High-risk HPV is found in 99.7% of cervical cancers. The causative role of <span><span><span><span>HPV in cervical cancer has led to the inclusion of HPV testing as part of cervica</span>...High-risk HPV is found in 99.7% of cervical cancers. The causative role of <span><span><span><span>HPV in cervical cancer has led to the inclusion of HPV testing as part of cervica</span></span></span></span><span><span><span><span style="font-family:;" "=""><span>l screening. A pilot of HPV testing as primary screening was commenced in 2013 at six pilot sites in England. North Cumbria Integrated Care (NCIC) NHS Foundation Trust took part in the pilot, in which women with an HPV-</span><span>positive/cytology-negative result were recalled at 12 months. Women with HPV </span><span>ty</span><span>pe 16/18 found at initial screening and persisting at 12 months in spite of negative cytology were referred to Colposcopy services at 12 months. Women</span><span> with smear positive for hrHPV other than 16/18 types were recalled twice at 12 and 24 months before referral to colposcopy. Persistent hrHPV positive/cytology </span><span>negative smear at 12 and 24 months initiated a colposcopy referral. </span><b><span>Objective: </span></b><span>To assess the prevalence of high grade CIN and invasive cancer in patients referred to colposcopy services at NCIC NHS Foundation Trust with hrHPV </span><span><span>positive/cytology negative smears. </span><b><span>Method: </span></b><span>The study was conducted at NCIC</span></span><span> NHS Foundation Trust between January 2015 and December 2017. Data was collected retrospectively from the colposcopy data base (INFOFLEX). All patients with HPV positive/cytology negative smears seen in colposcopy clinic during the study period were included. Patients with high grade CIN, cervical glandular intraepithelial neoplasia (CGIN) or invasive cancer were recorded. </span><b><span>Results: </span></b><span>763 women were included in the study. A total of 50 (6.6%) women had high grade CIN, CGIN or invasive cancer. 40 of these 50 women (80%) </span><span><span>were treated by large loop excision of the transformation zone (LLETZ). </span><b><span>Conclusi</span></b></span><b><span>on: </span></b><span>HPV primary screening is more effective than cytology-based screening.</span><span> A high grade HPV positive result with negative cytology, persisting for one year in type 16/18 and for two years in other high-risk HPV types, warrants referral for colposcopy, as 6.6% of women in this study had high grade or invasive pathology.展开更多
Cervical cancer remains a major public health problem accounting for continuous female death in developing countries.Cervical cancer is the second most common cancer in women globally with an estimated number of 500,0...Cervical cancer remains a major public health problem accounting for continuous female death in developing countries.Cervical cancer is the second most common cancer in women globally with an estimated number of 500,000 new cases of cervical cancer and 273,000 mortalities annually.Cervical screening is the best cancer screening test in the history of medicine and most cost-effective of all medical screening tests.The study review aimed to highlight methods of cervical cancer prevention,identify the uptake of cervical screening among women,and explain the role of nurses in uptake of cervical screening.Cervical cancer is preventable and easily treatable if it is detected at early stages,but poor information on prevention and access to screening and treatment contributes to 90%of deaths.In the developing countries such as Nigeria,a large proportion of cervical cancers are diagnosed in advanced stages,with poor rates of survival.The three main methods for preventing cervical cancer are through primary prevention(human papillomavirus vaccination and health education),secondary prevention(cervical screening,early detection of precancerous lesions,and treatment),and tertiary prevention(measures to slow the progression or recurrence,surgical removal,radiotherapy,and chemotherapy).Nurses can help improve the acceptability of this neglected promise by focusing on health education on cervical screening and vaccination in prenatal clinics and infant welfare clinics where there are more women.Inclusion of cyberspace could also serve as a successful and popular platform for this health teaching.All nurses/midwives must preach and fervently work toward the WHO 90–70–90 plan for eradicating cervical cancer.展开更多
Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rat...Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rates,CIN2+detection,colposcopy follow-up,and CIN2+management.Methods:A multi-county pre-post observational study was conducted in six rural counties in Shanxi,Yunnan,and Sichuan Provinces(2021±2024),encompassing 153,978 encounters.The digital platform integrates OCR identity capture,deterministic One-ID linkage,and real-time duplicate alerts.Over-screening proportions before and after digital deployment were compared,changes in CIN2+detection rate were evaluated,and colposcopy follow-up and CIN2+management were assessed.Differences were tested withχ2 or Fisher's exact tests.Results:Among 153,978 encounters,the proportion of over-screening decreased from 12.64%in 2023 to 0.17%in 2024 with an absolute reduction of 12.17%(95%CI:11.94±12.40;P<0.001).The share of women receiving a first screening within the preceding 3 y increased from 78.3%to 88.2%(P<0.001).Colposcopy completion improved from 64.1%to 84.9%.The CIN2+detection rate rose from 0.35%(2021±2023 pooled)to 0.67%in 2024(P<0.001)and CIN2+management completion increased from 56.0%to 76.2%(95%CI:13.3±27.2;P<0.001).These improvements were consistent across age groups,counties,and screening strategies.Conclusions:The OCR-enabled One-ID platform substantially reduced over-screening,increased CIN2+detection rate,and strengthened case follow-up/management,particularly where baseline tracking was weak,supporting scalable digital reinforcement of rural screening programmes.展开更多
Cervical cancer is a severe threat to women’s health.The majority of cervical cancer cases occur in developing countries.The WHO has proposed screening 70%of women with high-performance tests between 35 and 45 years ...Cervical cancer is a severe threat to women’s health.The majority of cervical cancer cases occur in developing countries.The WHO has proposed screening 70%of women with high-performance tests between 35 and 45 years of age by 2030 to accelerate the elimination of cervical cancer.Due to an inadequate health infrastructure and organized screening strategy,most low-and middle-income countries are still far from achieving this goal.As part of the efforts to increase performance of cervical cancer screening,it is necessary to investigate the most accurate,efficient,and effective methods and strategies.Artificial intelligence(AI)is rapidly expanding its application in cancer screening and diagnosis and deep learning algorithms have offered human-like interpretation capabilities on various medical images.AI will soon have a more significant role in improving the implementation of cervical cancer screening,management,and follow-up.This review aims to report the state of AI with respect to cervical cancer screening.We discuss the primary AI applications and development of AI technology for image recognition applied to detection of abnormal cytology and cervical neoplastic diseases,as well as the challenges that we anticipate in the future.展开更多
BACKGROUND Cervical cancer is the second leading cause of death in women worldwide,second only to breast cancer.Around 80%of women have been infected with human papillomavirus(HPV)in their lifetime.Early screening and...BACKGROUND Cervical cancer is the second leading cause of death in women worldwide,second only to breast cancer.Around 80%of women have been infected with human papillomavirus(HPV)in their lifetime.Early screening and treatment are effective means of preventing cervical cancer,but due to economic reasons,many parts of the world do not have free screening programs to protect women’s health.AIM To increase HPV cervical cancer screening in Changsha and reduce the incidence of cervical cancer.METHODS Cervical cancer screening included gynecological examination,vaginal secretion examination and HPV high-risk typing testing.Cervical cytology examination(ThinPrep cytology test)was performed for individuals who test positive for HPV types other than 16 and 18.Vaginal colposcopy examination was performed for HPV16 and 18 positive individuals,as well as for those who were positive for ThinPrep cytology test.If the results of vaginal colposcopy examination were abnormal,histopathological examination was performed.We conducted a cost-benefit analysis after 4 years.RESULTS From 2019 to 2022,523437 women aged 35-64 years in Changsha city were screened and 73313 were positive,with a 14%positive rate.The detection rate of precancerous lesions of cervical cancer was 0.6%and the detection rate of cervical cancer was 0.037%.Among 311212 patients who underwent two cancers examinations,the incidence rate was reduced by more than half in the second examination.The average screening cost per woman was 120 RMB.The average cost of detecting early cases was 10619 RMB,with an early detection cost coefficient of 0.083.CONCLUSION Our screening strategy was effective and cost-effective,making it valuable for early diagnosis and treatment of cervical cancer.It is worth promoting in economically limited areas.展开更多
Objective:We investigated the relation between man papillomavirus(HPV)integration status and the immediate risk of cervical intraepithelial neoplasia(CIN),as well as the triage strategy based on HPV integration test.M...Objective:We investigated the relation between man papillomavirus(HPV)integration status and the immediate risk of cervical intraepithelial neoplasia(CIN),as well as the triage strategy based on HPV integration test.Methods:4086 women aged 20 to 65 years in China were enrolled in 2015 for a prospective,population-based,clinical observational study to evaluate the triage performance of HPV integration.Cervical exfoliated cells were collected for HPV testing and cytologic test.If high-risk HPV was positive,HPV integration test was performed at baseline,2-year and 5-year follow-up.Results:At baseline,HPV integration was positively correlated with the severity of cervical pathology,ranging from 5.0%(15/301)in normal diagnosis,6.9%(4/58)in CIN1,31.0%(9/29)in CIN2,70%(14/20)in CIN3,and 100%(2/2)in cervical cancer(P<0.001).Compared with cytology,HPV integration exhibits comparable sensitivity and negative predictive value for the diagnosis of CIN3+,higher specificity(92.8%[90.2%-95.4%]vs.75.5%[71.2%-79.8%],P<0.001)and higher positive predictive value(36.4%[22.1%-50.6%]vs.15.2%[8.5%-21.8%],P<0.001).HPV integration testing strategy yielded a significantly lower colposcopy referral rate than cytology strategy(10.7%[44/410]vs.27.3%[112/410],P<0.001).The HPV integration-negative group exhibited the lowest immediate risk for CIN3+(1.6%)and accounted for the largest proportion of the total population(89.3%),when compared with the normal cytology group(risk,1.7%;proportion,72.7%).Conclusion:As a key molecular basis for the development of cervical cancer,HPV integration might be a promising triage strategy for HPV-positive patients.展开更多
Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introdu...Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.展开更多
Objective:To study the screening for cervical cancer in postmenopausal women in liquid-based cell test(TCT)application value.Methods:From January 2023 to March 2024 hospital check-ups and outpatient reached 400 cases ...Objective:To study the screening for cervical cancer in postmenopausal women in liquid-based cell test(TCT)application value.Methods:From January 2023 to March 2024 hospital check-ups and outpatient reached 400 cases of postmenopausal women,and they were TCT and HPV detection,during the study period to pathological diagnosis of numerical results as the standard,analysis of TCT detection application of screening for cervical cancer in postmenopausal women and the effect.Results:After the TCT detection,the inflammation group and normal group by use of HPV testing positive rate higher than other groups(P<0.05).Hospital after pathological diagnosis and research,after the screening system found CINⅠlevel and above cases about 39 cases,the TCT and HPV detection rate of positive difference is not obvious,and there is no statistical significance(P>0.05).Joint test analysis,the sensitivity and specificity were higher than that of TCT and HPV testing positive(P<0.05).Conclusion:TCT detection screening for cervical cancer in postmenopausal women is of great importance to the application,if you can join HPV testing,help to improve the detection sensitivity,avoid missed diagnosis of problems,and then for treatment and later restore to lay a solid foundation.展开更多
Objectives:The objective of our study is to examine cervical length measurements,identification of short cervix,vaginal progesterone use,and rate of spontaneous preterm delivery before and after departmental transitio...Objectives:The objective of our study is to examine cervical length measurements,identification of short cervix,vaginal progesterone use,and rate of spontaneous preterm delivery before and after departmental transition to a universal transvaginal ultrasound screening protocol from a universal transabdominal screening protocol.Methods:This is a retrospective observational pre-post study examining the year prior to and year following a transition to a universal transvaginal ultrasound screening protocol to assess cervical length at the time of the anatomy survey.Prior to this transition,universal transabdominal cervical length screening was performed,with reflex transvaginal ultrasound measurement if transabdominal measurement was<35 mm or was unable to be obtained.Results:A total of 1760 charts were reviewed;962 charts were from the pre-transition/transabdominal year and 798 charts were from the post-transition/transvaginal year.In the post-transition/transvaginal year,cervical length less than 20 mm was identified in 1.5%of cases,compared to 0.7%of cases in the pretransition/transabdominal year(p=0.114).There was no difference in the rate of spontaneous preterm delivery between the two groups(5.1%in the pre-transition/transabdominal year vs.6.9%in the post-transition/transvaginal year;p=0.111).Conclusions:In this pre-post study,introduction of a universal transvaginal cervical length screening did not decrease spontaneous preterm delivery rates or detection of short cervix<20 mm,compared to a protocol of universal transabdominal cervical length screening with reflex to transvaginal for measurement<35 mm.展开更多
In May 2018,the Director-General of the World Health Organization(WHO)called for global action to eliminate cervical cancer~1.This call marked the beginning of an ambitious international effort to scale up 3 key strat...In May 2018,the Director-General of the World Health Organization(WHO)called for global action to eliminate cervical cancer~1.This call marked the beginning of an ambitious international effort to scale up 3 key strategies:human papillomavirus(HPV)vaccination,cervical cancer screening,and treatment of precancerous lesions and cancer.Subsequently,the WHO and its partners developed a global strategy to accelerate the reduction of cervical cancer incidence,with an ultimate goal of achieving elimination within the next century.This Global Strategy represents a formal international commitment and is anchored in the 90-70-90 targets to be achieved by 2030.In parallel,several countries have also set national commitments,such as Sweden's pledge to achieve elimination by 2027 and Australia's target of achieving elimination by 2035.展开更多
Purpose: There is a significant rise in mortality rates from breast and cervical cancers in Low- and Middle-Income Countries. In Ghana, approximately 4482 women are diagnosed with these diseases at advanced stages. Un...Purpose: There is a significant rise in mortality rates from breast and cervical cancers in Low- and Middle-Income Countries. In Ghana, approximately 4482 women are diagnosed with these diseases at advanced stages. Unfortunately, the early detection rate for these cancers is low compared to other women’s health services. This situation underscores the need to identify the locations of reproductive-age women who have not been screened for these cancers, to implement targeted public health interventions. This study aims to pinpoint these women’s locations for tailored interventions. Method: Bivariate analysis assessed the relationship between the independent and outcome variables. Hot spot analysis and Kriging Ordinary interpolation were employed to pinpoint the locations of these women. Results: Breast cancer examination and cervical cancer test rates were low, with a strong association between the two screening services. Several significant variables were identified: place of residence (p Conclusion: Low participation in these screening services was related to women’s age and the outreach efforts of fieldworkers. Breast and cervical cancer screenings are interconnected and could be combined to improve attendance rates. The Community-based Health Planning and Services (CHPS) implementation strategy could be cost-effective for screening women through targeted interventions, especially in identified clusters.展开更多
Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other h...Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other high-risk HPV(OHR-HPV)positive Thinprep cytologic test(TCT)atypical squamous cells of undetermined significance(ASCUS)/lower-grade squamous intraepithelial lesion(LSIL)women.We evaluated the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the triage test.Results:The sensitivity,specificity,PPV and NPV of p16/Ki-67 dual stain in HPV 16/18-positive women were91.5%/68.4%,77.0%/75.0%,73.9%/59.1%and 92.8%/81.8%.In 12 OHR-HPV positive TCT ASCUS/LSIL women,the results were 79.1%/95.0%,88.5%/66.7%,88.5%/70.4%and 89.2%/94.1%.The risk of precancerous lesions in p16/Ki-67 dual stain positive cases was much higher than before,and the negative cases had lower risk.Besides,there was no cervical intraepithelial neoplasia(CIN)III case missed after triaged by p16/Ki-67 dual-stained cytology.In p16/Ki-67 dual-stained cytology positive women with benign pathology or CIN I,the 1-year progression rate is 20.5%and in p16/Ki-67 dual-stained cytology negative women,the 1-year progression rate is5.6%.Conclusions:hr-HPV genotyping test plays an important role in cervical cancer screening.p16/Ki-67 dual stain may be a promising triage test.As for chronic cervicitis or CIN I patients,a positive p16/Ki-67 dual-stained cytology suggests a high risk in progression and need to be followed up closely.展开更多
Objective:We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus(hrHPV)-positive women in primary healthcare settings in China.Methods:This study was undertaken in 11 ...Objective:We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus(hrHPV)-positive women in primary healthcare settings in China.Methods:This study was undertaken in 11 rural and 9 urban sites.Women aged 35-64 years old were enrolled.HrHPV-positive women were randomly allocated to liquid-based cytology(LBC),visual inspection with acetic acid and Lugol’s iodine(VIA/VILI)(rural only)triage,or directly referred to colposcopy(direct COLP).At 24 months,hrHPV testing,LBC and VIA/VILI were conducted for combined screening.Results:In rural sites,1,949 hrHPV-positive women were analyzed.A total of 852,218 and 480 women were randomly assigned to direct COLP,LBC and VIA/VILI.At baseline,colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%-80%.LBC(n=3 and n=7)or VIA/VILI(n=8 and n=26)could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia(CIN)2 or worse and CIN3+compared with direct COLP(n=14 and n=23).For the 24-month cumulative detection rate of CIN2+,VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP.When stratified by age,baseline LBC triage+performed best(P<0.001),peaking among women aged 35-44 years(Ptrend=0.002).In urban sites,1,728 women were hrHPV genotyping test positive.A total of 408,571 and 568women were randomly assigned to direct COLP for HPV16/18+,direct COLP for other hrHPV subtypes+,and LBC triage for other hrHPV subtypes+.LBC(n=12 and n=31)significantly decreased the number of colposcopies needed to detect one CIN2+and CIN3+compared with direct COLP(n=14 and n=44).HPV16/18+increased the 24-month cumulative detection rate of CIN2+(17.89%,P<0.001).Conclusions:LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+women and LBC triage for other hrHPV subtype+women in urban settings might be feasible strategies.展开更多
This study compared HPV testing and liquid-based cytology （LCT） as performance indicators for cervical cancer screening in a hospital-based study. A total of 61,193 outpatients were screened initially by LCT. Sample...This study compared HPV testing and liquid-based cytology （LCT） as performance indicators for cervical cancer screening in a hospital-based study. A total of 61,193 outpatients were screened initially by LCT. Samples with screening results showing atypical squamous cells of undetermined significance （ASC-US） or worse were referred for colposcopy, and some samples were tested for high-risk HPV types with the Hybrid Capture II system （HC II）. Data on LCT （n=61,193） and HC II （n=1056） results were analysed. Overall test positivity for LCT was 2.53% using an ASC-US threshold, 3.11% using a low-grade squamous intraepithelial lesion （LSIL） threshold, and 0.67% using a high-grade squamous intraepithelial lesion （HSIL） threshold. A total of 1839 women （84% of the 3893 patients with abnormal cytology） underwent colposcopy-directed biopsy. HPV was positive in 80.3% of women with cervical intraepithelial neoplasia 1 （CIN1）, 88.3% of those with CIN2, 79.2% of women with CIN3 and 50% （2 of 4） of women with invasive cancer. There was a significant increase in the detection of CIN2 or worse with adjunct HPV testing of women with ASC-US and LSIL However, there were detection of CIN2＋ cases no differences in the with adjunct HPV testing of women with HSlI.. The results indicate that HPV testing for HSlL triage should not be recommended in cervical cancer screening.展开更多
There is a higher Human Papilloma Virus peak prevalence in younger women (18 - 25 years) of university age. The undergraduate university students are more at a risk of acquiring cervical cancer because they are at the...There is a higher Human Papilloma Virus peak prevalence in younger women (18 - 25 years) of university age. The undergraduate university students are more at a risk of acquiring cervical cancer because they are at the stage of exploring which predisposes them to risky behavior like early sexual intercourse and multiple sexual partners among others. This creates a need for cervical cancer screening in the population. The facilitators and barriers to cervical cancer screening have been studied in the Ugandan general population but little is known among University students which this study is taking interest. <strong>Objective: </strong>This study is aimed at determining the facilitators, barriers and background factors associated to cervical cancer screening among female undergraduate students in Makerere University. <strong>Methods: </strong>Four hundred twenty-two (422) female undergraduate students of Makerere University who fit the eligibility criteria were recruited in this descriptive cross-sectional quantitative study. A self-administered semi structured questionnaire was administered to these participants chosen by convenient sampling. Data collected was analyzed using SPSS version 23 software and logistic regression models was used. <strong>Results:</strong> Less than a half of (21.1%) of the participants had ever screened for cervical cancer. At multivariate analysis, only year of study and married status were associated to cervical cancer screening with a P-values were of (0.015) and (0.001) with a (1.173 - 4.261) and (1.594 - 6.130) 95% CI respectively. The facilitators agreed upon by participants included: Access to free cervical cancer screening services, adequate knowledge about cervical cancer screening and advice from a friend, family or physician among others. The reported barriers to screening were fear of bad result, low risk perception and fear of embarrassment among others. <strong>Conclusions and Recommendations: </strong>Among the female undergraduate students of Makerere University, only 21.1% had screened for cervical cancer. Therefore, there is a critical need for university based cancer education campaign on cervical cancer and the benefits of screening. Screening services should be integrated into the existing university medical services.展开更多
Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised q...Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.展开更多
The purpose of this research is to implement an IT-based education program in order to promote cervical cancer screenings for women aged 20 - 29 years, as well as to examine the results of said program. This is a long...The purpose of this research is to implement an IT-based education program in order to promote cervical cancer screenings for women aged 20 - 29 years, as well as to examine the results of said program. This is a longitudinal/comparative study of two groups, one for which the program was implemented (the intervention group), and the other for which it was not (the control group). The program consisted of attending a health lecture and encouragement to be screened one month, six months, and one year later sent through IT-based methods. The target was unmarried women aged 20 - 29 who had neither previously given birth nor had been screened for cervical cancer in a period one year prior. They were divided into two groups, the intervention group (n = 142) and control group (n = 145). The effectiveness of the program was assessed via an initial survey and further surveys six months and one year later. Results were based on the Japanese version of the Health Belief Model Scale for Cervical Cancer and the Pap Smear Test (HBMSCCPST), knowledge scores in the categories of Healthy Lifestyles, Cervical Cancer, Cervical Cancer Screening, and screening behavior. A two-way ANOVA of the HBMSCCPST subscales and knowledge scores in the initial, six-month, and one-year surveys was performed, showing interaction in Cervical Cancer (p = 0.00). Main effects were observed in Cervical Cancer Screening (p = 0.00) and Healthy Lifestyles (p = 0.00). Regarding the amount of change from the initial survey, knowledge scores in the Cervical Cancer (p = 0.027) and Cervical Cancer Screening (p = 0.016) categories were significantly higher in the intervention group than in the control group. There was no significant difference in cervical cancer screening rates (p = 0.26) between the two groups. However, a small-degree effect size was observed for Benefits, Seriousness, and Susceptibility subscales in both examinees and non-examinees. Although the educational program of this study was effective in improving the knowledge of women in their twenties, there was little improvement in HBMSCCPST and it did not lead to the promotion of cervical cancer screening. In order to raise interest in cervical cancer screening, it is necessary to consider useful content to guide women to consult with healthcare professionals, a long-term population approach, and organizational structure of consultation.展开更多
Background: Cervical cancer is the second common cancer among women worldwide. It is a preventable cancer, and early detection of precancerous conditions through the Papanicolaou cytology screening (Pap smear) is a ke...Background: Cervical cancer is the second common cancer among women worldwide. It is a preventable cancer, and early detection of precancerous conditions through the Papanicolaou cytology screening (Pap smear) is a key aspect of prevention;it is accepted worldwide as an efficient tool for secondary prevention. While the PS test is simple, inexpensive, and relatively reliable as a method of diagnosing cervical cancer, most women do not take the test. Therefore, this study is sought to describe the barriers to pap smear uptake among Sudanese women. Materials and Method: This total coverage observational, analytical and cross sectional, hospital-based study was conducted in Saad Abu El Ella Hospital in April 2022. The study was conducted using an anonymous questionnaire to assess the perceived barriers of 93 participants. All data were computerized using Microsoft Excel’17 and the data were described and analyzed using statistical package for social science (SPSS23). Results: The findings revealed that the mean age of the participants was 39.5 years and only 3.2% had ever undergone a pap smear test. Identified barriers were lack of information, not knowing where to go, and fear of pain. The majority, 72% are willing to routinely perform a pap smear test if well informed about it. The study also demonstrates that there is a significant correlation between perceived barriers score and willingness to perform the pap smear test (p value = 0.008), and between the perceived barriers score and the sociodemographic factors: Age (p value = 0.006), educational level (p value = 0.028) and occupation (p value = 0.040), but no association with the economic status was found (p value = 0.378). Conclusion: The detection rate is too low compared to the national target of over 70%. Therefore, more work is needed to reduce perceived barriers to cervical cancer screening by providing education/raising for popular awareness;addressing misconceptions and false beliefs;informing women about the necessity and importance of Pap smear;and health promotion using mass media such as national television, social media, radio, billboards, and newspapers and other print media.展开更多
The aim of this study is to investigate cyclin E, pl6ink4a and ki67 as possible diagnostic biomarkers for cervical preneoplasia using cervical exfoliated-cell specimens, and evaluate the significance for screening pat...The aim of this study is to investigate cyclin E, pl6ink4a and ki67 as possible diagnostic biomarkers for cervical preneoplasia using cervical exfoliated-cell specimens, and evaluate the significance for screening patients at high risk of de- veloping cervical carcinoma. The expression of cyclin E, p16ink4a and ki67 was examinated in 78 cervical exfoliated epithe- lial specimens diagnosed as atypical squamous cells of undetermined significance (ASCIIS) (12 cases), cervical intraepithe- lial neoplasia (CIN) of type 1 (17 cases), CIN2-3(38 cases) and invasive carcinoma (11 cases) using immunohistochemical analysis, and simultaneously, the DNA status of human papillomavirus (HPV) type 16/18 was detected by polymerase chain reaction (PCR) using type specific primers, cyclin E, pl6ink4a and ki67 were all overexpressed in CINs and invasive carci- noma, compared with little expression in ASCUS ( P < 0.005). Overexpression of cyclin E was observed in CIN1 (94.1 % , x2 = 21.16, P < 0.01), and pl6ink4a and ki67 were overexpressed in invasive carcinoma (100% and 90.9% respective- ly) . The degree of pl6ink4a and ki67 expression correlated well with that of epithelial lesions ( P < 0.005). HPV16/18 infec- tion was assessed in CINs and invasive carcinoma samples, and revealed a significant relationship with the degree of cervical epithelial lession. The expression level of pl6ink4a and ki67 seemed more closely associated with HPV16 infection than that of cyclin E ( r s = 1.0 vs rs = 0 . 4 ) . Only 1 case in CIN, and 4 cases in CIN2-3 of HPV18 positive samples were detected. Therefore no statistical significance was found by statistical analysis. Overexpression of cyclin E, p16ink4a and ki67 in CINs and invasive carcinoma cells demonstrates the potential use of cyclin E, p16ink4a and ki67 as diagnostic biomarkers for HPV-related cervical neoplastic lesions. In addition, this technique can be used for screening patients at high risk of devel- oping cervical carcinoma.展开更多
Objectives: To explore attitudes to cervical cancer screening and sexual behaviour among human papillomavirus (HPV)-vaccinated young women in southern Sweden. Methods: Sixteen women aged 17-26 years who had received t...Objectives: To explore attitudes to cervical cancer screening and sexual behaviour among human papillomavirus (HPV)-vaccinated young women in southern Sweden. Methods: Sixteen women aged 17-26 years who had received the HPV vaccine were submitted to an individual semi-structured interview. Interviews were recorded and transcribed verbatim. The data were analysed qualitatively by means of latent content analysis. Results: The interviewees had a poor understanding of cervical cancer screening. After it was explained to them, they stated that they were willing to participate in the screening. The young women thought their future sexual behaviour would not be affected by the vaccination. They considered themselves to be more aware of it and less likely to engage in risky behaviour than their peers. They knew little about the relation among HPV, sexual transmission and cervical cancer, and they expressed a desire for more information. Conclusions: These young women who recently had been administered HPV vaccine had a limited understanding of the importance of participating in future cervical cancer screening. It is necessary that more and more appropriate information of cervical cancer screening be given on the occasion of the HPV vaccination.展开更多
文摘High-risk HPV is found in 99.7% of cervical cancers. The causative role of <span><span><span><span>HPV in cervical cancer has led to the inclusion of HPV testing as part of cervica</span></span></span></span><span><span><span><span style="font-family:;" "=""><span>l screening. A pilot of HPV testing as primary screening was commenced in 2013 at six pilot sites in England. North Cumbria Integrated Care (NCIC) NHS Foundation Trust took part in the pilot, in which women with an HPV-</span><span>positive/cytology-negative result were recalled at 12 months. Women with HPV </span><span>ty</span><span>pe 16/18 found at initial screening and persisting at 12 months in spite of negative cytology were referred to Colposcopy services at 12 months. Women</span><span> with smear positive for hrHPV other than 16/18 types were recalled twice at 12 and 24 months before referral to colposcopy. Persistent hrHPV positive/cytology </span><span>negative smear at 12 and 24 months initiated a colposcopy referral. </span><b><span>Objective: </span></b><span>To assess the prevalence of high grade CIN and invasive cancer in patients referred to colposcopy services at NCIC NHS Foundation Trust with hrHPV </span><span><span>positive/cytology negative smears. </span><b><span>Method: </span></b><span>The study was conducted at NCIC</span></span><span> NHS Foundation Trust between January 2015 and December 2017. Data was collected retrospectively from the colposcopy data base (INFOFLEX). All patients with HPV positive/cytology negative smears seen in colposcopy clinic during the study period were included. Patients with high grade CIN, cervical glandular intraepithelial neoplasia (CGIN) or invasive cancer were recorded. </span><b><span>Results: </span></b><span>763 women were included in the study. A total of 50 (6.6%) women had high grade CIN, CGIN or invasive cancer. 40 of these 50 women (80%) </span><span><span>were treated by large loop excision of the transformation zone (LLETZ). </span><b><span>Conclusi</span></b></span><b><span>on: </span></b><span>HPV primary screening is more effective than cytology-based screening.</span><span> A high grade HPV positive result with negative cytology, persisting for one year in type 16/18 and for two years in other high-risk HPV types, warrants referral for colposcopy, as 6.6% of women in this study had high grade or invasive pathology.
文摘Cervical cancer remains a major public health problem accounting for continuous female death in developing countries.Cervical cancer is the second most common cancer in women globally with an estimated number of 500,000 new cases of cervical cancer and 273,000 mortalities annually.Cervical screening is the best cancer screening test in the history of medicine and most cost-effective of all medical screening tests.The study review aimed to highlight methods of cervical cancer prevention,identify the uptake of cervical screening among women,and explain the role of nurses in uptake of cervical screening.Cervical cancer is preventable and easily treatable if it is detected at early stages,but poor information on prevention and access to screening and treatment contributes to 90%of deaths.In the developing countries such as Nigeria,a large proportion of cervical cancers are diagnosed in advanced stages,with poor rates of survival.The three main methods for preventing cervical cancer are through primary prevention(human papillomavirus vaccination and health education),secondary prevention(cervical screening,early detection of precancerous lesions,and treatment),and tertiary prevention(measures to slow the progression or recurrence,surgical removal,radiotherapy,and chemotherapy).Nurses can help improve the acceptability of this neglected promise by focusing on health education on cervical screening and vaccination in prenatal clinics and infant welfare clinics where there are more women.Inclusion of cyberspace could also serve as a successful and popular platform for this health teaching.All nurses/midwives must preach and fervently work toward the WHO 90–70–90 plan for eradicating cervical cancer.
基金supported by the Chongqing Tencent Sustainable Development Foundation through the project"Comprehensive Prevention and Control Demonstration Project for Eliminating Cervical Cancer and Breast Cancer in Low Health Resource Areas of China"(Project No.SD20240904145730)by the Tencent Sustainable Social Value(SSV)Inclusive Health Lab(Project No.SSVPJ202307060001)。
文摘Objective:To describe temporal changes associated with deployment of an optical character recognition(OCR)-enabled OneIdentity(One-ID)digital platform for rural cervical cancer screening,focusing on over-screening rates,CIN2+detection,colposcopy follow-up,and CIN2+management.Methods:A multi-county pre-post observational study was conducted in six rural counties in Shanxi,Yunnan,and Sichuan Provinces(2021±2024),encompassing 153,978 encounters.The digital platform integrates OCR identity capture,deterministic One-ID linkage,and real-time duplicate alerts.Over-screening proportions before and after digital deployment were compared,changes in CIN2+detection rate were evaluated,and colposcopy follow-up and CIN2+management were assessed.Differences were tested withχ2 or Fisher's exact tests.Results:Among 153,978 encounters,the proportion of over-screening decreased from 12.64%in 2023 to 0.17%in 2024 with an absolute reduction of 12.17%(95%CI:11.94±12.40;P<0.001).The share of women receiving a first screening within the preceding 3 y increased from 78.3%to 88.2%(P<0.001).Colposcopy completion improved from 64.1%to 84.9%.The CIN2+detection rate rose from 0.35%(2021±2023 pooled)to 0.67%in 2024(P<0.001)and CIN2+management completion increased from 56.0%to 76.2%(95%CI:13.3±27.2;P<0.001).These improvements were consistent across age groups,counties,and screening strategies.Conclusions:The OCR-enabled One-ID platform substantially reduced over-screening,increased CIN2+detection rate,and strengthened case follow-up/management,particularly where baseline tracking was weak,supporting scalable digital reinforcement of rural screening programmes.
基金supported by grants from CAMS Innovation Fund for Medical Sciences(Grant No.CAMS 2021-I2M-1-004)from the Bill&Melinda Gates Foundation(Grant No.INV-031449).
文摘Cervical cancer is a severe threat to women’s health.The majority of cervical cancer cases occur in developing countries.The WHO has proposed screening 70%of women with high-performance tests between 35 and 45 years of age by 2030 to accelerate the elimination of cervical cancer.Due to an inadequate health infrastructure and organized screening strategy,most low-and middle-income countries are still far from achieving this goal.As part of the efforts to increase performance of cervical cancer screening,it is necessary to investigate the most accurate,efficient,and effective methods and strategies.Artificial intelligence(AI)is rapidly expanding its application in cancer screening and diagnosis and deep learning algorithms have offered human-like interpretation capabilities on various medical images.AI will soon have a more significant role in improving the implementation of cervical cancer screening,management,and follow-up.This review aims to report the state of AI with respect to cervical cancer screening.We discuss the primary AI applications and development of AI technology for image recognition applied to detection of abnormal cytology and cervical neoplastic diseases,as well as the challenges that we anticipate in the future.
文摘BACKGROUND Cervical cancer is the second leading cause of death in women worldwide,second only to breast cancer.Around 80%of women have been infected with human papillomavirus(HPV)in their lifetime.Early screening and treatment are effective means of preventing cervical cancer,but due to economic reasons,many parts of the world do not have free screening programs to protect women’s health.AIM To increase HPV cervical cancer screening in Changsha and reduce the incidence of cervical cancer.METHODS Cervical cancer screening included gynecological examination,vaginal secretion examination and HPV high-risk typing testing.Cervical cytology examination(ThinPrep cytology test)was performed for individuals who test positive for HPV types other than 16 and 18.Vaginal colposcopy examination was performed for HPV16 and 18 positive individuals,as well as for those who were positive for ThinPrep cytology test.If the results of vaginal colposcopy examination were abnormal,histopathological examination was performed.We conducted a cost-benefit analysis after 4 years.RESULTS From 2019 to 2022,523437 women aged 35-64 years in Changsha city were screened and 73313 were positive,with a 14%positive rate.The detection rate of precancerous lesions of cervical cancer was 0.6%and the detection rate of cervical cancer was 0.037%.Among 311212 patients who underwent two cancers examinations,the incidence rate was reduced by more than half in the second examination.The average screening cost per woman was 120 RMB.The average cost of detecting early cases was 10619 RMB,with an early detection cost coefficient of 0.083.CONCLUSION Our screening strategy was effective and cost-effective,making it valuable for early diagnosis and treatment of cervical cancer.It is worth promoting in economically limited areas.
基金supported by the National Nature Science Foun-dation of China(grant numbers:82141106,81630060)the National Key Research and Development Program of China(grant number:2021YFC2701204)+2 种基金Key Technology R&D Program of Hubei(grant num-ber:2024BCB057)Panyu District Science and Technology Plan Project(grant number:2020-Z04-014)Guangzhou Health Science and Tech-nology Project(grant number:20221A011118).
文摘Objective:We investigated the relation between man papillomavirus(HPV)integration status and the immediate risk of cervical intraepithelial neoplasia(CIN),as well as the triage strategy based on HPV integration test.Methods:4086 women aged 20 to 65 years in China were enrolled in 2015 for a prospective,population-based,clinical observational study to evaluate the triage performance of HPV integration.Cervical exfoliated cells were collected for HPV testing and cytologic test.If high-risk HPV was positive,HPV integration test was performed at baseline,2-year and 5-year follow-up.Results:At baseline,HPV integration was positively correlated with the severity of cervical pathology,ranging from 5.0%(15/301)in normal diagnosis,6.9%(4/58)in CIN1,31.0%(9/29)in CIN2,70%(14/20)in CIN3,and 100%(2/2)in cervical cancer(P<0.001).Compared with cytology,HPV integration exhibits comparable sensitivity and negative predictive value for the diagnosis of CIN3+,higher specificity(92.8%[90.2%-95.4%]vs.75.5%[71.2%-79.8%],P<0.001)and higher positive predictive value(36.4%[22.1%-50.6%]vs.15.2%[8.5%-21.8%],P<0.001).HPV integration testing strategy yielded a significantly lower colposcopy referral rate than cytology strategy(10.7%[44/410]vs.27.3%[112/410],P<0.001).The HPV integration-negative group exhibited the lowest immediate risk for CIN3+(1.6%)and accounted for the largest proportion of the total population(89.3%),when compared with the normal cytology group(risk,1.7%;proportion,72.7%).Conclusion:As a key molecular basis for the development of cervical cancer,HPV integration might be a promising triage strategy for HPV-positive patients.
文摘Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.
文摘Objective:To study the screening for cervical cancer in postmenopausal women in liquid-based cell test(TCT)application value.Methods:From January 2023 to March 2024 hospital check-ups and outpatient reached 400 cases of postmenopausal women,and they were TCT and HPV detection,during the study period to pathological diagnosis of numerical results as the standard,analysis of TCT detection application of screening for cervical cancer in postmenopausal women and the effect.Results:After the TCT detection,the inflammation group and normal group by use of HPV testing positive rate higher than other groups(P<0.05).Hospital after pathological diagnosis and research,after the screening system found CINⅠlevel and above cases about 39 cases,the TCT and HPV detection rate of positive difference is not obvious,and there is no statistical significance(P>0.05).Joint test analysis,the sensitivity and specificity were higher than that of TCT and HPV testing positive(P<0.05).Conclusion:TCT detection screening for cervical cancer in postmenopausal women is of great importance to the application,if you can join HPV testing,help to improve the detection sensitivity,avoid missed diagnosis of problems,and then for treatment and later restore to lay a solid foundation.
文摘Objectives:The objective of our study is to examine cervical length measurements,identification of short cervix,vaginal progesterone use,and rate of spontaneous preterm delivery before and after departmental transition to a universal transvaginal ultrasound screening protocol from a universal transabdominal screening protocol.Methods:This is a retrospective observational pre-post study examining the year prior to and year following a transition to a universal transvaginal ultrasound screening protocol to assess cervical length at the time of the anatomy survey.Prior to this transition,universal transabdominal cervical length screening was performed,with reflex transvaginal ultrasound measurement if transabdominal measurement was<35 mm or was unable to be obtained.Results:A total of 1760 charts were reviewed;962 charts were from the pre-transition/transabdominal year and 798 charts were from the post-transition/transvaginal year.In the post-transition/transvaginal year,cervical length less than 20 mm was identified in 1.5%of cases,compared to 0.7%of cases in the pretransition/transabdominal year(p=0.114).There was no difference in the rate of spontaneous preterm delivery between the two groups(5.1%in the pre-transition/transabdominal year vs.6.9%in the post-transition/transvaginal year;p=0.111).Conclusions:In this pre-post study,introduction of a universal transvaginal cervical length screening did not decrease spontaneous preterm delivery rates or detection of short cervix<20 mm,compared to a protocol of universal transabdominal cervical length screening with reflex to transvaginal for measurement<35 mm.
基金supported by the CAMS Innovation Fund for Medical Sciences(No.2023-I2M-3-019)National Natural Science Foundation of China(No.82404366)。
文摘In May 2018,the Director-General of the World Health Organization(WHO)called for global action to eliminate cervical cancer~1.This call marked the beginning of an ambitious international effort to scale up 3 key strategies:human papillomavirus(HPV)vaccination,cervical cancer screening,and treatment of precancerous lesions and cancer.Subsequently,the WHO and its partners developed a global strategy to accelerate the reduction of cervical cancer incidence,with an ultimate goal of achieving elimination within the next century.This Global Strategy represents a formal international commitment and is anchored in the 90-70-90 targets to be achieved by 2030.In parallel,several countries have also set national commitments,such as Sweden's pledge to achieve elimination by 2027 and Australia's target of achieving elimination by 2035.
文摘Purpose: There is a significant rise in mortality rates from breast and cervical cancers in Low- and Middle-Income Countries. In Ghana, approximately 4482 women are diagnosed with these diseases at advanced stages. Unfortunately, the early detection rate for these cancers is low compared to other women’s health services. This situation underscores the need to identify the locations of reproductive-age women who have not been screened for these cancers, to implement targeted public health interventions. This study aims to pinpoint these women’s locations for tailored interventions. Method: Bivariate analysis assessed the relationship between the independent and outcome variables. Hot spot analysis and Kriging Ordinary interpolation were employed to pinpoint the locations of these women. Results: Breast cancer examination and cervical cancer test rates were low, with a strong association between the two screening services. Several significant variables were identified: place of residence (p Conclusion: Low participation in these screening services was related to women’s age and the outreach efforts of fieldworkers. Breast and cervical cancer screenings are interconnected and could be combined to improve attendance rates. The Community-based Health Planning and Services (CHPS) implementation strategy could be cost-effective for screening women through targeted interventions, especially in identified clusters.
文摘Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other high-risk HPV(OHR-HPV)positive Thinprep cytologic test(TCT)atypical squamous cells of undetermined significance(ASCUS)/lower-grade squamous intraepithelial lesion(LSIL)women.We evaluated the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the triage test.Results:The sensitivity,specificity,PPV and NPV of p16/Ki-67 dual stain in HPV 16/18-positive women were91.5%/68.4%,77.0%/75.0%,73.9%/59.1%and 92.8%/81.8%.In 12 OHR-HPV positive TCT ASCUS/LSIL women,the results were 79.1%/95.0%,88.5%/66.7%,88.5%/70.4%and 89.2%/94.1%.The risk of precancerous lesions in p16/Ki-67 dual stain positive cases was much higher than before,and the negative cases had lower risk.Besides,there was no cervical intraepithelial neoplasia(CIN)III case missed after triaged by p16/Ki-67 dual-stained cytology.In p16/Ki-67 dual-stained cytology positive women with benign pathology or CIN I,the 1-year progression rate is 20.5%and in p16/Ki-67 dual-stained cytology negative women,the 1-year progression rate is5.6%.Conclusions:hr-HPV genotyping test plays an important role in cervical cancer screening.p16/Ki-67 dual stain may be a promising triage test.As for chronic cervicitis or CIN I patients,a positive p16/Ki-67 dual-stained cytology suggests a high risk in progression and need to be followed up closely.
基金National Health Commission(formerly Health and Family Planning Commission)of China(No.201502004)CAMS Innovation Fund for Medical Sciences(CIFMS)(No.2021-I2M-1-004)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2019PT320010 and No.2018PT32025)。
文摘Objective:We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus(hrHPV)-positive women in primary healthcare settings in China.Methods:This study was undertaken in 11 rural and 9 urban sites.Women aged 35-64 years old were enrolled.HrHPV-positive women were randomly allocated to liquid-based cytology(LBC),visual inspection with acetic acid and Lugol’s iodine(VIA/VILI)(rural only)triage,or directly referred to colposcopy(direct COLP).At 24 months,hrHPV testing,LBC and VIA/VILI were conducted for combined screening.Results:In rural sites,1,949 hrHPV-positive women were analyzed.A total of 852,218 and 480 women were randomly assigned to direct COLP,LBC and VIA/VILI.At baseline,colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%-80%.LBC(n=3 and n=7)or VIA/VILI(n=8 and n=26)could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia(CIN)2 or worse and CIN3+compared with direct COLP(n=14 and n=23).For the 24-month cumulative detection rate of CIN2+,VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP.When stratified by age,baseline LBC triage+performed best(P<0.001),peaking among women aged 35-44 years(Ptrend=0.002).In urban sites,1,728 women were hrHPV genotyping test positive.A total of 408,571 and 568women were randomly assigned to direct COLP for HPV16/18+,direct COLP for other hrHPV subtypes+,and LBC triage for other hrHPV subtypes+.LBC(n=12 and n=31)significantly decreased the number of colposcopies needed to detect one CIN2+and CIN3+compared with direct COLP(n=14 and n=44).HPV16/18+increased the 24-month cumulative detection rate of CIN2+(17.89%,P<0.001).Conclusions:LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+women and LBC triage for other hrHPV subtype+women in urban settings might be feasible strategies.
基金funded by Beijing Municipal Science & Technology Commission(No.Y0905001000091)
文摘This study compared HPV testing and liquid-based cytology （LCT） as performance indicators for cervical cancer screening in a hospital-based study. A total of 61,193 outpatients were screened initially by LCT. Samples with screening results showing atypical squamous cells of undetermined significance （ASC-US） or worse were referred for colposcopy, and some samples were tested for high-risk HPV types with the Hybrid Capture II system （HC II）. Data on LCT （n=61,193） and HC II （n=1056） results were analysed. Overall test positivity for LCT was 2.53% using an ASC-US threshold, 3.11% using a low-grade squamous intraepithelial lesion （LSIL） threshold, and 0.67% using a high-grade squamous intraepithelial lesion （HSIL） threshold. A total of 1839 women （84% of the 3893 patients with abnormal cytology） underwent colposcopy-directed biopsy. HPV was positive in 80.3% of women with cervical intraepithelial neoplasia 1 （CIN1）, 88.3% of those with CIN2, 79.2% of women with CIN3 and 50% （2 of 4） of women with invasive cancer. There was a significant increase in the detection of CIN2 or worse with adjunct HPV testing of women with ASC-US and LSIL However, there were detection of CIN2＋ cases no differences in the with adjunct HPV testing of women with HSlI.. The results indicate that HPV testing for HSlL triage should not be recommended in cervical cancer screening.
文摘There is a higher Human Papilloma Virus peak prevalence in younger women (18 - 25 years) of university age. The undergraduate university students are more at a risk of acquiring cervical cancer because they are at the stage of exploring which predisposes them to risky behavior like early sexual intercourse and multiple sexual partners among others. This creates a need for cervical cancer screening in the population. The facilitators and barriers to cervical cancer screening have been studied in the Ugandan general population but little is known among University students which this study is taking interest. <strong>Objective: </strong>This study is aimed at determining the facilitators, barriers and background factors associated to cervical cancer screening among female undergraduate students in Makerere University. <strong>Methods: </strong>Four hundred twenty-two (422) female undergraduate students of Makerere University who fit the eligibility criteria were recruited in this descriptive cross-sectional quantitative study. A self-administered semi structured questionnaire was administered to these participants chosen by convenient sampling. Data collected was analyzed using SPSS version 23 software and logistic regression models was used. <strong>Results:</strong> Less than a half of (21.1%) of the participants had ever screened for cervical cancer. At multivariate analysis, only year of study and married status were associated to cervical cancer screening with a P-values were of (0.015) and (0.001) with a (1.173 - 4.261) and (1.594 - 6.130) 95% CI respectively. The facilitators agreed upon by participants included: Access to free cervical cancer screening services, adequate knowledge about cervical cancer screening and advice from a friend, family or physician among others. The reported barriers to screening were fear of bad result, low risk perception and fear of embarrassment among others. <strong>Conclusions and Recommendations: </strong>Among the female undergraduate students of Makerere University, only 21.1% had screened for cervical cancer. Therefore, there is a critical need for university based cancer education campaign on cervical cancer and the benefits of screening. Screening services should be integrated into the existing university medical services.
基金supported by Faculty of Medicine Siriraj Hospital,Mahidol University,Thailand(Grant No.[IO]R016233023).
文摘Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.
文摘The purpose of this research is to implement an IT-based education program in order to promote cervical cancer screenings for women aged 20 - 29 years, as well as to examine the results of said program. This is a longitudinal/comparative study of two groups, one for which the program was implemented (the intervention group), and the other for which it was not (the control group). The program consisted of attending a health lecture and encouragement to be screened one month, six months, and one year later sent through IT-based methods. The target was unmarried women aged 20 - 29 who had neither previously given birth nor had been screened for cervical cancer in a period one year prior. They were divided into two groups, the intervention group (n = 142) and control group (n = 145). The effectiveness of the program was assessed via an initial survey and further surveys six months and one year later. Results were based on the Japanese version of the Health Belief Model Scale for Cervical Cancer and the Pap Smear Test (HBMSCCPST), knowledge scores in the categories of Healthy Lifestyles, Cervical Cancer, Cervical Cancer Screening, and screening behavior. A two-way ANOVA of the HBMSCCPST subscales and knowledge scores in the initial, six-month, and one-year surveys was performed, showing interaction in Cervical Cancer (p = 0.00). Main effects were observed in Cervical Cancer Screening (p = 0.00) and Healthy Lifestyles (p = 0.00). Regarding the amount of change from the initial survey, knowledge scores in the Cervical Cancer (p = 0.027) and Cervical Cancer Screening (p = 0.016) categories were significantly higher in the intervention group than in the control group. There was no significant difference in cervical cancer screening rates (p = 0.26) between the two groups. However, a small-degree effect size was observed for Benefits, Seriousness, and Susceptibility subscales in both examinees and non-examinees. Although the educational program of this study was effective in improving the knowledge of women in their twenties, there was little improvement in HBMSCCPST and it did not lead to the promotion of cervical cancer screening. In order to raise interest in cervical cancer screening, it is necessary to consider useful content to guide women to consult with healthcare professionals, a long-term population approach, and organizational structure of consultation.
文摘Background: Cervical cancer is the second common cancer among women worldwide. It is a preventable cancer, and early detection of precancerous conditions through the Papanicolaou cytology screening (Pap smear) is a key aspect of prevention;it is accepted worldwide as an efficient tool for secondary prevention. While the PS test is simple, inexpensive, and relatively reliable as a method of diagnosing cervical cancer, most women do not take the test. Therefore, this study is sought to describe the barriers to pap smear uptake among Sudanese women. Materials and Method: This total coverage observational, analytical and cross sectional, hospital-based study was conducted in Saad Abu El Ella Hospital in April 2022. The study was conducted using an anonymous questionnaire to assess the perceived barriers of 93 participants. All data were computerized using Microsoft Excel’17 and the data were described and analyzed using statistical package for social science (SPSS23). Results: The findings revealed that the mean age of the participants was 39.5 years and only 3.2% had ever undergone a pap smear test. Identified barriers were lack of information, not knowing where to go, and fear of pain. The majority, 72% are willing to routinely perform a pap smear test if well informed about it. The study also demonstrates that there is a significant correlation between perceived barriers score and willingness to perform the pap smear test (p value = 0.008), and between the perceived barriers score and the sociodemographic factors: Age (p value = 0.006), educational level (p value = 0.028) and occupation (p value = 0.040), but no association with the economic status was found (p value = 0.378). Conclusion: The detection rate is too low compared to the national target of over 70%. Therefore, more work is needed to reduce perceived barriers to cervical cancer screening by providing education/raising for popular awareness;addressing misconceptions and false beliefs;informing women about the necessity and importance of Pap smear;and health promotion using mass media such as national television, social media, radio, billboards, and newspapers and other print media.
文摘The aim of this study is to investigate cyclin E, pl6ink4a and ki67 as possible diagnostic biomarkers for cervical preneoplasia using cervical exfoliated-cell specimens, and evaluate the significance for screening patients at high risk of de- veloping cervical carcinoma. The expression of cyclin E, p16ink4a and ki67 was examinated in 78 cervical exfoliated epithe- lial specimens diagnosed as atypical squamous cells of undetermined significance (ASCIIS) (12 cases), cervical intraepithe- lial neoplasia (CIN) of type 1 (17 cases), CIN2-3(38 cases) and invasive carcinoma (11 cases) using immunohistochemical analysis, and simultaneously, the DNA status of human papillomavirus (HPV) type 16/18 was detected by polymerase chain reaction (PCR) using type specific primers, cyclin E, pl6ink4a and ki67 were all overexpressed in CINs and invasive carci- noma, compared with little expression in ASCUS ( P < 0.005). Overexpression of cyclin E was observed in CIN1 (94.1 % , x2 = 21.16, P < 0.01), and pl6ink4a and ki67 were overexpressed in invasive carcinoma (100% and 90.9% respective- ly) . The degree of pl6ink4a and ki67 expression correlated well with that of epithelial lesions ( P < 0.005). HPV16/18 infec- tion was assessed in CINs and invasive carcinoma samples, and revealed a significant relationship with the degree of cervical epithelial lession. The expression level of pl6ink4a and ki67 seemed more closely associated with HPV16 infection than that of cyclin E ( r s = 1.0 vs rs = 0 . 4 ) . Only 1 case in CIN, and 4 cases in CIN2-3 of HPV18 positive samples were detected. Therefore no statistical significance was found by statistical analysis. Overexpression of cyclin E, p16ink4a and ki67 in CINs and invasive carcinoma cells demonstrates the potential use of cyclin E, p16ink4a and ki67 as diagnostic biomarkers for HPV-related cervical neoplastic lesions. In addition, this technique can be used for screening patients at high risk of devel- oping cervical carcinoma.
文摘Objectives: To explore attitudes to cervical cancer screening and sexual behaviour among human papillomavirus (HPV)-vaccinated young women in southern Sweden. Methods: Sixteen women aged 17-26 years who had received the HPV vaccine were submitted to an individual semi-structured interview. Interviews were recorded and transcribed verbatim. The data were analysed qualitatively by means of latent content analysis. Results: The interviewees had a poor understanding of cervical cancer screening. After it was explained to them, they stated that they were willing to participate in the screening. The young women thought their future sexual behaviour would not be affected by the vaccination. They considered themselves to be more aware of it and less likely to engage in risky behaviour than their peers. They knew little about the relation among HPV, sexual transmission and cervical cancer, and they expressed a desire for more information. Conclusions: These young women who recently had been administered HPV vaccine had a limited understanding of the importance of participating in future cervical cancer screening. It is necessary that more and more appropriate information of cervical cancer screening be given on the occasion of the HPV vaccination.
