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Abstract
OBJECTIVE The aim of the study was to describe temporal trends in screening and outcomes for women, after changes in guidelines in Alberta, Canada, that raised starting age to 21 years, then to 25 years of age, and reduced frequency to 3 yearly. MATERIALS AND METHODS Calgary Laboratory Information System data were used to examine screening rates, follow-up procedures, and cancer among women 10-29 years from 2007 to 2016 in the whole population of Calgary. Interrupted time-series analyses were used to assess changes in screening and subsequent diagnostic procedures over the 10-year period. RESULTS Annual screening rates dropped by approximately 10% at all ages older than 15 years after the 2009 Alberta cervical cancer screening guidelines, followed by a steady decrease. Further change continued subsequent to minimal apparent effect of the 2013 Canadian Task Force on Preventive Health Care guidelines. The rates of abnormal test results decreased in concert with decreased screening. No increases in cervical intraepithelial neoplasia 1, cervical intraepithelial neoplasia 2/3, or invasive cervical cancer rates were observed after reduced testing. CONCLUSIONS The largest decrease in screening and follow-up procedures occurred in the period immediately after implementation of 2009 Alberta screening guidelines. The number of consequent procedures also decreased in proportion to decreased screening, but there was no increase in cancer rates. Starting screening at the age of 25 years and reducing intervals seem to be safe.
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Affiliation(s)
- Sayeeda Amber Sayed
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Naugler
- Departments of Pathology and Laboratory Medicine, Family Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Guanmin Chen
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - James A. Dickinson
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Donkoh ET, Agyemang-Yeboah F, Asmah RH, Wiredu EK. Prevalence of cervical cancer and pre-cancerous lesions among unscreened Women in Kumasi, Ghana. Medicine (Baltimore) 2019; 98:e14600. [PMID: 30921178 PMCID: PMC6456016 DOI: 10.1097/md.0000000000014600] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 12/26/2018] [Accepted: 01/28/2019] [Indexed: 10/31/2022] Open
Abstract
Ghana does not have a universal population-based cervical cancer screening program and there is very limited information about the distribution of cervical epithelial cell lesions. This study provides evidence that a moderately high prevalence of cervical cancer and precancerous lesions exists among unscreened women in Kumasi.The prevalence of cervical epithelial cell abnormalities among a cross-section of women attending cervical cancer screening for the first time in a suburb of Ghana from 2011 to 2014 was studied. Cervical smears were prepared and examined independently by 2 cytotechnologists and confirmed by a pathologist. Cervical lesions were classified according to the Bethesda System for cervical cytology 2001.Out of the 592 women for whom a Pap smear was available for evaluation, 555 (93.8%) were negative for intraepithelial lesion or malignancy. Eight women (1.4%) showed atypical squamous cells of undetermined significance (ASCUS), 9 (1.4%) low-grade squamous intraepithelial lesions, and 2 (0.3%) high-grade squamous intraepithelial lesions. A total of 15 (2.5%) smears were unsatisfactory for cervical cytology. Additionally, 3 women (0.5%) had squamous cell carcinoma, giving an overall rate of 3.7% for epithelial cell abnormalities.Cervical cancer and precursor epithelial cell abnormalities are common among women in Kumasi for a disease that can be prevented by early detection through routine screening and management. This study provides adequate background data to recommend the implementation of cervical cancer screening in all eligible women in Ghana.
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Affiliation(s)
- Emmanuel Timmy Donkoh
- Department of Basic and Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani
| | - Francis Agyemang-Yeboah
- Department of Molecular Medicine, School of Medical Sciences, KNUST, Private Mail Bag, Kumasi
| | | | - Edwin K. Wiredu
- Department of Pathology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Ghana
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3
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Abstract
Ninety years ago, at the Battle Creek conference, Papanicolaou introduced cervical exfoliative cytology. Since then, the "Pap test" has come a long way. The discovery of a causal relationship between cervical carcinoma and HPV infection opened the door for molecular testing and immunomarkers for HPV. The Clinical Laboratory Improvement Amendments, 1988, established quality assurance and quality control programs to monitor performance of cytology laboratories. The Bethesda System for reporting cervical cytology laid the foundations for cervical cytology education, implementation of management guidelines, and further research on cervical carcinogenesis. HPV vaccine penetration in both genders remains 62% or less.
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Affiliation(s)
- Catherine J Roe
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Krisztina Z Hanley
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
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Abstract
OBJECTIVE To explore the current and anticipated changes in the practice of cytopathology. STUDY DESIGN The present review is based on a review of recent literature and an evaluation of the authors' personal experiences. RESULTS AND CONCLUSION In recent years the practice of cytopathology, nationwide and in our institute, has witnessed a major change affecting gynecologic and nongynecologic cytology. There has been a decline in the number of Papanicolaou tests which has affected the utilization of cytotechnologists and provoked a reorganization of their work flow. The "need to do more with less" in the era of targeted therapy/personalized medicine has resulted in an increasing preference for needle core biopsy when performing a rapid on-site evaluation. We feel that this change is unavoidable. It is pertinent that cytopathologists as a group recognize this change and prepare themselves and the trainees not only to become adapt but also to use this as an opportunity to discover the yet unexplored world of cytology.
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Affiliation(s)
- Maria F Gonzalez
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
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Tao X, Austin RM, Zhang H, Zhang L, Xiao J, Wang L, Zhou X, Zhao C. Pap Test Reporting Rates for Conventional Smear and Liquid-Based Cervical Cytology from the Largest Academic Women's Hospital in China: Analysis of 1,248,785 Pap Test Reports. Acta Cytol 2016; 59:445-51. [PMID: 26789332 DOI: 10.1159/000443679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/28/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The Obstetrics and Gynecology Hospital of Fudan University (OGHFU) in Shanghai is the largest academic women's hospital in China. Between 2009 and 2014, the use of liquid-based cytology (LBC) significantly increased while gradually adopting the Bethesda System (TBS), and in 2012 local regulations mandated that pathologists replace technicians to sign out Pap tests. DESIGN A retrospective OGHFU database search documented all Pap test reports between 2009 and 2014 by specimen type, either LBC or conventional Pap smears (CPS), and final reporting category. A total of 1,224,785 Pap reports were analyzed to document variations in Pap test reporting during a period of major change in cervical screening in China. RESULTS LBC gradually replaced CPS, which declined from over 65% of Pap tests in 2010 to 6.4% in 2014. Of 514,811 Pap reports using the traditional class system, class I (negative) reports accounted for 98.3% of results. With the introduction of TBS reporting, pathologist reviews and substantial replacement of CPS by LBC, the laboratory abnormal Pap test rate increased significantly to almost 5%. CONCLUSIONS Changes in cervical cytology reporting between 2009 and 2014 in China's largest academic women's hospital reflected both increased use of LBC and the introduction of pathologist TBS reporting. Abnormality rates increased significantly and fell within CAP benchmark ranges.
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Affiliation(s)
- Xiang Tao
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, PR China
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Cherenkov VG, Petrov AB, Ivanchenko OG, Chistiakova TV, Aleksandrov AS, Ivanova VV. [Are we ready for the growing threat of virus dependent cervical cancer and the initiation of screening in conditions of insurance medicine?]. Vopr Onkol 2014; 60:517-521. [PMID: 25552076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The dynamics is presented of the rates of virus dependent diseases, in particular cervical cancer (CC), which are directly connected with the level of organization of screening and subsequent treatment of cancer. It is shown that in conditions of insurance medicine a reduction of examination rooms and female enrollment in cytology screening is observed. As a result, over the past 5 years, CC incidence in the Novgorod region increased 1.2 times, and in Russia as a whole, the proportion of such cases in female population under 29 years since 2000 increased 4.5 times (from 2.0% to 9%). The urgent task of cancer control is to restore examination rooms, to overcome disagreements between government institutions and medical departments, to increase coverage of women by cytology screening by means of formation of the program of individual accounting of women.
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Muñoz-Matta A, Osorio R, Cabrera-León V, Oquendo H, Torres E, Romaguera J. CERVICAL CYTOLOGY TRENDS IN A SAMPLE OF INFLAMMATORY BOWEL DISEASE PATIENTS IN PUERTO RICO: A DESCRIPTIVE STUDY AND RESEARCH OF CURRENT LITERATURE. Bol Asoc Med P R 2014; 106:6-10. [PMID: 26148391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE OF THE STUDY To describe cervical cytology trends in a sample of patients with Inflammatory Bowel Disease (IBD) and to provide an overview of aspects such as contraception and menstrual patterns. STUDY DESIGN We identified women with diagnosis of IBD of ages between 21-49 years followed at the IBD clinics of the Medical Sciences Campus from June 2012 to April 2014. A 15-minute questionnaire was administered. Data was entered and analyzed calculating frequencies and percentages. RESULTS Sixty-three subjects were recruited. After reviewing the questionnaires, 52 subjects remained for analysis. All women were between 21 and 49 years of age. Thirty (58%) patients had a diagnosis of ulcerative colitis (UC), while 22 (42%) patients had Crohn's Disease (CD). Twenty-seven IBD patients (52%) were in remission. Use of immunomodulators was reported in ten (33%) and seventeen (61%) of patients for UC and CD respectively. Sixty six percent (67%) of participants specified having their cervical cytology for cervical cancer screening done a nually. Twenty patients (38%) reported abnormal cytology including 13 patients (43%) with UC and 7 patients (23%) with CD. No significant relation was found between the two conditions and the self-reported history of abnormal cervical cytology. Almost one-half of IBD patients reported a menstrual cycle of 25-30 days (45%). Duration of menses was described as normal (lasting between 4-6 days) in 45% of IBD patients (95% CI 31.13-59.66). Patients with UC were more likely to report regular menses than patients with CD. Eighty-six percent of participants reported no use of contraception. CONCLUSION This is the first descriptive report of gynecologic conditions in which Puerto Rican patients with IBD have been studied. It is imperative to continue with similar larger studies to gain a broader idea of what are the gynecological needs of this population.
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Saraiya M, Steben M, Watson M, Markowitz L. Evolution of cervical cancer screening and prevention in United States and Canada: implications for public health practitioners and clinicians. Prev Med 2013; 57:426-33. [PMID: 23402963 PMCID: PMC4515308 DOI: 10.1016/j.ypmed.2013.01.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 01/26/2013] [Accepted: 01/30/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Declines in cervical cancer incidence and mortality in Canada and in the United States have been widely attributed to the introduction of the Papanicolaou (Pap) test. This article reviews changes in screening and introduction of HPV vaccination. METHOD Sentinel events in cervical cancer screening and primary prevention through HPV vaccination in the US and Canada are described. RESULTS Despite commonalities, cervical cancer screening and prevention differ between the two countries. Canada has a combination of opportunistic and organized programs at the provincial and territorial level, while the US has opportunistic screening and vaccination systems. In the US, the HPV test along with the Pap test (co-testing) is part of national recommendations for routine cervical cancer screening for women age 30 and older. Co-testing is not being considered anywhere in Canada, but primary HPV testing is currently recommended (but not implemented) in one province in Canada. CONCLUSION Many prevention strategies are available for cervical cancer. Continued public health efforts should focus on increasing vaccine coverage in the target age groups and cervical cancer screening for women at appropriate intervals. Ongoing evaluation will be needed to ensure appropriate use of health resources, as vaccinated women become eligible for screening.
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Affiliation(s)
- M Saraiya
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, USA.
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Hansen K. Pap smear: what's new? S D Med 2013; 66:87. [PMID: 23544294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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10
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Vigliani MB. Whatever happened to the annual pap smear? R I Med J (2013) 2013; 96:36-38. [PMID: 23638458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Marguerite B Vigliani
- Clinical Associate Professor of Obstetrics and Gynecology at the Warren Alpert School of Medicine at Brown University
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11
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Schmidt D. [Where is gynecological cytology in Germany going from here?]. Pathologe 2012; 33:477-8. [PMID: 23085690 DOI: 10.1007/s00292-012-1699-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Pinto AP, Degen M, Villa LL, Cibas ES. Immunomarkers in gynecologic cytology: the search for the ideal 'biomolecular Papanicolaou test'. Acta Cytol 2012; 56:109-21. [PMID: 22378072 DOI: 10.1159/000335065] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/08/2011] [Indexed: 12/16/2022]
Abstract
Harnessing the knowledge we have gained on the cell cycle disruption caused by human papillomaviruses (HPV) will likely lead to improved screening modalities for cervical cancer and its precursors. An easily applied biomarker that has high specificity and sensitivity would represent an attractive alternative or complement to cytology and HPV testing. To date, a number of promising markers have been investigated. These include p16(INK4A), MIB-1, BD-ProEx C, and L1. Newer possibilities involve a variety of gene products associated with aberrations of chromosome 3q, such as telomerase, p63, and PIK3CA, as well the combination of biomarkers such as p16(INK4A) and MIB-1 in the same assay. Although none of them has yet been incorporated into screening algorithms or found its way into routine practice, their performance characteristics remain a focus of current investigations. This review summarizes what we know and where we hope to go in translating basic pathobiology into clinical practice.
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Affiliation(s)
- Alvaro P Pinto
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. 02115, USA.
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13
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Boon ME, Holloway PA, Breijer H, Bontekoe TR. Gardnerella, Trichomonas and Candida in cervical smears of 58,904 immigrants participating in the Dutch national cervical screening program. Acta Cytol 2012; 56:242-6. [PMID: 22555524 DOI: 10.1159/000336992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 01/31/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report the prevalence of Gardnerella, Trichomonas and Candida in the cervical smears of 9 immigrant groups participating in the Dutch national cervical screening program. STUDY DESIGN Cervical smears were taken from 58,904 immigrant participants and 498,405 Dutch participants. As part of the routine screening process, all smears were screened for the overgrowth of Gardnerella (i.e. smears with an abundance of clue cells) and for the presence of Trichomonas and Candida. The smears were screened by 6 laboratories, all of which use the Dutch KOPAC coding system. The odds ratio and confidence interval were calculated for the 9 immigrant groups and compared to Dutch participants. RESULTS Immigrants from Suriname, Turkey and the Dutch Antilles have a 2-5 times higher prevalence of Gardnerella and Trichomonas when compared to native Dutch women. Interestingly, the prevalence of Trichomonas in cervical smears of Moroccan immigrants is twice as high, yet the prevalence of Gardnerella is 3 times lower than in native Dutch women. CONCLUSIONS Immigrants with a high prevalence of Gardnerella also have a high prevalence of Trichomonas. In the context of the increased risk of squamous abnormalities in smears with Gardnerella, such slides should be screened with extra care.
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Affiliation(s)
- Mathilde E Boon
- Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands.
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14
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Wu J. Cervical cancer prevention through cytologic and human papillomavirus DNA screening in Hong Kong Chinese women. Hong Kong Med J 2011; 17:20-24. [PMID: 21673355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- J Wu
- School of Public Health, The University of Hong Kong.
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Read J, Hardy S, Corones A. Contested surveillance: risk, safety, and cervical screening in Australia. Health History 2011; 13:104-129. [PMID: 22329262 DOI: 10.5401/healthhist.13.2.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The expectation of participation in cervical screening programs has become a ubiquitous feature of women's lives; but despite the obvious importance of trying to prevent cervical cancer, both the expression and fulfilment of that expectation are far from straightforward. This is because the actors involved are not always consistent in their interpretation of the risks involved and safety sought. The history of cervical screening in Australia illustrates how the implementation of medical surveillance can be shaped by such interpretations. We argue in particular that conflict in Australia over screening frequency requires an explanation of this kind, and more broadly that we have entered an era of preventive medicine that can be described as one of 'contested surveillance'.
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Abstract
Despite the undisputed and impressive success which has been achieved since the 1960s by cervical cytology in the fight against cervical cancer and its precursor stages, during which the mortality rate in industrialized countries over the last 40 years has been reduced by two-thirds to three-quarters, a perfect and error-free screening procedure is still a long way off and will probably never be reached. There are two main reasons for this, the lack of adequate coverage and suboptimal quality and assessment of smears. Two screening procedures are in use Europe, an opportunistic and an organized system. Both systems have many advantages but also disadvantages. In organized programs the coverage is higher (up to 80%), although similar numbers are also achieved by non-organized programs over a 3-year cycle, even if they cannot be so exactly documented. The decision on which system is used depends on the health system of the country, public or non-public, and many other national circumstances. However, in both systems prerequisites for a satisfactory result is a high quality in the sampling technique, the processing and the assessment. Therefore, several guidelines have been introduced by state and medical societies for internal and external quality assurance. New technologies, such as thin-layer cytology or automation for replacement or support of conventional cytology liquid-based cytology proved not to be superior enough to justify the high costs of these systems. The recognition of the strong causal relationship between persistent infection with high-risk human papillomavirus (HPV) types and cervical cancer and its precursors has resulted in the development of comparably simple tests. Primary screening using HPV typing alone is not recommended in opportunistic screening due to the low specificity but high sensitivity because it leads to many clinically irrelevant results which place women under stress. In organized screening HPV testing is always and only possible in combination with cytology. Various models and approaches are in the testing phase and appear promising. HPV testing is on the other hand well accepted and recommended as a triage test to select women with equivocal smear results (Pap group III, ASCUS) if a biopsy is required or can be followed up and also for follow-up of patients after cone biopsy. However, vaccination of young girls against oncogenic HPV types which has now become widespread still leaves many questions open for the future because the observation period is too short. There is justified hope that this will become a valuable tool in cervical cancer control and may lead to a substantial reduction in the burden of cervical cancer in the future. However, as the current vaccines on the market do not cover all oncogenic virus types and the effects of vaccination will only be observed after many years, the necessity of a cytological screening will remain unrestricted. Therefore, cervical cytology will remain as the trusted, simple to use, economic and proven, like no other method for early cancer detection, efficient procedure even in the foreseeable future. If carried out with the highest quality demands it will play a central role in the early detection of cervical cancer.
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Affiliation(s)
- G Breitenecker
- Ehemals Abteilung Gynäkopathologie und Zytologie, Pathologisches Institut der Medizinischen Universität Wien, Wien, Osterreich.
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Selvaggi SM. The equivocal Pap test: its past, present, and future. Diagn Cytopathol 2009; 38:471-2. [PMID: 19941377 DOI: 10.1002/dc.21277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ronco G, Giubilato P, Naldoni C, Zorzi M, Anghinoni E, Scalisi A, Dalla Palma P, Zanier L, Barca A, Gaimo MD, Maglietta R, Mancini E, Pizzuti R, Iossa A, Segnan N, Zappa M. Extension of organised cervical cancer screening programmes in Italy and their process indicators: 2007 activity. Epidemiol Prev 2009; 33:41-56. [PMID: 19776486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Italian national guidelines recommend to Regions the implementation of organised screening programmes for cervical cancer. As in previous years since 1998, we collected from Italian organised cervical screening programmes aggregated tables of data in order to centrally compute process indicators. Data on women invited during 2007 and screened up to April 2008 were considered. In 2007, the target population of Italian organised screening programmes included 11,872,810 women, corresponding to 71.8% of Italian women aged 25-64 years. Uptake of invitation was 39.8%, with a clear North-South decreasing trend. It should, however, be considered that many women are screened outside the organised programmes. Of the women screened, 5.0% were referred for repeat cytology and 60.4 % of them complied; 2.4% of screened women were referred to colposcopy. Compliance with colposcopy referral was 82.3% among women referred because of ASCUS or more severe cytology and 89.5% among those referred because of HSIL or more severe cytology. The positive predictive value (PPV) of referral because of ASCUS or more severe cytology for CIN2 or more severe histology was 16.0%. The unadjusted detection rate of CIN2 or more severe histology was 2.9 per 1,000 screened women (3.1 standardised on the Italian population, truncated 25-64).
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Zappa M, Naldoni C, Paci E, Segnan N, Vettorazzi C, Federici A. Introduction. The diffusion of screening programmes in Italy: 2007. Epidemiol Prev 2009; 33:7-10. [PMID: 19776483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
The objective of screening for cervical cancer is to reduce mortality and incidence of the disease. To date there is extensive and strong evidence that this can be achieved by cytology-based screening programs, which continue to be the mainstay of cervical prevention worldwide despite their inherent methodological limitations. This article presents a review on the utility of conventional, ancillary and experimental methods for cervical screening both as single tests and test combinations, and describes possible future directions for enhanced screening accuracy using risk-adapted protocols.
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Pajtler M, Audy-Jurković S, Kardum-Skelin I, Mahovlić V, Mozetic-Vrdoljak D, Ovanin-Rakić A. Organisation of cervical cytology screening in Croatia: past, present and future. Coll Antropol 2007; 31 Suppl 2:47-54. [PMID: 17598505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This presentation highlights strengths and weaknesses of cervical cytology screening in Croatia, with particular reference to the opportunistic screening, the use of conventional Papanicolaou (Pap) test and the analysis of some organizational, educational and performance issues that are associated with it. Its aim is to propose measures to improve the efficacy of cervical cytology screening in order to reduce cervical cancer mortality. Currently, in excess of 450,000 Pap tests/ year are examined at 35 laboratories scattered throughout the country. All of these laboratories use standard operating procedures including internal and external quality control. They employ a total of 68 cytologists and 91 cytotechnologists. The sensitivity of cervical screening in Croatia is 90.0%, specificity 98.6%, positive predictive value 92.3%, negative predictive value 98.1% and overall diagnostic accuracy 97.2%. The high diagnostic accuracy of cervical cytology is attributed to the long-standing tradition of education and training of cytologists (postgraduate MSc course since 1967, independent residency since 1974) and cytotechnologists (since 1968). This tradition spanning more than half a century means that today in Croatia there is a developed network of cytology laboratories staffed by highly competent cytologists and trained cytotechnologists. The high accuracy of cancer detection through Pap tests provides strong evidence in support of cervical cytology screening remaining the basic method of prevention for cervical carcinoma. However, some modifications to the current situation are needed. These relate primarily to opportunistic screening. The current screening coverage rate is 68%, although there is capacity, which would allow for all women at risk, i.e. those aged 25-64, to be screened once in three years. The screening coverage relates mainly to those women visiting gynecological out patient clinics for unrelated conditions. A properly organized and controlled national screening programme should replace this. This should be accompanied by the introduction of alternative, highly sensitive methods of sample collection and preparation, such as are available through the introduction of new technologies, e.g. liquid based cytology.
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Affiliation(s)
- Marija Pajtler
- Department of Clinical Cytology, Osijek University Hospital, Osijek, Croatia.
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Heley S. Pap test update. Aust Fam Physician 2007; 36:112-5. [PMID: 17339970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND 2006 was an eventful year in the area of screening to prevent cervical cancer. New screening guidelines were introduced nationally in July, and in November the Australian Government agreed to fund one of the human papillomavirus (HPV) vaccines, Gardasil, under the National Immunisation Program. OBJECTIVE This article discusses the cervical screening program and the Pap test in the era of HPV vaccination. DISCUSSION With the introduction of a vaccine to prevent the acquisition of significant genital HPV types, many practitioners will be questioning the continuing need for the Pap test. But for those women who have missed out on the vaccine, the Pap test will still play a crucial role in preventing the development of cervical cancer, and the vaccinated cohort will need to continue screening in some form as the vaccine does not cover all the HPV types responsible for anogenital cancer.
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Affiliation(s)
- Stella Heley
- Melbourne Sexual Health Centre, Melbourne, Australia.
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Steven D, Fitch M, Dhaliwal H, Kirk-Gardner R, Sevean P, Jamieson J, Woodbeck H. Knowledge, Attitudes, Beliefs, and Practices Regarding Breast and Cervical Cancer Screening in Selected Ethnocultural Groups in Northwestern Ontario. Oncol Nurs Forum 2007; 31:305-11. [PMID: 15017446 DOI: 10.1188/04.onf.305-311] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the knowledge, attitudes, beliefs, and practices regarding breast and cervical cancer screening in selected ethnocultural groups (i.e., Italian, Ukranian, Finnish, and the native population) in Northwestern Ontario, Canada. DESIGN Descriptive, exploratory. SETTING Rural and urban settings in Northwestern Ontario. SAMPLE 105 women aged 40 and older who were residents of Northwestern Ontario and members of selected ethnic groups, including Italian, Ukranian, Finnish, Ojibwa, and Oji-Cree. METHODS An interview guide was designed specifically for this study to gather information regarding knowledge, attitudes, beliefs, and practices about breast self-examination (BSE), clinical breast examination (CBE), mammography, and cervical cancer screening procedures. Data were obtained through face-to-face interviews (two or three hours) in English or the language spoken. Interviews in other languages were transcribed into English. FINDINGS Ojibwa and Oji-Cree women were more likely than any other group to not have practiced BSE, to have refused CBE or mammogram, to not have been told how to perform BSE, to not have received written information about breast examination, and to be uncomfortable and fearful about cervical cancer screening procedures (33% refused internal examination as compared to 0-8% in the other ethnic groups). Four issues emerged from the findings: (a) using multimedia sources to inform women about screening programs, (b) educating women regarding breast and cervical cancer screening, (c) reminding women when they are due for screening, and (d) identifying that Pap tests are uncomfortable and frightening. CONCLUSIONS Cultural beliefs, attitudes, and practices of marginal populations (e.g., native women) are important to consider when developing strategies to address barriers to effective breast and cervical screening. IMPLICATIONS FOR NURSING Educational programs that are culturally sensitive to participants are imperative.
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Wiesner-Ceballos C, Vejarano-Velandia M, Caicedo-Mera JC, Tovar-Murillo SL, Cendales-Duarte R. La citología de cuello uterino en Soacha, Colombia: representaciones sociales, barreras y motivaciones. Rev Salud Publica (Bogota) 2006; 8:185-96. [PMID: 17269218 DOI: 10.1590/s0124-00642006000300004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE A social representation of the Pap smear is given in this article, as are the barriers against it and the motivation for practising it, aimed at adjusting preventative health services in a particular Colombian town. METHODS A phenomenological, qualitative study was carried out, using focal groups and workshops for validating the results. A theoretical sample was designed to find differences according to age, heatlh system affiliation and dwelling place within the municipality in question. Atlas ti software was used for giving the analysis a narrative interpretation. RESULTS The Pap smear is associated with infection and pre-cancer and cancer prevention. Cultural barriers, misinformation being spread by peers, a lack of social networks and the particularly poor quality of Colombian public health services were identified. DISCUSSION Attempts to make the Pap smear as objective as possible were found to be satisfactory, even though no logical relationship was found between knowledge of the Pap smear and its practice. Older women have the social representation of risk implicit in an acute infection model. Lack of opportunity for a having a Pap smear appointment and delays in presenting the corresponding report have a negative impact on cancer control.
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Altaf FJ. Cervical cancer screening with pattern of pap smear. Review of multicenter studies. Saudi Med J 2006; 27:1498-502. [PMID: 17013471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To estimate the frequency of abnormal cervical smears and to compare the findings with earlier reported data from Saudi Arabia. METHODS The study was divided into 2 parts. The prospective part was conducted at King Abdul-Aziz University Hospital and a private laboratory by using the Bethesda System criteria and diagnostic entities in evaluating all the pap smears that were received during the period of January 2000 to December 2004. All reliable published literature on pap smear performed at different hospitals from 1990-2004, from the Western and Abha regions of Saudi Arabia were retrospectively evaluated. RESULTS A total of 5132 cases were evaluated in the prospective part of the study. The percentage of abnormal pap smears was 4.7%. The significant categories were atypical squamous cell of undetermined significance (2.4%), low grade squamous intraepithelial lesion (0.6%), high grade squamous intraepithelial lesion (0.4%) and atypical glandular cells of undetermined significance (1.1%). The malignant categories were squamous cell carcinoma (0.08%), adenocarcinoma of cervix in situ (0.02%) and invasive (0.04%). Other malignancies were 0.04% and neuroendocrine carcinoma was 0.02%. In the second part of the study, the total number of cases reported in the literature were 45596. The percentage of abnormal pap smear was 1.4 %. The total cases evaluated in the current study and the previous published studies were 50,728 and the frequency of abnormal pap smear was 1.6%. CONCLUSION The percentage of abnormal pap smear was higher in the prospective part of this study than the previously reported results. Unified national programs for diagnosing cervical precancerous lesions should be established covering different region of the Kingdom to evaluate the magnitude of the problem.
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Affiliation(s)
- Fadwa J Altaf
- Department of Pathology, Faculty of Medicine, King Abdul-Aziz University Hospital, PO Box 51241, Jeddah 21543, Kingdom of Saudi Arabia.
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Bolger N, Heffron C, Regan I, Sweeney M, Kinsella S, McKeown M, Creighton G, Russell J, O'Leary J. Implementation and evaluation of a new automated interactive image analysis system. Acta Cytol 2006; 50:483-91. [PMID: 17017432 DOI: 10.1159/000326001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare automated interactive screening using the ThinPrep Imaging System with independent manual primary screening of 12,000 routine ThinPrep slides. STUDY DESIGN With the first 6,000 cases, the Review Scopes (RS) screening results from the 22 fields of view (FOV) only were compared to independent manual primary screening. In the next 6,000 cases, any abnormality detected in the 22 FOV resulted in full manual screening on the cytotechnologist's own microscope. Sensitivity and specificity together with their 95% CIs were calculatedfor each method. RESULTS In the first set of 6, 000 cases, diagnostic sensitivity and specificity of the imager were 85.19% and 96.67%, respectively. The diagnostic sensitivity and specificity of manual primary screening were 89.38% and 98.42%. This highersensitivity and specificity of manual primary screening were found to be statistically significant. The second set of 6,000 cases demonstrated no significant statistical difference in sensitivity or specificity between the sets of data. CONCLUSION The results from our study show that the sensitivity and specificity of the imager technology are equivalent to those of manual primary screening. The system is ideally suited to the rapid screening of negative cases, allowing increased laboratory productivity and greater throughput of cases on a daily basis.
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Affiliation(s)
- Noel Bolger
- Department of Cytopathology, Coombe Women's Hospital, Dublin, Ireland.
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Geyer SJ. HPV testing in liquid specimens. Acta Cytol 2006; 50:599-600. [PMID: 17017457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Tacken MAJB, Braspenning JCC, Mulder J, Hermens RPMG, Nelen WLDM, de Bakker DH, Grol RPTM. Loss to follow-up of cervical smears without endocervical columnar cells is not disturbing. EUR J GYNAECOL ONCOL 2006; 27:42-6. [PMID: 16550967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To investigate the six-month recommended follow-up after mass screening of Pap smears because of the absence of endocervical columnar cells (ECC-) or ECC+ smears with atypical squamous or glandular cells of undetermined origin (ASCUS/AGUS) or low-grade squamous or glandular intraepithelial lesions (LSIL/LGIL) in a Dutch mass screening cervical cancer programme. METHODS Data were extracted from computerised medical records of national representative Dutch general practices. We have studied the attendance at and the outcome of the subsequent Pap smears after a 6-month recommendation. RESULTS The six-month follow-up was linked to 8.7% of the Pap smears (n = 1,002); 77.6% were without endocervical columnar cells (ECC-). Clear differences were found between the follow-up of ECC+ and ECC- smears; after 36 weeks of follow-up of 43.5% the women had an ECC- smear and 66.9% had other conditions. For initial ECC- Pap smears, 84.1% had no abnormalities in the subsequent Pap smear; for initial ECC+ Pap smears, in about 64% of the cases no abnormalities were found (p < 0.0001). CONCLUSIONS Repeating ECC- smears has a low follow-up rate but also lacks evidence-based necessity. However, for the other 6-month recommended Pap smears, one in five women had still not responded within one year, so improvement is necessary.
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Affiliation(s)
- M A J B Tacken
- Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, The Netherlands
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Qureshi MN. Detecting high-risk human papillomavirus in liquid-based cytology specimens. Acta Cytol 2005; 49:582. [PMID: 16334042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Longatto-Filho A, Maeda MYS, Erzen M, Branca M, Roteli-Martins C, Naud P, Derchain SFM, Hammes L, Matos J, Gontijo R, Sarian LO, Lima TP, Tatti S, Syrjänen S, Syrjänen K. Conventional Pap smear and liquid-based cytology as screening tools in low-resource settings in Latin America: experience of the Latin American screening study. Acta Cytol 2005; 49:500-6. [PMID: 16334026 DOI: 10.1159/000326195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the performance of the conventional Pap test and liquid-based cytology (LBC) in an ongoing multicenter trial testing optional screening tools (cytology, screening colposcopy, visual inspection with acetic acid, visual inspection with Lugol's Iodine, cervicography and Hybrid Capture II [HCII] (Digene Brazil, São Paulo, Brazil) conventional and self-sampling), for cervical cancer in Brazil and Argentina. STUDY DESIGN A cohort of 12,107 women attending four clinics (Campinas, São Paulo, Porto Alegre, Buenos Aires) were randomized into the 8 diagnostic arms. Women testing positive with any of the tests were referred for colposcopy, and cervical biopsies were used as the gold standard to assess performance characteristics of the diagnostic tests. Conventional Pap smears were sampled by all clinics (n = 10,240), and LBC (Autocyte PREP, [TriPath Imaging, Burlington, North Carolina, U.S.A.], n=320, and DNA-Citoliq [Digene Brazil], n =1,346) was performed by 1 of the clinics. RESULTS Conventional Pap smears showed no squamous intraepithelial lesions (normal) in 8,946 (87.4%) and LBC in 1,373 (82.4%). Using high grade squamous intraepithelial lesions (HSIL) as the cutoff, Pap smears predicted high grade (cervical intraepithelial neoplasia [CIN] 3) with OR 63.0 (95% CI, 36.90-107.70), standard error (SE) 59%, SP 97.8%, positive predictive value (PPV) 68.1% and negative predictive value (NPV) 96.7%. The same figures for Autocyte PREP were: OR 9.0 (95% CI, 2.43-33.24), sensitivity (SE) 33.3%, specificity (SP) 100%, PPV 100% and negative PV (NPV) 88.8%. DNA-Citoliq detected CIN 3 as follows: OR 11.8 (95% CI 2.60-53.26), SE 40.0%, SP 94.6%, PPV 40.0% and NPV 94.6%. Lowering the cutoff to low grade squamous intraepithelial lesions increased SE and NPV but compromised SP and PPV. The detection rates for high grade lesions after an atypical squamous cells of undetermined significance diagnosis were similar with the 3 techniques. In our settings, the 3 methods of cervical cytology were slightly different in performance. The conventional Pap smear had the highest SE, while Autocyte PREP had 100% SP and PPV in detecting CIN3 with the HSIL cutoff. All 3 tests had lower SE but higher SP as compared to HCII.
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Toivonen T, Nieminen P, Tarkkanen J, Timonen T, Krogerus L, Klemi P. Cytopathology in Finland. Cytopathology 2005; 16:210-4. [PMID: 16048508 DOI: 10.1111/j.1365-2303.2005.00258.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Toivonen
- Department of Pathology, Pirkanmaa Hospital District Laboratory Centre, Finland.
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Drijkoningen M, Bogers JP, Bourgain C, Cuvelier C, Delvenne P, Gompel C, Saerens L, Thienpont L, Van Damme B, Van Eycken L, Verhest A, Weynand B. Cytopathology in Belgium. Cytopathology 2005; 16:100-4. [PMID: 15787653 DOI: 10.1111/j.1365-2303.2004.00228.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Drijkoningen
- Pathology Department, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.
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Grewal S, Bottorff JL, Balneaves LG. A Pap Test Screening Clinic in a South Asian Community of Vancouver, British Columbia: Challenges to Maintaining Utilization. Public Health Nurs 2004; 21:412-8. [PMID: 15363021 DOI: 10.1111/j.0737-1209.2004.21504.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this article is to describe experiences and challenges in establishing a South Asian Pap Test Clinic. The specialized Pap test clinic for immigrant South Asian women was a community-initiated response to high rates of cervical cancer within this population. Efforts were made to ensure that the clinic provided health services in a sensitive and culturally appropriate manner. Although women were generally positive about their experiences at the South Asian Pap Test Clinic and often encouraged other women to attend the clinic for Pap testing, attendance patterns have not been maintained. The three most significant challenges to the clinic's ongoing success were: (1) maintaining the continued involvement of stakeholders in developing long-term strategies to enhance community awareness about cervical cancer; (2) creating mechanisms to strengthen support from physicians in the community; and (3) meeting the needs of the underserved within a specialized health service for South Asian immigrant women. These challenges provide important lessons for others to increase the participation of immigrant women in screening practices. Nurses can play a key role in mobilizing and maintaining collaborations that are essential to the continuing success of community-based programs.
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Milojković M, Pajtler M. Influence of cytology development on frequency of pre-cancerous lesions and cervical cancer in east Croatia, 1978-2001. Coll Antropol 2004; 28:293-300. [PMID: 15636086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
We analyzed the influence of cytology development to frequency of precancerosa (Cervical intraepithelial neoplasia grade 3 - CIN 3) and cervical cancer. The number of examined Pap smears increased significantly in the analyzed period. The calculated linear trend shows an average four-year increase of 17,283.35 smears. The number of detected CIN 3 increased accordingly. The calculated linear trend shows an average four-year increase by 45.03 and decrease of the rate of 0.07. A slight increase in cervical cancer was also noticed. The calculated linear trend shows an average four-year increase in cancer by 1.6 and decrease in the rate of 0.51. Analyses of cervical cancer by stages showed an increase in number of stage I and decrease of other stages. The calculated linear trend shows an average four-year increase of stage I by 4.94 or decrease in other stages of cervical cancer of 3.29 respectively. The rate of cervical cancer stage I decreased by 0.11 and of other stages by 0.39. Further analyses of the stage I showed that the linear trend of IA stage had an average four-year increase by 5.40 and decrease in stage IB of 0.48. The rate of the cervical cancer stage IA increased by 0.02, whereas the rate of IB decreased by 0.13. Cytology development in our country has resulted in detection of higher number of CIN 3 and the earliest stage (IA) of cervical cancer whereas the number of other stages (IB, II, III, IV) has decreased. However, a total number of cervical cancers haven't changed over the whole period. Thus, it is obvious that opportunistic program of detection, which has been using in Croatia, could not decrease frequency of cervical cancer. In order to achieve it, well-organized national program of detection is needed.
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Affiliation(s)
- Miodrag Milojković
- Department of Gynecology and Obstetrics, University Hospital Osijek, Osijek, Croatia
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Abstract
Given interest from the professionals concerned, an external quality assurance scheme for cervical cytology can successfully be introduced in developing countries. This is a very important precondition if screening programs are to be expanded and decreases in mortality from cervical cancer are to occur in developing countries. Nicaragua and Peru have been experimenting with an external quality assurance system adapted from the Scottish and Northern Ireland scheme. It has been received with enthusiasm and acceptance and has helped cytology laboratories in these countries focusing on quality issues. Nevertheless, a successful quality control scheme that is to result in improvements in the quality of professionals' diagnostic skills needs to be accompanied by a remedial program for subperformers.
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Affiliation(s)
- Micol Salvetto
- Institute for Health Sector Development, 27 Old Street, London EC1V 9HL, U.K.
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Affiliation(s)
- Eduardo L Franco
- Department of Epidemiology, McGill University, Montreal, H2W1S6, Quebec, Canada.
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Lynch E. Nice and easy does it. Nurs Stand 2003; 18:20. [PMID: 14689660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Abstract
The field of cytology automation, through long investigation, trial and error, and finally, commercial success and failure, has arrived at the first levels of the "grail" of improvements in accuracy and productivity in cervical cytology screening. It remains to be seen how much further the road will lead toward so-called "diagnostic" instrumentation that would actually provide us with a fully automated system of "specimen in-diagnosis out" with little, or no, human input. Will commercial ventures or academic institutions continue to support investigations to further the applications that have been developed to date? This remains to be seen and is directly dependent on parallel processes that are detailed elsewhere in this issue. Will HPV vaccines eliminate the need for screening? Possibly, but probably not for many years [70]. Will more sensitive and specific genetic or protein markers (or combinations thereof) be found to be more accurate and cost-effective? Certainly the possibility of mass screening by high-risk HPV DNA testing, as a viable alternative, is being discussed at present. Despite all of these uncertainties, the present (or nearly available) technology has the potential to improve the practice of cervical cytology. Improvements in accuracy that are necessary to provide the highest possible level of patient care and to protect practitioners from unreasonable levels of medico-legal risk are a reality. Improvements in productivity that are necessary to help in the impending labor shortage in the field of cytotechnology are also a reality. Automation is clearly the short-term solution to the most difficult of the challenges that we face.
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Affiliation(s)
- David C Wilbur
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Scheiden R, Wagener C, Knolle U, Dippel W, Capesius C. Atypical squamous cells of undetermined significance: audit and the impact of potential litigation. Retrospective review of 682 cases. Cytopathology 2003; 14:257-62. [PMID: 14510889 DOI: 10.1046/j.1365-2303.2003.00070.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For quality assurance purposes, the frequency of 'abnormal' cytological diagnoses of the non-systematic National Cervical Cancer Screening Programme (NCCSP) was evaluated. In 1999, an unexpected high number of Class (Cl) III cases (i.e. atypical squamous cells of undetermined significance) was reported. The cytological and histological results were reviewed in order to detect a possible cause for this threefold increase. The abnormal Papanicolaou (PAP) smears examined by conventional methods from 1 January 1990 to 31 December 2002 were analysed. The smears of 682 cases diagnosed in 1999 with a Cl III category were reviewed in 2000 and correlated with the available histological diagnoses provided by the Central Department of Pathology. Of the 682 Cl III cases, 176 cases (26.1%) had no follow-up, 314 cases (46.0%) had repeat cytology and 192 cases (28.2%) an histological correlate corresponding to 90 (46.9%) benign lesions, 78 (40.6%) squamous intraepithelial lesions, two (1%) invasive cervical cancers (one squamous and one glandular). Twenty-two Cl III cases (11.5%) were histologically within normal limits. Retrospective smear review confirmed 330 Cl III diagnoses (48.3%), 127 cases (18.6%) were recategorized as Cl IIIG (i.e. atypical glandular cells of undetermined significance), 22 cases (3.2%) as Cl IIID (i.e. mild to moderate dysplasia) and six cases (0.9%) as Cl IVa (i.e. severe dysplasia and/or carcinoma in situ). A total of 197 original Cl III cases had to be reclassified in the Cl II category (28.9%), only two cases showing mild and moderate dysplasia on histology. Thus, 195 cases (28.6%) comprised cytological overdiagnoses. The Cl III category being, by definition, a delicate and often subjective diagnosis, all external influences such as pressure of litigation should be avoided to reduce cytological overdiagnoses as a result of an unnecessary 'fear-factor'.
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Affiliation(s)
- R Scheiden
- Division of Clinical Cytology, National Health Laboratory Division of Anatomic Pathology, National Health Laboratory Morphologic Tumour Registry, Grand-Duchy of Luxembourg.
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Rubin A. Clinical value of repeat Pap smear at the time of colposcopy. Acta Cytol 2003; 47:698. [PMID: 12920770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Pientong C, Ekalaksananan T, Swadpanich U, Kongyingyoes B, Kritpetcharat O, Yuenyao P, Ruckait N. Immunocytochemical detection of p16INK4a protein in scraped cervical cells. Acta Cytol 2003; 47:616-23. [PMID: 12920756 DOI: 10.1159/000326578] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop an immunocytochemical technique for p16INK4a protein detection in scraped cervical cells for cancer screening. STUDY DESIGN We took duplicate cervical scrapes from each participant, the first for a Pap smear and the second for p16INK4a protein detection. From a 50-microL cell suspension prepared from the scrape rinsing, a 10-microL aliquot was dropped in a 5-mm-diameter circle on a glass slide, air dried and fixed in 0.1% formal saline (1 hour) and in 95% ethanol (10 minutes). Using the immunocytochemical technique, slides from 30 samples of each Pap diagnosis class were stained sequentially with mouse monoclonal anti-p16INK4a (primary antibody), biotinylated goat antimouse IgG (secondary antibody), horse-radish peroxidase-labelled streptavidin and 3,3'-diaminobenzidine and mixed hydrogen peroxide, then counterstained with hematoxylin. A positive sample had to contain > or = 3 immunoreactive cells. Results were confirmed by western blot analysis of lysates from the remaining 40 microL of each cervical cell suspension. RESULTS Samples were grouped as control (normal cervical cells), mild dysplasia (ASCUS, LSIL) and high abnormality (HSIL, SCC). Using the immunocytochemical technique, > 95% of the positive (SiHa cells) but 0% of the negative controls (human embryonic lung fibroblast cells) showed immunoreactive cells. All slides displayed a clear background without mucus, and positive cells were stained in both the cytoplasm and nucleus. p16INK4a Protein was detected in 17 of 30 (56.67%) ASCUS and 10 of 30 (33.33%) LSIL and increased with the degree of abnormality to 93.33% (28 of 30) and 96.67% (29 of 30) in the HSIL and SCC group, respectively. Normal cervical cells and degenerated malignant cells were nonimmunoreactive. Western blot analysis confirmed similar positive samples in the low-abnormality group, while the whole high-abnormality group was immunoreactive. A sampling error might have caused the 2 HSIL and 1 SCC sample to be negative using our immunocytochemical technique. CONCLUSION p16INK4a Protein detection in scraped cervical cells using the immunocytochemical technique correlated with western blot analysis and was nontraumatic and precise. It offers a significant diagnostic adjunct to the Pap test for cervical cancer screening.
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Affiliation(s)
- Chamsai Pientong
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Ng WK. Thin-layer (liquid-based) cytologic findings of papillary squamotransitional cell carcinoma of the cervix. Review of cases over a 4-year period with emphasis on potential diagnostic pitfalls. Acta Cytol 2003; 47:141-8. [PMID: 12685179 DOI: 10.1159/000326494] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the thin-layer cytology and diagnostic pitfalls of papillary squamotransitional cell carcinoma of the cervix, with clinical and histologic correlation. STUDY DESIGN The author reviewed the clinical findings, thin-layer cytology and histologic features of papillary squamotransitional cell carcinoma of the cervix encountered at Pamela Youde Nethersole Eastern Hospital, Hong Kong, during the 4-year period January 1998-March 2002. Strict histologic criteria (basaloid/transitional cell-like cells constituted > 70% of the tumor cell population and papillary/anastomosing, frondlike structures seen in > 70% of tumor tissue in superficial biopsies) were employed in defining this entity. RESULTS During the study period, 10 biopsy cases of carcinoma of the lower female genital tract (9 in cervix and 1 in vagina) fulfilled the above histologic criteria. Six of them had thin-layer cytology performed The preparations were often of moderate to high cellularity and contained three-dimensional, arborizing, papillary clusters of basal/parabasal cells. Discernible fibrovascular cores were sometimes identified. Occasionally at the papillary surface, the basaloid cells were aligned horizontally. High-power cytology of the tumor cells ranged from bland-looking to high grade squamous intraepithelial lesions (HSILs) and sometimes squamous cell carcinoma. Mitotic figures were commonly identified. Tumor diathesis and dyskeratotic cells were occasional. Koilocytosis was not observed. Subsequent tumor biopsies showed evidence of stromal invasion in 3 cases. CONCLUSION Papillary squamotransitional cell carcinoma has a distinctive appearance in thin-layer cytologic preparations. The predominance of bland-looking basaloid cells or HSIL cells, together with scantiness of tumor diathesis and carcinoma cells, may lead to underdiagnosis. Recognition of the subtle cytologic features and clinical correlation are essential in arriving at a correct diagnosis.
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Affiliation(s)
- Wai-Kuen Ng
- Department of Pathology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, S.A.R., China.
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Tibbs RF, Wong JY, Logroño R. Enhancing recovery of endocervical component on gynecologic cytology specimens processed by thin-layer technology. Acta Cytol 2003; 47:172-6. [PMID: 12685184 DOI: 10.1159/000326499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To address the causes and report the corrective measures required for resolving the initial problem of high rates of cervical vaginal cytology specimens reported as having no endocervical component on SurePath (AutoCyte, Inc., Burlington, North Carolina, U.S.A.) liquid-based, thin-layer technology at an academic center cytology laboratory. STUDY DESIGN Analysis of 511 cases lacking endocervical/transformation zone component out of 9,221 SurePath thin-layer gynecologic specimens processed in a one-year period. The study encompassed a review of sample collection techniques by physicians and nurses, specimen processing, cytologic features of endocervical/squamous metaplastic cells processed by the SurePath method and statistical analysis of endocervical cell recovery rates after implementation of corrective measures. RESULTS Absence of endocervical/transformation zone component varied from an initial 18% in the first month to an average of 5.3% after corrective actions were implemented. Current rates of SurePath thin-layer specimens having no endocervical component are lower than those for conventional smears. CONCLUSION Since SurePath was only recently introduced to the market, there are no previously published data addressing how to optimize the recovery of endocervical component on liquid-based, thin-layer specimens processed by this methodology.
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Affiliation(s)
- Rita F Tibbs
- Division of Cytopathology, Department of Pathology, 9.300 John Sealy Annex, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0548, USA
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Abstract
OBJECTIVE To assess the utility of a thin-layer cytology system for cervicovaginal screening in clinical practice. STUDY DESIGN Twenty-five hundred cervicovaginal split samples were processed with the traditional direct smearing method and with the ThinPrep Pap Test (Cytyc Corp., Boxborough, Massachusetts, U.S.A.) method and evaluated according to the Bethesda system, focusing mainly on the cytomorphologic features. RESULTS The ThinPrep Pap Test yielded improved specimen adequacy and an increased detection rate of squamous abnormalities, which resulted in a decrease in the ASCUS/SIL ratio. Moreover, the thin-layer system provided adequate material for concomitant HPV testing, mainly in the LSIL and the ASCUS favor SIL cases, with satisfactory results, as well as for cell block preparations in a few selected cases that presented diagnostic difficulties. Furthermore, the morphologic features of the LSIL cases were virtually identical on both preparations, while in the HSIL cases, distinct features were noted on ThinPrep. CONCLUSION The ThinPrep Pap Test is significantly more effective than the conventional smear in clinical practice. However, training and experience are necessary to take full advantage of this promising new technology.
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Affiliation(s)
- Despina Malle
- Department of Cytopathology, Anticancer Hospital of Thessaloniki, Theagenion, Greece
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