Cervical Cancer Screening Tests Research Articles

Assessing 10-Year Safety of a Single Negative HPV Test for Cervical Cancer Screening: Evidence from FOCAL-DECADE Cohort.

Long-term safety of a single negative human papillomavirus (HPV) test for cervical cancer screening is unclear. The HPV FOr cerviCAL Cancer Trial (FOCAL) was a randomized trial comparing HPV testing with cytology. The FOCAL-DECADE cohort tracked women who received one HPV test during FOCAL, and were HPV negative, for up to 10 years to identify cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+) detected through a provincial screening program. FOCAL participants who received one HPV test, were negative, and had at least one post-FOCAL cervix screen were included (N = 5,537). We constructed cumulative incidence curves of CIN2+/CIN3+ detection, analyzed cumulative risk of detection at intervals post-HPV test, calculated average incidence rates for detection, and compared hazard across ages. Ten years after one negative HPV test, the probability of CIN2+ detection was lower than 1%, with most lesions detected 7 years or later. Average incidence rates of CIN2+/CIN3+ lesions over follow-up were 0.50 [95% confidence interval (CI), 0.31-0.78] and 0.18 (95% CI, 0.07-0.36) per 1,000 person-years, respectively. Hazards were higher for younger ages (nonsignificant trend). Among women with a single negative HPV test, long-term risk of CIN2+ detection was low, particularly through 7 years of follow-up; thus, one negative HPV test appears to confer long-term protection from precancerous lesions. Even 10-year risk is sufficiently low to support extended testing intervals in average-risk populations. Our findings support the safety of screening policies using HPV testing alone at 5-year or longer intervals.

Screening Tests for Cervical Cancer Up-To-Date

Screening Tests for Cervical Cancer Up-To-Date

Turkish and Moroccan Dutch women's views of using a self-sampling kit for human papillomavirus testing as a tool for cervical cancer screening: What are the barriers and the motivators?

Objective:This study explores barriers and motivators to use self-sampling kits for human papillomavirus testing for cervical cancer screening as perceived by Dutch women of Turkish and Moroccan origin living in the Netherlands.Methods:A total of 11 in-depth semi-structured interviews were conducted and structured according to the theory of planned behavior.Results:Findings suggest that self-sampling may lift important barriers hampering traditional cervical cancer screening, such as those related to shame and chastity. However, self-sampling raises its own barriers too. Most importantly, some women fear that self-sampling may harm virginity. Some women also do not feel confident about their ability to properly use the self-sampling kit, but fears about the inability to properly use it often fade away upon having seen the self-sampling kit. Moreover, results show that knowledge about cervical cancer and its origin is limited, which may undermine women’s willingness to participate in a screening program.Conclusions:These results suggest that communication strategies to encourage using self-sampling kits among women of Turkish and Moroccan origin could benefit from culturally sensitive approaches, for example, by placing emphasis on issues such as virginity and chastity. Consistent with a recent advice of the Health Council of the Netherlands, the kit could furthermore be sent to eligible women as a standard procedure, rather than upon request. This could reduce hassle and doubts about women’s ability to use the self-sampling kit. Finally, educating women about the importance of screening to prevent cervical cancer is needed to foster informed decision-making.

Procena uticaja stavova žena o benefitu skrininga i motivacionih faktora na njihovo učešće u Papanikolau skrining testu

Introduction: In Serbia, cervical cancer (CC) is the second most common cancer, after breast cancer, The Papanicolaou test is used for the early detection of cervical cancer. Motivational factors and attitudes of women about the benefits of the Papanicolaou screening test can affect the rate of participation in it. The aim of the research was to examine whether there is a connection between women's attitudes about the benefits of screening and motivational factors and their participation in the Papanicolaou screening test of CC. Methods: This cross-sectional study included 300 women aged 25 to 64, who came for a gynecological examination to the Gynecology and Obstetrics Clinic "Narodni Front" in Belgrade, in the period from June to December 2015. Data were collected from all respondents on their demographic characteristics, reason for coming to the clinic, how often they underwent screening (Papanicolaou test), as well as data on their attitudes about the benefits of screening and motivation for undergoing the Papanicolaou screening test using a part of the questionnaire called CPC -28 questionnaire (in Spanish Creencias, Papanicolaou, Cancer - 28). Results: Of the 300 women who participated in the study, 37.3% of women regularly participated in the Papanicolaou test, 43.7% irregularly, and 19.0% never. Women who participated regularly in screening were significantly more likely to believe that it was important to have a regular Pap test to know they were healthy (F = 13.59; p ˂ 0.001) and that the Pap test was the best way to determine early-stage CC (F = 12.29; p ˂ 0.001) compared to women who were irregular and who had never participated in screening. Women who participated irregularly or who had never participated in the screening program would be motivated to participate in it significantly more often if someone developed CC in their family or environment (F = 5.11; p = 0.007), while women who regularly participated would be motivated significantly more often by gynecologist's recommendations (F = 5.58; p = 0.004) and care for their own health (F = 6.93; p = 0.001). The high level of motivation was significantly related to the decision of women to regularly participate in screening (ch² = 13.05; p = 0.001) in relation to women who were irregular or who had never participated in screening. Conclusion: Within this research, it was noticed that only every third respondent regularly underwent the Papanicolaou screening test, which is far lower than the set national goals that at least 75% of the target population of women aged 21 to 69 should be covered by organized screening. It is necessary to raise women's awareness about the importance of Papanicolaou screening for early detection of CC, as well as about all other preventive measures, and especially about the importance of the HPV vaccine.

The first-round results of a population-based cohort study of HPV testing in Japanese cervical cancer screening: baseline characteristics, screening results, and referral rate.

ObjectiveIn 2013, a cohort study aimed to clarify the positive and negative effects of introducing the human papillomavirus (HPV) testing for population-based cervical cancer screening has been launched in Japan. This study included four screenings during the subsequent 7-year follow-up period. We aim to describe the results of the first round of this study on cervical cancer screening here.MethodsThis study began in September 2013 with recruitment completed in March 2016. Women aged 30–49 years were divided into 2 groups: those who received uterine cervical cytology alone in the first year (control group), or those who received a combination of cytology and HPV testing (intervention group), based on their age. After first screening, women with positive result of cytology or positive HPV test required referral. We summarized the results of the first round of cervical cancer screening.ResultsOf the 25,074 women who were eligible for the study, 13,845 women (55.2%) were screened with cytology alone; 11,229 women (44.8%) received a combination of cytology and HPV testing. After screening, 407 women (2.9%) in the control group and 1,003 women (8.9%) in the intervention group required referral, respectively. Adding HPV testing increased referral rate significantly (p<0.001).ConclusionAfter first screening, introduction of HPV testing appears to contribute to significantly higher referral rates, suggesting that the number of colposcopies as a detailed examination may increase. These preliminary findings suggest that if HPV testing is introduced into screening, medical institutions need to be prepared for an increasing number of follow-up examinations.

Learning From Cervical Cancer Survivors: An Examination of Barriers and Facilitators to Cervical Cancer Screening Among Women in the United States.

Background:Screening and timely follow-up have lowered cervical cancer incidence in the US; however, screening coverage, incidence, and death rates have remained fairly stable in recent years. Studies suggest that half of women diagnosed with cervical cancer don’t receive appropriate screening prior to diagnosis; cervical cancer survivors can provide crucial insight into barriers and facilitators to screening.Methods:Participants were cervical cancer survivors ≥21 years, identified through population-based central cancer registries (CR) in 3 US states or a social network (SN), Cervivor. CR participants completed a mailed survey on screening history, barriers, and facilitators to screening and sociodemographic data. SN participants completed the same survey online.Results:CR participants (N = 480) were older, with a lower proportion of non-Hispanic white, married, and insured women compared to SN participants (N = 148). Fifty percent of CR and 79% of SN participants were screened 5 years prior to their diagnoses. Of those screened, 28% in both groups reported not following-up on abnormal results. For both groups, the most frequently identified screening barrier was that participants never imagined they would develop cervical cancer (percent agree CR = 76%; SN = 86%), and the facilitator was wanting to take care of their bodies (CR = 95%; SN = 94%).Conclusion:Addressing key barriers to obtaining screening and timely follow-up related to lack of knowledge of cervical cancer risk and screening tests and addressing insurance coverage in the design or modification of interventions may increase cervical cancer screening and lower cervical cancer incidence in the US.

Summary of Current Guidelines for Cervical Cancer Screening and Management of Abnormal Test Results: 2016-2020.

Cervical cancer can be prevented through routine screening and follow-up of abnormal results. Several guidelines have been published in the last 4 years from various medical societies and organizations. These guidelines aim to personalize screening and management, reducing unnecessary testing in low-risk patients and managing high-risk patients with more intensive follow-up. However, the resulting complexity can lead to confusion among providers. The CDC, NCI, and obstetrician-gynecologists involved in guideline development summarized current screening and management guidelines. For screening, guidelines for average-risk and high-risk populations are summarized and presented. For management, differences between the 2012 and 2019 consensus guidelines for managing abnormal cervical cancer screening tests and cancer precursors are summarized. Current screening guidelines for average-risk individuals have minor differences, but are evolving toward an HPV-based strategy. For management, HPV testing is preferred to cytology because it is a more sensitive test for cancer precursor detection and also allows for precise risk stratification. Current risk-based screening and management strategies can improve care by reducing unnecessary tests and procedures in low-risk patients and focusing resources on high-risk patients. Knowledge of screening and management guidelines is important to improve adherence and avoid both over- and under-use of screening and colposcopy.

The Effect of Health Literacy Level on The Use of Primary Health Services in Adult Patients

Aim: In this study, we aimed to determine and evaluate the relationship between health attitudes, use of health services and health literacy levels of adult patients registered in the "Hürriyet Educational Family Health Center" where we provide primary health care services in our family medicine clinic. Methods: In our study, 242 patients admitted to the Hürriyet Education Family Health Center, aged between 18-80 years, underwent a two-stage questionnaire face-to-face. In the first part, the patients were asked questions on sociodemographic data as well as the use of primary health care services and their attitudes. In the second part, HL levels were determined using the TSOY-32 (Turkish Health Literacy Questionnaire-32) scale, which measures the HL levels of participants. Results: The total sample size was 242. Of the participants, 51.2% (n=124) were female and 48.8% (n=118) were male. The HL scores of the participants on the TSOY-32 were determined. The average score was calculated as 29.77±5.36. Inadaquate, problematic, sufficient and excellent health literacy levels were distributed as 13%, 64%, 22% and 1%, respectively. Health literacy scores of participants who applied to health institutions in acute or urgent situations were higher than those who applied only for prescription medicine. It was found that the mean scores of the group without any disease were higher than the group with one disease or the group with more than one disease. Evaluating primary health care service usage, it was determined that patients who were over 50 years old and gave a stool sample had a greater representation in the high HL group than those who did not. Likewise, women over 40 years who had mammography screening had a greater representation in the high HL group than those who did not. Looking at the aspect of cervical cancer screening tests, more women had a papsmear test in the high HL group than those who did not. Conclusions: Health literacy has an increasingly important place due to the increasing elderly population and the increasing number of patients with chronic diseases. Health literacy affects patient health attitudes on healthcare, outpatient appointments, family physician visits, usage of primary care services and cancer screening programs. All these subjects are important factors for improving the health of society. Family physicians should take great steps to improve the health literacy of their registered patients, since primary prevention starts with patient knowledge about health literacy.

Effectiveness of High-risk Human Papillomavirus Testing for Cervical Cancer Screening in China

Evidence is needed regarding the introduction of high-risk human papillomavirus (hrHPV) testing into China's national cervical cancer screening program. To evaluate hrHPV testing as a new screening modality for the national program. This population-based, multicenter, open-label, randomized clinical trial took place across 20 primary health care centers in urban and rural areas across China. At least 3000 women aged 35 to 64 years per site were invited to participate, for a total of 60 732 women evaluated. At baseline, women were randomly assigned to cytology, hrHPV testing, or visual inspection with acetic acid and Lugol iodine (VIA/VILI) (rural only). Women who tested positive for hrHPV were randomized into cytology-triage, VIA/VILI-triage (rural only), or direct colposcopy arms. Regarding primary or triaging tests, women with cytological abnormalities or who tested positive with VIA/VILI were referred to colposcopy. After 24 months, combined screening of cytology, hrHPV testing, and VIA/VILI was performed, and all women with positive results were referred to colposcopy. The primary outcomes were cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3+ yields. The secondary outcome was colposcopy referral rate. A total of 60 732 women were included in this study, with median (interquartile range) age of 47 (41-52) years. Among urban women, 8955 were randomized to cytology and 18 176 to hrHPV genotyping; among rural women, 11 136 were randomized to VIA/VILI, 7080 to cytology, and 15 385 to hrHPV testing. Participants who tested positive for hrHPV with direct colposcopy had higher risk ratios for disease yields at baseline (urban hrHPV vs cytology, CIN2+ 2.2 [95% CI, 1.6-3.2] and CIN3+ 2.0 [95% CI, 1.2-3.3]; rural hrHPV vs cytology, 2.6 [95% CI, 1.9-4.0] and 2.7 [95% CI, 2.0-3.6]; rural hrHPV vs VIA/VILI, 2.0 [95% CI, 1.6-2.3] and 2.3 [95% CI, 1.8-3.1]). At 24 months, baseline-negative women in the hrHPV arm had significantly lower risk ratios than those with cytology, or VIA/VILI for CIN2+ (0.3 [95% CI, 0.2-0.5], 0.3 [95% CI, 0.2-0.6]) and CIN3+ (0.3 [95% CI, 0.1-0.6], 0.4 [95% CI, 0.2-0.8]) in rural sites. The colposcopy referral rate for hrHPV-positive rural women was reduced to 2.8% by cytology triage, with significantly higher CIN2+ yields than cytology (2.1 [95% CI, 1.3-2.6]) or VIA/VILI arm (1.6 [95% CI, 1.03-2.1]). Genotyping for hrHPV with cytology triage significantly reduced the colposcopy referral rate compared with cytology (0.8 [95% CI, 0.7-0.9]) for urban women. In this randomized clinical trial, testing for hrHPV was an effective primary screening method in primary health care centers. Incorporating hrHPV testing (polymerase chain reaction-based for urban areas, hybrid capture-based for rural areas) into China's national screening program is reasonable. Chinese Clinical Trial Registry Identifier: ChiCTR1900022530.

A systematic review and meta-analysis of diagnostic accuracy of HPV tests for the screening of cervical cancer in low-resource settings.

HPV tests for the screening of cervical cancer in low-income countries (LICs) might improve early detection and preventive efforts. To determine the diagnostic accuracy of HPV tests for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) in LICs. The Cochrane Library, MEDLINE, and CINAHL databases were searched on June 1, 2020. References of relevant studies were hand-searched. Diagnostic test accuracy studies were included if women had an HPV test for cervical cancer screening, followed by verification with colposcopy and colposcopy-directed biopsy. The primary target was CIN2+. Two authors independently screened studies, extracted data, and assessed methodological quality. Bivariate diagnostic random-effects meta-analysis was used. Eleven studies including 82 556 women were eligible, most of which were at low risk of bias. The pooled diagnostic odds ratio of hybrid capture test of samples collected from the cervix by healthcare providers for detecting CIN2+ and CIN3+ was 42.0 (95% confidence interval [CI] 20.7-76.3) and 97.1 (95% CI 35.3-215.0), respectively. Evidence indicates that hybrid capture tests can be used for screening of cervical cancer in LICs. Future studies are warranted for self-sampling and for low-cost HPV tests.

Impact of knowledge and attitude on the utilization rate of cervical cancer screening tests among Ethiopian women: A systematic review and meta-analysis.

IntroductionCervical cancer is a major public health problem, particularly in resource-limited settings. The use of vaccination and screening tests has reduced the burden of cervical cancer in developed countries. However, the situation is quite the reverse in developing countries, including Ethiopia. Hence, this study aimed to estimate the pooled impact of knowledge and attitude on the prevalence of cervical cancer screening service utilization rates among Ethiopian women.MethodsStudies that examined cervical cancer screening service utilization among women in Ethiopia were searched from five international databases. Cochran’s Q chi-square and the I-squared test statistics were used to check the presence of heterogeneity among the included studies. The funnel plot and Egger’s regression tests were also used to assess the presence of publication bias. A weighted DerSimonian and Laird random-effects model was employed. Subgroup analysis was performed by the study population concerning the prevalence of cervical cancer screening service utilization rates. Sensitivity analysis was also conducted to assess the effect of a single study on the pooled estimates. Data analysis was performed using STATA™ Version 14 software.ResultsA total of 44 studies with 28,186 study participants were included. The estimated pooled prevalence of cervical cancer screening service utilization was 8.11% (95% CI: 7.26, 8.97). After adjustment for publication bias with the trim and fill analysis, the estimated prevalence rate appeared to be 5.47% (95% CI: 4.66, 6.28). The prevalence of cervical cancer screening service utilization was higher among HIV-positive women, 16.85%, and in studies conducted among health care workers, 10.24%, than the general population. The pooled effect of knowledge on the utilization of cervical cancer screening tests among Ethiopian women was statistically significant (AOR = 3.20, 95% CI: 1.63, 6.31). Similarly, the pooled estimated odds of utilizing cervical cancer screening tests were 6.1 times higher (AOR = 6.09, 95% CI: 1.09, 34.36) among women who had a favorable attitude towards the screening tests.ConclusionKnowledge and attitude had a significant impact on the prevalence of cervical cancer screening test utilization rates among women in Ethiopia. However, the prevalence of cervical cancer screening service utilization among Ethiopian women is very low. Hence, large-scale awareness programs and situation-based strategies need to be designed to increase the uptake of cervical cancer screening services in the country.

Analysis of Gynecological malignancy in surgical specimens during Covid-19 pandemic

Aims: To determine the pattern of female genital tract malignancies in a teaching hospital in eastern Nepal.&#x0D; Methods: This is a retrospective cross sectional study performed in the Department of Pathology at Nobel Medical College, Biratnagar, Nepal. This study was conducted over a period of 4 months during Covid-19 pandemic from June 2020 to September 2020. The records of the pathology department were analyzed.&#x0D; Results: A total of 600 specimens were received in the Pathology Department out of which 224 (37.3%) were gynecology samples. Total number of gynecology malignancy was 14 (2.3%). The most common was cervical carcinoma (57%) followed by ovarian malignancy. More than 70% fell in 40-60 years age group.&#x0D; Conclusions: In conclusion, in this cross sectional study we found more cervical cancer than other gynaecological malignancies which was followed by cancers of ovary. Most of the patients were in the 41-50 years age group. Tumor imprint cytology could be an option in place of frozen section in resource constraint setting. Effective screening test for cervical cancer would help prevent invasive cervical cancer and its morbidity.&#x0D; Keywords: gynecological malignancy, high grade neoplasia, squamous cell carcinoma

Acceptability of vaginal self-sampling with high-risk human papillomavirus testing for cervical cancer screening: a French questionnaire-based study

ABSTRACT In France, cervical cancer screening based on cervical smear has a participation rate of around 60%. New screening strategies are encouraged to increase the participation of under-screened women, including vaginal self-sampling with high-risk human papillomavirus (HR-HPV) testing. This study was based on the distribution of an anonymous self-administered questionnaire to assess the acceptability of vaginal self-sampling with HR-HPV testing by women aged 25 to 65 years in two French Departments of the South of France, Aude, and Hérault, showing low participation in cervical cancer screening. Factors influencing this acceptability were also analyzed. From May to July 2017, 349 completed questionnaires were collected. Women declared high acceptability for vaginal self-sampling (81%) preferably at home (82.6%). Acceptability was statistically higher in the Department of Herault (p = .001) and for women older than 50 years (p = .018). There was no difference according to educational level or attendance to cervical cancer screening. Knowledge about cervical cancer and cervical cancer screening was significantly influenced by educational level. This study confirmed that vaginal self-sampling with HR-HPV testing was highly accepted, including by under-screened women, encouraging further interventional studies. Education about cervical cancer and cervical cancer screening should be part of these programs, especially for women with lower educational level.

Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries

The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse. To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries. Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening. World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics. Self-report of having ever had a screening test for cervical cancer. Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened. In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening.

The Potential Benefits of HPV E6/E7 mRNA Test in Cervical Cancer Screening in China.

This study aims to evaluate the clinical performance of the HPV E6/E7 mRNA test in cervical cancer screening in China. A hospital-based study was conducted with mRNA, DNA, and liquid-based cytology (LBC) as primary screening tests. Each woman with a positive result received colposcopy with lesion-targeted-biopsy. Histopathological diagnosis was used as the gold standard. The total agreement of HPV DNA and mRNA was 90.7% (95%CI: 87.9, 92.9) with a kappa value of 0.81. The positive rates of HPV DNA, mRNA, and LBC increased with the severity of histopathology diagnosis, from 25.5, 19.1, and 11.4% in normal to 100.0% in SCC, respectively. The sensitivities for mRNA to detect CIN2+ and CIN3+ were 93.8% (95%CI: 89.7–96.4) and 95.7% (95%CI: 91.3–97.9), respectively, which were not different from HPV DNA testing (95.7% [95%CI: 92.0–97.7], 96.3% [95%CI: 92.1–98.3]), but higher than LBC (80.4% [95%CI: 74.5–85.2] and 88.8% [95%CI: 83.0–92.8]). The specificities for mRNA to detect CIN2+ (79.0% [95%CI: 74.2–83.0]) and CIN3+ (70.5% [95%CI: 65.7–74.9]) were higher than HPV DNA testing (71.0% [95%CI: 65.9–75.7], 62.8% [95%CI: 57.8–67.5]), but lower than LBC (84.5% [95%CI: 80.1–88.0] 79.8% [95%CI: 75.4–83.6]). All tests were more effective in women older than 30 years. HPV mRNA test showed excellent agreement with the DNA test, with similar sensitivity and a higher specificity in detecting high-grade cervical lesions. It is promising that mRNA test could be used for the national cervical cancer screening to reduce false positive without losing sensitivity.

Assessment of women's knowledge about cytology as a prophylactic method in cervical cancer

Introduction Cervical cancer (CC) is currently the eight most common cancer among women and the seventh leading cause of cancer-related death in women in Poland. Early, non-invasive cervical cancer may develop over the years without clinical symptoms. Also, given the fact that early forms are treatable effectively, it's important to get preventive examinations. It is especially important in the group of women at high risk of developing CC.Purpose The aim of the study was to analyse the opinions of 1,260 women on the cytology as a prophylactic method in cervical cancer.Material and methods Women's knowledge was verified with an anonymous online questionnaire. The obtained results were analysed and checked on the basis of scientific literature.Results The vast majority of respondents (89,6%) consider Pap smear test as a screening test for CC. According to 40.4% of women, the first test should take place after sexual initiation. 17.7% believed that the examination should be done after the first menstruation. 55% of the respondents answered that Pap smear test should be performed every year. 38.4% believed that the test should be performed every 3 year. 20.3% of respondents do not know when to take the first Pap smear test and 30.1% of the respondents had never performed a pap smear.Conclusions Most women know the importance of regular cytology, but unfortunately not all women relate this knowledge to themselves. Early, regular and continuous education of women on the prevention of cervical cancer is extremely important

Laser-assisted rapid evaporative ionisation mass spectrometry (LA-REIMS) as a metabolomics platform in cervical cancer screening.

BackgroundThe introduction of high-risk human papillomavirus (hrHPV) testing as part of primary cervical screening is anticipated to improve sensitivity, but also the number of women who will screen positive. Reflex cytology is the preferred triage test in most settings but has limitations including moderate diagnostic accuracy, lack of automation, inter-observer variability and the need for clinician-collected sample. Novel, objective and cost-effective approaches are needed.MethodsIn this study, we assessed the potential use of an automated metabolomic robotic platform, employing the principle of laser-assisted Rapid Evaporative Ionisation Mass Spectrometry (LA-REIMS) in cervical cancer screening.FindingsIn a population of 130 women, LA-REIMS achieved 94% sensitivity and 83% specificity (AUC: 91.6%) in distinguishing women testing positive (n = 65) or negative (n = 65) for hrHPV. We performed further analysis according to disease severity with LA-REIMS achieving sensitivity and specificity of 91% and 73% respectively (AUC: 86.7%) in discriminating normal from high-grade pre-invasive disease.InterpretationThis automated high-throughput technology holds promise as a low-cost and rapid test for cervical cancer screening and triage. The use of platforms like LA-REIMS has the potential to further improve the accuracy and efficiency of the current national screening programme.FundingWork was funded by the MRC Imperial Confidence in Concept Scheme, Imperial College Healthcare Charity, British Society for Colposcopy and Cervical Pathology, National Research Development and Innovation Office of Hungary, Waters corporation and NIHR BRC.

Evaluation of cytopathological screening results and risk factors of women who underwent Papanicolaou test in a maternity school in Fortaleza, Ceará, Brazil.

Papanicolaou test (Pap smear) is the standard screening test of pre-neoplastic lesions and cervical cancer. This study aimed to investigate cervical cancer screening results and risk factors such as age, reason for the examination, the epithelia detected in the sample, microbiota and signs of sexually transmitted infection (STIs) of women in a maternity school in Fortaleza, Ceará, Brazil. In this cross-sectional study, data were retrieved of 353 women who underwent Pap smear between April 2016 and January 2017 at the Federal University of Ceará. Of all Pap smear samples retrieved, 54.1% (191/353) had glandular epithelium and 40.2% (142/353) had metaplastic epithelium. After statistical analyses adjusted for the final model, age≥51years (odds ratio =3.47) and signs of STIs (odds ratio =4.95) remained as risk factors. The diagnosis of high-grade lesions and carcinomas in patients older than 50years indicates a deficiency in cervical screening. Women with signs and symptoms of STIs and candidiasis sought medical services more frequently than asymptomatic women, and presence of these signs and symptoms contributes to the diagnosis of cervical cancer. We highlight the importance of obtaining a correct smear sampling to allow prompt detection of all preneoplastic lesions; moreover, the implementation of human papillomavirus vaccination and an efficient routine Pap screening are necessary in low-resource settings.

Uptake of cervical cancer screening in Kuwait: A cross-sectional study

Abstract Background Despite the low incidence of cervical cancer in Kuwait in 2018, it is projected that it will increase by 48% by 2035. This is of concern considering that cervical cancer is a preventable disease if detected early. With limited research in this area in Kuwait, we sought to assess the prevalence of cervical cancer screening (CCS) among Kuwaiti women. Methods This study is part of the WHO's 2014 STEPS risk factor surveillance study. A representative random sample (n = 3915) of Kuwaiti citizens was recruited (response rate= 89.2%). CCS was assessed with the question “Have you ever had a screening test for cervical cancer using any of the methods described above”. All women aged 21-69 years who responded to the CCS question (n = 2183) were included in the analysis. Independent variables included age, area of residence, marital status, level of education, work status, smoking status, BMI level, history of CV disease, and history of diabetes. Statistical analysis included descriptive statistics, bivariate analysis, and multivariable logistic regression adjusted for participants' characteristics. Results The overall weighted CCS prevalence was 15.7% (95% CI [14.3-17.4]). CCS was associated with age (OR = 5.0 [2.5-10]) for age group 60-69, and OR = 3.1 [1.9-5.1] for age group 45-59 compared to the age group 21-29, area of residence (ORs ranged from 0.3 to 0.5 for those living in different governorates compared to those who lived in the Capital), marital status (OR = 4.4 for married and OR = 5.2 for divorced/widowed compared to those who were single), and level of education (ORs ranged from 2.7 to 2.9 for those who completed at least high-school education compared to those who did not). Conclusions The current uptake of CCS among Kuwaiti women is low. Disparities exist in terms of age, area of residence, level of education, and marital status. More efforts are needed to promote CCS through an organized screening program while considering the existing disparities. Key messages The current use of cervical cancer screening among Kuwaiti women is low. More efforts are needed to promote cervical cancer screening while paying attention to existing socioeconomic disparities.

Co-infection with trichomonas vaginalis increases the risk of cervical intraepithelial neoplasia grade 2\u20133 among HPV16 positive female: a large population-based study

BackgroundEvidence suggested that vaginal microbiome played a functional role in the progression of cervical lesions in female infected by HPV. This study aimed at evaluating the influence of common vaginal infection on the carcinogenicity of high risk HPV (hr-HPV).MethodsFrom January 15, 2017 to December 31, 2017, 310,545 female aged at least 30 years old had been recruited for cervical cancer screening from 9 clinical research centers in Central China. All the recruited participants received hr-HPV genotyping for cervical cancer screening and vaginal microenvironment test by a high vaginal swab. Colposcopy-directed biopsy was recommended for female who were infected with HPV 16 and HPV 18, and other positive hr-HPV types through test had undertaken triage using liquid-based cytology, cases with the results ≥ ASCUS among them were referred to colposcopy directly, and cervical tissues were taken for pathology examination to make clear the presence or absence of other cervical lesions.ResultsAmong 310,545 female, 6067 (1.95%) were tested with positive HPV 16 and HPV 18, 18,297 (5.89%) were tested with other positive hr-HPV genotypes, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and invasive cervical cancer (ICC) were detected in 861 cases, 377 cases, 423 cases, and 77 cases, respectively. Candida albicans and Gardnerella were not associated with the detection of cervical lesions. Positive trichomonas vaginitis (TV) was correlated with hr-HPV infection (p < 0.0001). Co-infection with TV increased the risk of CIN 1 among female infected with hr-HPV (OR 1.18, 95% CI: 1.42–2.31). Co-infection with TV increased the risk of CIN 2–3 among female infected with HPV 16 (OR 1.71, 95% CI: 1.16–2.53).ConclusionsCo-infection of TV and HPV 16 is a significant factor for the detection of cervical lesions.