Treatment Of Cervical Dysplasia Research Articles

The Role of Peptide Immunotherapy in the Treatment of Cervical Dysplasia: Clinical Cases

<i>Introduction</i>. Since one of the main factors determining the pathogenic effect of HPV infection is local immunodeficiency, a number of authors suggest using various cytokines and immunomodulators. Recently, peptide-based agents have been increasingly used in routine clinical practice. <i>Objective</i>. To study the effect of peptide immunocorrection on molecular and cellular factors affecting the course of grade II cervical dysplasia (CIN2) as a precancerous process and to evaluate the effectiveness of the proposed regimen. <i>Materials and methods</i>. The study included 2 groups of patients aged 28 to 44 years who were colposcopically and cytologically diagnosed with grade 2 cervical dysplasia. Clinical monitoring, determination of HPV by PCR, immunohistochemical studies of biomarkers of inflammation and proliferation, as well as counting of T-lymphocytes in cervical mucus preparations were performed before treatment, after treatment, after 6 weeks and after 3 months. <i>Results</i>. During the study of the expression level of pro-oncogenic interleukin IL-8 and anti-oncogenic IL-12, it was established that in both observation groups after the immunotherapy, a tendency to decrease the pro-oncogenic potential of cervical mucus was noted. Analysis of the level of expression of the cell proliferation marker Ki-67 in the clinical monitoring groups showed that the proposed therapy schemes reduced the proliferative potential of the cervical epithelium. The number of active cytotoxic lymphocytes in the cervical mucus in both observation groups predictably increased after the use of local immunotherapy. The study showed that immunotherapy of cervical dysplasia with the use of peptides demonstrated significantly better clinical results compared to the reference group. <i>Conclusion</i>. Taking into account the obtained research results and the given clinical cases, peptide immunocorrection can be reasonably recommended as an immunological component in the treatment of cervical dysplasia (ASCUS and LSIL).

(028) Patient and Provider Perspectives on LEEP/LLETZ Treatment

Abstract Introduction The loop electrosurgical excision procedure (LEEP) and large loop excision of the transformation zone (LLETZ) are highly effective in the treatment of cervical dysplasia. Though recent studies have identified the potential for negative outcomes following LEEP/LLETZ, the role of the cervix in sexual responses is contentious and has not been considered in conjunction with quality of life and relationship outcomes. Accordingly, there is a limited understanding of the patient and healthcare provider perspectives on procedural outcomes and experiences. Specifically, regarding current counselling and resource practices, and how risk information is represented in provider-patient interactions. Objective To investigate the procedural experiences associated with LEEP/LLETZ from patients who have reported bothersome symptoms and from providers who routinely perform the procedure. Also, to characterize a symptom profile for this subpopulation of patients and explore factors which may influence provider decision-making and approaches to care. Methods Patients who underwent LEEP/LLETZ treatment and reported negative outcomes, and providers with experience performing LEEP/LLETZ were recruited. Patients first completed an online survey which assessed demographic background, medical history, and sexual function. Both patients and providers completed semi-structured interviews relating to LEEP/LLETZ procedural outcomes and experiences. Interview responses were transcribed (Trint), and qualitative analyses were completed using NVivo 12. Results Perspectives and experiences gathered from patient and provider interviews revealed misaligned narratives surrounding LEEP/LLETZ outcomes and treatment. Patients reported a unique symptom profile and negative outcome experiences. Patient narratives highlighted impacts on domains of sexual functioning, including altered physical sensations and orgasm response, changed vaginal discharge and loss of arousal, interest and desire. Patients voiced changes to overall quality of life, with impacts on daily living and effects on interpersonal relationships. Patients discussed preferring open-ended and directed questions to comprehensively elucidate negative outcomes. Provider narratives outlined the current process of care, emphasizing limited experiences with adverse outcomes and the use of open-ended questions during counselling. Providers described an evolving intention to accommodate for and create comfortable clinical spaces. Regarding pre-and post-operative resources, patients described seeking support from online patient groups, and providers disclosed limitations to providing resources. Conclusions Results of this study call attention to discordance in the perceptions of patients and providers regarding LEEP/LLETZ procedural outcomes and experiences. The findings support the need for developments in pre-and post-operative procedural counselling, including a shift towards provider-initiated conversations to elucidate patient concerns. They also reveal a unique symptom profile of this subpopulation of patients who experience negative outcomes post-LEEP/LLETZ, which should be recognized within clinical practice with accessible conversations and resources. Disclosure No

(109) Analysis of Patient-Specific Microbiome Profiles and Possible Association with Sexual Dysfunction After Cervical Dysplasia Treatment

Abstract Introduction Electrocautery of the cervix during the loop electrosurgical excision procedure (LEEP) effectively treats cervical dysplasia (CD). Most patients do not report adverse symptoms post-operatively. However, a subset of patients has reported sexual issues and psychosexual sequalae, including some impact to their quality of life. The etiology of these symptoms has not been investigated, especially in a functional capacity. Moreover, there is some evidence that LEEP alters the cervical microbiome, from a small number of studies. Given the close anatomical relatedness of the pelvis, regions in close proximity to the cervix should also be considered, such as the vagina and urethra. Together, these three regions comprise the female urogenital tract (FUT), which should be examined for persistent inflammatory bacterial profiles post-LEEP. Correlations between LEEP patient-reported symptoms of psychological and sexual issues, and bacterial microbiome profiles, have not yet been investigated. Objective To analyze overall and individualized bacterial profiles (cervix, vagina, urethra) of patients with CD before and after treatment with LEEP and investigate associations with sexual functioning. Methods Women with typical female internal organs and external genitalia, undergoing LEEP treatment for CD, were recruited to participate in the study. Urethral samples, in addition to vaginal and cervical swabs, were collected immediately before treatment and 3 months post-treatment. Bacterial community analysis was characterized by 16S ribosomal RNA gene analysis. Self-report online surveys assessing demographics, medical history, and sexual function (FSFI) were completed by participants at the same time intervals. Chi square analyses and t-tests were conducted. Results Alpha diversity (observed species richness) revealed a significant decrease in species richness in the FUT microbiome post-LEEP (P &amp;lt; 0.05). Beta diversity demonstrated significant differences between the cervical, urinary, and vaginal microbiomes pre- and post-LEEP (P &amp;lt; 0.05). Lactobacillus was observed to be significantly higher in the cervical microbiome (P &amp;lt; 0.05), and Prevotella, Dialister, and Ruminococcus were significantly lower in the cervical microbiome (P &amp;lt; 0.05), when compared to the urinary and vaginal microbiomes pre- and post-LEEP. Analysis of individual microbiome patient profiles revealed individuals who showed discordant trends when compared to data summarizing averages. Namely, a subset of participants experienced a significant increase (P &amp;lt; 0.05) in pro-inflammatory bacteria post-LEEP with correlative changes in SD. These results suggest there may be a non-uniform healing response post-LEEP, and that individualized microbiome analysis could reveal regional dysbiosis that could be subsequently treated and managed. Conclusions A diverse inflammatory bacterial community characterizes CD in the FUT, and treatment with LEEP mostly returns the microbiomes to a healthy state. However, some participants showed increased inflammatory bacterial profiles post-LEEP, potentially demonstrating a non-uniform healing response. This study provides a basis for future studies to screen and restore FUT microbiomes post-LEEP, with the aim of detecting and treating any bothersome symptoms reported by patients. Disclosure No

Sexual health and quality-of-life concerns of cervical dysplasia treatments: Review

Thorough investigations have defined underlying disease mechanisms, determining effective cervical dysplasia (CD) treatments. Previous work has assessed the effects of different treatments on women’s sexual health. Recently however, several published studies have expanded the scope of findings, revealing the need for an updated examination and integration of knowledge to appropriately contextualize this clinical approach within sexual medicine and women’s healthcare. A review of relevant literature was completed. The findings indicate that treatments for CD may be correlated with sexual issues such as decreased interest and sexual functioning, and decreased QoL including psychosocial elements like anxiety. Methodological variations used to investigate different CD treatment outcomes were observed and should be streamlined to facilitate comparison in future studies. There is a need for additional research into alternative non-surgical CD treatments which could mitigate unintended outcomes, and consideration should be given to accessibility of these treatments across different regions in Canada.

Female Sexual Dysfunction in Women After Treatment of Cervical Dysplasia.

Cervical cancer is the fourth most common cancer worldwide and accounted for approximately 570,000 new cancer cases and 311,000 cancer deaths in 2018. Despite advances in screening algorithms many US women undergo excisional cervical procedures for the treatment of cervical dysplasia. The effects of loop electrosurgical excisional procedure (LEEP) and cold knife conization (CKC) on sexual function are relatively unknown. To conduct a comprehensive review of the literature regarding the effects cervical cancer screening and treatment on female sexual function and satisfaction METHODS: We conducted a review of the medical literature up to and including November 2021 on PubMED using search terms related to cervical dysplasia and sexual health. We identified 831 articles and selected 39 articles for inclusion in our review. Nine studies were included that specifically focused on the effect of loop electrosurgical excisional procedure (LEEP) on female sexual function. Multiple studies demonstrated adverse psychologic and sexual effects in patients with cervical dysplasia and after colposcopy. Some studies reported that women experience decreased arousal and interest 6 months following colposcopy. Several studies documented adverse effects on lubrication, sexual pain, and desire following LEEP. There is a lack of high quality research on the effect of LEEP and colposcopy on female sexual function. Important limitations in the review of the current literature include, a small sample size, inconsistent comparison groups, observer bias, and lack the use of standardized questionnaires. Clinicians should continue to provide patients education regarding the risks and benefits of different treatment modalities and potential for effects on sexual function should be included in comprehensive counseling. Ethan Litman. Female Sexual Dysfunction in Women After Treatment of Cervical Dysplasia. Sex Med Rev 2022;10:360-366.

Cervical cancer prevention program in Nepal: A comprehensive "train the trainer" approach.

5530 Background: Cervical cancer is the leading cause of cancer and cancer-related deaths among women in Nepal, due in part to a lack of access to screening and limited medical providers trained to diagnose and treat women with preinvasive cervical disease. Cancer Care Nepal has partnered with The University of Texas MD Anderson Cancer Center (MD Anderson) and the American Society of Clinical Oncology (ASCO) to implement a ‘train the trainer’ (TOT) program to teach visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, cryotherapy, thermal ablation, and loop electrosurgical excision procedure (LEEP). Methods: An initial cervical cancer prevention course was held in Kathmandu, Nepal in November 2019, supported by ASCO and with faculty from Civil Service Hospital, Bhaktapur Cancer Hospital, and National Academy of Medical Sciences and MD Anderson. As a continuation of this program, a TOT course was implemented for local specialists from five participating institutions throughout Nepal to learn how to deliver these trainings. Each participating institution then holds their own local course for nurses and doctors in their region. The training is complemented with monthly Project ECHO (Extension for Community Healthcare Outcomes) telementoring videoconferences. Results: The program was launched in November 2021. To date, two TOT training courses (2-day duration) have been held for clinicians from the 5 participating regions. Due to COVID-19 pandemic travel restrictions, didactic lectures were held virtually with MD Anderson and ASCO staff and included epidemiology of cervical cancer, screening guidelines, colposcopy, and treatment of cervical dysplasia. This was followed by hands-on training using simulation models to teach VIA, colposcopy, ablation and LEEP, led by the Nepalese faculty who had participated in the 2019 course. There were 41 participants in total (23 in the first course and 18 in the second course), including 21 gynecologists, 4 gynecologic oncologists, 1 medical oncologist, 1 general practitioner, and 14 nurses. 39 participants (73%) completed both the pre- and post- survey results. 86% of respondents from the first course and 100% of respondents from the second course reported that they intended to change their practice as a result of knowledge gained from the course. In addition, Cancer Care Nepal became a new hub for Project ECHO and held its first session in January 2022, with 20 participants representing two regions. The specialists from each of the 5 participating sites will be holding local courses for doctors and nurses in their respective regions throughout 2022. Conclusions: Our work shows that the TOT strategy can widen the reach of training in cervical cancer prevention in Nepal. Despite travel restrictions during the COVID-19 pandemic, global health training and mentoring can continue, though they require adaptions and use of virtual platforms.

Innovative Diagnostic and Therapeutic Interventions in Cervical Dysplasia: A Systematic Review of Controlled Trials.

Simple SummaryCervical dysplasia is one of the most common disorders of the female genital tract affecting millions of women worldwide. This systematic review of the literature of the last decade shows that significant progress has been made in its diagnosis and treatment. Based on >30 controlled clinical trials, specific and evidence-based recommendations can be formulated, such as for intravenous or intracervical lidocaine for pain reduction during colposcopically-directed cervical biopsies, but not topical lidocaine, music, or video colposcopy. Monsel’s solution might be used to control bleeding after cervical biopsies. The acetic acid test should be scored after 1 min and should be followed by Lugol’s iodine test for an optimal detection of dysplastic lesions. Loop electrical excision using standard instrumentation and techniques should be performed under local anesthesia and with direct colposcopic vision. Cryotherapy and thermoablation might be used in women with low-grade dysplasia, especially in women with HIV infection. Topical imiquimod remains an experimental procedure.Cervical dysplasia is a common precancerous lesion affecting 1% to 2% of women worldwide. Significant progress in the diagnosis and treatment of cervical dysplasia have been made in the last decade. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled clinical trials reporting on the efficacy and safety of diagnostic and therapeutic interventions for cervical dysplasia. Data were analyzed according to PRISMA guidelines. In total, 33 studies reporting on 5935 women were identified. We recommend intravenous or intracervical lidocaine for pain reduction during colposcopically-directed cervical biopsies but not topical lidocaine, music, or video colposcopy. Monsel’s solution might be used to control bleeding after cervical biopsies. The acetic acid test should be scored 1 min after the application of acetic acid and should be followed by Lugol’s iodine test for an optimal yield of LSIL/HSIL. LEEP/LLETZ remains the standard and techniques such as SWETZ, C-LETZ, and TCBEE are not superior. LEEP/LLETZ should be performed under local anesthesia and with direct colposcopic vision. Cryotherapy and thermoablation might be used in women with LSIL, especially in women with HIV infection, but LEEP/LLETZ remains the standard for HSIL. Topical imiquimod remains an experimental procedure. In conclusion, significant progress has been made in the last decade regarding both diagnostic interventions as well as therapeutic interventions for women with cervical dysplasia. Based on >30 controlled clinical trials, we were able to formulate specific and evidence-based recommendations.

The Influence of SARS-CoV-2 Pandemic in the Diagnosis and Treatment of Cervical Dysplasia.

Background and objectives. The risk of developing invasive cancer increased during the COVID-19 pandemic, especially in Romania, where the incidence of this disease is high due to limited medical education and broad screening. This study’s objective is to analyze the number of patients admitted with different types of cervical dysplasia and the treatment applied for the lesions during the SARS-CoV-2 pandemic compared to the same period for the year before the pandemic. Materials and methods: This is a retrospective study that took place in the Obstetrics and Gynecology Clinics I/II (OG I/II) of the Emergency County Hospital of Craiova during the SARS-CoV-2 pandemic (SP) (15.03.2020–14.03.2021) and in the 12 months before (non-pandemic period) (NPP) (15.03.2019–14.03.2020). The study includes 396 patients with pathological PAP smear results. All the patients included in this study were clinically examined and with colposcopy. The patients with Low-Grade Dysplasia were managed in a conservatory manner and reevaluated after six months. The patients with High-Grade Dysplasia were admitted for an excisional biopsy of the lesion. The excised fragments were sent to the Pathological Anatomy Laboratory for a histopathological examination. Results: This study reveals a decrease of more than half in the number of patients admitted with cervical intraepithelial neoplasia (CIN) lesions during the pandemic compared to the same period of the year before. The number of biopsies and excisional procedures has been decreasing by more than a factor of three during the pandemic period compared to the year before. Conclusion: During the SARS-CoV-2 pandemic, we found that the patients’ admission rate, diagnosis, and treatment was almost four times lower. As hospital restrictions were not dictated for cancer/precancer management during SP, we may assume that the differences were due to the fear of becoming infected with SARS-CoV-2 due to hospitalization. In the context of poor screening performance and high cervical cancer incidence, the influence of the SP may result in a further increase of severe cases related to this condition.

Loop electrosurgical excision in the treatment of precancerous lesions of the cervix

Introduction. In the period from 2010 to 2021, 150 patients were treated with loop electrosurgical excision of the cervix at the Special Gynecological Hospital ?Genesis?, Novi Sad. The aim of this study was to present the results of treatment, incidence of complications and recurrences after loop excision in the treatment of cervical dysplasia. Material and Methods. The study group A included 87 (58%) patients with cervical intraepithelial neoplasia, and the control group B included 63 (42%) patients with benign lesions of the cervix. Results. The total number of complications (bleeding, pain, infection) in the group A was recorded in 16 (20.7%) and in group B in 4 (6.4%) patients, and this difference was statistically significant. The absolute risk of complications in the group A was 18.39% and 6.34% in the group B. The relative risk of complications was 2.9, meaning that women in group A had a 3 times higher relative risk of complications compared to women in the group B. The absolute risk of recurrence in the group A was 4.56% and 4.76% in the group B. The relative risk of recurrence was 0.96. Women in the group A had a 4% lower relative risk of recurrence than women in the group B. The recurrence rate was lower in the group B (4.8%) compared to the group A (5.9%), but this difference was not statistically significant. Conclusion. Loop electrosurgical excision is the treatment of choice in the treatment of cervical dysplasia with good therapeutic outcomes and a low complication and recurrence rate.

Study of Prevalence of Abnormal Cervical Cytology in Al-Shatby Maternity University Hospital

Introduction: Cervical cancer is the most common cause of preventable cancer related deaths; cervical cancer has a long pervasive phase (cervical dysplasia); the prevalence of cervical dysplasia varies according to the socioeconomic characteristics and geographic areas of the population studied. Low-grade lesions regress spontaneously in a significant number of patients, while high grade lesions will progress to an invasive cancer if left untreated. Cervical cancer screening is an important component of the World Health Organization (WHO) strategy for combating cervical cancer. The incidence and prevalence of cervical cancer has reduced remarkably over the last three decades in developed countries where there are effective, well-coordinated screening programs, and treatment of cervical dysplasia, while in developing countries it has been increasing and has constituted major health problems among women where there are no well-coordinated and effective screening programs, also resources are very low and no insurance can cover this programs. Aim of the work: The aim is to assess the prevalence of abnormal cervical cytology in Al Shatby Maternity University Hospital patients using Pap smear. Materials and methods: Inclusion criteria: 1) Married woman from 3 years or more; 2) Women age from 21 to age 65 years. Exclusion criteria: 1) Previously known cervical cancer patient; 2) Virgin females; 3) Woman with active vaginal bleeding. Results: 83% of patients were -ve intraepithelial neoplasia {37.7% was normal cytology and 45.3% was inflammatory}. 17% was +ve intraepithelial neoplasia (abnormal cytology), {11.1% ASCUS, 2.9% LSIL, 1.3% HSIL, 1.1% ASC-H, 0.3% AGS-NO, 0.3% AGS-Favour Neoplastic}. Prevalence of abnormal cervical cytology in age group less than30 years was 8.4% which is lower than prevalence in the middle age group which was 19.9%. Prevalence of abnormal cervical cytology in women with normal vaginal delivery was higher than those with caesarean delivery. 39.8% of our patients were passive and active smokers 61.2% of their Pap smear was abnormal cytology. 78.9% of abnormal cytology was among patients from low socioeconomic class (rural areas). Abnormal cervical cytology in patients with high parity was 69% which is higher than abnormality found in lower parity. 60.2% of abnormal cervical cytology was in patients who became sexually active before age of 20 years. Prevalence of abnormal cervical cytology was higher in patients with multiple sexual partners (56.5%) than patients with single sexual partner (13.3%). Conclusion: Cervical cytology remains the gold standard for cervical cancer screening and the use of Bethesda system is a simple and accurate method for diagnosis and management of cases with abnormal cervical cytology.

From Pap to colposcopy: Delay in care in the evaluation and treatment of cervical dysplasia

Objective: The current cytology-based model for cervical cancer screening requires patients to attend multiple visits within a timely manner to be evaluated and treated for cervical dysplasia. The objective of this study was to investigate whether patients are receiving colposcopy and treatment within an appropriate period of time according to ASCCP guidelines of 56 days from Pap to colposcopy, in a clinic where low socioeconomic status predominates.

Abnormal Pap Smear

Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 25 years, and these women should be followed closely. This review contains 18 figures, 3 tables, and 43 references. Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia

Clinical evaluation of modifications to a human papillomavirus assay to optimise its utility for cervical cancer screening in low-resource settings: a diagnostic accuracy study

HPV-based screen and treat is the recommended approach for cervical cancer screening in low-resource settings, but quite low specificity of human papillomavirus (HPV) testing, particularly in women living with HIV, leads to overtreatment. We evaluated whether HPV type restriction and more stringent cutoffs on Xpert HPV optimise performance characteristics of this assay for screen and treat. We recruited HIV-negative and HIV-positive women aged 30-65 years from a primary care facility and a referral colposcopy clinic in Cape Town, South Africa. Women included had no history of any anogenital cancer or treatment for cervical dysplasia, had no hysterectomy, and were not pregnancy at the time of recruitment. All women had cervical samples collected for Xpert HPV (an assay that detects high-risk HPV types in five channels: HPV type 16; HPV types 18 or 45, or both; HPV types 31, 33, 35, 52, or 58, or more than one of these types; HPV types 51 or 59, or both; and HPV types 39, 56, 66, or 68, or more than one of these types) and underwent colposcopy and histological sampling with consensus pathology review. Logistic regression and receiver operating characteristic curves were used to evaluate improvements in specificity attained by modifying cycle threshold cutoffs to define screen-positive results. We recruited 1121 women aged 30-65 years, 586 of whom were HIV-negative and 535 HIV-positive. Sensitivity of detecting cervical intraepithelial neoplasia grade 2 or greater in HIV-negative women using manufacturer-defined cycle threshold cutoffs for all channels was 88·7% (95% CI 83·1-94·3), and specificity was 86·9% (83·4-90·4). Sensitivity was 93·6% (90·0-97·3) and specificity 59·9% (54·1-65·7) in HIV-positive women. Cycle threshold values from channels detecting HPV type 16, HPV types 18 or 45 (or both), and HPV types 31, 33, 35, 52, or 58 (or more than one of these types) were informative to predict cervical intraepithelial neoplasia grade 2 or greater. Shifting cycle threshold cutoffs on these three channels allowing sensitivity to decline to 75-85%, led to specificities of 91·3-95·3% in HIV-negative women and 77·0-85·8% in HIV-positive women. More stringent cycle threshold cutoffs on selected channels in Xpert HPV improve specificity with only modest losses in sensitivity, making this assay an optimal choice for HPV-based screen and treat in settings with a high prevalence of HIV. These modifications can be made from standard output with no need for new engineering. Decision making about performance characteristics of HPV testing can be shifted to programme implementers and cutoffs selected according to resource availability and community preferences. Supported by the National Cancer Institute UH2/3 CA189908.

Cervical Cancer Screening Access, Outcomes, and Prevalence of Dysplasia in Correctional Facilities: A Systematic Review.

Background: Incarcerated women often access health care primarily through contact with correctional systems. Cervical cancer screening within the correctional system can address the preventable outcome of cervical dysplasia and cancer in this high-risk population. Materials and Methods: A search of PubMed, EMBASE, CINAHL, and ClinicalTrials.gov was conducted for articles published between January, 1966 and December, 2018. All studies on a population of jailed or incarcerated females and at least one of the following outcomes: cervical cancer or dysplasia, pap smear screening, knowledge about screening, treatment of cervical dysplasia, and compliance with follow-up were analyzed. Results: Forty-two studies met inclusion criteria. All 21 studies with prevalence outcomes described a higher prevalence of cervical dysplasia and cancer in the women involved with corrections, compared to a variety of different sources that served as community control groups. The data on screening outcomes were inconsistent. Follow-up compliance for abnormal results was poor, with a study finding that only 21% of women were rescreened within 6 months of the recommended time period. Knowledge about cervical cancer and screening was evaluated in eight studies and was poor across all studies. Conclusion: Women involved in correctional systems have a higher prevalence of cervical dysplasia and cancer than women in the general population. Acceptance of screening varies, and no published interventions have been shown to improve screening within the prison system. Treatment and compliance with follow-up recommendations are extremely poor and should be a focus of future research.

Treatment of Cervical Dysplasia by Clinicians Who Perform Colposcopy in German-speaking Countries - a Questionnaire-based Study.

Introduction In connection with the reorganisation of cervical carcinoma screening, the importance of colposcopy as an integral part of the planned series of clarification testing will greatly increase. Quality standards for performing the colposcopic examination should therefore be defined in detail. A precondition for this is surveying the current standard in clinical practice. The objective of this study was to evaluate the current practice of colposcopy and conisation in Germany by means of a questionnaire aimed at gynaecologists who perform colposcopies in order to document the actual therapeutic standard of treatment of cervical dysplasia. Materials and Methods Gynaecologists were invited via e-mail or during events to participate in a web-based survey. The questionnaire contained 38 questions on management before, during and after the examination as well as questions on the technical implementation of colposcopy and conisation. Results From February 2018 to April 2018, 961 e-mails were sent. A response was received in 197 cases (response rate 20.5%). Responses were received for another 40 questionnaires during events (response rate approx. 80%). After taking the inclusion criteria into account, 160 questionnaires were evaluated. The majority of those surveyed take an average of 2 cervical biopsies (67.3%) and nearly all of those surveyed (94.5%) do not use any local anaesthetic. As a standard method for removing cervical precancerous cells, most of the physicians surveyed perform a loop excision with the electrosurgical loop (91.2%) under colposcopic visualisation (61.2%) under general anaesthesia (92.5%). Postoperative bleeding prophylaxis by means of tamponade is performed only in 27.6% of all cases. Conclusion A differential colposcopy with two colposcopically targeted biopsies and treatment with the electrosurgical loop are the methods most frequently used by clinicians who perform colposcopy in Germany. A uniform procedure should be defined in detail within the scope of directives or guidelines.

Barriers for Young Women to Participate in The Danish Cervical Screening Program

Background: In Denmark, the coverage rate for cervical cancer screening is about 75% for women aged 23 to 64 years whereas the participation rate is 65%. The participation rate varies with age, and is between 47%-57% among women in their twenties. In 2005, a qualitative study among women between 23 and 39 years found a range of barriers for nonparticipation. Barriers were lack of knowledge about the aim of cervical screening (i.e., the possibilities for early detection and treatment of cervical dysplasia), lack of knowledge about HPV as a very common virus causing dysplasia and cervical cancer and finding the time to make an appointment with the GP. 10 years later a follow-up study among women aged 30 to 50 years found similar barriers (i.e., lack of knowledge about HPV and cervical screening as a preventative method). Despite the different barriers, most women wanted to take part in screening, but a busy everyday life meant that they forgot about the invitation or they did not book an appointment with their GP. Aim: We investigated barriers for participation in the first generation of HPV-vaccinated women in Denmark aged 23 to 29 years. Methods: Qualitative interviews (focus groups) with women aged 23 to 29 years, who had all received one or more invitations to partake in cervical cancer screening, but who had not participated. Results: A preliminary analysis of the first six focus groups identified a handful of interrelated barriers similar to older women. The most important barrier being insufficient knowledge or lack of knowledge about HPV as the cause of dysplasia/cervical cancer (i.e., the high incidence of HPV-infection in women under the age of 35). Furthermore, few women knew about the screening program being an important supplement to their HPV-vaccine, and therefore did not find the program of relevance to them. Conclusion: Surprisingly, the preliminary results suggest important barriers for participation in cervical screening for women aged 23 to 29 to be insufficient knowledge or lack of knowledge about HPV-infection and the importance of regular smear tests as a supplement to their HPV-vaccine. The women did not perceive the smear test relevant enough to exert action and book an appointment with their GP. Barriers remained similar across age groups within the last 12 years despite health campaigns.

Cervical Cancer Screening

Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 20 years, and these women should be followed closely. This review contains 18 figures, 3 tables and 53 references Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia

Risk factors for HPV persistence and cytology anomalies at follow-up after treatment for cervical dysplasia.

To evaluate predictor factors of persistent cytologic dysplasia and/or high-risk human papillomavirus (hrHPV) infection at 6-month follow-up and at 3-5years during routine cervical smear testing. The present retrospective study included data from women treated for cervical dysplasia by large loop excision of the transformation zone (LLETZ) at Ipswich Hospital, UK, between January 1 and December 31, 2012. Age, parity, smoking, status of resection margins, and previous LLETZ treatment were evaluated by multivariate analyses. There were 192 patients included in the study. There was no association between age (relative risk [RR] 1.0, 95% confidence interval [CI] 0.80-1.23; P>0.99), smoking (RR 1.12, 95% CI 0.79-1.59; P=0.516), or parity (RR 1.10, 95% CI 0.88-1.38; P=0.382) and abnormal cytology and/or persistent hrHPV infection at 6months. There was an association between positive margins (RR 1.64, 95% CI 1.20-2.24; P=0.003), previous LLETZ (RR 3.48, 95% CI 1.69-7.15; P<0.001), and dyskaryosis and/or hrHPV infection at 6months. Only previous LLETZ treatment remained associated with abnormal cytology and persistent hrHPV infection at 3-5years (RR 6.37, 95% CI 3.56-11.3; P<0.001). Clinical factors, including age, smoking, treatment history, and status of surgical margins, could help to determine the risk of dysplasia recurrence and facilitate patient follow-up based on risk stratification.

Optimization of a Vaginal Suppository Formulation to Deliver SHetA2 as a Novel Treatment for Cervical Dysplasia

Cervical dysplasia induced by the human papilloma virus unpredictably progresses to cervical cancer. Therapeutic options are invasive and affect the patient's quality of life. SHetA2 has demonstrated therapeutic efficacy against human and murine human papilloma virus–induced tumors, but its oral bioavailability is <1%. An optimized vaginal suppository formulation can deliver SHetA2 in sufficient doses to prevent cervical dysplasia. The quality by design approach was employed to optimize the suppository formulation consisting of cocoa butter as base with 5% Kolliphor and 40% SHetA2. The suppository had a content uniformity of 105.44 ± 0.42%, melted in <8 min, and had a complete release of SHetA2 in water. Administration of the suppository to mice-achieved cervix concentrations that were significantly higher than the SHetA2 therapeutic concentration, with the maximum concentration (Cmax-cervix = 336.78 μg/g) being more than 100-fold the therapeutic SHetA2 concentration. Furthermore, the levels of cyclin D1 protein decreased 9-fold indicating a correlation of drug concentrations with the pharmacodynamic endpoint. These proof-of-concept studies suggest that the SHetA2 optimized vaginal suppository formulation may have a potential use in the prevention of cervical dysplasia, but detailed efficacy studies are required to confirm this assumption.

Colposcopy Simulation: A Necessary Tool in an Era of Decreased Referrals

OBJECTIVE: To develop a comprehensive curriculum and simulation for educating trainees on screening, evaluation and treatment of cervical dysplasia. METHODS: A needs assessment demonstrated that our residents' colposcopy numbers are low compared to American Society for Colposcopy and Cervical Pathology mentoring program expectations (mean of 22.6 per resident compared to 25 recommended). Existing colposcopy didactic content was updated and image review slides improved. An existing colposcopy simulation model was streamlined and enhanced with pathology specimen cervices to better simulate the colposcopic exam. Each resident completes the simulation at the start of their 6-week colposcopy rotation, allowing for hands-on training with the colposcope, proper techniques for biopsy acquisition and simulated patient conversations prior to having these experiences with patients. EVALUATION: Eight residents have completed the revised curriculum during the 2016–2017 academic year. I plan to continue to assess experiences and knowledge using a questionnaire tool before and after simulation and postrotation knowledge assessment. In the future, I would like to do a multi-institution assessment given the small numbers of trainees rotating at any given time in our residency program. DISSEMINATION: Submission of curriculum simulation construction tutorial to MedEdPORTAL for publication. REFLECTIVE CRITIQUE: I have learned the importance of a needs assessment, and how to improve existing materials to make them more useful for all participants. I plan to continue to update and improve didactic content at staggered intervals to ensure materials stay up to date. I hope to collaborate with others to help implement the simulation curriculum nationally.