. But, 27% are false negative pap smears and it is even 45% under 45 years. The first thing to do is an organized mass screening but the increasing number of false negatives raises the question of the quality control of the cytology, or else to turn to a new test.