妊娠期宫颈细胞学涂片的临床应用

目的 :探讨薄层宫颈涂片检查在妊娠期应用的必要性及异常细胞学涂片对产后评估的意义。方法 :对 734例孕妇和 318例同龄非孕者普查的薄层宫颈涂片结果进行分析对比。结果 :孕妇组感染性病变检出率 10 .2 2 % ,明显高于对照组的 5 .97% (P <0 .0 1)。孕妇组宫颈鳞状上皮内病变的发生率 5 .0 4 % ,与对照组相似 ;对孕期存在宫颈上皮病变的妇女在产后 6～ 12周重复宫颈涂片 ,进行再评估 ,有宫颈鳞状上皮内病变的 19例 ,15例病变程度降低 ,4例病变程度无进展 ,无浸润癌发生。结论 :妊娠期需常规行细胞学涂片检查 ,产前涂片异常者 ,产后应再次评估     

绝经后妇女宫颈病变的特点及其早期诊断

目的　探讨绝经后妇女宫颈病变的特点、筛查的必要性及早期诊断。方法　对北京大学第三医院自2 0 0 1年 1月至 2 0 0 4年 1月因宫颈涂片异常或临床检查可疑宫颈病变者 934例进行总结分析。根据绝经与否分为未绝经组和绝经组 ,对患者行宫颈涂片、阴道镜下宫颈多点活检。结果　未绝经组及绝经组宫颈异常涂片的检出率分别为 6 8 2 6 % (40 0 / 5 86 )及 85 31% (2 73/ 32 0 ) ,二组比较差异有显著性意义 (P <0 0 5 )。阴道镜下宫颈活检组织病理学诊断宫颈上皮内瘤变 (cervicalintraepithelialneoplasia ,CIN)分别为 2 4 34% (138/ 5 6 7)及 15 0 6 %(5 0 / 332 ) ,二组比较差异有显著性意义 (P <0 0 5 ) ;其中CINⅢ的检出率分别为 8 99% (5 1/ 5 6 7)及 8 73%(2 9/ 332 )。未绝经组与绝经组涂片及组织病理学提示人乳头瘤病毒 (humanpapillomavirus ,HPV)感染共 138例 ,其中高危型HPV阳性率分别为 6 2 2 2 % (5 6 / 90 )和 4 3 75 % (2 1/ 4 8) ,二组比较差异有显著性意义 (P <0 0 5 )。结论　为早期发现宫颈病变 ,阻遏疾病进展为宫颈癌 ,在绝经后妇女进行宫颈细胞学筛查是必要的。     

新疆生产建设兵团育龄妇女紧急避孕知晓率及其影响因素分析

目的:了解兵团育龄妇女紧急避孕知晓率及其影响因素。方法:采取整群分层、四阶段、概率比例抽样方法随机抽样,共调查育龄妇女7533人;对影响紧急避孕知晓率的因素进行单因素分析和非条件Logistic逐步回归分析。结果:兵团育龄妇女的紧急避孕知晓率为47.1%,受教育程度、宣传教育状况、婚姻状况、工作性质是紧急避孕知晓率的影响因素;25.4%的对象听说过且了解紧急避孕内容。结论:应进一步加大宣传教育力度,重点关注未婚人群和少数民族妇女相关知识的获得,提高受教育程度是提高育龄妇女紧急避孕知晓率的根本途径。     

内蒙古镶黄旗地区妇女宫颈病变筛查现状

目的探讨宫颈细胞学(包括巴式涂片及超柏氏薄层液基细胞学)及阴道镜检查筛查内蒙古镶黄旗地区妇女宫颈病变的现状及临床意义。方法2004年7月至2009年1月对内蒙古镶黄旗地区的642例28～67岁有性生活妇女进行宫颈病变筛查,其中557例妇女行传统宫颈巴式涂片法,85例妇女行宫颈超柏氏薄层液基细胞学,并对宫颈细胞学异常者(≥ASCUS)行阴道镜检查及活检。结果642例妇女中宫颈细胞学阳性(≥ASCUS)者34例,占5.3%(34/642),其中ASCUS者22例,占64.7%(22/34);低度鳞状上皮内病变(LSIL)者6例,占17.6%(6/34);高度鳞状上皮内病变(HSIL)者6例,占17.6%(6/34),其中有1例肯定为宫颈癌。宫颈细胞学阴性608例,占94.7%(608/642)。宫颈细胞学阳性34例人群中,行阴道镜活检病理检查者有25例,其中慢性宫颈炎13例(52.0%);CIN1为5例(20.0%);CIN2为4例(16.0%);CIN3为1例(4.0%);浸润癌为2例(8.0%)。结论应重视并及时进行经济不发达地区妇女人群宫颈病变的早期筛查,传统宫颈巴式涂片法及阴道镜活检及病理学检查为可行的筛查方法,有条件者可进行宫颈薄层液基细胞学结合阴道镜活检及病理学检查,对提高早期宫颈癌筛查的准确性效果明显。对内蒙古等西部地区,应在完善技术力量支持、筛查质量控制、建立筛查后的转诊制度及治疗的绿色通道等方面,以降低宫颈癌的发病率。     

妊娠期和产后妇女宫颈病变筛查研究新进展

近来有研究显示,妊娠期宫颈细胞学异常及人乳头瘤病毒(HPV)感染检出率较高,但分娩后又有一定的自然消退率和进展率。HPV感染易致宫颈细胞学异常,另有研究指出多个性伴侣、初次性生活早、多产次、社会经济地位低下、非白种人、吸烟均是宫颈细胞学异常的高危因素。妊娠期妇女宫颈存在特异性生理改变易导致诊断误差。目前专门针对妊娠期妇女宫颈筛查新方法的研究甚少,仍是使用与非妊娠妇女相同的筛查方法,如液基细胞学、传统巴氏涂片(Pap Smear)、HPV DNA检测。而各项指南对妊娠妇女宫颈病变筛查时机和间隔的选择仍有争论,有待进一步大规模研究。     

宫颈鳞癌与腺癌生物学行为的回顾性对比分析

目的探讨宫颈鳞癌(SCC)和宫颈腺癌(AC)在生物学行为方面存在的差异,为宫颈癌的合理诊治提供更多的临床依据。方法回顾分析山东大学齐鲁医院妇产科1997年1月至2006年3月收治的273例宫颈癌初治患者的临床资料,对比分析SCC和AC在发病相关因素、临床病理特征、5年生存率等生物学行为方面的不同。结果SCC和AC两组病例中有吸烟史者分别占22%和10%、宫颈涂片阳性率分别为80%和46%,体重指数(body mass index,BMI)≥24kg/m2者分别占15%和34%,确诊时FIGOⅠ期、Ⅱ期、Ⅲ期、Ⅳ期患者分别占SCC患者的42%、46%、11%、1%和AC患者的31%、47%、12%、10%,卵巢转移率分别为0.5%和6.7%,5年生存率分别为69.9%和50.6%,以上差异均有统计学意义(P<0.05)。结论SCC和AC在发病相关因素、临床病理特征和预后等方面均有统计学差异,SCC组有吸烟史者的比例及宫颈涂片阳性率更高,AC患者中则体重超重或肥胖者占较高比例,AC患者确诊时晚期患者较多而且更容易发生卵巢转移,预后较SCC差。     

闵行区宫颈疾病筛查模式效果的回顾性研究

目的:探索上海闵行地区宫颈疾病筛查最为经济可靠的模式。方法:以2008.07.01～2011.06.30录入电子病历信息管理系统(EHR)中的宫颈疾病筛查对象为研究对象(n=14 526),依社区健康教育督促(A组,n=2 507)、贫困妇女免费普查(B组,n=7 396)、因症就医机会性筛查(C组,n=4 623)3类筛查方式进行分组,通过队列研究比较3组间宫颈疾病筛查的效果。结果:所有研究对象中巴氏涂片≥Ⅲ级者占26.3%(3 781/14 526),B组高达29.20%(2 160/7 396),3组间构成比具有统计学差异(χ2=87.58,P<0.000 1)。因巴氏涂片≥Ⅲ级进一步行TCT+阴道镜+组织活检者共计3 491例,经组织病理学诊断为LSIL者占8.34%(291/3 491)、HSIL者占2.95%(103/3 491)、宫颈癌占1.17%(41/3 491);宫颈病变总体检出率各组间具有统计学差异(χ2=14.26,P=0.000 8),C组最高,达15.23%(141/926);不同级别宫颈病变检出率在各组间也具有统计学差异(χ2=14.52,P=0.02)。所有对象(剔除未能转诊的失随访者)中LSIL检出率为2.04%(291/14 236),HSIL检出率为0.72%(103/14 236),宫颈癌检出率为0.29%(41/14 236)。Logistic回归提示年龄增大及流动人口是筛查出HSIL及宫颈癌的风险因素,在C组对象中尤为明显。结论:贫困免费筛查以及因症就医机会性筛查对象是今后初筛人群选择的重点。机会性筛查因针对性更强,相对节约资源,或许能成为城市地区最为经济可靠的宫颈疾病长期筛查模式。     

阴道镜检查对宫颈接触性出血患者的临床诊断价值

目的：观察与探讨阴道镜检查对宫颈接触性出血患者的临床应用价值。方法对临床首诊的326例接触性出血妇女患者（观察组）给予阴道镜检查及镜下活检,并随机以同期症状相同的288例患者给予常规宫颈刮片作为对照（对照组）,对比观察两组的检查结果。结果对照组常规宫颈刮片细胞学检查CIN和宫颈癌的检出率分别为5.7%、2.1%,观察组阴道镜下常规活检CIN和宫颈癌的检出率分别为18.7%、5.5%,P〈0.05,两组差异具有统计学意义。结论在临床上阴道境检查宫颈接触性出血可以提高宫颈癌与宫颈上皮内瘤样病变的检测率,有利于对该类疾病的早期诊断及早期防治,具有重要临床价值,值得推广。     

液基宫颈刮片检查是否受水质润滑剂的影响[英]

在美国．每年有500万妇女要进行宫颈刮片检查，按期行刮片检查的妇女由于癌前病变的早期治疗使宫颈癌的发生率低。尽管刮片检查简便易行，但对妇科检查的恐惧是一些妇女不愿意接受刮片检查和随访最主要原因。减少妇科检查的不适方法之一是在窥器表面涂些水质润滑剂，减少疼痛可能增加高危人群的随访。但现代妇产科教材并不提倡应用任何润滑剂。为探讨润滑剂是否直接污染细胞。在将样本细胞放入贮存液之前应用润滑剂污染后进行分析。评估应用水质润滑剂对宫颈细胞学诊断、标本采集量以及对细菌性阴道病或真菌感染等疾病是否存在影响．对2004年3月-2004年8月应诊时按计划行常规宫颈细胞学涂片检查的200例成年妇女进行随机、盲法、自身对照研究。窥器常规蘸水润滑，分别用刮板和宫颈刷采集每例患者的宫颈标本。样本随机放入污染组或对照组。污染组的窥器和宫颈刷用0．5mL水质润滑剂（Surgilube）沾染后．放入盛有贮存液的新柏氏宫颈细胞学样本杯中．然后对两组样本进行宫颈细胞学分析。比较两组问的诊断不一致率。将对照组与污染组中细胞学异常和诊断不一致者进行分析。两组中其他诊断如真菌感染和细菌性阴道病不一致者也进行分析．     

宫颈癌医院机会筛查与社区筛查相关因素分析

目的分析宫颈癌医院机会筛查和社区筛查的相关因素。方法对2008年1月至2008年12月在北京市垂杨柳医院妇科门诊行宫颈癌机会筛查和社区筛查妇女的相关因素进行分析,其中门诊机会筛查7223例（机会筛查组）,社区筛查11539例（社区筛查组）。结果社区筛查组年龄[（45.75±9.29）岁]大于门诊机会筛查组[（33.55±10.49）岁],其中社区筛查组年龄〉50岁者占39.8%,初中及以下文化程度者占96.2%,两组筛查妇女年龄比较,差异有统计学意义（P〈0.001）。两组宫颈鳞状上皮内低度病变所占比例（机会筛查组1.2%;社区筛查组0.4%）比较,差异有统计学意义（P〈0.001）;机会筛查组鳞状上皮内高度病变及宫颈癌发生率高于社区筛查组,但差异无统计学意义（P〉0.05）。机会筛查组不同级别的宫颈上皮内瘤变（CIN）和宫颈癌的检出率均高于社区筛查组,差异有统计学意义（P〈0.05）。结论社区筛查人群年龄较大,文化程度低,应重视这一群体防癌知识宣教,提高筛查率。宫颈癌医院机会筛查与社区筛查同样重要。     

Self-reported cervical screening practices and beliefs of women from urban, rural and remote regions.

This survey aimed to explore women's perceptions of a number of issues relating to the availability and utilisation of cervical cancer screening services in the rural, remote and urban regions of New South Wales (NSW) Australia. The survey involved urban, rural and remote regions of NSW determined by the definition of the Department of Community Services and Health. This was a cross-sectional telephone survey. Of the 339 eligible urban households, 265 (78%) completed interviews; of the 286 eligible rural households, 238 (83%) completed interviews; of the 285 eligible remote households, 230 (81%) completed interviews. Telephone contact was made with randomly selected households in each region. Women in the households were asked to complete a computer-assisted telephone interview. The survey addressed a number of issues relating to cervical screening: cervical cancer risk status; provider of Pap smear service; distance travelled to have a Pap smear; perceived barriers and facilitators to cervical screening. There was no statistically significant difference in the proportions of women from urban (74%), rural (76%), and remote (71%) regions who reported having a Pap smear in the 2 years preceding the survey. General practitioners provided the majority (more than 70%) of tests irrespective of region. Compared with women from urban areas, women from rural and remote areas were almost twice as likely to have had their last Pap smear from a male general practitioner. A greater proportion of women from remote regions had to travel for 60 minutes or more to access providers of Pap smear services. Few differences in the top three reported barriers to, and facilitators for screening were evident between regions and between those women who had and had not been adequately screened. Issues of distance, isolation and access to alternative service providers are a concern to women in rural and remote regions and should be considered by those involved in the implementation of cervical cancer screening services.     

Human papillomavirus infection and intrauterine growth restriction: a data-linkage study

Objective: Using unbiased population data, to examine whether having a positive Pap smear, and thus a high probability of Human Papilloma Virus (HPV) infection, is a significant risk factor for intrauterine growth restriction (IUGR) in a subsequent pregnancy.

Study design and methods: Two independent population-based databases, namely the South Australian Perinatal Statistics Collection and the South Australian Cervical Screening Database, were deidentified and linked by the SANT Datalinkage Service. Analyses were performed on cases where Pap smear screening data was available for up to 2 years prior to a singleton live birth. Population characteristics and pregnancy related data were compared statistically by normal birth weight versus IUGR (10th percentile – known as small for gestational age (SGA), small for gestational age) and (3rd percentile birth weight – known as VLBW, very low birth weight). The association between cervical screening results and IUGR was assessed using generalized linear log binomial regression models.

Results: A total of 31,827 women met the criteria. Of these, 1311 women (4.1%) had a positive Pap smear within 2 years of the current pregnancy. Those having a positive Pap smear were more likely to have a baby with IUGR than those with negative smear results. For SGA, 5.8% babies were from mothers with positive Pap smears compared to 4.0% with negative smears indicating a 40% higher risk of having an SGA baby (95%CI 20–70%) among women with positive Pap smears. For VLBW, 7.6% mothers had positive Pap smears compared with 4.0% with negative smears (p?Conclusions: Mothers with a positive Pap smear have an increased risk of IUGR, especially for VLBW, which is independent of other risk factors. The results confirm previous findings in a small study and emphasise the need to consider the risks of both cancer and IUGR in all HPV vaccination programs.     

Cervix cancer screening among Greek and immigrant women: the experience of a Greek District Hospital

PURPOSE: To explore whether there are differences in Papanicolaou (Pap) smear screening between native and immigrant women that attended our outpatient clinic. METHODS: In this retrospective study, from January 2002 until December 2003 we examined age, nationality, marital status, economic status (self-reported family income per year) and previous Pap test screening frequency; 3,316 women were included in the study. RESULTS: The average age was 41.95 years. The majority of the women who had had a Pap test (58.4%) were Greeks and 41.6% immigrants. Regarding marital status a percentage of 61.2% were married, 13.7% were single and 24.9% were divorced. Regarding economic status 71.0% of the women had a low-income, 25.1% a middle-income and 3.8% a high-income. Of the women 24.99% had never had a Pap test in their lives. DISCUSSION/CONCLUSION: The possibility of having easy access to a clinic and to routine health care has a critical influence on the cancer screening habits of immigrant women. Opportunistic Pap smear screening as part of a pregnancy or family-planning checkup in local clinics is an acceptable strategy for poor immigrant women.     

Improved cervical cancer screening in premenopausal women by combination of Pap smear and speculoscopy

OBJECTIVE: This study was done to evaluate the efficacy of the Pap smear, speculoscopy, and a combination of Pap smear and speculoscopy (PapSure examination) in pre- and postmenopausal women. STUDY DESIGN: All women were screened using the Pap smear and speculoscopy and combination of both (PapSure examination) in the multicenter trial. Final diagnosis of each patient was based on a histological evaluation of the colposcopic target biopsy. Results were analyzed using a proportional comparison test, sensitivity, specificity, and predictive value with significance determined at p<0.05. RESULTS: Of 1813 women screened, 1701 were eligible for analysis. Two hundred and fourteen women (12.6%) received at least one positive screening test result. Of the 1084 colposcopic biopsy specimens obtained, 24 showed low-grade squamous intraepithelial lesion (LSIL) and 19 high-grade SIL (HSIL). HSIL were considered test-positive. Rate of colposcopy was 21.5% (125/582) in the premenopausal group and 63.9% (321/502) in the postmenopausal group (p<0.001). For premenopausal women, speculoscopy (75.0%) or PapSure (91.7%) provided higher sensitivity than Pap smear (50%) (p<0.05). In postmenopausal women, no statistical significance in sensitivity existed between PapSure (85.7%) and Pap smear (57.1%). Speculoscopy (96.8%) or PapSure (96.5%) had lower specificity than Pap smear (99.6%) (p<0.001). CONCLUSION: PapSure was an accurate alternative screening method to Pap smear or speculoscopy for cervical intraepithelial lesions because of a significantly higher sensitivity along with adequate specificity for premenopausal women; however, PapSure was not a more effective cervical screening method for postmenopausal women.     

Screening practices and invasive cervical cancer risk in different age strata

Relative and population attributable risks for invasive cervical cancer in different age strata relative to screening practices have been estimated using data from a case-control study conducted since 1981 in the greater Milan area, northern Italy. A total of 548 women under 75 years of age with a histologically confirmed diagnosis of invasive cervical cancer were compared with 515 controls admitted to hospital for a spectrum of nongynecological, hormonal or neoplastic, acute conditions. The percentage of never-screened women increased with age: no Pap smear was reported in 34% of controls aged 44 years or younger and 63% of older women (greater than or equal to 65 years). A similar trend emerged in recency of Pap smear, with 14% of older controls and 52% of the younger group reporting a cervical smear within 3 years before the interview. The number of Pap smears was strongly and inversely related to cervical cancer risk at all ages. Compared with no Pap smear, three or more cervical smears decreased the risk of invasive cervical cancer by about 90%. Compared with women screened the last time 6 years before the interview or never, relative risks were about 60% lower in women reporting their last Pap within 2 years in all age groups. A slightly larger proportion of older cases were attributable to the absence or delay in the screening: population attributable risk estimates were 78% in women up to 55 years of age, and 86% in those 65 years or older. Thus, deficiencies in screening were greater at ages at which the incidence of disease was higher.     

Comparison of the diagnostic value of the visual inspection with acetic acid (VIA) and Pap smear in cervical cancer screening

ObjectiveThis study aimed to compare the diagnostic value of VIA with Pap smear in screening for cervical cancer.Materials and methodsIn this cross-sectional study, 440 women who had eligibility criteria, in Kashan city were assessed. All women underwent Pap smear test and then a visual inspection with acetic acid and colposcopy-biopsy (Gold Standard). Then, the diagnostic value indices including the specificity, sensitivity, positive and negative predictive values for the results of VIA and Pap smear were analyzed by SPSS V16 software.ResultsFinding showed that 29.9% of women had abnormal Pap smear. The false positive rate of Pap smear was 40.2%, and its false negative rate was 37.4%. For VIA, the false positive and false negative rates were 21.2% and 4.6%. The sensitivity, specificity, NPV and PPV of Pap smear was 29.7%, 85.5%, 59.8%, 62.6%, and these values for VIA was 94.6%, 81.6%, 78.8%, 95.4% respectively. Combination of Pap smear and VIA showed the sensitivity of 97.3% and 100% in low grade and high grade cervical lesions.ConclusionVIA has a higher sensitivity than Pap smear in detection of low and high grade cervical lesions, however, its specificity is less than Pap smears. Therefore it is recommended to use of VIA along with Pap smear to reach a higher sensitivity.     

Occurrence of cervical intraepithelial neoplasia in generally healthy women with exophytic vulvar condyloma acuminata

AIM: To disclose possible association between exophytic vulvar condyloma acuminata and cervical intraepithelial neoplasia in generally healthy, sexually active women. METHODS: This retrospective study included 74 patients (study group) who were referred for laser vaporization therapy of exophytic vulvar condyloma acuminata, and 88 asymptomatic volunteers without evidence of exophytic vulvar condyloma acuminata (control group) who were referred for screening Papanicolaou (Pap) test cervical evaluation including colposcopy. The diagnosis of cervical intraepithelial neoplasia was based on Pap smear, colposcopy and/or biopsy. RESULTS: On Pap smear, atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions were found in 10 (13.5%) women with exophytic vulvar condyloma acuminata and in 2 (2.3%) asymptomatic volunteers (p < 0.05). Cervical intraepithelial neoplasia was found in 8 women with exophytic vulvar condyloma acuminata and in none of the asymptomatic volunteers (p < 0.05). CONCLUSION: An association was found between exophytic vulvar condyloma acuminata and abnormal Pap smear or positive cervical biopsy, in generally healthy women.     

改良取样巴氏涂片在人群子宫颈癌筛查中的应用

目的：探讨改良取样巴氏涂片（Pap）在子宫颈癌筛查中的应用价值。方法：对500例30~59岁、3年内未行宫颈癌筛查的妇女行改良Pap、液基细胞学（LCT）和第二代杂交捕获实验（HC-Ⅱ）人乳头瘤病毒（HPV）检测,Pap采用液基细胞学刷取样,2种细胞学取样采用分配样本法。细胞学以无明确诊断意义不典型鳞状细胞（ASCUS）为阳性阈值,对任一细胞学结果或HPV检测阳性的妇女行阴道镜下宫颈多点活检,以病理诊断为金标准,评价2种细胞学方法筛查宫颈癌的价值。结果：宫颈细胞学筛查宫颈上皮内瘤样病变（CIN）Ⅱ以上病变以ASCUS为阳性阈值的筛查效率最高;改良Pap和LCT的筛查效率（ROC曲线下面积比较,Z ＝0.70,P ＞0.05）和不满意率（χ2＝0.343,P =0.558）差异无统计学意义;两种细胞学的诊断完全一致率为86.8%,宫颈癌和宫颈癌前病变级别越高,2种细胞学方法判读结果的一致性越好。结论：改良Pap经济有效,可广泛应用于人群子宫颈癌筛查。     

Comparative analysis of characteristics of women with cervical cancer in high- versus low-incidence regions

OBJECTIVE: To identify particular characteristics that might help explain the markedly higher rate of invasive cervical cancer in southern China as compared with Australia. METHODS: One hundred eighty-five women with cervical cancer were recruited between 1999 and 2001: 106 from Guangzhou and Changsha (southern China), and 79 from Sydney (southeast Australia). Demographic and risk factor information was obtained by questionnaire; clinicopathologic data were extracted from hospital records. The human papillomavirus (HPV) status of cancer biopsies was ascertained by consensus PCR assays, direct sequencing and/or Amplicor trade mark hybridisation. RESULTS: The mean age of the Chinese was significantly lower than the Australians (44 versus 53 years), although mean age at first sexual intercourse was similar. Australian women were more likely to smoke, to report multiple sexual partners and to have a history of sexually transmitted diseases (but not of genital warts). However, they were better educated, were more frequent users of barrier contraception and were far more likely to report regular Pap smears before diagnosis. The HPV positivity rate of Chinese cancers (83%) was less than Australian tumours (90%); but HPV 16 and 18 were the most common genotypes in both populations (59% and 77%), and predominated in cancers from younger women. HPV types 58 or 59 were amplified from 12 (14%) of the Chinese but from only one Australian cancer. CONCLUSIONS: Cervical cancer is not only more common in China but also develops at a younger age than in Australia. While significant differences in some risk factors were observed, the much lower participation in cervical screening in southern China is likely to be of greatest consequence.     

Attitudes to self-sampling of vaginal smear for human papilloma virus analysis among women not attending organized cytological screening

BACKGROUND: The major problem with the cytological screening is the non-optimal participation rate among women invited for cervical smear collection. The aim of the present investigation was to examine the attitudes of the non-responding women to perform self-sampling of vaginal smear at home as a method to increase the coverage of the screening and to examine the prevalence of high-risk human papilloma virus (HPV) among the responding women. METHODS: From the database of the Department of Cytology, University Hospital of Uppsala 198 women, aged 35-55 years, who had not attended the organized gynaecological screening for over 6 years were identified. They were sent a letter of information about the study and one week later a self-sampling device aimed to collect vaginal smear. The vaginal smear of the women responding to the offer of self-sampling was analysed for high-risk HPV using Hybrid Capture 2 method or polymerase chain reaction amplification of HPV DNA. All women in the study also received a questionnaire in order to investigate their attitudes towards self-sampling as an alternative in the organized screening. RESULTS: Of the 198 women 15 women had to be excluded. Fifty-eight per cent of the women responded and collected vaginal smear at home and among them 7% were positive for high-risk HPV. The questionnaire revealed no significant difference of age, country of birth and occupation or marital status, on using self-sampling of vaginal smear at home. The attitudes among responding and non-responding women differed. The responding women who contributed by sampling vaginal smear were more positive to self-sampling of vaginal smear (p<0.01). CONCLUSIONS: Offering self-sampling of vaginal smear in women not attending the organized cytological screening increases the coverage and identifies an additional group of women with an increased risk to develop cervical cancer. The attitude towards self-sampling was mainly positive.