Objective Human papillomavirus infection is an important aetiological agent associated with the development of cervical neoplasia. However, even with the most sensitive methods of detection, human papillomavirus DNA h...
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Objective Human papillomavirus infection is an important aetiological agent associated with the development of cervical neoplasia. However, even with the most sensitive methods of detection, human papillomavirus DNA has been detected in only 90% of cases of cervical cancer and between 80%-90% of cases of dysplasia. This study aimed to determine if there are epidemiological differences between women who are positive or negative for human papillomavirus, with high grade cervical intraepithelial neoplasia (CIN). Design Four hundred and sixty women with CIN II and III lesions were studied. To ensure optimal detection of human papillomavirus DNA two specimens !i.e. tampon and cervical biopsy) were collected from each woman and tested by three techniques: L1-polymerase chain reaction, EG-PCR and Low stringency Southern blotting. A detailed questionnaire was completed and blood sample collected for determination of serum levels of beta-carotene, vitamin A and E from each patient. Human leucocyte antigen (HLA)-DQB1 alleles were also compared between the groups of women who were positive or negative for human papillomavirus. Results Overall, human papillomavirus DNA analysis was positive in 411 women (89%). Age, number of sexual partners in the last 12 months, past pregnancy and marital status were associated with human papillomavirus detection in the crude analysis. However, in the adjusted analysis no epidemiological features remained significantly different between the human papillomavirus positive and negative patients. Moreover, examination of vitamin A, E and beta-carotene levels did not show a significant difference between the two groups of patients. However in the HLA-DQB 1 allele profile a significantly higher proportion of women who were negative for human papillomavirus had DQB1 *0201,*0603 and *0604 (P = 0.05, 0.001, 0.03, respectively). Conclusion We did not find a significant difference in epidemiological factors between women with human papillomavirus positiv
Objective: To compare cervical screening outcomes associated with age and three screening intervals, 1, 2, and 3 years. Methods: We did a prospective cohort study comprising 128,805 women at community-based clinics th...
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Objective: To compare cervical screening outcomes associated with age and three screening intervals, 1, 2, and 3 years. Methods: We did a prospective cohort study comprising 128,805 women at community-based clinics throughout the United States who were screened for cervical cancer within 3 years of normal smears through the National Breast and Cervical Cancer Early Detection Program. We determined the incidence of cytologic abnormalities defined as atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (SIL), high-grade SIL, and suggestive of squamous cell cancer. Results: Over the 3 years after normal smear results, the incidence of new smears interpreted as high-grade SIL or suggestive of squamous cell cancer (high-grade SIL or worse) was 66 of 10,000 for women under 30 years old, 22 of 10,000 for those 30-49 years, 15 of 10,000 for those 50-64 years, and 10 of 10,000 for those over 65 years. Age-adjusted incidence rates of high-grade SIL or worse were similar for women screened at 9-12 months (25 of 10,000), 13-24 months (29 of 10,000), and 25-36 months (33 of 10,000) after normal smears (P = .46). Age-adjusted incidence rates of ASCUS, the most common cytologic abnormality, did not change (P = .36). Incidence of smears interpreted as low-grade SIL increased as time from the normal smear increased (P = .01). Conclusions: Within 3 years after normal cytology results, cervical smears interpreted as high-grade SIL or worse are uncommon, and the incidence rate is unrelated to the time since last normal smear. Optimal screening strategies for women with recent normal cytology results should be based on comprehensive modeling studies that incorporate the true risks and benefits of repetitive screening. (C) 2000 by The American College of Obstetricians and Gynecologists.
Objective. The aim of this study was to determine the incidence and severity of dysplasia associated with a cytologic diagnosis of atypical cells of undetermined significance (ASCUS) in women infected with the human i...
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Objective. The aim of this study was to determine the incidence and severity of dysplasia associated with a cytologic diagnosis of atypical cells of undetermined significance (ASCUS) in women infected with the human immunodeficiency virus (HIV), Methods. A cross-sectional analysis of cervical cytology, colposcopic impression, and cervical biopsy results was performed on 261 HIV-positive women diagnosed with ASCUS. The prevalence and grade of histologically documented cervical intraepithelial neoplasia (CIN) was determined. Patients with CD4 counts above and below 200 cells/mm(3) were compared using chi(2) analysis to determine any effect: of worsening immunosuppression on the rates of associated dysplasia. Results. Seven hundred sixty-one Pap smears were performed during the study period. Two hundred nine (27%) were diagnosed as ASCUS. All patients (pts) received colposcopic evaluation. The incidence of human papilloma virus (HPV) effect, low-grade CIN (I), and high-grade CIN (II, III, and carcinoma in situ) documented by cervical biopsy, cervical conization or endocervical curettings was 40, 17, and 15%, respectively. No cases of invasive cancer were found. These results are similar to those of previous cytohistologic studies of ASCUS in HIV-untested populations. There was no significant difference in frequency or severity of CIN in pts with severe immunosuppression (P = 0.4). Conclusion. A cytologic diagnosis of ASCUS in HIV-positive women identifies a group at significant risk for histologic abnormalities. The majority of pts will be diagnosed with HPV or low-grade GIN. HIV infection and severe immunosuppression do not appear to increase the frequency or severity of CIN associated with ASCUS, Given the 32% risk of associated GIN, all HIV-positive women with ASCUS cytology should undergo colposcopic evaluation, (C) 1999 Academic Press.
The purpose of this study was to examine the prevalence of abnormal Pap smears in rural family practice, to compare this to the published literature, and to determine if the prevalence of abnormalities is higher in th...
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The purpose of this study was to examine the prevalence of abnormal Pap smears in rural family practice, to compare this to the published literature, and to determine if the prevalence of abnormalities is higher in the younger age group (less than or equal to 35 years of age). A retrospective chart audit was performed on all Pap smears from four rural family practice sites during a 12-month period. Data collected were Pap smear result, patient's age, and interval since previous Pap smear. Statistical analysis was used to determine if the prevalence of abnormal Pap smears was consistent among the practices as well as similar to the three larger published studies. Also, chi-square analysis was used to compare the prevalence of abnormal Pap smears in the younger (less than or equal to 35 years of age) versus the older (>35 years ofage) age groups. There were 2,891 Pap smears reviewed, with 782 (27%) recorded as abnormal. The prevalence of cervical intraepithelial neoplasia (CIN) (76 or 2.6%) was compared to the published literature and was found to be statistically significantly higher (chi square=772.194, P=0.000). The prevalence of abnormal Pap smears was higher in the younger than age 35 group when compared to the older than age 35 group (chi square=20.953, P=0.000). Pap smear interval and age varied between the four practice sites, but the prevalence of CIN was not statistically different (chi square=3.154, P=0.368). The results of this study suggest that rural family physicians may encounter abnormal Pap smears at rates similar to those reported in the literature. This study also suggests that the prevalence of abnormal Pap smears may be higher in the younger groups in this population.
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