ABSTRACT
El Programa Nacional de Pesquisa y Control del Cáncer Cervicouterino de Chile ha contribuido al descenso sostenido de la mortalidad por cáncer de cuello uterino. Para la reducción de esta mortalidad ha sido fundamental la citología exfoliativa del cérvix, la que no está exenta de resultados inciertos. En este sentido, los frotis clasificados como atípicos se consideran ambiguos por la presencia de anomalías celulares de difícil determinación, lo que se traduce en un diagnóstico de probabilidad incierta. En la literatura nacional como internacional, se manifiesta un notorio interés por unificar la nomenclatura citológica cervical y los algoritmos de derivación y confirmación diagnóstica, para el manejo clínico de las mujeres con anomalías citológicas cervicales y lesiones precursoras de cáncer cervicouterino. Por lo anterior, se considera relevante los estudios que proporcionen evidencia clínica epidemiológica actualizada, que permitan optimizar el cumplimiento del Programa Nacional de Cáncer Cervicouterino, conducentes al logro de los Objetivos Sanitarios del período 2011-2020.
The National Research and Control of Cervical Cancer in Chile had contributed to the sustained decline in mortality from cervical cancer. The exfoliative cytology of the cervix has been to reduce this mortality, which is not without uncertain results. The smears classified as atypical are considered ambiguous by the presence of cellular abnormalities difficult to determine, resulting in a diagnosis of uncertain probability. The literature, both nationally and internationally, is widespread interest to unify the nomenclature cervical cytology and the support of the derivation algorithms for the clinical management of women with cytologic abnormalities cervical and cervical cancer precursor lesions. Therefore, it is relevant to perform studies the provide updated epidemiological clinical evidence, to optimize the performance of the National Program for the achievement of health objectives for the period 2011-2020.
Subject(s)
Female , Neoplasms, Squamous Cell/pathology , Neoplasms, Squamous Cell/prevention & control , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/prevention & control , Algorithms , Colposcopy , Cervix Uteri/cytology , Cervix Uteri/pathology , Uterine Cervical Diseases/pathology , Uterine Cervical Diseases/prevention & control , Neoplasms, Squamous Cell/diagnosis , Uterine Cervical Neoplasms/diagnosis , Referral and Consultation , Vaginal SmearsABSTRACT
Objetivo Evaluar el acceso y la oportunidad al diagnóstico y al tratamiento que tienen las pacientes con lesiones cervicales de alto grado o cáncer de acuerdo con el reporte citológico, en Colombia entre junio 2005 a junio del 2006. Metodología Estudio retrospectivo mediante encuestas a una muestra de mujeres con anormalidad citológica residentes de cuatro departamentos de Colombia seleccionados por conveniencia en relación con diferentes tasas de mortalidad. Se realizó análisis descriptivo y se compararon las diferencias entre los departamentos. Resultados El 27 por ciento de las mujeres con lesiones de alto grado o invasoras no tuvieron acceso a alguno de los servicios diagnósticos o terapéuticos por razones de tipo administrativo de los servicios de salud, razones clínicas y culturales de las mujeres. Discusión Un elemento crítico que explica el bajo impacto en la mortalidad por cáncer de cuello uterino en la mayoría de los países de Latino América es la disociación entre actividades de tamización y las de tratamiento.
Objective Evaluating the opportunity and access to diagnosis and treatment for females having had an abnormal Pap smear (high-grade epithelial lesion and cervical cancer) in Colombia from June 2005 to June 2006. Materials and Methods This was a retrospective appraisal using a semi-closed survey of females having had an abnormal Pap smear with high squamous intraepithelial lesions or cervical cancer living in four Colombian departments. These areas were conveniently selected according to their different mortality rates. A descriptive analysis was made and the departments differences compared. Results It was found that 27 percent of females having high-grade squamous intraepithelial lesion or cervical cancer had no access to any of the diagnostic or therapeutic services. Health service administration problems and clinical and cultural ones affecting the females in the study could explain such results. Discussion Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Adenocarcinoma/epidemiology , Biopsy , Uterine Cervical Dysplasia/epidemiology , Cervix Uteri/pathology , Colposcopy , Health Services Accessibility/statistics & numerical data , Mass Screening , Neoplasms, Squamous Cell/epidemiology , Uterine Cervical Diseases/epidemiology , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Adenocarcinoma/prevention & control , Adenocarcinoma/therapy , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/pathology , Uterine Cervical Dysplasia/prevention & control , Uterine Cervical Dysplasia/therapy , Colombia/epidemiology , Culture , Early Diagnosis , Health Knowledge, Attitudes, Practice , Health Services Accessibility/economics , Health Surveys , Insurance Coverage/statistics & numerical data , Neoplasms, Squamous Cell/diagnosis , Neoplasms, Squamous Cell/pathology , Neoplasms, Squamous Cell/prevention & control , Neoplasms, Squamous Cell/therapy , Patient Acceptance of Health Care/statistics & numerical data , Precancerous Conditions/diagnosis , Precancerous Conditions/epidemiology , Precancerous Conditions/pathology , Precancerous Conditions/therapy , Retrospective Studies , Sampling Studies , Uterine Cervical Diseases/diagnosis , Uterine Cervical Diseases/pathology , Uterine Cervical Diseases/therapy , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/therapy , Vaginal Smears/statistics & numerical dataABSTRACT
CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.
CONTEXTO E OBJETIVO: A ectopia do colo do útero é hoje considerada um fenômeno fisiológico, mas parece ainda haver uma forte tendência no sentido da intervenção (tratamento). Este estudo se propõe a realizar revisão da literatura buscando evidências de benefícios conseqüentes ao tratamento da ectopia. MÉTODOS: Pesquisa nas bases Medical Literature Analysis and Retrieval Sysem Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americane e do Caribe em Ciências da Saúde (Lilacs), Biblioteca Cochrane e seis livros especializados. RESULTADOS: A revisão mostrou que: 1) existe provavelmente associação de ectopia com infecção cervical por Chlamydia trachomatis, pelo vírus HPV e maior risco de soroconversão para HIV; 2) existe provavelmente associação entre ectopia e neoplasia intra-epitelial cervical; 3) existe associação com mucorréia e nictúria; 4) não existem evidências sobre associação entre ectopia e câncer de colo do útero nem sobre proteção contra este câncer proporcionada pelo tratamento da ectopia. CONCLUSÕES: 1) Não foram encontrados na literatura dados que justifiquem o tratamento rotineiro da ectopia; 2) O tratamento pode ser utilizado para tratar sintomas associados à ectopia, porém mais sintomas são atribuídos à ectopia do que se pôde confirmar em um estudo controlado; 3) Seriam necessários novos estudos para testar a hipótese de proteção contra o câncer de colo proporcionada pelo tratamento.
Subject(s)
Humans , Female , Adolescent , Adult , Cautery , Neoplasms, Squamous Cell/prevention & control , Uterine Cervical Erosion/surgery , Uterine Cervical Neoplasms/prevention & control , Brazil , Uterine Cervical Dysplasia/etiology , Uterine Cervical Dysplasia/pathology , Uterine Cervical Dysplasia/prevention & control , Chlamydia Infections/complications , Chlamydia Infections/pathology , Electrocoagulation , HIV Infections/complications , HIV Infections/pathology , Information Storage and Retrieval/methods , Metaplasia/pathology , Neoplasms, Squamous Cell/etiology , Neoplasms, Squamous Cell/pathology , Uterine Cervical Erosion/microbiology , Uterine Cervical Erosion/pathology , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/pathology , Young AdultABSTRACT
Antecedentes: La citología cérvico uterina convencional (CCUC) es la prueba de tamizaje más empleada en la detección del cáncer de cuello uterino, sin embargo su calidad es discutida. Objetivo: Evaluar el rendimiento de la CCUC en el tamizaje de cáncer escamocelular invasor de cuello uterino. Métodos: Fueron seleccionadas 1980 usuarias de la Liga Santandereana de Lucha Contra el Cáncer. Siguiendo un muestreo prospectivo se realizó un análisis estadístico para validar la CCUC en el diagnóstico de carcinoma escamocelular invasor utilizando como prueba de referencia el informe histopatológico de biopsia. Fue determinada la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y negativo (VPN). Resultados: La CCUC tuvo una sensibilidad de 12 por ciento, una especificidad de 99 por ciento, un VPP de 83,3 por ciento y un VPN de 98,2 por ciento en la identificación de carcinoma escamocelular invasor, en una población con una prevalencia de la enfermedad de 2 por ciento. Conclusiones: En este estudio se encontró que la CCUC tuvo unos parámetros de evaluación similares a los patrones internacionalmente definidos. Su baja sensibilidad da a entender que no es un método de tamizaje, por lo cual es recomendable la mejora de los criterios empleados en su interpretación para aumentar este parámetro, así como hacer énfasis en el desarrollo de nuevas tecnologías que permitan un mejor tamizaje y diagnóstico de esta patología, que al igual que la citología convencional ofrezcan su servicio a bajos costos y con facilidad en su implementación.