SEARCH · PubMed Health

Results for “cervical screening”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources

PubMed1995

Human papillomavirus testing in primary cervical screening.

Several studies have examined the role of tests for human papillomavirus (HPV) in screening for cervical cancer but as yet the relevance is unclear. We looked at HPV testing for types 16, 18, 31, and 33 on material taken at the time of a cervical smear in 2009 eligible women having routine screening. Women with any degree of dyskaryosis or high levels of one of these HPV types were referred for colposcopy. 44% of the cervical intraepithelial neoplasia (CIN) lesions of grade 2/3 detected had negative cytology and were found only by HPV testing. A further 22% of the CIN 2/3 lesions were positive for HPV but showed only borderline or mild cytological changes. The positive predictive value of HPV testing was 42%, which was similar to that for moderate dyskaryosis. HPV types 16 and 31 were more sensitive and specific for CIN 2/3 than were types 18 or 33. However, 25% of the CIN 2/3 lesions were not detected by these four HPV tests. We suggest that HPV testing could usefully augment but not replace conventional cytology. These results should stimulate a much larger randomised trial to assess the impact of these improved CIN 2/3 detection rates on the subsequent incidence of invasive cancer.

Adult↗

PubMedDate not supplied

Opportunistic cervical screening at a sexual health clinic.

Women attending sexual health services may be higher risk for cervical cancer than the general population. In the United Kingdom, where a national cervical screening programme is underway, sexual health clinics no longer routinely offer their attendees cervical smears. Abnormal cervical smears add considerably to the workload of a sexual health service. In the absence of an organised national cervical screening programme in Ireland opportunistic screening is heavily relied upon. Opportunistic screening is performed in primary care, sexual health services and other women's health services. In the absence of this opportunistic cervical screening treatable pre-cancerous lesions may go unrecognised.

Adolescent↗

PubMed2002

A proposal for cervical screening information systems in developing countries.

The effective and efficient delivery of cervical screening programs requires information for planning, management, delivery and evaluation. Specially designed systems are generally required to meet these needs. In many developing countries, lack of information systems constitutes an important barrier to development of comprehensive screening programs and the effective control of cervical cancer. Our report outlines a framework for creating such systems in developing countries and describes a conceptual model for a cervical screening information system. The proposed system is modular, recognizing that there will be considerable between-region heterogeneity in current status and priorities. The proposed system is centered on modules that would allow for the assembly and computerization of data on Pap tests, since these represent the main screening modality at the present time. Additional modules would process data and create and maintain a screening database (e.g., standardize, edit, link and update modules) and allow for the integration of other types of data, such as cervical histopathology results. An open systems development model is proposed, since it is most compatible with the goals of local stakeholder involvement and capacity-building.

Databases as Topic↗

PubMed2002

Women's knowledge about cervical cancer and cervical screening practice: a pilot study of Hong Kong Chinese women.

Cervical cancer is the seventh leading cause of death and the fourth most common type of cancer among Hong Kong Chinese women. Despite the provision of cervical screening programs, women's attendance for screening remains low at 59%. Evidence suggests that women's knowledge about cervical cancer and preventive strategies are significant to their screening practice. A preliminary pilot study consisting of a two-phase descriptive design using quantitative and qualitative methods of data collection was undertaken to investigate the level of knowledge about cervical cancer and cervical screening among a population of Hong Kong Chinese women. From a total sample of 467 women, 242 (52%) responded to a confidential questionnaire, 18 of whom, aged between 30 and 54 years, volunteered to participate in a semistructured interview. A total of 135 (57%) women had attended screening, with those who were married with children significantly more likely to attend. Although no significant difference was found between the overall level of knowledge of attenders and nonattenders, individual items such as women's knowledge of risk factors were significant. The need for further knowledge about the preventive nature of cervical screening and regular screening was demonstrated. Other factors influencing Chinese women's attendance patterns included advice from practitioners and the significance of children to women's propensity for self-care. The implications of these findings to women's attendance patterns for screening are considered, particularly the need for culturally sensitive health promotion and intervention strategies.

Adult↗

PubMedDate not supplied

Criteria for organized cervical screening programs. Special emphasis on The Netherlands program.

Based on the criteria of Wilson and Jungner and experiences in the population-based organized cervical screening program in the Netherlands, conditions for efficient and effective population screening for cervical cancer are described. The purpose of this paper is to determine if these criteria are met for cervical cancer screening and to give recommendations for improvement. Cervical cancer is still an important health problem; the present incidence reflects both background risk and screening activity during previous decades. A positive effect of screening is reached because of the long development time of the disease and the ability of the Pap smear test to detect precancer and early, symptomatic disease. Considerable reduction in the incidence and mortality of cervical cancers can be reached if all women attend and all detected lesions are adequately followed up. Common terminology and classification criteria for histology and cytology should be used. Whether newly developed techniques that may improve or replace cytology can be used in screening programs should be a multidisciplinary decision after clinical trials have given evidence-based information on the performance, cost-effectiveness and need of these techniques. When cervical cancer screening is undertaken, it should be offered in organized programs at the medical level closest to the patients, the general practitioner. High compliance is the most important factor in reducing cervical cancer incidence. Quality control and assurance must be performed at all levels. In the case of limited resources, the program should use a five-year interval and concentrate on the age range 25-60 years, with special attention to women who have never been screened or were screened > 10 years previously. Evaluation of medical and organizational aspects is mandatory. Cooperation between all involved parties is a prerequisite of creating a successful screening program.

Cost-Benefit Analysis↗

PubMedDate not supplied

What do Irish women know about cervical screening?

In anticipation of the launch of the national cervical screening programme, a questionnaire was distributed amongst 200 women on the maternity wards of the Coombe Women's Hospital. The questionnaires revealed that 24% of the women surveyed never had a smear test and 50% of these did not know how the test was performed. The majority of all women did not know what a smear test showed and 26% did not know the meaning of an abnormal smear. Irish women's knowledge of cervical screening is limited, and the success of the proposed programme will depend on an improvement in public information and education.

Adolescent↗

PubMed2000

Cervical screening in England and Wales: its effect has been underestimated.

Opinions about cervical screening in the UK tend to follow one of two negative lines of thought. The first is that cervical cancer is a rare disease, and too much time and effort are spent on screening. The second is that it has been relatively ineffective, since incidence of invasive carcinoma did not fall until the NHS Cervical Screening Programme (NHSCSP) was introduced in 1988, although it fell by 40% since then. This paper presents publicly available data to demonstrate that neither of these views is true. Registrations of invasive carcinoma of the uterine cervix and carcinoma in situ in England and Wales between 1971 and 1996 show that a substantially increased risk of disease in women born since 1940 has been reversed, almost certainly by greatly improved screening. Cervical carcinoma is now a rare disease because most cases are prevented before they become invasive, mostly by screening young women, aged 20-40, before the decade of life when symptomatic cervical carcinoma most frequently presents.

Adolescent↗

PubMed2004

The predicted effect of changes in cervical screening practice in the UK: results from a modelling study.

In 2003, the National Health Service Cervical Screening Programme (NHSCSP) announced that its screening interval would be reduced to 3 years in women aged 25-49 and fixed at 5 years in those aged 50-64, and that women under 25 years will no longer be invited for screening. In order to assess these and possible further changes to cervical screening practice in the UK, we constructed a mathematical model of cervical HPV infection, cervical intraepithelial neoplasia and invasive cervical cancer, and of UK age-specific screening coverage rates, screening intervals and treatment efficacy. The predicted cumulative lifetime incidence of invasive cervical cancer in the UK is 1.70% in the absence of screening and 0.77% with pre-2003 screening practice. A reduction in lifetime incidence to 0.63% is predicted following the implementation of the 2003 NHSCSP recommendations, which represents a 63% reduction compared to incidence rates in the UK population if it were unscreened. The model suggests that, after the implementation of the 2003 recommendations, increasing the sensitivity of the screening test regime from its current average value of 56 to 90% would further reduce the cumulative lifetime incidence of invasive cervical cancer to 0.46%. Alternatively, extending screening to women aged 65-79 years would further reduce the lifetime incidence to 0.56%. Screening women aged 20-25 years would have minimal impact, with the cumulative lifetime incidence decreasing from 0.63 to 0.61%. In conclusion, the study supports the 2003 recommendations for changes to cervical screening intervals.

Adult↗

PubMed2004

Multiple high risk HPV infections are common in cervical neoplasia and young women in a cervical screening population.

AIMS: If human papillomavirus (HPV) testing is to be included within cervical screening programmes, the importance of multiple HPV infections in cervical neoplasia needs to be determined. This study investigated the diversity of multiple HPV types in a routine cervical screening population, and assessed associations with cervical neoplasia. METHODS: Overall HPV prevalence, type specific prevalence, and extent of multiple infection were assessed in residual material from 3444 liquid based cytology samples, using real time GP5+/GP6+ polymerase chain reaction for screening and linear array assay for genotyping. HPV status was studied in relation to age and concurrent cytological evidence of dyskaryosis. RESULTS: Twenty per cent of samples were HPV positive. HPV type diversity was broad, and multiple HPV infections occurred in half of the HPV positive samples. Younger women were significantly more likely to harbour multiple high risk HPV (HR-HPV) infections. Infections with multiple HR-HPV types were found in 3.4% of samples negative for neoplasia and in 33.3%, 41.8%, and 40.4% of samples with borderline, mild, or high grade dyskaryosis, respectively. Single HR-HPV infections were found in 4.9%, 38.6%, 45.0%, and 51.1% of negative, borderline, mild, or high grade dyskaryosis samples, respectively. CONCLUSIONS: Multiple HR-HPV infections were most prevalent in young women. Multiple HR-HPV infections were not more frequent in high grade than in low grade cervical neoplasia, reflecting common sexual transmission of multiple HR-HPV. Prospective cohort studies linking sequential loss or gain of HPV types with cytological analysis are required to assess the impact of multiple HR-HPV infections on neoplastic progression.

Adult↗

PubMed2004

[Trends in the development of the cytological cervical screening].

Cytological method, as a part of cervical screening, demands to keep strictly to the defined standards for its implementation. At the same time the interpretation of the findings appears a subjective assessment of an objective realities. In this connection, the improvement of the screening method becomes the difficult task, which in the last decade resolved at the several directions: preparation of the standard adequate smear (thin preptechnique), automation of the screening and HPV typization as a part of the screening. It is pointed out, that these new technologies reduce the errors, increase the sensitivity and specificity of the diagnostics, as well as show better proportion "cost-effectiveness", comparing to standard screening.

Cytological Techniques↗

PubMed2003

The significance of psammoma bodies in screening cervical cytologic smears.

OBJECTIVE: Although the presence of psammoma bodies in cervical cytologic smears has been associated previously with gynecologic malignancies, the clinical significance of this finding in asymptomatic women who undergo routine cervical cytologic screening has not been well defined. STUDY DESIGN: For this retrospective clinicopathologic study, a search of the Virginia Mason Medical Center computerized cytology registry from 1993 through March 2002 identified 25 evaluable cervical cytologic smears that contained psammomatous calcifications. Slides were reviewed, and clinical information was obtained from medical records. RESULTS: The median patient age was 36 years (range, 22-72 years). Nine women were postmenopausal. All cytologic smears were obtained for routine screening, and no abnormal cells that were diagnostic of malignancy were identified. Possible explanations for the psammoma bodies was determined for 11 women, including foci of calcifications in benign endometrial or endocervical tissue (4 women), polyps (3 women), marked atrophy (3 women), postpartum (2 women), and follicular cervicitis (1 woman). None of the 25 women had cancer. After excluding 1 woman who was to lost to follow-up, the remaining 24 women were followed up for a median of 3 years (range, 6 months-7 years) without the subsequent detection of cancer. CONCLUSION: Cancers that were reported in previous studies usually were diagnosed in women with malignant background cytology or abnormal symptoms, such as postmenopausal bleeding. In contrast, our study suggests that the presence of psammoma bodies in normal cytologic smears of asymptomatic women is an incidental finding.

Adult↗

PubMed2003

Long-term follow-up of patients following negative colposcopy: a new gold standard and its implications for cervical screening.

From 1189 colposcopy referrals in 1997 at a single cervical screening centre, 88 women who had no biopsy taken at colposcopy (negative colposcopy) were identified. We followed up these women for a maximum of 4 years and calculated the positive predictive value (PPV) of a single smear before and after follow-up. Using slide review we attempted to correlate the grade of smear leading to colposcopy referral with final outcome. Our results showed that long-term follow-up alters the PPV of cervical cytology. Analysis showed a strong correlation between the review grade of the referring smear and the final outcome after follow-up. From these results we suggest an evidence-based protocol for cervical screening follow-up after negative colposcopy.

Adult↗

PubMed1998

Reaching targets in the national cervical screening programme: are current practices unethical?

The principle of informed consent is now well established within the National Health Service (NHS) in relation to any type of medical treatment. However, this ethical principle appears to be far less well established in relation to medical screening programmes such as Britain's national cervical screening programme. This article will critically examine the case for health care providers vigorously pursuing women to accept an invitation to be screened. It will discuss the type of information which women would need in order to make an informed decision about whether or not to be screened. The lack of such information in current patient leaflets on the "smear test" will then be documented. Finally, the article will explore possible ways of maximising women's autonomy in relation to the cervical screening programme without sacrificing any of its main benefits.

Adult↗

PubMed1998

Challenges of developing a cervical screening information system: the Ontario pilot project.

OBJECTIVE: To create a cervical screening information and reporting system in 2 geographic areas of Ontario. DESIGN: A pilot project involving access to, and linkage of, cervical screening-related cytology, colposcopy and histopathology records for women in the study areas, followed by development and production of woman-specific and aggregate reports. SETTING: Hospital cytology and pathology departments, colposcopy clinics, private cytology laboratories, and the provincial cancer agency (Cancer Care Ontario, formerly the Ontario Cancer Treatment and Research Foundation). MAIN OUTCOME MEASURES: Access to required records; data quality (i.e., standardization, completeness, accuracy); quality of record linkage; utility of reports to evaluators, data sources and physicians. RESULTS: The pilot project was not completed because of a number of major challenges, including multiple data sources requiring separate investigation and negotiations for access; variations in reporting terminology and coding; incompatibility or lack of computer systems; incompleteness of identifiers for record linkage; variation in legislation permitting data access and sharing and in its interpretation; and major financial, resource and time requirements. CONCLUSIONS: Although sufficient will and resources can overcome technical obstacles, changes in legislation will be required to overcome other challenges. Strong links with all sectors involved in cervical screening and attention to changes in the health care system are essential.

Colposcopy↗

PubMed1999

Withdrawing low risk women from cervical screening programmes: mathematical modelling study.

OBJECTIVE: To evaluate the impact of policies for removing women before the recommended age of 64 from screening programmes for cervical cancer in the United Kingdom. DESIGN: A mathematical model of the clinical course of precancerous lesions which accounts for the influence of infection with the human papillomavirus, the effects of screening on the progression of disease, and the accuracy of the testing procedures. Two policies are compared: one in which women are withdrawn from the programme if their current smear is negative and they have a recent history of regular, negative results and one in which women are withdrawn if their current smear test is negative and a simultaneous test is negative for exposure to high risk types of human papillomavirus. SETTING: United Kingdom cervical screening programme. MAIN OUTCOME MEASURES: The incidence of invasive cervical cancer and the use of resources. RESULTS: Early withdrawal of selected women from the programme is predicted to give rise to resource savings of up to 25% for smear tests and 18% for colposcopies when withdrawal occurs from age 50, the youngest age considered in the study. An increase in the incidence of invasive cervical cancer, by up to 2 cases/100 000 women each year is predicted. Testing for human papillomavirus infection to determine which women should be withdrawn from the programme makes little difference to outcome. CONCLUSIONS: This model systematically analyses the consequences of screening options using available data and the clinical course of precancerous lesions. If further audit studies confirm the model's forecasts, a policy of early withdrawal might be considered. This would be likely to release substantial resources which could be channelled into other aspects of health care or may be more effectively used within the cervical screening programme to counteract the possible increase in cancer incidence that early withdrawal might bring.

Adult↗

PubMed2000

The effect of nonscreening smears on screening smear results: a statistical analysis with its implications for the NHS cervical screening programme.

This is a statistical analysis of individual NHS Cervical Screening Programme laboratories screening smear 'pick-up' rates (defined here as percentage low grade and percentage high grade of total adequate smears for ages 20-64 years derived from general practitioners and community clinics) in relation to their nonscreening smear workload proportion (here defined as percentage nonscreening smears of total laboratory workload from all sources for all ages). This was achieved by the use of three one way ANOVA models in order to receive a complete overview of the results. The models were applied to the following: (1) Laboratories with a total workload of less than 15000 general practitioner (GP) and community clinic smears; (2) laboratories with a total workload of greater than 15000 GP and community smears and; (3) all laboratories (i.e. a combination of 1 and 2). The 'test' groups within each of these models comprised three subgroups based on the percentage of laboratory workload that consisted of smears from a nonscreening source. This figure ranged from 2.8% to 82.6%. The subgroups were divided so as to contain approximately the same number of laboratories in each one (172 laboratories in total, 42 with workload < 15000 and 130 with > 15000). The results show that laboratories high and low grade pick-up rates have a positively correlated but variable relationship with the proportion of their workload that consists of nonscreening smears. The results show significance overall at the 5% level for high grade and the 10% level for low grade (high grade at P = 0.045 and low grade at P = 0.071). Significance for laboratories viewing less than 15000 screening smears at the 1% level (high grade P = 0.006 and low grade P = 0.005). They show no significance, however, for laboratories viewing more than 15000 screening smears (high grade P = 0.457 and low grade P = 0.622). There is an intriguing possibility that a greater exposure to abnormal smears results in a greater tendency to detect them. The current data provides no evidence to support the NHS Executive's use of 15000 as a designated figure when quality monitoring and service provision becomes a specific issue. The closure or amalgamation of laboratories with workloads less than this would appear to have no scientific evidence base.

Adult↗

PubMed1996

Cost-effectiveness of interventions to promote cervical screening in general practice.

A cost-effectiveness study of three different interventions to promote the uptake of screening for cervical cancer in general practice was carried out in Perth in 1991. Women eligible for a Pap smear were randomly allocated to one of four groups: one receiving letters with specific appointments to attend a screening clinic staffed by female doctors, one receiving letters informing them of the availability of the clinic and suggesting they make an appointment, one whose files were tagged to remind a doctor to offer a smear during a consultation, and a comparison control group that received opportunistic screening only. Variable and fixed costs for each group were itemised and summarised to give an average cost per smear taken. The cost and effectiveness of each intervention were then compared with those of the control group. Sensitivity analysis was performed on the major component of the costs, the doctor's time. Opportunistic screening cost $14.60 per smear and attained 16 per cent recruitment. Tagging files was the cheapest intervention ($14.75 per smear) although it was the least effective in recruiting women (20 per cent). This result held true for different scenarios of doctor's time allocated. Intervention by invitation letter with no appointment cost $45.35 per smear and attained 26 per cent recruitment, and intervention with a specific appointment cost $48.21 per smear and attained 30 per cent recruitment. Compared with the control group, the incremental cost-effectiveness for the tagged group was $15.40, for the letter-without-appointment group $97.75 and for the letter-with-appointment group $86.50.

Adult↗

PubMed2000

Advances in cervical screening technology.

The Pap smear unquestionably is a successful screening test for cervical cancer. However, recent advances in technology have raised questions regarding whether the conventional Pap smear is still the standard of care. This article relates issues of screening and cost-effectiveness to the state of the art in thin layer preparations, cytology automation, human papillomavirus screening, human papillomavirus vaccines, and other cervical screening adjuncts. Perhaps nowhere in medicine is clinical decision making being more strongly influenced by market and other external forces than in cervical cytopathology.

Automation↗