Comparative Assessment of a Self-sampling Device and Gynecologist Sampling for Cytology and HPV DNA Detection in a Rural and Low Resource Setting: Malaysian Experience

Purpose: This study was conducted to assess the agreement and differences between cervical self-sampling with a Kato device (KSSD) and gynecologist sampling for Pap cytology and human papillomavirus DNA (HPV DNA) detection. Materials and Methods: Women underwent self-sampling followed by gynecologist sampling during screening at two primary health clinics. Pap cytology of cervical specimens was evaluated for specimen adequacy, presence of endocervical cells or transformation zone cells and cytological interpretation for cells abnormalities. Cervical specimens were also extracted and tested for HPV DNA detection. Positive HPV smears underwent gene sequencing and HPV genotyping by referring to the online NCBI gene bank. Results were compared between samplings by Kappa agreement and McNemar test. Results: For Pap specimen adequacy, KSSD showed 100% agreement with gynecologist sampling but had only 32.3% agreement for presence of endocervical cells. Both sampling showed 100% agreement with only 1 case detected HSIL favouring CIN2 for cytology result. HPV DNA detection showed 86.2%agreement (K=0.64, 95% CI 0.524-0.756, p=0.001) between samplings. KSSD and gynaecologist sampling identified high risk HPV in 17.3% and 23.9% respectively (p= 0.014). Conclusion: The self-sampling using Kato device can serve as a tool in Pap cytology and HPV DNA detection in low resource settings in Malaysia. Self-sampling devices such as KSSD can be used as an alternative technique to gynaecologist sampling for cervical cancer screening among rural populations in Malaysia.     

The Coverage of Cervical Cancer Screening in Khon Kaen,Northeast

Cervical cancer is a common cancer in Thai women and one of the only cancers that can be readily cured if early ‍detection is successful. The Pap smear is an accepted as an appropriate means for cervical cancer screening at ‍present. However, there are still some management problems with early detection programmes. Since data showing ‍how many women have been screened by Pap smear are limited in Thailand, the present study was conducted with ‍the aim of determining coverage in a defined population in the sample area, Thakaserm sub- district in Nampong ‍district, Khon Kaen province, Thailand. The investigation was carried out during June-August 2000 to collect ‍information on history of screening for cervical cancer using questionnaires. All women aged 20 and above were ‍asked to answer the set of questionnaires a total of 1,199 women responded. There were 66.9% that reported having ‍received a Pap smear test for screening for cervical cancer at least once. However, there were 33.1 % that had never ‍undergone a Pap smear in their life. It is important to find a strategy to increase the coverage of cervical cancer ‍screening programme for this population. ‍     

Hypothesis: the act of taking a Papanicolaou smear reduces the prevalence of human papillomavirus infection: a potential impact on the risk of cervical cancer

BACKGROUND: Based on data collected in a case-control study of hormonal contraceptive use and invasive cervical cancer among South African colored and black women, we have reported a five-fold reduction in incidence among women who in their lifetimes had previously received as few as two Papanicolaou (Pap) smears. Given the conditions prevailing in the community under study, a reduction in risk of this magnitude was surprising. We hypothesized that the act of performing a Pap smear may trigger an immune response to human papillomavirus (HPV) infection and thus reduce the risk of cervical cancer. METHODS: Among 1540 control women we compared prevalence rates of infection with specific HPVs known to cause cervical cancer among those who previously received 0, 1, 2 or > or = 3 Pap smears in their lifetimes. FINDINGS: Overall, 16% of the controls were HPV-positive. Among women who received 0, 1, 2 and > or = 3 Pap smears the HPV positivity rates were 24, 17, 12, and 11%, respectively. Compared with never having received a smear, the confounder-adjusted relative risk estimates for the receipt of 1, 2, and > or = 3 smears were 0.7 (95% confidence interval, 0.5-1.0), 0.5 (0.3-0.8). and 0.5 (0.3-0.7), respectively (test for trend among Pap smear recipients: p = 0.04). The data were consistent within strata of age, parity, and race. INTERPRETATION: The data are compatible with the hypothesis that the minor trauma involved in taking a Pap smear may reduce the risk of cervical cancer by triggering an immune response to HPV infection.     

Limited Understanding of Pap Smear Testing among Women,a Barrier to Cervical Cancer Screening in the United Arab Emirates

Global data indicate that cervical cancer is the fourth most common cancer among women worldwide. Important factors that affect interventions for early diagnosis of cervical cancer include social beliefs and values and poor knowledge. These may contribute to women’s participation in screening for cervical cancer and have a significant impact on decisions to take preventive action. The present study was conducted with 599 women in the UAE between September 2016 and March 2017. A cross-sectional survey was conducted to determine knowledge about cervical cancer and screening, demographic characteristics and perceived barriers. Knowledge about the Pap smear test was limited, and awareness that they should undergo the Pap smear test every three years even with an initial negative/normal Pap smear result was abysmal. In spite of the positive attitude of the women towards the Pap smear test, almost 80% of the women surveyed had no knowledge of precancerous lesions. Having higher income (21/29, 72%, p=0.027) and more miscarriages were associated with better practice of Pap smears (19/26, 73%, p=0.010). Knowledge levels were significantly higher (66.3±22.2,) that values for attitude (60.5±20.9, p= 0.03, 95% CI {0.22-11.3}, Chi-square 4.38) and practice (53.7 24.1, p= 0.001, 95% CI {6.9-18.1}, Chi-square 19.7). A well-designed health education programme on cervical cancer and benefits of screening should increase the awareness among women in UAE. One point to stress is that better communication with health professionals and improvement of access to health care services should increase the rate of cervical cancer screening.     

First Trial of Cervical Cytology in Healthy Women of Urban Laos using by Self-sampling Instrument

Cervical cancer is the most common cancer in Laos women and a screening programme, even with the PAPsmear test (PAP test), has yet to be established for routine use. The Pap test is accepted as the most appropriatefor cervical cancer screening in some settings but it is not commonly available in Laos hospitals, because thereare few cytopathologists and gynecologists have little experience. As a pilot program, seminars for the PAPtest were given in 2007 and 2008, and then PAP tests were carried out using self-sampling instrument (Kato’sdevice) with 200 healthy volunteers in Setthathirath hospital, Laos, in 2008. The actual examination number was196, divided into class I 104 (53.1%), class II 85 (43.3%), class IIIa 4 (2.0%), class IIIb 1 (0.5%), and class V 1(0.5%) by modified Papanicalau classification. Four cases had menstruation. There were 6 cases with epithelialcell abnormalities including malignancy. There were 7 cases with fungus and 2 cases with trichomonas in ClassII. More than 70% volunteers felt comfortable with the Kato’s device and wanted to use it next time, becauseof the avoidance of the embarrassment and a low cost as compared with pelvic examination by gynecologists.This first trial for PAP test for healthy Laos women related to a hospital found three percent to have avnormalcervical epithelial cells. Therefore, this appraoch using a self-sampling device suggests that it should be plannedfor cervical cancer prevention in Laos.     

Association of Abnormal Pap Smear with Occult Cervical Stromal Invasion in Patients with Endometrial Cancer

Objective: The purpose of this study was to determine the association between abnormal preoperative Pap smearresults and occult cervical stromal invasion in endometrial cancer patients. Methods: Medical records were reviewed ofpatients with endometrial cancer who had undergone surgical staging at Srinagarind Hospital. Patients with gross cervicalinvolvement, with an unsatisfactory Pap smear, without available Pap smear results, with no cervical intraepitheliallesion/invasive cervical cancer, or who had previously undergone pelvic radiation therapy were excluded. The patientswere assigned to one of two groups according their Pap smear results (negative and epithelial cell abnormalities).Logistic regression was used to determine the independent association between an abnormal Pap smear and the riskof cervical stromal invasion. Results: All cervical smears in this study were performed as conventional Pap smears.Smears were abnormal in 50 (21.0%) of the 238 patients enrolled and normal in the remaining 188 (79.0%). The typesof Pap smear abnormalities included adenocarcinoma (n=22); atypical endometrial cells (n=2); atypical glandular cells(n=17); high-grade squamous intraepithelial lesions (n=4); atypical squamous cells, cannot exclude high-grade squamousintraepithelial lesions (n=2); and atypical squamous cells of undetermined significance (n=3). After controlling for type ofendometrial cancer, abnormal Pap smear results were found to be a significant independent factor that indicated cervicalstromal invasion (adjusted OR 2.65; 95% CI 1.35 to 5.21). Conclusion: Endometrial cancer patients with abnormalPap smears were strongly and independently associated with histopathologically diagnosed cervical stromal invasion.     

Situation Analysis for Management of Abnormal Pap Smears in the Lower Southern Thailand

Objective: To identify the resources for management of abnormal Pap smears and the treatment facilities in preinvasive ‍cervical neoplasia in the lower southern Thailand. Methods: After reviewing the necessary data, an expert ‍meeting was scheduled for questionnaire development. The questionnaires were then sent to the general, regional, ‍and university hospitals in the lower southern Thailand for self-evaluation and on-site visits were made for intensive ‍interviews, exploring the services and treatment facilities for women with abnormal Pap smears. Results: All of the ‍12 target hospitals provided passive cervical cancer screening although the quality of cytological services was obscure ‍and the process of patient notification for the results of the abnormal Pap smears was not convincing. There was a ‍limitation in the pathological laboratory services. The incidence of the abnormal Pap smears in the one-year period ‍of the study, defined as atypical squamous cells of undetermined significance (ASCUS) or above and high grade ‍squamous intraepithelial lesions (HSIL) or above were 1.24%(95%CI 1.15-1.32) and 0.36%(95% CI 0.30-0.43) ‍respectively. All but one hospital reported having a colposcope, but only one could provide standard colposcopy ‍services. The efficiency of the referral system is questionable. Conclusion: The resources for the management of ‍abnormal Pap smears as well as the conventional referral system need to be reorganized. The data from this survey ‍support the concept of a centralized colposcopy service with the University hospital as suitable place for the referral ‍center. Two further 2 hospitals have potential for future development as referral centers.     

Accuracy of Visual Inspection with Acetic Acid (VIA) for Early Detection of Cervical Dysplasia in Tehran,Iran

Objective: To evaluate the accuracy of visual inspection with 5% acetic acid (VIA) when used to detect cervical ‍cancer and its precursors. ‍Methods: The study population included women attended Family Planning and Gynecological Clinic in Bagher ‍Abad Health Center and Mirza Koochak Khan Hospital for regular cervical screening tests. After obtaining informed ‍consent from each woman, VIA was performed. One hundred with a positive VIA test and 100 women with a ‍negative VIA test were randomly selected for this study. Cytology and colposcopy examination were performed for ‍all 200 cases and cervical biopsies were conducted for those individuals showing abnormal colposcopic findings. ‍Results: Nine cases in VIA-positive group and two cases in VIA-negative group had an abnormal cytology. Ninety ‍five women in the VIA-positive group and 25 in the VIA-negative group had abnormal colposcopic findings. From ‍biopsy examination, 67 (71%) of cases in the VIA-positive group and 3 (12%) cases in the VIA-negative group had ‍a final diagnosis of dysplasia. Among biopsied samples, only 7 cases of VIA-positive group showed abnormal result ‍and the remaining were normal. Based on these results, VIA test sensitivity and specificity were 95.7% and 44.0% ‍respectively, while they were 10% and 92% for cytology tests. ‍Conclusions: The results of this study indicate that although VIA is a sensitive screening test for detection of ‍cervical dysplasia, it can not be used by itself. Applying VIA along with Pap smears helps to detect a higher number ‍of cases with cancer precursor lesions.     

The PapSpin: a reasonable alternative to other, more expensive liquid-based Papanicolaou tests

BACKGROUND: This study was designed to optimize a liquid-based Papanicolaou (Pap) test by using common cytopathology laboratory equipment and resulted in an inexpensive test that was equivalent at least diagnostically to the conventional Papanicolaou (Pap) smear. METHODS: Adult women (n = 482) were consented, enrolled, and included in this Institutional Review Board-approved study. After conventional Pap smear slides were obtained, clinicians placed the collection device with residual cells from the uterine cervix in a preservative fluid. In the cytopathology laboratory, a conventional centrifuge device was used to deposit the cells from the liquid onto a glass slide. RESULTS: Among the conventional Pap smears, 43 were categorized as low-grade squamous intraepithelial lesions (LSIL), and 30 were categorized as high-grade squamous intraepithelial lesions or greater (HSIL+). Among the PapSpin samples, 49 were categorized as LSIL and 24 were categorized as HSIL+. Biopsy confirmation was obtained in 124 patients. There were 23 women diagnosed with LSIL and 27 women diagnosed with HSIL+. Diagnostic agreement between cytologic samples and biopsies is as follows: for conventional Pap smears, there was agreement on 11 of 23 LSIL diagnoses and on 15 of 27 HSIL+ diagnoses; for PapSpin samples, there was agreement on 11 of 23 LSIL diagnoses and on 14 of 27 HSIL+ diagnoses. Exact agreement was achieved between PapSpin and conventional smears in 404 patients (84%). Quality indictors were better in the PapSpin group, except for inadequate endocervical component, which was greater in the PapSpin samples, a difference that was explained by the split-sample study design, which favored the conventional smear. CONCLUSIONS: The current results indicated that PapSpin is a legitimate, inexpensive alternative to the conventional Pap smear for the detection of cervical intraepithelial neoplasia, resulting in better preservation and improved cell visualization. In addition, the liquid residual allows for reflex human papillomavirus-DNA or polymerase chain reaction testing.     

A Descriptive Study of Different Methods of Cervical Cancer Screening among Ever-Married Women in 35-Year and 45-Year Cohorts in Kalutara District,Sri Lanka

Objective: Screening for cervical cancer in Sri Lankan females with Pap smears (conventional cytology) has shown no marked reduction in cervical cancer incidence over the past two decades. The study aims to compare the efficacy of Pap smear, with other screening tools such as Liquid Based Cytology (LBC) and Human Papilloma Virus/deoxyribonucleic acid (HPV/DNA) (using cobas 4800) in detection of underlying cervical intraepithelial neoplasia (CIN) and cervical cancer among 35 and 45 year old ever married women in Kalutara districtin Sri Lanka. Methods: Women from 35-year cohort and 45-year cohort were selected from all Public Health Midwife areas (n=413) in Kalutara district by random sampling. Pap smear, LBC, and HPV/DNA specimen were collected s from women who attended the Well Woman Clinics (WWC) . Women with positive results from any method were confirmed by colposcopy.  Results: Of the, 510 and 502 women in the 35-year cohort and 45-year cohort, respectively, included in the analysis, nine women among 35-year cohort (1.8%) and 7 women among 45-year cohort (1.4%) had cytological abnormality (positive results) with Pap smears. Thirteen women among 35-year cohort (2.5%) and 10 women among 45-year cohort (2%) age groups had cytological abnormality (positive results) with Liquid Based Cytology reports. Total of 32 women among 35-year cohort (6.2%) and 24 women among 45-year cohort (4.8%)  were positive for HPV/DNA test. Of  the women tested positive on screening, colposcopy revealed that HPV/DNA method was superior to Pap and LBC for detecting CIN while the results of latter two were comparable. Conclusions and Recommendations: The CIN detection rate by colposcopy was high with HPV/DNA screening with cobas 4800, whereas the detection rate by LBC was insignificantly higher than Pap smears.     

No increased risk for cervical cancer after a broader definition of a negative Pap smear

The definition of minimal relevant Pap smear abnormality is crucial for balancing the beneficial effects of screening (prevented mortality) with negative side-effects (the high positivity rate). After inflammation ceased to be defined as a borderline abnormal smear outcome in The Netherlands in 1996, the proportion of these smears dropped from 10% to less than 2%. Because this may have caused a loss in smear sensitivity, we analysed the changes in the incidence of cervical cancer after a negative Pap smear. All negative smears made at ages 30-64 in 1990-1995 (n = 1,546,252) and 1998-2006 (n = 3,552,716), registered in the national registry of histo- and cytopathology (PALGA), were followed for up to 9 years. During follow-up of the 1990-1995 smears, 377 women developed cervical cancer within 5,232,959 woman-years at risk, while during the follow-up of the 1998-2006 smears, 619 women developed cervical cancer within 11,210,675 woman-years at risk. The cumulative incidence after the definition change was not significantly higher than before: e.g. at 6 years, the cumulative incidence for smears made in 1990-1995 was 46 per 100,000 (95% CI: 41-52), and for smears in 1998-2006 was 48 per 100,000 (95% CI: 43-54), p = 0.59. The hazard ratio for 1998-2006 compared to 1990-1995 adjusted for age, number of previous negative smears and history of abnormalities was 0.90 (95% CI: 0.78-1.03). In The Netherlands, a setting with high-quality cytological screening, treating smears with only signs of inflammation as negative leads to a considerably lower positivity rate without increasing the risk for cervical cancer after a negative smear.     

巴氏涂片联合液基细胞学筛查宫颈癌癌前病变的价值

目的:探讨巴氏涂片法联合液基细胞学（liquid-based cytology test,LCT）筛查宫颈癌癌前病变的应用价值。方法:选取1 000例2014年3月至2017年4月进入我院进行宫颈癌癌前病变筛查的患者作为研究对象,对其进行巴氏涂片法、液基细胞学及两者联合检测,比较三种方式的灵敏度、特异度、准确度、约登指数。结果:单用巴氏涂片法检测的灵敏度、特异度、准确度、约登指数分别为45.90%、96.06%、93.00%、0.42,单用LCT检测分别为77.05%、90.31%、89.50%、0.67,LCT联合巴氏涂片法检测分别为78.69%、97.87%、96.70%、0.76。单独使用LCT检测的灵敏度较单独使用巴氏涂片高（P＜0.05）,而两种方法的特异度、准确度比较无显著差异（P＞0.05）。LCT联合巴氏涂片法检测的灵敏度较单独使用巴氏涂片法有明显提高（P＜0.05）,准确度较单独使用LCT检测法有显著提高,特异度无显著差异（P＞0.05）。单用LCT检测判断正确的比例比单用巴氏涂片法判断正确的比例高（NRI值=0.24）;LCT联合巴氏涂片法检测判断正确的比例比单用巴氏涂片法和单用LCT法判断正确的比例均高,其中NRI值分别为0.34和0.32。结论:巴氏涂片法联合液基细胞学能准确地检测出宫颈癌病变,数据较准确可靠,有较高的临床应用价值。     

Consistency of Cytology Diagnosis for Cervical Cancer between Two Laboratories

The principal approach to the prevention of cancer of the cervix uteri has been through screening programmes,using the cervical smear (Pap test) to detect precursor lesions. The sensitivity and specificity of Pap smears dependon the skill of the observer in recognizing and classifying a variety of cellular abnormalities. We have studied thereproducibility of cytological diagnosis, according the Bethesada classification, made by cytologists in Khon Kaen,north-east Thailand, and in Helsinki, Finland, on smears taken from rural women undergoing screening during1994-2001. A total of 313 slides were reviewed. The prevalence of abnormalities was relatively high, since the seriesincluded smears judged abnormal in Khon Kaen or from women who developed cancer during follow-up, as well asa group whose smears were negative.In general, the reviewing cytologist in Finland evaluated more slides as abnormal than in the initial report. Thelevel of agreement between the two observers was evaluated by calculating the coefficient of concordance (Kappa).The kappa score depended upon the degree of detail in the diagnosis; it was 0.43 for the presence or not of anepithelial abnormality (the General Categorization of the Bethesda system), and rather higher (0.5) for separatinglow grade from high grade (HSIL or worse) abnormalities or glandular lesions. Agreement was only fair (0.37) whenthe more detailed Bethesda categories (seven) were used.The reproducibility of cervical cytology evaluations is critical to the success of screening programmes, and in thisprogramme in a moderate-high risk population of women in rural Thailand, we found that agreement betweenskilled observers, at the level of tests requiring diagnostic follow-up or not, was only moderate. The women in thisstudy are being traced to evaluate the true sensitivity of screening in terms of the lesions found on histology, duringa prolonged follow up of 4 or more years.     

A comparison of liquid-based cytology and Pap smear as a screening method for cervical cancer

The implementation of population-based screening for cervical cancer with Pap smear in the early sixties was set to detect and treat precancerous lesions, hopefully preventing a subsequent invasive cervical cancer. Epidemiological data indicate that organized screening has a major impact on morbidity and mortality from cervical cancer. The limited sensitivity of a single smear necessitates repeated smears in organized program. It is suggested that liquid-based cytology improves the sensitivity. The aim of this split-sample study was to compare ThinPrep liquid-based cytology with conventional Pap smear, relying on a laboratory with long-term experience of the latter. In total, 137 women with atypical Pap smear in population-based cervical screening were enrolled for the split-sample study. The performance of both techniques (ThinPrep liquid-based cytology and conventional Pap smear) were compared and validated by a histological follow-up. Women without representative histological biopsy were excluded from the study. Pap smear had sensitivity for detection of CIN2-3 of 47% compared to 66% for liquid-based material. The concordance of the two sampling techniques with the histological diagnosis was 37% and 53%, respectively, this difference being statistically significant. The proportion of reports on atypical squamous cells of undetermined significance (ASCUS) was significantly less in the liquid-based material, 4.3% compared to 8% of the conventional smears. This improved sensitivity in combination with the possibility to perform reflex testing such as HPV DNA or p16 immunocytochemistry without renewed sampling gives ThinPrep a substantial advantage and makes the liquid-based technique interesting.     

ThinPrep detection of cervical and endometrial adenocarcinoma: a retrospective cohort study

BACKGROUND: The current study was performed to compare the accuracy of the ThinPrep trade mark Papanicoloau (Pap) test with that of the conventionally prepared Pap smear in detecting cervical and endometrial adenocarcinomas. METHODS: The subject group consisted of all ThinPrep cases of atypical glandular cells of undetermined significance (AGCUS) or adenocarcinoma diagnosed between March 1998 and March 2000. Conventional smears collected between January 1996 and January 1998, before laboratory conversion to the ThinPrep system, comprised the control group. Histologic follow-up was obtained. RESULTS: One hundred eighty-six (0.17%) of 112,058 ThinPrep Pap tests were interpreted as AGCUS/adenocarcinomas, compared with 77 (0.09%) of 83,464 conventional smears (P < 0.001). The overall sensitivity of a ThinPrep AGCUS/adenocarcinoma smear in detecting either cervical or endometrial adenocarcinoma was increased (72.0% vs. 41.5%; P < 0.001). The ThinPrep Pap test was more sensitive in detecting endometrial adenocarcinomas (65.2% vs. 38.6%; P = 0.010) and there was a trend for a higher sensitivity in detecting cervical adenocarcinomas (87.1% vs. 55.5%; P = 0.108). CONCLUSION: The ThinPrep Pap test is a more sensitive method of detecting cervical and endometrial adenocarcinomas than the conventional Pap smear.     

High‐grade cervical abnormalities and cervical cancer in women following a negative Pap smear with and without an endocervical component: A cohort study with 10 years of follow‐up

The proportion of Pap smears containing an endocervical component (ECC) has been declining in Australia. Given that ECC negative (ECC?) smears may be associated with reduced sensitivity, we undertook a retrospective cohort study to estimate rates of histologically confirmed high‐grade cervical abnormality (HGA) and cancer in women with negative Pap smears with and without an ECC. Women 18‐69 years with at least two Pap smears between 1 January 2001 and 31 December 2010 with the first smear in that period (index smear) showing no abnormality were eligible. Follow‐up ended at date of the first abnormal smear, date of histological diagnosis, date of hysterectomy, date of death, or 31 December 2010, whichever came first. ECC status was treated as a time varying exposure. Follow‐up was split at each smear after the index smear. Poisson regression was used to estimate adjusted incidence rates and incidence rate ratios (IRR) by ECC status. The incidence rate of histologically confirmed HGA was significantly lower following ECC? smears than after ECC+ smears (adjusted IRR: 0.69, 95%Confidence Interval (CI) 0.62‐0.77), particularly at older ages (interaction between ECC status and age, p = 0.001). In contrast, the overall rate of invasive cancer was not significantly different after ECC? than after ECC+ smears (IRR: 1.27, 95%CI 0.90‐1.77). In conclusion, women had a lower rate of confirmed HGA and no significant increase in the rate of invasive cervical cancer following ECC? smears. This study does not support differential (accelerated) follow‐up in women with a negative smear without an endocervical component.     

Present standards for cervical cancer screening

Survival rates for cancer of the uterine cervix have improved over the last 40 years largely because of the impact of screening measures such as the Pap smear. The ability to screen and treat women for preinvasive disease, cervical dysplasia, is the key factor leading to the reduction in the incidence of invasive cervical cancer. More recently, the ability to test women for the causative agent, the human papilloma virus, has emerged as a potential screening tool. New research has focused on new technologies for Pap smear screening such as thin layer technology, the appropriate intervals for screening, and the appropriate methods of incorporation of human papilloma virus testing into the screening protocols. Reviews of published studies evaluating the efficacy of new technologies suggest that there is still insufficient information to confirm improved outcome; however, results to date suggest that thin layer Pap smear technology may improve sensitivity in the detection of cervical dysplasia. Automated rescreening technologies in use may decrease the number of false-negative Pap smears and are an option for laboratories. Various professional groups and countries have differing recommendations on the interval for screening, primarily on the basis of cost-effectiveness. Some of the most important new information this year regarding cervical cancer screening includes the new Bethesda System for the reporting of Pap smears and the new guidelines for the management of the abnormal Pap smear by the American Society of Colposcopy and Cervical Pathology. These guidelines incorporate human papilloma virus testing based on a multicenter trial documenting its efficacy in the triage of women with atypical squamous cells on Pap smear. These recommendations are reviewed along with the current literature on cervical cancer screening.     

Cytology-Based Screening During Antenatal Care as a Method for Preventing Cervical Cancer

Background: Cervical cancer is one of the most serious threats to women’s lives. Therefore, the present study aimed to know the dynamics in the collection of cytologic samples during antenatal care as a method of cervical cancer screening and to identify the factors associated with its performance. Material and Methods: Analytical cross-sectional study carried out with pregnant and postpartum women in Fortaleza, Ceará, Northeastern Brazil. Data were collected using a questionnaire addressing sociodemographic variables, antenatal care, pregnancy and cytology-based screening for cervical cancer during antenatal care. Measures of central tendency were calculated and the Chi-squared test and Fisher’s exact test were used with a significance level of 5%. Results: Participants were 229 pregnant women and 89 postpartum women. Age ranged 18 to 43 years, with a mean of 27.9 years (SD=6.1). Only 35 (11%) participants had Pap smears during antenatal care. A total of 283 women did not have Pap smears during pregnancy; of these, 229 (80.9%) did not have the test because of lack of clear information from the health professional, 25 (8.8%) for fear of bleeding or abortion, and 29 (10.3%) because they had had the test before pregnancy. Undergoing cytology-based screening for cervical cancer was associated with high-risk pregnancy (p=0.002), antenatal care provided by a physician (p=0.003), knowledge about the possibility of having the test during pregnancy (p<0.001) and paid job (p=0.043). Conclusion: The percentage of cytology-based screening for cervical cancer during antenatal care was low. Therefore, health education is suggested to improve this figure. However, receiving antenatal care at MEAC, having consultations with a physician, and knowing that it is possible to have a Pap smear during pregnancy were significant protective factors for undergoing cytology screening during pregnancy.