The annual incidence rates of cervical intraepithelial neoplasia (CIN), grades I to III, from 1975 to 1983 among 2440 prisoners in British Columbia for whom a history of screening by means of the Papanicolaou test was available were two to three times higher than the expected rates in the general female population of British Columbia. The rates among the prisoners from 1970 to 1984, although small, increased with a trend similar to that in the general population. Despite increases in the general population we conclude that prisoners are still at high risk for CIN.
Cites: Am J Obstet Gynecol. 1968 Mar 1;100(5):607-145638481
Data from the provincial cytology program has shown a progressive increase in the number of cases of cervical carcinoma in situ detected in the general population and a doubling of disease rate in third decade women, with most of the cases now in the 25- to 29-year-old age group. The introduction of a colposcopy service has led to a significant decrease in the number of diagnostic conizations performed over a 5-year period. Conization was still used for therapy in a substantial number of women despite the availability of cryotherapy and laser surgery. Eighty-five percent of all patients undergoing cone biopsy had sever dysplasia or carcinoma in situ (CIN III) on pathological examination. In 25% of patients, the conization specimen revealed either dysplasia or carcinoma in situ extending to resection margins. During review of 2249 patients, 1174 were spared a conization and were treated by either hysterectomy, cryotherapy, or laser surgery. It would appear that, although colposcopy can reduce dramatically the number of diagnostic cone biopsies, conization will still be required for therapy in a substantial number of patients.
The British Columbia Cervical Cytology Program is operated through the Central Laboratory at the Cancer Control Agency in Vancouver and processes all of the gynecologic Papanicolaou smears collected by 3,200 physicians throughout the province of British Columbia. The laboratory receives approximately 2,400 smears per day, and the program currently processes in excess of 500,000 smears annually. This article describes the methods that have been developed for ensuring that adequate quality control is present in the screening and interpretation of half a million smears per year, both at the cytotechnologist and at the cytopathologist level. The results of the quality control program, which was considerably modified in 1985, are also presented. The modified program shows a significant improvement in the number of undercalled and overcalled cases detected in two comparable six-month periods.
The purpose of this study was to document some of the results of a comprehensive provincial cytology and colposcopy program for the year 1988 and also to review the impact on the incidence and mortality rates for a clinical carcinoma of the cervix.
This study is a retrospective analysis of the cytologic results of all patients examined provincially in 1988 and a review of the clinical records of patients diagnosed with invasive cancer and those who died of disease.
In 1988 490,985 women (40% of all women over the age of 15 in the population) were screened, with 9.2% showing abnormal cells. A total of 79% of women screened were less than 50 years old and accounted for 86.3% of all abnormal smears. Women less than 35 years old were more likely than older women to have moderate dyskaryosis or worse.
Intensive comprehensive cytology and colposcopy programs reduce not only the incidence and mortality of clinical carcinoma of the cervix but also rates of in situ disease and other precursors.
This article discusses the process by which a country can effectively solve health problems through recommended changes in the nutrient content of the diet. Each country must consider not only the development of scientific guidelines suitable for its population, but also strategies for effective food-based dietary guidance to achieve the goal. This is best done by integrating health and dietary goals when forming scientific guidelines and by developing effective partnerships among the many sectors that influence the food supply and food selection. Using fat intake in children as an example, this article describes the determinants of success in achieving the goals of science-based dietary guidelines through food-based dietary guidance.
Dietary guidelines of the U.S. and Canada recommend that 55% of dietary calories of individuals should come from carbohydrates, especially complex carbohydrates. However, they generally fail to describe how much should come from complex carbohydrates. Undoubtedly, this is because of confusion about the composition of complex carbohydrate foods and incomplete knowledge of the health benefits of all components of grain products. With the intent of shifting dietary food selection to increase carbohydrate consumption above the current 46% of calories, food guides recommend 5 to 12 servings per day from grain products. Current estimated intake for adults is between four to five servings of grain products, of which less than one is from whole grain, in an average 2000-kcal adult diet. To follow the advice of the U.S. Food Guide Pyramid, which suggests half the bread (grains) group should be whole-grain products, adult Americans should increase their intake of whole-grain products four- to fivefold and double their intake of total grain products.