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Rezq KA, Algamdi M, Alanazi R, Alanazi S, Alhujairy F, Albalawi R, Al-Zamaa W. Knowledge, Perception, and Acceptance of HPV Vaccination and Screening for Cervical Cancer among Saudi Females: A Cross-Sectional Study. Vaccines (Basel) 2023; 11:1188. [PMID: 37515004 PMCID: PMC10385735 DOI: 10.3390/vaccines11071188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Cervical cancer (CC) ranks as the eighth most prevalent malignancy in Saudi Arabian women of all ages. This cross-sectional study intends to assess women's knowledge, perceptions, and acceptance concerning HPV vaccination and CC screening in Saudi Arabia as well as the contributing variables to women's screening and vaccine acceptability. Data were collected between 1 April 2023 and 30 May 2023 through online questionnaires. Out of 421 responses, 70% of the studied sample had fair knowledge, and 30% had good knowledge related to cervical cancer screening and vaccine. Only 1.9% of the participants had a positive perception, while 41% of the participants had a negative perception toward cervical cancer screening and vaccine. A total of 38% of the participants were fearful of the side effects of the vaccine, while 22.2% doubted the effectiveness of the vaccine. Acceptance was much better correlated with perception (Rho = 0.47) than with knowledge (Rho = 0.177). However, this correlation remains weak. We conclude that Saudi women still have a poor understanding or impression of cervical cancer and prevention methods. Fear of the vaccination's negative effects and skepticism about the effectiveness of the vaccine/screening have recently been the most often-mentioned hurdles to vaccine uptake.
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Affiliation(s)
- Khulud Ahmad Rezq
- Nursing Department, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 47512, Saudi Arabia
| | - Maadiah Algamdi
- Nursing Department, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 47512, Saudi Arabia
| | - Raghad Alanazi
- Nursing Department, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 47512, Saudi Arabia
| | - Sarah Alanazi
- Nursing Department, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 47512, Saudi Arabia
| | - Fatmah Alhujairy
- Nursing Department, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 47512, Saudi Arabia
| | - Radwa Albalawi
- Nursing Department, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 47512, Saudi Arabia
| | - Wafa Al-Zamaa
- Nursing Department, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 47512, Saudi Arabia
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Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest Ethiopia. PLoS One 2022; 17:e0274466. [PMID: 36094938 PMCID: PMC9467373 DOI: 10.1371/journal.pone.0274466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/27/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Cervical cancer is an important public health problem in Ethiopia. However, the disease is not well characterized and studied in various parts of the country. This study was designed to describe the histopathological profile of cervical biopsies and to identify risk factors associated with high-grade cervical lesions and cancer (CIN2+C). Methods A cross-sectional study was conducted at Felege Hiwot Compressive Specialized Hospital (FHCSH) between 1 March 2019 and 30 October 2021. A structured questionnaire was used to collect data on the participants’ demographic, reproductive and gynecologic history. From women presented with different degrees of cervical lesions, a senior gynecologist collected cervical swabs using (Digene HC2 DNA collection device: Qiagen, Hilden, Germany) for detection of high-risk Human papillomaviruses (HR-HPV) and punch biopsy for histopathological examinations. HR-HPVs were detected using the Abbott Alinity m system following the manufacturer protocol at the Institute of Virology, Leipzig University Hospital, Germany. Collected data entered and analyzed using SPSS version 25. A logistic regression model was used for both bivariable & multivariable analysis in order to determine the association between independent variables and CIN2+C. Statistical significance was set at a p-value <0.05. Results In this study, 335 women were included; the mean age was at 46.5±11.4 years. Most were living in rural settings, 221(66%) and had no formal education, 259 (77.3%). More than half of the participants, 193(57.6%) were unaware of cervical cancer. The prevalence of HIV infection and previous history of cervical screening were 44(13.1%) and 93(27.8%), respectively. HR-HPVs were detected in 178(54.3%) of the participants. The majority of biopsies, 140(41.8%; 95%CI: 36.6–47.1%), were diagnosed as cervical carcinoma. Normal histology, cervicitis, cervical intraepithelial neoplasia (CIN)-1, CIN-2, and CIN-3 accounted for 74(22.1%), 30(9.0%), 40(11.9%), 12(3.6%), and 12(3.6%), respectively. High-grade lesions and cancer (CIN2+C) together accounted 164(49.0%; 95%CI: 43.6–54.2). Cervical cancer increased steadily with the age of the participants (p<0.001) in which women above the age of fifty were approximately four times more likely to develop CIN2+C than the younger ones (AOR: 3.73; 95%CI: 1.80–7.82; p<0.001). Likewise, no screening history in the last five years (AOR: 2.03; 95%CI: 1.05–3.92; p = 0.035) and being infected with HR-HPVs (AOR: 14.23; 95%CI: 7.9–25.64; p<0.001) were found significantly associated with CIN2+C. Conclusions The findings of this study revealed that cervical cancer continues to be an important women’s health challenge in northwest Ethiopia. Postmenopausal women, who had no screening history within a five-year period and those women who tested positive for HR-HPV need special attention. It is important to increase the awareness of women about cervical cancer and actions for early detection of precancerous lesions should be expanded.
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Kangethe JM, Monroe-Wise A, Muiruri PN, Komu JG, Mutai KK, Nzivo MM, Pintye J. Utilisation of cervical cancer screening among women living with HIV at Kenya’s national referral hospital. South Afr J HIV Med 2022; 23:1353. [PMID: 35706549 PMCID: PMC9082290 DOI: 10.4102/sajhivmed.v23i1.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA) and Pap smear cytology. Objectives We evaluated utilisation of cervical cancer screening and human papillomavirus (HPV) vaccination among women living with HIV (WLHIV) receiving HIV care at KNH. Method From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services. We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers. Results Overall, 305 WLHIV participated in the survey. Median age was 36 years (interquartile range [IQR]: 28–43), 41% were married, and 38% completed secondary education. Most (90%) had HIV RNA < 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination. Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P < 0.05). In FGDs, barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times. Conclusion Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers contributed to low utilisation.
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Affiliation(s)
- James M Kangethe
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
- Department of Global Health, International AIDS Research and Training Program, University of Washington, Seattle, United States of America
| | - Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Peter N Muiruri
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - James G Komu
- Department of Medical Laboratory Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Kenneth K Mutai
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - Mirriam M Nzivo
- Department of Biological Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Biological Sciences, University of Embu, Embu, Kenya
| | - Jillian Pintye
- Department of Global Health, International AIDS Research and Training Program, University of Washington, Seattle, United States of America
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, United States of America
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Sompawong N, Mopan J, Pooprasert P, Himakhun W, Suwannarurk K, Ngamvirojcharoen J, Vachiramon T, Tantibundhit C. Automated Pap Smear Cervical Cancer Screening Using Deep Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:7044-7048. [PMID: 31947460 DOI: 10.1109/embc.2019.8856369] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
This study aims to apply Mask Regional Convolutional Neural Network (Mask R-CNN) to cervical cancer screening using pap smear histological slides. Based on our current literature review, this is the first attempt of using Mask R-CNN to detect and analyze the nucleus of the cervical cell, screening for normal and abnormal nuclear features. The data set were liquid-based histological slides obtained from Thammasat University (TU) Hospital. The slides contained both cervical cells and various artifacts such as white blood cells, mimicking the slides obtained in actual clinical settings. The proposed algorithm achieved mean average precision (mAP) of 57.8%, accuracy of 91.7%, sensitivity of 91.7%, and specificity of 91.7% per image. As we needed to evaluate the efficiency of our algorithm in comparison to single cell classification algorithm (Zhang et al., IEEE JBHI, vol. 21, no. 6, pp. 1633, 2017), we modified our method to also classify single cells on TU dataset test using Mask R-CNN segmentation. The results obtained had an accuracy of 89.8%, sensitivity of 72.5%, and specificity of 94.3%.
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Lv R, Zhang QW. The long noncoding RNA FTH1P3 promotes the proliferation and metastasis of cervical cancer through microRNA‑145. Oncol Rep 2019; 43:31-40. [PMID: 31789421 PMCID: PMC6908927 DOI: 10.3892/or.2019.7413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 08/09/2019] [Indexed: 12/12/2022] Open
Abstract
Emerging evidence has revealed that long noncoding RNAs (lncRNAs) play crucial roles in the development and progression of tumors. The present study aimed to examine the roles and illustrate the underlying mechanisms of lncRNA ferritin heavy chain 1 pseudogene 3 (FTH1P3) in cervical cancer. The expression of lncRNA FTH1P3 and microRNA-145 (miRNA-145 or miR-145) in human cervical cancer samples and cervical cancer cell lines was detected by qRT-PCR (reverse transcription-quantitative polymerase chain reaction). FTH1P3 overexpression, siRNA plasmid, hsa-miR-145 mimic or hsa-miR-145 inhibitor were transfected. The target of FTH1P3 was predicted by bioinformatics analysis and validated by luciferase assay. Statistical significance analysis was performed by SPSS software. The results revealed that FTH1P3 was significantly upregulated in cervical cancer tissues compared with normal tissues. Increased expression of FTH1P3 was revealed in human cervical cancer cell lines compared with cervical normal epithelial cells. Downregulation of FTH1P3 inhibited cell proliferation, invasion and migration, and promoted apoptosis in cervical cancer cells. miR-145 was predicted and validated as a direct target of FTH1P3. Moreover, FTH1P3 siRNA partially attenuated the effects of the miR-145 inhibitor on cell viability and mobility in cervical cancer cells. The present results demonstrated that lncRNA FTH1P3 functioned as a promoting factor in cervical cancer by targeting miR-145.
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Affiliation(s)
- Rui Lv
- Department of Gynecological Oncology Ward, Gansu Provincial Cancer Hospital, Lanzhou, Gansu 730050, P.R. China
| | - Qian Wen Zhang
- Department of Gynecological Oncology Ward, Gansu Provincial Cancer Hospital, Lanzhou, Gansu 730050, P.R. China
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Efficient inhibition of cervical cancer by dual drugs loaded in biodegradable thermosensitive hydrogel composites. Oncotarget 2017; 9:282-292. [PMID: 29416613 PMCID: PMC5787464 DOI: 10.18632/oncotarget.22965] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/09/2017] [Indexed: 01/02/2023] Open
Abstract
Background and Purpose We aimed to explore the anti-tumor effect and mechanism of the combination of cisplatin (DDP)-containing thermosensitive hydrogel (PEG-PCL-PEG, or PECE) and paclitaxel (PTX)-loaded MPEG-PCL polymeric micelles called PDMP on human cervical carcinoma (HeLa) cell. In our previous studies, we found that PDMP in situ treatment of lung cancer will be liable to have potential in Lung cancer patients. Results Compared with other treatments, PDMP was most effective in prolonging survival time (P < 0.05), inhibiting tumor growth (P < 0.05), decreasing expression of CD133 (P < 0.05), CD31 (P < 0.05), and aldehyde dehydrogenase 1 (ALDH1) (P > 0.05), inducing G1 phase arrest (P < 0.05), increasing the apoptosis rate (P < 0.05), and in expressing ATM and γ-H2AX (P < 0.05). Conclusions PDMP is regarded as a promising anti-tumor reactant, when it comes to the treatment of cervical carcinoma. Methods we used a xenograft cervical cancer model to verify the anti-tumor activity of PDMP and to explore its mechanism of action. Mice were intratumorally administered with NS, PECE, PTX+DDP or PDMP. After two days of treatment, three mice per group were sacrificed and tumor tissue was harvested. Levels of histone H2AX phosphorylation (γ-H2AX) were determined by immunohistochemistry and ataxia telangiectasia mutated(ATM) protein levels were measured by western blot analysis. In addition, it would sacrifice each of group of three mice through 10 days’ treatment, what’s more, it would harvest tumor by virtue of flow cytometry and immunohistochemical analysis. It would like to use there maining mice to analyze tumor growth and survival. The remaining mice were analyzed for tumor growth and survival.
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Ali S, Skirton H, Clark MT, Donaldson C. Integrative review of cervical cancer screening in Western Asian and Middle Eastern Arab countries. Nurs Health Sci 2017; 19:414-426. [PMID: 29058371 DOI: 10.1111/nhs.12374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 07/12/2017] [Accepted: 07/20/2017] [Indexed: 01/21/2023]
Abstract
Population-based screening programs have resulted in minimizing mortality and morbidity from cervical cancer. The aim of this integrative review was to explore the factors influencing access of women from Western Asian and Middle Eastern Arab countries to cervical cancer screening. A systematic search for studies conducted in Arab countries in those regions, and published in English between January 2002 and January 2017, was undertaken. Thirteen papers were selected and subjected to quality appraisal. A three step analysis was used, which involved a summary of the evidence, analysis of both quantitative and qualitative data, and integration of the results in narrative form. Few population-based cervical cancer screening programs had been implemented in the relevant countries, with low knowledge of, and perceptions about, cervical screening among Arab women, the majority of whom are Muslim. Factors affecting the uptake of cervical cancer screening practices were the absence of organized, systematic programs, low screening knowledge among women, healthcare professionals' attitudes toward screening, pain and embarrassment, stigma, and sociocultural beliefs. Policy changes are urgently needed to promote population-based screening programs. Future research should address the promotion of culturally-sensitive strategies to enable better access of Arab Muslim women to cervical cancer screening.
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Affiliation(s)
- Suhailah Ali
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK.,College of Nursing, Kirkuk University, Kirkuk, Iraq
| | - Heather Skirton
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK
| | - Maria T Clark
- School of Nursing, University of Birmingham, Edgbaston, UK
| | - Craig Donaldson
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth, UK
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Costa RFA, Longatto-Filho A, Pinheiro C, Zeferino LC, Fregnani JH. Historical Analysis of the Brazilian Cervical Cancer Screening Program from 2006 to 2013: A Time for Reflection. PLoS One 2015; 10:e0138945. [PMID: 26402737 PMCID: PMC4581862 DOI: 10.1371/journal.pone.0138945] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/05/2015] [Indexed: 12/22/2022] Open
Abstract
Background The Cervical Cancer Database of the Brazilian National Health Service (SISCOLO) contains information regarding all cervical cytological tests and, if properly explored, can be used as a tool for monitoring and managing the cervical cancer screening program. The aim of this study was to perform a historical analysis of the cervical cancer screening program in Brazil from 2006 to 2013. Material and Methods The data necessary to calculate quality indicators were obtained from the SISCOLO, a Brazilian health system tool. Joinpoint analysis was used to calculate the annual percentage change. Results We observed important trends showing decreased rates of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and an increased rate of rejected exams from 2009 to 2013. The index of positivity was maintained at levels below those indicated by international standards; very low frequencies of unsatisfactory cases were observed over the study period, which partially contradicts the low rate of positive cases. The number of positive cytological diagnoses was below that expected, considering that developed countries with low frequencies of cervical cancer detect more lesions annually. Conclusions The evolution of indicators from 2006 to 2013 suggests that actions must be taken to improve the effectiveness of cervical cancer control in Brazil.
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Affiliation(s)
- Ricardo Filipe Alves Costa
- Graduate Program of Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Barretos School of Health Sciences Dr. Paulo Prata – FACISB, Barretos, São Paulo, Brazil
- * E-mail:
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Laboratory of Medical Investigation (LIM 14), Faculty of Medicine, São Paulo University, FMUSP, São Paulo, Brazil
- Life and Health Sciences Research Institute, ICVS, School of Health Sciences, Minho University, Braga, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Céline Pinheiro
- Barretos School of Health Sciences Dr. Paulo Prata – FACISB, Barretos, São Paulo, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Luiz Carlos Zeferino
- School of Medical Sciences, Women’s Hospital CAISM, Unicamp, Campinas, São Paulo, Brazil
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Discacciati MG, Gimenes F, Pennacchi PC, Faião-Flores F, Zeferino LC, Derchain SM, Teixeira JC, Costa MC, Zonta M, Termini L, Boccardo E, Longatto-Filho A, Consolaro ME, Villa LL, Maria-Engler SS. MMP-9/RECK Imbalance: A Mechanism Associated with High-Grade Cervical Lesions and Genital Infection by Human Papillomavirus and Chlamydia trachomatis. Cancer Epidemiol Biomarkers Prev 2015; 24:1539-47. [DOI: 10.1158/1055-9965.epi-15-0420] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/12/2015] [Indexed: 11/16/2022] Open
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A cornucopia of screening and diagnostic techniques for human papillomavirus associated cervical carcinomas. J Virol Methods 2015; 222:192-201. [PMID: 26133260 DOI: 10.1016/j.jviromet.2015.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/26/2015] [Indexed: 01/19/2023]
Abstract
Cervical carcinoma is one of the major consequences of human papillomavirus (HPV) infections. Although HPV infections of cervix do not always progress to cancer, 90% cases of cervical cancer have been found associated with high risk HPV (hrHPV) infection. Usually, HPV infection is asymptomatic; however, this asymptomatic infection can cause abnormal changes in cervix ultimately leading to cancer development. These changes can be detected by the application of screening tests at regular time intervals. For this purpose, morphological, cytological, and DNA based techniques are available. Nevertheless, abnormal screening tests have only the predictive value for precancerous lesions and thus require further evaluation which is usually done by using diagnostic techniques. So far, colposcopy and histological examination alone were considered as the gold standards for cervical cancer diagnosis. Currently, some tests based on expression level of host cell biomarkers are also being used along with histology for diagnostic purpose. Albeit, these tests have significant specificity and sensitivity values but they are unable to suggest a particular viral genotype involved in infection. Diagnostic methods such as PCR, HPV genotyping assays, microarray, and mRNA based assays are useful to predict the genotypes as well as the quantity of viral load in a host cell. Similarly, these diagnostic procedures have high specificity and sensitivity ranges. However, only few of them are practiced commonly, as approval of these tests as routine diagnostic tests requires clinical validation and cost effectiveness.
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Ribeiro AA, Costa MC, Alves RRF, Villa LL, Saddi VA, Carneiro MADS, Zeferino LC, Rabelo-Santos SH. HPV infection and cervical neoplasia: associated risk factors. Infect Agent Cancer 2015; 10:16. [PMID: 26244052 PMCID: PMC4524198 DOI: 10.1186/s13027-015-0011-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavioral risks such as age at first sexual intercourse, number of sexual partners and partner's sexual behavior are associated with an increased risk of HPV infection, persistence of the infection and the development of neoplastic precursor lesions. The objective of this study was to evaluate the risk factors associated with HPV positivity and with a diagnosis of cervical neoplasia in women referred with an abnormal cervical smear. METHODS This study evaluated a series of 198 women referred with an abnormal cervical smear. Risk factors for HPV infection were investigated using a questionnaire. All cervical specimens were tested for 27 HPV genotypes using the Roche polymerase chain reaction reverse line blot assay. RESULTS The overall prevalence of HPV was 87 %. First sexual intercourse before 16 years of age was significantly associated with a positive HPV test (OR 4.41; 95 %CI: 1.20 - 19.33; p = 0.01). A significant association was also found between this risk factor and CIN 1 lesions or worse (OR 2.2; 95 %CI 0.94 - 5.08; p = 0.03). CONCLUSIONS The age at which a woman begins to be sexually active is associated with HPV infection and with a diagnosis of cervical neoplasia.
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Affiliation(s)
- Andrea Alves Ribeiro
- />Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO Brazil
- />Pontifical Catholic University of Goiás, Goiânia, GO Brazil
| | - Maria Cecília Costa
- />Santa Casa de São Paulo, INCT-HPV at Santa Casa Research Institute, School of Medicine, São Paulo, Brazil
| | - Rosane Ribeiro Figueiredo Alves
- />Santa Casa de Misericórdia de Goiânia, Goiânia, GO Brazil
- />Pontifical Catholic University of Goiás, Goiânia, GO Brazil
- />School of Medicine, Federal University of Goiás, Goiânia, GO Brazil
| | - Luísa Lina Villa
- />Santa Casa de São Paulo, INCT-HPV at Santa Casa Research Institute, School of Medicine, São Paulo, Brazil
- />Department of Radiology and Oncology, School of Medicine, University of São Paulo and Cancer Institute of the State of São Paulo, ICESP, São Paulo, Brazil
| | - Vera Aparecida Saddi
- />Pontifical Catholic University of Goiás, Goiânia, GO Brazil
- />Program in Environmental Sciences and Health, Pontifical Catholic University of Goiás, Goiânia, GO Brazil
- />Laboratory of Oncogenetics and Radiology, Associação de Combate ao Câncer, Goiás, Goiânia, GO Brazil
| | | | | | - Sílvia Helena Rabelo-Santos
- />Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO Brazil
- />School of Pharmacy, Federal University of Goiás, Goiânia, GO Brazil
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Hu F, Vishwanath K, Lo J, Erkanli A, Mulvey C, Lee WT, Ramanujam N. Rapid determination of oxygen saturation and vascularity for cancer detection. PLoS One 2013; 8:e82977. [PMID: 24358243 PMCID: PMC3865147 DOI: 10.1371/journal.pone.0082977] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 11/01/2013] [Indexed: 01/22/2023] Open
Abstract
A rapid heuristic ratiometric analysis for estimating tissue hemoglobin concentration and oxygen saturation from measured tissue diffuse reflectance spectra is presented. The analysis was validated in tissue-mimicking phantoms and applied to clinical measurements in head and neck, cervical and breast tissues. The analysis works in two steps. First, a linear equation that translates the ratio of the diffuse reflectance at 584 nm and 545 nm to estimate the tissue hemoglobin concentration using a Monte Carlo-based lookup table was developed. This equation is independent of tissue scattering and oxygen saturation. Second, the oxygen saturation was estimated using non-linear logistic equations that translate the ratio of the diffuse reflectance spectra at 539 nm to 545 nm into the tissue oxygen saturation. Correlations coefficients of 0.89 (0.86), 0.77 (0.71) and 0.69 (0.43) were obtained for the tissue hemoglobin concentration (oxygen saturation) values extracted using the full spectral Monte Carlo and the ratiometric analysis, for clinical measurements in head and neck, breast and cervical tissues, respectively. The ratiometric analysis was more than 4000 times faster than the inverse Monte Carlo analysis for estimating tissue hemoglobin concentration and oxygen saturation in simulated phantom experiments. In addition, the discriminatory power of the two analyses was similar. These results show the potential of such empirical tools to rapidly estimate tissue hemoglobin in real-time spectral imaging applications.
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Affiliation(s)
- Fangyao Hu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Karthik Vishwanath
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Justin Lo
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Christine Mulvey
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Walter T. Lee
- Division of Otolaryngology–Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
- Section of Otolaryngology–Head and Neck Surgery, Veterans Administration Medical Center, Durham, North Carolina, United States of America
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
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Fonseca AJD, Ferreira LCDL, Neto GB. Cost-effectiveness of the vaccine against human papillomavirus in the Brazilian Amazon region. Rev Assoc Med Bras (1992) 2013; 59:442-51. [PMID: 24041909 DOI: 10.1016/j.ramb.2013.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/25/2013] [Accepted: 03/23/2013] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess the cost-utility of the human papillomavirus (HPV) vaccination on the prevention of cervical cancer in the Brazilian Amazon region. METHODS A Markov cohort model was developed to simulate the natural evolution of HPV and its progress to cervical cancer, considering the current preventive programs and treatment costs. The one-year transition probabilities were mainly based on empirical data of local and national studies. The model evaluated the addition of the vaccine to three cervical cancer-screening scenarios (0, 3 or 10 exams throughout life). RESULTS The scenario of three Pap tests resulted in satisfactory calibration (base case). The addition of HPV vaccination would reduce by 35% the incidence of cervical cancer (70% vaccination coverage). The incremental cost-effectiveness ratio was US$ 825 for each quality-adjusted life year gained. The sensitivity analysis confirms the robustness of this result, and duration of immunity was the parameter with greater variation in incremental cost-effectiveness ratio. CONCLUSION Vaccination has a favorable profile in terms of cost-utility, and its inclusion in the immunization schedule would result in a substantial reduction in incidence and mortality of invasive cervical cancer in the Brazilian Amazon region.
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Affiliation(s)
- Allex Jardim da Fonseca
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Post-Graduate Program in Economics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Mungo C, Cohen CR, Maloba M, Bukusi EA, Huchko MJ. Prevalence, characteristics, and outcomes of HIV-positive women diagnosed with invasive cancer of the cervix in Kenya. Int J Gynaecol Obstet 2013; 123:231-5. [PMID: 24095308 DOI: 10.1016/j.ijgo.2013.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/01/2013] [Accepted: 09/04/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the prevalence of invasive cervical cancer (ICC) and assess access to, and outcomes of, treatment for ICC among HIV-infected women in Kisumu, Kenya. METHODS We performed a retrospective chart review to identify women diagnosed with ICC between October 2007 and June 2012, and to examine the impact of a change in the referral protocol. Prior to June 2009, all women with ICC were referred to a regional hospital. After this date, women with stage IA1 disease were offered treatment with loop electrosurgical excision procedure (LEEP) in-clinic. RESULTS Of 4308 women screened, 58 (1.3%) were diagnosed with ICC. The mean age at diagnosis was 34years (range, 22-50years). Fifty-four (93.1%) women had stage IA1 disease, of whom 36 (66.7%) underwent LEEP, 7 (12.9%) had a total abdominal hysterectomy, and 11 (20.4%) had unknown or no treatment. At 6, 12, and 24months after LEEP, 8.0% (2/25), 25.0% (6/24), and 41.2% (7/17) of women had a recurrence of cervical intraepithelial neoplasia 2 or worse, respectively. CONCLUSION Most HIV-positive women diagnosed with ICC through screening had early-stage disease. The introduction of LEEP in-clinic increased access to treatment; however, recurrence was high, indicating the need for continued surveillance.
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Affiliation(s)
- Chemtai Mungo
- Doris Duke Clinical Research Fellow, University of California San Francisco, San Francisco, USA.
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Chang VTC, Merisier D, Yu B, Walmer DK, Ramanujam N. Towards a field-compatible optical spectroscopic device for cervical cancer screening in resource-limited settings: effects of calibration and pressure. OPTICS EXPRESS 2011; 19:17908-24. [PMID: 21935155 DOI: 10.1364/oe.19.017908] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Quantitative optical spectroscopy has the potential to provide an effective low cost, and portable solution for cervical pre-cancer screening in resource-limited communities. However, clinical studies to validate the use of this technology in resource-limited settings require low power consumption and good quality control that is minimally influenced by the operator or variable environmental conditions in the field. The goal of this study was to evaluate the effects of two sources of potential error: calibration and pressure on the extraction of absorption and scattering properties of normal cervical tissues in a resource-limited setting in Leogane, Haiti. Our results show that self-calibrated measurements improved scattering measurements through real-time correction of system drift, in addition to minimizing the time required for post-calibration. Variations in pressure (tested without the potential confounding effects of calibration error) caused local changes in vasculature and scatterer density that significantly impacted the tissue absorption and scattering properties Future spectroscopic systems intended for clinical use, particularly where operator training is not viable and environmental conditions unpredictable, should incorporate a real-time self-calibration channel and collect diffuse reflectance spectra at a consistent pressure to maximize data integrity.
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Alves de Sousa NL, Alves RRF, Martins MR, Barros NKDS, Ribeiro AA, Zeferino LC, Dufloth RM, Rabelo-Santos SH. Cytopathic effects of human papillomavirus infection and the severity of cervical intraepithelial neoplasia : A frequency study. Diagn Cytopathol 2011; 40:871-5. [PMID: 21591275 DOI: 10.1002/dc.21656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 12/31/2010] [Indexed: 11/11/2022]
Abstract
Cytopathic effects related to the human papillomavirus (HPV) infection are more frequently found in cervical intraepithelial neoplasia (CIN) 1; however, there are indications that at least half the histological diagnoses of CIN2 and CIN3 include koilocytosis areas. The objective of this study was to evaluate the frequency of the cytological criteria suggestive of HPV infection in the cervical smears of women with a histological diagnosis of CIN. One hundred and sixty-two women with abnormal cervical smears and a diagnosis of CIN confirmed by histopathology were selected, including 46 cases of CIN 1, 42 of CIN 2 and 74 cases of CIN 3. Koilocytosis was found in 63% of the smears from women with a histopathological diagnosis of CIN 1. This sign was observed in 26.2% and 25.7% of smears of women with a diagnosis of CIN 2 and CIN 3, respectively. Cytomegaly also was frequent in cervical smears of women with histopathological diagnosis of CIN 1 (71.8%). On the other hand, spindle cells and atypical metaplasia were more frequent in women with CIN 2 and CIN 3. Atypical parakeratosis showed similar frequency in all grades of CIN diagnosis. Koilocytois and cytomegaly were inversely correlated with the diagnosis of CIN2 or CIN 3, with OR values respectively of 0.30 (95%CI 0.13-0.68) and 0.26 (95%CI 0.11-0.58). The others signs analyzed did not show any significant association. Koilocitosis and cytomegaly can provides good reassurance that a patient with atypical cervical smear have CIN 1.
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Vale DBAPD, Morais SS, Pimenta AL, Zeferino LC. [Assessment of the cervical cancer screening in the Family Health Strategy in Amparo, São Paulo State, Brazil]. CAD SAUDE PUBLICA 2010; 26:383-90. [PMID: 20396853 DOI: 10.1590/s0102-311x2010000200017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 11/14/2009] [Indexed: 11/22/2022] Open
Abstract
Uterine cervical cancer mortality has not been declining. The territorial distribution and registration of families in Brazil's Family Health Strategy help identify women that have performed a Pap smear or that have not had one for more than three years. This study analyzed whether cervical cancer screening in Amparo, São Paulo State, Brazil, made progress in complying with the prevailing guidelines during the seven years of experience with the Strategy. The annual examination rate remained high, with a slight trend towards greater intervals between follow-up tests. Distribution of tests tended to increase in the 40-59-year age bracket and decrease in the over-60 age group, while annual coverage tended to decrease. The proportions of excess tests varied from 61.2% to 65.5%. Concluding, the upgrading of cervical cancer screening was slight, and did not change the opportunistic pattern of follow-up tests. Considering that community health agents can act to increase the coverage of these measures, it is essential to train them for this work.
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Alves RRF, Rabelo-Santos SH, Ribeiro AA, Carneiro MADS, Ximenes Y, Tavares SBDN, Saddi V, Zeferino LC. Usefulness of repeat cytology at the time of first colposcopy. Diagn Cytopathol 2009; 37:68-73. [PMID: 18973263 DOI: 10.1002/dc.20976] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The value of repeat cytology in the detection of high-grade preinvasive or invasive disease was analyzed at the time of colposcopy in cases of patients with abnormal referral cytology. A series of 136 patients with squamous abnormalities in their referral cytology, who had undergone repeat cytology and for whom outcome had been established, were included in the study. Final diagnosis consisted of 27 negative results (20%), 37 cases of CIN1 (27%), 31 CIN2 (23%), 39 CIN3 (29%), and 2 (1%) cases of squamous cell carcinoma (SCC). Referral and repeat cytology suggestive of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL) were findings significantly associated with a final diagnosis of CIN2 or worse. Sensitivity and positive predictive value of repeat cytology for the histological diagnosis of significant histological neoplasia (CIN2 or worse) were 81.9% and 77.6%, respectively. In women with referral cytology findings of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion (ASC-US/LSIL), repeat cytology was suggestive of HSIL in 20% of cases (11/54), and in 4% (2/54) biopsy was negative or CIN1, and the final diagnosis established by LLETZ was CIN3. Eight cases (10%) of HSIL in referral and repeat cytology in which biopsies were negative or insufficient were diagnosed as CIN3 or worse in the final diagnosis. Repeat cytology would have changed therapeutic management in 4 and 10%, respectively, of patients included as ASC-US/LSIL and ASC-H/HSIL in referral cytology.
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Wong LP. HPV information needs, educational messages and channel of delivery preferences: views from developing country with multiethnic populations. Vaccine 2009; 27:1410-5. [DOI: 10.1016/j.vaccine.2008.12.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 12/01/2008] [Accepted: 12/20/2008] [Indexed: 11/25/2022]
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Fotinatos N, Warmington A, Walker T, Pilbeam M. Estimates for cervical abnormalities in Vanuatu. Aust N Z J Public Health 2007; 31:571-5. [DOI: 10.1111/j.1753-6405.2007.00146.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cain J, Denny L, Ngan HYS. Overcoming barriers to the eradication of cervical cancer: women's health and rights. Int J Gynaecol Obstet 2007; 97:232-4. [PMID: 17451715 DOI: 10.1016/j.ijgo.2007.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J Cain
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, Oregon 97239, USA.
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