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1.
Pan Afr Med J ; 33: 125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558924

RESUMO

Introduction: Persistent high-risk HPV (hrHPV) infection is higher among women living with HIV/AIDS thus increasing their risk for cervical cancer. We evaluated the virological and immunological correlates of cervical dysplasia in HIV-infected women. Methods: A cohort of 220 consenting women attending the antiretroviral clinic of the Federal Medical Centre, Keffi, Nigeria was tested for cervical human papilloma virus (HPV) infection using PCR. The prevalent HPV genotypes were determined by DNA sequencing. CD4+T count and type specific HPV was correlated with cervical cytology. Descriptive and inferential statistical analysis of the data was done using the statistical package for social sciences (SPSS) version 20 (SPSS Inc, Illinois, USA) for analysis after validation. Results: Overall HPV prevalence was 54.1% while the hrHPV prevalence was 35.9%. Premalignant and malignant lesions were observed among participants with CD4+T counts between 200-300/mm3. A statistically significant association was observed between cervical premalignant lesions and CD4+ count (X2=24.747, P value=0.001) as well as hrHPV infections (X2=46.800, P<0.001). Conclusion: Risk stratification with HPV screening among HIV-infected women will help in early case management of cervical precancerous lesions.


Assuntos
Infecções por HIV/complicações , Programas de Rastreamento/métodos , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Adulto , Idoso , Contagem de Linfócito CD4 , Estudos de Coortes , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Papillomaviridae/isolamento & purificação , Prevalência , Displasia do Colo do Útero/diagnóstico
2.
Gynecol Oncol ; 155(1): 88-92, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31375270

RESUMO

OBJECTIVES: To estimate the frequency of abnormal surveillance cytology leading to high-grade dysplasia after surgical management for high-grade vulvar intraepithelial neoplasia (VIN) and vulvar cancer and to determine whether prior hysterectomy reduces this risk. METHODS: Women who underwent surgery for high-grade VIN or vulvar cancer between 2006 and 2014 were identified retrospectively. Patients who underwent prior hysterectomy for any indication were included. Univariate and multivariate logistic regression analyses were used to identify clinical correlates of abnormal cytology after surgical treatment for VIN and vulvar cancer. RESULTS: During a median follow-up for 72 months, 302 women underwent surveillance with cytologic screening after vulvar surgery including 99 (33%) women with prior hysterectomy. 75 (25%) women had abnormal cytology results. Of those, 47 (63%) were low-grade and 28 (37%) were high-grade, including 2 (3%) cases of invasive cancer. The rates of high-grade vaginal intraepithelial neoplasia (VAIN), cervical intraepithelial neoplasia (CIN), or cancer were not significantly different despite prior hysterectomy (9% VAIN 2+, 7% CIN 2+). Multivariate analysis showed that correlates of high-grade cytology following treatment for VIN or vulvar cancer included non-white race [odds radio (OR) 3.6, 95% confidence interval (CI) 1.7-7.8], prior abnormal cytology (OR 3.5, 95% CI 1.6-7.6), and immunodeficiency (OR 3.4, 95% CI 1.3-8.8). Prior hysterectomy did not significantly decrease risk of high-grade cytology (OR 0.87, 95% CI 0.5-1.6). CONCLUSIONS: Women treated surgically for VIN/vulvar cancer have an 8% risk of at least high-grade dysplasia from surveillance screening and prior hysterectomy does not mitigate the risk. Extrapolating from current guidelines, we recommend surveillance cytology screening at least 6-12 months after treatment.


Assuntos
Carcinoma in Situ/cirurgia , Lesões Pré-Cancerosas/patologia , Displasia do Colo do Útero/patologia , Doenças Vaginais/patologia , Neoplasias Vulvares/cirurgia , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Lesões Pré-Cancerosas/epidemiologia , Estudos Retrospectivos , Displasia do Colo do Útero/epidemiologia , Doenças Vaginais/epidemiologia , Neoplasias Vulvares/epidemiologia , Neoplasias Vulvares/patologia , Washington/epidemiologia
3.
Int J Immunogenet ; 46(5): 331-338, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31183980

RESUMO

Human papillomavirus (HPV) infection can lead to the development of productive epithelial lesions and cervical cancer. Most cervical HPV infections are solved by cell-mediated immunity within 1-2 years, and it is known that chronic inflammation predisposes to lesions progression and tumour development. In this context, we highlight the CC chemokine receptor 5 (CCR5) which is involved in leucocytes chemotaxis to sites of inflammation, controlling the immune response. The CCR5 rs333 genotyping of 164 HPV infected women and 185 non-infected women was performed using polymerase chain reaction (PCR). HPV infection was more frequent among women under 34 years old (p < 0.001), single (p = 0.001), that received 1 minimum wage or less (p = 0.002), tobacco smokers (p = 0.007), who had the first sexual intercourse before 17 years old (p = 0.038) and that had 4 or more sexual partners during lifetime (p = 0.001). No significant difference regarding genotypes and alleles distribution according to HPV infection was observed. CCR5/CCR5 genotype was observed in 94.1% of HPV non-infected women and in 89% of infected ones, CCR5/Δ32 in 5.9% of HPV infected and in 10.4% of non-infected women, and Δ32/Δ32 was observed in only one (0.6%) infected patient. CCR5 genotypes were also not associated with cervical lesions development among HPV infected women (p = 0.167). Since CCR5 may control the antitumour immune response and cervical lesions and the studied rs333 polymorphism is not very frequent, other studies are necessary, in order to establish CCR5 role on HPV infection and squamous intraepithelial lesions development.


Assuntos
Variação Genética , Infecções por Papillomavirus/complicações , Receptores CCR5/genética , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/etiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/etiologia , Adulto , Idoso , Alelos , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Polimorfismo Genético , Medição de Risco , Fatores de Risco , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia
4.
Gulf J Oncolog ; 1(30): 52-56, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31242982

RESUMO

OBJECTIVE: To determine the incidence and the association between atypical glandular cells (AGC) reported on cervical pap smears and the underlying malignant and pre-malignant genital tract pathology. METHODS: A retrospective study was performed on the files of women who were had attended our colposcopy clinic at King Hussein Medical Centre (KHMC), between April 2014 and April 2018. Out of 8483 cervical pap smears reviewed, 68 patients have smears reported to be atypical glandular cells of undetermined significance (AGUS). Proper evaluation and follow up was available for 62 patients by performing colposcopic examination, repeating pap smear, proper biopsies and histological results. The factors considered included patients age, parity, symptoms, presence of pregnancy, smoking habits, hormonal therapy usage, colposcopic finding, and histological results of biopsies performed. Data were analyzed and comparison was performed between malignant and pre-malignant lesions. RESULTS: 68 cases of AGUS pap smears were identified out of 8483 cases reviewed forming incidence of about (0.8%). Of 62 patients with AGUS pap smears, twenty-two cases (32.3%) were found to have clinically significant malignant lesions on subsequent histological follow up. It included 12 cases of endometrial adenocarcinoma, 5 cases of adenocarcinoma of cervix, 3 cases of squamous cell carcinoma of cervix and 2 cases with secondary metastasis to vagina. Of the 62 patients with AGUS pap smears, fourteen cases (20.6%) were found to have pre-malignant lesions. This included 7 cases of endometrial hyperplasia, 3 cases of adenocarcinoma in situ of cervix (ACIS) and 4 cases with cervical squamous intra-epithelial lesions. Abnormal vaginal bleeding was the most common presenting symptom (30.6%); Woman above the age of 40 years and especially post-menopausal were more likely to have significant histological abnormalities. CONCLUSION: Though the incidence of AGUS is low, it still important and clinically significant due to high substantial risk of having underlying premalignant or malignant lesions. Colposcopy and directed biopsy, endo-cervical curettage and endometrial biopsy should be performed to all women with AGUC especially to those above the age of 40 years, menopause, or having abnormal vaginal bleeding.


Assuntos
Adenocarcinoma/epidemiologia , Neoplasia Intraepitelial Cervical/epidemiologia , Colo do Útero/patologia , Lesões Pré-Cancerosas/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal/estatística & dados numéricos , Adenocarcinoma/patologia , Adulto , Idoso , Neoplasia Intraepitelial Cervical/patologia , Feminino , Seguimentos , Humanos , Incidência , Jordânia/epidemiologia , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Prognóstico , Estudos Retrospectivos , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia
5.
Diagn Cytopathol ; 47(7): 659-664, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31184808

RESUMO

INTRODUCTION: Age range for cervical screening varies widely between countries. In addition, sexual behavior has changed, life expectancy is increasing, and new insights have been gained into the pathogenesis of HPV infection. Our aim is to evaluate the distribution of cervical lesions in young and older patients. METHODS: Review of all cervical smears diagnosed in a public institution (2010-2017) and a private institution (2016-2017) in Madrid, Spain. We have included all women aged younger than 30 and older than 65 years with atypical smears (n = 1573). RESULTS: Women younger than 30 years were diagnosed with ASCUS, ASC-H, LSIL, and HSIL in 47%, 5.3%, 45.17%, and 2.6% of atypical cases, respectively. Women older than 65 years were diagnosed with ASCUS, ASC-H, LSIL, HSIL, and SCC in 38%, 12.39%, 16.8%, 13.27%, and 19.5% of atypical cases, respectively. Medical records of patients from the public institution were reviewed. Of note, 76.3% of young women showed negative smears at follow-up and 14.1% showed high-grade dysplasia (HGD). Mean ages for low-grade and HGD were 24.7 and 25.7 years, respectively. HGD was found in 37.9% of women with histological examination (33.5%). As for older patients, 25% of them had no Pap smears performed before age 65, and in 60% of the previously screened women, the screening program had not been used adequately. Mean age of first smear was 69.5 years. Carcinoma was subsequently detected in 20.7% of patients. CONCLUSIONS: Current guidelines seem to be adequately preventing carcinoma in young women. However, screening adherence should be encouraged to detect important lesions in both age groups, especially among older women.


Assuntos
Carcinoma/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Fatores Etários , Idoso , Carcinoma/patologia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Espanha , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal/estatística & dados numéricos
6.
PLoS One ; 14(5): e0217396, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120980

RESUMO

BACKGROUND: Postcoital bleeding (PCB) is a common gynecological symptom that may cause concern among both patients and physicians. Current literature is inconclusive regarding management recommendations. OBJECTIVE: To identify risk-factors for dysplasia/cancer among patients presenting post-coital bleeding (PCB). METHODS: Using large health maintenance organization (HMO) database, all women reporting PCB in 2012-2015 were identified. PCB patient records in a single colposcopy center were reviewed. Age, marital status, ethnicity, gravidity, parity, BMI, smoking, PAP smear result (within 1 year of PCB presentation), colposcopy and biopsy results were recorded. Cases were matched by age and socio-economic enumeration area to controls accessing primary care clinics for routine care. RESULTS: Yearly incidence of PCB ranged from 400 to 900 per 100,000 women; highest among patients aged 26-30 years. Among the sample of 411 PCB cases with colposcopy, 201 (48.9%) had directed biopsy. Biopsy results included 68 cervicitis (33.8%), 61 koilocytosis/CIN 1/condyloma (30.3%), 44 normal tissue (21.9%), 25 cervical polyp (12.4%), 2 CIN 2/3 (1%) and 1 carcinoma (0.5%). Positive predictive value for koilocytosis/CIN 1 or higher pathology was 15.6% (64/411) and 0.7% for CIN 2 or higher grade pathology (3/411). In conditional logistic regression, multiparty was a protective factor: OR 0.39 (95% CI 0.22-0.88, P = 0.02), while pathological PAP smear was a related risk-factor: OR 3.3 (95% CI 1.31-8.35, P = 0.01). When compared to controls, PCB patients were significantly (P = 0.04) more likely to present CIN 1 or higher grade pathology (OR 1.82, 95% CI 1.02-3.33). CONCLUSIONS: Study results indicate that PCB may require colposcopy, especially for nulliparous women with an abnormal PAP smear.


Assuntos
Coito , Hemorragia/etiologia , Doenças do Colo do Útero/etiologia , Displasia do Colo do Útero/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/epidemiologia , Colposcopia , Feminino , Hemorragia/epidemiologia , Humanos , Incidência , Israel/epidemiologia , Pessoa de Meia-Idade , Teste de Papanicolaou , Paridade , Estudos Retrospectivos , Fatores de Risco , Doenças do Colo do Útero/diagnóstico , Doenças do Colo do Útero/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Esfregaço Vaginal , Adulto Jovem
7.
J Obstet Gynaecol ; 39(6): 827-832, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31020870

RESUMO

Primary vaginal malignancies constitute a rare entity. The aim of this study was to review all primary vaginal malignancies diagnosed in an oncologic referral centre over 11 years. A total of 35 cases were retrospectively analysed, including clinical and MRI features. Squamous cell carcinoma (SCC) was the most frequent histologic subtype (77.1%), followed by adenocarcinoma (14.3%). There was no statistically significant difference for the mean age at diagnosis or for the mean largest diameter of the tumour. Most SCCs (95%) were homogeneous on T2-weighted imaging, while all adenocarcinomas were heterogeneous (p = .0001). Concerning location, both SCCs (59.3%) and adenocarcinomas (80%) occurred more often on the upper third. However, regarding the wall of origin, all adenocarcinomas originated on the anterior vaginal wall (p = .0002), while SCCs (62.5%) had a predisposition for the posterior wall (p = .017). Regarding the history of previous hysterectomy, in the SCC group, 73.3% of patients with previous hysterectomies had cervical dysplasia (p = .018). Impact statement What is already known on this subject? MRI plays an important role in the initial approach of primary vaginal malignancies. In previous studies, it is said that SCCs usually appear homogeneous on T2WI, with the intermediate-high signal, while adenocarcinomas are often homogeneously hyperintense. Regarding location, it is known that SCCs usually arise from the posterior wall of the upper third, while adenocarcinomas often originate on the anterior wall of the proximal third. What do the results of this study add? In this study, we found that all of our cases of adenocarcinomas were heterogeneous on T2WI, with high-signal intensity areas, while SCCs were predominantly homogeneous, and this association was statistically significant. We could also confirm the data in the literature regarding the most common location of these tumours. This study also showed an association between vaginal SCC and a previous hysterectomy with cervical dysplasia. What are the implications of these findings for clinical practice and/or further research? The histologic type of vaginal malignancy has clinical and management impact. Although MRI is usually performed after histologic characterisation, this is not always the case. We think that this study can constitute a starting point to better understand the MRI features of these rare tumours. Although this technique will obviously never preclude histologic characterisation, it may provide some initial hint on the type of tumour and its aggressiveness.


Assuntos
Neoplasias Vaginais/patologia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Displasia do Colo do Útero/epidemiologia , Vagina/patologia
8.
Asian Pac J Cancer Prev ; 20(2): 653-659, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30816687

RESUMO

Introduction: There is a high burden of cervical cancer in Cambodia, yet published data on the prevalence of cervical dysplasia and the risk factors contributing to the development of pre-cancerous lesions in Cambodian women is very limited. In addition, as it is well known that HIV positivity increases cervical cancer risk, it is important to quantify the prevalence of cervical dysplasia and carcinoma among Cambodian women living with HIV disease. Methods: A cross-sectional study was conducted with a sample of 499 HIV+ and 501 HIV- Cambodian women at the Sihanouk Hospital Center of HOPE. Visual inspection with 5% acetic acid was the method of screening. Colposcopy was performed on all VIA+ patients, and subsequent treatment followed WHO guidelines. Logistic regression models, stratified by both HIV+ and HIV- groups, were used to assess significant factors associated with having dysplasia. Results: VIA+ results were prevalent in both the HIV+ and HIV- arms of the study. The HIV+ patients were more likely to have a lower age at coitarche, lower weight, 2 or more lifetime sexual partners, two or greater pregnancies, or be unmarried. The estimated prevalence of VIA detected cervical dysplasia was 11% for the entire study sample, 13.4% in the HIV positive (HIV+) group and 8.6% in the HIV negative (HIV-) group (OR: 1.65; 95% CI: 1.10, 2.48; p=0.01). For the HIV+ group, having a history of 4 or more full-term pregnancies (OR: 3.42; 95% CI: 1.01-11.64; p=0.049) was found to be significantly associated with having an increased risk of developing cervical dysplasia in the multivariate model. Conclusion: Cervical dysplasia is prevalent in both HIV positive and negative Cambodian women and a VIA based national screening programs need to be developed and expanded to provide access to affordable and effective treatment for cervical dysplasia and cancers.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Infecções por HIV/complicações , HIV/isolamento & purificação , Lesões Pré-Cancerosas/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Camboja/epidemiologia , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/virologia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Seguimentos , Infecções por HIV/virologia , Humanos , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/virologia , Prevalência , Prognóstico , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Adulto Jovem
9.
J Gynecol Oncol ; 30(3): e50, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887765

RESUMO

OBJECTIVE: Human papillomavirus (HPV) infection is the most important risk factor for cervical cancer, which progresses from precursor lesions with no symptom if left untreated. We compared the risk of cervical dysplasia among HPV-positive Korean women based on HPV types and infection patterns. METHODS: We observed participants of a 5-year multicenter prospective cohort study, comprising HPV-positive women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion of the cervix at their enrollment. Follow-ups, comprising cytology and HPV DNA testing results, were included in the final analysis. Incidence was calculated for each infection pattern (persistent infection, incidental infection, and clearance). To investigate cervical dysplasia risk, we used Cox proportional hazard models adjusted for variables that were significantly different among infection patterns. From April 2010 to September 2017, 71 of 1,027 subjects developed cervical dysplasia more severe than high-grade squamous intraepithelial lesion of the cervix. RESULTS: Of these 71 subjects, persistent infection, incidental infection, and clearance were noted in 30, 39, and 2 individuals, respectively. Based on changes in DNA results during follow-up, cumulative incidence was 27.2%, 10.4%, and 0.5% for persistent infection, incidental infection, and clearance, respectively. Compared to clearance, the adjusted hazard ratios for cervical dysplasia were 51.6 and 24.1 for persistent and incidental infections, respectively (p<0.001). CONCLUSION: Individuals persistently infected with the same HPV types during the follow-up period had the highest risk of severe cervical dysplasia. Hence, it is necessary to monitor HPV types and infection patterns to prevent severe cervical precancerous lesions.


Assuntos
Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Infecções por Papillomavirus/patologia , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/virologia , Estudos Prospectivos , República da Coreia/epidemiologia , Fatores de Risco , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/virologia , Adulto Jovem
10.
Int J Cancer ; 145(3): 671-677, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30653261

RESUMO

The effectiveness of a vaccination program is influenced by its design and implementation details and by the target population characteristics. Using routinely collected population-based individual-level data, we assessed the effectiveness (against cervical dysplasia) of Manitoba's quadrivalent human papillomavirus (qHPV) routine school-based vaccination program and a short-lived campaign that targeted women at high-risk of developing cervical cancer. Females ≥9 years old who received the qHPV vaccine in Manitoba (Canada) between September 1, 2006, and March 31, 2013 (N = 31,442) were matched on age and area of residence to up to three unvaccinated females. Cox proportional hazards models were used to estimate qHPV VE against high-grade (HSILs) and low-grade squamous intraepithelial lesions (LSILs) and atypical squamous cells of undetermined significance (ASCUS). Among 14-17-year-old participants who had Pap cytology after enrollment, the adjusted qHPV VE estimates were 30% (17-58%) and 36% (21-48%) against the detection of HSILs and LSILs, respectively. There was, however, no evidence of program effectiveness among females vaccinated at ≥18 years of age and among those with a history of abnormal cytology, who were mostly vaccinated as part of the high-risk program. Estimates of VE for females vaccinated in the school-based program are consistent with the expected benefits from qHPV vaccination. No similar benefits were detected among women vaccinated at an older age, and those with abnormal cytology, who were targeted by the high-risk program. Further efforts should be targeted at achieving higher vaccine coverage among preadolescents, prior to the initiation of sexual activity.


Assuntos
Programas de Imunização/organização & administração , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Serviços de Saúde Escolar/organização & administração , Displasia do Colo do Útero/prevenção & controle , Adolescente , Criança , Estudos de Coortes , Feminino , Humanos , Manitoba/epidemiologia , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologia
11.
Arch Gynecol Obstet ; 299(1): 167-171, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30374649

RESUMO

BACKGROUND: Dental and cervical controls are two established screening programs in Germany. Compliance to orthodontic treatment in childhood is essential for dental health and one of the first health interventions that requires adherent behavior; therefore, it may be associated with participation in further screening programs in adulthood. However, it is not yet known whether early orthodontic treatment influences long-term screening adherence. METHODS: Using a questionnaire administered during a visit to a special dysplasia outpatient service, this case-control study evaluated women's personal history of orthodontic care, long-term satisfaction, and dental and gynecological screening adherence. Oral health status and dental anxiety were assessed with validated instruments. Cases were categorized as cervical dysplasia only (S2) or cervical dysplasia with conization (S1) and compared to healthy controls with a normal PAP smear. RESULTS: A study population of 233 participants included 132 cases and 101 controls. The control group had had orthodontic treatment during childhood more often than our study population with abnormal PAP smears (68.3% controls versus 56.1% subjects; p < 0.005). Orthodontic treatment was not associated with attending dental appointment or gynecological check-ups. However, women with an orthodontic treatment in childhood were significantly more often vaccinated against human papillomavirus than women without orthodontic treatment (p < 0.03). CONCLUSION: Data suggest that women with orthodontic treatment in childhood are more conscious about prevention strategies in adulthood; therefore, compliant behavior might be established in childhood.


Assuntos
Colo do Útero/patologia , Programas de Rastreamento/estatística & dados numéricos , Ortodontia/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Displasia do Colo do Útero/patologia , Adulto , Estudos de Casos e Controles , Criança , Conização , Ansiedade ao Tratamento Odontológico , Feminino , Alemanha/epidemiologia , Fidelidade a Diretrizes , Humanos , Pessoa de Meia-Idade , Saúde Bucal , Inquéritos e Questionários , Displasia do Colo do Útero/epidemiologia , Esfregaço Vaginal/estatística & dados numéricos , Adulto Jovem
12.
Am J Obstet Gynecol ; 221(1): 9-18.e8, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30550767

RESUMO

OBJECTIVE: The vaginal microbiota proposedly influence the association between human papillomavirus and cervical cancer. Our aim was to assess whether vaginal dysbiosis affects human papilloma virus acquisition, persistence, and progression to related cervical premalignancy. DATA SORUCES: MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science (inception until June 2018) were used for this study. The study protocol was registered at PROSPERO (CRD42016035620). STUDY ELIGIBILITY CRITERIA: This systematic review included all observational studies reporting on incident human papilloma virus, persistent human papilloma virus, and/or related cervical disease in women with or without vaginal dysbiosis prior to outcome assessment. STUDY APPRAISAL AND SYNTHESIS METHODS: We used random-effects models for meta-analyses and report pooled relative risks with 95% confidence intervals. The risk for incident and/or persistent human papilloma virus or related cervical disease based on longitudinal results was determined. RESULTS: Of 1645 unique articles, 15 mainly prospective cohort studies were included, published between 2003 and 2017, including a total of 101,049 women. Vaginal dysbiosis was associated with an increased risk of incident human papilloma virus (overall relative risk, 1.33, 1.18-1.50, I2 = 0%; among young women relative risk, 1.43, 1.10-1.85, I2 = 0%), human papilloma virus persistence (overall relative risk, 1.14, 1.01-1.28, I2 = 44.2%; for oncogenic types relative risk, 1.18, 1.01-1.38, I2 = 0%), and high-grade lesions and cancer (relative risk, 2.01, 1.40-3.01, I2 = 0%), but women with lesions/cancer were compared with those without, regardless of their oncogenic human papilloma virus status. Overall, comparable results were found in the molecular vaginal microbiota studies. CONCLUSION: This study supports a causal link between vaginal dysbiosis and cervical cancer along the oncogenic human papillomavirus acquisition, persistence, and cervicovaginal dysplasia development pathway.


Assuntos
Disbiose/epidemiologia , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Vagina/microbiologia , Progressão da Doença , Feminino , Humanos , Microbiota , Lesões Pré-Cancerosas/epidemiologia
13.
PLoS One ; 13(12): e0207714, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517176

RESUMO

BACKGROUND: About 30% of the cervical cancer cases in Sweden occur in women older than 60. The primary aim was to evaluate the acceptability of repeated self-sampling at home for HPV-testing in elderly women. The prevalence of HPV and HPV related dysplasia as well as the sensitivity of cytology was evaluated. METHODS: Repeated self-sampling at home for HPV testing was offered 375 women in each of the four age groups 60, 65, 70 and 75 years. Women with two consecutive positive HPV tests were examined with sampling for histology and cytology. FINDINGS: A self-sample was provided by 59.5% (893/1500) of the invited women. The overall prevalence of HPV was 4.4% (95% CI 3.2-6.0, n = 39) in the first test, and 2.5% were persistent positive in the second test (95% C 1.6-3.8, n = 22) collected on average 5.5 months later. Dysplasia, was found in 1.8% (16/893) (95% CI 1.1-3.0) and CIN 2+ in 1.0% (9/893) (95%CI 0.5-2.0) of the women. Of the 16 women with dysplasia in histology, 13 (81.2%) had a normal cytology. INTERPRETATION: Repeated self-sampling at home combined with HPV testing was well accepted among elderly women. A high prevalence of CIN was diagnosed by histology. Cytology showed extremely low sensitivity and should not be recommended for this age group.


Assuntos
Infecções por Papillomavirus/diagnóstico , Autoexame/métodos , Displasia do Colo do Útero/diagnóstico , Esfregaço Vaginal/métodos , Idoso , Neoplasia Intraepitelial Cervical/diagnóstico , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Estudos Prospectivos , Manejo de Espécimes , Suécia/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/diagnóstico
14.
Acta Oncol ; 57(12): 1663-1670, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30169991

RESUMO

BACKGROUND: Accurate information about treatment is needed to evaluate cervical cancer prevention efforts. We studied completeness and validity of reporting cervical treatments in the Cancer Registry of Norway (CRN). MATERIAL AND METHODS: We identified 47,423 (92%) high-grade cervical dysplasia patients with and 3983 (8%) without recorded treatment in the CRN in 1998-2013. We linked the latter group to the nationwide registry of hospital discharges in 1998-2015. Of patients still without treatment records, we randomly selected 375 for review of their medical history. Factors predicting incomplete treatment records were assessed by multiple imputation and logistic regression. RESULTS: Registry linkage revealed that 10% (401/3983) of patients received treatment, usually conization, within one year of their initial high-grade dysplasia diagnosis. Of those, 11% (n = 44) were missing due to unreporting and 89% (n = 357) due to misclassification at the CRN. Of all cases in medical review, patients under active surveillance contributed almost 60% (223/375). Other reasons of being without recorded treatment were uncertain dysplasia diagnosis, invasive cancer or death. Coding error occurred in 19% (73/375) of randomly selected cases. CRN undercounted receipt of treatment by 38% (n = 1526) among patients without recorded treatment which translates into 97% overall completeness of treatment data. Incomplete treatment records were particularly associated with public laboratories, patients aged 40-54 years, and the latest study years. CONCLUSIONS: CRN holds accurate information on cervical treatments. Completeness and particularly validity can be further improved through the establishment of new internal routines and regular linkage to hospital discharges.


Assuntos
Confiabilidade dos Dados , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Colo do Útero/patologia , Colo do Útero/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Hospitais/estatística & dados numéricos , Humanos , Incidência , Pessoa de Meia-Idade , Noruega/epidemiologia , Alta do Paciente/estatística & dados numéricos , Sumários de Alta do Paciente Hospitalar/normas , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Sistema de Registros/normas , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/epidemiologia
15.
Int J STD AIDS ; 29(12): 1204-1214, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29966506

RESUMO

Cervical cancer is the third leading cause of cancer-related death and the second most diagnosed cancer among women in developing countries. We determined the prevalence of abnormal Papanicolaou (Pap), high-risk HPV (hrHPV), and colposcopy among transactional female sex workers (FSWs) in La Romana, Dominican Republic. The results of 144 FSWs of ages 18-54 years who completed a demographic interview and Pap testing with hrHPV detection between June 2015 and April 2016 were analyzed. Women with abnormal results were referred for colposcopy. Risk factors for abnormal Pap were assessed through bivariate and multivariate analyses. Overall, 36.1% (52/144) of Paps were abnormal and 43.4% (62/143) had hrHPV. Of all women with hrHPV and/or abnormal Pap (68/144; 47.2%), 61 (89.7%) were referred and 16 (26.2) underwent colposcopy. HPV16 and/or 18/45 was detected in 33.3% (15/45) of low-grade Paps. Binge drinking, weekly (AOR 5.1, 95% CI: 1.8-14.5) or daily (AOR 4.9, 95% CI: 1.5-16.6), and age at first sexual relation (AOR 1.2, 95% CI: 1.0-1.5) were significantly associated ( p < 0.05) with abnormal Pap. Although almost half of participants had abnormal Pap or hrHPV, few underwent colposcopy. Improving access to cervical cancer screening and follow-up for FSWs is imperative.


Assuntos
Detecção Precoce de Câncer/métodos , Programas de Rastreamento , Teste de Papanicolaou/estatística & dados numéricos , Infecções por Papillomavirus/diagnóstico , Profissionais do Sexo/estatística & dados numéricos , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Colposcopia , República Dominicana/epidemiologia , Feminino , Papillomavirus Humano 16 , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem
16.
Obstet Gynecol ; 131(1): 47-55, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29215531

RESUMO

OBJECTIVE: To estimate the risk of cervical intraepithelial neoplasia grade 2, 2-3, 3, adenocarcinoma in situ, or cancer (CIN 2 or worse) among women with human immunodeficiency virus (HIV)- and non-HIV-associated immunosuppression. METHODS: We performed a case-control study of 20,146 women with incident CIN 2 or worse and 5:1 age-matched, incidence-density selected women in a control group (n=100,144) enrolled in an integrated health care system from 1996 to 2014. Adjusted rate ratios (RRs) from conditional logistic regression were obtained for HIV status (stratified by CD4 T-cells), solid organ transplant history, and immunosuppressive medication use. RESULTS: Risk of CIN 2 or worse was increased among women with HIV (n=36 women in the case group and 79 women in the control group; adjusted RR 2.0, 95% CI 1.3-3.0) compared with those without HIV and in solid organ transplant recipients (n=51 women in the case group and 68 women in the control group; RR 3.3, 95% CI 2.3-4.8) compared with women without a prior transplant. The highest risks were among women with HIV and less than 200 CD4 T-cells/microliter (n=9 women in the case group and eight women in the control group; RR 5.6, 95% CI 2.1-14.7) compared with those without HIV and in solid organ transplant recipients prescribed three or greater immunosuppressive medication classes (n=32 women in the case group and 33 women in the control group; RR 4.1, 95% CI 2.5-6.8) compared with women without a prior transplant and zero medication classes. No increased risks were observed for women with HIV and 500 or greater CD4 T-cells/microliter (n=9 women in the case group and 43 women in the control group; RR 0.8, 95% CI 0.4-1.7) compared with those without HIV or women without prior solid organ transplantation prescribed two or fewer immunosuppressive medication classes (n=1,262 women in the case group and 6,100 women in the control group; RR 0.95, 95% CI 0.89-1.01) compared with women without and a prior transplant and zero medication classes. CONCLUSION: Risk of CIN 2 or worse is increased in women with a prior solid organ transplant or who have HIV and CD4 cells/microliter less than 500 but not in women with HIV and higher CD4 levels or in women without a prior solid organ transplant but who are prescribed only one or two immunosuppressive medication classes.


Assuntos
Adenocarcinoma/virologia , Infecções por HIV/imunologia , Displasia do Colo do Útero/imunologia , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/imunologia , Neoplasias do Colo do Útero/virologia , Adenocarcinoma/epidemiologia , Adenocarcinoma/imunologia , Adenocarcinoma/patologia , Adulto , Distribuição por Idade , California , Estudos de Casos e Controles , Feminino , Infecções por HIV/complicações , Humanos , Imunossupressão , Incidência , Modelos Logísticos , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Valores de Referência , Sistema de Registros , Medição de Risco , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia
17.
Bull Cancer ; 104(11): 914-920, 2017 Nov.
Artigo em Francês | MEDLINE | ID: mdl-29126586

RESUMO

OBJECTIVE: Reduce morbidity and death rates of women with cervical cancer in Guinea. METHODOLOGY: This was a five-day cross-sectional study carried out in two successive years (2012 and 2013) at the CERFFO-PCG in Conakry. The target population was women aged 25-49. Approximately 500 women for 2012 and 900 women were expected in these cervical screening campaigns by visual methods (IVA and IVL) with immediate treatment of precancerous lesions. After histologic confirmation of the cancer lesions, the management was carried out according to the protocols in force in the country. We performed a simple descriptive analysis and the results expressed as a percentage and on average. RESULTS: The target population represented 60.4% in 2012 and 76.2% in 2013, of the total number of women received. The incidence rate of high-grade intraepithelial lesions and cancers increased from 2.6% in 2012 to 0.9% in 2013. In 2012, the 57 precancerous lesions were treated with immediate treatment and 10 cases of cancers out of the 16 had a surgical treatment. Also in 2013, all precancerous lesions were treated immediately and 2 cancers out of the 4 benefited from surgery. CONCLUSION: Our research shows that, with creativity, flexibility, good organization and efficient use of resources, morbidity and death rates of women with cervical cancer in a very resources can be significantly reduced.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/cirurgia , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/cirurgia , Estudos Transversais , Criocirurgia , Eletrocoagulação , Feminino , Guiné/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem
18.
Medicine (Baltimore) ; 96(29): e7304, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28723743

RESUMO

Cervical human papillomavirus (HPV) infection is a dangerous disease, whose subtypes exhibit different distribution patterns in particular countries, regions, and races. In this study, the HPV distribution in patients with cervical precancerous lesions in Western China was investigated to assess a probability for prevention of cervical cancer and the clinical application of an HPV vaccine in China. The retrospective study of patients with different HPV subtypes and cervical precancerous lesions, who have undergone loop eelectrosurgical excision procedure, cold knife conization, or a total hysterectomy in our hospital from January 2016 to August 2016, was performed. All patients were tested for 27 HPV subtypes via the liquid suspension chip technology (Luminex 200). A total of 3393 cases of cervical intraepithelial neoplasia (CIN) were investigated, including 1098 cases of CIN I, 762 cases of CIN II, and 1533 cases of CIN III. The overall HPV infection rate was 82.58%. The high-risk HPV infection rate was 76.61%, and the low-risk rate was 9.88%. The most common 5 subtypes were HPV16, HPV52, HPV58, HPV33, and HPV18. The patients were grouped into 6 age groups: ≤20, 21 to 30, 31 to 40, 41 to 50, 50 to 64, and ≥65. The HPV subtypes' distribution varied across different age groups. In patients with cervical precancerous lesions in Western China, the top 5 HPV subtypes with the highest infection rates were HPV16, HPV52, HPV58, HPV33, and HPV18. The rate of cervical precancerous lesions unrelated to HPV was 17.42%. Thus, HPV screening with no cytology may leave unobserved about 20% of cervical precancerous lesions, which is worth of significant clinical attention.


Assuntos
Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologia , Adulto , Fatores Etários , Idoso , China , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/cirurgia , Estudos Retrospectivos , Displasia do Colo do Útero/cirurgia , Adulto Jovem
19.
Zhonghua Liu Xing Bing Xue Za Zhi ; 38(4): 467-471, 2017 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-28468064

RESUMO

Objective: To analyze the type-specific prevalence of human papillomavirus (HPV) among women aged 18-45 years from the general population in Liuzhou, Guangxi Zhuang Autonomous Region. Methods: Totally, 2 300 women aged 18-45 years old were enrolled in Liuzhou,from March to July, 2013. Cervical exfoliated cells were collected for liquid based cytological and HPV DNA tests. Women were referred to colposcopy exam, based on the clinical practice guideline. Results: Overall, the prevalence rates of any HPV or oncogenic HPV appeared as 22.7% (95% CI: 21.0%-24.4%) and 17.3% (95% CI: 16.0%-19.1%), respectively in this population under study. The high-risk HPV prevalence peaked at the age groups of 18-25 and 41-45, increasing along with the severity through cytological and histological tests. Statistically significant differences between the prevalence of CIN2+ (Cervical intraepithelial neoplasia 2+) in women older than 26 years (1.7%, 95% CI: 1.0%-2.4%) and 18-25 years (1.2%, 95% CI: 0.5%-1.9%) of age, were not observed. Among samples diagnosed as CIN2+, positivity of HPV bivalent (16/18) and nine-valent (6/11/16/18/31/33/45/52/58) vaccine, related high risks on the types of HPV types appeared as 44.1% and 97.1%. Conclusions: The age-specific HPV prevalence rates in the general women aged 18-45 in Liuzhou presented as having bimodal distribution, suggesting that the disease burden of cervical diseases in women aged 26-45 years should not be ignored. Nine-valent HPV vaccine might provide more effective prevention outcomes on cervical cancer in China.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/virologia , China/epidemiologia , Colposcopia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Gravidez , Prevalência , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia
20.
Transpl Infect Dis ; 19(4)2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28456141

RESUMO

BACKGROUND: This study aimed to analyze the relationship between the several risk factors for human papillomavirus (HPV) infection and its persistence and to assess the prevalence of the lower genital tract precursor lesions, cancer, and HPV infection in female transplant recipients, besides the most prevalent HPV types. METHODS: The methodology adopted was a cross-sectional study with a random sample of 61 patients. RESULTS: The results indicated 10 cases (16.4%) of lesions, 54.5% of the overall prevalence of HPV infection, and HPV 16 was the most common high-risk HPV type, followed by HPV 51/53/70. A multiple logistic regression was done and hormone use presented a statistically significant association with high-risk HPV infection (P=.037). No statistically significant association was identified for the set of all factors with the lesions studied. CONCLUSIONS: The high prevalence of HPV infection and its precursor lesions confirmed the importance of differential screening and follow-up of transplanted patients. Condom use must be encouraged. The study result also confirmed the importance of knowledge of the viral type, in order to analyze the impact of HPV immunization, particularly against HPV types that are not 16/18. The reasonable rate of other genotypes, besides the vaccine types, should be considered to evaluate vaccination strategies.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasias/epidemiologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Neoplasia Intraepitelial Cervical/complicações , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias/complicações , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Prevalência , Fatores de Risco , Transplantados , Displasia do Colo do Útero/complicações , Adulto Jovem
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