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Desai KT, Hansen N, Rodriguez AC, Befano B, Egemen D, Gage JC, Wentzensen N, Lopez C, Jeronimo J, de Sanjose S, Schiffman M. Squamocolumnar junction visibility, age, and implications for cervical cancer screening programs. Prev Med 2024; 180:107881. [PMID: 38286273 PMCID: PMC10922959 DOI: 10.1016/j.ypmed.2024.107881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 01/31/2024]
Abstract
Visual assessment is currently used for primary screening or triage of screen-positive individuals in cervical cancer screening programs. Most guidelines recommend screening and triage up to at least age 65 years old. We examined cervical images from participants in three National Cancer Institute funded cervical cancer screening studies: ALTS (2864 participants recruited between 1996 to 1998) in the United States (US), NHS (7548 in 1993) in Costa Rica, and the Biopsy study (684 between 2009 to 2012) in the US. Specifically, we assessed the visibility of the squamocolumnar junction (SCJ), which is the susceptible zone for precancer/cancer by age, as reported by colposcopist reviewers either at examination or review of cervical images. The visibility of the SCJ declined substantially with age: by the late 40s the majority of people screened had at most partially visible SCJ. On longitudinal analysis, the change in SCJ visibility from visible to not visible was largest for participants from ages 40-44 in ALTS and 50-54 in NHS. Of note, in the Biopsy study, the live colposcopic exam resulted in significantly higher SCJ visibility as compared to review of static images (Weighted kappa 0.27 (95% Confidence Interval: 0.21, 0.33), Asymmetry chi-square P-value<0.001). Lack of SCJ visibility leads to increased difficulty in diagnosis and management of cervical precancers. Therefore, cervical cancer screening programs reliant on visual assessment might consider lowering the upper age limit for screening if there are not adequately trained personnel and equipment to evaluate and manage participants with inadequately visible SCJ.
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Affiliation(s)
- Kanan T Desai
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States; Internal Medicine Residency, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, United States.
| | - Natasha Hansen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Ana-Cecilia Rodriguez
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Brian Befano
- University of Washington, Seattle, United States; Information Management Services, MD, United States
| | - Didem Egemen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Julia C Gage
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Nicolas Wentzensen
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | | | - Jose Jeronimo
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Silvia de Sanjose
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States; ISGlobal Barcelona, Spain
| | - Mark Schiffman
- Clinical Epidemiology Unit, Clinical Genetic Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
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Papoutsis D, Underwood M, Parry-Smith W, Tzavara C. Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia and its association with high-grade histopathological recurrence after cervical excision in women with negative excision margins: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:939-948. [PMID: 37821642 PMCID: PMC10867046 DOI: 10.1007/s00404-023-07242-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for disease recurrence after cervical treatment. OBJECTIVES To provide a systematic review and meta-analysis on whether endocervical crypt involvement by high-grade CIN on the excised cervical specimen is associated with high-grade histopathological recurrence during the follow-up of women after cervical excisional treatment. SEARCH STRATEGY We searched the Medline, Scopus, Central, and Clinical Trials.gov databases from inception till May 2023. SELECTION CRITERIA Studies that reported on women with a single cervical treatment with any method of excision for CIN2 or CIN3 lesion, negative excision margins, and whose recurrence was defined histopathologically were included. DATA COLLECTION AND ANALYSIS Two reviewers independently evaluated study eligibility. We used the fixed effects model for meta-analysis. MAIN RESULTS There were 4 eligible studies included in the present systematic review that evaluated 1088 women treated with either large loop excision of the transformation zone (LLETZ) or with cold knife conization (CKC). We found no significant association of endocervical crypt involvement by CIN2-3 with high-grade histopathological recurrence at follow-up after cervical excision (OR 1.93; 95% CI 0.51-3.35). The subgroup analysis of women with LLETZ cervical excision showed again no significant association with high-grade histopathological recurrence at follow-up (OR 2.00; 95% CI 0.26-3.74). CONCLUSION Endocervical crypt involvement by high-grade CIN does not seem to be a risk factor for high-grade histopathological recurrence after cervical excision with negative excision margins.
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Affiliation(s)
- Dimitrios Papoutsis
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK.
- School of Health Sciences, University of Western Macedonia, 50100, Ptolemaida, Kozani, PC, Greece.
| | - Martyn Underwood
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - William Parry-Smith
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Xiao L, Dong X, Sun J, Zhang X, Feng Q, Chang S. Focused ultrasound versus the loop electrosurgical excision procedure to treat women with cervical high-grade squamous intraepithelial lesions under 40: a retrospective study. BMC Cancer 2024; 24:169. [PMID: 38310208 PMCID: PMC10837863 DOI: 10.1186/s12885-024-11938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study aimed to compare the efficacy of focused ultrasound (FUS) and the loop electrosurgical excision procedure (LEEP) for the treatment of cervical high-grade squamous intraepithelial lesions (HSILs) among women of reproductive age. METHODS Case records of patients aged < 40 years who were treated for cervical HSILs using either FUS or LEEP from September 1, 2020 to May 31, 2022 were retrospectively reviewed. Patients were followed up for cure, recurrence, human papillomavirus (HPV) clearance, and complications within 1 year of treatment. Odds ratios and 95% confidence intervals were determined using univariate and multivariate logistic regression models to analyze the association between disease evidence or HPV clearance and treatment modalities or other covariates. RESULTS Of the 1,054 women who underwent FUS or LEEP, 225 met our selection criteria. Among the selected women, 101 and 124 received FUS and LEEP, respectively. There was no significant difference between the FUS and LEEP groups in the cure rate during the 3-6 months of follow-up (89.11% vs. 94.35%, P = 0.085) and recurrence rate during the 6-12 months follow-up (2.22% vs. 1.71%, P = 0.790). Both groups exhibited enhanced cumulative HPV clearance rates; however, the rates were not significantly different between the FUS and LEEP groups (74.23% vs. 82.79%, P = 0.122 during the 3-6 months follow-up; 84.95% vs. 89.17%, P = 0.359 during the 6-12 months follow-up). Furthermore, the incidence of complications caused by the FUS and LEEP techniques was comparable (5.0% vs. 5.6%, P = 0.818). CONCLUSIONS We found that FUS and LEEP have similar efficacy, safety, and reliability in treating women (aged < 40 years) with HSILs.
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Affiliation(s)
- Linlin Xiao
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Xu Dong
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Jiangchuan Sun
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Xuerui Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Qing Feng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400000, China
| | - Shufang Chang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing, 400000, China.
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Creswell L, Rolnik DL, Lindow SW, O’Gorman N. Preterm Birth: Screening and Prediction. Int J Womens Health 2023; 15:1981-1997. [PMID: 38146587 PMCID: PMC10749552 DOI: 10.2147/ijwh.s436624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023] Open
Abstract
Preterm birth (PTB) affects approximately 10% of births globally each year and is the most significant direct cause of neonatal death and of long-term disability worldwide. Early identification of women at high risk of PTB is important, given the availability of evidence-based, effective screening modalities, which facilitate decision-making on preventative strategies, particularly transvaginal sonographic cervical length (CL) measurement. There is growing evidence that combining CL with quantitative fetal fibronectin (qfFN) and maternal risk factors in the extensively peer-reviewed and validated QUanititative Innovation in Predicting Preterm birth (QUiPP) application can aid both the triage of patients who present as emergencies with symptoms of preterm labor and high-risk asymptomatic women attending PTB surveillance clinics. The QUiPP app risk of delivery thus supports shared decision-making with patients on the need for increased outpatient surveillance, in-patient treatment for preterm labor or simply reassurance for those unlikely to deliver preterm. Effective triage of patients at preterm gestations is an obstetric clinical priority as correctly timed administration of antenatal corticosteroids will maximise their neonatal benefits. This review explores the predictive capacity of existing predictive tests for PTB in both singleton and multiple pregnancies, including the QUiPP app v.2. and discusses promising new research areas, which aim to predict PTB through cervical stiffness and elastography measurements, metabolomics, extracellular vesicles and artificial intelligence.
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Affiliation(s)
- Lyndsay Creswell
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC, Australia
| | - Stephen W Lindow
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
| | - Neil O’Gorman
- Department of Obstetrics and Gynecology, The Coombe Hospital, Dublin, Ireland
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé. CMAJ 2023; 195:E1674-E1701. [PMID: 38081626 PMCID: PMC10718275 DOI: 10.1503/cmaj.230237-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Contexte: Malgré des investissements importants dans un système de soins de santé public qui comprend des services préventifs, on continue d’observer des disparités évitables en matière de santé au Canada. L’équipe avait pour objectif de formuler des recommandations pour des soins de santé préventifs qui puissent améliorer l’équité en matière de santé par la priorisation des interventions efficaces à l’intention des groupes défavorisés. Méthodes: La ligne directrice a été élaborée par un comité composé de spécialistes en soins primaires et de membres de la patientèle, avec la contribution d’un groupe de patientes-et patientspartenaires ayant vécu diverses expériences. Après avoir sélectionné les sujets à prioriser, nous avons recensé les revues systématiques, les essais randomisés et contrôlés récents sur les méthodes de dépistage et d’autres études pertinentes sur l’efficacité du dépistage et de la prise en charge. Nous avons utilisé l’approche GRADE (Grading of Recommendations, Assessment, Development and Evaluation) pour formuler les recommandations et avons suivi le guide AGREE II (Appraisal of Guidelines for Research and Evaluation) pour rédiger le rapport. Il en a été de même avec les principes du Guidelines International Network pour la gestion des intérêts concurrents. Les recommandations ont été passées en revue par un comité externe d’experts en contenu avant d’être distribuées à des intervenants à l’échelle nationale pour approbation. Recommandations: Nous avons formulé 15 recommandations concernant le dépistage et d’autres soins préventifs et 1 recommandation de nature politique visant à améliorer l’accès aux soins primaires. Ainsi, nous recommandons de prioriser une stratégie de communication pour le dépistage du cancer colorectal à partir de l’âge de 45 ans et pour l’évaluation du risque de maladie cardiovasculaire pour lutter contre les iniquités en matière de santé et promouvoir la santé. Les interventions particulières qui devraient être déployées pour lutter contre les iniquités comprennent l’autodépistage du virus du papillome humain (VPH) et du VIH, et le test de libération de l’interféron γ pour l’infection tuberculeuse. Le dépistage de la dépression, de la toxicomanie, de la violence conjugale et de la pauvreté devrait également permettre aux personnes touchées d’accéder plus facilement à des interventions éprouvées. Nous recommandons une prise de contact systématique avec des professionnels de la santé en soins primaires pour les personnes défavorisées. Interprétation: Les interventions préventives éprouvées peuvent aider à combattre les iniquités en matière de santé si la priorité est accordée aux personnes défavorisées. Les médecins, les organisations de santé et les gouvernements devraient adopter des mesures fondées sur des données probantes et en faire le suivi s’ils veulent promouvoir l’équité en matière de santé partout au Canada.
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Affiliation(s)
- Nav Persaud
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont.
| | - Areesha Sabir
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Hannah Woods
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Ambreen Sayani
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Arnav Agarwal
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Muna Chowdhury
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Alan Katz
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Melanie Lewis
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Trudy McFarlane
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Anjali Oberai
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Yinka Oladele
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Lisa Peters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Patrick Wong
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Aisha Lofters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
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Novais IR, Coelho CO, Machado HC, Surita F, Zeferino LC, Vale DB. Cervical cancer screening in Brazilian Amazon Indigenous women: Towards the intensification of public policies for prevention. PLoS One 2023; 18:e0294956. [PMID: 38064494 PMCID: PMC10707695 DOI: 10.1371/journal.pone.0294956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Indigenous women are vulnerable to cervical cancer. Screening is a strategy to reduce the burden of the disease. OBJECTIVE To evaluate the prevalence profile of cervical cancer screening cytological results in Brazilian indigenous women by age and frequency of tests compared to non-indigenous women. METHODS A cross-sectional study evaluating the prevalences of screening test results in indigenous women assisted in the Brazilian Amazon from 2007 to 2019 (3,231 tests), compared to non-indigenous women (698,415 tests). The main outcome was the cytological result. Other variables were frequency, age groups, and population. The frequency was categorized as "1st test", the first test performed by the women in their lifetime, or "screening test," tests from women who had previously participated in screening. Analyzes were based on prevalences by age group and population. We used Prevalence Ratios (PR) and 95% Confidence Intervals for risks and linear regression for trends. RESULTS Data from the 1st test showed a higher prevalence of Low-grade Squamous Intraepithelial Lesion (LSIL) in indigenous women. Peaks were observed in indigenous under 25, 35 to 39, 45 to 49, and 60 to 64. The prevalence of High-grade Squamous Intraepithelial Lesion or more severe (HSIL+) was low in both groups in women younger than 25. The indigenous HSIL+ prevalence curve showed a rapid increase, reaching peaks in women from 25 to 34 years, following a slight decrease and a plateau. In screening tests, HSIL+ was more prevalent in indigenous from 25 to 39 (PR 4.0,2.3;6.8) and 40 to 64 (PR 3.8,1.6;9.0). In indigenous, the PR of HSIL+ results in screening tests over 1st tests showed no screening effect in all age groups. In non-indigenous, there was a significant effect toward protection in the age groups over 25. CONCLUSION This screening study of indigenous women from diverse ethnicities showed a higher prevalence of cytological LSIL and HSIl+ than in non-indigenous women. The protective screening effect in reducing HSIL+ prevalence was not observed in indigenous.
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Affiliation(s)
- Iria Ribeiro Novais
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Camila Olegario Coelho
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Helymar Costa Machado
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Fernanda Surita
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Luiz Carlos Zeferino
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
| | - Diama Bhadra Vale
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil
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Petráš M, Dvořák V, Lomozová D, Máčalík R, Neradová S, Dlouhý P, Malinová J, Rosina J, Lesná IK. Timing of HPV vaccination as adjuvant treatment of CIN2+ recurrence in women undergoing surgical excision: a meta-analysis and meta-regression. Sex Transm Infect 2023; 99:561-570. [PMID: 37553234 PMCID: PMC10715477 DOI: 10.1136/sextrans-2023-055793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE The main aim was to determine the overall vaccine effectiveness (VE) against recurrent cervical intraepithelial neoplasia grade 2 or worse (CIN2+) including specific VE associated with timing of human papillomavirus (HPV) vaccination using data from published studies. DESIGN Meta-analysis and meta-regression. DATA SOURCES A computerised literature search was undertaken using the MEDLINE, EMBASE, International Pharmaceutical Abstracts, Derwent Drug File, ProQuest Science and Technology, Cochrane and MedRxiv databases. To be eligible, the studies, with no language restrictions, had to be published between 1 January 2001 and 25 May 2023. REVIEW METHODS Included were studies with an unvaccinated reference group that assessed CIN2+ recurrence irrespective of the HPV genotype in women undergoing conisation provided. The present study was carried out in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines. The risk of study bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to assess the strength of evidence for the primary outcome. Data synthesis was conducted using meta-analysis and meta-regression. RESULTS Out of a total of 14 322 publications, 20 studies with a total of 21 estimates were included. The overall VE against recurrent CIN2+ irrespective of the HPV genotype achieved 69.5% (95% CI: 54.7% to 79.5%). While the HPV vaccine valency, follow-up duration, type of study including its risk of bias had no effect on VE, the highest VE of 78.1% (95% CI: 68.7% to 84.7%) was reported for women receiving their first dose not earlier than the day of excision. This outcome was supported by additional analyses and a VE prediction interval ranging from 67.1% to 85.4%. CONCLUSIONS The outcome of this meta-analysis and meta-regression convincingly showed the beneficial effect of post-excisional HPV vaccination against CIN2+ recurrence. Studies published to date have been unable to determine whether or not vaccination, completed or initiated before conisation, would be associated with more favourable results. PROSPERO REGISTRATION NUMBER CRD42022353530.
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Affiliation(s)
- Marek Petráš
- Department of Epidemiology and Biostatistics, Charles University, Prague, Czech Republic
| | - Vladimír Dvořák
- Center of Ambulatory Gynecology and Primary Care, Brno, Czech Republic
| | - Danuše Lomozová
- Department of Epidemiology and Biostatistics, Charles University, Prague, Czech Republic
| | - Roman Máčalík
- Department of Epidemiology and Biostatistics, Charles University, Prague, Czech Republic
| | - Sylva Neradová
- Department of Epidemiology and Biostatistics, Charles University, Prague, Czech Republic
| | - Pavel Dlouhý
- Department of Hygiene, Charles University, Prague, Czech Republic
| | - Jana Malinová
- Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Jozef Rosina
- Department of Medical Biophysics and Medical Informatics, Charles University, Prague, Czech Republic
- Department of Health Care and Population Protection, Ceské vysoké ucení technické v Praze Fakulta biomedicinského inzenyrstvi, Kladno, Czech Republic
| | - Ivana Králová Lesná
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Anesthesia, Charles University First Faculty of Medicine, Prague, Czech Republic
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8
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Hall MT, Simms KT, Murray JM, Keane A, Nguyen DTN, Caruana M, Lui G, Kelly H, Eckert LO, Santesso N, de Sanjose S, Swai EE, Rangaraj A, Owiredu MN, Gauvreau C, Demke O, Basu P, Arbyn M, Dalal S, Broutet N, Canfell K. Benefits and harms of cervical screening, triage and treatment strategies in women living with HIV. Nat Med 2023; 29:3059-3066. [PMID: 38087116 PMCID: PMC10719091 DOI: 10.1038/s41591-023-02601-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/20/2023] [Indexed: 12/17/2023]
Abstract
To support a strategy to eliminate cervical cancer as a public health problem, the World Health Organisation (WHO) reviewed its guidelines for screening and treatment of cervical pre-cancerous lesions in 2021. Women living with HIV have 6-times the risk of cervical cancer compared to women in the general population, and we harnessed a model platform ('Policy1-Cervix-HIV') to evaluate the benefits and harms of a range of screening strategies for women living with HIV in Tanzania, a country with endemic HIV. Assuming 70% coverage, we found that 3-yearly primary HPV screening without triage would reduce age-standardised cervical cancer mortality rates by 72%, with a number needed to treat (NNT) of 38.7, to prevent a cervical cancer death. Triaging HPV positive women before treatment resulted in minimal loss of effectiveness and had more favorable NNTs (19.7-33.0). Screening using visual inspection with acetic acid (VIA) or cytology was less effective than primary HPV and, in the case of VIA, generated a far higher NNT of 107.5. These findings support the WHO 2021 recommendation that women living with HIV are screened with primary HPV testing in a screen-triage-and-treat approach starting at 25 years, with regular screening every 3-5 years.
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Affiliation(s)
- Michaela T Hall
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia.
| | - Kate T Simms
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - John M Murray
- School of Mathematics and Statistics, University of New South Wales, Sydney, NSW, Australia
| | - Adam Keane
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Diep T N Nguyen
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Michael Caruana
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Gigi Lui
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Helen Kelly
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Linda O Eckert
- Department of Global Health and the Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Silvia de Sanjose
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Edwin E Swai
- Universal Health Coverage and Life Course Cluster, World Health Organization, Dar es Salaam, Tanzania
| | - Ajay Rangaraj
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Morkor Newman Owiredu
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Cindy Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- SUCCESS Project, Expertise France, Paris, France
| | - Owen Demke
- Global Diagnostics, Clinton Health Access Initiative, Kigali, Rwanda
| | - Partha Basu
- Early Detection Prevention and Infections, International Agency for Research on Cancer, Lyon, France
| | - Marc Arbyn
- Cancer Epidemiology Unit, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Shona Dalal
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karen Canfell
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
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9
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Simms KT, Keane A, Nguyen DTN, Caruana M, Hall MT, Lui G, Gauvreau C, Demke O, Arbyn M, Basu P, Wentzensen N, Lauby-Secretan B, Ilbawi A, Hutubessy R, Almonte M, De Sanjosé S, Kelly H, Dalal S, Eckert LO, Santesso N, Broutet N, Canfell K. Benefits, harms and cost-effectiveness of cervical screening, triage and treatment strategies for women in the general population. Nat Med 2023; 29:3050-3058. [PMID: 38087115 PMCID: PMC10719104 DOI: 10.1038/s41591-023-02600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/19/2023] [Indexed: 12/17/2023]
Abstract
In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer as a public health problem. To support the strategy, the WHO published updated cervical screening guidelines in 2021. To inform this update, we used an established modeling platform, Policy1-Cervix, to evaluate the impact of seven primary screening scenarios across 78 low- and lower-middle-income countries (LMICs) for the general population of women. Assuming 70% coverage, we found that primary human papillomavirus (HPV) screening approaches were the most effective and cost-effective, reducing cervical cancer age-standardized mortality rates by 63-67% when offered every 5 years. Strategies involving triaging women before treatment (with 16/18 genotyping, cytology, visual inspection with acetic acid (VIA) or colposcopy) had close-to-similar effectiveness to HPV screening without triage and fewer pre-cancer treatments. Screening with VIA or cytology every 3 years was less effective and less cost-effective than HPV screening every 5 years. Furthermore, VIA generated more than double the number of pre-cancer treatments compared to HPV. In conclusion, primary HPV screening is the most effective, cost-effective and efficient cervical screening option in LMICs. These findings have directly informed WHO's updated cervical screening guidelines for the general population of women, which recommend primary HPV screening in a screen-and-treat or screen-triage-and-treat approach, starting from age 30 years with screening every 5 years or 10 years.
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Affiliation(s)
- Kate T Simms
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
| | - Adam Keane
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Diep Thi Ngoc Nguyen
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Caruana
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michaela T Hall
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Gigi Lui
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Cindy Gauvreau
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- SUCCESS Project, Expertise France, Paris, France
| | - Owen Demke
- Global Diagnostics, Clinton Health Access Initiative, Kigali, Rwanda
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Silvia De Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- ISGlobal, Barcelona, Spain
| | - Helen Kelly
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shona Dalal
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Linda O Eckert
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Karen Canfell
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
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10
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Preventive care recommendations to promote health equity. CMAJ 2023; 195:E1250-E1273. [PMID: 37748784 PMCID: PMC10519166 DOI: 10.1503/cmaj.230237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages. METHODS The guideline was developed by a primary care provider-patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders. RECOMMENDATIONS We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages. INTERPRETATION Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.
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Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont.
| | - Areesha Sabir
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Ambreen Sayani
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Arnav Agarwal
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Muna Chowdhury
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Alan Katz
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Melanie Lewis
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Trudy McFarlane
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Anjali Oberai
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Yinka Oladele
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Lisa Peters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Patrick Wong
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
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11
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Weiss M, Arnholdt M, Hißnauer A, Fischer I, Schönfisch B, Andress J, Gerstner S, Dannehl D, Bösmüller H, Staebler A, Brucker SY, Henes M. Tissue-preserving treatment with non-invasive physical plasma of cervical intraepithelial neoplasia-a prospective controlled clinical trial. Front Med (Lausanne) 2023; 10:1242732. [PMID: 37654659 PMCID: PMC10465690 DOI: 10.3389/fmed.2023.1242732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
ObjectiveCervical cancer represents the fourth leading cause of cancer among women and is associated with over 311,000 annual deaths worldwide. Timely diagnosis is crucial given the lengthy pre-cancerous phase, which is typified by cervical intraepithelial neoplastic lesions. However, current treatment methods are often tissue-destructive and can be accompanied by severe side effects. To address these concerns, our study introduces a novel, gentle approach for the tissue-preserving treatment of CIN lesions.ResultsWe present findings of a controlled, prospective, single-armed phase IIb clinical trial performed at the Department for Women’s Health, Tübingen, Germany. From September 2017 to March 2022 we assessed 570 participants for study eligibility. Of the screened patients, 63 participants met with CIN1/2 lesions met the inclusion criteria and were treated with non-invasive physical plasma (NIPP). Assessment of treatment efficacy was based on a comprehensive analysis of histological and cytological findings, along with high-risk HPV infection load at 3 and 6 months post-treatment. Comparative analyses were performed retrospectively with data obtained from 287 untreated patients in the control group. Our findings indicate that patients treated with NIPP experienced an 86.2% rate of full remission, along with a 3.4% rate of partial remission of CIN lesions, which compares favorably to the control group’s rates of 40.4% and 4.5%, respectively. Additionally, we observed a twofold reduction in high-risk HPV infections following NIPP treatment. Minor side effects were observed, such as mild pain during treatment and short-term smear bleeding or increased vaginal discharge within 24 h after treatment. Given the experimental nature of NIPP treatment and the availability of established standard treatments, our study was designed as a non-randomized study.ConclusionNIPP treatment offers a highly flexible and easy-to-apply method for treating pre-cancerous CIN1/2 lesions. This non-invasive approach is notable for its tissue-preserving nature, making it a promising alternative to current excisional and ablative treatments. CIN1/2 lesions were employed as preliminary in vivo models for the targeted treatment of CIN3 lesions.Clinical trial registrationhttps://www.clinicaltrials.gov, identifier NCT03218436.
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Affiliation(s)
- Martin Weiss
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
- NMI Natural and Medical Sciences Institute, University of Tübingen, Reutlingen, Germany
| | - Marcel Arnholdt
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
| | - Anna Hißnauer
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
| | - Irma Fischer
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | | | - Jürgen Andress
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
| | - Sophia Gerstner
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
| | - Dominik Dannehl
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
| | - Hans Bösmüller
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Annette Staebler
- Department of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | - Sara Y. Brucker
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
| | - Melanie Henes
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
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12
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Inayama Y, Takamatsu S, Hamanishi J, Mizuno K, Horinouchi N, Yamanoi K, Taki M, Murakami R, Yamaguchi K, Kosaka K, Efthimiou O, Kawakami K, Furukawa TA, Mandai M. Imiquimod for Cervical and Vaginal Intraepithelial Neoplasia: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:307-318. [PMID: 37411024 DOI: 10.1097/aog.0000000000005256] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/04/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To evaluate the treatment efficacy and the risk of adverse events of imiquimod for cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VAIN), compared with placebo or no intervention. DATA SOURCES We searched Cochrane, PubMed, ISRCTN registry, ClinicalTrials.gov , and the World Health Organization International Clinical Trials Registry Platform up to November 23, 2022. METHODS OF STUDY SELECTION We included randomized controlled trials and prospective nonrandomized studies with control arms that investigated the efficacy of imiquimod for histologically confirmed CIN or VAIN. The primary outcomes were histologic regression of the disease (primary efficacy outcome) and treatment discontinuation due to side effects (primary safety outcome). We estimated pooled odds ratios (ORs) of imiquimod, compared with placebo or no intervention. We also conducted a meta-analysis of the proportions of patients with adverse events in the imiquimod arms. TABULATION, INTEGRATION, AND RESULTS Four studies contributed to the pooled OR for the primary efficacy outcome. An additional four studies were available for meta-analyses of proportions in the imiquimod arm. Imiquimod was associated with increased probability of regression (pooled OR 4.05, 95% CI 2.08-7.89). Pooled OR for CIN in the three studies was 4.27 (95% CI 2.11-8.66); results of one study were available for VAIN (OR, 2.67, 95% CI 0.36-19.71). Pooled probability for primary safety outcome in the imiquimod arm was 0.07 (95% CI 0.03-0.14). The pooled probabilities (95% CI) of secondary outcomes were 0.51 (0.20-0.81) for fever, 0.53 (0.31-0.73) for arthralgia or myalgia, 0.31 (0.18-0.47) for abdominal pain, 0.28 (0.09-0.61) for abnormal vaginal discharge or genital bleeding, 0.48 (0.16-0.82) for vulvovaginal pain, and 0.02 (0.01-0.06) for vaginal ulceration. CONCLUSION Imiquimod was found to be effective for CIN, whereas data on VAIN were limited. Although local and systemic complications are common, treatment discontinuation is infrequent. Thus, imiquimod is potentially an alternative therapy to surgery for CIN. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022377982.
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Affiliation(s)
- Yoshihide Inayama
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Shiro Takamatsu
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Junzo Hamanishi
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Kayoko Mizuno
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Noboru Horinouchi
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Koji Yamanoi
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Mana Taki
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Ryusuke Murakami
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Ken Yamaguchi
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Kenzo Kosaka
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Orestis Efthimiou
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Koji Kawakami
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Toshiaki A Furukawa
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
| | - Masaki Mandai
- From the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, and the Department of Pharmacoepidemiology and the Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, the Department of General Medicine, Oita University Faculty of Medicine, Oita, and the Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan; and the Institute of Primary Health Care (BIHAM) and the Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Each author has confirmed compliance with the journal's requirements for authorship
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13
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Morello L, Mancini J, Carcopino X. Predictors factors of the absence of high-grade intraepithelial lesion in excisional therapy specimen. J Gynecol Obstet Hum Reprod 2023; 52:102550. [PMID: 36773647 DOI: 10.1016/j.jogoh.2023.102550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To identify predictive factors of the absence of high-grade intraepithelial lesion (HGSIL) in cervical excisional therapy specimen. METHODS Data from 835 women who underwent excisional therapy for a cervical intra epithelial lesion at the department of Gynaecology from two university hospitals, between January 2015 and December 2020 were reviewed. Demographic data, referral cytology, colposcopic findings, results of cervical biopsy and endocervical curettage were retrieved. Primary outcome was the absence of HGSIL on cervical excisional specimen analysis defined by the identification of no intraepithelial lesion or of low-grade lesion only. RESULTS The absence of HGSIL on specimen was observed in 137 (16.4%) cases. Three factors were identified to have a significant and independent impact on the probability of the absence of HGSIL on specimen: age higher than 40 years (aOR: 1.8; 95%CI: 1.1-3.0; p=0.024), a small abnormal transformation zone (TZ) (aOR: 2.3; 95%CI: 1.4-3.7; p=0.001) and the result of the cervical biopsy at the time of colposcopic assessment not showing HGSIL (aOR: 8.6; 95%CI: 4.7-15.5; p < 0.001). No significant impact of the referral cytology nor of the colposcopic impression were observed. CONCLUSION Although the result of cervical biopsy performed at the time of colposcopic assessment is the key risk factor for the absence of HGSIL on excisional specimen, age over 40 and a small abnormal TZ are the two other identified risk factors. Practitioners should consider these findings when deciding for excisional therapy.
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Affiliation(s)
- Lea Morello
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Chemin des Bourrely, Marseille, France
| | - Julien Mancini
- Aix-Marseille University (AMU), Inserm, IRD, UMR912 SESSTIM, équipe cancers, biomédecine & société, 13273 Marseille, France; Department of biostatistics and technologies of information (BIOSTIC), Hôpital de la Timone (APHM), 264 Rue Saint Pierre, 13385 Marseille, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Chemin des Bourrely, Marseille, France; Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France.
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Stefanovic S, Mitic IS, Sütterlin M, WEIß C, Spaich S. Operator Sex and Experience Do Not Influence Conization Outcomes in Terms of Cone Volume, Depth or Resection Margins. In Vivo 2023; 37:841-847. [PMID: 36881101 PMCID: PMC10026644 DOI: 10.21873/invivo.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM Conization in patients with cervical intraepithelial neoplasia is associated with longer time required to conceive, a higher risk of preterm delivery, and a myriad of obstetric complications. This study assessed whether operator sex and experience correlate with cone volume, depth, and resection margins in patients wishing to conceive and the general patient population. PATIENTS AND METHODS This retrospective single center cohort study included 141 women who had undergone conization for cervical dysplasia in 2020 and 2021. Loop size selection was guided by the preoperative colposcopy report and intraoperative diluted Lugol staining. The hemiellipsoid cone volume was compared for subgroups in three categories: patients operated on by residents vs. board-certified gynecologists; patients operated on by female vs. male surgeons; patients who wished to pursue future pregnancy after conization vs. those who did not. RESULTS Female surgeons excised insignificantly less cervical tissue compared with their male counterparts (p=0.08). In the subgroup of patients without the wish to conceive, male surgeons tended to excise significantly bigger volumes during conization (p=0.008). No significant difference (p=0.74) regarding volume of resected tissue was evidenced when comparing residents to board-certified surgeons, both in patient subgroups with (p=0.58) and without (p=0.36) a wish to conceive. Male surgeons tended to resect higher volumes (p=0.012) if board-certified compared to their board-certified female colleagues. CONCLUSION There were insignificant differences regarding cone depth and volume or incomplete resection when stratified by operator experience and sex. However, male gynecologists removed significantly larger cone volumes in the subgroup of patients who did not pursue future pregnancy.
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Affiliation(s)
- Stefan Stefanovic
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany;
| | - Iva Stefanovic Mitic
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Christel WEIß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Saskia Spaich
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Li M, Zhao C, Zhao Y, Li J, Wang J, Luo H, Tang Z, Guo Y, Wei L. The role of PAX1 methylation in predicting the pathological upgrade of cervical intraepithelial neoplasia before cold knife conization. Front Oncol 2023; 12:1064722. [PMID: 36713512 PMCID: PMC9875021 DOI: 10.3389/fonc.2022.1064722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Objective To explore the ability of PAX1 methylation (PAX1m) to predict the pathological upgrade of cervical intraepithelial neoplasia (CIN) before cold knife conization (CKC). Methods A total of 218 women that underwent colposcopy-directed biopsy (CDB) pathology for the confirmation of CIN2 and CIN3 between December 2020 to September 2021 were enrolled in this study. The methylation levels of PAX1 (ΔCpPAX1) were determined by quantitative methylation-specific polymerase chain reaction (qMSP). Receiver operating characteristic curve was used to identify the optimal cut-off value of ΔCpPAX1 for predicting the pathological upgrade of disease. Results In the CDB-confirmed CIN2 group, 36% of CIN2 was found to have pathologically upgraded to CIN3 and 30% regressed to low-grade squamous intraepithelial lesion (LSIL) and below, and none of CIN2 upgraded to early-stage cervical cancer (ESCC) after CKC. In the CDB-confirmed CIN3 group, 19.5% (23/118) of CDB-confirmed CIN3 were pathologically upgraded to ESCC after CKC. Regardless of CIN2 or CIN3, the ΔCpPAX1 level of women with upgraded pathology after CKC was significantly lower than that of women with degraded pathology. The optimal △CpPAX1 cut-off value in predicting CIN3 to be upgraded to ESCC after CKC was 6.360 and the area under the curve (AUC) was 0.814, with similar sensitivity (78.3%) and higher specificity (84.2%) than cytology≥LSIL (Se:78.3%;Sp:58.9%) and HPV16/18 positive (Se:73.9%;Sp:46.3%) patients. Conclusions PAX1m could be a promising auxiliary marker in predicting the pathological upgrade of CIN before CKC. We found that if the △Cp PAX1 cut-off value is lower than 6.360, it is highly suggestive of invasive cervical cancer.
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Yoneda JY, Teixeira JC, Derchain S, Bragança JF, Zeferino LC, Vale DB. Screen-and-treat approach in managing cervical cancer precursor lesions: An observational study with 524 women. Eur J Obstet Gynecol Reprod Biol 2023; 280:78-82. [PMID: 36434824 DOI: 10.1016/j.ejogrb.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To detect factors related to overtreatment with the "Screen-and-treat" approach (S&T) in women with suspicious cervical precancerous lesions. STUDY DESIGN A retrospective observational study of 524 women with high-grade squamous intraepithelial lesions (HSIL) or more severe (HSIL+) in cytology, treated by the Large Loop Excision of the Transformation Zone (LLETZ): 161 without a previous biopsy (S&T group) and 363 with a previous biopsy (biopsy group) from January 2017 to July 2020. The main outcome was a diagnosis of LLETZ: negative (negative or low-grade squamous intraepithlelial lesion LSIL) or HSIL+. A negative diagnosis was interpreted as "overtreatment." Results were analyzed as a function of the S&T approach (whether previous biopsy or not). Variables were obtained from medical records, and were compared with Chi-square or Fisher's exact test (p, p-value), to estimate the chances of a logistic regression analysis (Odds Ratio, OR, or admitting a Confidence Interval (CI) of 95 %). RESULTS No differences were observed in groups regarding menopausal status, smoking, hormonal contraceptive use, colposcopy findings, LLETZ diagnosis, and recurrence. Comparing biopsy vs S&T groups, the frequency of women over 40 years was 28.4 % vs 39.7 % (p = 0.011), and transformation zone type 3 was 12.2 vs 26.8 % (p < 0.001), respectively. In women managed by S&T, when compared to a LLETZ diagnosis, an HSIL+ result was more frequent in women presenting with TZ 1 (93.1 % TZ1 vs 78.5 % TZ2 vs 73.8 % TZ3, p = 0.008) and in women with abnormal colposcopy (92.9 % abnormal vs 38.1 % negative, p < 0.001). Multiple regression analysis found that women with negative colposcopic findings presented a higher risk for negative LLETZ diagnosis (LSIL/Negative final histology) (18.6; 6.18-56.02). CONCLUSIONS No difference was observed in the LLETZ diagnosis in women who did or did not use the S&T approach: it was adequate for women referred by cytological HSIL along with high-grade colposcopic findings.
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Affiliation(s)
- Juliana Y Yoneda
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Julio C Teixeira
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Joana F Bragança
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Luiz C Zeferino
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil.
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Gao Y, Wang H, Xiao Y. The effect of cold-knife conization on pregnancy outcomes in patients with cervical lesions. PLoS One 2022; 17:e0278505. [PMID: 36454992 PMCID: PMC9714936 DOI: 10.1371/journal.pone.0278505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/16/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the pregnancy outcomes of patients with cervical lesions treated by cold-knife conization (CKC). METHODS Clinical data of healthy pregnant women and pregnant women who underwent CKC in Dalian Women and Children's Medical Group from March 2010 to December 2019 were retrospectively analyzed. These patients were divided into a CKC group and a control group according to inclusion and exclusion criteria. Statistical methods were used to compare pregnancy and delivery outcomes between the two groups. RESULTS There were 400 patients in CKC group and control group, with 200 patients in each. There was no significant difference in the mode of delivery, abortion, ectopic pregnancy, in-hospital perinatal management, and cervical cerclage between the CKC group and the control group (P>0.05). The rates of preterm delivery, premature rupture of membranes, cesarean section, and neonatal admission in the CKC group were higher than those in the control group (P<0.05). In the CKC group, the incidence of premature rupture of membranes within six months postoperatively was higher than that after six months (P<0.05). The incidences of preterm delivery and premature rupture of membranes were not completely consistent in different conization ranges (P<0.05). CONCLUSION CKC increases the incidence of preterm delivery, premature rupture of membranes, and neonatal adverse outcomes. Conization height can predict the occurrence of preterm delivery. Delaying pregnancy after surgery can reduce the incidence of adverse outcomes during the perinatal period.
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Affiliation(s)
- Yue Gao
- Department of Gynecology, Dalian Women and Children’s Medical Group, Dalian, Liaoning, People’s Republic of China
| | - Huali Wang
- Department of Gynecology, Dalian Women and Children’s Medical Group, Dalian, Liaoning, People’s Republic of China
- * E-mail:
| | - Yunyun Xiao
- Department of Gynecology, Dalian Women and Children’s Medical Group, Dalian, Liaoning, People’s Republic of China
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Risk Factors of Preterm Birth in Women After Local Treatment of Cervical Intraepithelial Neoplasia – a Retrospective Cohort Study. Geburtshilfe Frauenheilkd 2022; 82:1397-1405. [DOI: 10.1055/a-1909-0735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/25/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Purpose A previous cervical intraepithelial neoplasia is associated with an increased obstetrical risk. It was the aim of the study to identify risk factors of preterm birth in
patients with cervical intraepithelial neoplasia in dependence of the treatment modality (excisional vs. ablative).
Methods Women with treated cervical intraepithelial neoplasia and subsequent pregnancy (n = 155) were included in this retrospective study. Methods of treatment were either
conization by large loop excision of the transformation zone (LLETZ) or ablative laser vaporization.
Results Of the total population 60.6% (n = 94) had a conization and 39.4% (n = 61) a laser vaporization alone. The frequency of preterm birth < 37 weeks was 9.7% (n = 15) without
differences between conization and laser (11.7 vs. 6.7%, p = 0.407) with an odds ratio (OR) of 1.9 (95% confidence interval [CI] 0.6–6.2). Preterm birth < 34 weeks was found in 2.6%
(n = 4), of which all had a conization (4.3 vs. 0%, p = 0.157). Risk factors for preterm birth were repeated cervical intervention (OR 4.7 [95% CI 1.5–14.3]), especially a combination of
conization and laser ablation (OR 14.9 [95% CI 4.0–55.6]), age at intervention < 30 years (OR 6.0 [95% CI 1.3–27.4]), a history of preterm birth (OR 4.7 [95% CI 1.3–17.6]) and age at
delivery < 28 years (OR 4.7 [95% CI 1.5–14.3]).
Conclusion The large loop excision of the transformation zone as a modern, less invasive ablative treatment did not obviously increase the risk of preterm birth compared to laser
vaporization. The most important risk factor for preterm delivery was the need of a repeated intervention, especially at younger age. We assume that the persistence or recurrence of the
cervical intraepithelial neoplasia following a high-risk human papillomavirus infection is mainly responsible for the observed effect.
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Sun H, Su X, Liu Y, Huang S, Liu X, Li G, Du Q. Association between cervical disorders and adverse obstetric outcomes: A retrospective cohort study. Front Med (Lausanne) 2022; 9:981405. [DOI: 10.3389/fmed.2022.981405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe purpose of this study was to explore the association of cervical disorders on obstetric outcomes of singleton pregnancies in China.MethodsThis hospital-based retrospective cohort study of women with live singleton births included 71,097 Chinese women. We compared the risk of adverse obstetric outcomes in different types of pregnancies with cervical disorders with those with normal cervix. Logistic regression model was used to estimate the association between cervical disorders and adverse obstetric outcomes.ResultsWomen with cervical disorders had a higher risk of premature delivery (10.98 vs. 4.41%), preterm premature rupture of membranes (PPROM) (3.48 vs. 1.62%), low birth weight (LBW) (7.62 vs. 2.92%) and very low birth weight (VLBW) (2.01 vs. 0.28%) than women with normal cervix. After adjusting for confounding factors, compared with women with normal cervix, women with high-grade abnormal cervical cytology are at greater risk of premature birth (adjusted OR 1.971, 95% CI: 1.302–2.983), premature rupture of membranes (PROM) (adjusted OR 1.379, 95% CI: 1.047–1.815), LBW (adjusted OR 1.790, 95% CI: 1.059–3.025), and VLBW (adjusted OR 4.519, 95% CI: 1.662–12.292) than women with low-grade abnormal cervical cytology, and women with abnormal cervical cytology after treatment had a higher risk of premature birth (adjusted OR 2.060, 95% CI: 1.348–3.147), PROM (adjusted OR 1.381, 95% CI: 1.038–1.839), PPROM (adjusted OR 1.995, 95% CI: 1.022–3.892), LBW (adjusted OR 1.801, 95% CI: 1.046–3.102), and VLBW (adjusted OR 4.868, 95% CI: 1.788–13.255) than untreated women.ConclusionsOur research showed that pregnant women with cervical disorders were more likely to have premature delivery, PPROM, LBW, and VLBW. Moreover, pregnant women with high-grade abnormal cervical cytology and abnormal cervical cytology after treatment had a higher risk of premature birth, PROM, LBW, and VLBW.
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Nassiri S, Aminimoghaddam S, Sadaghiani MR, Nikandish M, Jamshidnezhad N, Saffarieh E. Evaluation of the diagnostic accuracy of the cervical biopsy under colposcopic vision. Eur J Transl Myol 2022; 32:10670. [PMID: 36226527 PMCID: PMC9830395 DOI: 10.4081/ejtm.2022.10670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 01/13/2023] Open
Abstract
This study was conducted to evaluate the diagnostic accuracy of the cervical biopsy under colposcopic vision. This retrospective study was performed on 190 women, who were selected from a total of 412 cases referring for colposcopy in one year. All patients underwent colposcopy and loop electrosurgical excision procedure (LEEP). After the investigation of demographic characteristics and data confirmation, colposcopic characteristics were examined. Then, the diagnostic indicators and diagnostic accuracy of the cervical biopsy under colposcopic vision were determined. The mean age of patients was 35.51± 5.91 years. In smokers, the percentage of cancer and CIN3 cases was higher than in normal individuals, and this difference was statistically significant in terms of the frequency of cancerous lesions (P = 0.2). A comparison of colposcopic biopsy with LEEP has shown that the frequency of advanced cases in LEEP has been detected more, and the correlation coefficient (kappa) indicated the weak agreement between the findings of colposcopically directed biopsy (CDB) and LEEP methods. (k = 0.23). The diagnostic accuracy of the cervical biopsy under colposcopic vision for cervical cancer is effectively high. It is recommended that this procedure be performed to diagnose cancerous lesions; however, contrary to what is seen in colposcopy, malignant cases may be spreading and follow-up of patients can affect therapeutic performance.
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Affiliation(s)
- Setare Nassiri
- Endometriosis Research Center, Iran University of Medical Sciences. Tehran, Iran
| | | | - Marjan Ranjbar Sadaghiani
- Shahid AkbarAbadi Clinical Research Development Unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Niousha Jamshidnezhad
- Shahid AkbarAbadi Clinical Research Development Unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Saffarieh
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Science, Semnan, Iran,Abnormal Uterine Bleeding Research Center, Semnan University of Medical Science, Semnan, Iran. ORCID ID: 0000-0001-9432-7263
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21
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Concordance Rate of Colposcopy in Detecting Cervical Intraepithelial Lesions. Diagnostics (Basel) 2022; 12:diagnostics12102436. [PMID: 36292125 PMCID: PMC9600163 DOI: 10.3390/diagnostics12102436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The purpose of this research is to estimate the rate of concordance, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of colposcopy for high-grade squamous lesions and carcinomas (HSIL+). Methods: We conducted a retrospective study of colposcopies performed in the certified Dysplasia Unit in Erlangen between January 2015 and May 2022 (7.5 years). The colposcopic findings were correlated with biopsies obtained during examinations or surgery. Cases without histology were excluded. The primary outcome was the rate of concordance between the colposcopic and histological findings in relation to the type of transformation zone (TZ), examiner’s level of experience and age of the patients. Results: A total of 4778 colposcopies in 4001 women were analyzed. The rates of concordance for CIN I/LSIL, CIN II/HSIL, CIN III/HSIL, and carcinoma were 43.4%, 59.5%, 78.5%, and 53.9%, respectively. The rate of concordance was lowest for TZ3 and highest for colposcopists with more than 10 years’ experience. Conclusions: Colposcopy is an important, feasible, and effective method. Careful work-up needs to be performed for women with TZ3 who are over 35 years old, as they are at the highest risk of being misdiagnosed. The highest concordance for detecting HSIL+ was seen for colposcopists with >10 years’ experience.
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22
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Muacevic A, Adler JR. Patient Adherence to Follow-Up Recommendations Following Cryotherapy for Treatment of High-Grade Cervical Dysplasia. Cureus 2022; 14:e30154. [PMID: 36397919 PMCID: PMC9646447 DOI: 10.7759/cureus.30154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Determine the rate of patient adherence to follow-up recommendations after cryotherapy for high-grade cervical lesions, and identify patient characteristics associated with adherence to follow-up. Methods This is a retrospective case series from May 2016 to June 2018 of patients who underwent cryotherapy for high-grade dysplasia at a single academic safety-net hospital. Patient demographics and clinical information were abstracted from the electronic medical record. All patients were recommended to follow up with Pap and high-risk human papillomavirus (HPV) testing 12 months after their procedure. The primary outcome was patient adherence to these recommendations. Descriptive statistics and statistical testing were utilized to compare adherence by demographic and clinical characteristics. A multivariable logistic model was used to preliminarily look at potential factors associated with increased odds of adherence. We further described the proportion of follow-up testing among those patients who adhered to recommendations. Results One hundred and forty-three patients met the inclusion criteria. The adherence percentage was 60.1% (95% CI: 51.6, 68.2). Only employment was associated with follow-up among demographic variables reviewed (p=0.039). Of those who were adherent with follow-up, 4.7% (4/86) had high-grade findings on follow-up Pap testing, and 56.9% (49/86) had negative cytology and negative HPV testing. Conclusion Adherence to follow-up recommendations for the following cryotherapy for high-grade dysplasia within our system was poor, and demographic factors were generally not associated with adherence to follow-up. Given these findings, cryotherapy should be used with caution.
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Muñoz-Mata LS, López-Cárdenas MT, Espinosa-Montesinos A, Sosa-Delgado SM, Rosales-García VH, Moreno-Lafont MC, Ramón-Gallegos E. Photodynamic therapy stimulates IL-6 and IL-8 in responding patients with HPV infection associated or not with LSIL. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2022. [DOI: 10.1016/j.jpap.2022.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kechagias KS, Kalliala I, Bowden SJ, Athanasiou A, Paraskevaidi M, Paraskevaidis E, Dillner J, Nieminen P, Strander B, Sasieni P, Veroniki AA, Kyrgiou M. Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis. BMJ 2022; 378:e070135. [PMID: 35922074 PMCID: PMC9347010 DOI: 10.1136/bmj-2022-070135] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore the efficacy of human papillomavirus (HPV) vaccination on the risk of HPV infection and recurrent diseases related to HPV infection in individuals undergoing local surgical treatment. DESIGN Systematic review and meta-analysis DATA SOURCES: PubMed (Medline), Scopus, Cochrane, Web of Science, and ClinicalTrials.gov were screened from inception to 31 March 2021. REVIEW METHODS Studies reporting on the risk of HPV infection and recurrence of disease related to HPV infection after local surgical treatment of preinvasive genital disease in individuals who were vaccinated were included. The primary outcome measure was risk of recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) after local surgical treatment, with follow-up as reported by individual studies. Secondary outcome measures were risk of HPV infection or other lesions related to HPV infection. Independent and in duplicate data extraction and quality assessment were performed with ROBINS-I and RoB-2 tools for observational studies and randomised controlled trials, respectively. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was implemented for the primary outcome. Observational studies and randomised controlled trials were analysed separately from post hoc analyses of randomised controlled trials. Pooled risk ratios and 95% confidence intervals were calculated with a random effects meta-analysis model. The restricted maximum likelihood was used as an estimator for heterogeneity, and the Hartung-Knapp-Sidik-Jonkman method was used to derive confidence intervals. RESULTS 22 articles met the inclusion criteria of the review; 18 of these studies also reported data from a non-vaccinated group and were included in the meta-analyses (12 observational studies, two randomised controlled trials, and four post hoc analyses of randomised controlled trials). The risk of recurrence of CIN2+ was reduced in individuals who were vaccinated compared with those who were not vaccinated (11 studies, 19 909 participants; risk ratio 0.43, 95% confidence interval 0.30 to 0.60; I2=58%, τ2=0.14, median follow-up 36 months, interquartile range 24-43.5). The effect estimate was even stronger when the risk of recurrence of CIN2+ was assessed for disease related to HPV subtypes HPV16 or HPV18 (six studies, 1879 participants; risk ratio 0.26, 95% confidence interval 0.16 to 0.43; I2=0%, τ2=0). Confidence in the meta-analysis for CIN2+ overall and CIN2+ related to HPV16 or HPV18, assessed by GRADE, ranged from very low to moderate, probably because of publication bias and inconsistency in the studies included in the meta-analysis. The risk of recurrence of CIN3 was also reduced in patients who were vaccinated but uncertainty was large (three studies, 17 757 participants; 0.28, 0.01 to 6.37; I2=71%, τ2=1.23). Evidence of benefit was lacking for recurrence of vulvar, vaginal, and anal intraepithelial neoplasia, genital warts, and persistent and incident HPV infections, although the number of studies and participants in each outcome was low. CONCLUSION HPV vaccination might reduce the risk of recurrence of CIN, in particular when related to HPV16 or HPV18, in women treated with local excision. GRADE assessment for the quality of evidence indicated that the data were inconclusive. Large scale, high quality randomised controlled trials are required to establish the level of effectiveness and cost of HPV vaccination in women undergoing treatment for diseases related to HPV infection. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021237350.
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Affiliation(s)
- Konstantinos S Kechagias
- Department of Metabolism, Digestion, and Reproduction and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Ilkka Kalliala
- Department of Metabolism, Digestion, and Reproduction and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sarah J Bowden
- Department of Metabolism, Digestion, and Reproduction and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Antonios Athanasiou
- Department of Metabolism, Digestion, and Reproduction and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Maria Paraskevaidi
- Department of Metabolism, Digestion, and Reproduction and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | | | - Joakim Dillner
- Centre for Cervical Cancer Prevention, Medical Diagnostics Karolinska, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Pekka Nieminen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Bjorn Strander
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Sasieni
- King's Clinical Trials Unit, King's College London, London, UK
| | - Areti Angeliki Veroniki
- Department of Metabolism, Digestion, and Reproduction and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Maria Kyrgiou
- Department of Metabolism, Digestion, and Reproduction and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Damgaard RK, Jenkins D, de Koning MN, Quint WG, Stoler MH, Doorbar J, Kahlert J, Gravitt PE, Steiniche T, Petersen LK, Hammer A. Performance of HPV E4 and p16 INK4a biomarkers in predicting regression of cervical intraepithelial neoplasia grade 2 (CIN2): protocol for a historical cohort study. BMJ Open 2022; 12:e059593. [PMID: 35793925 PMCID: PMC9260811 DOI: 10.1136/bmjopen-2021-059593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Cervical intraepithelial neoplasia grade 2 (CIN2) represents a spectrum of lesions with variable progression and regression. Pathological diagnosis of CIN2 is subjective and poorly reproducible. Accurate diagnosis and identification of different patterns of CIN2 related to outcome are essential to reduce the risks of overtreatment or undertreatment. It is important to explore novel methods for risk stratification of CIN2 to enable targeted treatment of women at high risk of progression or persistent disease and follow-up of women at low risk. The combination of the novel biomarker human papillomavirus (HPV) E4 with p16INK4a targets steps in the transition from a productive oncogenic HPV infection (CIN1) to a transformed lesion (CIN3) within CIN2. Previous cross-sectional studies suggest that HPV E4 combined with p16INK4a may be valuable for risk assessment of CIN2. However, data on HPV E4/p16INK4a as a predictor for CIN2 regression is lacking. METHODS AND ANALYSIS We will conduct a historical cohort study including 500 women aged 23-40 years with a first CIN2 diagnosis in Aarhus, Denmark during 2000-2010. Women will be eligible if they have undergone active surveillance and have no previous record of hysterectomy, cone biopsy, and CIN2 or worse. Women will be randomly selected through the Danish Pathology Databank. Tissue samples from women included will be sectioned for p16INK4a and HPV E4 immunohistochemical staining in addition to conventional hematoxylin and eosin (H&E) staining. A positive result will be defined as HPV E4 positive. Through the Danish Pathology Databank, we will collect results on all subsequent cervical biopsies. Regression will be used as the primary outcome. ETHICS AND DISSEMINATION The study has been approved by the Ethical Committee in Central Denmark Region (1-10-72-60-20) and registered at the Faculty of Health, Aarhus University. Results will be published in a peer-reviewed journal and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT05049252.
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Affiliation(s)
- Rikke Kamp Damgaard
- Dep. Clinical Medicine, Aarhus University, Aarhus, Denmark
- Dep. Gynecology and Obstetrics, Center for Research and Education, Gødstrup Hospital, Herning, Denmark
| | - David Jenkins
- Viroclinics-DDL, DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | | | - Wim Gv Quint
- Viroclinics-DDL, DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Mark H Stoler
- Dep. Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - John Doorbar
- Dep. Pathology, Division of Virology, University of Cambridge, Cambridge, UK
| | - Johnny Kahlert
- Dep. Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Patti E Gravitt
- National Cancer Institute, University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Torben Steiniche
- Dep. Clinical Medicine, Aarhus University, Aarhus, Denmark
- Dep. Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Dep. Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- OPEN, University of Southern Denmark, Odense, Denmark
| | - Anne Hammer
- Dep. Clinical Medicine, Aarhus University, Aarhus, Denmark
- Dep. Gynecology and Obstetrics, Center for Research and Education, Gødstrup Hospital, Herning, Denmark
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Enomoto S, Yoshihara K, Kondo E, Iwata A, Tanaka M, Tabata T, Kudo Y, Kondoh E, Mandai M, Sugiyama T, Okamoto A, Saito T, Enomoto T, Ikeda T. Trends in Pregnancy-Associated Cervical Cancer in Japan between 2012 and 2017: A Multicenter Survey. Cancers (Basel) 2022; 14:cancers14133072. [PMID: 35804845 PMCID: PMC9264791 DOI: 10.3390/cancers14133072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Large-scale data on maternal and neonatal outcomes of pregnancy-associated cervical cancer in Japan are scarce, and treatment strategies have not been established. This multicenter retrospective observational study investigated clinical features and trends in pregnancy-associated cervical cancer treatments at 523 hospitals in Japan. We included cervical cancer cases that were histologically diagnosed (between 1 January 2012, and 31 December 2017), and their clinical information was retrospectively collected. Of 40 patients diagnosed with pregnancy-associated cervical cancer at ≥22 gestational weeks, 34 (85.0%) were carefully followed until delivery without intervention. Of 163 diagnosed at <22 gestational weeks, 111 continued and 52 terminated their pregnancy. Ninety patients with stage IB1 disease had various treatment options, including termination of pregnancy. The 59 stage IB1 patients who continued their pregnancy were categorized by the primary treatment into strict follow-up, conization, trachelectomy, and neoadjuvant chemotherapy groups, with no significant differences in progression-free or overall survival. The birth weight percentile at delivery was smaller in the neoadjuvant chemotherapy group than in the strict follow-up group (p = 0.029). Full-term delivery rate was relatively higher in the trachelectomy group (35%) than in the other groups. Treatment decisions for pregnancy-associated cervical cancer are needed after estimating the stage, considering both maternal and fetal benefits.
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Affiliation(s)
- Sayako Enomoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan;
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
- Correspondence: (E.K.); (T.E.); Tel.: +81-59-232-1111 (E.K.); +81-25-227-2320 (T.E.)
| | - Akiko Iwata
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan;
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Hiroshima University Graduate School of Medicine, Hiroshima 739-0046, Japan;
| | - Eiji Kondoh
- Department of Obstetrics and Gynecology, Kumamoto University School of Medicine, Kumamoto 860-8556, Japan;
| | - Masaki Mandai
- Department of Obstetrics and Gynecology, Kyoto University School of Medicine, Kyoto 606-8507, Japan;
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University School of Medicine, Ehime 791-0295, Japan;
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo 105-8471, Japan;
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo 060-8543, Japan;
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan;
- Correspondence: (E.K.); (T.E.); Tel.: +81-59-232-1111 (E.K.); +81-25-227-2320 (T.E.)
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
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Bergman H, Henschke N, Villanueva G, Loke YK, Golder SP, Dwan K, Crosbie EJ, Kyrgiou M, Platt J, Morrison J. Human papillomavirus (HPV) vaccination for the prevention of cervical cancer and other HPV-related diseases: a network meta-analysis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Yoon Kong Loke
- Norwich Medical School; University of East Anglia; Norwich UK
| | - Su P Golder
- Department of Health Sciences; University of York; York UK
| | - Kerry Dwan
- Methods Support Unit, Editorial & Methods Department; Cochrane Central Executive; London UK
| | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health; University of Manchester; Manchester UK
| | - Maria Kyrgiou
- IRDB, Department of Gut, Metabolism & Reproduction - Surgery & Cancer; Imperial College London; London UK
| | - Joanne Platt
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group; Royal United Hospital; Bath UK
| | - Jo Morrison
- Department of Gynaecological Oncology; Musgrove Park Hospital; Taunton UK
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The Effect of Surgeon Volume on the Outcome of Laser Vaporization: A Single-Center Retrospective Study. Curr Oncol 2022; 29:3770-3779. [PMID: 35621692 PMCID: PMC9139925 DOI: 10.3390/curroncol29050302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
Although laser vaporization is a popular minimally invasive treatment for cervical intraepithelial neoplasia (CIN), factors influencing CIN recurrence are understudied. Moreover, the effect of surgeon volume on patients’ prognosis after laser vaporization for CIN is unknown. This single-center retrospective study evaluated the predictive value of surgeon volume and patient characteristics for laser vaporization outcomes in women with pathologically confirmed CIN2. Histologically confirmed CIN2 or higher grade after laser vaporization was defined as persistent or recurrent. Various patient characteristics were compared between women with and those without recurrence to examine the predictive factors for laser vaporization. There were 270 patients with a median age of 36 (18–60) years. The median follow-up period was 25 (6–75.5) months and the median period between treatment and persistence or recurrence was 17 (1.5–69) months. The median annual number of procedures for all seven surgeons was 7.8. There were 38 patients (14.1%) with persistent or recurrent lesions—24 had CIN2, 13 had CIN3, and one had adenocarcinoma in situ. Patient age, body mass index, surgeon volume, and history of prior CIN treatment or invasive cervical cancer were not significantly correlated with lesion persistence or recurrence. In conclusion, laser vaporization has comparable success rates and is a feasible treatment for both low- and high-volume surgeons.
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Noninvasive Physical Plasma as Innovative and Tissue-Preserving Therapy for Women Positive for Cervical Intraepithelial Neoplasia. Cancers (Basel) 2022; 14:cancers14081933. [PMID: 35454839 PMCID: PMC9027888 DOI: 10.3390/cancers14081933] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The treatment of cervical intraepithelial neoplasia (CIN) is still associated with the use of invasive therapeutic procedures. Although CIN 1/2 lesions show high remission rates, treatment is necessary in individual cases and noninvasive and oncologically safe therapeutic options should be available for these patients. Here, we characterized the antineoplastic properties of noninvasive physical plasma (NIPP) at the in vitro, ex vivo and in vivo levels and performed a prospective, single-armed phase-IIb trial on 20 patients with CIN1/2 (NCT03218436). NIPP-treated dysplastic cell models exhibited significant cell growth retardation due to DNA damage, cell cycle arrest and apoptosis. A tissue level analysis showed a transmucosal tissue devitalization while preserving the tissue morphology. Within 24 weeks of follow-up, treatment success was achieved in 19 (95%) participants with CIN 1/2 without peri- or postinterventional complications. Therefore, NIPP may be a sufficient treatment alternative for CIN, other mucosal dysplasia and beyond. Abstract (1) Background: Cervical intraepithelial neoplasia (CIN) of long-term persistence or associated with individual treatment indications often requires highly invasive treatments. These are associated with risks of bleeding, infertility, and pregnancy complications. For low- and middle-income countries (LMICs), standard treatment procedures are difficult to implement and manage. We characterized the application of the highly energized gas “noninvasive physical plasma” (NIPP) for tissue devitalization and the treatment of CIN. (2) Methods: We report the establishment of a promising tissue devitalization procedure by NIPP application. The procedure was characterized at the in vitro, ex vivo and in vivo levels. We performed the first prospective, single-armed phase-IIb trial in 20 CIN1/2 patients (NCT03218436). (3) Results: NIPP-treated cervical cancer cells used as dysplastic in vitro model exhibited significant cell growth retardation due to DNA damage, cell cycle arrest and apoptosis. Ex vivo and in vivo tissue assessments showed a highly noninvasive and tissue-preserving treatment procedure which induces transmucosal tissue devitalization. Twenty participants were treated with NIPP and attended a 24-week follow-up. Treatment success was achieved in 19 (95%) participants without postinterventional complications other than mild to moderate discomfort during application. (4) Conclusions: The results from this study preliminarily suggest that NIPP could be used for an effective and tissue-preserving treatment for CIN without the disadvantages of standard treatments. However, randomized controlled trials must confirm the efficacy and noninferiority of NIPP compared to standard treatments.
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Lūse L, Urtāne AĶ, Lisovaja I, Jermakova I, Donders GGG, Vedmedovska N. Literature Review of Cervical Regeneration after Loop Electrosurgical Excision Procedure, and Study Project (CeVaLEP) Proposal. J Clin Med 2022; 11:jcm11082096. [PMID: 35456188 PMCID: PMC9030886 DOI: 10.3390/jcm11082096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Objective: To compile existing knowledge on the level of cervical regeneration (detected by ultrasound) after loop electrosurgical excision procedure (LEEP) and to suggest research protocol for further studies. Methods: We conducted a literature search of Medline, Web of Science, Scopus, and Cochrane databases using the keywords “cervix” and “regeneration” without year restrictions. Our eligibility criteria included studies that analysed cervical volume and length regeneration using ultrasound. A literature review was conducted following PRISMA guidelines and registered in PROSPERO (reg. no. CRD42021264062). Information about the studies was extracted from each analysed study on an Excel datasheet and the average regeneration with standard deviation was calculated. All included studies’ possible biases were assessed by the National Institutes of Health’s (NIH) quality assessment tool. Results: The literature search identified 802 papers and four trials (n = 309) that met our criteria. They investigated cervical length and volume regeneration after LEEP using ultrasound, concluding that there is a profound regeneration deficit. Average cervical length regeneration after 6 months was 83.4% (±10.8%) and volume regeneration was 87.4% (±6.1%). All analysed studies had their biases; therefore, based on the conducted studies’ protocols, we present a CeVaLEP research protocol to guide high-quality studies. Conclusion: After LEEP, there is a cervical regeneration deficit. There is a lack of high-quality studies that assess cervical volume regeneration and its relation to obstetrical outcomes. There is a gap in the field and more research is needed to define the prenatal risks related to cervical regeneration.
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Affiliation(s)
- Laura Lūse
- Faculty of Residency, Rīga Stradiņš University, LV-1007 Riga, Latvia;
- Correspondence:
| | - Anda Ķīvīte Urtāne
- Department of Public Health and Epidemiology, Rīga Stradiņš University, LV-1007 Riga, Latvia;
| | - Ija Lisovaja
- Faculty of Residency, Rīga Stradiņš University, LV-1007 Riga, Latvia;
| | - Irina Jermakova
- Gynecology Department, Riga Eastern Clinical University Hospital, LV-1079 Riga, Latvia;
| | - Gilbert G. G. Donders
- Department OB/Gyn, Antwerp University Hospital, 2650 Edegem, Belgium;
- Femicare VZW, Clinical Research for Women, 3300 Tienen, Belgium
| | - Natālija Vedmedovska
- Department of Obstetrics and Gynecology, Rīga Stradiņš University, LV-1007 Riga, Latvia;
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Muntinga CLP, de Vos van Steenwijk PJ, Bekkers RLM, van Esch EMG. Importance of the Immune Microenvironment in the Spontaneous Regression of Cervical Squamous Intraepithelial Lesions (cSIL) and Implications for Immunotherapy. J Clin Med 2022; 11:jcm11051432. [PMID: 35268523 PMCID: PMC8910829 DOI: 10.3390/jcm11051432] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/10/2022] Open
Abstract
Cervical high-grade squamous intraepithelial lesions (cHSILs) develop as a result of a persistent high-risk human papilloma virus (hrHPV) infection. The natural course of cHSIL is hard to predict, depending on a multitude of viral, clinical, and immunological factors. Local immunity is pivotal in the pathogenesis, spontaneous regression, and progression of cervical dysplasia; however, the underlying mechanisms are unknown. The aim of this review is to outline the changes in the immune microenvironment in spontaneous regression, persistence, and responses to (immuno)therapy. In lesion persistence and progression, the immune microenvironment of cHSIL is characterized by a lack of intraepithelial CD3+, CD4+, and CD8+ T cell infiltrates and Langerhans cells compared to the normal epithelium and by an increased number of CD25+FoxP3+ regulatory T cells (Tregs) and CD163+ M2 macrophages. Spontaneous regression is characterized by low numbers of Tregs, more intraepithelial CD8+ T cells, and a high CD4+/CD25+ T cell ratio. A ‘hot’ immune microenvironment appears to be essential for spontaneous regression of cHSIL. Moreover, immunotherapy, such as imiquimod and therapeutic HPV vaccination, may enhance a preexisting pro-inflammatory immune environment contributing to lesion regression. The preexisting immune composition may reflect the potential for lesion regression, leading to a possible immune biomarker for immunotherapy in cHSILs.
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Affiliation(s)
- Caroline L. P. Muntinga
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands; (C.L.P.M.); (R.L.M.B.)
- GROW—School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Peggy J. de Vos van Steenwijk
- GROW—School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
- Department of Gynecology and Obstetrics, Maastricht Universitair Medisch Centrum, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ruud L. M. Bekkers
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands; (C.L.P.M.); (R.L.M.B.)
- GROW—School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Edith M. G. van Esch
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands; (C.L.P.M.); (R.L.M.B.)
- Correspondence: ; Tel.: +31-402-399-111
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Mirandez CC, Yoneda JY, Gertrudes LN, Carvalho CF, Derchain S, Teixeira JC, Vale DB. The value of the endocervical margin status in LEEP: analysis of 610 cases. Arch Gynecol Obstet 2022; 306:851-856. [DOI: 10.1007/s00404-022-06464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022]
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Wiik J, Kärrberg C, Nilsson S, Strander B, Jacobsson B, Sengpiel V. Associations between cervical intraepithelial neoplasia during pregnancy, previous excisional treatment, cone-length and preterm delivery: a register-based study from western Sweden. BMC Med 2022; 20:61. [PMID: 35189872 PMCID: PMC8862518 DOI: 10.1186/s12916-022-02276-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excisional treatment of cervical intraepithelial neoplasia (CIN) has been associated with increased risk of preterm delivery (PTD), although the underlying mechanism is as yet unclear. Studies on formalin-fixed excised tissue indicate that the risk increases with cone-length, but the magnitude of increase is uncertain, especially in case of minor excisions (≤10 mm), as well compared to women with untreated CIN during pregnancy. This study assesses the impact of cone-length at previous treatment for CIN as well as diagnosis of CIN during pregnancy on the risk of PTD. METHODS A register-based cohort study in western Sweden linking cervical cytology, histology, and treatment data from the Swedish National Cervical Screening Registry to data on obstetric outcomes in singleton pregnancies 2008-2016 from the Swedish Medical Birth Registry. These groups were compared for PTD and other obstetric outcomes: (1) women with one excisional treatment (n=3250, including a subgroup (n=2408) with cone-length measured before fixation; (2) women with untreated CIN diagnosed during pregnancy (n=1380); and (3) women with normal cytology (n=42,398). Logistic regression analyses were adjusted for socioeconomic and health-related confounders. RESULTS Treated women had increased risk of PTD (adjusted odds ratio (aOR) 1.60, 95% confidence interval (CI) 1.21-2.12), spontaneous PTD (aOR 1.95, 95% CI 1.40-2.72) and preterm prelabor rupture of membranes (pPROM) (aOR 2.74, 95% CI 1.66-4.51) compared to the CIN during pregnancy group. ORs were similar when compared to the normal cytology group. Risks of these outcomes increased with cone-length. Mean cone-length was 9.1 mm. Cone-length ≤10 mm was associated with increased risk of PTD (aOR 1.41, 95% CI 1.02-1.94), spontaneous PTD (aOR 1.73, 95% CI 1.18-2.54), and pPROM (aOR 2.44, 95% CI 1.40-4.28), compared to the CIN during pregnancy group. The PTD risk was similar for cone-lengths 3-10 mm, thereafter increasing by 15% with each additional millimeter. CONCLUSIONS This study suggests that all excisional treatment, including small cones, are associated with increased risk of PTD and pPROM. Risks increase further with cone-length. In women of reproductive age, clinicians should aim to remove all CIN but minimal healthy cervical tissue. Cone-length should be recorded at treatment, for future prenatal risk estimation.
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Affiliation(s)
- Johanna Wiik
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Gynecology and Obstetrics, Østfold Hospital Trust, Kalnes, Norway. .,Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Cecilia Kärrberg
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Regional Cancer Centre West, Region Västra Götaland, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Björn Strander
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Centre West, Region Västra Götaland, Gothenburg, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Division of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Papoutsis D, Williams J, Underwood M, Parry-Smith W. Healing pattern of the cervical stroma following cold coagulation treatment for cervical intraepithelial neoplasia: A case report. Oncol Lett 2022; 23:81. [PMID: 35126723 DOI: 10.3892/ol.2022.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/05/2021] [Indexed: 11/06/2022] Open
Abstract
Cold coagulation of the cervix for cervical intraepithelial neoplasia (CIN), when compared with cervical excision, has previously demonstrated comparable cure rates and a reduction in the rate of spontaneous preterm birth. In the present report the healing pattern in the cervices of two women after cold coagulation is described. Both women underwent cold coagulation due to CIN3, which was found on pre-treatment cervical punch biopsies. They were followed up after cold coagulation and at 7 and 18 months, respectively, they underwent cervical excision. The histopathological slides from the excised specimen were reviewed, which represents the healed cervix after cold coagulation. A clear boundary of collagenisation was noted in the superficial stroma, which appeared to stop at the junction with the healthy muscular stroma. The collagenised superficial stroma depth, which represents the area that was thermally ablated and has now healed, measured 1.6 and 1.5 mm for the two women, respectively, which is less compared with that typically removed by cervical excision. Observations from these two cases indicate that cold coagulation does not appear to disrupt the deep tissue architecture of the cervix and could therefore explain the reduced levels of adverse obstetric morbidity in patients who underwent cold coagulation ablative treatment of the cervix, which has been previously reported.
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Affiliation(s)
- Dimitrios Papoutsis
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford TF16TF, UK.,Midwifery Department, School of Health Sciences, University of Western Macedonia, 50200 Kozani, Greece
| | - Joanna Williams
- Department of Histopathology, Shrewsbury and Telford Hospitals NHS Trust, Telford TF16TF, UK
| | - Martyn Underwood
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford TF16TF, UK
| | - William Parry-Smith
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford TF16TF, UK
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Perkins RB, Werner C, Wentzensen N. What Contributes to Pregnancy Complications Among Women With Cervical Intraepithelial Neoplasia Grade 3? Ann Intern Med 2022; 175:293-294. [PMID: 35130047 DOI: 10.7326/m21-4666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Claudia Werner
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicolas Wentzensen
- Department of Clinical Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Tantengco OAG, Menon R. Breaking Down the Barrier: The Role of Cervical Infection and Inflammation in Preterm Birth. Front Glob Womens Health 2022; 2:777643. [PMID: 35118439 PMCID: PMC8803751 DOI: 10.3389/fgwh.2021.777643] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/27/2021] [Indexed: 01/06/2023] Open
Abstract
Approximately 40% of cases of spontaneous preterm birth (sPTB) are associated with ascending intrauterine infections. The cervix serves as a physical and immunological gatekeeper, preventing the ascent of microorganisms from the vagina to the amniotic cavity. The cervix undergoes remodeling during pregnancy. It remains firm and closed from the start until the late third trimester of pregnancy and then dilates and effaces to accommodate the passage of the fetus during delivery. Remodeling proceeds appropriately and timely to maintain the pregnancy until term delivery. However, risk factors, such as acute and chronic infection and local inflammation in the cervix, may compromise cervical integrity and result in premature remodeling, predisposing to sPTB. Previous clinical studies have established bacterial (i.e., chlamydia, gonorrhea, mycoplasma, etc.) and viral infections (i.e., herpesviruses and human papillomaviruses) as risk factors of PTB. However, the exact mechanism leading to PTB is still unknown. This review focuses on: (1) the epidemiology of cervical infections in pregnant patients; (2) cellular mechanisms that may explain the association of cervical infections to premature cervical ripening and PTB; (3) endogenous defense mechanisms of the cervix that protect the uterine cavity from infection and inflammation; and (4) potential inflammatory biomarkers associated with cervical infection that can serve as prognostic markers for premature cervical ripening and PTB. This review will provide mechanistic insights on cervical functions to assist in managing cervical infections during pregnancy.
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Affiliation(s)
- Ourlad Alzeus G. Tantengco
- Division of Basic and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Ramkumar Menon
- Division of Basic and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
- *Correspondence: Ramkumar Menon
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Phototheranostics of Cervical Neoplasms with Chlorin e6 Photosensitizer. Cancers (Basel) 2022; 14:cancers14010211. [PMID: 35008375 PMCID: PMC8750251 DOI: 10.3390/cancers14010211] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Neoplasms of the cervix are the most common types of oncological pathology. Photodynamic therapy with intravenous administration of the photosensitizer chlorin e6 shows high efficiency in the treatment of precancerous lesions of the cervix with complete eradication of the human papillomavirus. The treatment method can reduce deaths from cervical cancer and preserve fertility in patients. Spectral and video fluorescence diagnostics allows intraoperatively assessing the degree of photosensitizer accumulation and photobleaching and visualizing the boundaries of pathologically altered tissues. Abstract (1) Purpose: Improving the treatment effectiveness of intraepithelial neoplasia of the cervix associated with human papillomavirus infection, based on the application of the method of photodynamic therapy with simultaneous laser excitation of fluorescence to clarify the boundaries of cervical neoplasms. (2) Methods: Examination and treatment of 52 patients aged 22 to 53 years with morphologically and cytologically confirmed mild to severe intraepithelial cervix neoplasia, preinvasive, micro-invasive, and squamous cell cervix carcinoma. All patients were carriers of human papillomavirus infection. The patients underwent photodynamic therapy with simultaneous laser excitation of fluorescence. The combined use of video and spectral fluorescence diagnostics for cervical neoplasms made it possible to control the photodynamic therapy process at all stages of the procedure. Evaluation of the photodynamic therapy of intraepithelial cervical neoplasms was carried out with colposcopic examination, cytological conclusion, and morphological verification of the biopsy material after the photodynamic therapy course. The success of human papillomavirus therapy was assessed based on the results of the polymerase chain reaction. (3) Results. The possibility of simultaneous spectral fluorescence diagnostics and photodynamic therapy using a laser source with a wavelength of 660 nm has been established, making it possible to assess the fluorescence index in real-time and control the photobleaching of photosensitizers in the irradiated area. The treatment of all 52 patients was successful after the first photodynamic therapy procedure. According to the PCR test of the discharge from the cervical canal, the previously identified HPV types were not observed in 48 patients. Previously identified HPV types were absent after repeated PDT in four patients (CIN III (n = 2), CIS (n = 2)). In 80.8% of patients, regression of the lesion was noted. (4) Conclusions. The high efficiency of photodynamic therapy with intravenous photosensitizer administration of chlorin e6 has been demonstrated both in relation to eradication therapy of human papillomavirus and in relation to the treatment of intraepithelial lesions of the cervix.
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Cokan A, Pakiž M, Serdinšek T, Dovnik A, Kodrič T, Repše Fokter A, Kavalar R, But I. Comparison of Conservative Treatment of Cervical Intraepithelial Lesions with Imiquimod with Standard Excisional Technique Using LLETZ: A Randomized Controlled Trial. J Clin Med 2021; 10:5777. [PMID: 34945073 PMCID: PMC8706260 DOI: 10.3390/jcm10245777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023] Open
Abstract
(1) Background: There are limited data on the success of conservative treatment of high-grade cervical squamous intraepithelial lesions (HSIL) with imiquimod directly compared to standard of treatment with LLETZ. (2) Methods: Patients aged 18-40 with histological HSIL (with high-grade cervical intraepithelial neoplasia, CIN2p16+ and CIN3), were randomly assigned to treatment with imiquimod or LLETZ. The primary outcome was defined as the absence of HSIL after either treatment modality. The secondary outcomes were the occurrence of side effects. (3) Results: 52 patients were allocated in each group and were similar regarding baseline characteristics. In the imiquimod group, 82.7% of patients completed treatment, which was successful in 51.9%. All patients in the LLETZ group completed treatment, which was successful in 92.3% (p < 0.001). In the subgroup of CIN2p16+ patients, treatment with imiquimod was not inferior to LLETZ (73.9% vs. 84.2%, p = 0.477). During and after treatment, no cases of progression to cancer were observed. Side effects and severe side effects (local and systemic) were more prevalent in the imiquimod than in the LLETZ group (88.5% vs. 44.2% (p-value < 0.001) and 51.9% vs. 13.5% (p-value < 0.001), respectively). (4) Conclusion: Generally, in patients with HSIL, LLETZ remains the gold standard of treatment. However, in a subgroup analysis of patients with CIN2p16+, the success rate was comparable between the two treatment modalities. Due to the prevalence of side effects, the treatment compliance with imiquimod use may, however, present a clinically important issue.
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Affiliation(s)
- Andrej Cokan
- Department for Gynaecological and Breast Oncology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (M.P.); (A.D.); (T.K.)
| | - Maja Pakiž
- Department for Gynaecological and Breast Oncology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (M.P.); (A.D.); (T.K.)
| | - Tamara Serdinšek
- Department for General Gynaecology and Urogynaecology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (T.S.); (I.B.)
| | - Andraž Dovnik
- Department for Gynaecological and Breast Oncology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (M.P.); (A.D.); (T.K.)
| | - Tatjana Kodrič
- Department for Gynaecological and Breast Oncology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (M.P.); (A.D.); (T.K.)
| | - Alenka Repše Fokter
- Medical Faculty Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia;
- General Hospital Celje, Oblakova Ulica 5, 3000 Celje, Slovenia
| | - Rajko Kavalar
- Department for Pathology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia;
| | - Igor But
- Department for General Gynaecology and Urogynaecology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia; (T.S.); (I.B.)
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Park HS, Kim HS, Lee SA, Yoon J, Kim EH. Prophylactic Cerclage to Prevent Preterm Birth after Conization: A Cohort Study Using Data from the National Health Insurance Service of Korea. Yonsei Med J 2021; 62:1083-1089. [PMID: 34816638 PMCID: PMC8612859 DOI: 10.3349/ymj.2021.62.12.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/25/2021] [Accepted: 09/07/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate potential differences in the frequency of preterm births (PTB) between pregnancies with or without prophylactic cerclage in women with a history of conization. MATERIALS AND METHODS We identified women who had their first singleton delivery after conization between 2013 and 2018 using records in the National Health Insurance Service of Korea claims database. We only included women who had undergone a health examination and interview within 2 years before delivery. We used timing of maternal serum alpha-fetoprotein (MSAFP) tests to differentiate early (before) from late (after the MSAFP test) cerclage. The frequency of adverse pregnancy outcomes, including PTB, preterm labor and premature rupture of membranes, antibiotics and tocolytics use, cesarean delivery, and number of admissions before delivery, were compared. RESULTS A total of 8322 women was included. Compared to the no cerclage group (n=7147), the risks of adverse pregnancy outcomes were higher in the cerclage group (n=1175). After categorizing patients with cerclage into two groups, the risk of PTB was still higher in the early cerclage group than in the no cerclage group after adjusting for baseline factors (4.48%, 30/669 vs. 2.77%, 159/5749, odds ratio 2.42, 95% confidence interval 1.49, 3.92). Other adverse pregnancy outcomes were also more frequent in the early cerclage group than the no cerclage group. CONCLUSION Early cerclage performed before MSAFP testing does not prevent PTB in pregnancy with a history of conization, but increases the risk of adverse pregnancy outcomes, including PTB.
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Affiliation(s)
- Hyun Soo Park
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hee-Sun Kim
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang Ah Lee
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jisun Yoon
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Targeted Protein Profiling of In Vivo NIPP-Treated Tissues Using DigiWest Technology. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112311238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Non-invasive physical plasma (NIPP) is a novel therapeutic tool, currently being evaluated for the treatment of cancer and precancerous lesions in gynecology and other disciplines. Additionally, patients with cervical intraepithelial neoplasia (CIN) may benefit from NIPP treatment due to its non-invasive, side-effect-free, and tissue-sparing character. However, the molecular impact of in vivo NIPP treatment needs to be further investigated. For this purpose, usually only very small tissue biopsies are available after NIPP treatment. Here, we adapted DigiWest technology, a high-throughput bead-based Western blot, for the analysis of formalin-fixed paraffin-embedded (FFPE) cervical punch biopsies with a minimal sample amount. We investigated the molecular effects of NIPP treatment directly after (0 h) and 24 h after in vivo application. Results were compared to in vitro NIPP-treated human malignant cervical cells. NIPP effects were primarily based on an inhibitory impact on the cell cycle and cell growth factors. DigiWest technology was suitable for detailed protein profiling of small, primary FFPE biopsies.
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Muvunyi TZ, Rohner E, O'Connor S, Kalebi AY, Waweru W, Kairu J, Ochuk W, Smith JS, Muchiri LW. Utility of p16INK4a expression for the interpretation of uterine cervical biopsies in Kenya. Pan Afr Med J 2021; 40:55. [PMID: 34795834 PMCID: PMC8571924 DOI: 10.11604/pamj.2021.40.55.21116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 10/29/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction histologic interpretation of hematoxylin and eosin-stained cervical biopsies is subject to substantial discordance among pathologists. Immunohistochemical staining for p16INK4a can reduce inter-observer disagreement. We did a cross-sectional study to evaluate the utility of p16INK4a staining in the assessment of cervical biopsies in Nairobi, Kenya. Methods hematoxylin and eosin-stained sections from 91 colposcopic biopsies diagnosed as negative for dysplasia or as cervical intraepithelial neoplasia (CIN) grade 1-3 from 2011-2013 in Nairobi, Kenya, were reviewed and immunostained for p16INK4a. Agreement in interpretation of cervical biopsies was compared between primary and consensus review results. Results on primary evaluation, 16 cases were negative for squamous dysplasia; 23 were CIN 1; 37 CIN 2; and 15 CIN 3. On consensus review, 32 cases were negative for dysplasia; 19 were CIN 1; 16 CIN 2 and 24 CIN 3. Agreement was moderate between primary and consensus histology review results for the diagnosis of low-grade versus high-grade squamous intraepithelial lesions (Kappa = 0.568). None of the cases negative for dysplasia were positive for p16INK4a expression, but in primary and consensus review results, 17% and 5% cases of CIN 1; 49% and 69% of CIN 2, and 80% and 96% of CIN 3 were p16INK4a positive, respectively. Conclusion there was significant variability in the interpretation of cervical biopsies on hematoxylin and eosin between primary and consensus review assessments. 75% of CIN 1 cases that were upgraded to CIN 2 during consensus review expressed p16INK4a. These findings demonstrate the role of p16INK4a in increasing diagnostic accuracy and as a marker of high-grade CIN 2/3.
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Affiliation(s)
- Thierry Zawadi Muvunyi
- Department of Pathology, University of Nairobi, School of Health Sciences, Nairobi, Kenya
| | - Eliane Rohner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Siobhan O'Connor
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Wairimu Waweru
- Department of Pathology, University of Nairobi, School of Health Sciences, Nairobi, Kenya
| | - John Kairu
- Department of Pathology, University of Nairobi, School of Health Sciences, Nairobi, Kenya
| | - Willis Ochuk
- Department of Pathology, University of Nairobi, School of Health Sciences, Nairobi, Kenya
| | - Jennifer Susan Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Lucy Wangari Muchiri
- Department of Pathology, University of Nairobi, School of Health Sciences, Nairobi, Kenya
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Mitra A, MacIntyre DA, Paraskevaidi M, Moscicki AB, Mahajan V, Smith A, Lee YS, Lyons D, Paraskevaidis E, Marchesi JR, Bennett PR, Kyrgiou M. The vaginal microbiota and innate immunity after local excisional treatment for cervical intraepithelial neoplasia. Genome Med 2021; 13:176. [PMID: 34736529 PMCID: PMC8567681 DOI: 10.1186/s13073-021-00977-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Vaginal microbiota (VMB) composition is altered in women with cervical intra-epithelial neoplasia (CIN) compared to healthy controls and is associated with disease progression. However, the impact of CIN excision on the VMB and innate immunity is not known. This observational study aims to explore the impact of CIN excision on the VMB, antimicrobial peptides (AMP) and proinflammatory cytokines. METHODS We sampled 103 non-pregnant, premenopausal women at the time of excisional treatment for CIN and at their 6-month follow-up visit. A further 39 untreated controls with normal cytology were also sampled. We used metataxonomics to group vaginal swab samples into community state types (CSTs) and ELISA to quantify cytokine and AMP levels in matched vaginal secretions. Analyses were performed to compare the bacterial composition and immune analyte levels before and after CIN excision and in healthy controls. RESULTS Women with CIN had significantly higher rates of Lactobacillus species depletion pre-treatment compared to healthy controls (CST IV 21/103, 20% vs 1/39, 3%, p = 0.0081). Excision did not change the VMB composition, with CST IV remaining significantly more prevalent after excision compared to untreated, healthy controls (CST IV 19/103, 20% vs 1/39, 3%, p = 0.0142). Prevotella bivia and Sneathia amnii were significantly higher in samples before treatment compared to untreated controls, and Prevotella bivia remained significantly higher amongst the treated, with less Lactobacillus crispatus compared to untreated controls. IL-1β and IL-8 remained significantly elevated pre- (p < 0.0001 and p = 0.0014, respectively) and post-treatment (p < 0.0001 and p = 0.0035, respectively) compared to untreated controls. Levels of human beta-defensin-1 and secretory leukocyte protease inhibitor were both significantly reduced following CIN excision (p < 0.0001); however, their levels remained lower than controls post-treatment. CONCLUSIONS Women with CIN have an increased prevalence of Lactobacillus sp. depletion, high-diversity VMB composition, and higher levels of proinflammatory cytokines and AMPs compared to normal controls. Surgical excision of the disease reduces levels of vaginal AMPs but does not alter VMB composition or cytokine levels. These findings suggest that women with CIN have an inherent predisposition to a high-diversity proinflammatory environment that is not corrected by disease excision. The failure to re-establish a Lactobacillus-enriched CST may explain why women remain at high risk of pre-invasive and invasive disease recurrence.
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Affiliation(s)
- Anita Mitra
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Imperial College London, London, W12 0NN, UK
- Department of Obstetrics & Gynaecology, Imperial College NHS Trust, London, W120HS, UK
| | - David A MacIntyre
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Maria Paraskevaidi
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Anna-Barbara Moscicki
- Ronald Reagan UCLA Medical Center, UCLA Mattel Children's Hospital, Santa Monica, CA, USA
| | - Vishakha Mahajan
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Ann Smith
- Faculty of Health and Applied Sciences, University West of England, Bristol, Glenside Campus, Bristol, BS16 1DD, UK
| | - Yun S Lee
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Deirdre Lyons
- Department of Obstetrics & Gynaecology, Imperial College NHS Trust, London, W120HS, UK
| | - Evangelos Paraskevaidis
- Department of Obstetrics & Gynaecology, Imperial College NHS Trust, London, W120HS, UK
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - Julian R Marchesi
- Division of Digestive Diseases, Imperial College London, London, W2 1NY, UK
| | - Phillip R Bennett
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Imperial College London, London, W12 0NN, UK
- Department of Obstetrics & Gynaecology, Imperial College NHS Trust, London, W120HS, UK
| | - Maria Kyrgiou
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction - Surgery and Cancer, Imperial College London, London, W12 0NN, UK.
- Department of Obstetrics & Gynaecology, Imperial College NHS Trust, London, W120HS, UK.
- IRDB, Department of Gut, Metabolism and Reproduction - Surgery and Cancer, Imperial College London, Hammersmith Campus, 3rd Floor, Du Cane Road, London, W12 0NN, UK.
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Wormald B, Rodriguez-Manzano J, Moser N, Pennisi I, Ind TEJ, Vroobel K, Attygalle A, Georgiou P, deSouza NM. Loop-Mediated Isothermal Amplification Assay for Detecting Tumor Markers and Human Papillomavirus: Accuracy and Supplemental Diagnostic Value to Endovaginal MRI in Cervical Cancer. Front Oncol 2021; 11:747614. [PMID: 34790573 PMCID: PMC8591099 DOI: 10.3389/fonc.2021.747614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To establish the sensitivity and specificity of a human papillomavirus (HPV) and tumor marker DNA/mRNA assay for detecting cervical cancer that is transferrable to a Lab-on-a-chip platform and determine its diagnostic benefit in early stage disease when used in conjunction with high-resolution endovaginal magnetic resonance imaging (MRI). METHODS Forty-one patients (27 with Stage1 cervical cancer [Group1] and 14 non-cancer HPV negative controls [Group2]) had DNA and RNA extracted from cervical cytology swab samples. HPV16, HPV18, hTERT, TERC/GAPDH and MYC/GAPDH concentration was established using a loop mediated isothermal amplification (LAMP) assay. Thresholds for tumor marker detection for Group1 were set from Group2 analysis (any hTERT, TERC/GAPDH 3.12, MYC/GAPDH 0.155). Group 1 participants underwent endovaginal MRI. Sensitivity and specificity for cancer detection by LAMP and MRI individually and combined was documented by comparison to pathology. RESULTS Sensitivity and specificity for cancer detection was 68.8% and 77.8% if any tumor marker was positive regardless of HPV status (scenario1), and 93.8% and 55.8% if tumor marker or HPV were positive (scenario 2). Adding endovaginal MRI improved specificity to 88.9% in scenario 1 (sensitivity 68.8%) and to 77.8%% in scenario2 (sensitivity 93.8%). CONCLUSION Specificity for cervical cancer detection using a LAMP assay is superior with tumor markers; low sensitivity is improved by HPV detection. Accuracy for early stage cervical cancer detection is optimal using a spatially multiplexed tumor marker/HPV LAMP assay together with endovaginal MRI.
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Affiliation(s)
- Benjamin Wormald
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Jesus Rodriguez-Manzano
- Department of Infectious Disease, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nicolas Moser
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Ivana Pennisi
- Department of Infectious Disease, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Thomas E. J. Ind
- Departmentof Surgical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Katherine Vroobel
- Department of Histopathology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ayoma Attygalle
- Department of Histopathology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pantelis Georgiou
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Nandita M. deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- MRI Unit, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Tirone NR, Campos CG, Ferreira KJA, Stark LM, Vieira JF, Murta EFC, Michelin MA. Pathways of IFN-alpha Activation in Patients with Cervical Intraepithelial Neoplasia (CIN). REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:682-689. [PMID: 34670303 PMCID: PMC10183884 DOI: 10.1055/s-0041-1735301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The aim of the present study was to compare the local and systemic expression of the factors linked to the interferon alpha (IFN-α) activation pathway in different degrees of cervical intraepithelial neoplasia (CIN) and cervical cancer. METHODS A total of 128 patients with CIN I, CIN II, CIN III and cervical cancer was evaluated. The real-time polymerase chain reaction (RT-PCR) technique was used to evaluate the gene expression of IFNR1, IFNR2, IFN-α, oligoadenylate synthase (2'5'OAS), cytokine signal suppressor 1 (SOCS) 1, SOCS3, signal transducer and transcription activator 1 (STAT1), and IRF9 from 128 biopsies. A total of 46 out of 128 samples were evaluated by flow cytometry for IFNAR1, IFNAR2, STAT1, IRF7 and IFN-α in peripheral blood cells. RESULTS Patients with CIN II and III (63 samples) had a low local expression of IFNR1, but not IFNR2. Patients with some degree of injury showed high expression of SOCS1 and SOCS3. Systemically, patients with CIN II and III (20 samples) had a significant increase in IFNR1, IFNR2, STAT1, IRF7, and IFN-α in helper, cytotoxic T lymphocytes, and in monocytes. CONCLUSION Patients with high-grade lesions have increased systemic expression of IFN-α and its activation pathways in helper and cytotoxic T lymphocytes, as well as in monocytes due to an exacerbation of the immune response in these patients. This phenomenon is not accompanied by resolution of the lesion due to a defect in the IFN-α activation pathway that revealed by low local IFNAR1 expression and high local expression of SOCS1 and SOCS3.
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Affiliation(s)
- Nelson Ranieri Tirone
- Instituto de Pesquisa em Oncologia, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | - Carolina Guissoni Campos
- Instituto de Pesquisa em Oncologia, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | | | - Léticia Montes Stark
- Instituto de Pesquisa em Oncologia, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | - Jéssica Ferreira Vieira
- Instituto de Pesquisa em Oncologia, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | - Eddie Fernando Cândido Murta
- Instituto de Pesquisa em Oncologia, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.,Department of Gynecology and Obstetrics, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | - Márcia Antoniazi Michelin
- Instituto de Pesquisa em Oncologia, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.,Discipline of Immunology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
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The impact of cervical conization size with subsequent cervical length changes on preterm birth rates in asymptomatic singleton pregnancies. Sci Rep 2021; 11:19703. [PMID: 34611206 PMCID: PMC8492699 DOI: 10.1038/s41598-021-99185-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023] Open
Abstract
The study aimed to explore the impact of cervical conization size (CCS) with subsequent cervical length (USCL) changes on preterm birth (PTB) rates in asymptomatic singleton pregnancies as compared to pregnancy outcomes in healthy women with an intact cervix (ICG), and to estimate PTB prevention efficiency in patients with a short cervix. Pregnancy outcomes in populations of similar age, ethnicity, residency, education and harmful habits having undergone cervical conization (CCG) were retrospectively analyzed and compared to ICG and cervical conization sub-populations adjusted by USCL during pregnancy (adequate cervical length vs. a short cervix) and a progesterone-only group (POG) vs. a progesterone-pessary group (PPG). Cervical conization was not associated with an increased PTB risk (CCG vs. ICG) when parameters of CCS and USCL were not adjusted (p = NS). A significantly higher proportion of parous women was observed in the CCG population than in the ICG (p = 0.0019). CCS turned out to be a key PTB risk during pregnancy, the larger CCS being associated with a short cervix (p = 0.0001) and higher PTB risks (p = 0.0001) with a notably increased PTB rate (p = 0.0001) in nulliparous women (p = 0.0022), whereas smaller CCS with adequate cervical length and a lower PTB rate was predominantly observed in women with prior parity. An initial equal USCL size was to be considerably elongated in women with adequate cervical length (p < 0.0001), and shortened in those with a short cervix (p < 0.0001). USCL assessment during pregnancy proved to be the PTB risk-predicting tool, with CCS supplementation apt to increase its diagnostic value. No substantial impact on pregnancy outcomes could be linked to any particular PTB prevention mode (POG or PPV). However, during pregnancy, the USCL changes relating to CCS proved to be more critical in pregnancy outcomes.
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Yuill S, Velentzis LS, Smith M, Egger S, Wrede CD, Bateson D, Arbyn M, Canfell K. The impact of HPV vaccination beyond cancer prevention: effect on pregnancy outcomes. Hum Vaccin Immunother 2021; 17:3562-3576. [PMID: 34506257 PMCID: PMC8437490 DOI: 10.1080/21645515.2021.1936860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/22/2021] [Indexed: 10/20/2022] Open
Abstract
While the benefits of human papillomavirus (HPV) vaccination relating to cervical cancer prevention have been widely documented, recent published evidence is suggestive of an impact on adverse pregnancy outcomes (APOs) in vaccinated mothers and their infants, including a reduction in rates of preterm births and small for gestational age infants. In this review, we examine this evidence and the possible mechanisms by which HPV vaccination may prevent these APOs. Large-scale studies linking HPV vaccination status with birth registries are needed to confirm these results. Potential confounding factors to consider in future analyses include other risk factors for APOs, and historical changes in both the management of cervical precancerous lesions and prevention of APOs. If confirmed, these additional benefits of HPV vaccination in reducing APO rates will be of global significance, due to the substantial health, social and economic costs associated with APOs, strengthening the case for worldwide HPV immunization.
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Affiliation(s)
- Susan Yuill
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Louiza S. Velentzis
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Megan Smith
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Sam Egger
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - C. David Wrede
- Department of Oncology & Dysplasia, Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Family Planning NSW, Australia
- Discipline of Obstetrics, Gynaecology & Neonatology, Faculty of Medicine and Health, The University of Sydney School of Medicine, Sydney, Australia
| | - Marc Arbyn
- Unit Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Karen Canfell
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
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Giannella L, Delli Carpini G, Di Giuseppe J, Bogani G, Gardella B, Monti E, Liverani CA, Ghelardi A, Insinga S, Montanari M, Raspagliesi F, Spinillo A, Vercellini P, Roncella E, Ciavattini A. Trend of HPV 16/18 Genotypes in Cervical Intraepithelial Neoplasia Grade 3: Data for 2007-2018. Infect Drug Resist 2021; 14:3763-3771. [PMID: 34557001 PMCID: PMC8453441 DOI: 10.2147/idr.s326851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Aim In the post-vaccination era, the starting age and time intervals of cervical screening could change (older age and longer screening intervals). This scenario may be achieved by significantly reducing human papillomavirus (HPV) 16/18 prevalence (genotypes included in the current vaccines). In this regard, assessing the trend over time of these HPV infections in high-grade cervical lesions can provide information on the objective. The present study aimed to evaluate the trend of HPV 16/18 over the years 2007–2018 in women with cervical intraepithelial neoplasia (CIN) grade 3. Methods This is a retrospective multi-institutional study including HPV genotyped and unvaccinated women under 30 with CIN3. The sample was divided into the following periods: 2007–2010, 2011–2014, 2015–2018. HPV genotypes were grouped in genotypes 16/18, genotypes 31/33/35/52/58/67 (genetically related to HPV16), genotypes 39/45/59/68/70 (genetically related to HPV18), genotypes 31/33/45/52/58 (high-risk types included in the nonavalent vaccine), possibly carcinogenic HPV (genotypes 26/30/53/67/70/73/82/85), low-risk HPV (genotypes 6/11/40/42/43/44/54/55/61). The trend between periods and HPV genotypes was measured using the Cochran–Armitage test for trend. Results The final analysis included 474 participants. HPV 16/18 prevalence decreased significantly over the years (77.8% vs 68.9% vs 66.0%, respectively, Ptrend=0.027). Possibly carcinogenic HPV (genotypes 26/30/53/67/70/73/82/85) showed a significant negative prevalence trend over time (4.9% vs 1.1% vs 1.3%, respectively, Ptrend=0.046). Finally, there was a significant positive trend over the years for high-risk HPV genotypes 31/33/45/52/58 in women under 25 (9.9% vs 17.0% vs 24.0%, respectively, Ptrend=0.048). Conclusion The prevalence of CIN3 lesions related to HPV 16/18 genotypes decreased over time from 2007 to 2018. These data highlight a herd effect of the HPV vaccine. However, fifteen years after HPV vaccine introduction, we are still a long way from herd immunity. The increase in high-risk types 31/33/45/52/58 will need to be reassessed when the nonavalent vaccine impact will be more reliable.
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Affiliation(s)
- Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Ermelinda Monti
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Carlo Antonio Liverani
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy
| | - Salvatore Insinga
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Michele Montanari
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elena Roncella
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
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Niyibizi J, Mayrand MH, Audibert F, Monnier P, Brassard P, Laporte L, Lacaille J, Zahreddine M, Bédard MJ, Girard I, Francoeur D, Carceller AM, Lacroix J, Fraser W, Coutlée F, Trottier H. Association Between Human Papillomavirus Infection Among Pregnant Women and Preterm Birth. JAMA Netw Open 2021; 4:e2125308. [PMID: 34524433 PMCID: PMC8444026 DOI: 10.1001/jamanetworkopen.2021.25308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Preterm birth remains a leading cause of perinatal mortality and lifelong morbidity worldwide. The cause of most preterm births is unknown, although several infectious processes have been implicated. OBJECTIVE To assess whether human papillomavirus (HPV) infection, a frequent infection among women of childbearing age, is associated with preterm birth. DESIGN, SETTING, AND PARTICIPANTS The prospective HERITAGE cohort study was conducted at 3 academic hospitals in Montreal, Québec, Canada, among 899 pregnant women recruited between November 8, 2010, and October 16, 2016. Follow-up was completed on June 15, 2017. Statistical analysis was conducted from February 6, 2020, to January 21, 2021. EXPOSURES Vaginal HPV DNA detection in the first and third trimesters of pregnancy and placental HPV infection. MAIN OUTCOMES AND MEASURES The main outcome was preterm birth (defined as a live birth or stillbirth between 20 weeks and 0 days and 36 weeks and 6 days of gestation). The association between HPV DNA detection and preterm birth was measured using logistic regression. Odds ratios (ORs) and 95% CIs were adjusted by inverse probability of treatment weights of the propensity score. RESULTS The study included 899 women (mean [SD] age, 31.3 [4.6] years [range, 19-47 years]) with singleton pregnancies. A total of 378 women (42.0%) had HPV DNA detected in vaginal samples collected during the first trimester, and it was detected in 91 of 819 placentas (11.1%) at delivery. Fifty-five participants experienced preterm birth (38 spontaneous and 17 medically indicated). Persistent vaginal HPV-16/18 detection was significantly associated with all preterm births (adjusted OR [aOR], 3.72; 95% CI, 1.47-9.39) and spontaneous preterm births (aOR, 3.32; 95% CI, 1.13-9.80), as was placental HPV infection (all preterm births: aOR, 2.53; 95% CI, 1.06-6.03; spontaneous preterm births: aOR, 2.92; 95% CI, 1.09-7.81). Results were similar when restricting the analysis to participants without a history of cervical intraepithelial neoplasia treatment. CONCLUSIONS AND RELEVANCE The study's results suggest that persistent HPV-16/18 infection is associated with an increased risk of preterm birth, independent of cervical treatment. Future studies should investigate the association of HPV vaccination and vaccination programs with the risk of preterm birth.
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Affiliation(s)
- Joseph Niyibizi
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Hélène Mayrand
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Patricia Monnier
- Department of Obstetrics and Gynecology, McGill University, Montreal, Québec, Canada
- Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | - Paul Brassard
- Research Institute of the McGill University Health Center, Montreal, Québec, Canada
- Division of Clinical Epidemiology, McGill University, Montreal, Québec, Canada
| | - Louise Laporte
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Julie Lacaille
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Monica Zahreddine
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, St-Mary’s Hospital Center, Montreal, Québec, Canada
| | - Diane Francoeur
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Ana Maria Carceller
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - François Coutlée
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
- Département Clinique de Médecine de Laboratoire, Service de Biologie Moléculaire, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Département de Médecine, Service d’Infectiologie, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Québec, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
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Han JY, Wong WL, Chan JKY. Labor Complicated by Cervical Stenosis Following a Laser Cone Biopsy. J Med Cases 2021; 12:13-15. [PMID: 34434420 PMCID: PMC8383636 DOI: 10.14740/jmc3605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
A 34-year-old lady, with three previous spontaneous vaginal deliveries, presented in labor at 37 + 0 weeks’ gestation. Following the birth of her third child, she underwent a laser cone biopsy for cervical intraepithelial neoplasia (CIN) 3. Despite sustained regular contractions and augmentation with Syntocinon, progressive cervical dilatation beyond 1 cm failed to occur in this multiparous lady. A delayed diagnosis of cervical stenosis was made. She eventually underwent a cesarean section where her internal cervical os was found to be thin and fibrotic. This case describes an uncommon occurrence of cervical stenosis presenting in labor and seeks to increase awareness of this condition so as to allow preemptive counselling of similar patients, early recognition in a labor with poor progress and a swift, better-informed decision to deliver via an emergency cesarean section. We review the existing literature on cervical stenosis following cervical conization and analyze the various definitions available.
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Affiliation(s)
- Jonathan Y Han
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wai Loong Wong
- Department of Gynecological Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jerry K Y Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
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50
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Basile M, Calabrò GE, Ghelardi A, Ricciardi R, De Vincenzo R, Cicchetti A. HPV Vaccination in Women Treated for Cervical Intraepithelial Neoplasia: A Budget Impact Analysis. Vaccines (Basel) 2021; 9:816. [PMID: 34451941 PMCID: PMC8402448 DOI: 10.3390/vaccines9080816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Human Papillomavirus (HPV) is the most common sexually transmitted infection. Its progression is related to the development of malignant lesions, particularly cervical intraepithelial neoplasias (CINs). CINs correlate with a higher risk of premature births, and their excisional and ablative treatment further increases this risk in pregnant women. These complications are also correlated with higher healthcare costs for their management. In Italy, more than 26,000 new cases of CINs are estimated to occur yearly and their economic burden is significant. Therefore, the management of these conditions is a public health priority. Since HPV vaccination is associated with a reduced risk of relapse in women surgically treated for HPV-related injuries, we estimated the economic impact of extending HPV vaccination to this target population. This strategy would result in a significant reduction in the general costs of managing these women, resulting in an overall saving for the Italian Health Service of €155,596.38 in 5 years. This lower cost is due not only to the reduced incidence of CINs following vaccination, but also to the lower occurrence of preterm births. Extending HPV vaccination to this target population as part of a care path to be offered to women treated for HPV injuries is therefore desirable.
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Affiliation(s)
- Michele Basile
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.B.); (A.C.)
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Alessandro Ghelardi
- Azienda USL Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Via Enrico Mattei, 21, 54100 Massa, Italy;
| | - Roberto Ricciardi
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Rosa De Vincenzo
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, 00168 Rome, Italy;
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.B.); (A.C.)
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