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Nessa A, Ara R, Fatema P, Nasrin B, Chowdhury A, Khan KH, Barua AR, Rashid MHU. Influence of Demographic and Reproductive Factors on Cervical Pre-Cancer and Cancer in Bangladesh. Asian Pac J Cancer Prev 2020; 21:1883-1889. [PMID: 32711411 PMCID: PMC7573429 DOI: 10.31557/apjcp.2020.21.7.1883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In Bangladesh, cervical cancer (CC) is the 2nd most common cancer with estimated 8068 new cases and 5,214 deaths every year. It is also revealed that different socio-demographic factors have association with CC. This study was performed to evaluate the colposcopy outcomes and the association of different demographic and reproductive risk factors with cervical pre-cancer and cancer. METHODS This retrospective cross-sectional study was carried out at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) between January 2010 and December 2016. RESULTS A total 16147 women attended the colposcopy clinic of BSMMU with VIA positive reports. Among them, 65.73% women were referred from different VIA centers of Dhaka district. Mean age of marriage of the subjects was 16. 93 (± 1) and mean age of 1st delivery was 18.45 years (± 4.10). Almost three-fourth of them were married before 18 years and had their 1st delivery by 20 years. Colposcopy examination of the VIA positive women revealed that 36.7% had CINI, 10.6% had CINII/ III and 7.1% had carcinoma of cervix. Considering CIN as disease the Sensitivity, Specificity, PPV and NPV of colposcopy were found 99.7%, 75.3%, 70.3% and 99.8% respectively. On other hand considering CIN2+ as disease the Sensitivity, Specificity, PPV and NPV of colposcopy were found 73.8%, 92.7%, 64.4% and 95.2% respectively. Statistical analysis revealed that higher age (p=0.000), lower level of education (p=0.007), lower socioeconomic status (p=0.014), higher parity (p=0.001) had individual influence on cervical pre-cancer and cancer. CONCLUSIONS This study indicated higher age, low level of education, lower socio-economic condition and higher parity as most important socio-demographic factors for developing cervical pre-cancer and cancer in Bangladesh.
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Affiliation(s)
- Ashrafun Nessa
- Department of Gynaeclogical Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka-1000, Bangladesh
| | - Rowson Ara
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Parveen Fatema
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Begum Nasrin
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Afroza Chowdhury
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Kamrul Hasan Khan
- Department of Histopathology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | | | - Mohammad Harun Ur Rashid
- Institute of Epidemiology, Diseese Control and Research (IEDCR), Directorate General of Health Services, Mohakhali, Dhaka-1212, Bangladesh
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de Oliveira Martins CA, Do Val Guimarães ICC, Velarde LGC. Relationship between the risk factors for human papillomavirus infection and lower genital tract precursor lesion and cancer development in female transplant recipients. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
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Discacciati MG, da Silva ID, Villa LL, Reis L, Hayashi P, Costa MC, Rabelo-Santos SH, Zeferino LC. Prognostic value of DNA and mRNA e6/e7 of human papillomavirus in the evolution of cervical intraepithelial neoplasia grade 2. Biomark Insights 2014; 9:15-22. [PMID: 24812482 PMCID: PMC3999821 DOI: 10.4137/bmi.s14296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/26/2014] [Accepted: 02/28/2014] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study aimed at evaluating whether human papillomavirus (HPV) groups and E6/E7 mRNA of HPV 16, 18, 31, 33, and 45 are prognostic of cervical intraepithelial neoplasia (CIN) 2 outcome in women with a cervical smear showing a low-grade squamous intraepithelial lesion (LSIL). METHODS This cohort study included women with biopsy-confirmed CIN 2 who were followed up for 12 months, with cervical smear and colposcopy performed every three months. RESULTS Women with a negative or low-risk HPV status showed 100% CIN 2 regression. The CIN 2 regression rates at the 12-month follow-up were 69.4% for women with alpha-9 HPV versus 91.7% for other HPV species or HPV-negative status (P < 0.05). For women with HPV 16, the CIN 2 regression rate at the 12-month follow-up was 61.4% versus 89.5% for other HPV types or HPV-negative status (P < 0.05). The CIN 2 regression rate was 68.3% for women who tested positive for HPV E6/E7 mRNA versus 82.0% for the negative results, but this difference was not statistically significant. CONCLUSIONS The expectant management for women with biopsy-confirmed CIN 2 and previous cytological tests showing LSIL exhibited a very high rate of spontaneous regression. HPV 16 is associated with a higher CIN 2 progression rate than other HPV infections. HPV E6/E7 mRNA is not a prognostic marker of the CIN 2 clinical outcome, although this analysis cannot be considered conclusive. Given the small sample size, this study could be considered a pilot for future larger studies on the role of predictive markers of CIN 2 evolution.
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Affiliation(s)
- Michelle G Discacciati
- Laboratory of Clinical Pathology and Cytology, Department of Clinical Chemistry and Toxicology, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ismael Dcg da Silva
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
| | - Luisa L Villa
- Laboratory of Virology, Ludwig Institute for Cancer Research, São Paulo, Brazil
| | - Leandro Reis
- Department of Molecular Biology, Salomão & Zoppi Laboratory, São Paulo, Brazil
| | - Priscila Hayashi
- Department of Molecular Biology, Salomão & Zoppi Laboratory, São Paulo, Brazil
| | - Maria C Costa
- Laboratory of Virology, Ludwig Institute for Cancer Research, São Paulo, Brazil
| | | | - Luiz C Zeferino
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
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Kawai K, de Araujo GTB, Fonseca M, Pillsbury M, Singhal PK. Estimated health and economic impact of quadrivalent HPV (types 6/11/16/18) vaccination in Brazil using a transmission dynamic model. BMC Infect Dis 2012; 12:250. [PMID: 23046886 PMCID: PMC3517904 DOI: 10.1186/1471-2334-12-250] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 10/01/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cervical cancer is the second most common cancer among women in Brazil. We examined the health and economic impacts of quadrivalent HPV vaccination in Brazil. METHODS We adapted a previously developed transmission dynamic model to estimate the effectiveness of HPV vaccination on cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), CIN1, and genital warts. We evaluated following vaccination strategies: routine vaccination of 12-year-old girls and routine vaccination in combination with a catch-up vaccination of 12 to 26-year-old women. RESULTS The model projected that the vaccination would reduce the incidence rates of HPV 6/11/16/18-related cervical cancer, CIN2/3, CIN1, and female genital warts by 94% to 98% at year 100. Routine vaccination in combination with a catch-up vaccination could prevent approximately 163,000 cases of cervical cancer, 48,000 deaths from cervical cancer, 2.3 million cases of CIN2/3, and 11.4 million genital warts in the next 50 years. The incremental cost-effectiveness ratios for female vaccination strategies ranged from R$350 to R$720 (US$219 to US$450) per quality-adjusted life year (QALY) gained. CONCLUSIONS Our study demonstrates that quadrivalent HPV female vaccination can be a cost-effective public health intervention that can substantially reduce the burden of cervical diseases and genital warts in Brazil.
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Affiliation(s)
- Kosuke Kawai
- Temple University, 3307 N, Broad Street, Philadelphia, PA 19140, USA.
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Discacciati MG, de Souza CAS, d'Otavianno MG, Ângelo-Andrade LAL, Westin MCA, Rabelo-Santos SH, Zeferino LC. Outcome of expectant management of cervical intraepithelial neoplasia grade 2 in women followed for 12 months. Eur J Obstet Gynecol Reprod Biol 2010; 155:204-8. [PMID: 21193261 DOI: 10.1016/j.ejogrb.2010.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 11/05/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the outcome of CIN 2 diagnosed by colposcopy-directed biopsy in women followed without treatment for 12 months and to verify whether the regression and progression of this lesion are associated with the woman's age at diagnosis and age at first sexual intercourse. STUDY DESIGN Women diagnosed with CIN 2 by biopsy and with previous cervical smear showing LSIL were included in this cohort study and followed up for one year with cervical smear and colposcopy every three months. The rates of progression, persistence and regression of the CIN 2 were evaluated. The Kruskal-Wallis test was used to analyze the woman's age at diagnosis, age at first sexual intercourse and interval since the first sexual intercourse according to the CIN 2 outcome, assuming a significance level of 5%. RESULTS At the end of 12 months of follow-up the CIN 2 regression rate was 74% (31/42), progression rate to CIN 3 was 24% (10/42) and in one case CIN 2 persisted (2%). Among women who had regression, this event was detected in the first six months of follow-up in 26 of the 31 cases. There was no statistically significant association between the evolution of CIN 2 and the woman's age at diagnosis, age at first sexual intercourse and interval since first sexual intercourse. Women whose lesions were restricted to one quadrant were more likely to have CIN 2 regression at three-month follow-up compared with women with a lesion extending to one or more quadrants (OR: 6.50; 95% CI: 1.20-35.23). CONCLUSIONS The results of this study indicate that the majority of CIN 2 diagnosed by biopsy in women with previous Pap smear showing LSIL will regress in 12 months and therefore an expectant approach could be considered in these cases, not only for young women. Nevertheless these findings are not conclusive, and larger studies are required in order to certify when it is safe to adopt expectant management for CIN 2.
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Affiliation(s)
- Michelle G Discacciati
- Woman's Hospital Prof Dr Jose Aristodemo Pinotti-CAISM, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Is Higher Prevalence of Cervical Intraepithelial Neoplasia in Women With Lupus Due to Immunosuppression? J Clin Rheumatol 2010; 16:153-7. [DOI: 10.1097/rhu.0b013e3181df5261] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pedrosa ML, Mattos IE, Koifman RJ. Lesões intra-epiteliais cervicais em adolescentes: estudo dos achados citológicos entre 1999 e 2005, no Município do Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2008; 24:2881-90. [DOI: 10.1590/s0102-311x2008001200017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 04/16/2008] [Indexed: 11/22/2022] Open
Abstract
A freqüência das lesões precursoras do câncer cervical vem crescendo entre a população de adolescentes, possivelmente, em conseqüência da diminuição da idade de início da vida sexual e do aumento no número de parceiros sexuais. Com o objetivo de analisar o comportamento das lesões precursoras do câncer cérvico-uterino entre adolescentes do Município do Rio de Janeiro, Brasil, estudou-se, de forma retrospectiva, 1.516.407 exames citológicos provenientes de unidades do Sistema Único de Saúde entre 1999 e 2005. Foram comparadas, ao longo do período, a distribuição das alterações citológicas e a tendência temporal dessa distribuição entre adolescentes e mulheres adultas. No período, observou-se maior freqüência de anormalidades citológicas no grupo de adolescentes, predominando as lesões de baixo grau. A prevalência de alterações cervicais em adolescentes duplicou, passando de 6,4% para 12,4%, enquanto, nas mulheres adultas, aumentou de 4% para 6,1%, sendo estimado incremento anual médio entre as adolescentes e mulheres adultas de, respectivamente 0,008% e 0,003%. Com base neste estudo e na literatura consultada, sugerimos a inclusão das adolescentes no grupo prioritário para rastreio citológico periódico do "Programa Viva Mulher".
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Abstract
In developed countries, systematic screening programmes have reduced the morbidity and mortality resulting from cervical cancer. Cytological methods of screening have been the mainstay in these countries. Nevertheless, there is scant evidence that cytology-based screening has had any effect in reducing cervical cancer mortality in less-developed countries. In fact, the challenge in less-developed countries is surpassed by the complex array of problems that go far beyond the introduction of simplified technologies. Currently, there are two main issues on this subject: the assessment of simpler screening methods, and the evaluation of different strategies regarding which women to target and the screening interval. Achieving high rates of coverage and compliance of the target population through high-quality procedures has remained the most difficult goal to achieve. Nevertheless, it is believed that creativity, flexibility and well-focused use of resources can reduce the inequitable burden of cervical cancer borne by women in poor countries.
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