Comparative study between pap smear and visual inspection with acetic acid (via) in screening of CIN and early cervical cancer

Background:

Cervical cancer is the second most common among women globally. In most cases of Assam, Ca Cervix is detected late due to lack of effective screening programme.

Aim:

To screen the patient at Gynaecology OPD at the age 18-60 yrs by doing pap smear, VIA (Visual Inspection with Acetic Acid) and to detect sensitivity and specificity for detecting CIN and early Ca Cervix.

Material and Method:

It is a cross sectional study of 300 women (18- 60 yrs) who fulfill selection criteria. The pap smear and VIA are done in these cases. In positive cases, cervical biopsy and histopathological studies are done, The sensitivity and specificity of each test are determined and compared.

Result and observation:

The positive result detected from cytology are 22, VIA was positive in 52 cases. The histology of 19 cases are suggestive of CIN and Ca Cervix.

Discussion:

The findings were compared with other studies and evaluated.

Summary:

The most common finding in per speculum examination is cervical erosion. The sensitivity of VIA is 89% (versus pap smear-52%) the specificity of VIA is 87% (versus pap smear-95%). The accuracy VIA is 87% compared to pap smear-93%.

Conclusion:

The lack of effective and implementable screening programme lead to reporting of advanced cases of Ca Cervix. If detected at CIN or early Ca cervix stage, effective treatment can be provided with encouraging results. Therefore effective & implementable Ca Cervix screening need to be provided in our country.

Acceptance of Cervical Cancer Screening and its Correlates Among Women of a Peri-Urban High-Density Residential Area in Ndola, Zambia

BACKGROUND

Zambia has one of the highest cervical cancer incidence and mortality rates in the world. Cervical cancer screening leads to reduction in the incidence of invasive disease. The objectives of the study were to determine the level of acceptance of cervical cancer screening and its correlates among women of a peri-urban high-density residential area in Ndola, Zambia.

METHODS

A cross sectional study was conducted. With a population size of 12,000 women in reproductive age and using an expected frequency of 50 + 5% and at 95% confidence interval, the required sample size was 372. A stratified sampling method was used to select participants. Independent factors that were associated with the outcome were established using multi-variate logistic regression. Adjusted odds ratios and their 95% confidence intervals are reported.

RESULTS

In total, 355 out of 372 questionnaires were administered, achieving a response rate of 95.4%. Out of 355 participants, 9 (2.5%) had ever been screened for cervical cancer. In bivariate analyses, factors associated with screened were knowledge of body part affected, screening as a prevention tool, whether cervical cancer was curable in its early stages or not, awareness of cervical cancer screening, knowledge on frequency of screening and cervical cancer screening causing harm. However, in multivariate analysis, participants who knew that cervical cancer screening prevented cervical cancer were 3.58 (95% CI [1.49, 8.64]) times more likely to have been screened than those who did not have the knowledge. Participants who knew that cervical cancer is curable were 2.76 (95% CI [1.92, 8.31]) times more likely to have been screened than those who did not have the knowledge.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

The uptake of screening was low. Interventions should be designed to increase uptake of screening for cervical cancer by considering factors that have been identified in the current study that are independently associated with cervical cancer screening among this population.

Prevalence and Associated Factors of Genital and Sexually Transmitted Infections in Married Women of Iran

OBJECTIVES

This study aimed to determine the prevalence of genital and sexually transmitted infections and its related factors in married women in Iran.

METHODS

We conducted a cross-sectional study of 4 274 married women living in urban and rural areas of the Zanjan province from 2012 to 2013. We used stratified cluster sampling to select the participants. Data collection included demographic characteristics, reproductive status, and cervical cytology results.

RESULTS

The prevalence of lower genital infections and sexually transmitted infections were 20.1% and 7.4%, respectively. The most common vaginal infection was bacterial vaginosis with a prevalence of 8.5%, and the most common sexually transmitted infection was Trichomonas vaginalis (1.4%). The use of the intrauterine device (IUD) as a contraceptive, living in an urban area, and experiencing vaginal discharge were significantly related to genital tract and sexually transmitted infections.

CONCLUSIONS

There was a high prevalence of genital infection among women living in Zanjab. Screening and treatment of genital infection are necessary to prevent adverse consequences in women who use an IUD or live in urban areas.

Detection of Chlamydia trachomatis in Pap Smear Samples from South Khorasan Province of Iran

Background

Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI), leads to pelvic inflammatory disease, infertility and chronic pelvic pain in women as well as an increased risk of vertical transmission, conjunctivitis and pneumonitis in infants. It may also be a co-factor along with human papillomavirus (HPV) in cervical cancer progression. We aimed to determine the prevalence of CT genotypes in genital specimens of women from South Khorasan, Iran and to test the association between CT and cytology statistics.

MATERIALS AND METHODS

This was a cross-sectional study on 248 Pap smear samples from women who visited a gynecologist for routine Pap smear testing in South Khorasan province. Nested polymerase chain reaction (PCR) was used to test the residual fluids of Pap smears for CT-DNA after cytological examination. Direct sequencing, alignment and phylogenic analyses were performed on eight samples to identify their genotypes.

RESULTS

The mean age of patients was 37.54 ± 5.21 years. Most samples had a normal cytology (214 cases, 86.29%). Overall, 31 samples were positive for CT infection (12.5%) of which 20 (9.34%) were normal and 11 (32.35%) were abnormal, with the frequency difference being significant (P=0.022). The co-infection of CT/HPV in total was identified in 14 cases (5.6%). The results of sequencing eight samples out of the 31 CT positive samples revealed the detection of genotypes D and E, each with four cases.

CONCLUSION

We show that a high prevalence of genital CT infection is present in women with both normal and abnormal cytology; however, the higher prevalence among women in the abnormal group may indicate its involvement in cervical neoplasia.

Knowledge, Attitude and Practice Concerning Cervical Cancer Screening Among Reproductive Age Group Women in Low-Resource Settings Yenagoa Bayelsa State

Background

Nigeria has one of the highest rates of cervical cancer morbidity and mortality in Sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Cervical cancer is the second most diagnosed cancer and the third leading cause of cancer death in women worldwide. Eighty three percent (83%) of the world's new cases and 85% of all cervical cancer-related deaths occur in developing countries. It is primarily caused by human papilloma virus (HPV); a sexually transmitted pathogen that could be prevented with safe sexual practice and using vaccines, among others. The aim of the study was to assess the knowledge and attitude of reproductive age group women in low resource setting in towards cervical cancer and its prevention in Yenagoa, Bayelsa State Nigeria.

Methodology

This study employed the use of a descriptive study design to examine the knowledge and assessment of cervical cancer among women of reproductive age (19-54), about cervical cancer, its prevention, and their utilization of Pap smear screening; using a convenience sample of 406 women in two communities (Okaka and Agudama) in Yenagoa Local Government Area of Bayelsa State, Nigeria. Women voluntarily completed a structured questionnaire.

Result

Results showed that women who participated in the study were aware of cervical cancer (78.3%; n=318) but many (70.4%; n= 286) were unaware of Pap smears as the screening tests for cervical cancer. Although few of them (45.6%; n =185) knew about a screening center, out of which 17.6% (n= 32) reported that the screening center was less than 2km away from their residences.

Conclusion

There is need for health care professionals, to intensify efforts to increase awareness about cervical cancer screening and encourage women through the different clinics to use these services. The benefits of screening and early diagnosis of cervical cancer should be emphasized to enhance the utilization of cervical cancer screening services.

Evaluation of the risk of cervical cancer in patients with Multiple Sclerosis treated with cytotoxic agents: A cohort study

Background: Since most patients with relapsing-remitting multiple sclerosis (RRMS) are women, the present study aimed to determine whether treatment of patients with MS by cytotoxic agents is associated with an increased risk of cervical dysplasia. Cancer screening is often neglected in the chronic diseases such as MS, so more attention in this field was needed. Decreasing morbidity and mortality due to cervical cancer is the most important goal of screening in female MS patients especially in child bearing age. Thus, it can be said that this is the first study which investigated this important issue. Methods: A total of 129 individuals participated in this cohort study. They were assigned into 3 groups including 43 patients with MS who were treated with cytotoxic drugs, 43 patients with MS on immunomodulators, and 43 normal healthy controls. Pap smears were performed following standard methods and the results obtained from the three groups were compared by statistical analysis. Demographic data, Expanded Disability Status Scale (EDSS), and Pap smear changes were analyzed by SPSS software. Results: The most commonly detected abnormality in all examined patients and healthy controls was inflammation. Five patients with MS who were treated with cytotoxic agents revealed benign cellular changes (BCC) in their Pap smear that were statistically significant in comparison with other groups (P = 0.03). Patients who took Mitoxantrone presented BCC more than other groups [Odds ratio (OR) = 9.44, 95% confidence interval (CI): 1.46-60.70]. There was no significant difference between mean duration of MS diagnosis (P = 0.12), mean duration of previous MS treatments (P = 0.25), and mean duration of current MS treatments (P = 0.21) in patients with BCC compared to normal healthy controls or inflammatory change. Conclusion: According to the results of present study, BCC is more frequently observed in patients with MS who were treated with cytotoxic agents with immunosuppressive effect. Since BCC is a 'premalignant condition', the authors suggest that mandatory annual Pap smear should be performed for patients with MS who are treated with cytotoxic agents irrespective of their age in order to detect early signs of malignancy.

Barriers to Pap Smear Test for the Second Time in Women Referring to Health Care Centers in the South of Tehran: A Qualitative Approach

BACKGROUND

Cervical cancer is a preventable disease with a regular screening program. Many studies have reported a large number of barriers that women had for the first time, but this study decided to find other barriers for the second time pap smear.

METHODS

In this qualitative research, data were gathered through in-depth interviews and expressed through conventional content analysis in the form of constant comparison. The participants were 15 women with family profile at 30 health care centers who lived in the south of Tehran and had done Pap smear for one time but didn't do it for the second time.

RESULTS

Three main themes emerged from the analysis of the interviews: negative experiences of the first Pap test were as follows: results of the first time test, readiness for performing the test, getting the test itself, and the site of the first Pap test. Personal barriers to getting the second Pap test were: inattention to time, physical barriers to the second Pap test, and inhibitory beliefs. Perceived social barriers to getting the second Pap test with two sub-themes included social supports and abstract norms.

CONCLUSION

This study provided other barriers about Pap smear including lack of the spouse's support, the role of health care providers and physicians in screening program for early diagnosis in women.

Prevalence of Cytological Abnormalities in Papanicolaou Smears and Risk Factors for Cervical Cancer Among Women in Muscat, Oman

Objectives

This study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women.

Methods

A cross-sectional study was conducted from March to September 2019 at the gynaecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21 and 65 years were included. Data regarding the participants' sociodemographic characteristics and known risk factors were collected using a self-reported sheet. Pap smears were performed and the results were reported by a cytotechnologist and histopathologist.

Results

A total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( P = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity (P >0.050 each).

Conclusion

The prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. The findings of this study also highlighted the need for a future vaccination program against HPV infections.

Problem-Based Learning: Cervical Adenocarcinoma Three-Session Case for First-Year Medical Students-Patient Minnie Pauls

INTRODUCTION

Cervical adenocarcinoma represents a critical health problem in many underserved regions of the world and parts of the U.S. This module provides learning opportunities in the areas of female anatomy, physiology, histology, and pathology. This includes diagnosis by ultrasound and CT/PET scan, detailed staging and treatment of the cancer by various criteria, and future prevention by vaccination and screening.

METHODS

Authors include a fourth-year medical student and a seasoned PBL facilitator with a basic science interest in cancer. In this problem-based learning module (PBL), a group of first-year medical students review the material that is released online for each of three weekly 90-minute sessions. Key learning issues are identified, researched out-of-class, and discussed at the beginning of the subsequent session. A differential diagnosis is weighed and the module culminates with a concept map drawn by students to integrate all relevant aspects and mechanisms of the case.

RESULTS

The module was implemented twice with a small group of seven students. Students learned to correlate relevant biochemical mechanisms, histological, and anatomical features with the clinical signs and symptoms, to diagnose and suggest treatment options. The module was well-liked, and revised for publication by rebalancing the material based on specific student feedback.

DISCUSSION

The PBL small-group format provides a unique opportunity over both semesters for first-year medical students to study clinical cases in a student-directed fashion and develop professional skills at various levels. Potential pitfalls lie in the online format, as this requires clear rules on computer usage and data sharing.

The Predictors for Non-Adherence to Colposcopy among Women in an Underserved Community in Rural Southern Western Nigeria

Background

Cervical cancer is the fourth most common cancer in women. It is a major public health problem in developing countries. Effective cervical cancer screening requires that women adhere to the screening program. The factors that influence adherence to colposcopy in rural areas of Nigeria are unknown. The objective of the study was to determine the factors that 0determine adherence and the sexual and reproductive factors that are associated with non-adherence of women to colposcopy.

Methods

This is a cross-sectional study of a project undertaken to determine the age- specific incidence of Human Papillomavirus (HPV) infection in Irun Akoko, a rural town in Ondo state of Nigeria. A total of 492 women with abnormal results from 1420 women that were screened were recalled for colposcopy examination.

Results

The non-adherence rate for colposcopy in this study was 25.8%. Women younger than 40years (p=0.0011) and those with number of living children ≤2 (p=0.04) are more likely to be non-adherent to colposcopy.

Conclusion

The non-adherence rate to colposcopy was high. Younger women and those with fewer children were more likely not to adhere to colposcopy.