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BACKGROUND: Cervical cancer (CC) is a significant global public health concern, particularly in developing countries such as Colombia. The main risk factor involves high-risk HPV types (HR-HPV) infection, coupled with population-specific variables. The Caribbean region in Colombia lacks research on HR-HPV-type frequencies. Therefore, this study aims to establish the prevalence of type-specific HR-HPV and its association with sociodemographic factors among women undergoing cervical cytology screening. METHODS: A cross-sectional study involving voluntary women who provided informed consent and completed a questionnaire capturing sociodemographic, clinical, and sexual behavior information was conducted. All participants underwent cervical cytology and molecular analysis. Generic HPV detection employed three simultaneous PCRs (GP5+/6+, MY09/11, and PU1R/2 M), and positive samples were genotyped using the Optiplex HPV Genotyping kit. The analysis encompassed the 12 types of high-risk HPV (HR-HPV-16,-18,-31,-33,-35,-39,-45,-51,-52,-56,-58, and - 59). Frequencies were reported based on geographic subregions within the Córdoba department, and disparities were made between single and multiple infections. Sociodemographic and clinical variables were subjected to ordinal logistic regression, with statistical significance at a p-value < 0.05. The statistical analyses utilized STATA 14® and R-Core Team-software. RESULTS: We included 450 women, mean age 40 (SD±11.44). PCR analysis revealed 43% HPV-positive (n=192). GP5+/6+ detected the most positives at 26% (n=119), followed by PU1R/2 M at 22% (n = 100) and MY09/11 at 15% (n=69). Multiple infections occurred in 87.3% (n=142), primarily 2 to 4 types (47.37%, n=90). Dominant types were HPV-18 (15.6%, n=61), HPV-16 (14.9%, n=58), HPV-31 (13.0%, n = 51), and HPV-45 (11.5%, n=45). Logistic regression identified age above 60 as a risk for concurrent multiple types (OR=6.10; 95% CI 1.18-31.63). Menopause was protective (OR=0.31; 95% CI 0.11-0.89). CONCLUSIONS: Our study reveals a notable prevalence of multiple (2-4) high-risk HPV infections among adult women engaged in CC detection initiatives. Predominantly, α7 species constitute the prevalent HR-viral types, with the Medio Sinú subregion showing elevated prevalence. Menopausal status confers protection against diverse HR-HPV infections. Nevertheless, advancing age, particularly beyond 60 years, is linked to an increased susceptibility to simultaneous infections by multiple HPV-types.
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Detecção Precoce de Câncer , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Humanos , Feminino , Adulto , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/diagnóstico , Colômbia/epidemiologia , Estudos Transversais , Neoplasias do Colo do Útero/virologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Pessoa de Meia-Idade , Prevalência , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Papillomaviridae/classificação , Genótipo , Adulto Jovem , Fatores de Risco , Idoso , Alphapapillomavirus/genética , Alphapapillomavirus/isolamento & purificação , Alphapapillomavirus/classificação , Região do Caribe/epidemiologiaRESUMO
Haitian immigrant women living in the U.S. have a higher rate of cervical cancer mortality than any other ethnic group, primarily due to lower rates of screening test utilization. Therefore, it is important to understand the issues affecting their pap smear screening behaviors. We conducted a narrative review of articles from PubMed, SCOPUS, Embase, CINAHL/Nursing, and Psych Info. Inclusion criteria: U.S. Haitian immigrant, screening, cervical cancer, health beliefs/perceptions. Exclusion criteria: HPV-vaccine. Primary barriers: (1) lack of knowledge of cervical cancer, HPV, and pap smears; (2) lack of culturally appropriate dissemination of information; and (3) difficulty obtaining the test. Primary facilitators: (1) provider recommendations, (2) Haitian media to disseminate health information, and (3) having health insurance. This review highlights the points for intervention by health professionals and policy makers to address this group's low pap smear utilization.
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Detecção Precoce de Câncer , Emigrantes e Imigrantes , Conhecimentos, Atitudes e Prática em Saúde , Teste de Papanicolaou , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Haiti/etnologia , Detecção Precoce de Câncer/estatística & dados numéricos , Estados Unidos , Esfregaço Vaginal/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto , Acessibilidade aos Serviços de SaúdeRESUMO
SUMMARY OBJECTIVE: The aim of this study was to assess the results and efficiency of two real-time polymerase chain reaction procedures for detecting human papillomavirus utilizing urine samples. METHODS: This study comprised 151 patients who had previously tested positive for human papillomavirus in their cervical samples. Two different commercial real-time polymerase chain reaction techniques were used for identification and genotyping human papillomavirus in urine specimens. The urine samples of 151 patients were evaluated via the Roche Cobas test, and the urine samples of 91 patients were also evaluated via the Qiagen test. RESULTS: The overall consistency of urine and cervical swab specimens for the identification of human papillomavirus in Roche Cobas and Qiagen tests were 44.8 and 44%, respectively. The rates of positive human papillomavirus results from urine samples were 57 and 70.3%, respectively. The overall concordance among Roche Cobas and Qiagen tests utilizing urine samples for human papillomavirus type 16/18 was 84.3% with a kappa value of 0.675, and for other high-risk-human papillomavirus, it was 75.60% with a kappa value of 0.535. Roche Cobas showed high concordance with Qiagen test. CONCLUSION: human papillomavirus positivity was not detected in all urine samples. It is still inappropriate to recommend the use of urine liquid biopsy for the accurate and reliable detection of human papillomavirus. Due to the lack of a standardized tool, the utilization of urine samples as a screening human papillomavirus test remains a challenge.
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Objetivo: desenvolver uma oficina como forma de contribuição ao empoderamento de mulheres para a realização periódica do Papanicolau. Método: qualitativo, exploratório e descritivo, tipo pesquisa participante, em uma unidade de saúde, com mulheres entre 25 a 59 anos, através de entrevista semiestruturada coletiva, durante uma oficina ocorrida em fevereiro de 2023, analisada por meio da Análise Temática de Conteúdo. Resultados: a oficina mostrou-se como um dispositivo que potencializa o empoderamento feminino, interferindo no processo saúde-doença. Desvelou-se ainda como ferramenta de dialogicidade e escuta ativa, na compreensão dos determinantes que se configuram como empecilhos na realização periódica do Papanicolau. Considerações finais: como forma de romper barreiras, ao tratar-se da periodicidade do Papanicolau, a oficina é uma ferramenta eficiente e incentivadora de promoção à participação ativa, à autonomia, à autoestima e ao empoderamento social por meio do processo educativo
Objective: develop a workshop as a way of contributing to the empowerment of women to carry out regular Pap smears. Method: qualitative, exploratory and descriptive, participant research type, in a health unit, with women between 25 and 59 years old, through collective semi-structured interviews, during a workshop, analyzed through Thematic Content Analysis. Results: the workshop proved to be a device that enhances female empowerment, interfering in the health-disease process. It also revealed itself as a tool for dialogue and active listening, in understanding the determinants that constitute obstacles in the periodic performance of the Pap smear. Final considerations: as a way of breaking down barriers, when it comes to the frequency of the Pap smear, the workshop is an efficient and encouraging tool to promote active participation, autonomy, self- esteem and social empowerment through the educational process
Objetivos: desarrollar un taller como forma de contribuir al empoderamiento de las mujeres para la realización periódica de Papanicolaou. Método: investigación cualitativa, exploratoria y descriptiva, tipo participante, en una unidad de salud, con mujeres entre 25 y 59 años, a través de entrevistas colectivas semiestructuradas, durante un taller, analizadas mediante Análisis de Contenido Temático. Resultados: el taller resultó ser un dispositivo que potencia el empoderamiento femenino, interfiriendo en el proceso salud-enfermedad. También se reveló como una herramienta de diálogo y escucha activa, en la comprensión de los determinantes que constituyen obstáculos en la realización periódica del Papanicolaou. Consideraciones finales: como una forma de romper barreras en cuanto a la frecuencia de la prueba de Papanicolaou, el taller es una herramienta eficiente y alentadora para promover la participación activa, la autonomía, la autoestima y el empoderamiento social a través del proceso educativo
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Processo Saúde-Doença , Saúde da Mulher , Teste de Papanicolaou , EmpoderamentoRESUMO
BACKGROUND: Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas. METHODS: Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software. RESULTS: Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members' lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening. CONCLUSIONS: Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers' ability to perform screening.
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Neoplasias do Colo do Útero , Feminino , Masculino , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Bolívia , Detecção Precoce de Câncer/métodos , População Rural , Pesquisa Qualitativa , Programas de Rastreamento/métodosRESUMO
Introducción: La prueba de Papanicolau ayuda a detectar de manera oportuna en la intervención de rutina el cáncer de cuello uterino. Objetivo: Analizar factores asociados al tamizaje para cáncer de cuello uterino en mujeres de 12 a 49 años en Perú durante el año 2019. Metodología: Se realizó un estudio observacional, analítico-transversal de un análisis secundario de datos de la Encuesta Demográfica y de Salud Familiar del 2019. Muestreo bietápico, probabilístico, equilibrado y estratificado. Se utilizó estadística descriptiva y analítica (nivel de inferencia p<0.05). Para el análisis bivariado y multivariado se utilizaron razones de prevalencia con intervalo de confianza de 95% y p<0.05. Resultados: La frecuencia de tamizaje de cáncer de cuello uterino en las regiones políticas con menores valores de prevalencia fueron Pasco (0,52%) y Tumbes (0,55%). Discusión: Los factores asociados al tamizaje de cáncer de cuello uterino son la edad, tener pareja, nivel educación superior, nivel socioeconómico pobre, residir en área rural, tener seguro de salud, edad de inicio de relaciones sexuales y haber escuchado del cáncer de cuello uterino.
Introduction: The Papanicolaou test smear helps detect cervical cancer in a timely manner in routine intervention. Objective: To analyze factors associated with screening for cervical cancer in women aged 12 to 49 years in Peru in 2019. Methods: An observational, analytical-cross-sectional study of a secondary analysis of data from 2019 Demographic and Family Health Survey was carried out. Two-stage, probabilistic, balanced, and stratified sampling. Descriptive and analytical statistics were used (level of inference p<0.05). For the bivariate and multivariate analysis, prevalence ratios were used with a 95% confidence interval and p<0.05. Results: The frequency of cervical cancer screening in the political regions with the lowest prevalence values were Pasco (0.52%) and Tumbes (0.55%). Discussion: The factors associated with cervical cancer screening are age, having a partner, higher education level, poor socioeconomic level, residing in a rural area, having health insurance, age at the start of sexual relations, and having heard of cervical cancer.
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Resumen Objetivo analizar las experiencias de enfermeras en la toma de las citologías cervicales y otros factores organizacionales durante una intervención educativa asistida por metodologías B-learning. Método estudio cualitativo realizado en San Luis Potosí, México. Participaron 15 enfermeras. La recolección de datos se hizo a través de entrevistas semiestructuradas con base en una sistematización de experiencias. Para el análisis de la información se utilizó el programa Taguette y como referente teórico las metodologías B-learning. Resultados se identificaron debilidades en factores relacionados con la accesibilidad de las usuarias al servicio, insumos, infraestructura, bioseguridad, capacitación del personal de salud, entrega de resultados a las pacientes y conocimiento del programa por parte de las usuarias. Conclusiones e implicaciones para la práctica el cáncer cervical es un problema de salud pública. La citología cervical es la prueba de tamizaje más utilizada; sin embargo, existen limitantes en la calidad, por lo que se proponen acciones para mejorar los conocimientos y habilidades del personal de enfermería que tiene como función la toma. La intervención educativa fue efectiva para fomentar el aprendizaje integral sobre la toma de las citologías cervicales y permitió al personal de enfermería compartir sus experiencias.
Resumo Objetivo analisar as experiências das enfermeiras na realização de esfregaços cervicais e outros fatores organizacionais durante uma intervenção educacional assistida por metodologias de b-learning. Método estudo qualitativo realizado em San Luis Potosí, México. Participaram 15 enfermeiras. A coleta de dados foi feita por meio de entrevistas semiestruturadas a partir de uma sistematização de experiências. Para a análise das informações, utilizou-se o programa Taguette e metodologias de b-learning como referencial teórico. Resultados foram identificadas fragilidades em fatores relacionados com a acessibilidade dos usuários ao serviço, insumos, infraestrutura, biossegurança, capacitação da equipe de saúde, entrega de resultados aos pacientes e conhecimento do programa pelos usuários. Conclusões e implicações para a prática o câncer do colo do útero é um problema de saúde pública. A citologia cervical é o teste de triagem mais utilizado; no entanto, existem limitações na qualidade, por isso são propostas ações para aprimorar os conhecimentos e habilidades das enfermeiras que estejam desempenhando essa função. A intervenção educacional foi eficaz para promover o aprendizado integral sobre a realização do esfregaço cervical e permitiu que as enfermeiras compartilhassem suas experiências.
Abstract Objective to analyze the nursing staff's experiences in taking cervical smears and other organizational factors during an educational intervention assisted by B-learning methodologies. Method a qualitative study was carried out in San Luis Potosí, Mexico, with 15 nurses. Data collection was done through semi-structured interviews based on a systematization of experiences. The Taguette program and B-learning methodologies as theoretical references were used to analyze the information. Results weaknesses were identified in factors related to the accessibility of users to the service, supplies, infrastructure, biosafety, training of health personnel, delivery of results to patients, and knowledge of the program by the users. Conclusions and implications for practice cervical cancer is a public health problem. Cervical cytology is the most widely used screening test; however, there are limitations in quality, so actions are proposed to improve the knowledge and skills of the nursing staff in their functions. The educational intervention effectively promoted comprehensive learning about taking cervical smears and allowed the nursing staff to share their experiences.
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Esfregaço Vaginal/enfermagem , Neoplasias do Colo do Útero/prevenção & controle , Colo do Útero/citologia , Teste de Papanicolaou/enfermagem , Capacitação em Serviço , Enfermeiras e Enfermeiros , Programas de Rastreamento , Saúde da Mulher , Infecções por PapillomavirusRESUMO
Abstract Objective To evaluate the rates of precancerous lesions, colposcopy referral, and positive predictive value (PPV) by age groups of a population-based screening with DNA-HPV testing. Methods The present demonstration study compared 16,384 HPV tests performed in the first 30 months of the program with 19,992 women tested in the cytology screening. The colposcopy referral rate and PPV for CIN2+ and CIN3+ by age group and screening program were compared. The statistical analysis used the chi-squared test and odds ratio (OR) with 95% confidence interval (95%CI). Results The HPV tests were 3.26% positive for HPV16-HPV18 and 9.92% positive for 12 other HPVs with a 3.7 times higher colposcopy referral rate than the cytology program, which had 1.68% abnormalities. Human Papillomavirus testing detected 103 CIN2, 89 CIN3, and one AIS, compared with 24 CIN2 and 54 CIN3 detected by cytology (p < 0.0001). The age group between 25 and 29 years old screened by HPV testing had 2.4 to 3.0 times more positivity, 13.0% colposcopy referral, twice more than women aged 30 to 39 years old (7.7%; p < 0.0001), and detected 20 CIN3 and 3 early-stage cancer versus 9 CIN3 and no cancer by cytology screening (CIN3 OR= 2.10; 95%CI: 0.91 -5.25; p = 0.043). The PPV of colposcopy for CIN2+ ranged from 29.5 to 41.0% in the HPV testing program. Conclusion There was a significant increase in detections of cervix precancerous lesions in a short period of screening with HPV testing. In women < 30 years old, the HPV testing exhibited more positivity, high colposcopy referral rate, similar colposcopy PPV to older women, and more detection of HSIL and early-stage cervical cancer.
Resumo Objetivo Avaliar as taxas de lesões pré-cancerosas, encaminhamento para colposco pia e valor preditivo positivo (VPP) por faixas etárias de rastreamento populacional com teste DNA-HPV. Métodos O presente estudo de demonstração comparou 16.384 testes de HPV realizados nos primeiros 30 meses do programa com 19.992 mulheres testadas no rastreio citológico. Os programas foram comparados por taxa de encaminhamento de colposcopia e VPP para NIC2+ e NIC3+ por faixa etária. A análise estatística utilizou o teste de qui-quadrado e odds ratio (OR, na sigla em inglês) com intervalo de confiança (IC) de 95%. Resultados Os testes de HPV foram 3,26% positivos para HPV16-HPV18 e 9,92% positivos para 12 outros HPVs, com uma taxa de encaminhamento de colposcopia 3,7 vezes maior do que o programa de citologia, que teve 1,68% de anormalidades. O teste de HPV detectou 103 NIC2, 89 NIC3 e um AIS, em comparação com 24 NIC2 e 54 NIC3 detectados por citologia (p < 0,0001 ). O rastreio por teste de HPV no grupo etário 25 a 29 anos teve 2,4 a 3,0 vezes mais positividade, 13,0% de encaminhamento para colposcopia, 2 vezes mais que mulheres de 30 a 39 anos (7,7%; p < 0,0001 ), e detectou 20 NIC3 e 3 cânceres em estágio inicial versus nove NIC3 e nenhum câncer pelo rastreio citológico (NIC3 OR= 2,10; 96%CI: 0,91 -5,25; p = 0,043). O VPP da colposcopia para NIC2+ variou de 29,5 a 41,0% no programa de teste de HPV. Conclusão Houve um aumento significativo na detecção de lesões pré-cancerosas do colo do útero em um curto período de rastreamento com teste de HPV. Em mulheres < 30 anos, o teste de HPV exibiu mais positividade, alta taxa de encaminhamento para colposcopia com VPP semelhante a mulheres mais velhas, e mais detecção de HSIL e de câncer cervical em estágio inicial.
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Humanos , Feminino , Neoplasias do Colo do Útero , Programas de Rastreamento , Infecções por Papillomavirus , Detecção Precoce de Câncer , Testes de DNA para Papilomavírus Humano , Teste de PapanicolaouRESUMO
Cervical cancer (CC) is tightly related to a low Human Development Index. Mexico is an upper-middle-income country with 126 million inhabitants, and its public health system aims to provide universal health coverage. Currently, employment-based social insurance covers approximately 60% of the population, and the scope of the remaining 40% is on course via the "IMSS-Bienestar" Institute. However, the annual government spending on health remains at 3% of the Gross Domestic Product, which is well below the 6% recommended by the Organization for Economic Cooperation and Development. CC is the second in incidence and mortality among women. Regarding primary prevention with the Human Papilloma Virus-vaccine, the current coverage for girls aged 9 to 14 years is only around 7%. Among secondary prevention with screening, the program is yet to cover the total number of women at risk; nevertheless, the age-standardized CC mortality rate has decreased from 12 per 100,000 women in 1979 to 5.7 per 100,000 women in 2020 due in part to increased screening coverage. Still, around two-thirds of patients present with locally advanced disease at diagnosis. Data from our country demonstrate that even socially disadvantaged CC patients achieve "standard" survival outcomes if treatment is granted. Nevertheless, there is a shortage in almost every aspect regarding CC treatment, including oncologists, chemotherapy units, medical physicists, radiation technicians, and both teletherapy and brachytherapy facilities. In conclusion, advances in the public health system in Mexico are urgently required to achieve CC control and reduce the mortality from this neoplasia that mainly targets socially disadvantaged women.
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BACKGROUND: Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish "El Valle". METHOD: A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. RESULTS: Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, there is also certain resistance to undergo the Pap smear test, for reasons such as inaccessibility and its sampling process. CONCLUSIONS: It is necessary to develop educational programs for the prevention of cervical cancer and to implement diagnostic alternatives to reach populations with precarious accessibility, as well as women who refuse to undergo the Pap smear test.
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Infecções por Papillomavirus , Neoplasias do Colo do Útero , Detecção Precoce de Câncer , Equador , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento , Teste de Papanicolaou , Papillomaviridae , Infecções por Papillomavirus/prevenção & controle , Pesquisa Qualitativa , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço VaginalRESUMO
Background: The aim of this study was to outline the Pap smears rate done in women with total hysterectomy, sent to an urban diagnostic center that attends Mexican Government workers in the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE: State´s Employees´ Social Security and Social Services Institute) at Mexico City. Methods: It was a retrospective study on Pap smear reports taken in 2017. The reports came from users of four family medicine clinics and a general hospital´s gynecology service. Demographic facts, instruments for collection, kind of insurance (ISSSTE-insurance or non-insurance), and total hysterectomy history were evaluated. Results: From 4989 reports, 600 (12%) had a total hysterectomy history. In the patients with ISSSTE-insurance, 586 of 4618 (12.68%) had a Pap smear whereas in the patients with non-insurance, only 14 of 371 (3.7%) had it, and this difference was significant (P < 0.00001; OR 3.7, 95% IC 2.15-6.36). Conclusions: Although Pap smear is not indicated in women with total hysterectomy, this study is still carried out frequently.
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Background: Cervical cancer is a preventable disease, and the Brazilian screening is opportunistic and has low impact. The current study evaluated an initiative to organize screening using DNA-HPV testing as a replacement for cytology. Methods: This demonstration study examined information from 16 384 DNA-HPV tests for screening in women aged 25-64 years from Indaiatuba city between October 2017-March 2020. The comparison was 20 284 women screened using cytology between October 2014-March 2017. The flowchart indicates the repetition of a negative test in five years. HPV16- and/or HPV18-positive tests and the 12 pooled high-risk HPV-positive tests with abnormal liquid-based cytology were referred for colposcopy. If cytology was negative, the HPV test was repeated in 12 months. The analyses evaluated coverage, age-group compliance, and cancer detected. Findings: After 30 months, the coverage projection was greater than 80%. The age compliance for the HPV test was 99.25%, compared to 78.0% in the cytology program. The HPV test program showed 86.8% negative tests and 6.3% colposcopy referrals, with 78% colposcopies performed. The HPV testing program detected 21 women with cervical cancer with a mean age of 39.6 years, and 67% of cancers were early-stage compared to 12 cervical cancer cases detected by cytological screening (p=0.0284) with a mean age of 49.3 years (p=0.0158), and one case of early-stage (p=0.0014). Interpretation: Organizing cervical cancer screening using DNA-HPV testing demonstrated high coverage and age compliance in a real-life scenario, and it had an immediate impact on cervical cancer detection at an early-stage. Funding: University of Campinas, Indaiatuba City, and Roche Diagnostics.
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INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública, siendo una de las principales causas de morbilidad y mortalidad en países en vía de desarrollo. Para el screening y diagnóstico de las lesiones del cuello uterino se realiza citología cervical (Papanicolaou). Ante un reporte de citología sospechosa, la colposcopia es un procedimiento imprescindible en la evaluación del tracto genital inferior para detectar lesiones tempranas y cáncer. El objetivo de la presente investigación fue caracterizar los procedimientos colposcópicos realizados, como método diagnóstico y terapéutico, en las pacientes con resultados anormales del Papanicolaou. MATERIALES Y MÉTODOS: El presente es un estudio observacional, descriptivo de corte transversal, cuyo universo lo conformaron todas las pacientes con diagnóstico citológico anormal en Papanicolaou, que se realizaron un procedimiento colposcópico entre el año 2015 hasta el año 2019 en el Hospital José Carrasco Arteaga, con un total de 1 628 pacientes. RESULTADOS: Se incluyen 1 628 procedimientos colposcópicos. El 55.46% de la población estuvieron entre los 27 a 46 años de edad. El estado civil predominante fue casada (75%). El 63.45% de las mujeres iniciaron vida sexual entre los 21 a 30 años. El 95.20% de las pacientes tuvieron entre 1 y 3 parejas sexuales. Los resultados de Papanicolaou anormales representan; el 37.28% a LIE-BG, seguido de 35.81% con ASC-US y 14.18% como LIE-AG. El 67.32% de colposcopías fueron satisfactorias. Se realizó biopsia en el 71% de las pacientes, seguido de la toma de muestra de cono con ASA-LEEP (13.69%), legrado endocervical en el 11.05%. Los resultados de anatomía patológica reportaron LIE-AG en 46.56% de los casos, seguido de 22.23 % como LIE-BG y cervicitis crónica en el 16.27%, 12.28% de los resultados fueron negativos. CONCLUSIÓN: Tres cuartas partes de las colposcopias se realizaron en mujeres entre los 27 y 56 años de edad. Los resultados anormales más frecuentemente encontrados en el Papanicolaou fueron: LIE-BG, seguido de ASC-US. 67% de las colposcopias realizadas fueron satisfactorias. Tras la colposcopia, en la mayoría de pacientes se realizó biopsia, en un menor porcentaje y en orden de frecuencia: conización electro quirúrgica con asa (ASA-LEEP), legrado endocervical e histerectomía diagnóstica. Los resultados de anatomía patológica reportaron LIE-AG en el 46.56%, LIE-BG en el 22.23 % como y cervicitis crónica en el 16.27%; 12.28% de estudios fueron negativos.(au)
BACKGROUND: Cervical cancer is a public health issue, being one of the main causes of morbidity and mortality in developing countries. Cervical cytology (Papanicolaou) is performed for screening and diagnosis of cervical lesions. In case of a suspicious cytology report, colposcopy is an essential procedure for evaluation of the lower genital tract, to detect early lesions and cancer. The aim of this study was to characterize the colposcopy procedures performed, as a diagnostic and therapeutic method, in patients with abnormal Papanicolaou results. METHODS: This is an observational, descriptive cross-sectional study, whose universe were all the patients with abnormal cytological diagnosis in pap smear, who underwent a colposcopy procedure between 2015 and 2019 at Hospital José Carrasco Arteaga, with a total of 1 628 patients. RESULTS: 1 628 colposcopic procedures were included. 55.46% of the population were between 27 to 46 years of age. The predominant marital status was married status (75%). 63.45% of women had their first sexual experience between 21 and 30 years of age. 95.20% of the patients had between 1 and 3 sexual partners. Abnormal pap smear results represent; 37.28% to LSIL, followed by ASC-US (35.81%), and HSIL (14.18%). 67.32% of colposcopies were classified as satisfactory. Biopsy was performed in 71% of the patients, followed by loop electrosurgical excision procedure (LEEP) (13.69%), endocervical curettage in 11.05%. The pathology results reported HSIL in 46.56% of the cases, followed by 22.23% as LSIL and chronic cervicitis in 16.27%, 12.28% of the results were negative. CONCLUSION: Three-quarters of all colposcopies were performed on women between 27 and 56 years of age. The most frequently abnormal Pap smear results were: LSIL, followed ASC-US. 67% of the colposcopies were satisfactory. After colposcopy, biopsy was performed in most of the patients, in lower percentage: loop electrosurgical excision procedure (LEEP), endocervical curettage and diagnostic hysterectomy. Pathology results reported HSIL in 46.56%, LSIL IN 22.23% and chronic cervicitis in 16.27%; 12.28% of studies were negative.(au)
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Biópsia , Cervicite Uterina , Neoplasias do Colo do Útero , Colo do Útero , Colposcopia , CuretagemRESUMO
Objetivo: Descrever o processo de desenvolvimento de uma webtecnologia educacional, do tipo blog, sobre citologia clínica, para estudantes e profissionais da área da saúde. Métodos: Pesquisa metodológica para construção de tecnologia educacional em saúde, desenvolvida em três etapas: Revisão da literatura (2019), a partir da qual se deu o delineamento teórico; Fotodocumentação (2020), que foi a fase responsável pela obtenção do conteúdo imagético; Construção (2020-2021), a partir da qual se deu a criação do blog. Resultados: Na primeira fase, obteve-se a fundamentação teórica. Na segunda fase, realizou-se a obtenção das imagens e na terceira fase, o desenvolvimento do produto técnico-tecnológico. Conclusão: O blog, emerge como modelo de suporte para proporcionar um caráter de ubiquidade à informação e como consequência disso, ampliar o potencial gerador de conhecimento sobre citologia clínica entre estudantes e profissionais de diversos campos da área da saúde, com enfoque à Biomedicina e Enfermagem(AU)
Objective: To describe the development process of an educational webtechnology, like a blog, about clinical cytology, for students and health professionals. Methods: Methodological research for the construction of educational technology in health, developed in three stages: Literature review (2019), from which the theoretical outline was given; Photodocumentation (2020), which was the phase responsible for obtaining the image content; Construction (2020-2021), from which the creation of the blog took place. Results: In the first phase, the theoretical foundation was obtained. In the second phase, the images were obtained and in the third phase, the development of the technical-technological product. Conclusion: The blog emerges as a support model to provide a ubiquitous character to information and, as a consequence, expand the potential generator of knowledge about clinical cytology among students and professionals from different fields of health, with a focus on Biomedicine and Nursing(AU)
Objetivo: Describir el proceso de desarrollo de una tecnología web educativa, como un blog, sobre citología clínica, para estudiantes y profesionales de la salud. Métodos: Investigación metodológica para la construcción de tecnología educativa en salud, desarrollada en tres etapas: Revisión de la literatura (2019), a partir de la cual se dio el esquema teórico; Fotodocumentación (2020), que fue la fase encargada de obtener el contenido de la imagen; Construcción (2020-2021), a partir de la cual tuvo lugar la creación del blog. Resultados: En la primera fase se obtuvo el fundamento teórico. En la segunda fase se obtuvieron las imágenes y en la tercera fase, el desarrollo del producto técnico-tecnológico. Conclusión: El blog surge como un modelo de apoyo para dotar de un carácter ubicuo a la información y, como consecuencia, ampliar el potencial generador de conocimiento sobre citología clínica entre estudiantes y profesionales de diferentes campos de la salud, con enfoque en Biomedicina y Enfermería(AU)
Assuntos
Tecnologia , Educação Continuada , Teste de Papanicolaou , BlogRESUMO
OBJECTIVE: To identify reasons among Brazilian women for never having a Pap test. DESIGN: We designed a cross-sectional study that used data from the National Health Survey. SAMPLE: Two thousand four hundred and two women 25-64 years old who never had a pap test. MEASURES: Variables were age, race, education, marital status, housing condition, primary health care access, health insurance, self-perceived health, and social support network. We calculated the prevalence of different reasons and odds ratios for each. RESULTS: The most frequent reason for never having a test were linked to women thinking the test was unnecessary (42.3%) which had a significant association with marital status (OR = 1.52; 95% CI = 1.07-1.91), age (OR = 1.56; 95% CI = 1.21-1.99), area of residence (OR = 1.15; 95% CI = 1.02-1.39), having a health insurance (OR = 1.18; 95% CI = 1.01-1.36), and self-perceived health (OR = 1.42; 95% CI = 1.28-1.56). The second most frequent reason was not knowing they needed a test (22.9%) which was associated with age (OR = 1.95; 95% CI = 1.74-2.16) and self-perceived health (OR = 1.56; 95% CI = 1.33-1.80). CONCLUSIONS: The findings suggest lack of knowledge about cervical cancer and its prevention among Brazilian women. We consider it essential that the health service can provide the test, as well as the necessary guidelines for raising the awareness of the target audience.
Assuntos
Teste de Papanicolaou , Neoplasias do Colo do Útero , Adulto , Brasil/epidemiologia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controleRESUMO
El CaÌncer Cervicouterino es una de las principales problemaÌticas en salud de las mujeres a nivel mundial. Las teÌcnicas de tamizaje para la deteccioÌn de CaÌncer Cervicouterino han ido desarrollaÌndose a traveÌs de la historia reciente tanto intencionada como casualmente, incorporando con cada nuevo descubrimiento a las nuevas tecnologiÌas. Actualmente existen diversos procedimientos vigentes que van desde pruebas sencillas de inspeccioÌn visual, pasando por las tradicionales muestras citoloÌgicas, hasta la utilizacioÌn de tecnologiÌa molecular, y los usos que se les dan a estos meÌtodos de cribado potencian la deteccioÌn temprana del CaÌncer Cervicouterino, razoÌn por lo cual se realiza una revisioÌn respecto de las teÌcnicas de tamizajes disponibles y su aplicacioÌn en Chile.
Cervical Cancer is one of the main problems in women's health worldwide. Screening techniques for the detection of Cervical Cancer have been developed throughout recent history both intentionally and incidentally, incorporating new technologies with each new discovery. Currently there are various procedures in force that range from simple visual inspection tests, through traditional cytological samples, to the use of molecular technology, and the uses that are given to these screening methods enhance the early detection of Cervical Cancer, which is why which is carried out a review regarding the available screening techniques and their application in Chile.
Assuntos
Humanos , Feminino , Neoplasias do Colo do Útero/diagnóstico , Programas de Rastreamento/métodos , Papillomaviridae/isolamento & purificação , Algoritmos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Chile/epidemiologia , Exame Ginecológico , Teste de PapanicolaouRESUMO
BACKGROUNG: Cervical cancer is a serious public health problem in Brazil and around the world. Its screening through the Pap smear screening is crucial for prevention and early detection. OBJECTIVE: The objective of the study was to evaluate the Pap smear ratio in the regions of the State of Rio Grande do Norte from 2008 to 2014, and to describe the regions with lower and higher screening for cervical cancer according to the space. METHODS: It is a quantitative, retrospective, descriptive and cross-sectional study that used secondary data from SISCOLO/DATASUS. The sample was composed by the 167 municipalities of the State of Rio Grande do Norte in Brazil, divided by the eight regions of that State. The results were expressed in absolute and relative frequencies, the differences between means were analyzed by the T student tests, in which significant differences were considered when p<0.05. The mapping of results was done through the TabWin program 32. CONCLUSION: The average ratio of Pap smear varied considerably between the regions of the State in the years 2008 to 2014. There was decrease in the average of the ratio between the years 2008 and 2014, especially in the metropolitan region. Regarding the space, it was seen that most of the municipalities with the lower ratio are located at the ends of the map. Knowing the cytopathological ratio indicator in the regions of the State is fundamental for the management of health in that State, in order to better qualify practitioners and to establish specific goals for the evaluation of coverage of cervical cancer.
INTRODUÇÃO: O câncer de colo do útero é um grave problema de saúde pública no Brasil e no mundo. Sua triagem através do exame de papanicolau é crucial para a prevenção e detecção precoce. OBJETIVO: O objetivo do estudo foi avaliar a relação de papanicolau nas regiões do Rio Grande do Norte de 2008 a 2014, e descrever as regiões com menor e maior rastreamento de câncer do colo do útero de acordo com o espaço. MÉTODO: Trata-se de um estudo quantitativo, retrospectivo, descritivo e transversal que utilizou dados secundários do SISCOLO/DATASUS. A amostra foi composta pelos 167 municípios do Estado do Rio Grande do Norte, divididos pelas oito regiões daquele Estado. Os resultados foram expressos em frequências absolutas e relativas, as diferenças entre os meios foram analisadas pelas provas dos alunos T, nas quais foram consideradas diferenças significativas quando p<0,05. O mapeamento dos resultados foi feito através do programa TabWin 32. CONCLUSÃO: A razão média do papanicolau variou consideravelmente entre as regiões do Estado nos anos de 2008 a 2014. Houve queda na média da relação entre os anos de 2008 e 2014, especialmente na região metropolitana. Em relação ao espaço, veram-se que a maioria dos municípios com menor proporção está localizada nas extremidades do mapa. Conhecer o indicador de razão citopatológica nas regiões do Estado é fundamental para a gestão da saúde naquele Estado, a fim de qualificar melhor os profissionais e estabelecer metas específicas para a avaliação da cobertura do câncer do colo do útero.
Assuntos
Neoplasias do Colo do Útero , Saúde Pública , Prevenção de Doenças , Teste de Papanicolaou , Estudos de Avaliação como AssuntoRESUMO
In recent years, deep learning methods have outperformed previous state-of-the-art machine learning techniques for several problems, including image classification. Classifying cells in Pap smear images is very challenging, and it is still of paramount importance for cytopathologists. The Pap test is a cervical cancer prevention test that tracks preneoplastic changes in cervical epithelial cells. Carrying out this exam is important in that early detection. It is directly related to a greater chance of curing or reducing the number of deaths caused by the disease. The analysis of Pap smears is exhaustive and repetitive, as it is performed manually by cytopathologists. Therefore, a tool that assists cytopathologists is needed. This work considers 10 deep convolutional neural networks and proposes an ensemble of the three best architectures to classify cervical cancer upon cell nuclei and reduce the professionals' workload. The dataset used in the experiments is available in the Center for Recognition and Inspection of Cells (CRIC) Searchable Image Database. Considering the metrics of precision, recall, F1-score, accuracy, and sensitivity, the proposed ensemble improves previous methods shown in the literature for two- and three-class classification. We also introduce the six-class classification outcome.
RESUMO
Objective: This study sought to identify the presence of HPV infection and the risk factors related to susceptibility to cervical cancer in asymptomatic women. Methods: It is a cross-sectional study with 428 users attended Basic Health Units, in Arapiraca, Alagoas, Brazil. Sociodemographic, behavioral variables, and cytopathological reports were collected. Molecular detection of the HPV virus was performed by Nested-PCR. Statistical analysis was conducted with SPSS version 22.0. Results: A total of 428 women were studied, HPV DNA detected in 39.2% (n = 168), with a mean age of 41 years old. There was an association of HPV with use of oral contraceptives (p <0.016) and alcoholism (p <0.038). It was showed a higher frequency of positive HPV in women older than 25 years old (88.7%), up to 5 sexual partners (93.4%), up to 3 pregnancies (71.4%), and with the cytopathologic results within the limits of normality (61.9%). HPV was identified in 40.3% (104/258) of the women with results within the limits of normality. Conclusion: Our results suggest that the use of oral contraceptives and alcoholism may be considered as possible risk factors related to cervical oncogenesis. With this, it is necessary to propose interventions aimed at the health education of this population, actions of prevention, and early detection.
Objetivo: Este estudo buscou identificar a presença de infecção pelo HPV e os fatores de risco relacionados à suscetibilidade ao câncer do colo do útero em mulheres assintomáticas. Métodos: Trata-se de um estudo transversal com 428 usuários atendidos em Unidades Básicas de Saúde, em Arapiraca, Alagoas, Brasil. Foram coletados relatórios sociodemográficos, variáveis comportamentais e citopatológicos. A detecção molecular do vírus HPV foi realizada por Nested-PCR. A análise estatística foi realizada com SPSS versão 22.0. Resultados: Foram estudadas 428 mulheres, com DNA de HPV detectado em 39,2% (n =168), com média de idade de 41 anos. Houve associação do HPV com o uso de anticoncepcional oral (p<0,016) e alcoolismo (p <0,038). Foi evidenciada maior frequência de HPV positivo em mulheres maiores de 25 anos (88,7%), até cinco parceiros sexuais (93,4%), até três gestações (71,4%) e com resultados citopatológicos dentro dos limites da normalidade (61,9%). O HPV foi identificado em 40,3% (104/258) das mulheres com resultados dentro dos limites da normalidade. Conclusão: Nossos resultados sugerem que o uso de anticoncepcionais orais e o alcoolismo podem ser considerados como possíveis fatores de risco relacionados à oncogênese cervical. Com isso, é necessário propor intervenções voltadas para a educação em saúde dessa população, ações de prevenção e detecção precoce.
Assuntos
Papillomaviridae , Infecções por Papillomavirus , Vírus , Mulheres , Neoplasias do Colo do Útero , Saúde , Educação em Saúde , Fatores de Risco , Saúde da Mulher , Prevenção de Doenças , Teste de PapanicolaouRESUMO
Objetivo: avaliar o conhecimento e a prática de mulheres atendidas em Unidades Básica de Saúde em relação ao exame Papanicolaou. Método: trata-se de um estudo quantitativo, descritivo com delineamento transversal. Foram entrevistadas 320 mulheres residentes na área de abrangência de três Unidades Básicas de Saúde da cidade de Caxias - MA. Resultados: apesar da quase totalidade das mulheres entrevistadas terem ouvido falar do exame Papanicolaou 311 (97,2%), mais da metade delas apresentou um conhecimento inadequado 233 (72,8%). Percebeu-se também, que apesar de mais da metade serem classificadas como tendo um conhecimento inadequado, a maioria das mulheres apresentaram uma prática adequada 187 (58,44%). Conclusão: desta forma, este estudo mostrou que não houve uma associação entre o nível de conhecimento e a prática das mulheres. Portanto, existe conhecimento precário da maioria das mulheres sobre o exame preventivo do Câncer do Colo do Útero, tendo como consequência uma atribuição errônea sobre a finalidades do mesmo
Objective: to evaluate the knowledge and practice of women assisted in Basic Health Units in relation to the Pap smear. Method: this is a quantitative, descriptive study with a cross-sectional design. 320 women living in the area covered by three Basic Health Units in the city of Caxias-MA were interviewed. Results: although almost all of the women interviewed heard about the Pap smear exam 311 (97.2%), more than half of them had inadequate knowledge 233 (72.8%). It was also noticed that despite the fact that more than half were classified as having inadequate knowledge, most women had an adequate practice 187 (58.44%). Conclusion: thus, this study showed that there was no association between the level of knowledge and the practice of women. Therefore, there is a precarious knowledge of the majority of women about the cervical cancer preventive exam, resulting in an erroneous attribution about its purposes
Objetivo: analizar el conocimiento y la práctica de las mujeres atendidas en las unidades básicas de salud en relación con la prueba de Papanicolaou. Metodo: este es un estudio cuantitativo, descriptivo con un diseño transversal. Se entrevistó a 320 mujeres que viven en el área cubierta por tres Unidades Básicas de Salud en la ciudad de Caxias-MA. Resultados:aunque casi todas las mujeres entrevistadas escucharon sobre el examen de Papanicolaou 311 (97.2%), más de la mitad tenían conocimiento inadecuado 233 (72.8%). También se observó que, aunque más de la mitad se clasificaron como de conocimiento inadecuado, la mayoría de las mujeres tenían una práctica adecuada 187 (58.44%). Conclusiones:por lo tanto, este estudio mostró que no había asociación entre el nivel de conocimiento y la práctica de las mujeres. Por lo tanto, existe un conocimiento precario de la mayoría de las mujeres sobre el examen preventivo del cáncer de cuello uterino, lo que resulta en una atribución errónea sobre sus propósitos