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1.
Rev Med Suisse ; 16(712): 2037-2041, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112516

RESUMO

The vaginal examination is too often part of the routine in periodic gynecological consultations. However, its performance as a screening examination for gynecological diseases such as cancers and infections is poor when performed in the asymptomatic patient. It is appropriate for cervical cancer screening every 3 years from the age of 21. Moreover, the intrusive nature of the vaginal examination, which is sometimes experienced as traumatic by patients, encourages the targeting of indications for its practice. Fear of this examination may also result in avoidance of care. The gynecological consultation is a privileged setting for screening for sexual risk taking or domestic violence, but also for exploring overall sexual health and promoting women's health.


Assuntos
Exame Ginecológico , Neoplasias do Colo do Útero/diagnóstico , Detecção Precoce de Câncer , Feminino , Humanos , Encaminhamento e Consulta , Saúde da Mulher
2.
Rev Med Suisse ; 16(712): 2046-2049, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112518

RESUMO

The treatment of the early-stage cervical cancer is surgical. In the last ten years we have seen a surgical de-escalation and the development of new techniques such as the sentinel node biopsy. In 2018, absolutely against the trend, the study published in the New England Journal of Medicine by Pedro Ramirez upset the world of gynecologic-oncologists by demonstrating that the open approach is superior to the minimally invasive technique in the surgical management of these cancers. A long debate arose after the publication of this article, which remains the only prospective randomized study published to date on the subject. We therefore must take a step back and return to open surgery in the treatment of early-stage cervical cancer.


Assuntos
Estadiamento de Neoplasias , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/cirurgia , Detecção Precoce de Câncer , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Biópsia de Linfonodo Sentinela
3.
N Z Med J ; 133(1524): 50-63, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-33119570

RESUMO

BACKGROUND: Most cervical cancers are associated with human papillomavirus (HPV) types 16 and 18. In 2008, New Zealand commenced a quadrivalent HPV (virus-like particles of types 6, 11, 16 and 18) vaccination programme. AIM: Document trends in number of colposcopy referrals and number and grade of cervical abnormalities diagnosed in women (20-24 years) referred to three large colposcopy clinics over time. METHOD: Retrospective analysis of colposcopy clinic data. RESULTS: The dataset included 5,012 episodes from 4,682 women. In Auckland (2013-2017), there was a 38% decrease in colposcopy referrals and 55% decrease in cervical intraepithelial neoplasia grade 2 (CIN2) or worse diagnoses. In Waikato (2011-2017), there was an 8% decrease in referrals and 22% reduction in CIN2 or worse diagnoses. In Canterbury (2011-2017), there was a 24% decrease in referrals and 49% reduction in CIN2 or worse diagnoses. Across all centres, the decrease in cervical intraepithelial neoplasia grade 3 (CIN3) or worse diagnoses was marked and more consistent than in CIN2 diagnoses. However, while the proportion of biopsies reported as CIN3 or worse decreased in non-Maori (24% in 2013 vs 16% in 2017, nptrend z=-4.24, p>|z| <.001), there was no change in Maori women (31% in 2013 vs 29% in 2017, nptrend z=-0.12, p>|z| =.90). CONCLUSIONS: We observed a decreased number of CIN diagnoses in young women over time, with a particularly large drop in the number of CIN3/AIS/CGIN diagnoses. However, compared to non-Maori, Maori women having biopsies are more likely to have CIN3 or worse and there was a smaller reduction in the total number of Maori women diagnosed with CIN2 or worse.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero/epidemiologia , Biópsia , Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia/tendências , Feminino , Humanos , Povos Indígenas , Gradação de Tumores , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Infecções por Papillomavirus/prevenção & controle , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnóstico , Adulto Jovem
4.
Zhonghua Fu Chan Ke Za Zhi ; 55(10): 708-715, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33120484

RESUMO

Objective: Evaluation of the clinical value of the BioPerfectus multiplex real time (BMRT)-HPV for cervical cancer screening. Methods: Physician-collected specimens of 1 495 women who were positive of Cobas 4800 HPV (Cobas-HPV), HPV genotyping based on SEQ uencing (SEQ-HPV), and (or) cytology ≥low grade squamous intraepithelial lesion (LSIL) in the primary screening of Chinese Multiple-center Screening Trial (CHIMUST), and 2 990 women selected from those who were negative of primary screening in the same project through nested control randomization with age-matching were tested for BMRT-HPV, which reported type-specific viral loads/10 000 cells in each specimen. With comparing to Cobas-HPV results and taking cervical histopathological diagnosis as the endpoint, the concordance of high-risk (HR)-HPV subtypes among the three assays was explored ,and the sensitivity and specificity of BMRT-HPV for cervical cancer screening were evaluated. Results: (1) The overall agreenment of HR-HPV subtypes between BMRT-HPV and Cobas-HPV, or SEQ-HPV test sample was 94.8%, 94.4%, with Kappa values 0.827, 0.814. (2) The sensitivity and specificity for cervical intraepithelial neoplasia (CIN) Ⅱ+ of BMRT-HPV, Cobas-HPV and SEQ-HPV were 92.62%, 94.26%, 93.44% and 84.67%, 83.25%, 82.76%, respectively. There were no significant difference in sensitivity among the three HPV assays (all P>0.05), but the specificity of BMRT-HPV for CIN Ⅱ+ was higher than those of Cobas-HPV and SEQ-HPV (P<0.01). The sensitivity for CIN Ⅲ+ of three HPV assays were all 100.00%, and the specificity for CIN Ⅲ+ of BMRT-HPV was higher than those of Cobas-HPV and SEQ-HPV (83.40% vs 81.95%, 83.40% vs 81.50%; P<0.01). The number of pathological examinations of colposcopy for cervical biopsy detected in 1 case of CIN Ⅱ+ or CIN Ⅲ+ in BMRT-HPV was less than those in Cobas-HPV and SEQ-HPV (P<0.01). When using HPV 16/18 + cytology ≥atypical squamous cell of undetermined signification (ASCUS) to triage HPV positive women among three assays, there was no different in the sensitivities of detecting CIN Ⅱ+ and CIN Ⅲ+ (P>0.05). The specificity BMRT-HPV was slightly higher than those in Cobas-HPV or SEQ-HPV (all P<0.05), and the colposcopy referral rate was lower than those in Cobas-HPV and SEQ-HPV (all P<0.05). Conclusions: BMRT-HPV is as sensitive as Cobas-HPV or SEQ-HPV for primary cervical cancer screening, and has higher specificity. Therefore it could be used as a primary screening method for cervical cancer, which is worthy of clinical application.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasia Intraepitelial Cervical/virologia , DNA Viral/análise , DNA Viral/genética , Detecção Precoce de Câncer , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Programas de Rastreamento/métodos , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Valor Preditivo dos Testes , Gravidez , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/métodos
5.
JAMA ; 324(15): 1532-1542, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33079153

RESUMO

Importance: The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse. Objective: To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries. Design, Setting, and Participants: Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening. Exposures: World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics. Main Outcomes and Measures: Self-report of having ever had a screening test for cervical cancer. Results: Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened. Conclusions and Relevance: In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Estudos Transversais , Países em Desenvolvimento , Feminino , Saúde Global , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Autorrelato
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1148-1151, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018190

RESUMO

We apply feature-extraction and machine learning methods to multiple sources of contrast (acetic acid, Lugol's iodine and green light) from the white Pocket Colposcope, a low-cost point of care colposcope for cervical cancer screening. We combine features from the sources of contrast and analyze diagnostic improvements with addition of each contrast. We find that overall AUC increases with additional contrast agents compared to using only one source.


Assuntos
Colposcópios , Neoplasias do Colo do Útero , Colposcopia , Detecção Precoce de Câncer , Feminino , Humanos , Aprendizado de Máquina , Sistemas Automatizados de Assistência Junto ao Leito , Gravidez , Neoplasias do Colo do Útero/diagnóstico
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1944-1949, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018383

RESUMO

Cervical cancer is the fourth most common cancer among women and still one of the major causes of women's death around the world. Early screening of high grade Cervical Intraepithelial Neoplasia (CIN), precursors to cervical cancer, is vital to efforts aimed at improving survival rate and eventually eliminating cervical cancer. Visual Inspection with Acetic acid (VIA) is an assessment method which can inspect the cervix and potentially detect lesions caused by human papillomavirus (HPV), which is a major cause of cervical cancer. VIA has the potential to be an effective screening method in low resource settings when triaged with HPV test, but it has the drawback that it depends on the subjective evaluation of health workers with varying levels of training. A new deep learning algorithm called Automated Visual Evaluation (AVE) for analyzing cervigram images has been recently reported that can automatically detect cervical precancer better than human experts. In this paper, we address the question of whether mobile phone-based cervical cancer screening is feasible. We consider the capabilities of two key components of a mobile phone platform for cervical cancer screening: (1) the core AVE algorithm and (2) an image quality algorithm. We consider both accuracy and speed in our assessment. We show that the core AVE algorithm, by refactoring to a new deep learning detection framework, can run in ~30 seconds on a low-end smartphone (i.e. Samsung J8), with equivalent accuracy. We developed an image quality algorithm that can localize the cervix and assess image quality in ~1 second on a low-end smartphone, achieving an area under the ROC curve (AUC) of 0.95. Field validation of the mobile phone platform for cervical cancer screening is in progress.


Assuntos
Smartphone , Neoplasias do Colo do Útero , Aprendizado Profundo , Detecção Precoce de Câncer , Feminino , Humanos , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/diagnóstico
8.
BMC Med Inform Decis Mak ; 20(1): 211, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887589

RESUMO

BACKGROUND: Most cost-effectiveness analyses in the context of cervical cancer prevention involve the use of mathematical models to simulate HPV infection, cervical disease and prevention strategies. However, it is common for professionals who would need to perform these analyses to not be familiar with the models. This work introduces the Online Cost-Effectiveness ANalysis tool, featuring an easy-to-use web interface providing health professionals, researchers and decision makers involved in cervical cancer prevention programmes with a useful instrument to conduct complex cost-effectiveness analyses, which are becoming an essential tool as an approach for supporting decision-making that involves important trade-offs. RESULTS: The users can run cost-effectiveness evaluations of cervical cancer prevention strategies without deep knowledge of the underlying mathematical model or any programming language, obtaining the most relevant costs and health outcomes in a user-friendly format. The results provided by the tool are consistent with the existing literature. CONCLUSIONS: Having such a tool will be an asset to the cervical cancer prevention community, providing researchers with an easy-to-use instrument to conduct cost-effectiveness analyses.


Assuntos
Técnicas de Apoio para a Decisão , Programas de Rastreamento/métodos , Modelos Teóricos , Infecções por Papillomavirus/economia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/economia , Análise Custo-Benefício , Feminino , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Humanos , Programas de Rastreamento/economia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/economia , Esfregaço Vaginal/métodos
9.
Artigo em Inglês | MEDLINE | ID: mdl-32867315

RESUMO

Background: Cervical cancer is one of the most common cancers in women and about 90% of cervical cancer can be reduced by regular screening. The Pap smear has been well in place as a primary cervical screening method since 1950s; however, coverage is still not optimal. This study explored the feasibility of HPV self-sampling in two under-screened population groups in Hong Kong (HK): never screened and not regularly screened females, to estimate the uptake rate and preference rate in the future. Materials and Methods: This was a cross-sectional study to explore the acceptability and feasibility of HPV self-sampling in two age groups: aged 25-35 and aged ≥45, which were reported as the highest proportion of the under-screened population in HK between 2017 and 2018. The study invited eligible women from an HPV study cohort to perform HPV self-sampling at home by themselves. The number of specimens returned from participants was recorded and used to determine the feasibility of HPV self-sampling in the community. The participants were asked to fill in the questionnaires before and after HPV self-sampling to indicate their attitudes, acceptability, and future preference for HPV self-sampling as an acceptable alternative primary cervical cancer screening method. Results: A total of 177 subjects participated in the present study and have achieved a good overall uptake rate of 73% (129/177) who returned the self-collected cervicovaginal sample for HPV testing. Among the under-screened population, there was a higher response rate in aged ≥45 than those aged 25-35. The findings also revealed that women who were under-screened, including those who have never been screened, were more likely to prefer HPV self-sampling than those who had regular screening. This study found that the acceptability of HPV self-sampling was fairly positive among the respondents. The findings also indicated that HPV self-sampling was not only beneficial to enhance their health awareness but also to promote the cervical cancer screening uptake rate, especially among the under-screened or never screened populations. Conclusions: HPV self-sampling would be a solution to overcome the perceived barriers in clinician-based screening. The findings also indicated that it could be feasible to use as an alternative primary cervical cancer screening.


Assuntos
Programas de Rastreamento/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Grupos Populacionais/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Estudos Transversais , Detecção Precoce de Câncer , Estudos de Viabilidade , Feminino , Hong Kong/epidemiologia , Humanos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Infecções por Papillomavirus/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Preferência do Paciente , Autocuidado , Manejo de Espécimes , Neoplasias do Colo do Útero/etnologia , Esfregaço Vaginal , Saúde da Mulher
12.
PLoS One ; 15(9): e0239611, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997696

RESUMO

BACKGROUND: Sweden revised their cervical cancer screening program in 2017 to include cytology-based screening for women aged 23-29 years and primary human papillomavirus (HPV) testing for women aged 30-64 years; however, alternative strategies may be preferred. To inform cervical cancer prevention policies for unvaccinated women, we evaluated the cost-effectiveness of alternative screening strategies, including the current Swedish guidelines. METHODS: We adapted a mathematical simulation model of HPV and cervical cancer to the Swedish context using primary epidemiologic data. We compared the cost-effectiveness of alternative screening strategies that varied by the age to start screening, the age to switch from cytology to HPV testing, HPV strategies not preceded by cytology, screening frequency, and management of HPV-positive/cytology-negative women. RESULTS: We found that the current Swedish guidelines were more costly and less effective than alternative primary HPV-based strategies. All cost-efficient strategies involved primary HPV testing not preceded by cytology for younger women. Given a cost-effectiveness threshold of €85,619 per quality-adjusted life year gained, the optimal strategy involved 5-yearly primary HPV-based screening for women aged 23-50 years and 10-yearly HPV-based screening for women older than age 50 years. CONCLUSIONS: Primary screening based on HPV alone may be considered for unvaccinated women for those countries with similar HPV burdens.


Assuntos
Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Testes de DNA para Papilomavírus Humano/economia , Neoplasias do Colo do Útero/diagnóstico , Adulto , Detecção Precoce de Câncer/normas , Feminino , Testes de DNA para Papilomavírus Humano/normas , Humanos , Sensibilidade e Especificidade , Suécia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Vacinação/estatística & dados numéricos
13.
BMC Infect Dis ; 20(1): 642, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873233

RESUMO

BACKGROUND: Evidence suggested that vaginal microbiome played a functional role in the progression of cervical lesions in female infected by HPV. This study aimed at evaluating the influence of common vaginal infection on the carcinogenicity of high risk HPV (hr-HPV). METHODS: From January 15, 2017 to December 31, 2017, 310,545 female aged at least 30 years old had been recruited for cervical cancer screening from 9 clinical research centers in Central China. All the recruited participants received hr-HPV genotyping for cervical cancer screening and vaginal microenvironment test by a high vaginal swab. Colposcopy-directed biopsy was recommended for female who were infected with HPV 16 and HPV 18, and other positive hr-HPV types through test had undertaken triage using liquid-based cytology, cases with the results ≥ ASCUS among them were referred to colposcopy directly, and cervical tissues were taken for pathology examination to make clear the presence or absence of other cervical lesions. RESULTS: Among 310,545 female, 6067 (1.95%) were tested with positive HPV 16 and HPV 18, 18,297 (5.89%) were tested with other positive hr-HPV genotypes, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 and invasive cervical cancer (ICC) were detected in 861 cases, 377 cases, 423 cases, and 77 cases, respectively. Candida albicans and Gardnerella were not associated with the detection of cervical lesions. Positive trichomonas vaginitis (TV) was correlated with hr-HPV infection (p < 0.0001). Co-infection with TV increased the risk of CIN 1 among female infected with hr-HPV (OR 1.18, 95% CI: 1.42-2.31). Co-infection with TV increased the risk of CIN 2-3 among female infected with HPV 16 (OR 1.71, 95% CI: 1.16-2.53). CONCLUSIONS: Co-infection of TV and HPV 16 is a significant factor for the detection of cervical lesions.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Coinfecção/complicações , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/complicações , Vaginite por Trichomonas/complicações , Trichomonas vaginalis/isolamento & purificação , Neoplasias do Colo do Útero/epidemiologia , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/virologia , China/epidemiologia , Coinfecção/diagnóstico , Colposcopia , Estudos Transversais , Citodiagnóstico , Detecção Precoce de Câncer/métodos , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Fatores de Risco , Vaginite por Trichomonas/diagnóstico , Vaginite por Trichomonas/parasitologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia
14.
PLoS One ; 15(9): e0238869, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946461

RESUMO

BACKGROUND: Cervical cancer is a malignant tumor of the lower-most part of the uterus and major cause of morbidity and mortality among women's in the world. Its high mortality rate in the globe can be reduced through comprehensive approaches' that include; primary prevention, early diagnosis, effective screening, and treatment packages. This study was aimed to assess the knowledge and practice of cervical cancer screening and its associated factors among reproductive age group women in districts of Gurage zone, Southern Ethiopia, 2019. METHODS: A community-based cross-sectional study design was conducted from March 1-30, 2019. A total of 268 respondents were selected using a systematic sampling technique. Data was collected using pretested, semi-structured, and interviewer-administered questionnaires. Data were entered into Epi data version 3.1software and exported to SPSS 24 for analysis. Bivariate and multivariate analyses with a 95% confidence level was done and variables (P <0.05) were deemed statistically significant. RESULT: A total of 260 respondents participated in the study with a response rate of 97%. About 3.8% of the respondents had experiences cervical cancer screening and 26.2% of respondents had good knowledge. Early age at first sex [AOR = 6.05 (95%CI; 1.167-31.36)], having information about cervical cancer [(AOR = 10.2 (95% CI 1.9-96.4)], and multiple sexual partners [AOR = 3.96 (95% CI; 1.48-10.58)] were factors affecting the practice of cervical cancer screening. Being uneducated [AOR = 15.5 (95%CI; 3.82-62.967)], family history of cervical cancer [AOR = 14.158 (95%CI;3.88-51.7)], having plans to screen for cervical cancer [AOR = 0.352 (95%CI;.175-.710)], menarcheal age [AOR = 2.63 (95%CI;1.28-5.37)] and age at first sex [AOR = 3.17 (95%CI;1.283-7.837)] were factors affecting knowledge of cervical screening. CONCLUSION: The study findings indicate that respondents' practice and knowledge of cervical cancer is mainly affected by early age at first sex, having information about cervical cancer, multiple sexual partners, Educational status, family history of cervical cancer, having plans to screen for cervical cancer, age at first sex and age of menarche. Therefore, all concerned bodies need to focus on women in the reproductive age group to increase the level of knowledge and practice of cervical cancer screening through appropriate interventions.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Detecção Precoce de Câncer/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias do Colo do Útero/diagnóstico , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/psicologia
16.
Value Health ; 23(9): 1246-1255, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940243

RESUMO

OBJECTIVES: Low uptake of cancer screening services is a global concern. Our aim was to understand factors that influence the screening decision, including screening and treatment subsidies and a gain-frame message designed to present screening as a win-win. METHODS: We analyzed preferences for mammography and Pap smear among women in Singapore by means of discrete choice experiments while randomly exposing half of respondents to a gain-framed public health message promoting the benefits of screening. RESULTS: Results showed that the message did not influence stated uptake, and given the levels shown, respondents were influenced more by treatment attributes, including effectiveness and out-of-pocket cost should they test positive, than by screening attributes, including the offer of a monetary incentive for screening. Respondents also underestimated the survival chances of screen-detected breast and cervical cancers. CONCLUSIONS: Combined, these findings suggest that correcting misconceptions about screen-detected cancer prognosis or providing greater financial protection for those who test positive could be more effective and more cost-effective than subsidizing screening directly in increasing screening uptakes.


Assuntos
Detecção Precoce de Câncer/psicologia , Mamografia/psicologia , Programas de Rastreamento/psicologia , Teste de Papanicolaou/psicologia , Adulto , Neoplasias da Mama/diagnóstico , Comportamento de Escolha , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Mamografia/economia , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Teste de Papanicolaou/economia , Singapura , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico
17.
PLoS One ; 15(8): e0237988, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853216

RESUMO

OBJECTIVE: To evaluate the 9-year incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and cumulative adherence to perform a next test in a cohort of women aged 40+ years with no cervical screening cytology within a window of 5 years (underscreened women), after baseline cervical cytology and HPV tests. METHODS: In Catalonia, Spain, co-testing with cytology and HPV test has been recommended in the Public Health system since 2006 for underscreened women. In 2007, 1,594 women with underscreened criteria were identified and followed through medical records form Pathological Department. 9-year cumulative incidence of histologically confirmed CIN2+ and cumulative adherence to perform a next test were estimated using Kaplan-Meier statistics. RESULTS: Follow-up was available for 1,009 women (63.3%) resulting in 23 women with. CIN2+ (2.3%). Of them, 4 women (17%) had both tests negative at baseline (3CIN2 and 1CIN3) with cumulative incidence of CIN2+ of 0.4% (95% CI: 0.1-1.4) at 5-years and 1.3% (95% CI: 0.4-3.7) at 9-years. During the first year, the prevalence among women with both tests positive was 27.0% (95% CI: 13.0-50.6) for CIN2+. Lost to follow-up was higher among women with both tests negative compared to those with both positive tests (38.7% vs 4.2%, p-value <0.001). 40.5% of the women HPV-/cyto- had a re-screening test during the 4 years following the baseline, increasing until 53.5% during the 6 years of follow-up. CONCLUSIONS: HPV detection shows a high longitudinal predictive value at 9-year to identify women at risk to develop CIN2+. The data validate a safe extension of the 3-year screening intervals (current screening interval) to 5-year intervals in underscreened women that had negative HPV result at baseline. It is necessary to establish mechanisms to ensure screening participation and adequate follow-up for these women.


Assuntos
Programas de Rastreamento , Papillomaviridae/isolamento & purificação , Neoplasias do Colo do Útero/virologia , Idoso , Estudos de Coortes , Detecção Precoce de Câncer , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Papillomaviridae/fisiologia , Risco , Fatores de Tempo , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia
18.
PLoS One ; 15(8): e0237911, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822401

RESUMO

Electronic health records (EHRs) contain rich documentation regarding disease symptoms and progression, but EHR data is challenging to use for diagnosis prediction due to its high dimensionality, relative scarcity, and substantial level of noise. We investigated how to best represent EHR data for predicting cervical cancer, a serious disease where early detection is beneficial for the outcome of treatment. A case group of 1321 patients with cervical cancer were matched to ten times as many controls, and for both groups several types of events were extracted from their EHRs. These events included clinical codes, lab results, and contents of free text notes retrieved using a LSTM neural network. Clinical events are described with great variation in EHR texts, leading to a very large feature space. Therefore, an event hierarchy inferred from the textual events was created to represent the clinical texts. Overall, the events extracted from free text notes contributed the most to the final prediction, and the hierarchy of textual events further improved performance. Four classifiers were evaluated for predicting a future cancer diagnosis where Random Forest achieved the best results with an AUC of 0.70 from a year before diagnosis up to 0.97 one day before diagnosis. We conclude that our approach is sound and had excellent discrimination at diagnosis, but only modest discrimination capacity before this point. Since our study objective was earlier disease prediction than such, we propose further work should consider extending patient histories through e.g. the integration of primary health records preceding referral to hospital.


Assuntos
Registros Eletrônicos de Saúde , Aprendizado de Máquina , Neoplasias do Colo do Útero/diagnóstico , Mineração de Dados , Feminino , Humanos , Redes Neurais de Computação , Suécia
19.
Cancer Causes Control ; 31(11): 965-977, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32840707

RESUMO

PURPOSE: Despite widespread promotion of breast and cervical cancer (BCC) screening, uptake remains low in rural communities. Barriers to healthcare, which often result in poorer health outcomes, differentially impact residents of rural communities. Effective interventions addressing the unique needs of rural women may target these barriers and increase BCC screening participation. Our objective is to review and assess the published literature on interventions to increase BCC screening in rural communities. METHODS: A systematic scoping review of PubMed/Medline was performed to identify BCC screening interventions conducted in rural settings. English language articles from peer-reviewed journals published from January 2006 to October 2019 were included if they reported results for BCC screening interventions in rural communities in the United States. RESULTS: We reviewed 228 articles and identified eight articles consistent with our inclusion criteria. Studies varied in sample population characteristics, geographic location, design, and mode of intervention delivery. Interventions included patient navigation strategies, educational outreach programs, peer counseling, and small media initiatives. Interventions focused on promoting uptake of initial or one-time screening rather than targeted repeat screening, and few studies detailed the cost-effectiveness of the interventions. CONCLUSION: This review may inform efforts to develop strategies to increase BCC screening among rural women. Additional cancer prevention and control research gaps in rural communities include the examination of the theoretical foundations, design, delivery, and cost-effectiveness of BCC screening interventions for rural communities. Future research might focus on methods to promote repeat BCC screening and effective translation of these interventions for other rural populations.


Assuntos
Neoplasias da Mama/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias da Mama/prevenção & controle , Assistência à Saúde , Detecção Precoce de Câncer , Feminino , Humanos , Navegação de Pacientes , População Rural , Estados Unidos , Neoplasias do Colo do Útero/epidemiologia
20.
Ginekol Pol ; 91(7): 428-431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32779165

RESUMO

The Polish Society of Gynecologists and Obstetricians and Polish Society of Colposcopy and Cervical Pathophysiology Interim Guidelines goal at aiding gynecologists in providing a cervical cancer prevention care during the evolving SARS-CoV-2 pan-demic. Presented guidelines were developed on a review of limited data and updated when new relevant publications were revealed. Timing for deferrals of diagnostic-therapeutic procedures were mostly covered in the guidelines. Also, a support for the existing Polish recommendations on abnormal screening results in a subject of minor and major screening abnor-malities terminology were given. The guidelines are obligatory for the specified COVID-19 pandemic period only and they might be changed depending on the new available evidence.


Assuntos
Neoplasia Intraepitelial Cervical , Colo do Útero/patologia , Colposcopia , Infecções por Coronavirus , Detecção Precoce de Câncer , Pandemias , Pneumonia Viral , Neoplasias do Colo do Útero , Betacoronavirus , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/patologia , Colposcopia/métodos , Colposcopia/normas , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Diagnóstico Diferencial , Detecção Precoce de Câncer/normas , Feminino , Humanos , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Polônia/epidemiologia , Prevenção Secundária/métodos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle
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