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Biomedical subjects

G Medley

Publications and source records attributed to G Medley.

At least 19 recordsLinked to original sources
PubMed2006

Pathways to diagnosis of cervical cancer: screening history, delay in follow up, and smear reading.

BACKGROUND: The aim of this study was to determine the most important ways to reduce incidence of and mortality from cervical cancer by a nationally co-ordinated screening programme. DESIGN: Descriptive study. SETTING: The New Zealand National Cervical Screening Programme: a nationally organised and co-ordinated programme. SAMPLE: Women aged younger than 80 years with histologically proven primary invasive cervical cancer, including microinvasive disease, diagnosed between 1 January 2000 and 30 September 2002. Consent for access to medical records was gained for 371 of 445 eligible women (83%). A total of 359 (81%) of eligible women or their next of kin consented to interview. METHODS: Data on events prior to diagnosis were obtained from routine sources, interview, medical record review and slide reread. MAIN OUTCOME MEASURES: Frequency of screening in the 7 years prior to diagnosis, time from abnormal smear or symptoms to appropriate diagnostic confirmation, proportion of negative smears upgraded to high grade on reread. RESULTS: Half of the 371 participants (83% of 445 eligible women) had not had a screening smear in the 3 years prior to diagnosis, and 80% were defined as inadequately screened. A maximum of 17% of women overall or within any defined subgroup experienced delays in follow up of abnormal smears or bleeding. Only 11% of women overall had had a high-grade smear, which was originally read as negative. CONCLUSIONS: The most important factor in women's pathways to a diagnosis of cervical cancer was inadequate screening. While delays in diagnosis could be reduced and laboratory performance improved, priority must be given to improving uptake and frequency of screening.

Adult↗
PubMed2005

Blind sampling is superior to anoscope guided sampling for screening for anal intraepithelial neoplasia.

OBJECTIVES: Anal cytology smears are either collected "blind" (swab inserted 4 cm into anal canal and rotated) or guided through an anoscope (transformation zone visualised and then sampled). We compared these smear techniques with respect to sample quality and patient acceptability. METHODS: Using a paired, random sequence clinical trial, 151 homosexual men (n = 95 HIV positive) underwent both smear techniques at a single visit; smear order was randomised and specimens were read blind. Both techniques utilised a Dacron swab, with water lubrication. Cytological specimens were prepared using a liquid based collection method (ThinPrep). The outcome measures were cytological specimen adequacy, cytological classification, presence of rectal columnar, squamous and metaplastic cells, contamination, patient comfort and acceptability, and volume of fluid that remained after the ThinPrep procedure. RESULTS: Regardless of smear order, guided smears were less likely to detect higher grade abnormalities than blind smears (15 v 27 cases, p = 0.001). Controlling for smear order, guided smears were more likely to be assessed as "unsatisfactory" for cytological assessment (OR 6.93, 95% CI 1.92 to 24.94), and contain fewer squamous (OR 0.20, 95% CI 0.04 to 0.94) and metaplastic cells (OR 0.12, 95% CI 0.03 to 0.54) than blind smears; there were no other statistically significant differences between techniques. Regardless of smear technique, first performed smears were more likely to detect a higher grade abnormality than second performed smears (23 v eight cases, p < 0.001). CONCLUSIONS: Blind cytology smears are superior to anoscope guided smears for screening for anal neoplasia in homosexual men.

Adult↗
PubMed2004

Getting to the bottom of anal itch - a cautionary tale.

Peri-anal rash is common and may appear macroscopically benign. In HIV-positive men, however, more serious pathology may be revealed by a biopsy. The high prevalence of human papillomavirus infection in these men predisposes them to pre-cancerous lesions of the peri-anal and anal skin. We report an unusual case of dual pathology in the anal region, which highlights the need to thoroughly investigate peri-anal symptoms in HIV-positive men.

Adult↗
PubMed1998

Differences between false-negative and true-positive Papanicolaou smears on Papnet-assisted review.

This study explored whether there were differences between false-negative and true-positive Papanicolaou (Pap) smears in the number of abnormal images on a Papnet-assisted review. The degree of agreement between cytotechnologists over Papnet tile status (normal/abnormal) was assessed. False-negative and true-positive Pap smears preceding a histologic diagnosis of carcinoma in situ were scanned by Papnet, and the resulting digital images and slides were assessed independently by three cytotechnologists. The median number of abnormal tiles was 7.3 for false-negative slides and 29.7 for true-positive slides. Three-way agreement between cytotechnologists was better for true-positive slides (kappa, 0.60) than for false-negative slides (kappa, 0.47). These results confirm intrinsic differences between false-negative and true-positive Pap smears. The fair to good agreement beyond chance on tile status indicates that a cautious approach should be adopted if digital image review is performed in a judgemental manner.

False Negative Reactions↗
PubMed1998

Effects of dietary phytoestrogens in postmenopausal women.

The aim of this study was to test the hypothesis that increased dietary intake of phytoestrogens reduces the health impact of the menopause. To test this hypothesis, a double-blind, randomized, entry-exit, cross-over study was conducted to assess the effects of three dietary manipulations--soy and linseed diets (high in phytoestrogens) and a wheat diet (low in phytoestrogens). Postmenopausal women were recruited and randomly assigned to one of the three dietary regimens. Urinary phytoestrogen concentrations, hot flush rate, vaginal smears, bone mineral density and bone mineral content were assessed for two 12-week periods. Comparative analysis showed no significant differences, but, when analyzed separately, groups consuming high phytoestrogen diets had between 10 and 30 times higher urinary excretion of phytoestrogens compared to those consuming the low phytoestrogen diet (p < 0.01). Study participants consuming soy, linseed and wheat diets had a 22% (not significant, n.s.), 41% (p < 0.009) and 51% (p < 0.001) reduction in hot flush rate; a 103% (p < 0.04), 5.5% (n.s.) and 11% (n.s.) increase in vaginal cytology maturation index; and a 5.2% (p < 0.04), 5.2% (n.s.) and 3.8% (n.s.) increase in bone mineral content, respectively. No changes were detected in bone mineral density. The differential effects of high phytoestrogen dietary manipulations on outcomes may represent tissue-specific responses to isoflavones and lignans contained in soy and linseed, respectively. Whilst health outcome measures were not significantly different between groups, the data obtained from separate analysis suggest that phytoestrogens in soy and linseed may be of use in ameliorating some of the symptoms of menopause. Furthermore, the significant decrease in hot flush rate in the wheat group cannot be attributable to phytoestrogens measured in this study. Due to subject variability, larger studies are still needed to evaluate population benefit.

4-Butyrolactone↗
PubMed1998

Notification of Pap smear results. A Victorian survey.

OBJECTIVE: To determine health practitioners' use of preprinted tear-off sections attached to all Papanicolaou (Pap) smear reports as a means of notifying women of their test results and to assess possible barriers to the use of these. METHOD: A questionnaire was sent to health practitioners who used the Victorian Cytology Service for their Pap smear reporting. RESULTS: A 74% response rate was achieved (1402/1886); 70.4% (987/1402) of respondents routinely used the tear-off section. Use was more common for negative Pap smear reports (62.8%) than for abnormal Pap smear reports (46.1%). The main barriers nominated by non users were a preference for an alternative approach and the impersonal nature of the communication. CONCLUSIONS: After 18 months, we conclude that preprinted tear-off sections appear to have an encouraging level of acceptability among practitioners. The laboratory has decided to maintain this initiative as a permanent feature.

Communication↗
PubMed1996

An audit of the women who died during 1994 from cancer of the cervix in Victoria, Australia.

An audit of 73 Victorian women who died from cervical cancer during 1994 is presented. Seventy per cent of the deaths occurred in women who were > or = 50 years at the time of cancer diagnosis. Younger women had significantly better screening histories than older women, but overall only 10% of the deaths occurred among women who were adequately screened. There was no excess of deaths in rural women or in women of non-English speaking background. Four of the 6 deaths in women who were diagnosed with cancer while < 35 years of age occurred in adequately screened women. If this finding is confirmed in a larger series, it raises questions about the ability of Papanicolaou screening to control disease in this age group.

Adenocarcinoma↗
PubMed1995

Cervical cytology reported as negative and risk of adenocarcinoma of the cervix: no strong evidence of benefit.

The relationship between negative cervical cytology reports and risk of adenocarcinoma of the cervix was evaluated in a case-control study of 113 cases and 452 controls. All cases and controls had received at least two negative cytology reports. There was no significant difference between the cases and controls in the number of negative cytology reports or in history of cervical abnormality; while a test for trend in the time since last negative cytology report was significant (P < 0.001), the estimated benefit was very modest. Although the estimates of relative protection were higher in women aged less than 35 years than in women aged 35-69 years, this difference was not statistically significant. These results suggest that cervical screening as practised in the 1970s and 1980s was much less effective in preventing adenocarcinoma than squamous carcinoma of the cervix.

Adenocarcinoma↗
PubMed1995

Differences between Papanicolaou smears with correct and incorrect diagnoses.

A case control study of women with carcinoma in situ (CINIII) was undertaken comparing Papanicolaou smears for which false negative reports had been issued with slides for which true positive reports had been made. The number of abnormal cells was the strongest differentiating factor. Where there were less than 50 abnormal cells on the slide, the odds of a false negative report being issued was 23.7 times greater (95% confidence interval 3.7-150) than when there were 200 or more abnormal cells. In false negative slides, the abnormal cells were likely to be not represented throughout the slide, present only as single cells rather than as groups, small in size and with finely granular normochromatic nuclei. We conclude that there are intrinsic differences between true positive and false negative slides. Given these characteristics, rapid rescreening of slides that are considered negative may not be an effective method of reducing the false negative rate.

Adolescent↗
PubMed1993

Cytological reporting of cervical abnormalities according to endocervical status.

An analysis of cytology reporting within Victorian Cytology Service demonstrates that the proportion of Papanicolaou smears which were reported as including an endocervical component increased from approximately one half during 1987-89 to more than three quarters during 1990-91. The improvement coincided with the routine provision of special sampling instruments to all practitioners supplemented by an education program. Despite the increase in endocervical sampling, no increase in the rate of reporting of high-grade intraepithelial lesions of the cervix has occurred. An increase between the two time periods in the cytological reporting of adenocarcinoma, adenocarcinoma in situ and endocervical dyskaryosis has occurred, but does not reach statistical significance.

Adenocarcinoma↗
PubMed1993

Accuracy and survival benefit of cytological prediction of endometrial carcinoma on routine cervical smears.

Among 359 women who received a cytology report of endometrial malignancy from the Victorian Cytology Service during 1982-87, the positive predictive value for a later histological diagnosis of endometrial malignancy was 64%. The positive predictive value was significantly higher for the group of women in whom the cytopathologists made definite predictions of endometrial malignancy as compared to the group where the cytologic features were only suggestive of endometrial malignancy (75% vs. 50%, chi 2 = 23.4; p < 0.001). The sensitivity of cervical cytology performed within two years of the diagnosis of endometrial malignancy was 28%. The odds ratio of death from endometrial cancer among women where the cytology may have allowed for an early diagnosis in comparison to women where cytology did not hasten the diagnosis was 0.78 (95% confidence interval = 0.25-2.47; p > 0.05). We conclude that while cervical cytology can predict the presence of malignancy for a small proportion of women with endometrial cancer, there remains no evidence that a cervical cancer screening program will make a major impact on reducing the morbidity and mortality from endometrial cancer.

Endometrial Neoplasms↗
PubMed1993

Cellular differences between true negative and false negative Papanicolaou smears.

A matched case-control study of 123 false negative Papanicolaou smears and 488 true negative Papanicolaou smears was undertaken to determine the association between the types of cells present on the smear and the correctness of the cytology report. The false negative slides were significantly more likely to include endocervical columnar cells than the true negative slides (odds ratio 1.90, 95% confidence interval (CI) 1.21-3.01). No statistically significant difference in metaplastic cell status was evident (odds ratio 1.48, 95% CI 0.95-2.30). When considered together, metaplastic and/or columnar cells were significantly more likely to be present in false negative smears than in true negative smears (odds ratio 1.87, 95% CI 1.13-3.08). The implications of these findings for improving the accuracy of cervical cytology for the detection of precancerous lesions are discussed.

Case-Control Studies↗
PubMed1992

Epidemiology, HIV and drugs: mathematical models and data.

The utility of mathematical models in understanding the dynamics of HIV transmission among injecting drug users (IDUs) and their non-IDU sex partners is discussed. We emphasize the need for collaborative relationships between modellers and drug-use researchers, and we stress that models should be based on data in both their formulation and development stages. We outline some of the possible data requirements of transmission models and we highlight the need for the collection of appropriate quantitative data, so that modellers can estimate specific parameters for their models. We believe that discussion of the needs and utility of mathematical modelling will lead to mutually beneficial collaborations between theoreticians and drug-use researchers. These collaborations may aid in the design and the evaluation of effective behavioural or medical intervention strategies.

England↗
PubMed1991

Cervical cancer screening: a comparison of recruitment strategies among older women.

OBJECTIVE: To compare the effectiveness of different recruitment strategies in encouraging older women to have a Papanicolaou (Pap) test. DESIGN: A 2 x 2 factorial study. SETTING: Two rural areas of Victoria, Australia. PARTICIPANTS: A total of 10,620 persons aged between 40 and 69 years and designated as female on electoral lists. INTERVENTIONS: A personal letter of invitation and a community-based campaign of 4 weeks' duration alone and in combination. A control group received no active intervention. OUTCOME MEASURE: The proportion of eligible women having a Pap test report issued by the Victorian Cytology Service during the 12 weeks after the intervention compared with the 12 weeks before the intervention, with an intervening two-week washout period. RESULTS: The odds ratio of an eligible woman being screened during the intervention period relative to the pre-intervention period was 3.00 for women who were exposed to the campaign and sent the letter of invitation (95% confidence interval, 2.38-3.77, P less than 0.001), 1.86 for women who were exposed to the campaign (95% confidence interval, 1.49-2.33, P less than 0.001), 1.61 for women who were sent the letter of invitation (95% confidence interval, 1.34-1.92, P less than 0.001). The baseline was a control group who received no active intervention. CONCLUSIONS: Both personal invitation letters and community-based campaigns are effective in recruiting women for Pap test screening. Combined strategies are more effective than single strategies.

Adult↗