Rural Cervical Cancer Screening Research Articles

Detailed analysis of different risk factors of cervical cancer including HPV infection at different stages of follow up of squamous intraepithelial lesions of cervix (SIL) in rural women

Background: As situation regarding carcinoma cervix is still alarming in rural population of India, the management of HPV infection and other risk factors contributing to the development of cervical cancer might play a great role in checking the incidence of the disease. Methods: Rural cervical cancer screening is in progress since May 2013 in the western rural region of Lucknow through camp approach and till date, follow up is available in 264 of the totals 498 Squamous Intraepithelial Lesions of Cervix (SIL) showing regression (204) and persistence of the lesions (60). The risk factors including HPV infection have been studied in detail at different stages of follow up in these two groups. Results: Number of risk factors as obvious showed decline in the regressed cases with subsequent follow up which was lacking in the persistent group. Individually, young age factor showed decline with subsequent follow up while multiparity has been found prominent risk factors in both the groups at all stages of follow up. It was seen that the regression rate was high in women above the age of 30 years with multiparity. The decrease in number of vaginal discharge and erosion cervix cases was also found associated with regression of SIL. Conclusion: The risk factors can predict the biological behavior of SIL towards the progression or regression of the lesions and lead to the better management of any cancer screening program. This will also reduce the follow up burden and treatment costs and will thus enhance the overall acceptability at rural level.

Our seven years experience of rural cervical cancer screening in Lucknow, India

This study was undertaken with aim to create awareness among rural women regarding hazards and risk factors of carcinoma cervix and offering single life time cytological screening for early detection of the disease. This was essential as majority of the rural women were illiterate and have poor personal genital hygiene. The present screening program was planned through organizing camps by counseling and motivating 100 women from each village for undergoing Pap smear examination. During last 7 years, a total of 186 camps have been organized in three Blocks of Lucknow, India and 2949 of the 5286 women attending the camps underwent Pap test. Cytological findings were analyzed in these 2949 women in relation to different risk factors of the disease.The squamous intraepithelial lesions of cervix (SIL) were seen in 498 cases (16.8%) while atypical squamous epithelial changes of unknown significance (ASCUS) were observed in only 234 (8.2%). The SIL incidence was found high for all risk factors of cervical cancer like young age, multiparity and vaginal discharge. Candida albicans was found more common and associated with inflammatory and SIL conditions of cervix.The organization of rural cervical cancer screening programs through camp approach and offering single life time cytological examination of cervical smears in rural women may prove very effective in the detection of large number of SIL cases, the adequate treatment of which will check the progression of the disease and minimize the incidence of carcinoma cervix and associated mortality in rural India.

Detection of human papillomavirus high-risk genotypes in rural women of Lucknow, North India.

Human papilloma virus (HPV) has been widely implicated in cervical carcinogenesis and 90% of carcinoma cervix cases are due to high-risk HPV infection. This study was done to find the high-risk HPV genotypes in the rural women of Lucknow, North India. HPV-DNA testing has been carried out in 130 cases of squamous intraepithelial lesions (SILs) of the cervix to find HPV status and type of high-risk HPV genotype infecting the rural women. These cases were collected from the rural cervical cancer screening program carried out in the villages of West Lucknow, North India. HPV status in 130 SIL cases revealed HPV positivity in only 17 cases (13.1%), whereas the remaining 113 cases were HPV negative (86.9%). HPV genotypes detected in the study were HPV-18, HPV-31, HPV-33, and HPV-35. HPV positivity was found highly associated with the young and sexually active group of women complaining of vaginal discharge. High HPV infection rate was also seen with multiparity and illiteracy as majority of women attending the camps were multiparous and illiterate. The present study revealed highly oncogenic HPV-18 alone or in combination with multiple infections of high-risk genotypes - 31, 33, and 35 - in the rural women of Lucknow, North India. Since HPV vaccine currently available in India is for HPV-16 and HPV-18 combined, efforts should be made to make region-specific vaccine according to their prevalence in that particular state of the country to provide effective HPV vaccination.

Assessment of micronuclei counts as tumour marker in cervical carcinogenesis: A follow-up study.

Micronuclei counts were performed in cervical smears with low-grade squamous intraepithelial lesions of the cervix (LSIL) to assess its potentiality as tumour marker in cervical carcinogenesis. The cases studied were from the ongoing rural cervical cancer screening in west Lucknow, India. Micronuclei counts were performed in the cervical smears of 100 LSIL cases, and the number of cells with micronuclei was defined as micronucleated cells (MNC) and the number of micronuclei per 1000 cells as MNC score. Human papillomavirus (HPV) DNA testing was also done in 100 LSIL cases by GeneNav qPCR test. A high MNC score was found in 20 of the 100 LSIL cases while the counts were low in the remaining 80. Persistence of LSIL was seen in 19 of the 20 LSIL cases with high MNC score while only six cases of the 80 cases with low MNC score showed persistence. The persistence of LSIL was very high in cases with high MNC score. The multiple high-risk HPV types such as 18, 31, 33 and 35 were seen in 12 of the 100 LSIL cases and a high positivity rate was seen in women with high MNC score. The persistence of LSIL was also higher with HPV positivity. The study revealed correlation between high MNC score, persistence of LSIL and HPV positivity. Hence, MNC score can prove to be very useful in discriminating high-risk LSIL cases that are less likely to regress and possibly may progress to high-grade squamous intraepithelial lesions or carcinoma.

Analysis of the reported data of national rural cervical cancer screening project from 2012 to 2013, China

To analyze the reported data of national rural cervical cancer screening project from 2012 to 2013 and to evaluate the project implementation condition. Data of the national breast carcinoma and cervical cancer (two-cancer) screening project for rural women were collected from the online report system of key women and children's public health service programs.The screening items included: preliminary screening of cervical lesions (cervical cytology, using Traian Bethesda System(TBS) or Pap grading for classification and reporting), acetate/iodide staining (VIA/VILI), colposcopy, histopathological examination, and pathological diagnosis. The study collected the quarterly reported data from 1 183 counties of 30 provinces in 2014 and 1 130 counties of 30 provinces in 2013. Chi-square test was used to test the difference of positive detection rate, as well as precancerous cervical lesions, and cervical cancer detection rates among difference preliminary screening methods in 2012 and 2013. In 2012 and 2013, the number of cervical cancer screening was 10 621 482 and 10 321 835. The percentage of using ThinPrep cytological test as the screening method was 77.17% (n=8 196 627) and 77.07% (n=7 954 949) in 2012 and 2013, respectively. Among these ThinPrep cytological tests in these two years, 65.49% (n=5 368 194) and 71.67% (n=5 701 033) used TBS report system. The abnormality rate of colposcopy increased from 27.29% (170 063/623 161) to 31.15% (203 397/652 935) (χ(2)=2 295.94,P<0.001). The abnormality rate of histopathology test increased from 19.54% (37 992/194 394) to 35.43% (59 004/166 518) (χ(2)=11 523.58, P<0.001). All together, 27 341 cervical cancer or precancerous lesions have been detected in these two years. The detection rate of invasive cervical cancer increased from 18.02/100 000 in 2012 to 19.71/100 000 (χ(2)=7.90,P=0.005) in 2013 and that of precancerous lesions rose from 106.85/100 000 to 119.26/100 000 (χ(2)=70.82,P<0.001). The early detection rate was 89.60% (11 883/13 263), and 89.57% (12 609/14 078), respectively in 2012 and 2013. In these two years, the rank of the detection rate of each cervical lesion were CIN1, CIN2, CIN3, invasive carcinoma, adenocarcinoma in situ, and microinvasive carcinoma, from the highest rate to the lowest rate. The program has achieved certain screening effect and the screening method has been improved. However, the quality of colposcope and histopathology should be enhanced.

Cervical Cytology Associated with Pelvic Inflammatory Diseases

Objective: The present study was aimed to investigate the incidence of squamous intraepithelial lesions of cervix (SIL), frank cervical cancer and different STDs in 503 women with pelvic inflammatory disease (PID). Study design: Cytological evolution of cervical smears was carried out in 503 women attending Gynae Outpatient Department of Era’s Lucknow Medical College, Lucknow India, between October 2009 and June 2014 who were diagnosed with PID and also during Rural Cervical Cancer Screening in Malihabad and Kakori Block of Lucknow District between May 2013 to April 2015. Results: The cervical cytology in 503 women with PID showed alarmingly high rate of SIL (144- cases -28.6%) though 134 of them were of low grade. No case of carcinoma cervix was seen. The incidence of Candida albicans was 4.3% in these women and only 2 cases of Trichomonal infection were seen. The incidence of SIL was maximum in younger, sexually active women between 21-30 years after which it declined. Conclusion: The study revealed a very high incidence of SIL associated with PID. As majority of the women screened were from rural areas, it appears that poor hygiene and persistent infection has led to the high incidence of SIL. Hence urgent need is felt in organizing cytological screening programme in rural region of the country to screen specially the symptomatic women to detect any early onset of cervical precancer, the subsequent treatment of which would check any progression of the disease to malignancy.

1455P - Cervical Cancer Screening Using Visual Inspection after Application of 5% Acetic Acid (VIA) in Rural West Bengal

ABSTRACT Background Because of problem of manpower in developing countries, cytology screening for cervical cancer is gradually replaced by a Visual Inspection after application of 5% acetic acid (VIA) with triage of colposcopy. Objectives Hence, government and other funding bodies in India are now eager to see its efficacy in the field to screen and manage cervical pre cancer (CIN) in a “see & treat” approach. Methods This simple technology combined with colposcopy is planned in a biotechnology based programme for women under Department of Biotechnology, Govt. of India where efficacy of VIA was assessed by camp approach in rural area of a remote district (Burdwan) of West Bengal province in India from August 2010 to August 2011. We used video colposcopy as triage and managed positive cases by Loop Electrosurgical Excision Procedure (LEEP). We evaluated our early screening and management results by finding out detection rates of early lesions of cervix and in this uncontrolled observational study. Results A total of 2836 women participated in our rural camp for screening during this period. Amongst them 2354women could be subjected to visual inspection by acetic acid (VIA) using 200 watt bulb and 5% acetic acid by the trainedcommunity nurse. We could not do VIA in 482 subjects because of no consent-22.80%, non-cooperation-23.40%, unmarried-18.60%, menstruating-12.80%, pregnant-10.50%, hysterectomised-9.10% and cervix cancer neglected or infollow up-2.50%. We could detect 415 cases of VIA positive cases showing white lesion in their cervix. Colposcopic prediction of cervical Intra-epithelial neoplasia grade I(CIN I) lesion could be detected in 174 cases. These cases are of no immediate risk and most of them actually showregression of their disease. Hence, they are advised to have follow-up colposcopy after six months. There were 25 cases of condyloma/ polyp. They were managed by electro- cautery. We could detect and treat 33 cases of CIN II andIII which are precursor of cervical cancer. They were treated by LEEP. Conclusion Our results show that VIA with colposcopy triage is viable option in rural cervical cancer screening programme in our outreach program. Disclosure All authors have declared no conflicts of interest.

Abstract B30: Patient navigation for cervical cancer in Kentucky: Baseline results

Abstract Background: Although morbidity and mortality rates are low compared to other types of cancer, cervical cancer remains a high priority for the following reasons: 1) invasive cervical cancer is a disease that could be prevented in nearly all cases, with greater use of the Pap test; 2) the Pap test is a well-established, low cost, widely available screening test that should present minimal barriers to its use; and 3) despite our ability to prevent and treat cervical cancer, the burden of cervical cancer morbidity and mortality continues to be higher among low-income women with limited education, many of whom reside in rural areas. Despite public health recommendations for cervical cancer screening and follow-up of abnormal Pap test results, adherence is still low among rural Appalachian women in Kentucky. In response to this concern, the University of Kentucky Prevention Research Center is implementing a National Cancer Institute-funded project that is integrating patient navigators (PN) in cervical cancer screening programs in several rural health departments. Goal: To reduce the disproportionate burden of cervical cancer experienced by rural Appalachian women in Kentucky. Objectives: To: 1) improve our understanding of the barriers to follow-up; 2) recruit, train, and utilize lay health workers as PNs in cervical cancer screening programs; 3) increase the proportion of women who adhere to recommended follow-up; and 4) evaluate the efficacy of the intervention. Method: Intervention activities are as follows: 1) nurse case managers refer patients with abnormal pap tests to PNs in selected local health departments in Big Sandy, Lake Cumberland, and Kentucky River Area Development Districts; 2) PNs enroll patients in the study; 3) study participants complete a baseline interview; 4) PNs provide navigation services including outreach, education, and support; 5) PNs conduct follow-up interviews; and 6) PNs document follow-up recommendations, barriers, patient needs, and specific actions taken to ensure adherence to follow-up recommendations. Evaluation: To assess the efficacy of the intervention, outcome data will be collected from health department records in intervention and control counties. Findings: The total number of referrals to date is 600. Among the referrals: 82 (14%) were ineligible (patient less than 18 years, refused services, dropped by health department for non-compliance, or lost to follow-up); 379 (63%) were offered enrollment; and enrollment is pending for 139 (23%). Among those offered enrollment, 297 (78%) agreed to participate in the study. Additional preliminary findings will be presented including reason for referral, characteristics of women enrolled, patient needs, adherence to follow-up, etc. Conclusions: The program creates a unique opportunity to support rural cervical cancer screening programs, ensuring women obtain their recommended follow-up care through the support of PNs. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B30.