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Results for “cervical screening”

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PubMed2000

Evaluation of a human papillomavirus assay in cervical screening in Zimbabwe.

OBJECTIVE: To determine the utility of an assay for high risk genital human papillomavirus (HPV) in cervical screening in Zimbabwe, Africa. DESIGN: Cross-sectional study. SETTING: Harare, Zimbabwe. POPULATION: Zimbabwe women (n = 2,140), 25 to 55 years old, recruited in clinics in Chitungwiza and Greater Harare. METHODS: Genital specimens were assessed for HPV, using the HPV DNA test Hybrid Capture II (probe B). Further assessment of the women was conducted using colposcopy and biopsy as indicated. High grade squamous intraepithelial lesions were diagnosed in 215 women. Colposcopy and/or biopsy showed low grade lesions in 346 women. RESULTS: The overall prevalences were: 42 x 7% for HPV, 10% for high grade squamous intraepithelial lesions and 16% for low grade lesions. Prevalence for HPV decreased significantly with increase in age (P for trend < 0 x 0001) and increased significantly with increasing disease severity, from 35% in normal women, to 53% in women with low grade lesions and 81% in women with high grade lesions (P for trend < 0 x 001). In specimens positive for HPV, the amount was 14-fold higher in women with high grade lesions compared with normal women. In screening for high grade lesions the assay for HPV had a sensitivity of 81% (CI 75%-86%); sensitivity for low grade lesions was 64% (CI 60%-68%). Specificity was 62% (CI 59%-64%) for high grade lesions and 65% (CI 62%-67%) for low grade lesions. The positive predictive value was 19% (CI 17%-22%) for high grade lesions and 39% (CI 36%-42%) for low grade lesions. CONCLUSION: For high grade squamous intraepithelial lesions the sensitivity of the Hybrid Capture II HPV DNA test was high, but the specificity was relatively low. The test may therefore be most useful in conjunction with other screening tests.

Adult↗

PubMed2006

[Clinical evaluation of high-risk HPV detection by hybrid capture II in screening cervical intraepithelial neoplasma].

OBJECTIVE: To evaluate the value of high-risk HPV (hrHPV) detection by Hybrid Capture II (HC2) in screening cervical intraepithelial neoplasm (CIN). METHODS: Totally 723 patients who had received a dual screening with thinprep cytologic test (TCT) and HC2 in our department were analyzed retrospectively. Among them, 350 patients received a triple examination with TCT, HC2, and colposcopic biopsy. RESULTS: Among the 723 patients, the incidences of hrHPV infection with atypical squamous cell (ASC), low squamous intraepithelial lesion, and high squamous intraepithelial lesion were 70.7% (94/133), 88.9% (249/280), and 90.9% (90/99), respectively, significantly higher than 55.5% (117/211), the incidence of hrHPV infection with normal cytological results (P = 0.005, P < 0.001, P < 0.001, respectively). Among 350 cases who were received triple examination, the incidence of hrHPV infection with cervical intraepithelial neoplasia (CIN) 1 and CIN 2 were 88.9% (72/81) and 96.3% (52/54), significantly higher than 77.7% (153/197), the incidence of hrHPV infection with normal pathological results (P = 0.03, P = 0.002); The incidence of hrHPV infection with CIN 3 and squamous cancer were 91.7% (11/12) and 100.0% (6/6), also higher than normal cases. Among these 350 cases, the incidence of hrHPV infection with ASC was 79.3% (69/87). The incidence of CIN 2-3 with ASC and hrHPV infection was 38.0%, significantly higher than the incidence of CIN 2-3 with ASC and without hrHPV infection (5.9%) (P = 0.04). CONCLUSION: hrHPV infection has a close relation with CIN, and the incidence of hrHPV infection increases along with the severity of CIN.

Adolescent↗

PubMed2003

Integration of cervical screening in family planning clinics.

OBJECTIVES: To assess the suitability of cervical cancer screening in family planning (FP) clinics and the relevance for women's health. METHODS: A survey was done on clients visiting the clinics of the Family Planning Association of Kenya (FPAK). Client characteristics, age, screening status and PAP smear results were registered. In-depth interviews were held with a limited number of staff and clients. RESULTS: In 1999, 38052 clients visited FPAK clinics, 43.5% were younger than 30 years old. More than 10000 cervical smears were taken. A total of 4.5% of the smears were abnormal, including 1.5% high-grade squamous intraepithelial lesions (HSIL) and 0.2% invasive cancers. The clinics were well prepared to provide high quality screening services. Patients and staff had a positive view on screening. CONCLUSIONS: Providing cervical cancer screening in FP clinics is beneficial for the clients but is unlikely to have an impact on the epidemiology of cervical cancer morbidity as FP services reach only a small percentage of the women who are most at risk. Measures to reach more and older women could assure a larger impact.

Adult↗

PubMed2000

A systematic review of the role of human papilloma virus (HPV) testing within a cervical screening programme: summary and conclusions.

A systematic review of the available evidence on the role of HPV testing in cervical screening has been published by the Health Technology Assessment Committee of the UK Department of Health. The review summarized relevant data on testing methods, natural history, and prevalence of the virus in different disease groups. Cost-effectiveness modelling was undertaken. Ten major conclusions were reached and are reported here. The key conclusions were that HPV testing was more sensitive than cytology, but that there were concerns about specificity, especially in young women. The increased sensitivity led to a recommendation that HPV testing be introduced on a pilot basis for women with borderline and mild smears. HPV testing has great potential as a primary screening test, but large trials are needed to properly evaluate this application and to determine if its introduction can reduce invasive cancer rates. There is an urgent need to undertake a large trial of HPV testing in conjunction with other new technologies (liquid-based cytology and computer-assisted cytology reading) to determine the best way to integrate them into ongoing screening programmes. A range of issues including the age to start and stop screening, the appropriate screening interval, the role of self-sampling for HPV testing and the choice of primary test (HPV and/or cytology) require further evaluation.

Adult↗

PubMed1999

Cervical screening in Africa: discordant diagnosis in a double independent reading. DYSCER-CI Group.

Interobserver variation in the cytological diagnosis of cervical lesions poses a problem for public health screening programs. This study assessed the frequency of discordant diagnoses between two independent cytopathologists in the screening of African women. In Abidjan, Côte d'Ivoire, 2157 women were recruited from three outpatient gynecology clinics and screened for cervical abnormalities and genital and human immunodeficiency virus (HIV) infections. The degree of agreement between the cytopathologists was assessed by kappa statistics. The overall agreement was poor (kappa = 0.33); however, the degree of agreement increased with the severity of the lesions and was fairly good (kappa = 0.53) for high-grade and invasive lesions requiring curative treatment. Discordance was associated with HIV infection but not with genital infections. For a prevention program of cervical cancer in this African context, strategies must be developed to minimize errors in cervical screening. Particularly, HIV-infected women require a systematic rereading to reduce false-negative results.

Adult↗

PubMed1993

A comparison of cytology and cervicography in cervical screening.

The sensitivity and specificity of cervical cytology and of cervicography in the detection of CIN and invasive cancer of the cervix were determined in a screening programme of an asymptomatic population of 418 women. Because all of the subjects were examined colposcopically and biopsies were taken from any suspicious areas, the presence or absence of disease was determined by the histology of directed cervical biopsies independently of the screening methods being tested. Cervicography correctly identified 24 of the 27 women with CIN or invasive cancer, whereas cytology detected only 14 (sensitivity of 0.89 vs. 0.52; P < 0.01). Cervicography detected CIN in 11 women with negative smears, six having CIN III. Only one case of CIN I was detected by cytology when cervicography was negative. Two cases of CIN II were not detected by either method. Inclusion in the analysis of the results from 23 women with technically defective cervigrams reduced the size of the difference in sensitivity, but it remained significant (0.74 vs. 0.48; P < 0.05). Cervicography was only slightly less specific than cytology (0.92 vs. 0.94; NS). Cervicography appears to be more effective than cytology in screening for cervical premalignancy but may be more demanding of those who perform the test.

Journal Article↗

PubMed2003

Investigating Hong Kong's Filipino domestic workers' healthcare behavior, knowledge, beliefs and attitudes towards cervical cancer and cervical screening.

The aim of this study was to investigate Hong Kong Filipino domestic workers health behaviors, knowledge, beliefs and attitudes about cervical screening and cancer. A concurrent cross sectional survey design used a snowball method of recruitment was used because of the acknowledged problematic access to a random sample of immigrant women. A total of 98 female domestic helpers were actively recruited through designated recreation centers. The women were between 24-45 years old (mean = 37.9, SD = 7.7). The majority of these women were employed as full-time domestic helpers (91%), were earning less than dollar 4000 Hong Kong dollars/month (92%), were married (82%), with children (91%), were non-smokers (88%), and had at least a secondary level of education (100%), with 66% of these women having completed post-secondary education. While the majority of women had previously heard about cervical smears (78%) more than half (53%) reported never having a cervical smear taken. Women who had a prior cervical smear had significantly more knowledge about cervical smears and cervical cancer (mean = 51.34, SD = 2.5) than those who never had a cervical smear (mean = 49.72, SD = 3.2). Recommendations are made for culturally tailored mass screening programmers out of office hours and health information to be provided in both written and oral Tagalong. Doctors and nurse ideally of Filipino origin should be used to deliver health messages that prioritize the importance of self protection for the family and future fertility issues, culturally prized within Filipino society.

Adult↗

PubMed2004

Monitoring and evaluating the performance of the UK NHS Cervical Screening Programme: monitoring performance by using cytology outcomes adjusted for population characteristics.

Current quality assurance measures used in the NHS cervical screening programme (NHSCSP) include a review of laboratories with percentages of moderate/severe and borderline/mild smear results outside the 10th-90th percentiles. The method is limited by the fact that many of these outlier smear percentages may reflect laboratories covering populations with low or high risk and/or short or long average screening intervals. This paper outlines a new approach to aid the detection of outlier laboratories, by using data collected at the primary care trust (PCT) or health authority (HA) level and making allowances for population characteristics and screening interval. The setting is the NHSCSP in England using annual data provided by HAs. Data from the screening year 2000-01 is used to illustrate the methodology, although the methods can also be applied to data at the PCT level (now being collected for 2002-03 onwards). Percentages of smear results have been analysed against a series of explanatory variables using logistic regression models. These explanatory variables include Townsend deprivation index, uptake-corrected ethnic minority composition, a measure of screening interval, area type and region. An expected percentage of borderline/mild and moderate/severe smears is estimated from the models and an observed : predicted ratio (OPRmod/sev and OPRbord/mild) calculated. Low values are suggestive of relative undercalling and high values overcalling, after allowance for population characteristics. Analysis of data for 2000-01 showed that the OPRmod/sev for the 99 HAs varied from 0.68 to 1.44. Laboratories with low percentages of moderate/severe smears, but associated with PCTs or HAs with OPRmod/sev values closer to unity may not need to be investigated as their observed rates are consistent with predicted rates based on population characteristics. The method could also be directly applied to laboratories if further information on the population covered by each laboratory were routinely collected.

Female↗

PubMed2001

Expanded cytological referral criteria for colposcopy in cervical screening: comparison with human papillomavirus testing.

OBJECTIVE: The goal of this study was to investigate whether expanded cytologic referral criteria for colposcopy or the addition of human papillomavirus (HPV) testing on cervical screening could improve the rates of detection of cervical intraepithelial neoplasia (CIN). METHODS: HPV testing by semiquantitative polymerase chain reaction/ELISA was performed in 1000 women who were self-referred for routine Pap smear. They underwent colposcopy following an abnormal smear result or a positive HPV test. As abnormal smear results were considered reports of low- or high-grade squamous intraepithelial lesion, atypical squamous cells of undetermined significance, and even HPV-associated reactive cellular changes (mild koilocytosis, mild dyskeratocytosis, hyperchromatic nuclei, bimultinucleation, and cleared cytoplasm). Loop excision of the transformation zone was performed in women with cytology and colposcopy indicative of CIN, as well as in women with normal cytology but positive HPV test and colposcopic impression of CIN. RESULTS: The Pap test was abnormal in 89% of the cases of CIN 1 (34/38) and 96% of CIN 2/3 (27/28) diagnosed in our population. HPV testing picked up four additional cases of CIN 1 (11%) and one case of CIN 2/3 (4%). Overall the HPV test detected 95% of the cases of CIN 1 (36/38) and 89% of the cases of CIN 2/3 (25/28). CONCLUSION: HPV testing does not appear to add significantly to cytology in terms of positive predictive value or detection rate, if extended cytologic indications for colposcopy are used.

Adolescent↗

PubMed1990

How complete can cervical screening be? The outcome of a call screening programme for women aged 20-60 years in Perth and Kinross.

In this paper a computer system for cervical screening call and recall based on the Community Health Index (CHI) population data-base is described. It allows the unscreened population to be identified and located on an individual general practice basis. The results of the call programme on 9517 women aged 20-60 years listed on the CHI and with no record of a cervical smear is described. There was a 24% smear uptake in the call programme which meant that after the call programme the total population cover had risen from 71% to 78%. In addition, if women with a valid reason are excluded, and the data-base corrected for women no longer in the area, the true cover rises to 88%. An analysis of the percentage cover in each GP practice is described with the implications for implementation of screening targets for primary care.

Adult↗

PubMed2003

Increasing readiness to stop smoking in women undergoing cervical screening: evaluation of two leaflets.

This study evaluated the impact of informing women smokers of the link between smoking and cervical cancer. Women smokers aged 20-64 years from two general practices in the United Kingdom were randomly assigned to receive an extended leaflet, a brief leaflet, or no leaflet. Both leaflets informed women of the threat of cervical cancer, how stopping smoking would decrease their vulnerability to it, and the effectiveness of smoking cessation services. The extended leaflet included an elaborated explanation of how smoking adversely affects the cervix. Questionnaires were completed by 172 women. The main outcome was readiness to stop smoking within the next 6 months. Secondary outcomes were perceptions of severity and vulnerability to cervical cancer, beliefs about the effectiveness of reducing susceptibility by stopping smoking, and self-efficacy in stopping smoking. Women sent the briefer leaflet were more likely to be ready to stop smoking within the next 6 months compared with those sent the extended leaflet (75% vs. 46%, 95% CI=11%-48%) and those not sent a leaflet (75% vs. 40%, 95% CI=19%-52%). Compared with smokers not sent a leaflet, those sent either of the two leaflets perceived their vulnerability to cervical cancer as higher and had greater expectations that stopping smoking would reduce this risk. In conclusion, providing women with brief written information about the link between smoking and cervical cancer increases their readiness to stop smoking. The impact on smoking cessation of combining such information with advice from health professionals conducting cervical screening needs to be evaluated.

Adult↗

PubMed2005

Sociodemographic and attitudinal correlates of cervical screening uptake in a national sample of women in Britain.

Sociodemographic and attitudinal correlates of self-reported cervical screening uptake were investigated among 1307 women in the target age group who participated in two national surveys conducted in Britain in 1999. Evidence for inequalities in screening uptake was mixed. Of the socioeconomic indicators, only age of completed full-time education showed a significant effect in the multivariate analysis. The strong effects of car ownership and housing tenure in the univariate analyses were eliminated by controlling for marital status, which showed a robust association with uptake. Uptake was highest among married and separated women and lowest among single and widowed women. There was no evidence that the effects of marital status and education were mediated by the attitudinal variables. Anticipated embarrassment and attitudes to screening (e.g., "There's no point going for screening if you don't have any symptoms") were significant independent predictors of uptake. These findings suggest that information campaigns need to address feelings of embarrassment and lack of understanding of the rationale for screening and that efforts should be made to encourage single and widowed women to attend.

Adult↗

PubMed2000

Hybrid capture based human papillomavirus typing in cervical screening compared to cytology and histology.

INTRODUCTION: Cervical cancer is frequently associated with infection from various types of human papillomavirus (HPV) with high a oncogenic potential (high-risk types). Commercial systems for HPV typing are available, but the question as to when HPV typing should be performed has not yet been solved. OBJECTIVES: To assess the value of HPV typing in a clinical setting in a population with opportunistic screening. STUDY DESIGN: Cytology, histology and HPV status of 593 patients from a high-risk collective were evaluated retrospectively. For HPV typing, the hybrid capture (HC) system was used. RESULTS: Infection with high-risk types of HPV was associated with more severe cervical lesions. Women with PAP III or PAP IIID who were infected with high-risk HPV were at increased risk for high-grade cervical lesions (CIN III+) (p = 0.006). Conization influenced HPV status: of 63 patients who were HPV high-risk positive before conization, 4 remained positive afterwards. CONCLUSION: HC appears to be a useful system to triage women with PAP III or IIID and to detect patients with residual HPV infection after conization. However, because of high costs and no significant increase in the sensitivity of cytology, the use of HPV typing in routine cervical screening cannot be recommended in countries with opportunistic annual cytological screening.

Adult↗

PubMed1999

The Transtheoretical Model and cervical screening: its application among culturally diverse communities in Queensland, Australia.

OBJECTIVES: To apply the Transtheoretical Model of Behaviour Change (TTM) to cervical cancer screening to determine and report on the level of support required by different language and cultural groups in Queensland to enhance participation. The model consists of six stages: Pre-contemplation (no intention to be screened, no past action), Contemplation (intention to be screened, no past action), Action (intention to be screened, initial screening), Maintenance (intention to be screened, regular screening), Relapse (no intention to be screened, initial screening) and Relapse Risk (no intention to be screened, regular screening). DESIGN: Focus groups and structured interviews were used to classify women in terms of the model and collect information regarding knowledge, health service contact barriers and enhancing factors and sources of information in relation to cervical cancer screening. The sample was recruited by bi-cultural workers for each community using snowball techniques. RESULTS: The interview sample consisted of Australian South Sea Islanders, Chinese, German, Greek and Moslem women. There was no evidence of significant differences in TTM stage according to ethnicity. Women who intended to be screened in the future were more likely to have positive decisional balance scores and higher knowledge scores than women who did not. Women who had had Pap tests were significantly more likely to have received information from their general practitioner (GP) than women who had not had Pap tests. Women in Action and Maintenance were also more likely to have had their last Pap test by a female GP compared to women in relapse categories. Women in Pre-contemplation were more likely than women who had Pap tests to agree that they would travel a long way to see a practitioner who spoke their own language. CONCLUSION: Classification based on the model was supported both by the decisional balance scale and measures of knowledge. Women in earlier stages of the model were more likely to express preferences for the provision of services in their own language and by a female. Cervical cancer screening among women in Action and Maintenance appeared to be better supported by GPs. Cervical cancer screening promotion for women of diverse cultures and ethnicities has tended to focus on Pre-contemplation and Contemplation stages, however, as most women in this sample were in Action or Maintenance, as are most Australian-born women, structuring cervical cancer screening promotion in terms of the TTM may significantly improve the effectiveness of interventions for women of diverse cultures and ethnicities.

Adult↗

PubMed2004

Comparing the information experience of women invited for cervical screening for the first time in 1994 with 2001.

We compared the information experience of women invited to attend cervical screening for the first time in 1994 and 2001 using postal questionnaires. Compared to 1994, women in 2001: found the invitation letter less easy to understand; were not aware of alternative venues for the test; and waited >4 weeks before receiving their results. Negative information experiences may influence attendance.

Adult↗

PubMed1991

Errors in reporting cervical screening among public health clinic patients.

This study examines women's knowledge of whether or not they had a cervical smear as part of their examination in a public health clinic for sexually transmitted diseases. Usable interviews were completed with a cluster sample of 318 women. Approximately 56% of the women were not able to correctly report if they had a cervical smear; and 90% of the erroneous responses consisted of reporting a cervical smear when none actually was done. Young women and single women were more likely to report incorrectly. Overall, the results suggest considerable error in overreporting cervical screening in this population.

Adult↗

PubMed2004

A randomized crossover trial of PAPNET for primary cervical screening.

OBJECTIVE: To develop and demonstrate efficient methods to estimate the relative true positive and false positive rates of two cervical screening tests (conventional cytology and PAPNET). METHODS: We designed the study to meet stringent methodologic criteria for comparison of two tests while simultaneously minimizing the numbers requiring reference standard verification. We used a cytology reference standard and also assessed histology when available. For the primary analysis, slides with discordant results around the test threshold (CIN 1) were reviewed by a panel of two cytopathologists, blind to previous results, to establish the reference standard result (reference standard threshold for abnormality CIN2). Where histology was available, a secondary analysis was conducted with the reference standard based on the highest grade lesion (either cytology or histology). RESULTS: Among 21,747 Pap smears, 372 were discordant around the test threshold, requiring verification. In the primary analysis PAPNET detected four more true positives than conventional reading; difference in sensitivity 1.29% (95%CI -5.79 to 8.36%, P=.40). There were two extra false positives using PAPNET; difference in the false positive rate 0.0097% (95%CI -0.122 to 0.142%, P=.47). The results of the combined cytology and histology analysis were similar; difference in true positive rate 0.29% (95%CI -6.76 to 7.34%, P=.50) and difference in false positive rate 0.024% (95%CI -0.098 to 0.15%, P=.39). CONCLUSION: This is an efficient and valid study design where the objective is to examine the comparative accuracy of two tests. The design provides an efficient means of estimating the difference between true positive and false positive detection by the two tests, which often is sufficient information for policy decisions.

Adolescent↗

PubMed2000

Probability of early repeat Pap smear in an integrated cervical screening programme.

The integration of routine Pap smear practice based on self-referral into an organized programme based on personal invitation is the recommended approach to cervical cancer screening. In this study, the cytology archive of the integrated cervical screening programme implemented in the Faenza district (northern Italy) was used to compare the population of women responding to invitation with that of self-referred women for the cumulative probability of early (< 36 months) repeat Pap smear after a negative result. Between 1995 and 1998, women aged 25-64 living in five municipalities of the district were targeted by the first round of the programme. Eligible for the study were 2356 women responding to invitation for screening and 2221 women not invited because of self-referral for Pap smear at any other setting. The probability of early repeat Pap smear was estimated by the life table method. Differences were evaluated by the Gehan test. Multivariate determinants were assessed by the Cox regression analysis. At 36 months' follow-up, the cumulative probability of early repeat Pap smear was 44% among self-referred women and 6% among women responding to invitation (relative hazard = 4.8). For self-referred women, the probability was related to age (with a peak at 35-44 years), previous Pap smear history and municipality of residence. Among women responding to invitation, only an inverse association with age was demonstrated. In conclusion, the observed differences in overall probability and determinants of early repeat Pap smear between the two screening populations provided important information on Pap smear usage in the total target population.

Adult↗