Uterine Cervical Cancer Screening Research Articles

Sensitivity, Specificity, and Cost-Benefit Effect Between Primary Human Papillomavirus Testing, Primary Liquid-Based Cytology, and Co-Testing Algorithms for Cervical Lesions.

Cytology has long been a major screening method for cervical cancer prevention. Human papillomavirus (HPV) testing has recently been introduced for cervical cancer screening, and HPV tests become a major screening method in some countries. To seek the optimal strategy considering the cost-effectiveness for cervical cancer screening, we compared the performance of primary LBC, primary HPV test, and LBC plus HPV co-test in real practice. From March 2016 to June 2018, 3742 patients were included in this study. Liquid-based cytology (LBC), HPV test, and histopathological assessment were performed in 3727, 1063, and 508 cases, respectively. The sensitivity, specificity, and cost-benefit effects of primary HPV, primary LBC, and co-test algorithms were simulated for 317 cases with LBC, HPV, and histopathological results. On the LBC, 13.0% of the cases were diagnosed with atypical squamous cells of undetermined significance or higher grade lesions. In the HPV test, high-risk HPV was found in 43.5%, and 11.9% was positive for HPV type 16 or 18. Among the three simulated algorithms, the co-test demonstrated the best sensitivity (97.5%) and the lowest specificity (50.3%). The primary LBC demonstrated the best specificity (53.5%) and a slightly better sensitivity, compare with the primary HPV (95.1% vs. 93.8%). Using the primary LBC algorithm, 82.0% can be determined without additional HPV test, whereas 50.1% could be determined without additional LBC using the primary HPV algorithm. The primary LBC algorithm for uterine cervical cancer (UCC) screening is comparable to the primary HPV algorithm and has the best cost-benefit effect among the three algorithms.

A transversal cross-sectional study of factors related to HPV vaccination status and cancer screening participation among French women aged 25–40

BackgroundIn 2020, uterine cervical cancer (UCC) was the 12th most common cancer among women in France and the 4th worldwide. French health authorities wanted to increase Human Papilloma Virus (HPV) vaccination and screening rates. There were still many barriers to these measures among young women, their families, and health professionals and teachers. Between 2014 and 2019, international studies found inconsistent effects of HPV vaccination on UCC screening. In 2022, a survey was conducted among women aged 25 to 40 in the Nord-Pas-de-Calais region to assess participation 1) in HPV vaccination and its barriers, 2) in UCC screening as a function of HPV vaccination status.MethodsData were collected using an anonymous online questionnaire distributed by QR code in 80 general practices randomly selected in the Nord-Pas-de-Calais region between January and June 2022. Results were analyzed bivariately using the Chi2 test, multivariately when numbers allowed, and in age subgroups (sensitivity analysis).Results407 complete questionnaires (for 602 participating women) were analyzed. In our sample, 41% of women aged 25 to 40 in the Nord-Pas-de-Calais region were vaccinated against HPV viruses in 2022. The risk factors for non-vaccination, after multivariable adjustment, were: the periods of eligibility for vaccination in the early days of French vaccination (2007–2012: odds ratio OR = 0.04 [95% CI, 0.02–0.09]; 2012–2017: OR = 0.5 [0.3–0.8]), information received from non-medical sources (OR = 0.3 [0.2–0.6]), and absence of information about vaccination (OR = 0.12 [0.05–0.27]). In our sample, 90% of women were screened for UCC. In bivariate analysis, women at risk of not being screened were those who were youngest, had been vaccinated against HPV, were not heterosexual, lived alone, had gynecological follow-up by their general practitioner, and did not have regular gynecological follow-up. Sensitivity analysis showed that the only risk factor significantly correlated with non-screening regardless of age group was lack of regular gynecological follow-up.ConclusionsParticipation in HPV vaccination and UCC screening is improved by medical education and gynecological follow-up. This multicenter study, limited by the relative youth of vaccination in France, should be repeated after 2037 to assess the possible effect of vaccination on screening.

Risk of uterine cervical cancer in inflammatory bowel disease: a systematic review and meta-analysis

Background and aims There are limited data on the association between uterine cervical cancer (UCC) and inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC). Methods This systematic review and meta-analysis assessed the risk of UCC in patients with IBD. We searched MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, gray literature and conference proceedings for studies published before 21 January 2022. Two reviewers independently screened studies, extracted data and assessed quality using the Newcastle–Ottawa Scale. Subgroup analyses were based on IBD type, biologic era, immunosuppression status, study location and design, and publication status. Fifteen studies were included. Results The pooled relative risk (RR) of UCC in IBD was 1.34 (95% confidence interval [CI], 1.07–1.69; I 2 = 53.4%). In subgroup analyses, the pooled RRs of UCC in CD and UC were 1.18 (95% CI, 0.97–1.42) and 1.50 (95% CI, 1.01–12.21), respectively. The pooled RRs of UCC in pre-biologic and biologic eras were 1.36 (95% CI, 0.83–2.23) and 1.99 (95% CI, 1.03–3.86), respectively. The pooled RR of UCC in immunomodulator users was 2.18 (95% CI, 0.81–5.87). The pooled RRs of UCC in Asia, Europe and North America were 5.65 (95% CI, 2.65–12.07), 1.13 (95% CI, 0.96–1.34) and 1.38 (95% CI, 1.10–1.73), respectively. Conclusions The risk of UCC was significantly increased in IBD, particularly in UC but not in CD, suggesting that women with IBD should undergo regular UCC screening and consider vaccination.

Diagnostic Accuracy of p16 Expression in Differentiating Cervical Intraepithelial Neoplasia from Invasive Squamous Cell Carcinoma: A Descriptive Analysis at a Tertiary Care Hospital of Bangladesh

Background: Cervical cancer is one of the most common cancers that affect women worldwide. It is well established thathigh-risk human papillomavirus (HR-HPV) is the prime risk factor for the development of cervical cancer. Early and accuratediagnosis of cervical neoplasia is of utmost significance for prolongation of patient survival. A panel of immunomarkers hasbeen developed and tested to overcome the limitations to histopathological diagnosis. Among them p16 is one of the commonlyused immunomarkers now-a-days. In recent years, routine haematoxylin and eosin (H & E) stain coupled with p16immunohistochemistry (IHC) have a major impact in the field of uterine cervical pathology and cancer screening. Objectives: The present study was aimed to determine the p16 scores and its association with histological types, and grades ofISCC including diagnostic accuracy in differentiating ISCC from CIN lesions. Materials and Methods: This descriptive type of cross-sectional study was conducted in the Department of Pathology,Rajshahi Medical College (RMC), Rajshahi, in collaboration with the Department of Pathology, Bangabandhu Sheikh MujibMedical University (BSMMU), Dhaka, during a period of two years from January 2019 to December 2020 by using routine H& E staining and p16 IHC analysis to evaluate the expression of p16 in samples of cervical biopsies from 51 patients withhistopathologically confirmed diagnosed cases of CIN and ISCC, considering the percentage of p16 positive cells and thereaction intensity. Results: This study revealed that the aberrant expression of p16 increased from LSIL to ISCC, thus emphasizing its usefulnessas an adjunct marker for predicting risk of developing cervical cancer in the test patients. Most of the cases of ISCC in this studyexpressed high level of p16, while only one patient with LSIL failed to express the marker. Notably, 90% of LSIL cases werelow to moderate p16 positive, 100% of HSIL cases were moderate to high p16 positive, while most of the ISCC cases (81%) hadhigh p16 expression. Among p16 positive cases, this is an attempt to verify direct association between lesion severity andreaction intensity. The frequency of positive cells and the reaction intensity were statistically significant (P<0.001) whencompared among different histologic types. Most importantly, the present results clearly demonstrated that p16 IHC wascapable of differentiating ISCC from CIN cases. Conclusion: In addition to routine H & E staining and histopathological diagnosis of cervical lesions, p16 immunomarkercould be used for risk assessment of histologically detected lesions and for distinguishing between ISCC and CIN specimenswhich, in turn, could help predict the progression of cervical lesions and thus monitor the screening of cervical cancer in thecommunity.

Uterine cervical cancer screening at the work place employee physical health checkup

Uterine cervical cancer screening at the work place employee physical health checkup

Genotype Distribution Change After Human Papillomavirus Vaccination in Two Autonomous Communities in Spain.

ContextIt has been more than 10 years since the human papillomavirus (HPV) vaccination program was initiated in most advanced countries. Thus, it seems necessary to change the uterine cervical cancer screening strategy. Molecular-based tests are considered essential in this scenario.ObjectiveWe aimed to review the distribution of the HPV genotypes after the introduction of the vaccination program with Cervarix® and Gardasil 4® in two autonomous communities in Spain, looking for possible changes in distribution and the occurrence of a herd effect.DesignA cross-sectional study was performed in 45,362 samples that were processed in the Cantabria and Aragon communities during the period from 2002 to 2016. We compared the genotype distribution before and after the vaccination program was initiated.ResultsGenotypes HPV6 and HPV11 have decreased significantly after the introduction of the vaccine. HPV16 has had a decrease, but not a significant one in the statistical analysis. However, HPV31, HPV52, and HPV45 have increased in percentage. A replacement phenomenon with other genotypes not included in the vaccine has been observed in our population.ConclusionsContinued surveillance is needed to provide further indication of any changes over time in the genotypes in circulation. This will be facilitated by monitoring the genotyping results from the new model of cervical screening using primary HPV DNA testing.

Follow-up results in patients with atypical glandular cells detected on uterine cervical cancer screening

Follow-up results in patients with atypical glandular cells detected on uterine cervical cancer screening

Social inequalities in cervical cancer screening: a discrete choice experiment among French general practitioners and gynaecologists

BackgroundCervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners’ (GPs) and gynaecologists’ preferences for actions designed to reduce screening inequalities.MethodsFrench physicians’ preferences to UCC screening modalities was assessed using a discrete choice experiment. A national cross-sectional questionnaire was sent between September and October 2014 to 500 randomly selected physicians, and numerically to all targeted physicians working in the French region Midi-Pyrénées. Practitioners were offered 11 binary choices of organized screening scenarios in order to reduce inequalities in UCC screening participation. Each scenario was based on five attributes corresponding to five ways to enhance participation in UCC screening while reducing screening inequalities.ResultsAmong the 123 respondents included, practitioners voted for additional interventions targeting non-screened women overall (p < 0.05), including centralized invitations sent from a central authority and involving the mentioned attending physician, or providing attending physicians with the lists of unscreened women among their patients. However, they rejected the specific targeting of women over 50 years old (p < 0.01) or living in deprived areas (p < 0.05). Only GPs were in favour of allowing nurses to perform Pap smears, but both GPs and gynaecologists rejected self-collected oncogenic papillomavirus testing.ConclusionsFrench practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.

National organization of uterine cervical cancer screening and social inequality in France

Some of the inequality in uterine cervical cancer (UCC) screening uptake are due to the socioeconomic deprivation of women. A national organized screening programme has proven to be effective in increasing the uptake, but may increase socioeconomic inequality. Therefore, we compared inequality in uptake of UCC screening between two French departments, one of which is experimenting an organized screening programme. We used reimbursement data from the main French health insurance scheme to compare screening rates in the municipalities of the two departments over a three-year period. The experimental department had higher screening rates, but the increase in deprivation in municipalities had a greater effect on the decrease in participation in this department. Moreover, while screening rates were higher in urban areas, the negative effect of deprivation on participation was greater in rural areas. Although these departments were compared at the same time under different conditions, socioeconomic inequality between them may have been greater before the experimentation started. However, screening may have led to an increase in socioeconomic inequality between women screened. Special attention must be paid to changes in socioeconomic and geographic inequality in the uptake of UCC screening when the programme is rolled out nationally.

Trends in Uterine Cervical Cancer Screening at Physical Health Checkups for Company Employees in Japan.

The consultation rate for uterine cervical cancer screening in Japan is markedly low in comparison with other developed countries. The purpose of this study is to investigate the trends in uterine cervical cancer screening during regular company checkups and to identify potential problems. Questionnaires were sent to occupational health physicians through Sansuiken (Alumni Association of the University of Occupational and Environmental Health, Japan). Overall, 127 valid responses showed that Papanicolaou (Pap) tests are conducted in 100 companies (79%). The detailed information from 50 of the 100 responses was analyzed. Mandatory cervical cancer screenings are performed at just 6 companies (12%). Pap test are started at 30 years of age at 9 of 49 companies, and only 18 of 49 companies (37%) start Pap tests for employees at 20 years old. Of the 86,695 women, 31,294 (36%) received cervical cancer screening. Abnormal Pap test results were detected in 3.0%. Although cervical cancer screening rates have slightly increased compared to our previous studies (17% in 2004, 23% in 2008), it remains at a low level. Complete examinations with colposcopy and punch biopsy were carried out in 70% (61 of 87 women) of those with an abnormal Pap test. Twelve of 26 companies had no information about detailed examination results. It is important to note that cervical cancer incidence and mortality are increasing among young women in Japan. Occupational physicians and health nurses should manage female health education and care at the workplace, by including uterine cervical cancer screening in the growing female working population.

Detection of HPV RNA molecules in stratified mucin-producing intraepithelial lesion (SMILE) with concurrent cervical intraepithelial lesion: a case report

BackgroundStratified mucin-producing intraepithelial lesion (SMILE) is a rare precursor lesion in the uterine cervix that is considered a variant of adenocarcinoma in situ (AIS). Although human papillomavirus (HPV) is thought to be related to the development of SMILE, there is little information available on the detection of HPV integrated into the lesion.Case presentationA 30-year-old female underwent a routine uterine cervical cancer screening, and her Pap smear indicated the possible existence of atypical glandular cells. A cervical biopsy with endocervical curettage was performed. The histopathological analysis showed that she had SMILE and high-grade squamous intraepithelial lesion (HSIL) on her cervix. The lesion was found to be positive for HPV genotypes 52 and 68 by multiplex PCR. In situ hybridization with HPV RNA probes revealed that these HPV types were involved in the onset of HSIL and SMILE, respectively.ConclusionsRare, high-risk HPV genotypes may contribute to the development of SMILE, and their detection can be useful for preventing the progression to carcinoma and ensuring adequate patient management.

Pathologists is indispensable, in screening, diagnosis and therapy of uterine cervical cancer

随着科学技术的进步，越来越多新的筛查及诊断技术进入到子宫颈癌筛查及诊治中，病理医师在其中的作用是否不重要了？本文从子宫颈细胞学在筛查中的作用、子宫颈病理取材及规范病理诊断、子宫颈腺性病变病理诊断等方面阐述了病理医师在子宫颈癌筛查及诊断中的重要作用，同时也指出了子宫颈癌筛查及诊治中目前国内病理学界存在的问题，提出了需要改进及提高的具体建议。.

Uterine Cervical Cancer and Chronic Kidney Disease An association that should not be skipped

We present the case of a 65 year old female patient with a history of bilateral hydronephrosis (known for about 3 years) diagnosed with keratinizing squamous carcinoma and chronic kidney disease. The low adherence of the patient to the uterine cervical cancer screening program led to the diagnosis of tumor in an advanced stage. In this patient, specific urological treatment (bilateral percutaneous nephrostomy) was not associated with significant improvement in renal function, and therefore she was deemed ESRD, dialysis dependent.

The diagnostic accuracy of a real-time optoelectronic device in cervical cancer screening: A PRISMA-compliant systematic review and meta-analysis.

Background:This study aimed to assess the diagnostic accuracy of a real-time optoelectronic device (TruScreen) for uterine cervical cancer screening.Methods:On the basis of Preferred Reporting Items for Systematic Reviews and Meta-analyses (the PRISMA statement) we performed this systematic review and meta-analysis. We searched PubMed, EMBASE, the Cochrane Library, CNKI, CBM, and WanFang Data using medical subject headings (MeSH) and text words. Title/abstract screening, full text check, data extraction, and methodological quality assessment (with the QUADAS-2 tool) were performed by 2 reviewers independently. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), the summary receiver operator characteristic curve, and the area under the curve (AUC) were analyzed with Meta-DiSc software. Statistical heterogeneity was evaluated by Cochran's Q test and I2, meta-regression was conducted based on patient type, and the possibility of publication bias was evaluated using Deeks funnel plot in Stata software.Results:Of 293 publications, nine met our inclusion criteria. These studies included a total of 2730 patients and 567 cervical intraepithelial neoplasias. The pooled test characteristics for the TruScreen were as follows: sensitivity 76% (95% CI, 73–80%), specificity 69% (95% CI, 67%–71%), PLR 2.30 (95% CI, 1.59–3.33), and NLR 0.34 (95% CI, 0.23–0.51). The corresponding pooled DOR was 7.03 (95% CI, 3.40–14.55). The AUC was 0.7859 (Q∗ = 0.7236).Conclusion:The diagnostic accuracy of the TruScreen device is moderately good. The study findings are based on Chinese studies only and could not be generalized to other populations.

Safety and usefulness of the Cervex brush&lt;sup&gt;®&lt;/sup&gt; for uterine cervical cancer screening of pregnant women

Safety and usefulness of the Cervex brush&lt;sup&gt;®&lt;/sup&gt; for uterine cervical cancer screening of pregnant women

Severe intimate partner physical violence as a risk factor for inadequate cervical cancer screening.

With the aim of assessing the occurrence of severe intimate partner physical violence as a risk factor for inadequate screening of uterine cervical cancer, a case-control study was performed with a multidimensional questionnaire in a sample of 640 users of the Family Health Strategy in the Municipality of Nova Iguaçu, Rio de Janeiro State, Brazil. Cases were defined as women who had not had a cervical cytology test in the previous three years. The results showed that severe physical violence against the woman (adjustedOR = 2.2; 95%CI: 1.1-4.4) and co-occurrence of the event in the couple (adjustedOR = 3.8; 95%CI: 1.4-9.8) were risk factors for inadequate screening. Alcohol abuse by the woman was an effect modifier for not having the test among victims of violence (adjustedOR = 10.2; 95%CI: 1.8-56.4) and in cases of co-occurrence of violence (adjustedOR = 8.5; 95%CI: 1.4-50.7). In addition to known causal factors for intimate partner violence, the results point to a risk association between women's exposure to abuse and inadequate screening. The findings call for an expanded view of women's absenteeism from screening, since this indicator can represent unmet demands not readily detected by health teams.

Comparison of Unsatisfactory Samples from Conventional Smear versus Liquid-Based Cytology in Uterine Cervical Cancer Screening Test

BackgroundCervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. MethodsEach participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. ResultsA total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. ConclusionsUnsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.

Factors Affecting Health Screening Action

Objectives: This study is conducted to investigate the factors related to the willingness of cancer screening with the ¨National Nutrition Survey Original document, a national representative health related survey data. Methods/Statistical Analysis: 4,817 subjects were finally selected and analyzed among 8,108 participated in national nutrition survey in 2013 who are above 30-year-old, the recommended age of uterine cervical cancer screening program which is the minimum age in several cancer screening recommendation program, after deducted the missing value. Findings: According to the study differentiate factors related to correlation analysis for the checkup were place of residence, subjective state of health, stress recognition level, weight control in 1 year, the number of moderate physical activity date in a week, smoking, alcohol intake amount, and subjective body perception. Improvements/Applications: Therefore, the public relations should be strengthened to encourage people in having checkup, and activate check-up program to improve check-up rate for enhancing the national health.

Tamizaje en al era de la vacuna del VPH

Existe mucha expectativa acerca de la introducción de las vacunas profilácticas contra el virus del papiloma humano (VPH), específicamente contra los tipos oncogénicos 16 y 18, ya que teóricamente permitiría prevenir aproximadamente el 70% de los cánceres de cuello uterino del mundo. La vacuna ha sido aprobada en algunos países y hay intenciones de introducirlo en los programas nacionales de inmunizaciones; por ejemplo, algunos estados de los Estados Unidos de Norteamérica están considerando la vacunación obligatoria de niñas en edad escolar. El objetivo de este capítulo es evaluar el efecto que la vacunación podría tener en el tamizaje del cáncer de cuello uterino, para lo que necesitamos hacer una revisión de la historia natural de la infección por VPH y la neoplasia cervical.

Uterine cervical cancer screening in kitakyushu city: present and future

Uterine cervical cancer is the most common primary gynecologic malignant tumor in Japan. Conventional cervical screening Papanicolaou (Pap) test has been shown to be extremely effective in reducing cervical cancer incidence and mortality, but the consultation rate for cancer screening in Japan is markedly low, at 20% of prescribed subjects, in comparison with other developed countries. In 2001, 15,501 women (6.8%) received a Pap test in Kitakyushu City, and that was less than half of national average. From 2009, free coupons for uterine cervical cancer screening were distributed to Japanese woman who were 20, 25, 30, 35 or 40 years of age as part of the project for women-specific cancer screening. The rate of participation in Pap testing was 22.3% in 2012, with 31,970 women receiving cervical tests. It was almost as high as the national level. It's obvious that high risk human papillomavirus (HPV) is responsible for cervical cancer incidence and HPV mainly infects through sexual practice. The rate of early cervical neoplasms and invasive cancers is currently increasing in young women. Abnormal Pap tests were detected in 2.3% of the women in 2008. To increase the population's participation in this screening process, a cost-effective and efficient system should be established. National and local governments, medical institutions, companies, and educational institutions must have an accurate understanding of the current situation, and take an assertive approach in order to decrease the mortality rate of uterine cervical cancer.