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Introduction: Preventive screening for cervical cancer is the best available strategy to reduce the incidence and mortality from this neoplasm. However, the low proportion of women who undergo routine screening is a pending concern for healthcare systems worldwide. Objective: To estimate the prevalence and factors associated with preventive cervical cancer screening in a Peruvian region. Methods: Cross-sectional, multicenter study. It enrolled 1146 women users of healthcare centers in a Peruvian sanitary region. The dependent variable was the performance of cervical cancer preventive screening with Papanicolaou or visual inspection with acetic acid in the last two years. The independent variables were sociodemographic and socio-sanitary factors, knowledge about cervical cancer and human papillomavirus, attitudes and information towards screening tests. To evaluate the association between the variables, crude and adjusted prevalence ratios were calculated with generalized linear models of Poisson. Results: The overall prevalence of preventive screening was 50.5%. This was associated with being tested, having a higher education level and urban area of residence, using contraceptive methods, having health insurance, being recommended by healthcare personnel to be screened, and being concerned about developing cervical cancer. It was also associated with responding that this cancer is preventable, being aware of cervical cancer or human papillomavirus, and believing it can cause cervical cancer. In contrast, considering preventive screening risky was associated with not having the test. Conclusions: The proportion of women with preventive cervical cancer screening is low. In addition, certain associated modifiable factors were identified, which could improve preventive screening behaviors and rates.
Introducción: El tamizaje preventivo del cáncer cervical es la mejor estrategia disponible para mermar la incidencia y mortalidad por esta neoplasia. No obstante, la baja proporción de mujeres que se someten al tamizaje de rutina, constituye un problema pendiente para los sistemas de salud del mundo. Objetivo: Estimar la prevalencia y los factores asociados a realizarse el tamizaje preventivo del cáncer cervical en una región de Perú. Métodos: Estudio transversal y multicéntrico. En él participaron 1146 mujeres usuarias de centros de salud de una región sanitaria de Perú. La variable dependiente fue la realización de un tamizaje preventivo de cáncer cervical con Papanicolaou o inspección visual con ácido acético, en los últimos dos años. Las variables independientes fueron factores sociodemográficos, sociosanitarios, conocimientos sobre cáncer de cuello uterino y virus del papiloma humano, actitudes e información ante las pruebas de tamizaje. Para evaluar la asociación entre las variables se calcularon razones de prevalencia crudas y ajustadas, con modelos lineales generalizados de la familia Poisson. Resultados: La prevalencia general del tamizaje preventivo fue de 50,5%. Esta se asoció a realizarse la prueba, el grado de instrucción superior y área de residencia urbana, usar métodos anticonceptivos, tener seguro de salud, recibir recomendación del personal de salud para realizarse el tamizaje y sentirse preocupada por adquirir cáncer de cuello uterino. También se vinculó a quienes respondieron que el cáncer es prevenible, que habían oído hablar de cáncer cervicouterino o virus del papiloma humano y si cree que este virus puede causar cáncer de cuello uterino, Además, se asoció el admitir que existe posibilidad de curar el cáncer con su detección temprana. En cambio, el considerar riesgoso el tamizaje preventivo se relacionó con no realizarse la prueba. Conclusiones: La proporción de mujeres con tamizaje preventivo de cáncer cervical es baja. Asimismo, se identificaron ciertos factores asociados modificables, los que podrían mejorar las conductas y tasas del tamizaje preventivo.
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Detecção Precoce de Câncer , Neoplasias do Colo do Útero , Feminino , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Estudos Transversais , Peru/epidemiologia , Prevalência , Papillomavirus HumanoRESUMO
INTRODUCCIÓN: El tamizaje preventivo del cáncer cervical es la mejor estrategia disponible para mermar la incidencia y mortalidad por esta neoplasia. No obstante, la baja proporción de mujeres que se someten al tamizaje de rutina, constituye un problema endiente para los sistemas de salud del mundo. OBJETIVO: Estimar la prevalencia y los factores asociados a realizarse el tamizaje preventivo del cáncer cervical en una región de Perú. MÉTODOS: Estudio transversal y multicéntrico. En él participaron 1146 mujeres usuarias de centros de salud de una región sanitaria de Perú. La variable dependiente fue la realización de un tamizaje preventivo de cáncer cervical con Papanicolaou o inspección visual con ácido acético, en los últimos dos años. Las variables independientes fueron factores sociodemográficos, sociosanitarios, conocimientos sobre cáncer de cuello uterino y virus del papiloma humano, actitudes e información ante las pruebas de tamizaje. Para evaluar la asociación entre las variables se calcularon razones de prevalencia crudas y ajustadas, con modelos lineales generalizados de la familia Poisson. RESULTADOS: La prevalencia general del tamizaje preventivo fue de 50,5%. Esta se asoció a realizarse la prueba, el grado de instrucción superior y área de residencia urbana, usar métodos anticonceptivos, tener seguro de salud, recibir recomendación del personal de salud para realizarse el tamizaje y sentirse preocupada por adquirir cáncer de cuello uterino. También se vinculó a quienes respondieron que el cáncer es prevenible, que habían oído hablar de cáncer cervicouterino o virus del papiloma humano y si cree que este virus puede causar cáncer de cuello uterino, Además, se asoció el admitir que existe posibilidad de curar el cáncer con su detección temprana. En cambio, el considerar riesgoso el tamizaje preventivo se relacionó con no realizarse la prueba. CONCLUSIONES: La proporción de mujeres con tamizaje preventivo de cáncer cervical es baja. Asimismo, se identificaron ciertos factores asociados modificables, los que podrían mejorar las conductas y tasas del tamizaje preventivo.
INTRODUCTION: Preventive screening for cervical cancer is the best available strategy to reduce the incidence and mortality from this neoplasm. However, the low proportion of women who undergo routine screening is a pending concern for healthcare systems worldwide. OBJECTIVE: To estimate the prevalence and factors associated with preventive cervical cancer screening in a Peruvian region. METHODS: Cross-sectional, multicenter study. It enrolled 1146 women users of healthcare centers in a Peruvian sanitary region. The dependent variable was the performance of cervical cancer preventive screening with Papanicolaou or visual inspection with acetic acid in the last two years. The independent variables were sociodemographic and socio-sanitary factors, knowledge about cervical cancer and human papillomavirus, attitudes and information towards screening tests. To evaluate the association between the variables, crude and adjusted prevalence ratios were calculated with generalized linear models of Poisson. RESULTS: The overall prevalence of preventive screening was 50.5%. This was associated with being tested, having a higher education level and urban area of residence, using contraceptive methods, having health insurance, being recommended by healthcare personnel to be screened, and being concerned about developing cervical cancer. It was also associated with responding that this cancer is preventable, being aware of cervical cancer or human papillomavirus, and believing it can cause cervical cancer. In contrast, considering preventive screening risky was associated with not having the test. CONCLUSIONS: The proportion of women with preventive cervical cancer screening is low. In addition, certain associated modifiable factors were identified, which could improve preventive screening behaviors and rates.
Assuntos
Humanos , Feminino , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Detecção Precoce de Câncer , Peru/epidemiologia , Prevalência , Estudos Transversais , PapillomaviridaeRESUMO
RESUMEN La incidencia del cáncer anal ha presentado un incremento en los últimos 10 años, sobre todo en población considerada vulnerable. Las mujeres con antecedentes de infección por Virus del Papiloma Humano (VPH) en el tracto genital, tienen mayor riesgo de este tipo de cáncer. Se ha demostrado que, la infección con genotipos de VPH de alto riesgo (AR), en la región anogenital, desempeña un papel en la etiopatogenia de dicho cáncer. Se desconocen muchos aspectos de la historia natural de las lesiones anales, pero se considera que la zona de transición anal presenta un alto recambio celular, por lo que se ha planteado un mecanismo fisiopatológico de infección por VPH-AR y desarrollo de lesiones invasoras, similar al del cáncer cervical. El objetivo de este trabajo fue mostrar el estado actual sobre la información epidemiológica que vincula el riesgo de desarrollar cáncer anal en mujeres con lesiones precursoras de cáncer cervical asociadas a la infección por VPH. La relevancia de dicha información es proporcionar una base de recomendaciones para la detección oportuna de cáncer anal en mujeres consideradas de AR de padecerlo y, favorecer la realización de estudios prospectivos en la población.
ABSTRACT The incidence of anal cancer has increased in the last 10 years, especially in the population considered to be at risk. Women with a history of infection in the genital tract by Human Papillomavirus (HPV) have higher risk of developing this type of cancer. The presence of high-risk (HR) HPV genotypes in the anogenital region has been shown to play a role in the etiopathogenesis of anal cancer. Many aspects of the natural history of anal lesions are unknown, but the anal transition zone is considered to have a high cell replacement. This is why a pathophysiological mechanism of HR-HPV infection and development of invasive lesions similar to those of cervical cancer has been suggested. The aim of this work was to show the current status of the epidemiological information that links the risk of developing anal cancer in women with cervical cancer precursor lesions associated with HPV infection. The relevance of this information is to provide a basis of recommendations for the timely detection of anal cancer in women considered to be at HR of suffering it, and to encourage more prospective studies in this population.
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Background and objectives: The standard treatment for locally advanced cervical cancer (CC) is chemoradiotherapy (CTRT) followed by high-dose-rate brachytherapy (HDRBT). The ideal scenario would be under novel intensity-modulated radiation therapy (IMRT) volumetric-modulated arc therapy (VMAT) radiation techniques over three-dimensional (3D) radiation therapy. However, radiotherapy (RT) centres in low- and middle-income countries have limited equipment for teletherapy services like HDRBT. This is why the 3D modality is still in use. The objective of this study was to analyse costs in a comparison of 3D versus IMRT versus VMAT based on clinical staging. Materials and methods: From 02/01/2022 to 05/01/2023 a prospective registry of the costs for oncological management was carried out for patients with locally advanced CC who received CTRT ± HDRBT. This included the administration of radiation with chemotherapy. The cost associated with patient and family transfers and hours in the hospital was also identified. These expenses were used to project the direct and indirect costs of 3D versus IMRT versus VMAT. Results: The treatment regimens for stage IIIC2, including 3D and novel techniques, are those with the highest costs. The administration of 3D RT for IIIC2 and novel IMRT or VMAT techniques, is $3,881.69, $3,374.76, and $2,862.80, respectively. The indirect cost from stage IIB to IIIC1 in descending order is IMRT, 3D and VMAT, but in IIIC2 the novel technique regimens reduce by up to 33.99% compared to 3D. Conclusion: In RT centres with an available supply of RT equipment, VMAT should be preferred over IMRT/3D since it reduces costs and toxicity. However, in RT centres where demand exceeds supply in the VMAT technique planning systems, the use of 3D teletherapy over IMRT/VMAT could continue to be used in patients with stage IIB to IIIC1.
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Human Papillomavirus (HPV) persistence leads to the chronification of cervical inflammation, where HLA-G and Foxp3; immunomodulatory molecules, may contribute to the aggravation of the lesion and cancerization. Here, we evaluated the synergic effect of these two molecules in the worsening of the lesion in presence of HPV infection. Hundred and eighty (180) women cervical cells and biopsies were collected for (i) HLAG Sanger sequencing and gene expression, and (ii) HLA-G and Foxp3 molecule expressions by immunohistochemistry. 53 women were HPV+ against 127 women HPV-. HPV+ women were more at risk of having cytological changes (p ≤ 0.0123), histological changes (p < 0.0011), and cervical lesion (p = 0.0004). The HLA-G + 3142CC genotype predisposed women to infection (p = 0.0190), while HLA-G + 3142C and +3035 T alleles were associated with HLA-G5 transcript expression. Both sHLA-G (p = 0.030) and Foxp3 (p = 0.0002) proteins were higher in cervical lesion as well as in high-grade lesion. In addition, sHLA-G+ cells were positively correlated to Foxp3+ cells in presence of HPV infection and in cervical grade II/III injuries. In conclusion, HPV may use HLA-G and Foxp3 as a way of host immune escape contributing to the persistence of infection and inflammation, leading to the cervical lesion and the worsening of lesions.
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Infecções por Papillomavirus , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Humanos , Feminino , Antígenos HLA-G/genética , Neoplasias do Colo do Útero/genética , Displasia do Colo do Útero/genética , Inflamação , Fatores de Transcrição Forkhead/genética , Papillomaviridae/genéticaRESUMO
Abstract Objective To determine the prevalence of the atypical glandular cells (AGCs) cytology and to analyze its clinical significance in different age ranges. Methods Retrospective observational study using computerized data from the Brazilian National Cancer Institute, including women screened between January 2002 and December 2008. The women included were those with an AGC result who were properly followed-up with colposcopy and a second cytology. Results A total of 132,147 cytopathological exams were performed during the study period. Five-hundred and thirty-three (0.4%) women with AGC cytology were identified and, of these, 69.41% (370/533) were properly referred for colposcopy and a new cytology. Most of the women (79.2%) with a 1st or 2nd AGC cytology were between the ages of 25 and 54 years. The 2nd cytology demonstrated 67.6% (250/370) of normality, 24.5% (91/370) of squamous atypia, and 6.2% (23/370) of AGC, 0.8% (3/370) adenocarcinoma in situ and 0.8% (3/370) adenocarcinoma invasor. On biopsy of the women with a second AGC cytology, 43.4% (10/23) had normal histology, 43.4% (10/23) had squamous lesions, 8.7% (2/23) had invasive adenocarcinoma, and 1.2% (1/23) had an inconclusive report. All of the women with high-grade squamous intraepithelial lesion (HSIL) or invasive adenocarcinoma (respectively 5 and 2 patients), after a 2nd AGC cytology were 25 years old or older. Conclusion The prevalence of the AGC cytology was low in the studied population. Most of the AGC cytology cases occurred in adult women between the ages of 25 and 54. Although most of the patients had normal histology after follow-up, several of them presented with squamous intraepithelial lesions or invasive adenocarcinoma.
Resumo Objetivo Determinar a prevalência de citologia com laudo de células glandulares atípicas (AGCs, na sigla em inglês) e analisar a significância clínica nas diferentes faixas etárias Métodos Estudo observacional retrospectivo, usando os dados arquivados no sistema do Instituto Nacional de Câncer no Brasil, que incluiu mulheres rastreadas entre janeiro de 2002 a dezembro de 2008. As mulheres incluídas tinham citologia com resultado de AGCs, que foram acompanhadas com colposcopia e nova citologia Resultados Um total de132,147 exames citopatológicos foram incluídos durante o período de estudo. Quinhentas e trinta e três mulheres com citologia de AGC foram identificadas e destas, 69.41% (370) foram encaminhadas para colposcopia e nova citologia. A prevalência de citologia de AGC na população estudada foi 0.4%. A maioria das mulheres (79.22%) com resultado citológico de AGC tinham idade entre 25 e 54 anos. A segunda citologia demonstrou 67.56% (250/370) de normalidade, 24.5% (91/370) de atipias escamosas, e 6.2% (23/370) de AGC. Na biopsia das mulheres com a 2ª citologia de AGC, 43.4% (10/23) tinham histologia normal, 43.4% (10/23) tinha lesões escamosas, 8.7% (2/23) tinha adenocarcinoma invasor e 1.2% (1/23) tinha laudo inconclusivo. Todas as mulheres com lesões intraepiteliais escamosas de alto grau (HSIL, na sigla em inglês) ou adenocarcinoma invasor (respectivamente 5 e 2pacientes), após a 2ª citologia com AGC, tinham 25 anos de idade ou mais. Conclusão A prevalência de citologia com AGC foi baixa na população estudada. Muitos casos de citologia com AGC apareceram em mulheres adultas, entre 25 e 54 anos de idade. Embora a maioria das pacientes tiveram histologia normal após seguimento, várias apresentaram lesões intraepiteliais escamosas ou glandulares invasoras.
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Humanos , Feminino , Displasia do Colo do Útero , Células Epiteliais , Detecção Precoce de CâncerRESUMO
Abstract Objective To analyze the quantity of cervical smears, also designated Papanicolaou tests, between 2006 and 2015 in all the Federal units of Brazil, as well as to verify the quantity of exams collected outside the recommended age range and the economic impact of such excess. Methods The data was collected from the Ministry of Health's database called Sistema de Informação do Câncer do Colo de Útero (SISCOLO), which contains all the test results collected nationwide by the Unified Health System (SUS, in the Portuguese acronym). From that, the number of exams and the age range of thewomen who underwent them were analyzed; besides, these numbers were stratified according to the state of where the exam was performed. The quantity of exams collected outside the recommended age range was verified, and, so, the economic impact generated was noted. Results Between 2006and2015, 87,425,549Papanicolaoutestswere collected in Brazil. Of these, 20,215,052 testswere collected outside the age range recommended by the Brazilian Ministry of Health; this number corresponded to 23.12% of all exams. From such data, considering that each Pap smear collected by SUS generates a cost of BRL 7.30 to the government, according to the information in the Tabela SUS dated September 2018, there was a total charge of BRL 147,569,880 for tests collected outside the protocol. Conclusion In Brazil, according to the Ministry of Health's protocol about the recommended practices on collecting Pap smears, whose newest edition dates of 2016, it is recommended that Pap smears are collected inwomen from a specific age range, inwhom the potential diagnosing advantages overcome the onus of overdiagnosis or of a lesion with great regression potential. However, such protocols have not been correctly followed, promoting more than 20 million tests in excess, and an exorbitant cost for the Brazilian public health system. It is relevant to take measures to correctly use the official protocol, reducing the patients risks, as well as the economic impact for SUS.
Resumo Objetivo Analisar a quantidade de exames cérvico-vaginais, também chamados de Teste de Papanicolau, entre os anos de 2006 e 2015 em todos os estados brasileiros, bem como verificar o número de exames realizados fora da faixa etária indicada, e o impacto econômico desse excesso. Métodos Os dados foram coletados a partir da base de dados do Ministério da Saúde chamada Sistema de Informação do Câncer do Colo de Útero (SISCOLO), que reúne os resultados de exames realizados em todo o Brasil pelo sistema único de saúde (SUS). A partir disso, foi analisado o número de exames e a faixa-etária de realização dos mesmos; além disso, esses números foram estratificados de acordo com o estado brasileiro de origem do exame. Foi verificada a quantidade de exames fora da idade recomendada, e, assim, foi observado o impacto econômico gerado. Resultado Entre 2006 e 2015, 87.425.549 exames de Papanicolau foram realizados no Brasil. Deste montante, 20.215.052 testes foram realizados fora da faixa-etária preconizada pelo Ministério da Saúde do Brasil, o que equivale a 23,12% do total. A partir desse número, considerando que cada exame cérvico -vaginal realizado pelo SUS gera um custo de R$ 7,30 para o governo, de acordo com informações na Tabela SUS datada de setembro de 2018, foram gastos R$ 147.569.880 em exames realizados sem indicação. Conclusão No Brasil, no protocolo do Ministério da Saúde sobre as práticas adequadas em coleta de exames cérvico-vaginais, sendo sua edição mais recente de 2016, a recomendação é realizar o teste de Papanicolau em mulheres dentro de uma faixaetária específica, na qual a chance de se diagnosticar uma lesão supera o ônus de um sobrediagnóstico ou uma lesão com grande potencial de regressão. Entretanto, essa recomendação não tem sido seguida corretamente, gerando mais de 20 milhões de exames excedentes e umcusto monetário exorbitante para o sistema público de saúde. É importante que medidas sejam tomadas para que o protocolo seja empregado corretamente a fim de reduzir riscos para a paciente, bem como a redução de gastos desnecessários para o SUS.
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Humanos , Feminino , Brasil/epidemiologia , Displasia do Colo do Útero/diagnóstico , Colo do Útero/patologiaRESUMO
Studies have demonstrated that the size of lesion in colposcopic imaging can be associated with the grade of CIN. We evaluated 36 patients and at the time of colposcopy, the images were recorded and analysed for lesion area measurement. A ROC curve was used to obtain the area under the curve and to determine the best cut-off values between area lesion (pixels2) and biopsy result. Fisher's exact test was performed (p < .05). Half of the sample had a cervical biopsy showing HPV or LSIL, and 18 (50%)a biopsy showing HSIL or invasive cancer. HSIL and invasive cancer were associated with a lesion area greater than 30,337.03 pixels2 (cut off) with p = .04. Thus the area of the colposcopic lesion is related to the severity of that; so small lesions can be more conservatively followed.IMPACT STATEMENT:What is already known on this subject? Studies have proposed that the size of lesion in colposcopic imaging can be associated with the grade of CIN, and the size of CIN lesions may be a factor in determining the risk of progression.What do the results of this study add? This is the first study in the literature that uses the measurement of the lesion area in pixels2 in comparison with the severity of the lesion, which provides greater accuracy of the lesion area than the mere measurement of its diameter.What are the implications of these findings for clinical practice and/or further research? The size of the lesion should be considered in the management of cervical intraepithelial lesions. This approach also leads to lower cost and is less invasive. Small lesions will have the best prognosis and would be treated in the way more conservative, bringing to the patients more comfort and less complications with the treatment.
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Traquelectomia , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Biópsia , Colposcopia , Feminino , Humanos , Gravidez , Neoplasias do Colo do Útero/diagnóstico por imagem , Displasia do Colo do Útero/diagnóstico por imagemRESUMO
Cervical Cancer (CC) is a significantly prevalent disease in developing countries. Currently, targeted therapies are not a primary standard of care in CC. This information could be crucial for developing directed therapies and patient screening for biomarkers that would allow personalised treatment of CC. This systematic review aimed to estimate the prevalence of potential therapeutic targets such as the epidermal growth factor receptor (EGFR) and the PI3K/Akt/mTOR and Ras/Raf/MAPK pathways in patients with CC, identified through genomic and non-genomic testing. Studies were identified through an ad-hoc search strategy from the available on MEDLINE (Ovid), CENTRAL, LILACS, SCOPUS, through the Clinical Trial registry on Clinicaltrials.gov, International Clinical Trials Registry Platform, RENIS (Argentine National Registry of Health Research) and grey literature sources. We included 74 studies which represented a total pool of 7,862 participants. Forty-five studies informed mutations of EGFR, with a combined positivity rate of 53% (95%CI: 45%-60%; I2 = 95%). Twenty studies informed the presence of mutations in PIK3CA with a combined positivity rate of 30% (95%CI: 21%-39%; I2 = 96%). Twenty-three studies reported a mutation in Ras, with a combined positivity rate of 14% (95%CI: 8%-21%; I2 = 95%). Raf mutations were informed in six studies. Six studies informed the presence of Akt mutations, two studies informed mTOR mutations and only one study reported mutations of MAPK. The most frequently described therapeutic targets were EGFR, and the PIK3CA and Ras pathways, though inconsistency in positivity rates was significant. Our study did not allow the identification of any specific clinical characteristics that might explain the observed heterogeneity. Despite the overall good quality of the included studies, the applicability of these results to patients' general population with CC is still unclear.
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OBJECTIVES: The aims of study were to assess platelet counts, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), RWD (red cells distribution width) and fasting glucose in patients with cervical intraepithelial neoplasia (CIN) and invasive cervical cancer; and to relate these parameters to prognostic factors and survival in cervical cancer. STUDY DESIGN: We evaluated the patients with confirmed diagnosis of invasive cervical cancer (n = 102), and CIN (n = 102). Histological type, NLR, PLR, RDW, platelets count, fasting glucose, staging, overall survival (OS), and disease-free survival (DFS) were evaluated. The results of laboratory parameters were assessed by Mann-Whitney test. A receiver operating characteristic (ROC) curve was used to determine the best cut-off values. Survival was verified by the Kaplan-Meyer method followed by the Gehan-Breslow test. Multivariate analysis was performed using Cox regression. The level of significance was less than 0.05. RESULTS: Comparing CIN and invasive malignancies, higher values of NLR, PLR, RDW and fasting glucose were found in cancer patients (p < 0.0001, p = 0.011, p = 0.0153 and p = 0.0096, respectively). In cervical cancer, higher NLR and PLR values were found at stage II to IV when compared to stage I (p = 0.0066 and p = 0.005, respectively). ROC curves were performed. In invasive neoplasms, the cut-off values for NLR and PLR in the comparison between stage I and greater than I were 4 and 165.45, respectively. For survival curves, there was lower OS and DFS in patients with NLR greater than 4 (p = 0.0004 and p = 0.0153, respectively) and PLR greater than 165.45 (p = 0.0319 and p = 0.0362, respectively). After multivariate analysis, only NLR remained as an independent factor in DFS (HR = 6.095, 95 % CI = 1.120-33.177, p = 0.037) and OS (HR = 4.522, 95 % CI = 1.241-16.479, p = 0.022) CONCLUSION: Higher NLR is associated to lower OS and DFS in invasive uterine cervical neoplasia, and can be considered an independent factor of worse prognosis.
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Neoplasias do Colo do Útero , Plaquetas , Feminino , Humanos , Laboratórios , Linfócitos , Neutrófilos , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Neoplasias do Colo do Útero/diagnósticoRESUMO
OBJECTIVES: The objective of this study was to evaluate the frequency of human papillomavirus (HPV) in the oral cavity of women with and without abnormal cervical cytology and to determine whether there is an association of oral HPV infection with infection of the cervix or with cervical cancer precursor lesions. METHODS: The present study was conducted among 406 women, aged 18-82 years, who attended the Prevention Department of Barretos Cancer Hospital (HCB), Brazil due to a previous altered cervical cytology result. Oral rinse, cervical cytology and biopsy were collected at the same day. The participants also answered a questionnaire about socioeconomic characteristics and risk factors for cervical cancer. Molecular screening for HPV16, HPV18 and 12 other high-risk HPV types was performed on cervical and oral rinse specimens using Cobas 4800 (Roche Molecular Systems, USA). RESULTS: HPV was detected in the oral rinse of 3.9% of participants. Infection of the oral cavity with a non-HPV16 or 18 type was most frequent (81.2%), followed by HPV16 (18.7%). Infection with HPV in the cervix and oral cavity was present in 11 (2.7%) of participants. There were no differences observed in the smoking status (p value 0.62), mean age of first sexual intercourse (p value 0.25), mean age of the first oral sex (p value 0.90) or mean lifetime number of sexual partners (p value 0.08) between the participants with oral HPV infection or not. CONCLUSION: The presence of HPV infection in the oral cavity was low in the group of women with abnormal cervical cancer screening findings and a high rate of cervical HPV infection.
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Boca/virologia , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Papillomavirus Humano 16 , Papillomavirus Humano 18 , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Fumar/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem , Displasia do Colo do Útero/virologiaRESUMO
OBJECTIVES: This clinical study was developed to primarily evaluate the Complete Cytopathological Response Rate of Cervical Intraepithelial Neoplasms to PDT using chitosan nanocapsules containing Chlorocyan-aluminum phthalocyanine as a photoactive agent. Analyses of the Free Recurrence Interval, toxicity profile (immediate and late), and complications (immediate and late), were secondarily analyzed. METHODS: This study was previously approved by the National Council of Ethics in Research of Brazil (CONEP), on May 28, 2014, under case number 19182113.4.0000.5009. On the surface of the cervix of each selected patient was applied one mL of the formulated gel, and after 30 min, the light was applied. Reports or the identification of adverse effects and/or complications were observed in follow-up visits, in addition to the collection of cervical oncotic cytology. RESULTS: Out of the total group, 11 (91.7%) primarily treated patients evolved with negative cervical oncotic cytology as soon as in the first evaluation following treatment, and one did not achieve any therapeutic benefit, even after reapplication. Two patients with initially positive response presented cytological recurrence determined by histopathology. A new round of PDT was developed, and both evolved with cytological remission three weeks later, remaining negative until the last follow-up. No important side effects were observed in all the patients. CONCLUSIONS: Our trial demonstrates that treatment of CIN 1 and 2 lesions using our PDT formulation is feasible and safe. Large randomized clinical trials are required to establish efficacy.
Assuntos
Infecções por Papillomavirus , Fotoquimioterapia , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Feminino , Humanos , Recidiva Local de Neoplasia , Neoplasias do Colo do Útero/tratamento farmacológicoRESUMO
Abstract Objective: To describe the epidemiological, clinical and laboratory profiles of women with anal neoplasia associated with cervical neoplasia attending a tertiary healthcare facility in northeastern Brazil. Methods: This epidemiological, descriptive study was conducted using a database from a cross-sectional study carried out between December 2008 and January 2016. Women with a diagnosis of cervical neoplasia associated with anal neoplasia were included in the present study. Results: Of the women with cervical neoplasia, 14% were found to have an anal intraepithelial lesion or anal cancer. Median age was 33 years, 68% were non-white, and 70% were from urban regions, had little schooling and low income. Most reported having had anoreceptive (73%) and unprotected intercourse (84%). Regarding symptoms, 7% reported bleeding and 11% pruritus. Overall, 10% of the sample tested positive for the human immunodeficiency virus. Anal cytology was abnormal in 92%. High-resolution anoscopy was abnormal in all cases. Histopathology revealed three cases of invasive carcinoma and high-grade lesions in 32% of the cases. Conclusion: Women with a diagnosis of anal and cervical neoplasia are often young, non-white women, who initiated their sexual life at an early age, were exposed to unprotected anoreceptive intercourse, live in urban centers, have little schooling and a low-income level.
Resumo Objetivo: Descrever os perfis epidemiológico, clínico e laboratorial de mulheres com neoplasia anal associada à neoplasia cervical atendidas em uma unidade de saúde terciária no nordeste do Brasil. Métodos: Este estudo epidemiológico e descritivo usou um banco de dados de um estudo transversal realizado entre dezembro de 2008 e janeiro de 2016. Mulheres com diagnóstico de neoplasia cervical associada à neoplasia anal foram incluídas no presente estudo. Resultados: Das mulheres com neoplasia cervical, 14% apresentaram lesão intra-epitelial anal ou câncer anal. A mediana de idade foi de 33 anos; 68% das pacientes não eram brancas e 70% eram provenientes de regiões urbanas, com baixa escolaridade e baixa renda. A maioria relatou histórico de relações sexuais anoreceptivas (73%) e desprotegidas (84%). Quanto aos sintomas, 7% relataram sangramento e 11% prurido. No geral, 10% das pacientes apresentaram serologia positiva para o vírus da imunodeficiência humana. A citologia anal foi anormal em 92% da amostra. A anuscopia de alta resolução foi anormal em todos os casos. A histopatologia revelou três casos de carcinoma invasivo e lesões de alto grau em 32% dos casos. Conclusão: As mulheres com diagnóstico de neoplasia anal e cervical geralmente são jovens, não brancas, que iniciaram sua vida sexual em idade precoce, foram expostas a relações sexuais anoreceptivas desprotegidas, moram em centros urbanos e têm baixa escolaridade e baixo nível de renda.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Neoplasias do Ânus/epidemiologia , Perfil de Saúde , Carcinoma in Situ/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Ânus/diagnóstico , Fatores Socioeconômicos , Brasil , Carcinoma in Situ/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , /diagnóstico , /epidemiologia , Centros de Atenção TerciáriaRESUMO
Introduction: Cervical cancer is a public health problem, and tracking of the disease must follow a set of organized programmed actions, with populations and periodicity defined. Objective: Identifying the prevalence of intraepithelial lesions in preventive examinations performed in the municipality of Sinop-MT between 2010 and 2013. Methods: Statistical data obtained using the DATASUS/SISCOLO system were used. Results: When considering the descriptive diagnosis for cellular alterations, 412 and 167 altered exams with low- and high-grade intraepithelial lesions (respectively) were found. The prevalence of both low-grade (25.45%) and high-grade (10.32%) intraepithelial lesions were higher outside of the recommended age range (25-64 years). Conclusions: Studies on the prevention of cervical cancer are extremely relevant in order to analyze the coverage of screening in areas served by basic health units and to understand the factors associated with non-adherence of women to preventive examination. It is noteworthy that during the time period analyzed, women in the municipality of Sinop did not fulfill the municipal goal.(AU)
Introdução: O câncer do colo do útero é um problema de saúde pública e o rastreamento dessa doença deve seguir um conjunto de ações programadas, organizadas com populações e periodicidade definidas. Objetivo: este estudo teve como objetivo identificar a prevalência da lesão intraepitelial em exames preventivos coletados no município de Sinop-MT, entre 2010 e 2013. Métodos: Estudo retrospectivo realizado no Município de Sinop. Os dados utilizados foram obtidos por meio do sistema DATASUS/SISCOLO, entre 2010 e 2013. As variáveis analisadas foram: número de exames citopatológicos dentro dos limites de normalidade, lesão intraepitelial de baixo grau (LIBG) e lesão intraepitelial de alto grau (LIAG) e faixa etária de 25 a 64 anos. Resultados: ao considerar o diagnóstico descritivo para alterações celulares, foram constatados 412 e 167 exames alterados com lesão intraepitelial de baixo e alto grau, respectivamente. Tanto a prevalência de lesão intraepitelial de baixo grau (25,45%), quanto de alto grau (10,32%), foram maiores fora da faixa etária preconizada (25 a 64 anos). Portanto, estudos sobre a prevenção do câncer do colo do útero são de extrema relevância, a fim de analisar a cobertura do rastreamento em áreas atendidas pelas unidades básicas de saúde e compreender os fatores associados à não adesão das mulheres à realização do exame preventivo. Conclusão: Ressalta-se que o município de Sinop nos quatros anos analisados não cumpriu a meta municipal.(AU)
Assuntos
Displasia do Colo do Útero , Doenças do Colo do Útero , Prevenção de DoençasRESUMO
Abstract Objective The current study evaluated the expression of WW domain-containing oxidoreductase (WWOX), its association with clinicopathological features and with p53, Ki-67 (cell proliferation) and CD31 (angiogenesis) expression in patients with invasive cervical squamous cell carcinoma (ICSCC). To the best of our knowledge, no other study has evaluated this association. Methods Women with IB stage-ICSCC (n = 20) and women with uterine leiomyoma (n = 20) were prospectively evaluated. Patients with ICSCC were submitted to type BC1 radical hysterectomy and pelvic lymphadenectomy. Patients in the control group underwent vaginal hysterectomy. Tissue samples were stained with hematoxylin and eosin for histological evaluation and protein expression was detected by immunohistochemistry studies. Results The WWOX expression was significantly lower in the tumor compared with the expression in thebenign cervix (p = 0.019). TheWWOXexpressionwas inversely associated with the CD31 expression in the tumor samples (p = 0.018). There was no association betweentheWWOXexpression with the p53 expression (p = 0.464)or the Ki-67expression (p = 0.360) in the samples of invasive carcinoma of the cervix. There was no association between the WWOX expression and tumor size (p = 0.156), grade of differentiation (p = 0.914), presence of lymphatic vascular invasion (p = 0.155), parametrium involvement (p = 0.421) or pelvic lymph node metastasis (p = 0.310) in ICSCC tissue samples. Conclusion The results suggested that WWOX may be involved in ICSCC carcinogenesis, and this marker was associated with tumor angiogenesis.
Resumo Objetivo O presente estudo avaliou a expressão do WWOX, sua associação com características clinicopatológicas e com a expressão do p53, ki-67 (proliferação celular) e CD31 (angiogênese) em pacientes com carcinoma invasivo de células escamosas do colo uterino, ou simplesmente câncer do colo uterino (CCE). Métodos Foram avaliadas prospectivamente pacientes com CCE no estágio IB (n = 20) e mulheres com mioma uterino, no grupo controle (n = 20). As pacientes com CCE foram submetidas à histerectomia radical e à linfadenectomia pélvica do tipo B-C1. As mulheres no grupo-controle foram submetidas à histerectomia vaginal. As amostras de tecido foramcoradas comhematoxilina e eosina para avaliação histológica e a expressão das proteínas foi detectada por imuno-histoquímico. Resultados A expressão do WWOX foi significativamente menor no tumor quando comparada com sua expressão no colo do útero benigno (p = 0,019). A expressão tumoral de CD31 foi inversamente associada à expressão de WWOX (p = 0,018). Sua expressão não foi associada à expressão tumoral de p53 e Ki-67 em pacientes com CCE (p = 0,464 e p = 0,360, respectivamente). Não houve associação entre a expressão de WWOX e o tamanho do tumor (p = 0,156), grau de diferenciação (p = 0,914), presença de invasão vascular linfática (p = 0,155), comprometimento do paramétrio (p = 0,421) ou metástase dos linfonodos pélvicos (p = 0,310) em pacientes com CCE. Conclusão Os resultados sugeriram que o WWOX pode estar envolvido na carcinogênese do CICECU e esse marcador foi associado à angiogênese tumoral.
Assuntos
Humanos , Feminino , Adulto , Idoso , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Regulação Neoplásica da Expressão Gênica , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/patologia , Proteína Supressora de Tumor p53/genética , Proteínas Supressoras de Tumor/genética , Proliferação de Células , Oxidorredutase com Domínios WW/genética , Neovascularização Patológica , Imuno-Histoquímica , Carcinoma de Células Escamosas/química , Neoplasias do Colo do Útero/química , Estudos Prospectivos , Proteína Supressora de Tumor p53/análise , Proteínas Supressoras de Tumor/análise , Oxidorredutase com Domínios WW/análise , Pessoa de Meia-IdadeRESUMO
Objetivo: Identificar las barreras para la detección temprana del cáncer de cuello uterino. Método: Revisión integrativa de literatura, en bases de datos como Science Direct, Medline, SciELO y Scopus, publicados durante los últimos seis años, escritos en inglés, portugués y español. Resultados: Los aspectos socioculturales, las estrategias de prevención empleadas y la dificultad para acceder a la atención fueron las barreras encontradas en la revisión; igualmente, la poca aceptación de la vacuna contra el virus del papiloma humano y la no asistencia a la citología cérvico-vaginal inciden en la aparición de numerosos casos de lesiones preneoplásicas. Conclusiones: Se evidencia la necesidad de fortalecer las acciones de educación, información y abogacía del profesional de enfermería, que contribuyan a reducir la incidencia de esta patología, lo cual representa un reto importante para el personal de salud.
Objective: To identify the barriers to early detection of cervical cancer. Method: Integrative literature review in databases such as Science Direct, Medline, SciELO and Scopus, published during the past six years, written in English, Portuguese and Spanish. Results: Socio-cultural aspects, prevention strategies employed and the difficulty in accessing care barriers were found in the review; also, the lack of acceptance of HPV vaccines and non-attendance to Pap test affect the appearance of numerous cases of pre-neoplastic lesions. Conclusions: It is evident that there is a need to strengthen actions of education, information and support to nursing professionals, to help reduce the incidence of this disease, which represents an important challenge to health care personnel.
Assuntos
Humanos , Educação em Enfermagem , Neoplasias do Colo do Útero , Promoção da SaúdeRESUMO
O tratamento cirúrgico padrão para o câncer do colo do útero em estádio inicial é a histerectomia radical abdominal (HRA). Nos últimos anos, os avanços na cirurgia minimamente invasiva tornaram possível a realização de histerectomia radical com o uso da laparoscopia, com objetivo de reduzir a morbidade cirúrgica e promover uma recuperação mais rápida. Esta revisão compara a eficácia e a segurança da histerectomia laparoscópica (HRL) com a HRA em mulheres com estádios iniciais (I até IIa) do câncer de colo uterino. Fez-se a busca da literatura através de pesquisa na base de dados do MEDLINE/PubMed, LILACS, SciELO e Cochrane Library entre 2010 - 2015, com as palavras-chave: histerectomia, histerectomia laparoscópica, laparoscopia laparotomia, câncer cervical precoce. Foi constatado que a HRL está associada à menor morbidade cirúrgica em termos de perda sanguínea intraoperatória e menor permanência hospitalar quando comparada com a HRA. No entanto, estudos multicêntricos randomizados são necessários para que se tenha dados definitivos sobre a sobrevida global e livre de doença.(AU)
Standard surgical management for selected early-stage cervical cancer is radical abdominal hysterectomy (HRA). In recent years, advances in minimal access surgery have made it possible to perform radical hysterectomy with the use of laparoscopy with the aim of reducing the surgical morbidity and promoting a faster recovery. This review compares the effectiveness and safety of laparoscopically (HRL) with a radical abdominal hysterectomy (HRA) in women with cervical cancer in early-stage (I to IIa). The literature review was performed using MEDLINE/PubMed, LILACS, SciELO e Cochrane Library for articles published between 2010 and 2015, and the keywords: hysterectomy, hysterectomy laparoscopic, laparoscopy, laparotomy, cervical cancer in early stages. When compared with HRA the HRL was associated with lower surgical morbidity, in terms of intraoperative blood loss and shorter hospital permanence. However, multicenter and randomized studies are needed for definitive data on overall survival and disease-free survival.(AU)
Assuntos
Humanos , Feminino , Neoplasias do Colo do Útero/cirurgia , Laparoscopia , Histerectomia/métodos , Laparotomia , Complicações Pós-Operatórias , Sobrevida , Morbidade , Perda Sanguínea Cirúrgica , Bases de Dados Bibliográficas , Intervalo Livre de Doença , Hemorragia Pós-Operatória , Complicações Intraoperatórias , Tempo de InternaçãoRESUMO
Introducción: el cáncer cervicouterino es una alteración celular que se origina en el epitelio del cuello del útero. Se manifiesta inicialmente a través de lesiones precursoras, de lenta y progresiva evolución, las cuales se suceden en etapas. Objetivo: evaluar el cumplimiento del Programa Nacional de Diagnóstico Precoz del cáncer cérvicouterino. Métodos: estudio descriptivo de corte transversal en el municipio Bartolomé Masó Márquez, provincia Granma, de 2013 a 2014. El universo de estudio quedó constituido por 6 794 mujeres que se realizaron prueba citológica. Se revisaron los registros de pruebas citológicas para obtener la información sobre las variables edad, tipo de examen (caso nuevo, reexamen), resultado del examen y etapa clínica de diagnóstico del cáncer, fue procesada y analizada mediante técnicas de estadística descriptiva y se expresaron en frecuencias absolutas y porcentajes. Resultados: se cumplió el 96,64 % de la meta planificada, 102,66 percent de casos nuevos, 100,0 percent Reexámenes, el 5,00 percent de las pruebas citológicas fueron no útiles, el 19,22 percent de realización de pruebas citológicas prevalece en las mujeres de 40-44 años, el diagnóstico citológico encontrado con mayor frecuencia fue la NIC II (45,83 percent) y un carcinoma en 2013. Conclusiones: el cumplimiento del programa fue evaluado como no satisfactorio, es necesario implementar nuevas acciones de salud encaminadas a modificar y controlar las dificultades, liderado desde la jefa del departamento de citología y cada enfermera como líder conjuntamente con los promotores de salud y médico de la familia(AU)
Introduction: Cervical cancer is a cellular alteration, which originates in the epithelium of the cervix. It was initially manifested by precursor lesions, slow and progressive evolution, which occur in stages. Objective: To evaluate the implementation of the National Program for Early Diagnosis of Cervical Cancer. Methods: A descriptive cross-sectional study was conducted in the municipality of Bartolome Maso Marquez of Granma province from 2013 to 2014. The study group was composed of 6794 women cytology were performed. records cytology were revised to obtain information about the variables age, type of test (new case, re-examination) test result and clinical diagnosis of cancer stage was processed and analyzed using descriptive statistical techniques and expressed in absolute frequencies and percentages. Results: 96.64 percent of the planned target, 102.66 percent of new cases, Sunset reviews 100.0 percent, 5.00 percent of cytological tests were not helpful, 19.22 percent of the testing is completed cytological prevalent in women aged 40-44 years, the cytological diagnosis was found more frequently IAS II (45.83 percent) and carcinoma in 2013. Conclusions: The implementation of the program was evaluated as unsatisfactory, it is necessary to implement new health measures designed to amend and control difficulties, lidereado from the head of the department of cytology and every nurse leader together with health promoters and Medical family(AU)
Assuntos
Humanos , Feminino , Adulto , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Citodiagnóstico , Epidemiologia Descritiva , Estudos Transversais , Interpretação Estatística de DadosRESUMO
Introducción: en Colombia se registran cada año 5 600 nuevos casos de cáncer de cérvix, constituyéndose en un problema de salud pública alarmante que ocasiona malestar, sufrimiento e incomodidad, y entorpece el pleno desarrollo vital de las mujeres afectadas. Objetivo: reconocer la religiosidad como estrategia de afrontamiento por parte de las mujeres diagnosticadas con cáncer de cérvix. Métodos: este estudio de tipo cualitativo se llevó a cabo en la zona metropolitana de Medellín Colombia, desde agosto de 2007 hasta mayo de 2009, con los lineamientos propuestos por la Teoría Fundada; se entrevistaron 14 mujeres diagnosticadas y tratadas de cáncer de cérvix, contactadas por intermedio de Instituciones Prestadoras de Salud encargadas de brindar el tratamiento. El análisis de los datos se hizo manualmente. Resultados: la religiosidad se constituye en un baluarte para sobrellevar las condiciones a que se ven abocadas las mujeres con cáncer de cérvix. Conclusiones: la experiencia de la religiosidad es vivida por las mujeres diagnosticadas de cáncer de cérvix y que han recibido tratamiento, y resulta definitiva para afrontar la carga de dolor y sufrimiento que trae consigo la enfermedad(AU)
Introduction: 5,600 new cases of cervical cancer are documented each year in Colombia, a reason why this is an alarming public health concern that causes discomfort and suffering, and hinders the full life development of the women affected. Objective: To acknowledge religiousness as a confrontation strategy for women diagnosed with cervical cancer. Methods: This qualitative study was carried out in the metropolitan area of Medellín, Colombia, from August 2007 to May 2009, with the guidelines proposed in Teoría Fundada. Fourteen women diagnosed and treated for cervical cancer were interviewed, contacted by health institutions providing the treatment. Data analysis was manual. Results: Religiousness constitutes a defense for women with cervical cancer to endure the conditions they are submitted to. Conclusions: The religiousness experience is lived by women diagnosed with cervical cancer and who have received treatment, and it is determinant to confront the pain and suffering burden brought by the disease(AU)
Assuntos
Humanos , Religião , Adaptação Psicológica , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Estatística como AssuntoRESUMO
The CDKN1A gene product is a p53 downstream effector, which participates in cell differentiation, development process, repair, apoptosis, senescence, migration, and tumorigenesis. The objective of our study was investigated the importance of two polymorphisms in the CDKN1A gene, rs1801270 (31C>A) and rs1059234 (70C>T), for the development of cervical lesions in a Southeastern Brazilian population (283 cases, stratified by lesion severity, and 189 controls). CDKN1A genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and/or DNA sequencing. CDKN1A 31A allele presents a genetic pattern of protection for the development of high-grade cervical lesions (CC vs CA genotype: OR = 0.60; 95 % CI = 0.38-0.95; p = 0.029; CA+AA vs CC genotype: OR = 0.60; 95 % CI = 0.39-0.93; p = 0.021). Allele distributions of the CDKN1A 70C>T polymorphism were also different between the two study groups, with the CDKN1A 70T allele being less prevalent among cases. Moreover, the double heterozygote genotype combination 31CA-70CT decreases the chance of developing high-grade squamous intraepithelial lesion (HSIL) and cancer (OR = 0.55; 95 % CI = 0.32-0.93; p = 0.034) by 50 %, representing a protective factor against the development of more severe cervical lesions.