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INTRODUCTION: Human papillomavirus molecular detection prevents cervical cancer (CC). To widen its use, cervical-vaginal self-collection devices are proposed. Our aim was to determine the acceptability of self-sampled cervical-vaginal protocol and the reproducibility of results using HPV detection brushes in a low-income Colombian population between 35 and 65 years old. METHODS: Cross-sectional study including women classified as medium to high-risk for developing CC by using a short-standardized survey. After receiving instructions, women self-collected a cervical-vaginal sample. Subsequently, a perception survey was conducted. RESULTS: Four hundred and twenty-three women performed self-collected sampling. The median age was 46.5 years (IQR 40-52), 56.5% were housewives, and 55.1% had finished elementary school. About 99% of the population (n=419) considered that they understood the instructions, 19.4% (n=82) reported having concerns about the self-collected sample, 9.2% (n=39) distrusted the results because of the self-collection, 7.3% (n=31) felt uncomfortable with the procedure, and 9.7% (n=41) reported some pain. The majority would recommend the procedure to others (99%), 88.5% of the sampled population preferred the self-collected method, 4% preferred conventional cytology, and 7.3% were not sure. The reasons behind favoring the self-collected procedure included privacy (n= 149, 40.1%), comfort (n=110, 29.7%), easiness (n=52, 14%), reliability (n=46, 12.4%), and less painful (n=110, 29.7%). The percentage of HPV detection agreement between the self-collected and the healthcare professional-collected procedures was 98.99% (Cohen's Kappa=0.9774). CONCLUSION: Women living in low-income households in Bucaramanga, Colombia preferred the self-sampling procedure because it was easy to use, convenient, and private, resulting in 98% acceptability, and positioning it as an excellent tool for CC prevention.

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OBJECTIVES: To determine the frequency of human papillomavirus (HPV) types and behavioral characteristics related to cytological abnormalities in women descendants of slaves, who live in isolated communities known as quilombos in the state of Maranhão, Brazil. METHODS: Cervicovaginal specimens of 353 women were analyzed by conventional cytology and genotyping. HPV detection and genotyping was performed using a linear array HPV genotyping test kit. Behavioral factors and their association with cytological abnormalities were analyzed, as well as the association between cytological abnormalities and HPV infection. RESULTS: The frequency of HPV infection was 13%, and infection with high-risk HPV types was more frequent than with low-risk types (10.2% vs. 2.8%). The most prevalent genotypes were HPV 68 (3.1%) and HPV 58 (2.6%). HPV-positive women were 6.5 times more likely than HPV-negative women to be diagnosed with cytological abnormalities. There was a significant association between HPV infection and the presence of cytological abnormalities in women 31-40 years of age and in women 51-60 years of age. CONCLUSIONS: A distinct profile of high-risk HPV genotypes was detected, with predominance of types 68 and 58. It is possible that the results of the present study are due to specific characteristics of the population, which is geographically isolated and maintains conservative sexual habits.

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O câncer de colo do útero é uma afecção iniciada com transformações intra-epiteliais progressivas. A prática de medidas preventivas para detecção e tratamento precoce deste tipo de câncer constitui uma medida essencial. Objetivo:Avaliar a não adesão das mulheres ao exame citopatológico em uma Unidade Básica de Saúde da Família.Método:O estudo foi exploratório, descritivo, longitudinal retrospectivo, de série temporal, com abordagem qualitativa e caracterizado como pesquisa-ação. Os dados foram analisados seguindo a técnica de Análise do Discurso do Sujeito Coletivo Resultados:Foram incluídos 293 mulheres de amostra ampliada. Foi visualizado que parte das mulheres possuíam conhecimentos sobre a prevenção e a importância do exame, no entanto, desconheciam a verdadeira utilidade deste. A falha no registro dos prontuários configurou-se como maior dificuldade na busca ativa dessas mulheres para a realização do preventivo.Conclusão:Os resultados contribuíram para o reconhecimento dos profissionais sobre o conhecimento dessas mulheres em relação ao exame citopatológico e dessa forma auxiliar a inverter o quadro de não adesão destas ao preventivo...

Cervical cancer is a disease initiated with progressive intraepithelial changes. The practice of preventive measures for early detection and treatment of this cancer is an essential measure. Objective: To evaluate the non-adherence of women to the cytological examination in a Basic Health Unit Family. Method: The study was exploratory, descriptive, retrospective longitudinal time series with a qualitative approach and characterized as action research. Data were analyzed according to the analysis technique of the Collective Subject Discourse Results: We included 293 women expanded sample. It was seen that some of the women had knowledge about prevention and the importance of the examination, however, unaware of the true utility of this. Failure to record the medical records was configured as greater difficulty in active search of these women to perform preventive. Conclusion: The results contributed to the recognition of professional knowledge about these women m relation to the Pap test and thus help reverse the non-compliance framework to these preventive...

El cáncer cervical es una enfermedad iniciada con cambios progresivos intraepiteliales. La práctica de medidas preventivas para la detección y el tratamiento de este cáncer a tiempo es una medida esencial. Objetivo: Evaluar la no adhesión de las mujeres para el examen citológico en una Unidad Básica de Salud Familiar. Método: El estudio fue exploratorio, descriptivo, retrospectivo de series de tiempo longitudinal con un enfoque cualitativo y caracterizado como la investigación-acción. Los datas se analizaron de acuerdo con la técnica de análisis de las resultados discurso del sujeto colectivo: Se incluyeron 293 mujeres muestra expandida. Fue visto . que algunas de las mujeres tenían conocimiento sobre la prevención y la importancia del examen, sin embargo, sin darse cuenta de la verdadera utilidad de este. Falta de registro de las registros médicos se configuró como una mayor dificultad en la búsqueda activa de estas mujeres para realizar preventiva. Conclusión: Los resultados contribuyeron ai reconocimiento de las conocimientos profesionales de estas mujeres en relación con la prueba de Papanicolaou y de este modo ayudar a revertir el marco de incumplimiento de estos preventiva...

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BACKGROUND: Human papillomavirus and Chlamydia trachomatis share the same route of sexual transmission and possess similar risk factors, indicating that coinfection may act synergistically in the induction of epithelial cell abnormalities. OBJECTIVE: This study aimed to determine the prevalence of human papillomavirus and Chlamydia trachomatis in adolescents and young women and identify factors associated with coinfection. STUDY DESIGN: This cross-sectional study included 276 female participants, aged 15-24 years, who were sexually active. Interviews were conducted and cervical specimens were collected for cervical smears and molecular tests. All cervical specimens were tested for 27 human papillomavirus genotypes by polymerase chain reaction amplification and hybridization to a human papillomavirus linear array. Detection of Chlamydia trachomatis was performed by polymerase chain reaction using primers directed to the region encoding the cryptic plasmid. Bivariate and multivariate analyses were performed to evaluate the factors associated with coinfection with human papillomavirus and Chlamydia trachomatis. The odds ratio, the adjusted odds ratio, and the 95% confidence interval were calculated. RESULTS: The prevalence of infection by Chlamydia trachomatis and human papillomavirus was 9.1% (95% confidence interval, 5.61-12.4) and 47.1% (95% confidence interval, 41.0-53.2), respectively. The prevalence of coinfection with human papillomavirus and Chlamydia trachomatis was 5.8% (95% confidence interval, 3.3-9.2); coinfection with 1 human papillomavirus type was 3.3% (95% confidence interval, 1.5-6.1) and with multiple types was 2.5% (95% confidence interval, 1.0-5.2). The prevalence of cytological abnormalities was 12.3% (95% confidence interval, 8.6-16.79). Human papillomavirus infections of high oncogenic risk were more prevalent (85.4%). Factors independently associated with coinfection of human papillomavirus/Chlamydia trachomatis obtained by multivariate analysis were the initiation of sexual activity under 16 years of age with an an odds ratio of 4.9 (95% confidence interval, 1.0-23.63; P = .05) and cytological abnormalities with an odds ratio of 10.7 (95% confidence interval, 1.9-59.5; P = .01), which indicates there is risk for the detection of cytological abnormalities in adolescents and young women coinfected with human papillomavirus/Chlamydia trachomatis. CONCLUSION: The prevalence of coinfection among our study population was of a magnitude that warrants attention by public health services. Adolescents and young women should be monitored for Chlamydia trachomatis infection and vaccinated against human papillomavirus. The association between cytological abnormalities and coinfection with human papillomavirus and Chlamydia trachomatis indicates the potential synergistic role of these infections in carcinogenesis of the cervix.

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OBJECTIVE: To compare cervical cytology test results among pregnant and non-pregnant women, and to assess associations with age, screening history, and onset of sexual intercourse. METHODS: A retrospective analysis was conducted of cervical smears obtained from women aged 18-34 years in the Campinas region of Brazil between January 2000 and December 2009. Eligible participants had not undergone cytological screening within the previous year and had no history of precursor lesions or cervical cancer. Multinomial logistic regression was performed for different age groups, with high-grade squamous intraepithelial lesions (HSILs) as the endpoint. RESULTS: Overall, 3072 (0.4%) of 861 353 non-pregnant women and 135 (0.4%) of 37 568 pregnant women had HSILs. Odds of HSIL among pregnant and non-pregnant women did not differ in any age group. An increased age at first sexual intercourse among pregnant women reduced odds of HSILs in all age groups (odds ratio 0.9 [95% confidence interval 0.8-0.9] for all). Among women aged 21-24 years, 25-29 years, and 30-34 years, some associations were identified between an interval of less than 5 years since previous screening and reduced odds of HSILs. CONCLUSION: Mandatory cervical cytology screening does not seem to be necessary for pregnant women; protocols in place for non-pregnant women should be followed.

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Studies about cervical carcinogenesis have demonstrated the increased expression of matrix-metalloproteinase (MMP) according to the grade of cervical intraepithelial lesions. Considering the importance of innovative techniques to introduce noninvasive and rapid diagnoses for patients, this study aimed to perform MMP-9 immunocytochemistry in cervical smears according to the cytopathological diagnoses, in order to monitor MMP activity in cervical smears. This cross-sectional study investigated the expression of MMP-9 in normal cervical smears, inflammatory cervical smears, squamous intraepithelial lesions, and cervical carcinoma. Cervical smears from 630 women were collected for cytopathological diagnoses and immunocytochemistry. Women with squamous intraepithelial lesions showed an increase in MMP-9 expression, with moderate to intense staining occurring with increasing cervical lesion grade. The prevalence of moderate to intense MMP-9 staining was 9% in normal cervical smears, 12% in cervical inflammation, 24% in low-grade squamous intraepithelial lesion (LSIL), 92% in high-grade squamous intraepithelial lesions (HSIL) and 100% in cervical carcinoma cases. In the specific case of LSIL, we found that association with MMP-9 is more evident when there is the simultaneous presence of an infectious agent. Thus, the expression of MMP-9 in cervical smears increases according to the grade of cervical lesion and LSIL in the presence of infectious agents showed higher MMP-9 expression than women with LSIL without infectious agents.

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BACKGROUND: Cervical cytology is the cervical cancer screening test for women aged <30 years because of the low specificity of human papillomavirus tests in this age group. The Bethesda System classifies cervical intraepithelial neoplasia grade 2 (CIN 2) and grade 3 (CIN 3) as high-grade intraepithelial lesions (HSIL). In this study, the authors subclassified cytologic HSIL as suggestive of CIN 2 (HSIL-CIN 2) or CIN 3 (HSIL-CIN 3) and evaluated whether there was a correlation between these findings and age for screened and unscreened women. METHODS: The study included 2,002,472 cervical smears collected from women who had at least 1 previous test (screened) and 217,826 previously untested women (unscreened). The laboratory has been using the Bethesda System since 1998 with the subcategorization of HSIL-CIN 2 and HSIL-CIN 3. RESULTS: For unscreened women, the prevalence of low-grade intraepithelial lesion (LSIL) and HSIL-CIN 2 decreased with age, whereas the prevalence of HSIL-CIN 3 increased. The prevalence of HSIL-CIN 2 was greater than that of HSIL-CIN 3 for women up to age 29 years (prevalence ratio [PR], 4.73; 95% confidence interval [CI], 3.90-5.75) and lower for the groups ages 30 to 49 years (PR, 0.66; 95% CI, 0.50-0.87) and ≥ 50 years (PR, 0.21; 95% CI, 0.12-0.36). For screened women, the prevalence of HSIL-CIN 2 also was greater in the group aged ≤ 29 years (PR, 2.72; 95% CI, 2.49-2.97). CONCLUSIONS: The prevalence pattern of HSIL suggestive of CIN 2 resembled the pattern observed in LSIL and was more prevalent than HSIL suggestive of CIN 3 in younger women. The impact of screening was less evident when HSIL was suggestive of CIN 2. A conservative approach for younger women who have HSIL is important for management guidance.

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Evaluar la frecuencia de la infección por virus del papiloma humano en pacientes con células escamosas atípicas de un programa de pesquisa de cáncer de cuello uterino. Laboratorio Asistencial “Lic. Celina Sánchez Rincón y Laboratorio de Biología y Medicina Experimental LABIOMEX. Universidad de Los Andes. Mérida, Estado Mérida. Estudio prospectivo y descriptivo que incluyó las pacientes vistas entre marzo de 2006 y diciembre de 2009. Se tomaron muestras para evaluación citológica y detección del virus papiloma humano, mediante la metodología molecular PCR-RFLP a pacientes de pesquisa de cáncer cervical. Se estudiaron 2 805 pacientes seleccionándose las que presentaron informe citológico de células escamosas con atipias de significado indeterminado y con atipias que no excluyen lesión intraepitelial escamosa de alto grado. Del total de mujeres evaluadas por citología, 121 (4,31 por ciento) tenían informe de anormalidades en células epiteliales. Las células escamosas atípicas se encontraron en 58 (2,06 por ciento) citologías, 52 (1,85 por ciento) eran células escamosas con atipias de significado indeterminado y 6 (0,21 por ciento) eran células escamosas con atipias que no excluyen lesión intraepitelial de alto grado. La prevalencia general de la infección por virus del papiloma humano fue de 32/58 (53,4 por ciento). Los virus del papiloma humano de alto riesgo oncogénico se encontraron en 10/58 (17,2 por ciento) de los casos, la mayoría en el grupo etario de 21-30 años. No se pudo determinar el tipo viral en un 16/58(27,5 por ciento) de las muestras. Se observó una elevada prevalencia de virus del papiloma humano en pacientes con informe citológico de células escamosas atípicas.

To evaluate the frequency of human papillomavirus infection in patients with atypical squamous cells of a cervical cancer detection program. Between March 2006 to December 2009, specimens for cervical smears and human papillomavirus molecular detection by PCR-RFLP were taken from the patients attended at the cervical cancer clinic prevention. Facultad de Farmacia y Bioanálisis. Laboratorio Asistencial “Lic. Celina Sánchez Rincón y Facultad de Ciencias, Laboratorio de Biología y Medicina Experimental LABIOMEX. Universidad de Los Andes. Mérida, Estado Mérida, Venezuela. A total of 2 805 patients were evaluated, those with atypical squamous cells of undetermined significance and atypical squamous cells that cannot exclude a high intraepithelial lesion were chosen. Abnormalities in epithelial cells were found in 4,31 percent. Atypical squamous cells were found in 58 (2,06 percent) of the cases, 1,85 percent were atypical squamous cells of undetermined significance and 0,21 percent were atypical squamous cells that cannot exclude a high intraepithelial lesion. The overall prevalence of human papillomavirus infection was 32/58 (53,4 percent). High risk human papillomavirus was found in 10/58 (17,2 percent)of the patients, most of them between 21 and 30 years old. Human papillomavirus could not be determinedin 16/58 (27,5 percent) of the cases. It was observed a high frequency of human papillomavirus in patients with atypical squamous cells in their cervical smears.

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En este artículo se presentan los resultados de un estudio epidemiológico analítico-descriptivo, cuyos objetivos fueron: conocer y determinar cómo se asocian factores biológicos y psicosociales con la presencia de lesiones neoplásicas del tracto genital inferior femenino en una población adolescente del departamento de Caldas, lo cual se relacionó, por un lado, con el análisis de la distribución y frecuencia de la población estudiada en cuanto a sexualidad, reproducción, factores culturales y factores psicosociales, y por otro, con la interacción de factores de riesgo en la aparición de dichas lesiones. Se tomó una muestra de 269 mujeres, seleccionadas después de su participación en jornadas educativas respecto a cáncer de cuello uterino y de mama. A este grupo se le aplicó una encuesta estructurada, diseñada para tal fin, la cual se diligenció directamente por los investigadores, previo consentimiento informado. A cada informante se le realizó citología y colposcopia, con un manejo estrictamente confidencial de la información. Los datos se analizaron retomando su distribución y frecuencia por categorías de variable, con lo cual se buscó determinar la asociación de los factores con la presencia o no de lesiones neoplásicas al contrastarlos con los resultados de citología y colposcopia.

This article presents the results of an epidemiologic analytical-descriptive study whose objectives were to examine and determine how biological and psychosocial factors are associated to the presence of neoplastic lesions of the lower female genital tract in a teenage population in the department of Caldas. The study analyzed the distribution and frequency of the studied population in terms of sexuality, reproduction, cultural and psychosocial factors, and secondly, the interaction of risk factors in the occurrence of such injury. A sample of 269 women, selected after their involvement in educational sessions related to cervical cancer and breast cancer, was interviewed by means of a structured survey, which was filled-out directly by the researchers, with prior consent from the women. A cervical smear and a colposcopy were performed on each patient, confidentially handling the information. The data was analyzed taking into consideration the distribution and frequency of the variable categories, looking to determine the association of factors with the presence or absence of neoplastic lesions, when contrasted with the cervical smear and colposcopy results.

Em este artigo apresentam se os resultados duma pesquisa epidemiológica analítico-descritivo, cujos objetivos foram: conhecer e determinar como associam se fatores biológicos y psicossociais com a presença de lesões neoplásicas do conduto genital inferior feminino numa povoação adolescente do Departamento de Caldas, o qual se relacionou, por um lado, com a análise da distribuição e freqüência da povoação estudada em quanto a sexualidade, reprodução, fatores culturais e fatores psicossociais, e por outro lado, com a interação de fatores de risco na aparição de ditas lesões. Tomou se uma amostra de 269 mulheres, selecionadas depois de sua participação em jornadas educativas respeito ao câncer de colo uterino e mama. A este grupo aplicou se uma enquete estruturada, desenhada tal fim, a qual diligenciou se direitamente por os pesquisadores, prévio consentimento informado. A cada informante realizou se citologia e colposcopia, com um manejo estritamente confidencial da informação. Os dados realizaram se retomando sua distribuição e freqüência por categorias de variável, com o qual se procurou determinar a associação dos fatores com a presença ou não de lesões neoplásicas ao contrastarlos com os resultados de citologias e colposcopias.

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El cáncer de cuello uterino es un problema de salud específico de la mujer con repercusiones sociales y económicas, en ella, la familia y la comunidad; en este sentido, los programas de detección precoz deben estructurarse y sistematizarse adecuadamente con el fin de garantizar educación, prevención, diagnóstico precoz y tratamiento oportuno. Con el fin de evaluar la estructura, procesos y resultados del Programa de Prevención de Cáncer Cuello Uterino en Caldas durante los años 2005 y 2006, se realizó un estudio en alianza Universidad de Caldas, Dirección Territorial de Salud de Caldas, con un diseño descriptivo, evaluativo y retrospectivo. Se seleccionaron 4 municipios estratégicamente situados en el departamento de Caldas; los responsables del programa de cada hospital, diligenciaron una base de datos que fué la guía para el diagnóstico, diseñado por las investigadoras. Las mujeres asistentes al programa en su mayoría tenían entre 26 y 45 años. Las horas de dedicación del personal de salud encargado fueron muy altas con relación al número de citologías tomadas; se presentaron problemas de registro de colposcopias; faltaron reportes de citologías; aspectos estos que afectan la calidad de la atención a las usuarias y al programa. Los reportes obtenidos sobre cáncer invasivo se realizaron sólo a través de citología; en el informe recibido no se reportaron resultados de biopsias a pesar de ser esta la prueba de oro que confirma el diagnóstico; además, el seguimiento a las usuarias tratadas era incipiente y discontinuo. Se evidenciaron fallas y ambigüedad para especificar las funciones del personal de enfermería; las citologías fueron tomadas en su mayoría por auxiliar de enfermería y la norma técnica para tamizaje recomienda que sea realizado por médico o enfermera capacitados. Del mismo modo, se detectaron debilidades en la educación para la salud a la comunidad para la prevención del cáncer de cuello uterino.

A structured and systematized early detection program for cervical cancer should ensure education, prevention, early diagnosis, and adequate treatment. Cervical cancer is a social and economic problem that impacts the woman, as well as her family and community. This study was conducted during 2005 and 2006 by means of an alliance with the Universidad de Caldas, Department and Territorial Health Office of Caldas. The study had a descriptive, evaluative and retrospective design. Four strategically located municipalities of Caldas were selected for education and follow-up. The staff of each hospital filled out a database that guided the process, which was designed by the researchers. Women between the ages of 26 and 45 were the most common cases. The hours the staff dedicated to the program were high, in comparison to the number of cervical smears performed. There were problems regarding the colposcopy records, lost cervical smear records, all of which affect the program's patients. The reports on invasive cancer were obtained only by means of cervical smears; no biopsies were reported, despite this being the best test for confirming the diagnosis. The patients' follow-ups were not continuous. A lack of specificity in nursing functions was also seen, since cervical smears are usually performed by nursing assistants, when the norm states that a trained physician or chief nurse should perform the procedure. A weakness in education to the community was seen.

O câncer de colo uterino é um problema de saúde especifico da mulher com repercussões sociais e econômicas, na família e a comunidade, neste sentido, os programas de detenção preços devem estruturasse e sistematizasse adequadamente com o fim de garantir educação, prevenção, diagnostico preços e tratamento oportuno. Com o fim de avaliar a estrutura, processos e resultados do Programa de Prevenção de Câncer de Colo Uterino em Caldas durante os anos 2005 e 2006, se realizou uma pesquisa em aliança Universidade Caldas, Direção Territorial de Saúde de Caldas, com um desenho descritivo, evaluativo, e retrospectivo. Se selecionaram 4 municípios estrategicamente situados no Estado de Caldas; os responsáveis do programa de cada hospital, diligenciaram uma base de dados que foi a guia para o diagnostico, desenhado pelas investigadoras. As mulheres assistentes ao programa em sua maioria tinham entre 26 e 45 anos. As horas de dedicação do pessoal de saúde encarregado foram muito altas com relação ao numero de citologias tomadas; se apresentaram problemas de risco de colposcopias; faltaram reportes de citologias, aspectos estes que afetam a qualidade da atenção às usuárias e ao programa. Os reportes obtidos sobre câncer invasivo se realizaram só a través de citologia, no informe recebido não se reportaram resultados de biopsias a pesar de ser esta a prova de ouro que confirma o diagnostico; alias o seguimento às usuárias tratadas era incipiente e descontinuo. Evidenciaram-se falha e antiguidades para especificar as funções do pessoal de enfermaria; as citologias foram tomadas em sua maioria por auxiliares de enfermaria e a norma técnica para tamisasse recomenda que seja realizado por um medico ou enfermeira capacitados. Do mesmo modo, detectaram debilidades na educação para a saúde à comunidade para a prevenção do câncer de colo uterino.

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