Reduction In Cervical Cancer Mortality Research Articles

Controversy in Colposcopic Management: A Canadian Survey

ObjectiveThe substantial reduction in cervical cancer mortality over the last 40 years is attributed to the use of Papanicolaou cervical smear screening with subsequent colposcopic assessment and treatment. Although there is consensus regarding colposcopic management of high-grade intraepithelial cervical lesions, optimal management of patients with low-grade (LG) lesions is less clear. Our goal was to document the colposcopic management of the latter group in Canada. MethodsA survey was mailed to 252 colposcopists in seven Canadian provinces who recommended management for colposcopy scenarios. Responses were reported in aggregate form. ResultsA total of 120/252 (48%) completed questionnaires. Most respondents were 41 to 50 years old, and 68% were male. For women found on colposcopy to have no evidence of a low-grade cervical LG lesion, 43% recommended discharge from colposcopy, and 53% recommended repeat colposcopy. For referrals with a biopsy-confirmed LG lesion, 13% recommended discharge to cytological follow-up, 65% recommended repeat colposcopy, and 16% recommended treatment. Following excisional treatment of LG lesions with negative margins, 13% recommended discharge to cytological follow-up, and 69% recommended further colposcopy. ConclusionThese results demonstrate wide variation in management of low-grade cervical lesions among Canadian colposcopists and highlight the need to establish evidence-based management protocols.

Proficiency testing in cervical cytopathology

Cervical cancer is a leading cause of cancer death in women and may be significantly reduced by the introduction of effective screening and treatment programs. Although proficiency testing programs should, in principle, contribute to the reduction of cervical cancer mortality, the data does not provide convincing evidence for such a result. In this paper we review some results from current and past cytology proficiency testing programs, outlining the challenges to be overcome if these programs are to have an effect on cervical cancer mortality.

Molecular detection of cervical intraepithelial neoplasia and cervical carcinoma by microsatellite analysis of Papanicolaou smears.

Carcinoma of the uterine cervix is one of the most common malignancies worldwide, yet it is clearly preventable by population screening. The Papanicolaou (Pap) smear has proved to be the most successful test for the detection of precancerous lesions and is largely responsible for the reduction of cervical cancer mortality and morbidity rates. However, the Pap smear is not perfect; false-negative results of various rates are reported. To improve the diagnostic efficacy of cervical cytology, we performed microsatellite analysis on paired Pap smear samples from cervical lesions. Nine microsatellite markers were chosen from chromosomal regions commonly displaying loss of heterozygostity (LOH) in cervical cancer and those displaying microsatellite instability (MI) in other squamous cell cancer. Microsatellite alterations were detected in 16/21 (76%) Pap smear DNA samples including 11 of 13 (85%) smears from invasive squamous cell carcinomas (SCCs) and 5 of 8 (63%) from squamous intraepithelial lesions (SILs). Microsatellite alterations detected in the Pap smear DNA were identical to those identified in seven paired primary tumors available for analysis. Moreover, this molecular approach detected genetic alterations in two cases apparently negative by cytologic examination. None (0/25) of the control patients displayed microsatellite alterations in paired Pap smears. Microsatellite analysis of cervical cytologic samples may provide a complementary method to analyze suspicious but not diagnostic cytologic samples further.

Detection of cervical intraepithelial neoplasia in developing countries

The reduction of cervical cancer mortality in developing countries is only one of many priorities competing for scarce funds. Incidence of cervical cancer may be up to six times higher in these countries than in developed countries due to lack of screening programs. The current WHO recommendation is to evaluate visual inspection as a way of identifying early curable cancer, as screening by cytology is too complex and expensive. Hence, an assessment of visual inspection aided by acetic acid (VIA) has been conducted in Zimbabwe. The study aimed to find out the true sensitivity, specificity, and positive predictive value (PPV) for high-grade CIN. The subject group was composed of 10,934 women screened by VIA and by exfoliative cervical cytology. The main findings of the study were that VIA was abnormal in about 20% of women; moreover, the test had a PPV of 25.9%, meaning that 3 out of 4 women would potentially be overtreated. VIA, however, represents a proven, simple means of identifying women in undeveloped health facilities, though level of training is probably critical to its success. Screening should go hand in hand with health education, which has proven valuable in reducing the rate of deaths from cervical cancer.

Pap smear screening and changes in cervical cancer mortality in Sweden

OBJECTIVES: Age-adjusted incidence of cervical carcinoma has fallen dramatically in Sweden in recent decades. This investigation is an attempt to evaluate the effectiveness of the gynecologic Pap smear screening program in terms of reduction of mortality from cervical cancer. METHODS: Cervical cancer mortality trends in relation to age, calendar period, county and degree of screening activities in the population were analyzed. Multiplicative Poisson regression models were utilized. The reduction of mortality was attributed to the activities of cervical screening. RESULTS: The analysis gave a calculated 53% reduction in cervical cancer mortality (95% confidence limits 23–72%), attributable to screening. CONCLUSIONS: The study supports the hypothesis that gynecological Pap smear screening has had an important impact on the reduction in cervical cancer mortality.