Pre-invasive cervical disease and uterine cervical cancer in Brazilian adolescents: prevalence and related factors

Prognosis of intraepithelial cervical lesion during adolescence in up to two years of follow-up

Our objective was to describe the evolution of cervical SIL within 24 months of the initial diagnosis, in a cohort study of 147 sexually active adolescents attending a public health service in Rio de Janeiro, between 1993 and 2006. The participants were divided in two groups, according to whether cervical biopsy was performed or not. The median of the interval between sexual debut and the atypical cytopathology was 12 months and in 8.2% of patients there was a diagnosis of HSIL at the first abnormal smear. After a two-year follow-up by cytology, the regression (ASCUS 91%, LSIL 63.6%, HSIL 50%) and progression (LSIL 6.1%) were verified. In the group undergoing biopsy, the final histological regression reached 59.4% for CIN1 and 71.4% for CIN2, while the progression from CIN1 to CIN 2/3 was 3.1%. Our results corroborate the recommendation for conservative management in compliant adolescents due to a high regression rate. However, there should be maintained a careful follow-up based on the possible evolution of the lesion.

Incidence of cervical intraepithelial lesions in a population of adolescents treated in public health services in Rio de Janeiro, Brazil

This study aimed to estimate the incidence and types of cervical cytopathological findings in adolescents who were treated in public health services between 1993 and 2006. This is a cohort study, with the following inclusion criteria: < 20 years of age, sexually-active, without cervical lesions upon entry into the study or sexually active < 1 year. The data were collected from 403 adolescents' medical records. Incidence density of cytopathological alterations was estimated and the actuarial method was used to calculate the 5-year incidence during follow-up after sexual initiation. In the first year of sexual activity, the incidence of cervical lesions was 24.1%. The incidence decreased to 3-8% over the following 4 years. The incidence density was 4.7 cases per 100 persons per year. The first abnormal cytological diagnosis showed atypical squamous cells of undetermined significance (ASCUS) in 5.5% (22) of patients, low-grade squamous intra-epithelial lesions (LSIL) in 28% (113), and high-grade squamous intraepithelial lesions (HSIL) in 3% (12). Eight (67%) cases of HSIL occurred during the first year of sexual activity. The incidence of cytopathological findings at beginning of sexual life is high, suggesting the importance of including sexually-active adolescents in cervical cancer prevention programs.

Human papillomavirus infection is principally found with cervical intra-epithelial neoplasia-III in Toluca, State of Mexico

INTRODUCTION

To describe the prevalence of human papillomavirus infection (HPV) in cases of cervical intra-epithelial neoplasia (CIN), micro-invasive carcinoma and invasive carcinoma in Toluca, State of Mexico.

MATERIALS AND METHODS

Cross-sectional study analysing slides with the diagnosis of CIN I to invasive carcinoma for one year and reporting the presence of HPV; also identifying these cervical-uterine cancer stages noted during one semester in the registery of histopathological studies, at the Department of Pathology, General Regional Hospital 220, Instituto Mexicano del Seguro Social (IMSS).

RESULTS

In one year, from a total of 5755 studies, 731 (13%) were of cervical-uterine cancer, 112 (16%) of these were positive for some stage of cervical cancer and 46.43% had HPV infection. In one semester, 2918 histopathological studies were done, 341 (11.68%) of these were cervix uterine biopsies, colposcopies and hysterectomies. 62 women (18.18%) diagnosed with CIN II-III, carcinoma in situ (CIS), micro-invasive carcinoma or invasive carcinoma and finding HPV infection in 51.92% of total cases.

CONCLUSIONS

The prevalence of HPV was higher than that reported in developed world and CIN II-III are the most common stages in Toluca, State of Mexico.

Lesões intra-epiteliais cervicais em adolescentes: estudo dos achados citológicos entre 1999 e 2005, no Município do Rio de Janeiro, Brasil

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".