Pap Smear Research Articles

Pixel-wise segmentation of cells in digitized Pap smear images

A simple and cheap way to recognize cervical cancer is using light microscopic analysis of Pap smear images. Training artificial intelligence-based systems becomes possible in this domain, e.g., to follow the European recommendation to screen negative smears to reduce false negative cases. The first step for such a process is segmenting the cells. A large and manually segmented dataset is required for this task, which can be used to train deep learning-based solutions. We describe a corresponding dataset with accurate manual segmentations for the enclosed cells. Altogether, the APACS23 (Annotated PAp smear images for Cell Segmentation 2023) dataset contains about 37 000 manually segmented cells and is separated into dedicated training and test parts, which could be used for an official benchmark of scientific investigations or a grand challenge.

Cytological Spectrum of Pap Smears according to the Bethesda System and its Clinical Correlation in a tertiary care centre

Cytological Spectrum of Pap Smears according to the Bethesda System and its Clinical Correlation in a tertiary care centre

Comparison of HPV and Cervical Cancer Awareness of Male and Female University Students

Aim: Cervical cancer is one of the most important types of cancer that is caused by the Human Papilloma Virus and affects women. HPV is one of the most common sexually transmitted diseases among young women and men. This study aimed to compare the knowledge of male and female university students studying in the field of health about cervical cancer, HPV infection, and their awareness of the HPV vaccine. Methods: A cross-sectional questionnaire was used, which was appropriate for both male and female students. One hundred university students attending a foundation university were asked to fill out a questionnaire by taking a consent form. Results: It was observed that sexually transmitted diseases, HPV, HPV vaccine, cervical cancer and risk factors, and PAP smear awareness were not very high. Conclusions: These findings showed that it is important to provide education to both male and female university students to increase their awareness about cervical cancer, risk factors, diagnosis and treatment methods, and the HPV vaccine.

Predicting cervical cancer screening participation using self-care behaviors among women in Iran.

Cervical cancer screening is an effective and accessible method for preventing this cancer. However, low participation rates among women have been reported. Self-care is one of the solutions to improve access to health services. This study was conducted to determine the prediction of cervical cancer screening participation using self-care behaviors among women in Iran. This cross-sectional study was conducted on 310 eligible women who were referred to comprehensive health centers and women's clinics in teaching hospitals in Isfahan, Iran, from November 2020 to April 2021. Participants were enrolled using convenience sampling. The data collection tool included researcher-made questionnaires on personal and fertility characteristics, participation in cervical cancer screening, and self-care behaviors related to cervical cancer and its screening. Descriptive and inferential statistical methods were used for data analysis using the Statistical Package for the Social Sciences (SPSS) version 22 software. The results showed that the intention to undergo screening was low among individuals who had not undergone screening. Lack of awareness and not having enough time were the most common barriers to screening. The results of logistic regression analysis indicated that self-efficacy was the significant predictor of cervical cancer screening. With an increase in the self-care score, the 12% chance of doing a Pap smear increases significantly (P = 0.002). Furthermore, the results of multiple regression showed that with an increase in the self-care score, the chance of women who refer to screening every year, every 2-3 years, and every 4-5 years is increased to 25% (P = 0.001), 34% (P < 0.001), and 11% (P = 0.032), respectively, compared with non-referral. According to the results, self-care was a predictor of performing a Pap smear, and it was related to its regular performance of Pap smear too. Therefore, designing and implementing necessary interventions to increase self-care behaviors can improve women's participation in cervical cancer screening and its regularity.

Comparative Evaluation of Honey Versus Alcohol as a Fixative in Cytological Samples: An Institutional Study.

Fixation plays an important role in fixing the cells, making them amenable for evaluation. Ethanol (95%) has been used as a standard cytological fixative. Honey can be introduced as a natural fixative. 1. To study cytomorphological features of smears fixed in 20% unprocessed honey. 2. To study the efficacy of honey as a fixative when compared with ethanol in both hematoxylin and eosin (H and E) stain and Papanicolaou (PAP) stain for cytological samples. A cross-sectional study was done in the Department of Pathology for 2 months on 100 cytological samples consisting of body fluids (peritoneal and pleural), cervical smears, and FNACs. These smears were fixed separately in 95% ethanol and 20% unprocessed honey for 5 minutes and were stained with both PAP and H and E stain. The cytomorphologies of both the smears were compared based on five parameters, clarity of staining, uniformity of staining, overall morphology, nuclear details, and cytoplasmic details, and the final score was calculated by adding all the scores: Total Score ≤2, poor score; 3-4, good score; 5, excellent score. Cervical smears fixed in honey showed similar features to ethanol-fixed smears. Fluid smears fixed in honey and stained with PAP yielded superior results compared to those stained with H and E, as shown by a kappa value of 0.259. However, neither of the smears demonstrated statistical significance. The FNAC samples stained with H and E and PAP exhibited nearly identical results, with a kappa value of 0.688 and 0.647, respectively. FNAC and PAP smears were the next two most successful cytological smear types, with cervical smears exhibiting the best results of the three. In honey-fixed smears, we can easily observe all cellular features with clarity. It enhances safety and the working environment in the laboratory. Honey can serve as an effective substitute in situations where resources are limited.

A Review of Abnormal Pap Smear Follow Up in the Resident Clinic

Introduction: The pap smear is a screening tool designed to reduce the incidence of invasive cervical cancer. The incidence of cervical cancer diagnosis has decreased by 50% from 1970 to 2010. This is largely accredited to pap smear screening, follow up colposcopy appropriate surgical treatment. The pap smear was performed annually for many years; however, in 2012 the guidelines changed to spaced screening pap smears. In our resident clinic we serve patients with barriers to health care. These barriers limit follow up for abnormal pap smears. This study aimed to identify the follow up rate after abnormal pap with colposcopy among resident continuity clinic patients. Methods: The patients with annual exams from resident clinic were collected from Jan 1st, 2023 to Jan 1st, 2024. Study Design: The pap smear results and follow up were reviewed. Results: During the year 2023, 402 patients presented to the resident continuity clinic for annual exams. Pap smears were obtained in 82% of our annuals and 12% had an abnormal pap result. Of these patients, only 62% had appropriate follow up colposcopy. Discussion: The results from our study revealed a low rate of follow up from abnormal pap smear. Conclusion: This study allowed us to better understand the abnormal pap smear follow up in our resident clinic population. Future area of study includes how shorter interval follow up after abnormal pap smear screening may affect colposcopy follow up rates.

Age and Peripheral Blood Values Relationship Evaluation of Trichomonas Vaginalis, Candida, and Gardnerella Vaginalis Frequency in Cervicovaginal Pap Smear Screening in Aksaray Province

This study aimed to explore the correlation between causative agents of vaginitis detected in Pap smear screenings and various hematological indices, alongside the severity of infections observed in Pap smears. We analyzed 348 Pap smear results, which were categorized into normal and abnormal findings and further subdivided into groups based on the presence of Vulvovaginal Candidiasis (VVC), Bacterial Vaginosis (BV), and Trichomoniasis (TV). The degree of inflammation (mild, moderate, severe) was assessed in relation to hematological indices (Platelet Index Value (PIV), Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR)), guided by the 2014 Bethesda System for evaluation. Out of 1654 patients screened, 348 met the inclusion criteria (253 aged below 45 years; 95 aged 45 years and above). In the under-45 age group, 83.3% had normal findings, with prevalence rates for VVC, BV, and TV at 73.4%, 60.2%, and 80.0%, respectively. In the over-45 group, these figures were 16.7% (normal), 26.6% (VVC), 39.8% (BV), and 20% (TV). The prevalence of moderate vaginitis in Pap smears was 45.3% for VVC, 96.1% for mild BV, and 53.3% for moderate TV. In cases of Atypical Squamous Cells of Undetermined Significance (ASCUS), BV was predominant, while VVC and TV were absent in Low-Grade Squamous Intraepithelial Lesion (LSIL) and High-Grade Squamous Intraepithelial Lesion (HSIL) cases. BV was present in 7.8% of normal smears. Significant associations were observed between hematological parameters and the severity of inflammation in the normal smear category (p&amp;lt;0.001). In squamous cell anomaly cases, especially ASCUS, differences in SII, NLR, PLR, SIRI, and PIV were noted between severe and mild infections, as well as between moderate and severe infection groups. This research underscores the linkage between the severity of infection and cellular abnormalities identified in cervical cytology, causative agents of vaginitis, and hematological indices with inflammatory parameters, potentially informing clinical management strategies

Pap Smears Cytology of Cervical Abnormalities in Derna, Libya

The study aimed to provide information about the prevalence of various cervical lesions diagnosed by Papanicolaou smear tests among women in the city of Derna, in eastern Libya. The reporting of the Pap smears is based on the 2014 Bethesda system. The study included seventy-two cervical Pap smears cytology received at the Noor-AL-Huda Medical Center Pathology Laboratory in Derna City, east of Libya, and processed using conventional smear techniques. The data was gathered retrospectively from March 2022 to August 2023. A total of 72 cervical Pap smears were included in the study. The majority of the cases reported were Negative for Intraepithelial Lesions or Malignancy (NILM) 54 (75%). Out of the 72 reports, 2 (2.7%) were unsatisfactory. Low-grade Squamous Intraepithelial Lesions (LSIL) were found in 8 cases (11.11%), and 4 (5.5%) were High-grade Intraepithelial Lesions (HSIL). Atypical Squamous Cells cannot exclude HSIL (ASC-H) were found in 4 cases (5.5%). LSIL and HSIL were more common among women aged 30-40 years. The age of the patients included in this study ranged from 30 to 56, with a mean age of 40 years. These findings emphasize the importance of a well-organized cervical screening program. In particular, women over 30 years should be educated about the importance of Pap smears and encouraged to undergo regular screening.

A Systematic Literature Review: Performance Comparison of Edge Detection Operators in Medical Images

Medical images play a crucial role in the diagnosis of diseases. To make the diagnosis more accurate, the image should usually be enhanced first using image processing methods such as segmentation and edge detection stages. However, the complexity and noise that may arise in these images pose challenges in edge detection. Therefore, to portray the characteristics of edge detection operators, this research presents a systematic literature review of the performance of various edge detection operators in medical images, focusing on literature published between 2019 and 2023. After the selection process, 41 papers out of the initial 112 collected papers were chosen for further review. The study evaluates edge detection operators e.g., Canny, Sobel, Prewitt, Roberts, and Laplacian of Gaussian (LOG) on medical images such as X-rays, MRI, CT scans, ultrasound, Pap smears, and others. In the analysis, the accuracy, computational time, and response to noise of each operator are compared. The results indicate that despite longer computational times, Canny emerges as the most accurate operator, especially in Pap smear and CT scan images. The LOG operator offers high accuracy in MRI images with more efficient computational time. Evaluation of operator reliability against noise confirms the superiority of Canny. Furthermore, the future potential of edge detection in medical services is also reviewed. For instance, Canny, known for accurate and noise-resistant edges, enhances detection in complex CT-Scan and X-ray images. Meanwhile, LOG, handling artifacts with lower computational time, improves edge clarity in medical images. Potential applications include enhanced diagnosis, efficient patient monitoring, and improved image clarity in future medical services.

Prevalence of Human Papillomavirus Infection and its Association with the Risk of Cervical Cancer among Hiv-Positive Women in Plateau State, North-Central Nigeria

Study’s Novelty/Excerpt This study investigates the prevalence and risk factors of HPV among HIV-infected women in Plateau State, Nigeria, highlighting a significant correlation between low CD4+ counts, high viral loads, and increased HPV infection rates. By utilizing comprehensive diagnostic methods including ELISA for HPV detection and cytology for cervical abnormalities, the research offers robust data linking immunosuppression and HPV-related cervical pathology in a high-risk population. The findings emphasize the urgent need for targeted interventions to improve sexual health behaviors and further research on how low immunity accelerates cervical cancer progression in both HIV-positive women and the broader population. Full Abstract Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STI) associated with cervical, uterine, and anogenital cancers. Persistent infection with HPV is associated with abnormal cervical cells, which can develop into cervical cancer if left untreated. Human papillomaviruses are the first viruses to have been acknowledged to prompt carcinogenesis, and they are linked with cancers of the uterine cervix, anogenital tumours, and head and neck malignancies. A hospital-based study of HIV-infected women across the three senatorial zones of Plateau State, Nigeria, was conducted between November 2018 to November 2020. Ethical approval for the study was first obtained from the ethical committee of Plateau State Specialist Hospital Jos, and informed consent to participate in the research was also obtained from each participant. HIV status confirmation was first done through standard rapid test procedures, followed by cytology testing via the Pap smear procedure to detect any precancerous or malignant changes in the cervix. Subsequent detection of HPV utilized the ELISA procedure, while CD4+ cell count and viral load estimations were done using flow cytometry and nucleic acid amplification techniques, respectively. Questionnaires were administered to obtain information on cervical cancer risk factors and clinical presentations. The overall prevalence of HPV was 28% among HIV-infected women. More HPV infection (31.9%) occurred in women with low CD4+ count (0-200 cells/mm3), and also highest (50.0%) among women with the highest HIV viral load (&gt;100 copies/mL). The possible risk factors identified in this study include multiple sexual partnering, low condom usage, and coinfection with other STIs, among others. In conclusion, this study identified a high HPV prevalence, low CD4+ counts, and coinfection with other STIs among high-risk populations (HIV-infected women). We, therefore, recommend improved sexual behaviours and further research on the impact of low immunity on the rate of progression of cervical abnormality to cervical cancer, not just in HIV-positive women but in the general population.

Primary Malignant Melanoma of the Cervix with Rapidly Progressing Metastases

Introduction: Mucosal melanomas only account for 0.03% of newly diagnosed cancer cases. Female genital tract melanomas account for only 3% of all melanomas, with melanoma of the cervix accounting for less than 3% of all female genital tract melanomas. It is difficult to understand how mucosal melanomas arise as the pathogenesis is still unknown. The incidence of cutaneous melanoma has greatly increased over the years whereas the incidence of mucosal melanomas has stayed relatively steady. Given the rarity of melanoma of the cervix, a standard of care treatment has not been established. Based on the limited cases that have previously been treated, the first option is surgery for early stage melanomas with adjuvant radiation therapy indicated in some cases. The use of systemic chemotherapy is still controversial as it has not been shown to prevent metastases. Case Report: A 66-year-old postmenopausal female presented with heavy vaginal bleeding. A transvaginal ultrasound showed a complex cystic structure in the cervix and she was referred to gynecologic oncology. She was up to date on her pap smears, and they have always been normal. Patient was found to have a fungating 4 x 5 cm mass in the upper vagina and pathology demonstrated poorly differentiated malignant neoplasm. The patient was diagnosed with FIGO Stage IIA2 cervical cancer. Patient’s initial PET/CT demonstrated hypermetabolic area in the cervix consistent with known cervical carcinoma with no other uptake in the uterus. Weekly chemosensitization with cisplatin and external beam radiation was initiated. On clinical examination after treatment by the gynecologic oncologist, visible disease was seen confined to the cervix. An MRI of the pelvis showed response with the suspected tumor limited to the cervical stroma in the anterior and lateral portion of the cervix with no definitive parametrial tumor and no evidence of nodal metastasis. Second opinion from pathology review was received and results showed poorly differentiated malignant neoplasm immunohistochemically consistent with “melanoma”. After 25 fractions of daily radiotherapy with weekly cisplatin, patient underwent exploratory laparotomy for radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling. Final pathology of the uterus and cervix showed invasive poorly differentiated melanoma with deepest invasion of melanoma measuring 8mm and negative surgical margins. All lymph nodes removed during surgery were negative for malignancy. Adjuvant Pembrolizumab was started at this time. Two months postoperatively, the patient underwent CT surveillance again due to new onset chest wall and axillary nodules varying in size from 2-4 cm. Right chest wall axilla biopsy pathology was consistent with melanoma. At this time Pembrolizumab was discontinued and the patient was transitioned to Nivolumab and Ipilimumab 19 days after discontinuing Pembrolizumab. Four months postoperatively, additional CT scans were performed showing widespread metastatic disease in the lungs, chest wall, liver, peritoneum, retroperitoneum and left eye. Patient underwent left frontal craniotomy with tumor resection, and pathology was consistent with metastatic melanoma. Subsequent to craniotomy, the patient underwent three treatments with stereotactic radiosurgery. Despite treatment, six months postoperatively, the patient’s symptoms continued to progress with slurred speech, generalized weakness and abdominal pain. Ultimately, the patient passed away nine months after the diagnosis and four months after a combination of external beam radiotherapy, surgery, and vaginal brachytherapy. Discussion: Melanoma of the cervix is a rare type of cervical cancer with poor prognosis. Globally, 5-year survival is 18.8% for stage I, 11.1% for stage II, and 0% for stages III–IV. It has been shown that median overall survival time decreases with increasing FIGO stage. Risk factors have not been identified for gynecologic melanomas or most other mucosal melanomas. Pembrolizumab is most effective for cutaneous melanomas, however, has been shown to prolong progression free survival in mucosal melanomas. The median overall survival is significantly shorter for patients with mucosal melanoma (11.3 months) as compared to patients with a cutaneous primary (23.5 months). Primary malignant melanoma of the cervix (PMMC) remains a rare tumor and the prognosis is generally poor. Radical hysterectomy, chemoradiation, and immunotherapy have all been utilized in the treatment of PMMC. Further investigation of primary melanoma of the cervix is necessary to formulate a standard of care treatment.

Primary Malignant Melanoma of the Cervix with Rapidly Progressing Metastases

Introduction: Mucosal melanomas only account for 0.03% of newly diagnosed cancer cases. Female genital tract melanomas account for only 3% of all melanomas, with melanoma of the cervix accounting for less than 3% of all female genital tract melanomas. It is difficult to understand how mucosal melanomas arise as the pathogenesis is still unknown. The incidence of cutaneous melanoma has greatly increased over the years whereas the incidence of mucosal melanomas has stayed relatively steady. Given the rarity of melanoma of the cervix, a standard of care treatment has not been established. Based on the limited cases that have previously been treated, the first option is surgery for early stage melanomas with adjuvant radiation therapy indicated in some cases. The use of systemic chemotherapy is still controversial as it has not been shown to prevent metastases. Case Report: A 66-year-old postmenopausal female presented with heavy vaginal bleeding. A transvaginal ultrasound showed a complex cystic structure in the cervix and she was referred to gynecologic oncology. She was up to date on her pap smears, and they have always been normal. Patient was found to have a fungating 4 x 5 cm mass in the upper vagina and pathology demonstrated poorly differentiated malignant neoplasm. The patient was diagnosed with FIGO Stage IIA2 cervical cancer. Patient’s initial PET/CT demonstrated hypermetabolic area in the cervix consistent with known cervical carcinoma with no other uptake in the uterus. Weekly chemosensitization with cisplatin and external beam radiation was initiated. On clinical examination after treatment by the gynecologic oncologist, visible disease was seen confined to the cervix. An MRI of the pelvis showed response with the suspected tumor limited to the cervical stroma in the anterior and lateral portion of the cervix with no definitive parametrial tumor and no evidence of nodal metastasis. Second opinion from pathology review was received and results showed poorly differentiated malignant neoplasm immunohistochemically consistent with “melanoma”. After 25 fractions of daily radiotherapy with weekly cisplatin, patient underwent exploratory laparotomy for radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling. Final pathology of the uterus and cervix showed invasive poorly differentiated melanoma with deepest invasion of melanoma measuring 8mm and negative surgical margins. All lymph nodes removed during surgery were negative for malignancy. Adjuvant Pembrolizumab was started at this time. Two months postoperatively, the patient underwent CT surveillance again due to new onset chest wall and axillary nodules varying in size from 2-4 cm. Right chest wall axilla biopsy pathology was consistent with melanoma. At this time Pembrolizumab was discontinued and the patient was transitioned to Nivolumab and Ipilimumab 19 days after discontinuing Pembrolizumab. Four months postoperatively, additional CT scans were performed showing widespread metastatic disease in the lungs, chest wall, liver, peritoneum, retroperitoneum and left eye. Patient underwent left frontal craniotomy with tumor resection, and pathology was consistent with metastatic melanoma. Subsequent to craniotomy, the patient underwent three treatments with stereotactic radiosurgery. Despite treatment, six months postoperatively, the patient’s symptoms continued to progress with slurred speech, generalized weakness and abdominal pain. Ultimately, the patient passed away nine months after the diagnosis and four months after a combination of external beam radiotherapy, surgery, and vaginal brachytherapy. Discussion: Melanoma of the cervix is a rare type of cervical cancer with poor prognosis. Globally, 5-year survival is 18.8% for stage I, 11.1% for stage II, and 0% for stages III–IV. It has been shown that median overall survival time decreases with increasing FIGO stage. Risk factors have not been identified for gynecologic melanomas or most other mucosal melanomas. Pembrolizumab is most effective for cutaneous melanomas, however, has been shown to prolong progression free survival in mucosal melanomas. The median overall survival is significantly shorter for patients with mucosal melanoma (11.3 months) as compared to patients with a cutaneous primary (23.5 months). Primary malignant melanoma of the cervix (PMMC) remains a rare tumor and the prognosis is generally poor. Radical hysterectomy, chemoradiation, and immunotherapy have all been utilized in the treatment of PMMC. Further investigation of primary melanoma of the cervix is necessary to formulate a standard of care treatment.

Role of Pap Smear Cervical Cytology in the Diagnosis of Extrauterine Malignancies: Largest Study of 104 Cases from Tertiary Care Cancer Centre in India

Introduction: Extrauterine malignancies in cervical samples are rarely seen. It is important to differentiate these cells from those of primary uterine malignancies to determine appropriate line of further investigations and management. Literature on these lesions is limited largely restricted to case reports. The aim of the present study was to study the spectrum and cytomorphological features of extrauterine malignancies in cervical Pap smears. Materials and Methods: It is a retrospective and descriptive study conducted in Department of Cytopathology from January 2019 to July 2023. All cases of extrauterine malignancies with available cytology material were included in this study. All cases of primary uterine malignancies, i.e., uterine corpus or cervix confirmed by clinical, radiological, and histopathological examination were excluded. Results: 104 out of 11,674 cytology Pap smears were those of extrauterine malignancy. Diagnosis of extrauterine malignancy was given in 47.1% cases, 30.9% were reported as positive for malignancy without giving the possibility of an extrauterine origin, and 22.0% were reported as atypical glandular cells only. In 56 cases where Pap smear was the first investigation which led to the diagnosis. Most common extrauterine malignancy was adenocarcinoma principally from ovarian, colorectal, and vaginal origin. Other epithelial malignancies noted were urothelial carcinoma and invasive breast carcinoma. Among non-epithelial malignancies, we reported vaginal mucosal melanoma, cutaneous melanoma, acute leukaemia, and anaplastic large cell lymphoma. Conclusion: High index of suspicion, presence of squamous and glandular elements with no atypical features, and occasional clusters of cells with marked atypia and usually no necrosis in the background are helpful cytomorphological clues to raise suspicion for extrauterine malignancy. Correlation with serology, radiology, and immunocytochemistry can help in reaching final diagnosis.

Women’s Health Literacy Levels and Health Beliefs Concerning Cervical Cancer and Pap Smear Test in Türkiye

Women’s Health Literacy Levels and Health Beliefs Concerning Cervical Cancer and Pap Smear Test in Türkiye

Detection of Cervical Precancer Using Visual Inspection Method with Acetic Acid.

Cervical cancer screening is the priority activity of the government. Visual inspection with Acetic acid (VIA), Pap smear Liquid-based cytology, and HPV DNA testing are different methods of screening. VIA-based screening is the cost-effective method of screening in a resource-constrained setting like in our country as this doesn't require cyto-histological testing, can be performed by trained paramedics too, and is as accurate as a cytological test. The aim is to explore pre-cancer cervical lesions by screening women in the community by visual inspection using acetic-acid. Community-based cross-sectional study done at a health camp setting for three months from March to June 2023. The married non-pregnant women of 30-60 years were screened. Descriptive tests as well as sub-group analysis performed by Chi-Square tests. From ten community health camps, 1255 cases were screened and screen positivity was 14.3%. Positive results were proportionately distributed to all parity by 13-19%. Half of the positive results (47.2%) were in the 34-40 age group. There were no significant differences in screen positivity by parity or vaginal discharge. Menopausal women had 7.7% screen positivity. The prevalence of VIA positivity in the community was found double the previous facility-based prevalence; and there was no significant difference by parity, menopausal status, and vaginal discharge. The positivity was more in 30-45 years of age.

Screening Methods for Cervical Cancer.

Cervical cancer seriously affects the health of women worldwide. Persistent infection of high-risk HPV (Human Papilloma Virus) can lead to cervical cancer. There is a great need for timely and efficient screening methods for cervical cancer. The current screening methods for cervical cancer are mainly based on cervical cytology and HPV testing. Cervical cytology is made of Pap smear and liquid-based cytology, while HPV testing is based on immunological and nucleic acid level detection methods. This review introduces cervical cancer screening methods based on cytology and human papillomavirus testing in detail. The advantages and limitations of the screening methods are also summarized and compared.

Investigating the relationship between health literacy and preconceptual care components during the first 14 weeks of pregnancy: a cross-sectional study

Background and AimPreconceptual care aiming to improve health is influenced by various factors including health literacy. Considering the importance and necessity of high quality preconceptual care, this study aimed to determine the relationship between health literacy and receiving components of preconceptual care prior to pregnancy.MethodsThis cross-sectional study included 693 participants with pregnancies of less than 14 weeks gestation referred to health centers and gynecologists in Shiraz city, Iran. Multi-stage sampling was done from May 2021 to February 2022 in 18 comprehensive urban health centers and 20 gynecology offices via proportional allocation method. The data collection tool comprised a questionnaire consisting of 3 parts: (1) individual and fertility characteristics, (2) information related to the components of preconceptual care and (3) health literacy for Iranian adults. This was completed by individual participants via the self-reporting method.ResultsThe majority of participants were between 30 and 34 years old. They also identified as women with a university education and were predominantly unemployed. The mean health literacy of participants was 76.81%. Health literacy obtained the highest mean score in the dimension of ‘understanding’ and the lowest mean score in the dimension of ‘access’. The frequency of preconceptual counseling, folic acid supplement consumption, exercise, blood testing, dental visits, genetic counseling, Pap smear testing and rubella, diphtheria, and hepatitis vaccinations prior to pregnancy was 66.8%, 53.8%, 45.6%, 71.86%, 44.44%, 12%, 53.4%, 10.83%, respectively. Many (> 64%) received preconceptual care at specialist gynecology offices. Results demonstrated that health literacy had a statistically significant relationship with preconceptual care, folic acid consumption, exercise and dental care, (p < 0.001), along with blood testing and Pap smear testing (p < 0.05).ConclusionOverall, our results demonstrate that despite health literacy being optimal, uptakes of some components of preconceptual care are low. As such, it will be important to further raise awareness of the importance of preconceptual care for people prior to pregnancy as a priority in health promotion and education.

Factors related to knowledge, attitudes, and behaviors regarding cervical cancer among Yemeni women

BackgroundCervical cancer (CxCa), although preventable, is still among the most prevalent cancers in women. Mortality from this cancer is high, especially in low-income countries where preventive strategies are often lacking. We studied the knowledge, attitudes, and practices regarding CxCa among Yemeni women.MethodsThis cross-sectional study was conducted in 2019 among 399 women in five major hospitals in Sanaa, the capital city of Yemen. Data were collected through face-to-face interviews using structured questionnaires. We used logistic regression models to analyze the likelihood of hearing about CxCa, believing that CxCa is treatable and preventable, awareness of the Pap smear test, and ever having this test, in relation to participant’s age, education level, working outside the household, and family history of CxCa.ResultsOnly 66.7% of the women had heard of CxCa. Women with higher education, working outside the household, and with a family history of CxCa were more likely to be aware of CxCa. Working outside the household was the only variable related to a higher likelihood of knowing that CxCa is a treatable and preventable. Furthermore, women with a family history of CxCa were more likely to have knowledge about Pap smear test and were more likely to have Pap smear test in the past.ConclusionThis study identified a low awareness of CxCa and its prevention among Yemeni women. In order to reduce the burden of CxCa in Yemen and save women’s lives, it is necessary to raise women’s awareness of this disease, especially among those with lower education and those not involved in work outside their homes.

Toward Interpretable Cell Image Representation and Abnormality Scoring for Cervical Cancer Screening Using Pap Smears.

Screening is critical for prevention and early detection of cervical cancer but it is time-consuming and laborious. Supervised deep convolutional neural networks have been developed to automate pap smear screening and the results are promising. However, the interest in using only normal samples to train deep neural networks has increased owing to the class imbalance problems and high-labeling costs that are both prevalent in healthcare. In this study, we introduce a method to learn explainable deep cervical cell representations for pap smear cytology images based on one-class classification using variational autoencoders. Findings demonstrate that a score can be calculated for cell abnormality without training models with abnormal samples, and we localize abnormality to interpret our results with a novel metric based on absolute difference in cross-entropy in agglomerative clustering. The best model that discriminates squamous cell carcinoma (SCC) from normals gives 0.908±0.003 area under operating characteristic curve (AUC) and one that discriminates high-grade epithelial lesion (HSIL) 0.920±0.002 AUC. Compared to other clustering methods, our method enhances the V-measure and yields higher homogeneity scores, which more effectively isolate different abnormality regions, aiding in the interpretation of our results. Evaluation using an external dataset shows that our model can discriminate abnormality without the need for additional training of deep models.

A 'smear campaign' against patient-excluded policy changes: a reflection on the language used in cervical screening programmes.

Cervical screening has transformed the diagnosis of cervical cancer. However, uptake within the national screening programme is not uniform across demographics. This raises the question of whether medical language, which conveys essential information but also shapes attitudes towards engaging with healthcare, is part of the problem. The term "smear test" has been used for generations and is embedded in colloquial and medical vocabulary. However, there is a danger that the phrase may conjure images of an unpleasant or even reckless ordeal, potentially contributing to unnecessary patient anxiety. To evaluate patient attitudes towards the terms "cervical smear" and "cervical brush". Female participants from a single GP surgery were randomly sampled. Data from questionnaires were then subjected to thematic analysis. Half of patients interviewed did not feel either term would significantly influence cervical screening uptake. Equal numbers of patients expressed an overall preference for each of the two terms, and the remaining 28% expressed no preference. Qualitative data revealed some patients favoured the familiarity of the term "cervical smear", and others preferred the descriptive accuracy of "cervical brush". It is imperative to consult target groups and use inclusive language that minimises stigmatising or negative connotations. Modifying language alone is unlikely to remedy the current access barriers in UK cervical screening. Instead, a multifaceted approach that also targets education and addresses systemic issues could offer a more sustainable strategy. Ultimately, prioritising a patient-centred approach could improve access to life-saving screening.