The incidence risk of gynecological cancer by antipsychotic use: a meta-analysis of 50,402 patients.

BACKGROUND: Female gynecological cancers represent a serious public health problem, with 1,398,601 new diagnoses and 671,875 deaths per year worldwide. Antipsychotics are often used in psychiatric disorders, including schizophrenia, bipolar disorder, and major depression. It is estimated that the prescription of these drugs is linked to 1,800 deaths a year in the United States, but their association with cancer remains controversial. METHODS: We searched PubMed, Scopus, and Web of Science databases for studies reporting the correlation in the incidence risk of gynecological cancer by antipsychotic use. We used DerSimonian and Laird random-effect models to compute logit transformed odds ratio (OR) for the primary binary endpoint with 95% confidence interval (CI). Heterogeneity was assessed through effect size width along with I-squared and Tau-squared statistics. Review Manager 5.4.1. was used for statistical analyses. A p-value of < 0.05 denoted statistically significant. RESULTS: 50,402 patients were included, of whom 778 (1,54%) took antipsychotic medication for at least 1 year. 1,086 (2,15%) with ovarian cancer and 49,316 (97,85%) with endometrial cancer. Antipsychotic use (OR 1.50; 1.06 to 2.13 95% CI; p-value 0.02), hypertension (OR 1.50; 95% CI 1.06 to 2.13; p-value < 0.01), nulliparity (OR 1.98; 95% CI 1.53 to 2.57; p-value < 0.01) and multiparity (OR 0.53; 95% CI 0.41 to 0.69; p-value < 0.01) showed significantly different distributions between groups of cancer and cancer-free patients. The primary endpoint of incidence risk of gynecological cancer by antipsychotic therapy showed a statistically significant difference (OR 1.67; 95% CI 1.02 to 2.73; p-value < 0.05) against the use of antipsychotic drugs. CONCLUSIONS: Our meta-analysis showed that the use of antipsychotic drugs increases the risk of gynecological cancers, particularly endometrial cancer. This result should be weighed against the potential effects of treatment for a balanced prescribing decision.

Obesity, weight loss and gynecologic neoplasms: a narrative review.

Obesity is a chronic metabolic condition affecting up to 40% of the adult population. Gynecologic neoplasms, such as those involving the breasts, uteri, and ovaries, are all associated with obesity, but data on whether weight loss could reduce cancer incidence, recurrence or mortality are still scarce. This article focuses on review the association between obesity and gynecologic cancer incidence and prognosis.

Obesity and gynecological cancers: A toxic relationship.

Despite the evidence supporting the relevance of obesity and obesity-associated disorders in the development, management, and prognosis of various cancers, obesity rates continue to increase worldwide. Growing evidence supports the involvement of obesity in the development of gynecologic malignancies. This article explores the molecular basis governing the alteration of hallmarks of cancer in the development of obesity-related gynecologic malignancies encompassing cervical, endometrial, and ovarian cancers. We highlight specific examples of how development, management, and prognosis are affected for each cancer, incorporate current knowledge on complementary approaches including lifestyle interventions to improve patient outcomes, and highlight how new technologies are helping us better understand the biology underlying this neglected pandemic.

Panorama of Gynecologic Cancer in Brazil.

PURPOSE: Little is known, or has been published previously, regarding consolidated data on the epidemiology of gynecologic cancers (GC) in Brazil. This article describes the incidence, morbidity, and mortality of women in Brazil affected with GC between the years of 2000 and 2017. METHODS: Incidence, morbidity, and mortality data from patients with a diagnosis of one out of the five most common GC, cervical (CC), uterine (UC), ovarian (OC), vulvar (VvC), and vaginal (VgC), were obtained from three governmental sources of data. RESULTS: From 2000 to 2015 CC, OC, and VgC incidence rates (IRs) decreased, whereas the IRs for UC and VvC remained relatively stable. Data from 382,932 women with GC were analyzed. Most patients presented with locally advanced or advanced disease at diagnosis: 60.1% of patients with CC, 31.2% of patients with UC, 67.2% of patients with OC, 45.2% of patients with VvC, and 67.0% of patients with VgC. Time from diagnosis to first treatment was ≥ 60 days in 58.0% of patients with CC, 58.5% of patients with UC, 27.0% of patients with OC, 55.3% of patients with VvC, and 52.7% of patients with VgC. Regarding mortality rates (MRs), with the exception of CC, UC, and VvC, which showed a slight decrease, MRs remained stable between 2000 and 2017. CONCLUSION: A comparison with international data indicates that Brazilian patients are diagnosed with more advanced disease and face a longer delay between diagnosis and first treatment. Despite advances in screening and treatment, GC mortality has not decreased satisfactorily in this country.

Gynaecological cancer in Caribbean women: data from the French population-based cancer registries of Martinique, Guadeloupe and French Guiana (2007-2014).

BACKGROUND: For the first time, we present regional-level cancer incidence and world-standardized mortality rates for cancers for Martinique, Guadeloupe and French Guiana. METHODS: For Martinique, Guadeloupe and French Guiana, incidence data come from population-based cancer registries, and cover the periods 2007-2014, 2008-2014 and 2010-2014 respectively. Standardized incidence and mortality rates were calculated using the world population. RESULTS: In the 3 regions, all cancers combined represent 3567 new cases per year, of which 39.8% occur in women, and 1517 deaths per year (43.4% in women). Guadeloupe and Martinique present similar world-standardized incidence rates. Among gynaecological cancers, breast cancer, the second most common cancer type in the 3 regions, has an incidence rate 35 to 46% lower than in mainland France. On the other hand, cervical cancer has a higher incidence rate, particularly in French Guiana. For both endometrial cancer and ovarian cancer, no significant differences in incidence rates are found compared to mainland France. Regarding mortality, world-standardized mortality rates are similar between Guadeloupe and Martinique, and higher than in French Guiana. This situation compares favourably with mainland France (all cancers). Among gynaecological cancers, the mortality rate is lower for breast cancer in all regions compared to mainland France, and also lower for ovarian cancer in Martinique and Guadeloupe, but higher (albeit non-significantly) in French Guiana. CONCLUSION: The ethno-geographic and socio-demographic characteristics in this population of mainly Afro-Caribbean origin could partially explain these disparities. Major disparities exist for certain cancer sites: excess incidence and excess mortality for cervical cancer; lower, but increasing incidence of breast cancer.

Incidence and factors associated with venous thromboembolism in women with gynecologic cancer.

INTRODUCTION: Venous thromboembolism (VTE) is a frequent clinical event in patients with gynecologic cancer. However, studies that exclusively address the incidence of VTE according the type of gynecologic cancer are poorly reported. OBJECTIVE: To analyze the incidence of VTE and the associated factors in women with different types of gynecologic cancer. RESULTS: A total of 1.885 women with gynecologic cancer was included. Among them, 40.8% (769) experienced venous thromboembolic events, most of them in the first two years after cancer diagnosis. There was no statistically significant difference in the incidence of VTE according to the type of gynecologic cancer. However, we observed statistically significant difference in the incidence of pulmonary embolism when stratified by type of thromboembolic events. Multiple regression analysis identified the absence of cancer treatment as a factor associated with VTE in patients with gynecologic cancer (OR = 3.14, CI 95% 2.50-3.96), particularly in patients with cervical (OR = 2.48, CI 95% 1.81-3.42), endometrial (OR = 4.18, CI 95% 2.46-7.10), and ovarian (OR = 3.55, CI 95% 2.22-5.68) cancer. For the total study population, especially patients with cervical and endometrial cancer an advanced stage of cancer was found to be associated with the incidence of VTE. CONCLUSION: We observed that 40.8% experienced venous thromboembolic events. These events were associated with the treatment modality and the stage of cancer.

Treat-and-Release Emergency Department Utilization by Patients With Gynecologic Cancers.

PURPOSE: Seventeen percent of patients with cancer visit the emergency department (ED) annually, often with nonemergent complaints. We sought to describe the burden of treat-and-release ED utilization by patients with gynecologic cancers and to identify opportunities for improved triage. MATERIALS AND METHODS: Patients with gynecologic cancer diagnoses who were treated and released were identified within the Nationwide Emergency Department Sample, a stratified sample of US hospital-based ED visits, from 2009 to 2013. Sample weights were applied to generate national estimates. Associations with visit charges were assessed with weighted multivariable linear regression. RESULTS: Between 2009 and 2013, there were an estimated 174,092 annual treat-and-release ED visits by patients with gynecologic cancer (95% CI, 163,480 to 184,703 visits), which corresponded to $736 million in annual charges with an average visit charge of $4,232 (95% CI, $4,099 to $4,366). Annual visits and total charges increased significantly over the 5 years under study. Visits were more frequent for patients with cervical cancer (44.1%) versus ovarian (27.8%) and uterine (24.6%) cancer. These patients were younger and more likely to be from low socioeconomic status areas. The most common primary diagnoses were similar across cancers, including abdominal pain (10.5%), chest pain (6.1%), and urinary tract infection (5.2%). The most frequent diagnostics were culture/smear, computed tomography scan, and x-ray, and the most frequent therapeutic procedures included wound care, transfusion, and paracentesis. CONCLUSION: Patients with gynecologic cancers, and cervical cancer in particular, are frequently seen in the ED with issues that could be less expensively managed in an outpatient clinic or urgent care setting. Visit frequency, but not per-visit cost, is increasing over time.

Neoplasia maligna ginecológica: incidencia en el nuevo milenio: experiencia del servicio oncológico hospitalario (IVSS) / Gynecological malignant neoplasm: incidence in the new millennium: experience of the hospital oncology service (IVSS)

Conocer los indicadores de salud, como una forma de evaluar calidad del servicio que una institución presta a la población. La incidencia, prevalencia y tasas de mortalidad, son tres elementos básicos a conocer, esto permite planificar priorizar las necesidades de una determinada población, mejorando la optimización de recursos y conocer en que eslabón de la historia natural de la enfermedad se puede actuar. Queremos determinar la incidencia registrada en nuestro servicio, desde el 2000 hasta el 2015, de cada una de las patologías malignas atendidas. Un total de 1 824 historias de un universo de 4 911; las restantes no pudieron ser revisadas, por su desincorporación del archivo activo. Apreciamos que la patología con mayor incidencia fue el cáncer de cuello uterino, con un pequeño orcentaje (10 %) iagnosticado en estadio I. Seguidamente encontramos al cáncer de endometrio representando un 12 % de los casos. Dentro de la patología de ovario, el carcinoma epitelial representó el 75 %. El carcinoma de trompa de Falopio solo el 0,3 % de todas las patologías malignas del área inecológica, similar a lo eportado en la literatura mundial. Igualmente el cáncer de vulva, vagina y sarcoma uterino, representaron un escaso porcentaje de incidencia. Este trabajo constituye una fase inicial de investigaciones futuras, en las cuales se deben calcular tasas de upervivencia y período libre de enfermedad, además de incentivar la actualización anual, para evitar sub-registro por la pérdida de datos.(AU)

To know health indicators, is a way to assess the quality of service an institution provides to the population. The incidence, the prevalence and the mortality rates are three basic known elements, which allow you to plan and prioritize the needs of a given population, the improving resource optimization and know that link the natural history of the disease can act. With our research we want to determine the impact registered in our department from the year 2000 to the year 2015, each of the malignant athologies treated. A total of 1 824 stories of a universe of 4 911 were reviewed; the other could not be reviewed by the divestiture of the active file. However, with the data analyzed appreciate that the disease was highest incidence was the cervical cancer, with a small percentage (8 %) diagnosed with stage I, and then found the endometrial cancer representing 12 % of cases. Within pathology ovarian epithelial carcinoma he represented the most frequent with 75 %. The Fallopian tube carcinoma represented only 0.3 % of all malignant gynecological pathologies area, similar to that reported in the literature. Likewise cancer of the vulva, the vagina and the uterine sarcoma, accounted for a small percentage of incidences. This paper is an initial phase of future investigations, which must be calculated survival rates and the disease-free period, in addition to encouraging the annual update, to avoid underreporting by data loss.(AU)

Pregnancy-associated-cancer in the French West Indies (Martinique): maternal and neonatal outcomes.

BACKGROUND: The management of pregnancy-associated-cancer (PAC) requires epidemiological evaluation of the pathways of care. The aim of this study was to describe maternal and neonatal outcomes of PAC in Martinique. METHODS: A retrospective study was conducted using data from medical records and the Martinique Cancer Registry for all PAC diagnosed between 1st January 2000 and 31st December 2014. RESULTS: Eighteen women were diagnosed with PAC: 17 during pregnancy and one during the postpartum period. Mean age at diagnosis was 35.7 ± 5.4 years. PAC were mainly gynecological cancers (12/18); the other sites were: lymphoma, brain, liver, colon, skin and unknown primary site. In most cases, PAC was detected in symptomatic individuals (72.2%). Nine women had nodal involvement or initial metastasis at diagnosis. No chemotherapy was administered in cases of preservation of pregnancy. Seven fetal losses caused by abortion and miscarriage were recorded, and 11 women conducted viable pregnancies. The main neonatal pathology observed was prematurity (58.3%). CONCLUSION: Cancer management during pregnancy is a challenge for French West-Indies territories. A Caribbean Observatory of rare cancers could help to ensure a coordinated approach to support and monitoring for these patients.

Gynecologic cancer mortality in Trinidad and Tobago and comparisons of mortality-to-incidence rate ratios across global regions.

PURPOSE: To examine the factors associated with gynecologic cancer mortality risks, to estimate the mortality-to-incidence rate ratios (MIR) in Trinidad and Tobago (TT), and to compare the MIRs to those of select countries. METHODS: Data on 3,915 incident gynecologic cancers reported to the National Cancer Registry of TT from 1 January 1995 to 31 December 2009 were analyzed using proportional hazards models to determine factors associated with mortality. MIRs for cervical, endometrial, and ovarian cancers were calculated using cancer registry data (TT), GLOBOCAN 2012 incidence data, and WHO Mortality Database 2012 data (WHO regions and select countries). RESULTS: Among the 3,915 incident gynecologic cancers diagnosed in TT during the study period, 1,795 (45.8%) were cervical, 1,259 (32.2%) were endometrial, and 861 (22.0%) were ovarian cancers. Older age, African ancestry, geographic residence, tumor stage, and treatment non-receipt were associated with increased gynecologic cancer mortality in TT. Compared to GLOBOCAN 2012 data, TT MIR estimates for cervical (0.49 vs. 0.53), endometrial (0.61 vs. 0.65), and ovarian cancers (0.32 vs. 0.48) were elevated. While the Caribbean region had intermediate gynecologic cancer MIRs, MIRs in TT were among the highest of the countries examined in the Caribbean region. CONCLUSIONS: Given its status as a high-income economy, the relatively high gynecologic cancer MIRs observed in TT are striking. These findings highlight the urgent need for improved cancer surveillance, screening, and treatment for these (and other) cancers in this Caribbean nation.

Do women offered assisted reproduction technologies have a higher incidence of gynecologic cancer? A systematic review and meta-analysis.

The last two decades have seen an increase in the number of women diagnosed with infertility. The consequent growth in the use of assisted reproductive technologies (ART) calls for the determination of its long-term effects, including the risk of cancer. Many studies have attempted to answer this question, albeit with contradictory results. This review aimed to assess whether assisted reproductive technologies are associated with an increased risk of gynecological cancer. A search for papers in the literature was carried out on MEDLINE, TRIP DATABASE and NICE, resulting in 11 studies enrolling 3,900,231 patients altogether. Of these, 118,320 were offered ART. The incidence of gynecological cancer in the group offered ART was 0.6%, while the incidence in the group not offered ART was 2.1%. Taking all the studies into consideration, women offered ART were not at greater risk of having gynecological cancer; instead, a protective association was found.

Características clínico-epidemiológicas y manejo del cáncer endometrial (2010-2013) / Clinical-epidemiological characteristics and management of endometrial cancer (2010-2013)

Introducción: el cáncer de endometrio ha incrementado su incidencia y se asocia a factores de riesgo presentes en muchas mujeres en la perimenopausia. El síntoma más común es el sangramiento y la modalidad de tratamiento más empleada es la cirugía. Objetivo: caracterizar el cáncer endometrial en el Hospital América Arias desde enero de 2010 hasta junio de 2013. Métodos: se realizó un estudio descriptivo en el Hospital América Arias, desde 1ro de enero de 2010 hasta el 30 de junio de 2013. Se incluyó el total las pacientes con sangramiento uterino anormal en la etapa peri y posmenopáusico a partir de 40 años de edad. Las pacientes con diagnóstico histopatológico de cáncer endometrial constituyeron la muestra (n= 49). Resultados: la edad promedio de las pacientes fue de 60,8 ± 9,9 años. Presentaban sobrepeso 30,6 por ciento, y 44,9 por ciento eran obesas. El examen histopatológico posquirúrgico muestra que la lesión estuvo limitada al endometrio en 14,3 por ciento de las pacientes; pero hubo invasión de los dos tercios externos del miometrio en 61,2 por ciento de ellas. La extensión al cuello y a los anejos uterinos fue de 38,8 por ciento y 22,4 por ciento respectivamente. Conclusiones: existe una tendencia a la aparición del adenocarcinoma endometrial en edades cada vez más avanzadas. Se asocia a factores de riesgo como obesidad, infertilidad y el uso de terapia hormonal de remplazo. Además de la cirugía, algunas pacientes requirieron tratamiento oncológico específico(AU)

Introduction: The incidence of endometrial cancer has increased and it is associated with risk factors present in many perimenopausewomen. The most common symptom is bleeding and the most widely used treatment modality is surgery. Objective: Characterize endometrial cancer at America Arias Hospital from January 2010 to June 2013. Methods: A descriptive study was conductedat America Arias Hospital, from 1 January 2010 to 30 June 2013. The total included over 40 year patients with abnormal uterine bleeding in perimenopausal and postmenopausal. Patients with histopathologic diagnosis of endometrial cancer constituted the sample (n= 49). Results: The mean age of patients was 60.8 ± 9.9 years. 30.6 percent were overweight and 44.9 percent were obese. Postoperative histopathologic examination shows that the lesion was limited to the endometrium in 14.3 percent of patients, but there was invasion of the two outer thirds of the myometrium in 61.2 percent. The extension cervix and adnexa was 38.8 percent and 22.4 percent, respectively. Conclusions: There is a tendency to the appearance of endometrial adenocarcinoma at increasingly advanced ages. It is associated with risk factors such as obesity, infertility, and the use of hormone replacement therapy. In addition to surgery, some patients required specific cancer treatment(AU)

[Diagnostic accuracy of malignancy risk index II in post-menopausal women with adnexal tumours]. / Exactitud diagnóstica del índice de riesgo de malignidad II en mujeres posmenopáusicas con tumor anexial.

BACKGROUND: The purpose of the diagnostic evaluation of adnexal tumours is to exclude the possibility of malignancy. The malignancy risk index II identifies patients at high risk for ovarian cancer. The cut-off value is greater than 200. OBJECTIVE: To evaluate the diagnostic accuracy of malignancy risk index II in post-menopausal women with adnexal tumours in relation to the histopathological results. MATERIAL AND METHODS: A total of 138 women with an adnexal mass were studied. The malignancy risk index II was determined in all of them. They were divided into two groups according to the histopathology results; 69 patients with benign tumours and 69 patients with malignant tumours. A diagnostic test type analysis was performed with respect to the results of malignancy risk index II ≤ 200 or greater than this. RESULTS: The percentages and 95% confidence intervals were calculated. The accuracy was 81.8% (75.5-88.3), sensitivity 76.8% (66.9-86.7), specificity 87% (79.1-94.9), with a positive predictive value of 85.5% (76.7-94.3), and a negative predictive value of 78.9% (69.7-88.1). The positive likelihood ratio was 590, and the negative likelihood ratio was 0.266. CONCLUSIONS: The malignancy risk index II has good performance in the proper classification of post-menopausal women with adnexal masses, both benign and malignant, with an accuracy of 81.8%.

Correlation of pelvic magnetic resonance imaging diagnosis with pathology for indeterminate adnexal masses.

OBJECTIVES: The aim of this study was to determine the accuracy of pelvic magnetic resonance imaging (MRI) diagnoses compared with the final pathology diagnoses for a series of women with indeterminate adnexal masses. MATERIALS AND METHODS: We performed a retrospective cohort study of women who underwent pelvic MRI with a diagnosis of an adnexal mass between June 2009 and 2010 after indeterminate ultrasound at our tertiary care institution. Chart abstraction was performed for demographic information and radiologic interpretations (benign or malignant) and favored a specific histologic subtype on MRI reports. The radiologic diagnoses were compared with the diagnoses by surgical pathology. RESULTS: Data from 237 female patients who underwent pelvic MRI were included, and 41.35% underwent surgical intervention for the adnexal mass. Pelvic MRI (n = 88) was determined to have a sensitivity of 95.0% and specificity of 94.1%. The predicted specific histologic subtype by MRI (n = 84) was accurate in 56 (98.25%) of 57 women with an anticipated benign diagnosis and in 23 (85.19%) of 27 women with an anticipated malignancy. The agreement between a benign diagnosis from MRI and benign final surgical pathology was 0.85 (95% confidence interval, 0.716-0.976). CONCLUSIONS: In our tertiary care center, MRI is used to further characterize indeterminate adnexal masses and can accurately differentiate benign versus malignant adnexal masses. The diagnosis on MRI was highly correlative with the final histopathology. The majority of the cohort (59%) were able to be managed expectantly based on reassuring results of the MRI. Magnetic resonance imaging offered diagnostic value, more detailed patient counseling, appropriate subspecialty referral, and surgical planning, as well as reassurance to pursue conservative management of benign masses by MRI.

Outcomes of critically ill gynecological cancer patients admitted to intensive care unit.

PURPOSE: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. METHODS: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. RESULTS: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). CONCLUSIONS: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

[Risk factors associated, diagnostic methods and treatment for endometriosis, used in clinical service endometriosis gynecology Hospital General de Mexico (2009-2011)]. / Factores de riesgo asociados, métodos diagnósticos y tratamiento para endometriosis, utilizados en la clínica de endometriosis del servicio de ginecología del Hospital General de México (2009- 2011).

BACKGROUND: Endometriosis no ectopic endometrial stroma and glands. Have different risk factors. Four theories explain it: the theory of coelomic metaplasia, embryonic cell debris, deployment and immunological. Clinical data are pain and infertility. For the American Fertility Society (AFS) is divided into minimal, mild, moderate and severe. Diagnostic studies are antigen Ca 125, Magnetic Resonance, and abdominal ultrasound. The ideal method is direct visualization with histological confirmation. The medical and surgical treatment. OBJECTIVE: To determine the risk factors, diagnosis of Endometriosis and effectiveness of treatments used in clinical Endometriosis Gynecology Unit at the General Hospital of Mexico OD. MATERIAL AND METHODS: A descriptive, longitudinal and retrospective duration of 2 years 6 months in 30 patients diagnosed with endometriosis in the clinical treatment of Endometriosis General Hospital of Mexico OD. RESULTS: The most affected age group was 21 to 25 years, the risk factors are Gesta 1, a resident of Mexico, Mullerian malformation. The symptom was dysmenorrhea. In 16 were diagnosed as a surgical finding and laparoscopically diagnosed. CONCLUSIONS: It is important to study the risk factors. The diagnosis is made using clinical data, quantification of CA125 antigen and imaging studies. Medical treatment is indicated both in the preoperative as well as postoperative surgical treatment and seeks to eradicate the lesions.

Anal intraepithelial lesions in women with human papillomavirus-related disease.

OBJECTIVE: This study aimed to determine the prevalence of anal intraepithelial lesions in women with histologic diagnosis of intraepithelial lesions of the lower genital tract. MATERIALS AND METHODS: This was a cross-sectional study conducted at the Lower Genital Tract and Colposcopy Unit of Hospital de Clínicas "José de San Martín," University of Buenos Aires, Argentina. A total of 481 women with histologically confirmed low-grade and high-grade cervical, vaginal, or vulvar intraepithelial lesions were evaluated between 2005 and 2011. They were referred for cytologic samples and examination with high-resolution anoscopy. We obtained biopsy specimens of any suspicious colposcopic images. RESULTS: Of a total of 481 patients, 404 (84%) were immunocompetent, 31 (6.4%) were HIV+, and 46 (9.6%) had other causes of immunosuppression. Moreover, of the 481 patients, 134 (27.86%) had anal intraepithelial neoplasia (AIN); 28 (5.82%) had high-grade AIN and 106 (22%) had low-grade AIN. Women with high-grade cervical intraepithelial neoplasia (CIN 2, 3) had 2 times the odds of developing AIN compared with women with low-grade CIN (CIN 1) (odds ratio = 1.91, 95% confidence interval = 1.1-3.6). Regarding localization, we found statistically significant difference between the frequency of vulvar and anal lesions. Women with vulvar condylomata and vulvar intraepithelial neoplasia (VIN) may be more likely to develop AIN. CONCLUSIONS: Immunocompetent women with CIN, vaginal intraepithelial neoplasia, or VIN may also present high-grade or low-grade anal intraepithelial lesions so we should consider AIN as part of multicentric disease of the lower genital tract. Cervical intraepithelial neoplasia, VIN, condyloma accuminatta, and vaginal intraepithelial neoplasia could be warning signs of anal intraepithelial lesions.