A Scoping Review of Complementary and Alternative Medicine for Human Papillomavirus Infections and Cervical Dysplasia.

OBJECTIVE: The goal of this scoping review is to synthesize clinically relevant scientific literature on current complementary and alternative medications that address human papillomavirus (HPV) infections and cervical dysplasia. MATERIALS AND METHODS: A systematic search of published studies was performed December 2021 for the following concepts: human papilloma virus, cervical dysplasia, and complementary and alternative medicine (CAM). Relevant publications were identified by searching Ovid MEDLINE ALL, Embase, Cochrane Library, AMED, and MEDLINE databases, in addition to clinical trial databases. Data were extracted based on specific study selection criteria and analyzed by 3 authors independently using Covidence software. RESULTS: A total of 2324 studies were identified of which 56 met inclusion criteria. Treatment outcomes measured regression of HPV, improvement of cervical cytology, and/or regression of histopathology with varied definitions of success across all studies. The CAM therapies found to have the most clinical benefit and best supporting data via randomized control trials were topical mushroom ( Coriolus versicolor) gel, oral and topical selenium therapies, and oral indol-3-carbinol. Adverse events were reported in only 28/56 (50%) of included studies. CONCLUSIONS: The evidence for treating HPV and cervical dysplasia with CAM is of low quality because of lack of standardized, clinically relevant treatment outcomes, lack of standardization of products, and minimal reporting on adverse and long-term effects. Future large, randomized control trials are needed to further assess efficacy and safety of CAM therapies to address HPV and cervical dysplasia.

Avaliação da função sexual e da atividade física em mulheres após tratamento do câncer de colo de útero: estudo transversal / Assessment of sexual function and physical activity in women after cervical cancer treatment: a cross-sectional study

Introdução: O tratamento do câncer do colo do útero (CCU) promove menopausa precoce em mulheres diagnosticadas durante o menacme. A consequente interrupção abrupta da produção dos hormônios ovarianos impacta na sexualidade e outras áreas da vida da mulher, inclusive sua atividade física. É possível que a atividade física influencie a atividade sexual nessas mulheres. Objetivo: Avaliar o nível de atividade física e a função sexual nas mulheres após o tratamento oncológico e verificar se a atividade física está associada a melhor função sexual. Método: Este estudo transversal incluiu mulheres tratadas para câncer do colo do útero em um hospital de referência em oncologia no Brasil, com idade entre 18 e 50 anos, submetidas a ooforectomia bilateral e/ou radioterapia pélvica há, no máximo 11 anos. O desfecho primário foi o estado da função sexual e do nível de atividade física e a correlação entre eles e o tratamento oncológico. As mulheres responderam os questionários Female Sexual Function Index (FSFI) e o International Physical Activity Questionnaire (IPAQ) por entrevista remota entre agosto de 2021 a julho de 2022. Resultados: 50 mulheres foram entrevistadas. A média de idade foi 50 anos (DP = ±5). Todas as mulheres que tinham atividade sexual apresentaram algum nível de disfunção sexual. A maior parte das mulheres era fisicamente ativa (60%). Não houve correlação do perfil de atividade física, nem da função sexual com o tratamento oncológico realizado. Não houve associação entre atividade física e maior qualidade na função sexual. Conclusão: Todas as mulheres que relataram relação sexual tinham disfunção sexual e a maioria delas era ativa fisicamente.

Background: Cervical cancer (CC) treatment promotes early menopause in women diagnosed during menacme. The consequent abrupt interruption of the production of ovarian hormones impacts on sexuality and other areas of a woman's life, including her physical activity. It is possible that physical activity influences sexual activity in these women. Aim: To evaluate the level of physical activity and sexual function in women after cancer treatment and to verify whether physical activity is associated with better sexual function. Method: This cross-sectional study included women aged between 18 and 50 years treated for cervical cancer at a reference hospital in oncology in Brazil, who had undergone bilateral oophorectomy and/or pelvic radiotherapy for a maximum of 11 years. The primary outcome was sexual function status and physical activity level and understanding between them and cancer treatment. The women answered the Female Sexual Function Index (FSFI) and the International Physical Activity Questionnaire (IPAQ) by remote interview between August 2021 and July 2022. Results: 50 women were interviewed. The mean age was 50 years (SD = ±5). All women who had sexual activity had some level of sexual dysfunction. Most women were physically active (60%). There was no change in the physical activity profile or sexual function with the oncological treatment performed. There was no association between physical activity and better quality of sexual function. Conclusion: All women who reported sexual intercourse had sexual dysfunction and most of them were physically active.

Conservative treatment of microinvasive squamous cell carcinoma of the cervix stage IA1: Defining conization height to an optimal oncological outcome.

OBJECTIVE: This paper searches an ideal cone height for stage definition and safe treatment of cervical microinvasive squamous carcinoma stage IA1 (MIC IA1), avoiding excessive cervix resection, favoring a future pregnancy. METHODS: A retrospective study was performed involving 562 women with MIC IA1, from 1985 to 2013, evaluating cone margin involvement, depth of stromal invasion, lymph vascular invasion, conization height, and residual uterine disease (RD). High-grade squamous lesions or worse detection was considered recurrence. Univariate and multivariate regression analyses were performed, including age, conization technique (CKC, cold-knife, or ETZ, excision of transformation zone), and pathological results. Conization height to provide negative margins and the risk of residual disease were analyzed. RESULTS: Conization was indicated by biopsy CIN2/3 in 293 cases. Definitive treatments were hysterectomy (69.8%), CKC (20.5%), and ETZ (9.7%). Recurrence rate was 5.5%, more frequent in older women (p = 0.030), and less frequent in the hysterectomy group (p = 0.023). Age ≥40 years, ETZ and conization height are independent risk factors for margin involvement. For ages <40 years, 10 mm cone height was associated with 68.6% Negative Predictive Value (NPV) for positive margins, while for 15 mm and 25 mm, the NPV was 75.8% and 96.2%, respectively. With negative margins, the NPV for RD varied from 85.7-92.3% for up to 24 mm cone height and 100% from 25 mm. CONCLUSION: Conization 10 mm height for women <40 years provided adequate staging for almost 70%, with 10% of RD and few recurrences. A personalized cone height and staging associated with conservative treatment are recommended.

Efectos de la enfermedad y tratamiento en la calidad de vida sexual de la mujer con cáncer cérvico uterino / Effects of the disease and treatment in the quality of sexual life of women with cervical uterine cancer

El cáncer cérvico uterino (CaCu) corresponde al 10% de los cánceres femeninos, se describe prevenible y con viabilidad de curación, no obstante, con la optimización de las terapias las sobrevivientes superan los cinco años en el 70% de los casos, evidenciando efectos adversos producto principalmente del tratamiento que deterioran la calidad de vida e impactan sobre su sexualidad. OBJETIVO: Identificar efectos de la enfermedad y tratamiento que comprometen la calidad de vida sexual de la mujer con CaCu. METODOLOGÍA: Revisión de artículos originales entre los años 2010 y 2019 desde las bases de datos Pubmed, Scopus, Scielo, Google Académico, Science Direct, Elsevier, Redalyc, Springer Link, Wiley Online Library, Dialnet y Ovid, seleccionando 51 artículos de 90 en inglés, español y portugués a texto completo, que reportaran efectos físicos y psicosociales que comprometieran la calidad de vida sexual de mujeres con CaCu. RESULTADOS: La sexualidad de estas mujeres es impactada por efectos físicos, relacionadas con el estadio de la enfermedad y tratamiento como dispareunia, anorgasmia, alteraciones digestivas, urinarias, insomnio, inapetencia, linfedema y neuropatía periférica. Desde el ámbito psicosocial manifiestan efectos sobre su autoestima, depresión e inseguridad en la permanencia del vínculo de pareja. Emerge la comunicación sexual de pareja como condición categórica en el nivel de afectación de la calidad de vida sexual. CONCLUSIONES: la sexualidad de la mujer con CaCu está comprometida por efectos físicas y psicosociales secundarias principalmente al tratamiento recibido. La comunicación sexual de pareja surge como interviniente para superar estos efectos y debe considerarse en la atención profesional.

Cervical uterine cancer (CaCu) corresponds to 10% of female cancers, it is described as preventable and with viability of cure, however, with the optimization of therapies the survivors exceed five years in 70% of the cases, evidencing adverse effects mainly due to the treatment that deteriorates the quality of life and impact on their sexuality. OBJECTIVE: To identify the effects of the disease and treatment that compromises the quality of sexual life of women with CaCu. METHODOLOGY: Review of original articles between 2010 and 2019 from Pubmed, Scopus, Scielo, Google Scholar, Science Direct, Elsevier, Redalyc, Springer Link, Wiley Online Library, Dialnet, and Ovid databases, selecting 51 articles out of 90 in English, Spanish, and Portuguese in full text, which reported physical and psychosocial effects that compromises the quality of sexual life of women with CaCu. RESULTS: The sexuality of these women is impacted by physical effects, related to the stage of the disease and treatment, such as dyspareunia, anorgasmia, digestive and urinary disorders, insomnia, inappetence, lymphedema and peripheral neuropathy. From the psychosocial perspective, they show effects on their self-esteem, depression and insecurity in the permanence of the couple's relationship. Sexual communication between couples is emerging as a categorical condition in the level of affectation of the quality of sexual life. CONCLUSIONS: The sexuality of women with CaCu is compromised by physical and psychosocial effects mainly secondary to the treatment received. Couple's sexual communication emerges as an intervention to overcome these effects and should be considered in professional care.

Safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade cervical intraepithelial neoplasia associated with human papillomavirus: a systematic review protocol.

INTRODUCTION: Eighty per cent of the sexually active population will get human papillomavirus (HPV) infection, which is the most prevalent sexually transmitted disease worldwide. Persistence of high-grade HPV infection may evolve to a cervical intraepithelial neoplasia (CIN), and these lesions may be precursors of cervical cancer. However, this progression can be prevented by the administration of therapeutic vaccines which use the main oncoproteins responsible for cancer development in an attempt to trigger a more specific and effective immunological response against this disorder. We aim to evaluate the safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade CIN 2/3 associated with HPV. METHODS AND ANALYSIS: A systematic review of clinical trials will be undertaken. Medline, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online and Scopus will be searched, with no restriction regarding publication date. Primary outcomes will include measures related to safety, efficacy and the immunogenicity of the therapeutic vaccines used in these patients. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for randomised controlled trials, and the quality evidence of the risk of bias in single studies will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. A narrative synthesis will be done for all included studies. Outcomes will be analysed according to the subgroups of HPV type, CIN grade, route of vaccine administration and vaccine type. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges' g score for both fixed and random effect models. I 2 statistics will be used to assess heterogeneity and identify their potential sources. ETHICS AND DISSEMINATION: Ethical approval is not required as primary data will not be collected. Findings will be disseminated widely via peer-reviewed publication and in different media, for example, conferences, congresses or symposia. PROSPERO REGISTRATION NUMBER: CRD42017077428.

Organized Cervical Cancer Screening Program in Barretos, Brazil: Experience in 18 Municipalities of São Paulo State.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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 situ carcinoma), and only 5% at stages III and IV. CONCLUSIONS: Since the organized system was implemented, 98% of women have attended their recall for colposcopy. So far, we have not reached the target of 70% of women for this proposal, as recommended by the international standards.

[Sociodemographic and clinical characterization of elderly women with cervical cancer]. / Caracterização sociodemográfica e clínica de idosas com câncer do colo do útero.

OBJECTIVE: To characterize sociodemographic and clinical aspects of elderly women with cervical cancer in Maranhão, Brazil. MATERIALS AND METHOD: Retrospective and descriptive study of secondary sources. RESULTS: 559 elderly women with cervical cancer from 2009 to 2013 and registered in the hospital-based cancer registry were included in the study. The mean age was 69.91 years, with a predominance of brown women (46%), with incomplete primary education (42%), married (45.4%), and without drinking and smoking habits (58.3% and 39.4%, respectively). Squamous cell carcinoma was the most frequent type pf cancer (80.5%) with advanced stage 3B in 29.0% of the cases. At the end of the first treatment, 43.6% did not show any evidence of disease or complete remission. CONCLUSION: Results point to the need to improve campaigns for the age group studied, as well as the coverage through campaigns to promote cytopathological examination. Also health professionals should be encouraged to identify women who are behind in the examination when attending health services, thus avoiding the loss of prevention opportunities.

Adherence to Management Recommendations in Patients Diagnosed With Cervical Intraepithelial Neoplasia 2 or 3.

OBJECTIVE: The aim of the study was to evaluate the rate of patient adherence to provider recommendations for biopsy proven cervical intraepithelial neoplasia (CIN) 2 or 3 in an academic safety-net hospital. MATERIALS AND METHODS: This is a case series of patients with biopsy-proven CIN 2 or 3 identified via pathology records between January 1, 2008 to December 31, 2012 at a single academic safety-net hospital. Patients with human immunodeficiency virus, lupus, or pregnancy were excluded. Patient demographics, recommended management, and patient adherence were extracted from the patient chart. Complete adherence was defined as completion of follow-up recommendations within 6 months of the recommended follow-up date. The primary outcome was rate of complete adherence to management recommendations. Descriptive statistics, univariate analysis, and multivariable logistic regression were performed. RESULTS: Six hundred eighty-four patients met inclusion and exclusion criteria. The complete adherence rate was 89% (n = 606). In multivariable analyses, those who completed follow-up were older (mean = 31 vs 29 years; p = .031), more likely to use a long-acting reversible contraceptive or sterilization for contraception (92% vs 87%; p = .036) and more likely to have been recommended excision (90% vs 83%; p = .009). In multivariable analysis, using a long-acting reversible contraceptive or sterilization (odds ratio = 1.75; CI = 1.02-3.0) and the recommendation of any kind of treatment as opposed to expectant management (odds ratio = 3.89; CI = 1.96-7.70) remained significantly associated with complete follow-up. CONCLUSIONS: Patients were overall highly adherent to management recommendations when diagnosed with CIN 2 or 3. Those patients recommended to undergo treatment as opposed to observation were more likely to follow up.

Clinical management of the first ASCUS report in Chile. Prospective single-cohort study / Manejo clínico do primeiro relatório ASCUS no Chile. Estudo prospectivo de coorte única

ABSTRACT CONTEXT AND OBJECTIVE: Worldwide, there is no single strategy for optimal management of patients with ASCUS (atypical squamous cells of undetermined significance) cytology reports. The objective of this study was to determine the kind of clinical management conducted among women with a first ASCUS Pap smear report. DESIGN AND SETTING: Prospective single cohort study at a cervical pathology unit in Santiago, Chile. METHODS: This was an epidemiological, descriptive, observational and quantitative follow-up study on a cohort of women with ASCUS cytological reports. RESULTS: In the screening phase, 92,001 cervical cytological smears were collected in primary healthcare clinics. In the diagnostic phase, all women with a first ASCUS report were selected (n = 446). These women were asked to undergo the Pap test again and it was found that 301 women had normal results, 62 women had abnormal results and 83 did not repeat the test. In the diagnostic confirmation phase, the 62 women with abnormal results underwent colposcopy and, from these results, 58 of them underwent a biopsy. The results from the biopsies showed that 16 women had negative histological reports, 13 had CIN 1 and 29 had CIN 2+. In the treatment phase, the 42 women with lesions underwent a variety of treatments, according to the type of lesion. In the post-treatment phase, cytological and colposcopic monitoring was instituted. CONCLUSION: The clinical management consisted of traditional management of screening, diagnosis, diagnostic confirmation, treatment and post-treatment monitoring.

RESUMO CONTEXTO E OBJETIVO: Mundialmente, não existe estratégia única para o gerenciamento ideal de pacientes com laudos de citologia ASCUS ( atypical squamous cells of undetermined significance ). O objetivo do estudo foi determinar o tipo de gerenciamento clínico realizado em mulheres com o primeiro laudo de Papanicolaou ASCUS. DESENHO E LOCAL: Estudo prospectivo de coorte única em uma unidade de patologia cervical em Santiago, Chile. MÉTODOS: Estudo epidemiológico, descritivo, observacional e quantitativo de seguimento de um grupo de mulheres com laudos de citologia ASCUS. RESULTADOS: Na fase de rastreamento, 92.001 relatórios de citologia cervical foram coletados nos ambulatórios da rede pública de saúde. Na fase de diagnóstico, foi selecionada a totalidade de mulheres com relatórios citológicos de ASCUS (n = 446). Essas mulheres foram submetidas a repetição do exame de Papanicolaou, obtendo-se 301 mulheres com resultados normais, 62 mulheres com resultados anormais e 83 que não repetiram o exame. Na fase de confirmação de diagnóstico, as 62 mulheres com resultados anormais foram submetidas a colposcopia e, considerando-se os resultados obtidos, 58 foram submetidas a biópsia. Os resultados das biópsias mostraram 16 mulheres com laudos histológicos negativos, 13 com NIC 1 e 29 com NIC 2 +. Na fase terapêutica, as 42 mulheres com lesões foram submetidas a diversos tratamentos de acordo com o tipo de lesão. Para a fase pós-tratamento, foi instituído um sistema de monitoramento citocolposcópico. CONCLUSÃO: As condutas clínicas tiveram gestão tradicional de rastreamento, diagnóstico, confirmação diagnóstica, tratamento e acompanhamento pós-tratamento.

Clinical management of the first ASCUS report in Chile. Prospective single-cohort study.

CONTEXT AND OBJECTIVE: Worldwide, there is no single strategy for optimal management of patients with ASCUS (atypical squamous cells of undetermined significance) cytology reports. The objective of this study was to determine the kind of clinical management conducted among women with a first ASCUS Pap smear report. DESIGN AND SETTING: Prospective single cohort study at a cervical pathology unit in Santiago, Chile. METHODS: This was an epidemiological, descriptive, observational and quantitative follow-up study on a cohort of women with ASCUS cytological reports. RESULTS: In the screening phase, 92,001 cervical cytological smears were collected in primary healthcare clinics. In the diagnostic phase, all women with a first ASCUS report were selected (n = 446). These women were asked to undergo the Pap test again and it was found that 301 women had normal results, 62 women had abnormal results and 83 did not repeat the test. In the diagnostic confirmation phase, the 62 women with abnormal results underwent colposcopy and, from these results, 58 of them underwent a biopsy. The results from the biopsies showed that 16 women had negative histological reports, 13 had CIN 1 and 29 had CIN 2+. In the treatment phase, the 42 women with lesions underwent a variety of treatments, according to the type of lesion. In the post-treatment phase, cytological and colposcopic monitoring was instituted. CONCLUSION: The clinical management consisted of traditional management of screening, diagnosis, diagnostic confirmation, treatment and post-treatment monitoring.

p16(INK) (4a) expression as a potential marker of low-grade cervical intraepithelial neoplasia progression.

To evaluate p16(INK) (4a) immunoexpression in CIN1 lesions looking for differences between cases that progress to CIN2/3 maintain CIN1 diagnosis, or spontaneously regress. Seventy-four CIN1 biopsies were studied. In the follow-up, a second biopsy was performed and 28.7% showed no lesion (regression), 37.9% maintained CIN1, and 33.4% progressed to CIN2/3. Immunostaining for p16(INK) (4a) was performed in the first biopsy and it was considered positive when there was strong and diffuse staining of the basal and parabasal layers. Pearson's chi-square was used to compare the groups (p ≤ 0.05). The age of the patients was similar. There was no significant difference in p16(INK) (4a) immunoexpression in the groups, however, statistical analyses showed a significant association when only the progression and regression groups were compared (p = 0.042). Considering p16(INK) (4a) positivity and the progression to CIN2/3, the sensitivity, specificity, positive, and negative predictive values in our cohort were 45%, 75%, 47%, and 94%, respectively. We emphasize that CIN1 with p16(INK) (4a) staining was associated with lesion progression, but the sensitivity was not high. However, the negative predictive value was more reliable (94%) and p16(INK) (4a) may represent a useful biomarker that can identify CIN1 lesions that need particular attention, complementing morphology.

Clinical and evolving features of women diagnosed with precancerous cervical lesions, screened and treated in the Amazon region of Brazil.

The objective of the study was to determine the dynamics of precancerous lesions in women of a cohort treated for cervical intraepithelial neoplasia (CIN) and followed up over the next two years. The conditional probability of failure was calculated using the Kaplan-Meier method, and the raw and adjusted hazard ratios (HR) were determined using Cox regression with a p-value entry of < 0.05. Of the 237 women who were treated, 51.5% were accompanied over 24 months, and treatment failed for 21.9% of those accompanied. Women who had five or more pregnancies (adjusted HR = 3.10, 95%CI: 1.28-7.51) or an initial histological diagnosis of CIN II/III demonstrated an independent risk of treatment failure (adjusted HR = 3.14, 95%CI: 1.20-8.19). Being in a stable relationship was a protective factor against treatment failure (adjusted HR = 0.47, 95%CI: 0.24-0.89). A history of more frequent pregnancies and a histological diagnosis of CIN II/III are directly correlated with risk of CIN treatment failure, whereas being in a stable relationship is inversely correlated with this risk.

Clinical and evolving features of women diagnosed with precancerous cervical lesions, screened and treated in the Amazon region of Brazil / Características clínicas e evolutivas de mulheres com diagnóstico de lesões precursoras de câncer cervical, rastreadas e tratadas na região amazônica brasileira / Las características clínicas y los resultados de mujeres con un diagnóstico de lesiones precursoras de lesión cervical, seguimiento y tratamiento en la Amazonia brasileña

The objective of the study was to determine the dynamics of precancerous lesions in women of a cohort treated for cervical intraepithelial neoplasia (CIN) and followed up over the next two years. The conditional probability of failure was calculated using the Kaplan-Meier method, and the raw and adjusted hazard ratios (HR) were determined using Cox regression with a p-value entry of < 0.05. Of the 237 women who were treated, 51.5% were accompanied over 24 months, and treatment failed for 21.9% of those accompanied. Women who had five or more pregnancies (adjusted HR = 3.10, 95%CI: 1.28-7.51) or an initial histological diagnosis of CIN II/III demonstrated an independent risk of treatment failure (adjusted HR = 3.14, 95%CI: 1.20-8.19). Being in a stable relationship was a protective factor against treatment failure (adjusted HR = 0.47, 95%CI: 0.24-0.89). A history of more frequent pregnancies and a histological diagnosis of CIN II/III are directly correlated with risk of CIN treatment failure, whereas being in a stable relationship is inversely correlated with this risk.

O objetivo do estudo foi determinar a dinâmica da lesão intraepitelial cervical (NIC) em mulheres tratadas que foram acompanhadas em uma coorte durante dois anos. Foi calculada a probabilidade condicional de falha usando o método de Kaplan-Meier e foram calculadas as hazard ratios (HR) bruta e ajustada para o risco de falha usando a regressão de Cox com valor de p de entrada < 0,05. Das 237 mulheres que foram tratadas, 51,5% foram acompanhadas por 24 meses e 21,9% delas tiveram falha no tratamento, apresentando recidiva da lesão cervical. Mulheres que tinham mais que cinco gestações (HR = 3,10; IC95%: 1,28-7,51) ou histológico de NIC II/III demonstraram risco independente para falha no tratamento (HR = 3,14; IC95%: 1,20-8,19) e estar em um relacionamento estável mostrou ser um fator de proteção para falha de tratamento (HR = 0,47; IC95%: 0,24-0,89). A história de maior número de gestações e histológico de NIC II/III estão diretamente correlacionados com o risco de falha no tratamento, enquanto que estar em um relacionamento estável é inversamente correlacionado ao risco.

El objetivo del estudio fue determinar la dinámica de las lesiones intraepiteliales de cuello uterino (NIC) en mujeres que fueron tratadas dentro de una cohorte, cuyo seguimiento se realizó durante dos años. Se calculó la probabilidad condicional de error, utilizando el método de Kaplan-Meier y se calcularon los cocientes de riesgo (HR) crudos y ajustados por el riesgo de fracaso mediante la regresión de Cox con el aporte valor p < 0,05. De 237 mujeres que recibieron tratamiento, el 51,5% fueron seguidas durante 24 meses y en el 21,9% fracasó el tratamiento, mostrando la repetición del daño cervical. Las mujeres que tenían más de cinco embarazos (HR = 3,10; IC95%: 1,28-7,51) o NIC histológico II/III mostraron un factor de riesgo independiente para el fracaso del tratamiento (HR = 3,14; IC95%: 1,20-8,19) y estar en una relación estable resultó ser un factor protector para el fracaso del tratamiento (HR: 0,47; IC95%: 0,24-0,89). La historia de embarazos múltiples y con diagnóstico histológico NIC II/III se correlaciona directamente con el riesgo de fracaso del tratamiento, mientras que si está en una relación estable se correlaciona inversamente con la relación riesgo.

Cervical dysplasias 1982-2010 in the Republic of Panama. Diagnosis, treatment, and evolution.

The aim of this work was to demonstrate the effectiveness of colposcopic diagnosis and conservative local treatments in cases of dysplasia after colpo-cytology and directed biopsy. The main treatments applied were cryosurgery and cauterization. The association of dysplasia and human papillomavirus (HPV) showed an increase of 96% in recent years. The local destructive treatments (TLC), in addition to destroy the virus, have also successfully activated the local immunological system mechanism against HPV. The evidence of such affirmation is based on the obtained results that are: 76% cured, 11% improved, 6.8% persistent, 3.4% recurrence, and only one percent progression.

Cost of the Cervical Cancer Screening Program at the Mexican Social Security Institute.

OBJECTIVE: To estimate the annual cost of the National Cervical Cancer Screening Program (CCSP) of the Mexican Institute of Social Security (IMSS). MATERIALS AND METHODS: This cost analysis examined regional coverage rates reported by IMSS. We estimated the number of cytology, colposcopy, biopsy and pathology evaluations, as well as the diagnostic test and treatment costs for cervical intraepithelial neoplasia grade II and III (CIN 2/3) and cervical cancer. Diagnostic test costs were estimated using a micro-costing technique. Sensitivity analyses were performed. RESULTS: The cost to perform 2.7 million cytology tests was nearly 38 million dollars, which represents 26.1% of the total program cost (145.4 million). False negatives account for nearly 43% of the program costs. CONCLUSION: The low sensitivity of the cytology test generates high rates of false negatives, which results in high institutional costs from the treatment of undetected cervical cancer cases.

Screen-and-treat approach to cervical cancer prevention using visual inspection with acetic acid and cryotherapy: experiences, perceptions, and beliefs from demonstration projects in Peru, Uganda, and Vietnam.

Cervical cancer is preventable but continues to cause the deaths of more than 270,000 women worldwide each year, most of them in developing countries where programs to detect and treat precancerous lesions are not affordable or available. Studies have demonstrated that screening by visual inspection of the cervix using acetic acid (VIA) is a simple, affordable, and sensitive test that can identify precancerous changes of the cervix so that treatment such as cryotherapy can be provided. Government partners implemented screening and treatment using VIA and cryotherapy at demonstration sites in Peru, Uganda, and Vietnam. Evaluations were conducted in the three countries to explore the barriers and facilitating factors for the use of services and for incorporation of screen-and-treat programs using VIA and cryotherapy into routine services. Results showed that use of VIA and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help ensure successful programs include mobilizing and educating communities, organizing services to meet women's schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. Although some challenges were found across all sites, others varied from country to country, suggesting that careful assessments before beginning new secondary prevention programs will optimize the probability of success.

Determinantes sociales del abandono del diagnóstico y el tratamiento de mujeres con Papanicolaou anormal en Buenos Aires, Argentina / Social determinants of dropout from diagnosis and treatment by women with abnormal Pap smears in Buenos Aires, Argentina

OBJETIVO:Determinar la magnitud y los motivos del abandono del proceso de diagnóstico y tratamiento de las mujeres con citología anormal, así como la relación entre las características socioeconómicas de las mujeres y dicho abandono. MÉTODOS: Estudio transversal-retrospectivo. Se realizó un análisis de fuentes secundarias y entrevistas domiciliarias a mujeres con Papanicolaou (Pap) anormal atendidas en el sistema público municipal entre 2009 y 2011. RESULTADOS: El abandono confirmado en la población de estudio fue de 18,3%. Las mujeres con mayor probabilidad de abandono fueron las que vivían en hogares con presencia de niños menores de 5 años de edad (razón de probabilidades [RP]: 2,4; intervalo de confianza de 95% [IC95%]: 1,2-4,8) y las que vivían en hogares con hacinamiento (RP: 2,9; IC95%: 1,2-7,3). Las mujeres que realizaron el Pap inicial en un centro de atención primaria poseían 4,6 veces más probabilidad de abandono que las atendidas en el hospital (IC95%: 1,7-12,3). Los principales motivos de abandono reportados fueron problemas con la organización de los servicios de salud y la carga de trabajo doméstico. CONCLUSIONES: Las condiciones de vida de las mujeres, y la organización y calidad de los servicios de salud, inciden en el abandono del proceso de diagnóstico y tratamiento de las lesiones precancerosas. Es fundamental desarrollar estrategias que actúen sobre los determinantes sociales del abandono como un modo de asegurar la efectividad de los programas de tamizaje del cáncer cervicouterino.

OBJECTIVE: Determine the extent and reasons why women with abnormal Pap smears drop out from diagnosis and treatment, and the relationship between women's socioeconomic characteristics and dropping out. METHODS: Cross-sectional retrospective study. Analysis of secondary sources and household interviews with women with abnormal Pap smears seen in the public municipal system from 2009 to 2011. RESULTS: Confirmed dropout in the study population was 18.3%. Women with the greatest probability of dropping out lived in homes where there were children under five (probability ratio [PR]: 2.4; 95% confidence interval [95%CI]: 1.2-4.8) and where there was overcrowding (PR: 2.9; 95%CI: 1.2-7.3). Women whose initial Pap smear was done in a primary care center had a 4.6 times greater probability of dropping out than those seen in a hospital (95%CI: 1.7-12.3). The main reasons reported for dropping out were problems with health services organization and domestic workload. CONCLUSIONS: Women's living conditions and the organization and quality of health services affect dropout from diagnosis and treatment of precancerous lesions. Strategies need to be developed that address social determinants of dropping out as a way to ensure effectiveness of cervical cancer screening programs.

Cervical intraepithelial neoplasia in a cohort of HIV-positive women at the University Hospital of the West Indies: management and outcome.

OBJECTIVE: To determine the rate of recurrence of cervical intraepithelial neoplasia (CIN) in HIV-positive women evaluated at the University Hospital of the West Indies (UHWI). METHOD: A chart review of all non-pregnant HIV-positive women who attended the gynaecologic and colposcopic clinics between January 1994 and December 2004 identified 21 such women. Fifteen of these patients who had CIN and had at least one follow-up Pap smear were the main subjects of this study. These patients were compared to 21 HIV-negative controls who were seen during the same period and who also had at least one follow-up Pap smear. Treatment modalities for the groups included cold coagulation and large loop excision of the transformation zone (LLETZ). Cox proportional hazards analysis was used to determine the effect of HIV status on the time to first recurrence of CIN. RESULTS: The mean ages of the subjects were 32.7 ± 8.0 and 33.2 ± 8.1 years, respectively. With a mean follow-up period of 1.7 years, the rate of recurrence of CIN in patients with and without HIV was 66.24 (95% CI 27.6, 159.1) and 3.0 (95% CI 1.3, 7.3) per 100 person years. The hazards rate ratio for recurrence in subjects with HIV after adjusting for age and CIN stage was 19.1 (95% CI 4.4, 82.1). CONCLUSION: HIV increases the risk of recurrence of CIN.

[Social determinants of dropout from diagnosis and treatment by women with abnormal Pap smears in Buenos Aires, Argentina]. / Determinantes sociales del abandono del diagnóstico y el tratamiento de mujeres con Papanicolaou anormal en Buenos Aires, Argentina.

OBJECTIVE: Determine the extent and reasons why women with abnormal Pap smears drop out from diagnosis and treatment, and the relationship between women's socioeconomic characteristics and dropping out. METHODS: Cross-sectional retrospective study. Analysis of secondary sources and household interviews with women with abnormal Pap smears seen in the public municipal system from 2009 to 2011. RESULTS: Confirmed dropout in the study population was 18.3%. Women with the greatest probability of dropping out lived in homes where there were children under five (probability ratio [PR]: 2.4; 95% confidence interval [95%CI]: 1.2-4.8) and where there was overcrowding (PR: 2.9; 95%CI: 1.2-7.3). Women whose initial Pap smear was done in a primary care center had a 4.6 times greater probability of dropping out than those seen in a hospital (95%CI: 1.7-12.3). The main reasons reported for dropping out were problems with health services organization and domestic workload. CONCLUSIONS: Women's living conditions and the organization and quality of health services affect dropout from diagnosis and treatment of precancerous lesions. Strategies need to be developed that address social determinants of dropping out as a way to ensure effectiveness of cervical cancer screening programs.

Cervical intraepithelial neoplasia in a cohort of HIV-positive women at the University Hospital of the West Indies: management and outcome / Neoplasia intraepitelial cervical en una cohorte de mujeres VIH-positivas en el Hospital Universitario de West Indies: manejo y resultados

OBJECTIVE: To determine the rate of recurrence of cervical intraepithelial neoplasia (CIN) in HIVpositive women evaluated at the University H ospital of the West Indies (UHWI). METHOD: A chart review of all non-pregnant HIV-positive women who attended the gynaecologic and colposcopic clinics between January 1994 and December 2004 identified 21 such women. Fifteen of these patients who had CIN and had at least one follow-up Pap smear were the main subjects of this study. These patients were compared to 21 HIV-negative controls who were seen during the same period and who also had at least one follow-up Pap smear. Treatment modalities for the groups included cold coagulation and large loop excision of the transformation zone (LLETZ). Cox proportional hazards analysis was used to determine the effect of HIV status on the time to first recurrence of CIN. RESULTS: The mean ages of the subjects were 32.7 ± 8.0 and 33.2 ± 8.1 years, respectively. With a mean follow-up period of 1.7 years, the rate of recurrence of CIN in patients with and without HIV was 66.24 (95% CI 27.6, 159.1) and 3.0 (95% CI 1.3, 7.3) per 100 person years. The hazards rate ratio for recurrence in subjects with HIV after adjusting for age and CIN stage was 19.1 (95% CI 4.4, 82.1). CONCLUSION: HIV increases the risk of recurrence of CIN.

OBJETIVO: Determinar la tasa de recurrencia de la neoplasia intraepitelial cervical (NIC) en las mujeres VIH-positivas evaluadas en el Hospital Universitario de West Indies (HUWI). MÉTODO: Una revisión de las historias clínicas de todas las mujeres VIH-positivas no embarazadas que asistieron a la clínica ginecológica y la clínica colposcópica entre enero de 1994 y diciembre de 2004, identificó 21 de estas mujeres. Quince de estas pacientes que tenían NIC y habían tenido al menos una prueba de Papanicolaou de seguimiento, fueron los sujetos principales de este estudio. Estas pacientes fueron comparadas con 21 controles de VIH-negativos que fueron vistos durante el mismo período y que también tuvieron al menos una prueba de Papanicolaou de seguimiento. Las modalidades de tratamiento para los grupos incluyeron coagulación fría y escisión con asa grande de la zona de transformación (LLETZ). El modelo de análisis de riesgos proporcionales de Cox fue utilizado para determinar el efecto del estatus de VIH al momento de la primera recurrencia de CIN. RESULTADOS: Las edades promedios de los sujetos fueron 32.7 ± 8.0 y 33.2 ± 8.1 años, respectivamente. Con un período de seguimiento promedio de 1.7 años, la tasa de recurrencia de NIC en pacientes con y sin VIH fue 66.24 (95% IC 27.6, 159.1) y 3.0 (95% IC 1.3, 7.3) por 100 persona/años. El cociente de tasas de riesgo de recurrencia en pacientes con VIH después de ajustar por edad y etapa de CIN fue 19.1 (95% IC 4.4, 82.1). CONCLUSIÓN: El VIH aumenta el riesgo de recurrencia de la NIC.