RESUMO
OBJECTIVE: To compare cervical cytology test results among pregnant and non-pregnant women, and to assess associations with age, screening history, and onset of sexual intercourse. METHODS: A retrospective analysis was conducted of cervical smears obtained from women aged 18-34 years in the Campinas region of Brazil between January 2000 and December 2009. Eligible participants had not undergone cytological screening within the previous year and had no history of precursor lesions or cervical cancer. Multinomial logistic regression was performed for different age groups, with high-grade squamous intraepithelial lesions (HSILs) as the endpoint. RESULTS: Overall, 3072 (0.4%) of 861 353 non-pregnant women and 135 (0.4%) of 37 568 pregnant women had HSILs. Odds of HSIL among pregnant and non-pregnant women did not differ in any age group. An increased age at first sexual intercourse among pregnant women reduced odds of HSILs in all age groups (odds ratio 0.9 [95% confidence interval 0.8-0.9] for all). Among women aged 21-24 years, 25-29 years, and 30-34 years, some associations were identified between an interval of less than 5 years since previous screening and reduced odds of HSILs. CONCLUSION: Mandatory cervical cytology screening does not seem to be necessary for pregnant women; protocols in place for non-pregnant women should be followed.
Assuntos
Programas de Rastreamento/métodos , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/métodos , Adolescente , Adulto , Brasil , Carcinoma de Células Escamosas/diagnóstico , Detecção Precoce de Câncer , Feminino , Humanos , Modelos Logísticos , Razão de Chances , Gravidez , Estudos Retrospectivos , Neoplasias do Colo do Útero/classificação , Adulto Jovem , Displasia do Colo do Útero/diagnósticoRESUMO
INTRODUCTION: Genital bleeding may be a common symptom among women with cervical cancer. MATERIAL AND METHODS: Cross-sectional study evaluating whether the prevalence of cervical smear results is different in women with and without clinical information about concurrent genital bleeding. RESULTS: The sample consisted of 2 324 836 smears; of these, 0.4% had clinical information on genital bleeding. When stratified by age group, women with genital bleeding had a higher chance of a cytological result of a high-grade squamous intraepithelial lesion [30-49 years odds ratio (OR) 2.38; 95% confidence interval (CI) 1.60-3.53 and ≥50 years OR 6.30; 95%CI 3.72-10.67), of squamous cell carcinoma (SCC) (30-49 years OR 24.70; 95%CI 11.96-51.03 and ≥50 years OR 48.91; 95%CI 31.28-76.47) and of atypical glandular cells (30-49 years OR 5.72; 95%CI 3.30-9.93 and ≥50 years OR 11.56; 95%CI 5.96-22.45); there was also a higher chance of adenocarcinoma for women ≥50 years (OR 53.13; 95%CI 28.08-100.51). The sensitivity of genital bleeding for women aged 18-29 years was 0.4% for high-grade squamous intraepithelial lesion (HSIL); for women 30-49 years old the rate was 0.9% for HSIL, 8.6% for SCC and 2.1% for atypical glandular cells of undetermined significance (AGUS), while for women aged from 50 years or more the rates were 2.0% for HSIL, 13.7% for SCC, 3.6% for AGUS and 14.7% for adenocarcinoma. CONCLUSION: Women ≥30 years old with genital bleeding should be referred for colposcopy to rule out the possibility of cervical cancer.
Assuntos
Células Escamosas Atípicas do Colo do Útero , Carcinoma de Células Escamosas/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Hemorragia Uterina/complicações , Hemorragia Uterina/patologia , Adolescente , Adulto , Fatores Etários , Carcinoma de Células Escamosas/patologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal , Adulto JovemRESUMO
OBJECTIVES: To evaluate if the prevalence of cervical smear results varies between pregnant and non-pregnant women stratified by age group. STUDY DESIGN: Observational analytical study with a total sample of 1,336,180 pregnant and non-pregnant women, aged between 20 and 34 years, who underwent cervical cancer screening in the Primary Health Care of the national health system in the area of Campinas in Brazil during the period of 2005-2009. The source is the information system for cervical cancer screening. Data collected on abnormal cervical smears were analyzed using the Chi-square test and Fisher's exact test and the magnitude of the association between pregnancy and high-grade squamous epithelial lesions was analyzed by odds ratio (OR) and estimated values with confidence intervals (CI) of 95%. RESULTS: 15,190 pregnant women and 395,961 non-pregnant women were analyzed and fulfilled the inclusion criteria. Regardless of age, no statistical differences were observed for high-grade squamous intraepithelial lesion prevalence (OR 0.90; CI 0.66-1.23). Taking into account the five-year age groups, however, low-grade squamous intraepithelial lesion was less prevalent in pregnant women aged 20-24 (OR 0.71; 0.54-0.95) and 25-29 years (OR 0.56; 0.35-0.89); also, atypical squamous cells of undetermined significance was more prevalent in non-pregnant women aged 25-29 years (OR 0.72; 0.54-0.97). CONCLUSION: The study showed that the cytological prevalence of high-grade squamous intraepithelial lesion was similar in pregnant and non-pregnant women, regardless of age. The results indicate that there are no reasons for specific approaches to cervical cancer screening for pregnant women. The examination should be carried out only on pregnant women who have not been tested according to current recommendations.
Assuntos
Complicações Neoplásicas na Gravidez/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Adulto , Fatores Etários , Brasil/epidemiologia , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
BACKGROUND: The germline TP53-R337H mutation is strongly associated with pediatric adrenocortical tumors (ACT) in southern Brazil; it has low penetrance and limited tissue specificity in most families and therefore is not associated with Li-Fraumeni syndrome. However, other tumor types, mainly breast cancer, have been observed in carriers of several unrelated kindreds, raising the possibility that the R337H mutation may also contribute to breast tumorigenesis in a genetic background-specific context. METHODS: We conducted a case-control study to determine the prevalence of the R337H mutation by sequencing TP53 exon 10 in 123 women with breast cancer and 223 age- and sex-matched control subjects from southern Brazil. Fisher's test was used to compare the prevalence of the R337H. RESULTS: The R337H mutation was found in three patients but in none of the controls (p = 0.0442). Among the carriers, two had familial history of cancer meeting the Li-Fraumeni-like criteria. Remarkably, tumors in each of these three cases underwent loss of heterozygosity by eliminating the mutant TP53 allele rather than the wild-type allele. Polymorphisms were identified within the TP53 (R72P and Ins16) and MDM2 (SNP309) genes that may further diminish TP53 tumor suppressor activity. CONCLUSION: These results demonstrate that the R337H mutation can significantly increase the risk of breast cancer in carriers, which likely depends on additional cooperating genetic factors. These findings are also important for understanding how low-penetrant mutant TP53 alleles can differentially influence tumor susceptibility.
Assuntos
Neoplasias da Mama/genética , Genes p53 , Mutação em Linhagem Germinativa , Proteína Supressora de Tumor p53/genética , Adulto , Brasil , Neoplasias da Mama/metabolismo , Estudos de Casos e Controles , Interpretação Estatística de Dados , Família , Feminino , Predisposição Genética para Doença , Humanos , Imuno-Histoquímica , Masculino , Polimorfismo Genético , Proteínas Proto-Oncogênicas c-mdm2/genéticaRESUMO
Avalia o papel da detecçäo do DNA-HPV e da carga viral como fator positivo de lesöes histológicas em mulheres com atipia de células escamosas na colpocitologia