Follicular cervicitis is usually easily identifiable on Papanicolaou (Pap) tests; however, historically, follicular cervicitis is reported to lead to false-positive diagnoses of epithelial cell abnormalities.
To assess participant responses in the College of American Pathologists (CAP) Pap educational program (CAP-PAP) to determine the accuracy and false-positive rate of follicular cervicitis cases. Design.-We performed a retrospective review of 4914 participant responses for gynecologic cytology challenges with the reference diagnosis of follicular cervicitis during 11 years (2000-2010) from CAP-PAP. Reference diagnosis category, false-positive rates by participant type (laboratory, cytotechnologist, pathologist), and preparation type (conventional smears, ThinPrep) were analyzed.
Of the total 4914 general category responses, 4368 (88.9%) were benign while 546 (11.1%) responses were epithelial cell abnormalities (false positives). Of benign responses, only 2026 (46.4%) were an exact match to follicular cervicitis. Adenocarcinoma and high-grade squamous intraepithelial lesion were the most common diagnoses chosen as a false-positive interpretation (42.3% and 20.1%, respectively). Participant type was significantly associated with false-positive interpretations (laboratory: 19.2%; cytotechnologist: 11.1%; pathologist: 7.9%; P
BACKGROUND: Most of women diagnosed as having cervical cancer have not participated in organized cytological screening. Aim. A study was conducted to evaluate the accuracy of human papilloma virus testing by self-collected vaginal samples in comparison to regular cytological screening. The agreement of hybrid capture 2 assay and polymerase chain reaction assay for detection of human papilloma virus DNA in self-collected vaginal samples and clinician-obtained cervical smears was investigated. METHOD: Forty-three women aged 23-58 years admitted for further examination due to previous positive cytology in the organized screening participated in self-collecting of vaginal samples with a novel self-sampling device. During the visit a clinician also collected a cervical smear using a cytobrush. The vaginal samples collected with the self-sampling device were analyzed for high-risk human papilloma virus with the hybrid capture 2 assay technique and the cervical smears were Pap-stained, examined cytologically and after that reanalyzed for human papilloma virus DNA using a polymerase chain reaction assay. RESULT: The vaginal samples were positive for high-risk human papilloma virus in 37% of the cases using hybrid capture 2 assay. Twelve of the 43 Pap smears showed positive cytology (ASCUS-CIN 3), of which 4 showed CIN 2-3. When polymerase chain reaction assay was performed, human papilloma virus DNA was detected in 40% of the glass slides. The agreement between cytology and the two human papilloma virus testing techniques was 67-74% (kappa 0.27-0.45) and the agreement between the two human papilloma virus tests was 70% (kappa 0.36). CONCLUSION: Testing for high-risk human papilloma virus can identify more women at risk of developing cervical cancer than cytology irrespective of the sampling method. Furthermore, offering a self-sampling device for collection of vaginal smear seems to be a useful screening tool for cervical cancer among women not responding to an invitation for smear sampling.
The quality of the data recorded by the British Columbia Cancer Registry for 521 new cases of invasive cervical cancer was evaluated. The registry's pathological diagnosis in all new registrations of invasive cervical cancer diagnosed in British Columbia between 1977 and 1979 was compared with a best estimate of the true diagnosis, which was determined from the results of the provincial cervical cytology screening program and the clinical charts at the Cancer Control Agency of British Columbia. The registry's data overestimated the true incidence of invasive cervical cancer by approximately 55%, since 184 (35%) of the cases were incorrectly registered. Of the 184, 141 (77%) were cases of preinvasive cervical cancer, 26 (14%) did not meet the criteria for a true case (i.e., they were not newly diagnosed in British Columbia between 1977 and 1979) and 17 (9%) were cases of invasive cancer of another primary site. In addition, 28 cases of invasive cervical cancer diagnosed in the province during the study period had not been reported to the registry. Thus, both over-reporting and under-reporting occurred. There is a need for constant evaluation of registry data if cancer registries are to fulfil their potential contribution to cancer control programs and research.
A substantial percentage of North American women are nonadherent to cervical cancer screening guidelines despite the effectiveness of the Papinicolaou (pap) test for papillomavirus. Our objective was to determine factors associated with changes in adherence for cervical cancer screening guidelines over a 14-year period.
Using data from cycles 1 (1994-1995) through 7 (2006-2007) of the Canadian National Population Health Survey, we used logistic regression to compare the regularity of pap testing (at least once every 36 months) among women. We compared women with increasing adherence to pap testing guidelines to those who were never adherent, and women with decreasing adherence to those who were always adherent. The sample included women aged 20-70 years who responded in at least three of seven waves of data collection and had not undergone a hysterectomy (n=4949). Independent variables were based on Andersen's Behavioral Model of predisposing, enabling, and need variables.
The majority of our sample were either always adherent (61.4%) or had increasing adherence (9.9%) over the course of the study. Another 4.8% were never adherent, and 6.6% had decreasing adherence over their involvement in the study. Predominantly, both enabling (e.g., presence of regular doctor) and need (e.g., birth control pill use, obesity) factors were associated with changing patterns of adherence.
Physicians have a crucial role to play in the trajectories of adherence to cervical cancer screening guidelines over time. In addition, women with obesity need to be particularly targeted for services because they are vulnerable to negative trajectories in adherence over time.
Women living with HIV (WLWH) are at increased risk of invasive cervical cancer (ICC). International HIV guidelines suggest cervical screening twice the first year after HIV diagnosis and thereafter annually. Adherence to the HIV cervical screening program in Denmark is unknown.
We studied women from a population-based, nationwide HIV cohort in Denmark and a cohort of age-matched females from the general population. Screening behaviour was assessed from 1999-2010. Adjusted odds ratios (OR's) for screening attendance in the two cohorts and potential predictors of attendance to guidelines were estimated. Pathology specimens were identified from The Danish Pathology Data Bank.
We followed 1143 WLWH and 17,145 controls with no prior history of ICC for 9,509 and 157,362 person-years. The first year after HIV diagnosis 2.6% of WLWH obtained the recommended two cervical cytologies. During the different calendar intervals throughout the study period between 29-46% of WLWH followed the HIV cervical screening guidelines. Adjusted OR's of attendance to the general population screening program for WLWH aged 30, 40 and 50 years, compared to controls, were 0.69 (95% CI: 0.56-0.87), 0.67 (0.55-0.80) and 0.84 (0.61-1.15). Predictors of attendance to the HIV cervical screening program were a CD4 count?>?350 cells/µL and HIV RNA?
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Cites: Scand J Public Health. 2011 Jul;39(7 Suppl):30-321775347
A clinico-pathologic review was performed on all younger (under 35 years) and older (55 years or over) women with a diagnosis of cervical squamous cell carcinoma assessed at the Tom Baker Cancer Centre from 1980 to 1985 to determine the effect of age at diagnosis on survival. 45 younger women were identified: 32 were Stage IB; 10, Stage II; and 3, Stage III. 64 older women were identified: 16 were Stage IB; 30, Stage II; 14, Stage III; and 4, Stage IV. For Stage IB women, 40.6% of younger patients developed persistent or recurrent disease and all except one are dead; only one (6.2%) older woman's tumour recurred and she is alive with disease. Younger women had a poorer disease-free survival not only for Stage IB disease (p = 0.014) but also in Stages II and III (p = 0.020). In this study age at diagnosis was an independent prognostic variable with younger women having a poorer disease-free and overall survival.