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Results for “cervical screening”

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PubMed1995

A community-based cervical screening program in a remote Aboriginal community in the Northern Territory.

We established a culturally appropriate, community-based women's health service in Yuendumu, Northern Territory, to improve women's health and to remedy the low rate of cervical screening. During the 16 months of the program 419 cervical smears were taken, increasing coverage of the women eligible from 51 to 78 per cent. Acceptance of the program was excellent, with only 2 per cent of the women approached refusing to have a smear. Over 70 per cent of the Pap smears were done by the nursing staff in the clinic; quality control was good, with 9 per cent of smears reported as having no endocervical cells. Sixty-four per cent of screened women had normal smears and 0.9 per cent showed evidence of cervical intraepithelial neoplasia (CIN). Three women were referred for treatment of CIN, two for CIN I and one for CIN III. The program illustrates how a combination of community involvement, staff stability, teamwork, and cross cultural understanding can achieve a comprehensive and successful cervical screening service in a remote Aboriginal community.

Adolescent↗

PubMed1999

Clinical impact of quality assurance in an organized cervical screening program.

BACKGROUND: We have studied whether clinical monitoring of an established population register based cervical screening program could reduce the number of cervical cancer cases and if drawbacks in the coverage could be detected. METHOD: A total of 123 consecutive cervical cancer cases were studied. A retrospective study of five years was followed by five prospective years after the introduction of increased efforts to find previously neglected low-grade positive smears. Cervical cancer incidence, histology, stage, and early mortality were related to smear history. RESULTS: The absence of cancer cases with neglected positive smears was a major reason for a 50 percent lower incidence of squamous cancers in the prospective period. Rapid onset interval cancers were few. Older women, never invited to the program, accounted for the majority of the advanced or aggressive cases in the former period. However, serious post-screening cancers remained common among women who had not had smears taken regularly up to the age of sixty, whereas there was little morbidity in women who had a regular smear to that age. CONCLUSION: This organized screening program is a versatile tool in identifying women at risk. To attain effectiveness it needs, however, active monitoring of the smear history and a mechanism to ascertain that all women have participated well beyond the age of fifty before being left out of the program.

Adult↗

PubMed2003

Performance indicators of organized cervical screening in Romagna (Italy).

The availability of published data from organized cervical screening programmes in southern Europe is scant. In the Italian area of Romagna, a first round of organized screening (based on a 3-yearly Pap smear for women aged 25-64 years) was initiated between December 1995 and January 1997 and was completed in an average of 42 months (range 36-48 months). The target population included 305 478 women. Of these, 253 949 were eligible and received a personal letter of invitation. Age-specific screening performance indicators were calculated according to standard methods. The response rate within 6 months of invitation was 49.1% (n=124 621). The total participation rate including women who presented later was 61.7% (n=156 735). The recall rate was 35.2 per 1000 of participants (n=5514). Positive cytology results were distributed as follows: atypical squamous cells of un-determined significance/atypical glandular cells of undetermined significance (ASCUS/AGUS) 40.1%, low-grade squamous intraepithelial neoplasia (LGSIL) 48.6%, high-grade squamous intraepithelial neoplasia (HGSIL) 10.7% and carcinoma 0.7%. Compliance to colposcopy follow-up was 93.4% (n=5149). The biopsy rate was 52.4% (n=2696) of patients undergoing colposcopy. The detection rate was 4.5 per 1000 of participants (n=707) for CIN2-3 and 0.5 (n=75) for invasive carcinoma. The proportion of microinvasive carcinomas was 36.0% (n=27). The positive predictive value for CIN2-3/carcinoma was 5.8% for the cytology reports of ASCUS/AGUS, 7.6% for those of LGSIL, 76.5% for those of HGSIL, and 100.0% for those of carcinoma (80.4% for combined HGSIL/carcinoma). The ratio of observed to expected (or prevalent to incident) cases of invasive carcinoma was 2.35 (95% confidence interval (CI) 1.85-2.95). In conclusion, most early results of the programme were compatible with an acceptable performance.

Adult↗

PubMed2006

Cervical screening history in patients with early stage carcinoma of the cervix.

This study aimed to examine whether a decade of heightened publicity on issues relating to cervical screening has changed the screening profile of women presenting with cervical cancer at the National Maternity Hospital. The screening history of 100 women diagnosed with early/surgically treated cervical cancer between 1998 and 2002 was compared with a similar study conducted in 1982 /1990. The percentage of women never screened was similar - 24 %( 2002) and 23% (1990). The interval between last recorded smear and diagnosis of disease was greater than 5 years in 45.6% and 41.7% respectively. Overall 60% of women in the recent period had either failed to avail of screening or were not screened within 5 years of diagnosis compared with 64% in 1990. Multiparous women comprised 90% of the study group and 50% of those inadequately screened were attending their general practitioner on a regular basis - therefore affording a potential for opportunistic screening The current method of screening has failed in this group and has not improved in 10 years despite of increased population awareness and greater opportunities for screening than ever before and would support an argument for a National Screening Program.

Adenocarcinoma↗

PubMed1994

An evaluation of cervical screening in general practice.

OBJECTIVES: To identify the technical practices of general practitioners (GPs) in relation to Papanicolaou (Pap) smear screening, and the differences in screening practices between male and female practitioners; to determine the cellular content of smears taken; and to correlate screening practices and demographic variables with smear results. DESIGN: During February-May 1992, a sample of Melbourne GPs filled in a questionnaire concerning their screening practices, and the results were correlated retrospectively with results of Pap smears taken in March and October 1991. SETTING: Melbourne metropolitan general practice. PARTICIPANTS: One hundred and seventy-nine GPs (72% participation rate among eligible practitioners) from a sample obtained from the register of the Medical Board of Victoria. RESULTS: Female doctors took significantly more smears than male doctors. An opportunistic approach to cervical screening was most commonly practised, with the patient being asked to ring for her results and the practice staff only contacted her if the result was abnormal. Only 43% of doctors indicated the use of a specific reminder system when rescreening was due. Endocervical cells were present in 79% of smears. The presence of endocervical cells was found to be related to the year of a doctor's graduation (with both very recent and older graduates [pre-1960s] having lower endocervical cell rates), and to be positively correlated with more postgraduate training. CONCLUSIONS: Our study suggests that further education and training in cervical screening is needed for some GPs, in particular, male doctors, graduates of less than four or greater than 20 years, and those without postgraduate training.

Adult↗

PubMedDate not supplied

Effects of the Bethesda System on the rate of unsatisfactory Pap smears in spontaneous cervical screening.

AIMS: In 1990, The Bethesda System (TBS) was introduced into spontaneous cervical screening practice in Ravenna, Italy. Negative/benign reports with the recommendation for early repeat smears (RERS) due to some limitation in sample adequacy were considered no longer acceptable. A monitoring program for the rate of unsatisfactory smears (UNS) was implemented. The aim of the present study was to evaluate the effects of such changes in the screening procedure. METHODS: The frequency of UNS in 1990 was compared with that of UNS+RERS in 1988 (assumed as a baseline year) by the calculation of the standardized rate ratio with the 95% confidence interval (CI). The trend in the standardized rate of UNS from 1990 to 1994 was evaluated by the calculation of the average annual variation with the 95% CI. RESULTS: The immediate effect of TBS (1990; 1988 comparison) was a significant increase in the rate of UNS attributable to scant cellularity, poor fixation and thick areas (rate ratio, 2.35; 95% CI, 2.18 to 2.53) and to the absence of endocervical component (1.45; 95% CI, 1.30 to 1.60). The rate of UNS attributable to the presence of cytolysis, inflammation, blood and foreign material decreased by about 6 times (0.16; 95% CI, 0.13 to 0.19). The midterm effect of TBS (trend from 1990 to 1994) was a decrease in the total rate of UNS by an average of 2.3% per year. The downward trend was significant for smears showing scant cellularity, poor fixation and thick areas (-1.5% per year) and the absence of endocervical component (-0.7% per year). UNS attributable to the presence of cytolysis, inflammation, blood and foreign material stabilized. CONCLUSIONS: TBS led to a substantial change in the type of information provided by the cytology report (immediate effect). The monitoring program according to TBS led to a reduction in UNS attributable to sample taker (midterm effect).

Female↗

PubMed1995

Assessing the effectiveness of a screening campaign: who is missed by 80% cervical screening coverage?

A case-control study was conducted to assess the effectiveness of a regional call programme in reaching women at risk of cervical cancer. Home interviews were conducted with a random sample of 614 women aged 20-64 who were identified from a computerized register as either having had a smear test within the previous 3 years or not having an up-to-date smear history. Unscreened women fell principally into two age cohorts: under 35 years and over 50 years. A small social class differential was found to persist following the campaign. Overall, unscreened women were not at epidemiologically higher risk than the screened population. Thirty-five per cent of unscreened women reported never having had sexual intercourse compared to 3% of screened women: 17% of the unscreened and 38% of screened women reported two or more lifetime sexual partners. No difference was observed between screened and unscreened women in the frequency of current cigarette smoking (37% unscreened, 38% screened). Cigarette smoking was, however, associated with social class (31% classes 1 or 2 compared with 50% classes 4 and 5). Level of practical difficulties did not differentiate those who attended from those who did not, suggesting that recent changes to delivery or screening services have been effective in ensuring equity of access. Non-attenders and lower class women held more negative attitudes towards the test procedure and were less likely to believe that they were at risk of cervical cancer. Perceived personal risk was not associated with cigarette smoking, suggesting that further attention might be given to this factor in educational campaigns.

Adult↗

PubMed2004

Cervical screening in England and Wales: an update.

PURPOSE OF REVIEW: The National Health Service Cervical Screening Programme (NHSCSP) has played a major role in reducing the mortality from cervical cancer in England and Wales. However, the current system has numerous shortcomings and it is likely that its success has reached a plateau. In light of this, significant changes have recently been made to the programme. These alterations, as well as further potential developments, are considered here. RECENT FINDINGS: The aim of any change to the programme is to improve its sensitivity and specificity whilst reducing patient morbidity and maintaining cost-effectiveness. Alterations to NHSCSP guidelines include the replacement of the Papanicolau smear with liquid-based cytology, the referral for colposcopy of women with a single dyskaryotic cytology result and the commencement of screening at the later age of 25. These changes appear to be beneficial overall. The role of newer technologies in the programme is being clarified and it is likely that human papillomavirus testing will be incorporated in the near future. Progress is being made in the field of human papillomavirus vaccines, particularly prophylactic, which may go on to have the most profound impact on the incidence of cervical cancer. The disease is now largely a burden of the developing world, where the use of these technologies is considered. SUMMARY: Changes currently being instituted in the NHSCSP should go some way towards improving the service. The importance of increasing coverage rates, reducing patient waiting times and the associated anxiety must not be overlooked.

Adult↗

PubMed1999

The Icelandic and Nordic cervical screening programs: trends in incidence and mortality rates through 1995.

BACKGROUND: The objective of cervical cancer screening is to lower the incidence and mortality rates of the disease. This study evaluates the effectiveness of cervical screening and the UICC and EC screening recommendations based on the Nordic screening experience. METHODS: The study analyzes the features of the Icelandic and the Nordic screening programs and the observed trends in the incidence and mortality rates in these countries through 1995. RESULTS: Organized screening started in all the Nordic countries soon after 1960 and had nation-wide coverage in all these countries, except in Denmark (45% coverage in 1991), by around 1973 but in Norway screening was only spontaneous up to late in 1994. Up to 1985 the target age group and screening interval were most intensive in Iceland, followed by Finland, Sweden and Denmark. All countries except Finland lowered the lower age limit and intensified the screening intervals after 1985. Through the period 1986-1995 the reduction in both the mortality and the incidence rates was greatest in Iceland (mortality: 76% and incidence: 67%) and Finland (73% and 75%, respectively), intermediate in Sweden (60% and 55%, respectively) and Denmark (55% and 54%, respectively), and lowest in Norway (43% and 34%, respectively). The age-specific incidence in the 20-29 age group has been increasing since 1971 in all the Nordic countries, except in Finland, where the yearly registered age-specific incidence has been increasing in the targeted 30-54 age group since 1991. In Iceland screening has greatly affected the rate of all stages of squamous cell carcinoma, but not the rate of adeno- and adenosquamous carcinomas. In fact the rate of adenocarcinoma has been increasing. CONCLUSIONS: Organized screening is more effective than spontaneous screening in reducing the risk of cervical cancer. Although differences in environmental, biological and ethnic factors may call for different screening strategies, screening should preferably start soon after age 20 with a screening interval of 2-3 years.

Adult↗

PubMed1995

General practitioner attitudes to recall systems for cervical screening.

OBJECTIVES: To document the factors associated with general practitioner (GP) use of Pap smear reminder/recall systems and to canvass options for coordinating these GP-based systems with similar centrally based schemes. METHODS: A questionnaire survey of a random sample of South Australian GPs. RESULTS: 259 (78%) of 334 GPs returned questionnaires. 117 (45.2%) GPs had practice-based reminder/recall systems, with a higher prevalence among metropolitan GPs with a computer and who had been in practice for less than 20 years. 91.9% of GPs reported that the central register would be of some help in ensuring regular cervical screening. 38.2% of the GPs preferred reminder letters from the register to be sent to their practice; 27.8% preferred them to be sent directly to women and 22.8% opted for letters to be sent from the register via the laboratories to their practice. 61.4% of respondents had a method of recording women with abnormal smears and 95.6% of these actively recalled such women. CONCLUSION: Substantial variation exists in the use of practice-based reminder/recall systems among GPs. A central register would assist most GPs by providing a back-up reminder service to follow-up women for cervical screening.

Adult↗

PubMed2001

Reasons for variation in coverage in the NHS cervical screening programme.

In order to investigate reasons for variation in coverage of cervical screening, data from standard Department of Health returns were obtained for all Health Authorities for 1998/1999. Approximately 80% of the variation between health authorities is explained by differences in age distribution and area classification. Considerable differences between Health Authority and Office of National Statistics (ONS) population figures in City and Urban (London) areas for the age group 25-29 years and for City (London) for age group 30-34 years, suggest an effect of list inflation in these groups. Coverage as a performance indicator may be more accurately represented using the age range 35-64 years. Using this narrower age range, the percentage of health authorities meeting the 80% 5-year coverage target increases from 87% to 90%.

Adult↗

PubMed1997

Is cervical screening working? A cytopathologist's view from the United Kingdom.

This article considers the NHS cervical screening program and the controversies which have attended the introduction of comprehensive screening in a partially screened population of women in whom the underlying risk of disease was unknown. The increase in screening coverage which has taken place since 1988 has coincided with a period of high prevalence of cervical cancer and its precursors among women in the screening age group, against which background the recent fall in mortality and incidence of the disease has been a far greater achievement than generally recognized. The success of the program is considered in the context of the expectations and limitations of the test itself, and the high standards required for screening to be effective.

Adult↗

PubMed1998

[Cervical screening in Bulgaria. An analysis of the basic indices over the period 1970-1994].

The aim of the present study was to analyze the results from the cervical screening in Bulgaria for the period 1970-1994, by studying the following indicators: incidence, mortality, frequency of carcinoma in situ and stage distribution of the cases with invasive cervical cancer. The relatively constant incidence and mortality until 1987 were evident, after that they shoved increasing and for 1994 they are 19.7% and 7.6% respectively. The similar is the data for the correlation carcinoma in situ/invasive cancer and for the stage distribution of the cervical cancer patients. The obtained results showed, that cervical cancer remain medico-social problem for our country, because the introduced in 1970 cervical cytological screening at the moment is not effective enough.

Bulgaria↗

PubMed2000

HIV-positive women and cervical screening.

To date the management of HIV-positive women regarding the prevention of cervical cancer remains controversial. There are different approaches to cervical screening in different health authorities in the UK and worldwide due to different funding and healthcare provision in general, the official disease prevalence and the attempt to tailor the screening programme according to a perceived risk for the population covered, but most of all in the diverse evidence provided to aid the development of a screening programme. The advent of high active antiretroviral therapy (HAART) may also have altered the natural history of cervical intraepithelial neoplasia (CIN) before it became sufficiently understood and future studies have to take this into account when investigating the impact of human papillomavirus (HPV) and CIN on the risk of developing cervical cancer. This article aims to summarize the available evidence to date and provide a basis on which an effective and acceptable screening programme for HIV-positive women can be developed.

Antiretroviral Therapy, Highly Active↗

PubMed2006

High grade squamous intraepithelial lesion in inmates from Ohio: cervical screening and biopsy follow-up.

BACKGROUND: Cervical carcinoma remains the second leading cause of cancer death in women worldwide and sexual behavior is regarded as the main contributing factor. We studied cervical cytology screening with surgical biopsy follow-up in women prisoners and compared the findings to those in the general population. METHODS: We reviewed 1024 conventional cervical smears, 73 cervical biopsies and 2 loop electrosurgical excision procedure (LEEP) specimens referred to us from the Correctional Center in Columbus, Ohio during a 12-month period. The results were compared to 40,993 Pap smears from the general population for the same 12-month period. RESULTS: High grade squamous intraepithelial lesion (HGSIL) was diagnosed in 1.3% of the cervical smears from the inmate population versus 0.6% in the general population (p < 0.01). The unsatisfactory rate was 1.6% compared to 0.3% in the general population (p < 0.01). Among the study population, follow-up tissue diagnosis was obtained in 24.3% of the abnormal cytology results (ASCUS, LGSIL, and HGSIL). Of the HGSIL Pap smears, 61.5% had a subsequent tissue diagnosis. Thirty-nine biopsies (52% of the all inmate biopsies and LEEP) showed CIN II/III (cervical intraepithelial neoplasia II/III). Eight of these thirty-nine follow-up biopsies diagnosed as CIN II/III had a previous cervical cytology diagnosis of ASCUS. The average age for HGSIL was 30.5 years (S.D. = 5.7) and for low grade squamous intraepithelial lesion (LGSIL) was 27.2 years (S.D. = 6.1). CONCLUSION: A significantly higher prevalence of HGSIL cervical cytology and unsatisfactory smears was encountered in female inmates, with tissue follow-up performed in less than two thirds of the patients with HGSIL. These results are in keeping with data available in the literature suggesting that the inmate population is high-risk and may be subject to less screening and tissue follow-up than the general population. Clinicians should proceed with urgency to improve screening and follow-up with treatment. The inmate population should be targeted for HPV vaccination promptly after FDA approval.

Journal Article↗

PubMed2003

Translational approaches to improving cervical screening.

Screening programmes for cervical cancer using the current test--the Pap smear--have markedly reduced the incidence of the disease. However, an individual Pap test is of limited sensitivity and is difficult and expensive to perform. Increased understanding of the molecular pathogenesis of cervical cancer indicates that new approaches to screening might offer increased accuracy, affordability and the potential for automation. Such approaches exemplify how improved understanding of the biology of neoplasia might be translated into clinical benefit.

Acetic Acid↗

PubMed1995

Assessing the effectiveness of cervical screening.

The mathematic models used to assess the benefits and cost-effectiveness of cervical screening reveal little consistency in the definition of disease status, the basic assumptions made, or the data used in the model. Conclusions derived from the models often are model and data dependent. Several authors have used simplified models and unrealistic assumptions, such as the failure to differentiate between different grades of dysplasia, or 100% sensitivity for the screening test. The Markov process assumes that the rate of transfer between states is independent of the duration of time spent in one state, and this assumption may be unsound. The difficulty with all models is in interpreting the appropriateness of the parameter values. Some are well documented, for example, stage-specific survival rates for treated patients or attendance for screening. Many, however, cannot be given a fixed value. The large number of factors that appear implicated in the incidence of and mortality from cervical cancer can lead to many feasible sets of parameter values that generate output that approaches the observed data.

Case-Control Studies↗

PubMed2001

Opinion survey of Hong Kong private primary care doctors about cervical screening.

The policy and practice of Hong Kong private primary care doctors regarding cervical screening were investigated by way of two different questionnaires sent to comparable random survey samples. The overall response rate was 60.8% (313/515). Both sexes of eligible doctors believed that cervical smears were effective and important, but only 40.2% (47/117) of male doctors performed the test compared with 65.5% (19/29) of female doctors. Those doctors who do not perform the test themselves usually refer their patients elsewhere. The small proportion of private doctors offering cervical smears may reduce opportunities for women who need them. Over 80% of private doctors recommended annual smears despite local recommendations for 3-yearly tests, while graduates from western countries were more likely to recommend longer intervals. Since the proportion of women in Hong Kong having Papanicolaou tests is still low, effort should focus on providing smears for more women, rather than repeated annual testing of those who already participate.

Attitude of Health Personnel↗