Reducing death from cervical cancer examining the prevention paradigms

Comparison of Pap smear screening results between Akha hill tribe and urban women in Chiang Rai province, Thailand

Cervical cancer is an important woman's health problems worldwide, especially in low socio-economic countries. The aim of this study was to compare the Pap smear screening results between Akha hill tribe and urban women who live in Chiang Rai province, Thailand. Screening was conducted for 1,100 Akha women and 1,100 urban women who came to have the Pap smear at Chiangrai Prachanukroh Hospital and 1 private cytology laboratory from January to June 2008. The demographic characteristics and factors related to abnormal Pap smears of these women were gathered using closed model questionnaires. Abnormal Rap smears were defined according to the Bethesda 2001 system. The results showed that the prevalence of abnormal Pap smears was 12.2% in Akha women and 4.5% in urban women. The highest prevalence of Pap abnormalities was found in the 41-50 years age group in both populations (4.5% in Akha and 1.7% in urban women). In both populations, abnormal Pap smears were found in <21 years age groups. From the questionnaires, the possible risk factors related to the higher prevalence of abnormal Pap smears in Akha women were early age at marriage (≤17 years), high frequency pregnacies and high parity and no/low education level. In conclusion, cervical cancer control by education and early detection by Pap smear screening is necessary for hill tribe women. More Pap smear screening service units should be set to improve the coverage for the risk group women who got married in young age, especial in ethnic groups.

Comparative study of visual inspection of the cervix using acetic acid (VIA) and Papanicolaou (Pap) smears for cervical cancer screening

This article is a comparative study of two screening methods for pre-invasive lesions of the cervix. The Papanicolaou (Pap) smear, an old and tested screening method, is compared with the findings from visual inspection of the cervix following acetic acid (VIA) wash. VIA is a new screening method being advocated by the World Health Organization as an alternative to Pap smear in low-resource settings.

Evaluation of the clinical performance of high-risk human papillomavirus testing for primary screening: a retrospective review of the Southern California Permanente Medical Group experience

OBJECTIVE

We investigated the potential impact of using the high-risk human papillomavirus (HPV) test as a primary screening tool for the detection of cervical cancer and its precursor lesions.

MATERIALS AND METHODS

From October 2005 to March 2006, conventional cervical cytological samples and Hybrid Capture II HPV tests were cocollected from all patients. Human papillomavirus tests were processed in all women aged 30 years and older and women younger than 30 years with a cytological finding of atypical squamous cells of undetermined significance. Patients with biopsy-proven cervical intraepithelial neoplasia (CIN) served as the study population.

RESULTS

We identified 263 women with CIN of whom 194 (73.8%) (95% confidence interval [CI] = 68.2%-78.8%) had HPV results. Human papillomavirus tests were negative in 4 (6.1%) of 66 CIN 3 cases (95% CI = 2.1%-14.5%), in 8 (16%) of 50 CIN 2 cases (95% CI = 7.3%-28.2%), and in 22 (22.8%) of 78 CIN 1 cases (95% CI = 18.6%-38.9%) distributed across all referral cytology categories. Negative HPV test rates were most significant for CIN 1 cases anteceded by a cytological finding of atypical squamous cells of undetermined significance (p =.0016). The mean age of women with HPV-negative CIN was 10 years older than that for women with HPV-positive CIN.

CONCLUSIONS

Human papillomavirus testing may miss more CIN than previously reported, especially in older women. Prospective trials of HPV testing as a primary screen for cervical cancer should incorporate additional tests to minimize missed lesions.

Human papillomavirus genotypes associated with cervical neoplasia in India

The aim of this study was to determine the prevalence of human papillomavirus (HPV) genotypes in tissue with cervical neoplasias in patients from south and east India. Cross-sectional cervical tissue was obtained from 100 patients from south India and 30 patients from east India who had a biopsy for clinically invasive cervical cancer or cervical intraepithelial neoplasia (CIN) in a tertiary care hospital in India. DNA amplification was done with biotinylated PGMY 09/11 primers, and the line blot assay was used to determine the HPV genotype. HPV DNA was detected in 95% of invasive cancers (113/119) and 91% of CINs (10/11). A single HPV type was found in 100 women (77%), and mixed infections were found in 23 women (18%). HPV 16 (60%) and HPV 18 (14%) were the most frequent types, but 16 other types (26, 31, 33, 35, 42, 45, 51, 52, 53, 56, 58, 61, 62, 64, 81, and 82) were also identified. HPV 16 was present in 63% of patients from south India and in 50% of patients from east India, while HPV 18 was present in 12% and 20%, respectively. There are several high-risk HPV types associated with cervical neoplasias of which types 16 and 18 are the most common.

The Effect of Medicare Health Care Systems on Women With Breast and Cervical Cancer

OBJECTIVE

Two common health care delivery systems in the United States are fee-for-service and managed care systems, including health maintenance organizations (HMOs). Differences may exist in patient outcomes depending upon the health care delivery system in which they are enrolled. We evaluated possible differences in the stage at diagnosis for breast and cervical cancer between 2 Medicare health care delivery systems (ie, fee for service and HMO) over the period 1985-2001.

METHODS

We used a linkage of 2 national databases: the Medicare database from the Centers for Medicare and Medicaid Services and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database to evaluate differences in stage at diagnosis between HMO and fee for service for breast and cervical cancer.

RESULTS

We studied 130,336 Medicare-aged women with breast cancer (83% Medicare fee for service) and 6,758 women with cervical cancer (87% Medicare fee for service). We found an earlier stage of diagnosis for HMO patients, which remained significant after adjusting for potential confounding variables. Women enrolled in HMOs with breast cancer were 17% more likely and those with cervical cancer 35% more likely to be diagnosed at an in situ stage of diagnosis than fee-for-service patients. It is of note that when women had other cancer diagnoses, no statistically significant differences were seen in stage at diagnosis for either cancer between fee-for-service and HMO patients.

CONCLUSION

Differences exist in stage at diagnosis between Medicare patients enrolled in HMOs compared with fee for service. This is likely due in part to use of or access to care.

Why do women still develop cancer of the cervix despite the existence of a national screening programme?

The study looked at why women developed invasive cervical cancer during a 10-year period. It reviewed the hospital records of 66 patients with cervical cancer with an age range of 21-81 years. Screening non-attenders accounted for a disproportionate number of cases. The proportion of women who had never been screened did not vary during the study period. Attention needs to focus on reasons why these women do not attend.