Assessing the role of education in women's knowledge and acceptance of adjunct high-risk human Papillomavirus testing for cervical cancer screening.

OBJECTIVE: To assess women's knowledge, concerns, and willingness for adjunct high-risk human papillomavirus (HR-HPV) testing before and after an educational intervention. MATERIALS AND METHODS: At the time of their annual gynecologic examination, women aged 30 years and older received an educational intervention about HR-HPV. Subjects completed preintervention and postintervention questionnaires. Demographic characteristics were summarized using frequency measures. Comparisons between the pre-education and posteducation questionnaires were performed using Fisher exact test. RESULTS: Fifty women completed the study. After the educational intervention, 77% of women were willing to be tested for HR-HPV. Sixty-seven percent of women would be likely to return for their annual gynecologic examination even if a Pap smear was not required for 3 years. Education statistically reduced concern regarding a positive HR-HPV result with 60% pre-education and 27% posteducation very concerned (p =.002). When surveyed about what their concerns would be if tested positive for HR-HPV, women associate future cervical cancer diagnosis (38% pre-education vs 48% posteducation, p =.903) but not partner infidelity (0%) with testing positive for HR-HPV. Knowledge concerning HPV, cervical cancer, and cervical cancer screening was statistically improved after the educational intervention in all but 2 questions. CONCLUSION: Women 30 years and older are willing to have adjunct HR-HPV testing, with education reducing their degree of concern about testing positive. Women who test positive would be most concerned about getting cervical cancer. Women would be willing to return for yearly gynecologic examinations, even if a Pap smear was not needed for 3 years. Education improves women's knowledge of HPV, cervical cancer, and cervical cancer screening, but did not allay the concern for getting cervical cancer.

Absence or Presence of High-Grade Squamous Intraepithelial Lesion in Cervical Conization Specimens: A Clinicopathologic Study of 540 Cases.

OBJECTIVES: To explore the implications of cervical conization specimens lacking the targeted high-grade squamous intraepithelial lesions (negative cone). METHODS: We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported. RESULTS: Negative cones comprised 22% of procedures triggered by CIN2 or higher biopsies. Procedures triggered by cytology produced much higher percentages of negative cones (37% high-grade squamous intraepithelial lesion [HSIL], 46% atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion [ASC-H], and 76% low-grade squamous intraepithelial lesion-cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). Upon reviewing negative excision-triggering biopsy and cytology, we downgraded 24 (24%) CIN2 biopsies, three (14%) HSIL, five (83%) ASC-H, and 12 (92%) LSIL-H. One-third of our negative cones can be attributed to overdiagnosis either on biopsy or cytology. Patients with negative cones were older and had smaller excisions, negative colposcopic findings, and negative/equivocal high-risk human papillomavirus (HR-HPV). Within 2 years, 35 (25%) women with negative cones experienced ASCUS or LSIL. Only one (0.7%) recurred as CIN3, a significantly lower percentage than women with positive cones (13%). CONCLUSIONS: We advocate careful review of all excision-triggering biopsy and cytology, especially in cases of LSIL-H. Patients with negative cones should be surveyed with cytology and HR-HPV testing.

Evidence for increasing usage of low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) Pap test interpretations.

BACKGROUND: Pap test (PT) interpretations of low-grade squamous intraepithelial lesion (LSIL), cannot exclude high-grade squamous intraepithelial lesion (HSIL), or LSIL-H, are used in many laboratories; however monitoring its usage for quality assurance purposes is understudied. METHODS: PTs from 2005 to 2010 were collected, and yearly frequencies of LSIL, HSIL, LSIL-H, and atypical squamous cells, cannot exclude HSIL (ASC-H) as a function of total PTs and total squamous intraepithelial lesions (SILs) were calculated. Two-year risk of cervical intraepithelial neoplasia 2 (CIN2) or worse (CIN2+) and CIN 3 or worse (CIN3+) was calculated. RESULTS: A total of 352,220 PTs were identified including 17,301 abnormal PTs. LSIL-H usage increased from 2005 to 2010 (from 0.28% of total PTs in 2005 to 0.61% in 2010, P < .01; from 5.8% of total SILs in 2005 to 12% in 2010, P < .001). HSIL usage decreased significantly from 2005 to 2010 (from 0.7% of total PTs in 2005 to 0.48% in 2010, P = .048; from 14.5% of total SILs in 2005 to 9.5% in 2010, P < .01). Usage of LSIL and ASC-H did not change. Two-year risk of CIN2+ and CIN3+ for HSIL increased significantly from 2005 to 2010 (P < .01). Two-year risk of CIN2+ and CIN3+ for LSIL-H did not change significantly from 2005 to 2010. CONCLUSIONS: The frequency of LSIL-H interpretations is significantly increasing at our institution, with a significant decrease in HSIL interpretations over the same period. Two-year risk of CIN2+ and CIN3+ for HSIL increased significantly as usage of LSIL-H increased and that of HSIL decreased. Laboratories using LSIL-H may benefit from monitoring its frequency to ensure its appropriate use. Cancer (Cancer Cytopathol) 2014;122:123-7. © 2013 American Cancer Society.