Poverty eradication and decreased human papilloma virus related cancer of the penis and vulva in Jamaica.

Human papilloma virus causes genital cancers. Decreases in cervical cancer have been reported to be due to comprehensive screening programmes difficult to replicate in poorer countries. HPV cancer may be related to poverty. In Jamaica, we have seen decreases in cancer of the penis and vulva and there has also been a decrease in poverty. The decrease cannot be attributed to screening. We believe elimination of poverty has decreased HPV persistence and decreased cancer rates.

Patología vulvar en pacientes post-menopáusicas del Hospital militar: un tamizaje con test de Collins

Objetivo: Identificar el tipo de frecuencia de la patología vulvar en pacientes post-menopáusicas, sintomáticas o no, que consultaron al HMC. Evaluar la sensibilidad y especifidad del test de Collins. Determinar la correlación clínico diagnóstico-patológica de la vulva. Material y Metodos: Tuvimos 73 pacientes remitidos a "Clínica de Vulva" a las cuales se les practicó Test de Collins y Biopsia dirigida, enviando este material a análisis histopatológico. Resultados:La edad de las pacientes osciló entre 45 y 73 años, con promedio de 53.3. El síntoma predominante fue prurito (50.5); asintomáticas (23 por ciento) y otros (26.5 por ciento). Las lesiones encontradas clasificadas como levantadas y no levantadas (69.86 por ciento), y sin lesión 9.5 por ciento. El diagnóstico histopatológico fue: lesiones Malignas (2.7 por ciento) discriminadas así: Carcinoma escamocelular infiltrante e In Situ, las lesiones no neoplásicas:(97.3 por ciento): Liquen escleroso (1.4 por ciento) Hiperplasia de células escamosas (2.7 por ciento) y otras dermatosis (93.2 por ciento). De éstas: Eccema, Liquenificación, Liquen simple, Condiloma. Para el test de Collins obtuvimos: sensibilidad de 33 por ciento y una especificidad no medible. Conclusiones: la patología maligna de la vulva es poco frecuente. Dentro de los trastornos no neoplásicos encontramos varios que deben ser de conocimiento para el Ginecólogo con miras a un tratamiento específico. El Test de Collins es útil para el diagnóstico de patología maligna vulvar no así para transtornos no neoplásicos

[The results of a selective program to detect intraepithelial neoplasms of the vulva]. / Resultados de un programa selectivo de detección de la neoplasia intraepitelial de la vulva.

Early detection and treatment of preinvasive neoplasias decrease the incidence and mortality of the subsequent invasive cancers. This paper presents the results of a selective program to detect vulvar intraepithelial neoplasia (VIN). The program was selective because only "relative high risk" women were included, i.e. women with one or more of the following items: a) age more than 50 years; b) past history of epidermoid cervical or vaginal cancer (included intraepithelial stages); c) past history of genital radiation; d) past or actual history of genital condyloma; and e) past or actual history of hyperplasic or mixed vulvar dystrophy. Detection was made with the test described by Collins et al., staining the vulva with a toluidine blue aqueous solution and decoloring it with acetic acid. All positive sites (areas retaining the blue color) were biopsied under local anesthesia. Histopathology diagnosis served as gold standard for the program's evaluation. Patient with negative tests and those with NIV I were rescreened each 6 months. From March 1984 to September 1986, 212 patients were admitted in this program and 318 tests were performed. Individual tests varied from 1 (105 patients) to 5 (3 patients). The group was followed-up until March 1989, when the program was evaluated. There were 77 positive tests, among them 21 cases of NIV. Three women with NIV I progressed to NIV II during the observation period. NIV cases were classified as: NIV I, 7 cases (33.3%); NIV II, 10 cases (47.7%); and NIV III, 4 cases (19.0%).(ABSTRACT TRUNCATED AT 250 WORDS)