Vaginal smears

Cervical cancer ranks as the third most common cancer among women in the world (1) and is also the third most common cancer among women in Malaysia. (2) Since 1980, the global incidence of cervical cancer has increased from 378,000 (range 256,000-489,000) to 454,000 (range 318,000-620,000), with an average annual increase of 0.6%. (3) 85% of its burden occurs in developing countries, where it accounts for 13% of all cancers in women. (1) The mortality of cervical cancer has increased from 174,000 deaths in 1980 to 200,000 deaths in 2010, with an annual increase of 0.46%. (3) Mortality from cervical cancer is higher in Southeast Asian countries than in Western Europe, North America, Australasia and high-income Asia Pacific regions, and is second only to that in the South Asia region. (3) The age standardised ratio (ASR) in Malaysia was 7.8 per 100,000 population, with those of Indian ethnicity recording the highest ASR (10.3 per 100,000 population), followed by the Chinese (9.5 per 100,000 population) and Malay (5.3 per 100,000 population) races. (2) Cervical cancer was more common among the elderly, with peak incidence seen among women aged 60-69 years. (2) In 2010, the probability of death among Malaysian women due to cervical cancer was 0.7 of the global population. The percentage of patients in Malaysia diagnosed with stage 3 and stage 4 cervical cancer was 26% and 19%, respectively. (2) Since the 1960s, Malaysia has been implementing opportunistic Pap smear for all sexually active women aged 20-65 years. (4) According to the 2006 National Health and Morbidity Survey (NHMS III), only 47.3% of Malaysian women have ever undergone Pap smear screening. (5) Other local studies have found that the uptake of Pap smear screening was 25% among factory workers (6) and 38% among urban school teachers, (7) revealing figures that were much lower than countries with population screening programmes. Poor knowledge of cervical cancer prevention was also noted among students in a local university. (8) Limited access to healthcare, poor access to information and empowerment, and poverty have been identified as barriers to cervical cancer screening uptake. These factors are likely to bear their greatest effects on rural communities. (9) It is thus vital to not only evaluate the cervical screening practices among this underserved community, but also to identify the positive and negative factors that may be associated with their compliance, so that more targeted approaches can be initiated to address poor screening attendance among women from these communities. Previous research has placed great focus on factors hindering women from attending cervical cancer screening. (10) Therefore, this study aimed to measure the prevalence of Pap smear screening uptake among the rural population in Malaysia, and to identify the socioeconomic and awareness factors associated with the uptake of cervical cancer screening in this cohort. METHODS Perak has a total population of 2,258,428, with an ethnic breakdown of Malay (50%-80%), Chinese (15%-30%), Indian

The entity of atypical squamous cells of undetermined significance (ASCUS) in The Bethesda System 2001 for reporting cervical cytology is characterized by equivocal diagnosis, poor reproducibility and debatable management. This retrospective study was done to analyse the causes of false ASCUS if any and identify the educational needs as part of quality assurance programme. Cervical smears of all ASCUS cases reported over the one-year period were reviewed by the Cytopathologist. Relevant clinical data was retrieved. ASCUS was the most common type of abnormality representing 43.0 % cases among 294 abnormal smears reported during study period. 16.0% cases were found to be non ASCUS on review. The main four causes of over use of ASCUS diagnosis were poor quality smears and cellular atypia associated with Candida infection, atrophy and squamous metaplasia. Educational measures are being undertaken to avoid over diagnosis and improve the patient management (Afr J Reprod Health 2011; 15[1]: 111-114). Résumé Causes des fausses cellules de l'épithélium atypique d'un diagnostic d'une signification inconnue et le besoin éducatif dans un Centre Hospitalier Universitaire. L'entité des cellules de l'épithélium atypique d'une signification non déterminée(CEAS) dans le système Bethesda 2001 destiné à la déclaration de la cytologie cervicale est caractérisée par le diagnostic équivoque, une mauvaise reproductivité et un traitement discutable. Cette étude rétrospective a été faite pour analyser les causes des fausses CEAS, si cela existe, et d'identifier les besoins éducatifs comme faisant partie du programme de l'assurance de qualité. Le Cytopathologue a passé en revue tous les frottis de tous les cas de la CEAS qui ont été déclarés au cours d'une année. Les données cliniques nécessaires ont été rétablies. La CEAS était l'anomalie la plus commune, ce qui représente 43,0% parmi les 294 frottis anomaux qui ont été déclarés au cours de la période de l'étude. A la revue, on a découvert que 16,0% n'étaient pas des CEAS. Les quatre causes principales du suremploi du diagnostic de la CEAS étaient la mauvaise qualité du frottis et l'atypie cellulaire liée à l'infection candidose, l'atrophie et la métaplasie squameuse. On prend des mesures éducatives pour éviter le surdiagnostic et pour améliorer le traitement de la patiente (Afr

Background: Subtyping of human papilloma virus (HPV) may enhance the precision of vaginal cytological assessments and will be important for investigating the effect of the recently introduced vaccine against types 16 and 18. Objectives and study design: To evaluate an in-house real-time PCR targeting HPV types 16-18-31-33-35-39-45-51-52-56-58-59-6-11, by analysing 107 liquid-based cytology specimens representing various degrees of dysplasia. Results: In all, 71 samples were HPV positive, with multiple types present in 37 (52%). Comparison with Roche Linear Array on a subset of 24 of these 71 samples showed a good agreement. One or several types were detected in 17/17 (100%) samples with cervical intraepithelial neoplasia grade 2-3 (CIN 2-3), 16/19 (84%) with CIN 1, 32/43 (74%) with Atypical Squamous Cells of Undetermined Significance (ASCUS), and in 6/28 (21%) with benign cytology. Estimates of mean viral load were lower in CIN 1-3 than in ASCUS (≈4000 vs. ≈25,000 copies/1000 cells), and clearly lower in samples with benign cytology (≈50 copies/1000 cells). Conclusion: The HPV rates in groups with different degrees of dysplasia agrees with previous reports and support a strong link between types 16/18 and severe dysplasia. The high rate of multiple type infection might influence the outcome of HPV vaccination. The possible importance of viral load should be further studied.

To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics. Subjects were women > 18 years with abnormal cervical cytology between February 1999 and April 2000. Inadequate follow-up was defined as lack of subsequent cervical cytology or pathology specimen within four months of the initial abnormal specimen for high-grade lesions or within 7 months for low-grade lesions. Of the 423 subjects, the mean age was 33 years. Sixty percent were black, 23% Hispanic, 15% white, 2% Asian. The population was largely uninsured or publically insured. The overall inadequate follow-up rate was 38%. In bivariate analysis, age was a significant risk factor; 46% of women ages 18-29 had inadequate follow-up (p < 0.01). In multivariate analysis, women aged 18-29 years were more likely than women 50 years and older to have inadequate follow-up (OR 2.7, 95% CI 1.1-6.4), as were women with Medicaid insurance compared...

Morus nigra L. is a plant employed as a substitute for the conventional hormonal replacement therapy. This work analyzes the estrogenic effect of M. nigra on the reproductive system and embryonic development of Wistar rats. Female rats were orally treated with M. nigra hydroalcoholic extract (MnHE) at the dose levels of 25, 50, 75, 350 and 700 mg/kg of body weight over 15 days, and continued through mating until the 14th day of gestation. Vaginal smears were performed daily and the body weight of the females was recorded at 5 days intervals. On day 15 of gestation, the females were killed and their kidneys, liver, spleen and ovaries were removed and weighed. The number of implants, resorptions, and live and dead fetuses were evaluated. Histological sections of ovaries, measurement of the height of the uterine epithelium and vaginal smears were performed to assess the estrogenic activity. The results showed that the administration of MnHE did not significantly alter the analyzed variables. Therefore, considering the experimental model used in this study, the data obtained indicate that M. nigra did not exhibit any estrogenic activity nor did exert a toxic effect on the female reproductive system and on the embryonic development of rats.

BACKGROUND. Rapid rescreening (RR) of negative Papanicolaou smears (PS) is used in many countries as a quality-assurance measure. Seeding of abnormal slides has been suggested as a way to increase the sensitivity of this procedure. Since 2004, the authors have carried out RR with seeding before issuing reports.

Background-Among Jamaican women, cervical cancer is the second leading cause of cancer mortality but factors that facilitate follow-up of women receiving abnormal Pap smear results are not known. We examined whether socio-demographic factors, factors reported by the women, and assistance received for follow-up facilitate adequate follow-up of abnormal Pap smears.

Background A cross sectional study to investigate HPV prevalence according to age and cytology. Methods Women presenting to a gynaecological outpatient clinic for a Pap smear test were included in the study (n=3177). All women had cervical cytology and HPV testing. Results Overall prevalence of any 24 HPV type analysed was 33.1% (95% CI 31.5% to 34.7%) and HPV 16 and HPV 42 were the most frequent (6.7% (95% CI 5.8% to 7.6%), 6.8% (95% CI 5.9% to 7.6%)), in total samples. Multiple HPV infection rate was 12.9% (95% CI 11.8% to 14.1%). High risk HPV (hrHPV) types were present in 27.4% (95% CI 25.8% to 28.9%) of the samples. HPV prevalence was highest among 14 to 19 y.o (46.6% (95% CI 40.7%-52.4%)) and second highest among 30–34 y.o. (39.7%, 95% CI 35.4%–44%). HPV 16 was highest among 20–24 (9.0% (95% CI 6.4%–11.6%)) and second highest among 50 to 54 y.o. (6.3% (95% CI 2.9% to 9.8%). In Low-grade Squamous Intraepithelial Lesions (LgSIL) cytology samples, the most frequently detected hrH...

Schwerpunkt: HPV-bedingte Veränderungen Nicht in allen Fällen gelingt es, mit dem Papanicolaou(PAP)-Abstrich eine präzise Vorhersage für eine möglicherweise vorliegende höhergradige präkanzeröse Läsion der Zervix zu stellen. Der Humane-Papilloma-Virus(HPV)-Test zeigt zwar das Risiko für die Entstehung einer solchen Veränderung an, weist aber keine hohe positive Prädiktion auf. Daher kann eine unerwünscht hohe Rate an Übertherapien resultieren. Demzufolge sind andere Testverfahren wünschenswert, mit denen eine effektive Follow-up-Erhebung für Frauen etabliert werden kann, die einen auffälligen zytologischen Vorbefund aufweisen. Eine Chance besteht im Einsatz von neuen Biomarkern. Schwerpunktherausgeber D. Schmidt, Mannheim Abb. 1 9 Starke diffuse p16-Reaktion in einem plattenepithelialen Carcinoma in situ und in einem angrenzenden Adenocarcinoma in situ. (p16 INK4a -Immunfärbung, Vergr. 100:1)

IntRODUCtIOn Diagnosis and management of Human Papilloma Virus (HPV)-related cervical lesions is a struggle. The main problem is which patient to treat, a decision largely (not solely) based on pathological diagnosis. Diagnosis is nontrivial due to conflicting classification schemas [3-class cervical intraepithelial neoplasia (CIN) vs. 2-class squamous intraepithelial lesion (SIL)] and subjective diagnostic criteria that are variously interpreted amongst pathologists (1-3). A recent study by Gage et al. showed that women would have a different probability of being treated depending on which laboratory and hence which pathologists reviewed the biopsy specimen (4). The aim of this study was to assess the interobserver reproducibility of the two classification systems of HPVrelated lesions of the cervix, namely the three-tiered "CIN"

BACKGROUND. Colposcopy biopsy procedure is a standard recommendation for atypical squamous cell cannot exclude high-grade lesion (ASC-H) in abnormal Papanicolaou smears. p16 (p16INK4a), a cell cycle regulator, has been shown to be overexpressed in squamous dysplasia. To further improve the diagnostic accuracy of the ASC-H Papanicolaou smear and to reduce unnecessary procedures, the authors evaluated the utility of immunodetection of p16 in liquid-based cytology specimens on cell blocks. METHODS. Seventy-five liquid-based (SurePath; TriPath Imaging, Inc. Burlington, NC) cytology specimens were prepared for cell blocks. Three groups (G1, G2, and G3) of cases were included: G1 comprised 44 cases of ASC-H; G2, 14 cases of high-grade dysplasia; and G3, 17 negative/reactive cases. All cases in G1 were confirmed by cervical biopsy or Digene Hybrid Capture 2 (Digene, Gaithersburg, Md) human papilloma virus (HPV) testing. Immunodetection for p16 was performed on cell blocks. RESULTS. In G1, 26 of 44 (59%) cases showed squamous dysplasia, with 14 highgrade squamous intraepithelial lesion (HSIL) cases. Twenty-two of 28 (79%) p16positive cases were confirmed by surgical biopsy or HPV testing, with a diagnostic sensitivity of 85%, specificity of 67%, positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 75%. Four cases with false-negative staining for p16 were identified. All 28 cases of HSIL (14 from G1 and 14 from G2) were positive for p16. CONCLUSIONS. 1) p16 is a sensitive marker to confirm the diagnosis of ASC-H on a cell block; 2) Multiple unstained slides with adequate cellularity can be obtained from each cell block; and 3) Additional markers can be used to further increase diagnostic sensitivity and specificity. Cancer (Cancer Cytopathol)

Cervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from the Centers for Disease Control (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to implement cervical cancer screening to low-income, uninsured or under insured women. The USAPI grantees report data on screening and follow-up activities to the CDC. We examined cervical cancer screening and follow-up data from the NBCCEDP programs in the four USAPIs from 2007 to 2015. We summarized screening done by Papanicolaou (Pap) and oncogenic human papillomavirus (HPV) tests, follow-up and diagnostic tests provided, and histology results observed. A total of 22,249 Pap tests were conducted in 14,206 women in the four USAPIs programs from 2007-2015. The overall percentages of abnormal Pap results (low-grade squamous intraepithelial lesions or worse...

The objective of the study was to assess the screening history of women with cervical cancer and review normal cervical smears 5 years preceding the diagnosis. STUDY DESIGN: Cytological and histological results of 401 women treated for invasive cervical cancer between 1991 and 2008 at the Radboud University Nijmegen Medical Center were studied. Ninety-eight normal smears were reviewed. RESULTS: Of the 401 women, 269 (67%) received at least 1 invitation for the national screening program for cervical cancer (NCSP). One-third fell outside the target age of the NCSP. Seventeen percent never responded to the invitation(s). Twenty-one percent had 1 or more normal smears within 5 years preceding the diagnosis. After review, only 39% of those smears were reviewed as a normal smear. CONCLUSION: Half of the women with cervical cancer were never screened because of the limited target age range or nonattendance. Twenty-one percent had a normal smear within 5 years preceding the diagnosis, caused by interpretation and/or sampling errors.

Cervical cytology remains the principal screening method to detect pre-invasive and invasive cervical lesions. Management of abnormal cervical cytology depends on the risk of encountering a significant cervical lesion or high-grade cervical disease. These risks may vary in different areas across the country. Thus, determining the rate of significant cervical lesion associated with each type of abnormal cervical cytology in each area is of critical importance for designing area-specific management approach. This review was conducted to evaluate the rate of high-grade cervical disease among Thai women with abnormal cervical cytology. A relatively high incidence of underlying significant lesions including invasive disease was demonstrated even in those having only minimal smear abnormality. This baseline information is crucial and must be taken into consideration in management of women with abnormal cytological screening to achieve the goals of comprehensive cervical cancer control in ...

The aim of this report is to demonstrate the Barretos Cancer Hospital initiative of organizational, laboratorial, and human resources training in the implementation of an organized cervical screening program in low-resource settings. We developed a computational program to report all epidemiological, clinical, and laboratorial findings, and to trace all necessary information to recruit women for regular screening or for referral for complementary exams after liquid-based Pap test analyses. All Pap tests were collected in liquid medium and in 2014 more than 160,000 tests were analyzed and 2,900 colposcopy examinations were performed. From 2012 to 2015, the percentage of exams collected increased from 54.6% in 2012 to 62.4% in 2013, 68.4% in 2014, and 71% in 2015. Per 1,000 Pap tests, 0.4 cases of invasive cancer were diagnosed; for in situ carcinoma, 1.9 cases were identified. More importantly, between 2011 and 2015, 89.4% of all carcinomas were detected at clinical stage 0 or I (in ...

Context The College of American Pathologists periodically surveys laboratories to determine changes in cytopathology practices. We report the results of a 2011 gynecologic cytology survey. Objective To provide a cross-sectional survey of gynecologic cytology practices in 2010. Design In 2011, a survey was sent to 1604 laboratories participating in the College of American Pathologists gynecologic cytology interlaboratory comparison education program and proficiency testing programs requesting data from 2010 on the following topics: terminology/reporting, cytotechnologist workload, quality assurance, reagents, and ancillary testing. Results Six hundred and twenty-five laboratories (39%) replied to the survey. The nonstandard use of “low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion” is used by most laboratories to report the presence of low-grade squamous intraepithelial lesion with possibility of high-grade squamous intraepithelial le...

The "see and treat" approach, proceeding without a biopsy directly to uterine cervix conization in women diagnosed with high grade squamous intraepithelial lesion (HGSIL) on Pap smear, shortens the treatment duration, lessens patient anxiety, and reduces health care costs. To evaluate the level of diagnostic accuracy and the over-treatment rate in the "see and treat" versus conventional management of women diagnosed with HGSIL. We retrospectively reviewed all women with HGSIL who had undergone the "see and treat" approach during 2001-2011 at Soroka University Medical Center. Similar cohorts, who were managed conventionally with a cervical biopsy prior to the conization, served as a comparison group. The study population consisted of 403 women: 72 (18%) had undergone the "see and treat" approach and 331 (82%) conventional management. The false positive rate was 11% for the "see and treat" group, compared to 6% for the conventional man...

Women express various opinions regarding expectations and experiences of having Pap tests, particularly with regards to explanation of the procedure, its implications and results, and accompanied preventive health activities. To explore patient expectations and experiences regarding Pap tests and associated screening activities. Semistructured interviews were conducted with volunteer female patients. Twenty-four women were interviewed. There was variation in expectations regarding consultations for a Pap test, and also of the information given as to what is meant by a 'normal' result. Many women expressed a preference for a female and regular health professional to undertake their smear. Recognition of general and individual barriers to cervical screening by health professionals will enhance patient access to, and acceptance of, screening activities. Understanding patient expectations regarding Pap tests ensures practitioners deliver health services with sufficient informati...

Testing for human papillomavirus (HPV) infection has recently been introduced into cervical screening programmes. We investigated (1) barriers to accessing and absorbing information and (2) factors that influence information needs among women undergoing HPV tests. In-depth interviews were conducted with 27 women who had HPV tests performed in a colposcopy clinic as part of follow-up of low-grade abnormal cytology or post-treatment for cervical intraepithelial neoplasia (CIN). Interviews were transcribed verbatim, coded and analysed using Framework Analysis, to identify main themes and sub-themes. Among these women, barriers to accessing and absorbing HPV information were: being overwhelmed with information; context of the HPV test; colposcopy clinic experience(s); women's perceptions of medical professionals' behaviours and attitudes, and information available on the Internet. Factors influencing women's HPV information needs were: concerns surrounding abnormal cytology ...

• Context.-Minimum cellular criteria for satisfactory Papanicolaou tests were established with the Bethesda System in 2001, and unsatisfactory rates are used as a qualityreporting measure. Objective.-To evaluate practices and unsatisfactory rates from laboratories responding to the 2007 College of American Pathologists supplemental questionnaire survey. Design.-In 2007, a supplemental questionnaire was mailed to 1621 laboratories enrolled in the 2006 College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology (PAP Education), requesting data from the 2006 calendar year. Unsatisfactory rates, reasons for unsatisfactory specimens, laboratory size, and specimen preparation type were analyzed. Results.-A total of 42% of the laboratories responded to the survey. Most of those laboratories (637 of 674; 94.5%) used the Bethesda System minimum cellularity criteria. Of those laboratories responding, 79% (527 of 667) used the Bethesda System criteria for atrophic or postirradiation specimens. Unsatisfactory rates have increased since 1996. SurePath preparations were associated with the lowest unsatisfactory rate (50th percentile, 0.30; 95th percentile, 1.3), conventional Papanicolaou tests had the highest 95th percentile rates (50th percentile, 1.0; 95th percentile, 5.90), and ThinPrep specimens had the highest median percentile (50th percentile, 1.1; 95th percentile, 3.4). The most-common reason for unsatisfactory Papanicolaou tests was too few squamous cells. Air-drying artifact was the least-common reason for unsatisfactory reporting for liquid-based preparations. Conclusions.-Use of the Bethesda System criteria for unsatisfactory specimens is widespread. Unsatisfactory rates have increased since 1996; however, the median rates are 1.1% or less for all preparations. Results from the College of American Pathologists PAP Education supplemental questionnaire continue to provide valuable benchmarking data for cytologic quality-improvement programs in laboratories.

Ethical approval was given by the Ministry of Health, Central African Republic, and the London School of Hygiene and Tropical Medicine. Verbal informed consent was obtained from all participants. Free treatment of sexually transmitted diseases was provided to all participants, and those willing to know their human immunodeficiency virus serostatus could receive counseling.

Vulvar Morbus Paget (MP) represents a rare intraepithelial adenocarcinoma. It accounts for less than 1% of all vulvar neoplasia and usually appears in postmenopausal women. Histologically it is analogous to Paget's disease of the breast. The most common clinical symptom is pruritus. The lesion appears as an erythematous or as an eczematous lesion with islands of hyperkeratosis. Occasionally, single anaplastic Paget's cells can be found on the vulvar smears which make cytological diagnosis of the disease possible. However, the disease can be diagnosed only by biopsy. We present a case of 49-year old woman with vulvar symptoms of pruritus, who had liver and kidney transplantation two years ago. During the standard gynecological examination the vulvar smear was taken for cytological evaluation. The smear was scanty, with inflammatory background, overloaded with squamae. There were two types of cells: dysplastic squamous cells from lower layer of the epithelium and the single, anaplastic cells with a high nuclear:cytoplasmic ratio who possessed eccentric, large nucleus. Nucleoli were rare. Cytoplasm varied from pale and delicate to densely basophilic. Accordingly, cytological diagnosis vulvar intraepithelial neoplasia (VIN III) with differential diagnosis of vulvar Paget's disease was made. The pathological verification supported the diagnosis of MP and an immunohistochemistry panel confirmed type III of Paget's disease and an evaluation of bladder was suggested.

Background: The AMPLICOR HPV Test has been validated for use with cervical cells collected in liquidbased preservative fluids, such as BD SurePath. It is currently recommended, however, that residual BD SurePath samples be stored at 4 • C prior to testing. Objectives: The aim of this study was to demonstrate that DNA isolated from SurePath cervical cytology specimens and stored at ambient temperature was also compatible with the AMPLICOR HPV Test. Study design: DNA was extracted using the AmpliLute Media Sample Preparation Kit. Amplification and detection of HPV was performed both as directed by the manufacturer and with minor protocol modifications. Results: Cervical specimens collected in SurePath preservative fluid remained stable for testing with the AMPLICOR HPV Test for at least 21 days. The performance of DNA extracted from specimens stored at room temperature was equivalent to DNA extracted from specimens stored at 4 • C. The ␤-globin internal control was detected in all of the 146 residual SurePath cervical cytology specimens tested using the AMPLICOR HPV Test, and high-risk HPV was detected in 46.2% (18/39) of ASCUS cases, in 63.3% (19/30) of LSIL cytology specimens, and 92.3% (24/26) of HSIL cases. Concordance of AMPLICOR HPV Test results with Hybrid Capture II was 83.9%. Conclusions: The AMPLICOR HPV Test can be successfully and reproducibly performed from DNA isolated from residual SurePath cervical cytology specimens stored at ambient temperature for at least 21 days. This provides clinical laboratories flexible storage conditions for residual SurePath cytology specimens.

Correlation between polymerase chain reaction and cervical cytology for detection of human papilloinavirus infection in women with and without dysplasia APMIS 105: 71-75. 1997. The aim of this study was to compare the ability of two methods, the polymerase chain reaction (PCR) and cervical cytology. to detect HPV infection. The study population included 222 randomly selected women without dysplasia (controls) and 91 women with histologically confirmed dysplasia (CIN 11-111) (cases). In women without dysplasia, 8.6% had cytological signs of HPV infection, whereas 15.3'%1 were HPV DNA positive by PCR. In women with dysplasia, 72.5%) had cytological signs of HPV infection, whereas 90.1'X were HPV PCR positive. The statistical agreement between the two diagnostic methods was low (controls: ~= 0. 7 6 , cases: K =-0.03). In total, PCR failed to detect 17 of 85 women with cytological signs of HPV infection, whereas cervical cytology failed to detect 48 of I16 HPV PCR-positive women. In women with dysplasia, but not in women without dysplasia, the oncogenic HPV types were associated with cytological signs of HPV infection.

the objective of this study is to explore the perceptions of medical students regarding the Pap smear test. Focus group discussion was held with twenty three medical students. The students were divided into three focus groups; two groups of female participants consisting of 9 and 8 students; respectively. The third group consisted of 6 male students. Questions regarding Pap smear testing included barriers that prevented women from taking the test, gender preference for the physician to conduct the cervical screening test, willingness to suggest Pap smear test to the family or friends. The data obtained were classified into various categories and analyzed manually. Most of the study participants mentioned that the main barriers for women to not perform Pap smear test is lack of awareness 16 (70%), followed by shyness 12 (52%) and the cost of the test 12 (52%). Most agreed that the gender of the physician will affect the women decision to do Pap smear test. All mentioned that the adva...

Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. There are few to no initial symptoms and signs. This study was conducted to assess the awareness level of young Pakistani women about cervical cancer and to educate them about this deadly disease. A detailed questionnaire regarding demographic data and information about cervical cancer was distributed in different cities of Punjab. A total of 873 women took part in this survey and 70.1 percent were totally unaware of this cancer. Only 8.5% of the whole surveyed population knew accurately about cancer of cervix, 7% of the surveyed respondents correctly specified the human papilloma virus as the causative agent. Only 5.2% respondents were able to identify the Pap smear test as a diagnostic measure. Out of all the surveyed population only 4.3% of individuals were found to be vaccinated against this disease and the majority was found fr...

The purpose of this study was to assess cervical cancer knowledge and prevention practices among college women and to determine predictors of human papillomavirus (HPV) vaccination in this group. A quantitative approach using two varying groups of women was undertaken. College women and women visiting a local community health center were surveyed on items assessing cervical cancer knowledge and prevention practices. Altogether, 410 women were sampled, 217 college women and 193 from the local community health center. HPV vaccine initiation was higher among the college group (36 %) compared to (5 %) among the community health center group. Seventy three (73 %) percent of women in the community group had a Papanicolaou test in the preceding 3 years compared to (61.8 %) in the college group. College women reported higher cervical cancer knowledge than community women. This study highlights that cervical cancer knowledge and preventive practices are variable among women and that significant differences exist among college and community women. This calls for more strategic and accessible services incorporating group specific messages and interventions.

As far as health economics is concerned, it is hard to determine the only useful tool which would disclose the actual costs associated with cancer. We analyzed hospitalization costs, which create the highest rate among all malignant cervical cancer-related medical costs. The main aim of the study was to evaluate the real costs of medical treatment in the case of patients diagnosed with cervical cancer based on the group with the primary and coexisting diagnoses. The analyzed data from 2011-2012 were obtained from the Silesian branch of the National Health Fund, which financed medical expenses due to the diagnosis of cancer in health facilities which have the agreement for such treatment. A total of 4 540 hospitalization-related health benefits were realized, with the final total cost was PLN 8 766 547, in the presented group of 2261 patients. The most popular procedures in patients with the diagnosis from the C53 group, included chemotherapy together with oncological hospitalization...

BACKGROUND Cervical cancer is the second most common cancer type seen among women in most countries and an important cause of mortality. Although it is a preventable disease, most women living in developing countries cannot reach effective screening programs. It is essential that appropriate education about cervical cancer is provided. OBJECTIVE This experimental field study was performed with the aim of evaluating the efficacy of training given to women about cervical cancer risk factors and primary and secondary prevention precautions. METHODS The research focused on women between 25 and 29 years of age, literate, married and having social security. The study was conducted in the district of Evka 4 Health Care Center between the dates of April to August 2005. The women were given survey forms and questionnaires in order to determine their socio-demographic features and knowledge level about cervical cancer in the course of home visits. They were trained and given a manual at the d...

The persistence of spermatozoa, seminal acid phosphatase, choline and seminal bloodgroup antigens in the human vagina after sexual intercourse has been studied and the following results obtained. 1. Spermatozoa were usually found up to 3 days after intercourse and were occasionally found up to 6 days afterwards. Smears without spermatozoa were obtained from swabs taken as early as 28 hours, but remained rare until 2 days after intercourse. 2. Seminal acid phosphatase sometimes remained detectable up to 3 days after sexual intercourse. The test was most useful on swabs taken within 1 day and rarely useful after 2 days. 3. Choline was usually only detectable on swabs taken within 1 day of intercourse and even within this time many negative results were obtained. The probability of positive results declined swiftly after 14 hours. 4. Seminal blood-group antigens were only detected at a useful level on swabs taken within 48 hours of intercourse. The chances of obtaining a positive result decreased swiftly with an increasing time interval after intercourse.

Vaginitis may be diagnosed as bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, or coinfection. A new molecular test assays the vaginal microbiome and organisms that cause three common infections. The objective of the trial was to evaluate the clinical accuracy of the investigational test for vaginal swabs collected by patients (self) or clinicians. The primary and secondary outcomes were to compare the investigational test with reference methods for the three most common causes of vaginitis and compare clinician-collected with self-collected swabs. We conducted a cross-sectional study in which women with symptoms of vaginitis were recruited at ten clinical centers and consented to the investigation between May and September 2015. The woman collected a vaginal swab, sheathed, and then handed it to the clinician. These swabs were to evaluate how self-collected swabs compared with clinician-collected swabs. The clinician collected an investigational test swab and referenc...

A significant number of women are diagnosed with minor cytological abnormalities on cervical screening. Many authorities recommend surveillance as spontaneous regression might occur. However, attendance for cytological follow-up decreases with time and might put some women at risk of developing invasive disease. To assess the optimum management strategy for women with minor cervical cytological abnormalities (atypical squamous cells of undetermined significance - ASCUS or low-grade squamous intra-epithelial lesions - LSIL) at primary screening in the absence of HPV (human papillomavirus) DNA test. We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL Issue 4, 2016), MEDLINE (1946 to April week 2 2016) and Embase (1980 to 2016 week 16). We included randomised controlled trials (RCTs) comparing immediate colposcopy to cytological surveillance in women with atypical squamous cells of undetermined significance (ASCUS/borderline) or low-g...

In organized cervical screening programs, typically 25% of the invited women do not attend. The Copenhagen Self-sampling Initiative (CSi) aimed to gain experiences on participation among screening nonattenders in the Capital Region of Denmark. Here, we report on the effectiveness of different communication platforms used in the pilot with suggestions for strategies prior to a full-implementation. Moreover, an innovative approach using self-sampling brushes with unique radio frequency

Cervical cancer is the most common cancer among women in Malawi. National guidelines recommend screening women aged 30-45 years every five years; however, no specific recommendations exist for women with HIV. We aimed to assess the frequency of high-grade dysplasia (CIN 2 or CIN3) and cervical cancer among women in central Malawi and to examine associations with CIN2+ (CIN2/3 or cancer). We extracted cervical pap smear, biopsy, loop electrosurgical excision procedure and uterine specimen reports from a hospital pathology database from November 2012 to November 2013. We used logistic regression to estimate associations with CIN2+. We reviewed specimens from 824 women; we excluded 194 with unknown HIV status, leaving 630 in the analytic sample. Twelve percent had high-grade dysplasia and 109 women (17%) had cancer. Twenty-five percent of high-grade dysplasia cases and 35% of cancers occurred among women outside recommended screening ages. The odds of having CIN2+ were 6.55 times (95% ...

Cervical cancer is the second commonest cancer among Indian women and its association with human papilloma virus (HPV) is well established. This preventable cancer accounts for the maximum number of cancer related deaths among rural Indian women. Unlike in developed countries there are no organized cervical cancer screening programmes in India due to lack of resources and manpower. To detect genital HPV infection using urine samples among asymptomatic rural women in the age group of 18-65 years. The study area chosen was Perdoor village in Udupi Taluk, Karnataka State and all the women in the age group of 18-65 years formed the study cohort. A cross sectional study was conducted by house visits and 1,305 women were enrolled in the study. After taking written informed consent a data sheet was filled and early stream random urine samples were collected, transported to a laboratory at 4OC and aliquoted. Samples were tested using nested HPV PCR with PGMY09/11 and GP5+/6+ primers. Positi...

This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty's registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13. The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents...

Objective: To determine the prevalence of abnormal cervical smears and high-grade lesions among HIV-positive and HIV-negative women, and to assess the relationship between severity of disease and CD4 count. Methods: In a prospective cross-sectional comparative study, 250 HIV-positive and 250 HIV-negative women attending the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, were enrolled between January and March 2012. Cervical smear samples were collected from participants, examined, and reported via the Bethesda system. Data management and analysis was done with SPSS. Differences between the 2 study groups were determined by χ 2 test and Student t test. Results: The prevalence of abnormal cervical smears was significantly higher among HIV-positive women (34.4%) than among HIV-negative women (20.2%) (P b 0.01). The proportion of high-grade lesions was significantly higher among HIV-positive women (23.5%) than among HIV-negative women (8.2%) (P = 0.025). HIV-positive women with a CD4 count below 500 cells/mm 3 had significantly more abnormal cervical smears (28.3%) compared with those with a CD4 count of 500 cells/mm 3 or more (6.1%) (P = 0.04). Conclusion: HIV-positive women were found to be at significantly greater risk of developing abnormal cervical cytology and high-grade lesions compared with HIV-negative women.

The Bhutanese Screening Programme recommends a Pap smear every 3 years for women aged 25-65 years, and coverage ranges from 20% to 60%, being especially challenging in rural settings. The 'REACH-Bhutan' study was conducted to assess the feasibility and outcomes of a novel approach to cervical cancer screening in rural Bhutan. Cross-sectional, population-based study of cervical cancer screening based on the careHPV test on self-collected samples. Women were recruited in rural primary healthcare centres, that is, Basic Health Units (BHU), across Bhutan. Overall, 3648 women aged 30-60 were invited from 15 BHUs differing in accessibility, size and ethnic composition of the population. Participants provided a self-collected cervicovaginal sample and were interviewed. Samples were tested using careHPV in Thimphu (the Bhutanese capital) referral laboratory. Screening participation by geographic area, centre, age and travelling time. Previous screening history and careHPV positivity...

Dietary studies of insectivorous bats are critical for a comprehensive analysis of their ecological role in pest control. Several factors including seasonality, reproductive status and sex may influence dietary specialization. However, data on insectivorous bat diet are scarce, especially in Mormoopidae family. Here, we analyzed the dietary variation of Mormoops megalophylla(Peters, 1864) between sexes, reproductive states and climatic seasons in Macaregua cave, located in Northeastern Andes of Colombia. We collected fecal samples and vaginal smears from 377 individuals. We assess differences between sexes in the frequency of insect consumption and we estimate dietary breadth in reproductive and non-reproductive bats. Moormops megalophylla has  a  highly  specialized  diet,  selecting  primarily  for  Lepidoptera  insects.  There  were  no differences  between  sexes,  but  wider  dietary  breadth  was  found  in  reproductive  bats  in  comparison  to non-reproductive bats. Probably, the specialization on Lepidoptera insects is explained by the high amounts of caloric energy that these insects can offer. It was remarkable the upward trend in Lepidoptera consumption from reproductive bats during the wet season, when moths are available. By contrast, non-reproductive bats increased Lepidoptera consumption in the dry season, possibly to prepare for the next reproductive events. The analysis of diet over time suggests variations between climatic seasons and reproductive states; that is, when bats are reproductively active, they increase the amount of Lepidoptera consumption in the wet season to supply their energy requirements during reproduction. These results provide key information about the ecology of M. megalophylla in the northern part of its South American distribution.

A total of 3,324 singleton pregnant women were screened for pre-term delivery and 128 women were finally randomised and analysed for outcome showing borderline cervical length (25-29 mm) and elevated cervico-vaginal interleukin 6 levels. To verify if vaginal administration of lactoferrin might have an influence on these variables, two groups of 64 patients were formed. Study cases were submitted to lactoferrin for 21 days; controls received no treatment. An inverse relation was found between interleukin 6 levels and cervical length. On day 30 from the beginning of the treatment, study cases showed a decrease in interleukin 6 levels and an increase in cervical length. A greater number of women with regular uterine contractions and reduced cervical consistency before the 37th week of gestation were found in the controls. Our data show that lactoferrin could play a role in reducing the number of women at risk for pre-term birth for shortened cervical length and elevated interleukin 6 levels.

Cervical cancer is the leading cause of cancer death among women in El Salvador. Utilizing data from the Cervical Cancer Prevention in El Salvador (CAPE) demonstration project, we assessed the health and economic impact of HPV-based screening and two different algorithms for the management of women who test HPV-positive, relative to existing Papbased screening. We calibrated a mathematical model of cervical cancer to epidemiologic data from El Salvador and compared three screening algorithms for women aged 30-65 years: (i) HPV screening every 5 years followed by referral to colposcopy for HPV-positive women (Colposcopy Management [CM]); (ii) HPV screening every 5 years followed by treatment with cryotherapy for eligible HPV-positive women (Screen and Treat [ST]); and (iii) Pap screening every 2 years followed by referral to colposcopy for Pap-positive women (Pap). Potential harms and complications associated with overtreatment were not assessed. Under base case assumptions of 65% screening coverage, HPV-based screening was more effective than Pap, reducing cancer risk by~60% (Pap: 50%). ST was the least costly strategy, and cost $2,040 per year of life saved. ST remained the most attractive strategy as visit compliance, costs, coverage, and test performance were varied. We conclude that a screen-and-treat algorithm within an HPV-based screening program is very costeffective in El Salvador, with a cost-effectiveness ratio below per capita GDP.

Despite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening for cervical cancer among young Koreans. Nationwide cross-sectional study. Republic of Korea. 3734. The Korea National Health and Nutrition Examination Survey (KNHANES V: 2010-2012) was used to evaluate factors associated with attendance for cervical cancer screening among women aged 15-39. After excluding those who were previously diagnosed with cervical cancer and those with incomplete responses to questionnaires, a total of 3734 subjects were eligible. Multi-dimensional covariates as potential predictors of cervical cancer screening were adjusted in multiple logistic regression analysis. The participation rate for cervical cancer screening was 46% among women aged 40 or younger. The logistic analyses showed that age, education, total household income, smoking and job ...