Encuesta sobre el uso en España de la prueba para la determinación del virus del papiloma humano

Objective

To determine knowledge of the Spanish guidelines for cervical cancer screening, and to evaluate the use of tests for the detection of human papilloma virus (HPV) by Spanish gynecologists.

Subjects and methods

The survey focused on gynecologists who were members of the Spanish Society of Gynecology and Obstetrics and the Spanish Association of Cervical Pathology and Colposcopy. One hundred forty-one specialists completed the questionnaire.

Results

Thirty percent of the target population participated. A total of 95.6% were aware of the recommendations and 93.5% routinely used the test for the detection of the HPV (77.7% for cervical cancer screening). The criteria for the use of the test varied considerably among participants. The main reason for not using the technique was its unavailability.

Conclusions

Training and information on the available recommendations for the new screening strategies and, particularly, on the clinical use of HPV determination should be reinforced.     

Evaluación de un nuevo protocolo de cribado de cáncer cervical con citología convencional y test del virus del papiloma humano

Objective

To compare the effectiveness of cervical cancer screening using cytology plus the high risk human papillomavirus (HR-HPV) DNA test in 2011 versus cytology alone in 2010.

Method

Screening was performed in primary care. The target population in the Barbastro sector consisted of 26,936 women (aged 25 to 65 years). The HPV test was performed with hybrid capture (HC2) and the PCR cobas^® system in women between the ages of 30 and 65 years. Women with negative Pap and HPV test results underwent a 5-year recheck as per the latest protocol of Spanish Society of Obstetrics and Gynecology (SEGO, 2010).

Results

A total of 4,770 Pap tests were received in 2010 and 5,241 in 2011 with coverage between 36.8 and 46.8%; 784 HPV tests were carried out in 2010 and 3,560 in 2011, with positive results in 10.58% the first year and in 7.5% the second year. Eighteen new cases of cervical intraepithelial neoplasia grades 2/3 were diagnosed in 2010 and 35 in 2011, along with 3 invasive carcinomas each year (in 2011, 3 microinvasive carcinomas).

Conclusions

The implementation of HPV testing in primary screening for cervical cancer increased the number of pre-invasive lesions detected by 98% in the year of its introduction. Primary Care involvement allows screening for cervical cancer to be performed without additional costs.     

Encuesta SEGO. Tratamiento de la amenaza de parto pretérmino en los hospitales españoles

Objective

To determine how threatened preterm labor is treated in Spanish hospitals.

Material and method

Under the aegis of the Spanish Society of Obstetrics and Gynecology, an Internet questionnaire on basic aspects of the treatment of threatened preterm labor was sent to 41 Spanish hospitals (37 public and four private hospitals).

Results

All hospitals use tocolysis in threatened preterm labor before 34th weeks. The most widely used tocolytic agent is atosiban (73,7%), followed by betamimetics (21.9%) and nifedipine (4.9%). Only 7.3% of the hospitals use tocolytics in threatened preterm labor after 34 weeks. All the hospitals use corticosteroids to accelerate lung maturation: 92.7% use betamethasone and 7.3% prefer dexamethasone. In 90% of the hospitals, steroid therapy is not repeated. In multiple pregnancies, the same steroid dose as that used in single pregnancies is administrated in all centers.

Conclusions

The most widely used tocolytic agent in Spanish hospitals is atosiban and the preferred corticosteroid is betamethasone.     

Impacto sanitario y económico de la vacunación frente al cáncer de cérvix y lesiones precursoras en España

Objective

To evaluate the healthcare and economic impact of vaccination against cervical cancer with the HPV 16/18 AS04-adjuvanted vaccine (Cervarix^®) in Spain from the perspective of the national health system.

Material and methods

A health economics model was adapted to the Spanish environment. The model simulated the impact of current vaccination programs on the burden of precancerous lesions and cervical cancer. National epidemiological data and the vaccine efficacy shown in clinical trials were used.

Results

Considering the average vaccination coverage in Spain, the model estimated that vaccination with Cervarix^® would prevent 45,060 cases of atypical squamous cells of undetermined significance (ASCUS), 35,166 cases of low-grade squamous intraepithelial lesions (LSIL), 29,549 cases of high-grade squamous intraepithelial lesions (HSIL) and 1,053 cases of cervical cancer. Thus, vaccination would save 89,271,085 € in direct medical costs.

Conclusions

Vaccination with Cervarix^® in Spain would significantly reduce the number of cases of cervical cancer and precancerous lesions and the associated medical costs.     

Expresión de marcadores hipóxicos y glucolíticos CAIX,GLUT-1, HKII y su relación con la respuesta temprana al tratamiento en carcinoma escamocelular de cuello uterino

Objective

To determine the expression of CAIX, GLUT-1 and HKII and whether there is an association between expression of these markers and early treatment response in squamous cell carcinomas of the uterine cervix.

Subjects and methods

This retrospective cohort study included 66 patients with squamous cell carcinomas of the uterine cervix in FIGO (International Federation of Gynecology and Obstetrics) stages IIB and IIIB between 2001 and 2007. The mean age was 47 years. Of the 66 patients, 22 were treated with radiotherapy and 44 with concurrent radiochemotherapy. Expression of the proteins CAIX, GLUT-1 and HKII was determined by immunohistochemistry in biopsies taken before treatment.

Results

The highest increase was found in expression of GLUT-1 (74%), followed by that of CAIX (41%) and HKII (18%). Coexpression of GLUT-1 and CAIX was significant (p <0.002) compared with that of GLUT-1 and HKII. When all three proteins were expressed simultaneously, we observed a tendency toward lack of treatment response.

Conclusions

Increased expression of GLUT-1 compared with that of CAIX and HKII supports the notion that carcinomas have high glucose consumption. Coexpression of GLUT-1 with CAIX and HKII as preexisting biological factors could help to elucidate the mechanisms of hypoxia in tumoral invasion. Coexpression could also help to explain the possible effect of these markers on response to treatments such as exclusive radiotherapy and concurrent radiochemotherapy in the management of stage iiB and iiiB cervical cancer.     

Cesárea a petición de la embarazada

Objetive

: To know Spanish Obstetrics and Gynaecology Society (SEGO) members about cesarean section on request.

Method

Three questions appeared on SEGO web: 1) If a normal primigravid with a term, cephalic presentation foetus ask you for a caesarean section, would you do it?; 2) If a normal primigravid with a term, breach presentation foetus ask you for a caesarean section, would you do it?; 3) If a woman on her normal third pregnancy with two previous vaginal and with a term, breach presentation foetus ask you for a caesarean section, would you do it? Questions were asked in May 2006 and answers were collected 19^th October 2006. Data analysis was processed with web page statistic method.

Results

Among the 5300 members of SEGO, 1222 contacted the web page (23%). To question n° 1, 57.8% answered no, 24.8% yes and 17.4% had no answer. To question n° 2, 6.1% answered no, 93.8% yes and there were no abstention. To n° 3 question, 16.7% said no, 74.5% said yes and 8.8% has no opinion.Results are commented, advantages and disadvantages of caesarean are discussed as well as sanitary consequences of such an indication.     

Idoneidad de las indicaciones de cesárea. Una aplicación en la gestión de la práctica clínica

Objectives

To describe the quality management system applied by the Obstetrics and Gynecology Service of the Manacor Hospital, Majorca (Spain) to the process of cesarean section, and to assess the appropriateness of caesarean sections performed in this service between 2004 and 2005.

Subjects and methods

Consensus was reached on evidence-based indications for emergency and elective cesarean sections and on their quality criteria. All clinical records were reviewed to assess the appropriateness of cesarean sections performed from 2004-2005 according to previously established standards.

Results

In all two-monthly periods, appropriateness was achieved according to previously established standards (100% of elective interventions and > 90% of emergency cesarean sections), except in July-August, 2004 and May-June 2005 (appropriateness of elective cesarean sections = 92%), and in July-August 2004 (appropriateness of emergency interventions = 84%).

Conclusions

To reduce unjustified variability in clinical practice, cesarean section indications must be standardized, based on scientific evidence, and regularly assessed.     

Es posible aplicar protocolos de cribado de cáncer de cérvix en la práctica diaria

Objective

To evaluate whether screening protocols for cervical cancer can be implemented without delaying the diagnosis of cancer and whether this practice is well accepted by patients.

Subjects and methods

In 2005, we developed a protocol for the early diagnosis of cervical cancer based on carrying out cervical smears every 3 years in women over the age of 30 with three previous normal smears. We studied 300 patients who had attended an appointment in 2006 and another 300 in 2008. We reviewed our records to determine whether we had performed a smear and, if one was indicated, whether we had recommended attendance at a follow-up visit 3 years later, and whether the women had returned earlier. Adherence to the protocol in cancers diagnosed from 2005 was also reviewed.

Results

The number of smears decreased by 32% in 2008 compared with 2004, the year prior to screening. In 2008, 21% of women were recommended to attend the next review 3 years later and 3% returned earlier. Of 17 cancers diagnosed since 2005, only one woman with adenocarcinoma had undergone screening.

Conclusions

The overuse of cytology/smears in daily clinical practice can be avoided.     

Influencia de la bibliografía en la calidad de los proyectos de tesis presentados en un departamento universitario. Modelos de regresión

Objective

To evaluate the current situation of the publications cited in doctoral thesis proposals in the Department of Obstetrics, Gynecology and Surgery of the University of Zaragoza (Spain) between 1995 and 2002 and to determine the influence of the bibliography on the quality of thesis proposals with a view to predicting the quality of thesis proposals according to their bibliographic parameters.

Material and method

We performed a casecontrol study (proposals with and without bibliography, respectively). A total of 273 thesis proposals corrected by two evaluators (546 subjects under study) and presented in the Department of Obstetrics, Gynecology and Surgery in the University of Zaragoza between 1995 and 2002 were analyzed.

Results

A statistically significant association was found between the variable of bibliography (present, incorrect, or absent) and the quality of thesis proposals (corrected evaluation) verified by two statistical tests. The number of citations seemed to be linearly related to the corrected evaluation (0.229). Various models were proposed through multiple linear regression but these models had little predictive power.

Conclusions

The publications cited did not influence the quality of doctoral thesis proposals.Although some significant variables were found (a large number of cited publications was weakly correlated with higher quality), these variables explained practically none of the variability in quality.The only variable with predictive or explanatory value on the quality of thesis proposals was the number of citations: the greater the number ofcitations the higher the quality but this variable explained only 8.5% of the variability in quality.     

Encuesta SEGO. Control del feto de bajo riesgo durante el embarazo y el parto en los hospitales españoles

Objective

To determine how low-risk fetuses are monitored during the last few weeks of pregnancy and labor in Spanish hospitals.

Method

An electronic survey on the management of low-risk fetuses was conducted under the aegis of the Spanish Society of Obstetrics and Gynecology in 31 public hospitals and in 5 private hospitals.

Results

During pregnancy, a non-stress test (NST) was used in 34 hospitals and the abbreviated biophysical profile was used in 5.6%. When a non-reassuring fetal pattern was found, the abbreviated biophysical profile was used in 10 hospitals, fetal Doppler in four and amnioscopy in three.During labor, all hospitals performed cardiotocographic monitoring (CTG), which was continuous in 83.3% and through windows in the remainder. When the results of CTG were non-reassuring, pulse-oximetry was used in five centers, ST space analysis (STAM) in three and fetal Doppler in a further three. Microtome and umbilical artery pH sampling were performed in 69.4% of hospitals.

Conclusion

NST is the preferred test for fetal monitoring in the last few weeks of pregnancy. During labor, CTG is currently used, and only 69.4% of centers use microtome when a non-reassuring CTG pattern is observed.     

Hospitalizaciones por cáncer de cuello de útero en la Comunidad de Madrid, 1999-2002

Objective

The aim of this study was to assess the frequency and characteristics of cervical cancer hospitalizations in the Autonomous Region of Madrid, and to estimate the resource consumption and costs related to hospital treatment of the disease.

Methods

A retrospective study was conducted by using information of the cervical cancer patients hospitalized in the Autonomous Region of Madrid from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos. Data on resource consumption for costs analysis was collected from clinical records of women admitted to Hospital Universitario 12 de Octubre of Madrid with cervical cancer.

Results

During the study period (1999-2002) an annual average of 667 hospitalizations with cervical cancer in the Autonomous Region of Madrid hospitals were reported. Hospitalization rate were 30.7 per 100,000 women ≥ 20 years of age and the average number of hospitalizations per patient was 2.2. A total of 126 deaths among hospitalized women were reported during the study period (average annual number of 32 deaths). The mean cost per patient of the hospital treatment was estimated in 5.247 €.

Conclusion

Each year more approximately 700 cervical cancer cases are notified in the Autonomous Region of Madrid hospitals. These represent an annual expenditure for the health care system of about 3,5 millions €.     

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de las isoflavonas en el climaterio

Introduction

Western countries have shown an increasing interest in the use of soya isoflavones to treat aging and menopause-related diseases and their associated symptoms, stimulating a proliferation of studies, many of which report contradictory results. Consequently, the role of isoflavones was assessed by the Spanish Menopause Society (SMS) using the most reliable scientific evidence.

Material and methods

A panel of experts on isoflavones was gathered. The selected studies were obtained by electronic search engines, Medline (1966-March 2007) and the Cochrane Controlled Clinical Trials Registry.

Results

The various reviews and meta-analysis on the effects of Isoflavones on women’s health are controversial. The contradictory results may be due, among other factors, to the lack of uniformity in the compounds under study. Data on doses and genisteine content have indicated beneficial effects on lipid profile, like antioxidants, as well as a mild decrease in hot flushes. Some studies suggest a positive effect on bone mass. However few data are available on other aspects such as breast, estrogendependent cancer, cognitive function, or skin

Conclusions

In certain situations, isoflavones can be a therapeutic alternative during the climacteric period. However, before general recommendations on the use of isoflavone supplements can be made, more specific clinical trials should be performed. These studies should be adequately designed, with supplements that are standarized according to isoflavone content and types, a sufficient number of patients and study duration     

Cribado del cáncer cervicouterino en colectivos de mujeres asintomáticas con factores de riesgo

Objectives

To determine the rates of cervical and vaginal disease in groups of asymptomatic women with risk factors and their degree of adhesion to the screening program.

Patients and methods

269 asimptomatic women attended during 1 year (1998) were interrogated in relation to risk practices; they underwent pap smear, colposcopy-biopsy of the cervix and determination of antibodies for VIH. A follow-up was made during 5 years.

Results

The prevalence of intaepithelial lesions was 26.8% and the accumulated incidence was 10.4%; 62.5% of the women never returned to revision more, whereas 37.6% returned at least once.

Conclusions

The women of the studied groups show high rates of cervical-vaginal pathology and high risk of developing cervical cancer. The adhesion of these women to the screening program is very low. Because of the low precision of the citology, this women must undergo a second screening test.     

Hiperplasia ductal atípica de mama: correlación de la biopsia percutánea y los resultados de la biopsia quirúrgica

Objetive

The purpose was to evaluate the prevalence of carcinoma found at surgical biopsy of llesions identified as atypical ductal hyperplasia by percutaneous breast biopsy.

Methods

We performed a retrospective study of all asymptomatic patients with a result of atypical ductal hyperplasia on percutaneous breast biopsy and who underwent surgical excision from January 2002 to December 2010.

Results

Sixty-eight patients were found to have atypical ductal hyperplasia at percutaneous breast biopsy and were evaluated with surgical biopsy. Seventeen patients (25%) had carcinoma at surgical excision, 10 had ductal carcinoma in situ, and 7 patients had invasive carcinoma. The mammographic characteristics associated with malignancy were analyzed.

Conclusions

A finding of atypical ductal hyperplasia at percutaneous breast biopsy frequently corresponds to cancer and is therefore an indication for surgical excision.     

Estudio comparativo de conizaciones realizadas en la provincia de Segovia antes y después del uso del test del virus del papiloma humano (2007-2010)

Objective

To assess epidemiological, diagnostic and therapeutic changes in the province of Segovia since the introduction of techniques for the detection of human papillomavirus (HPV) DNA in cervical cancer screening in women aged more than 30 years in primary care in January 2009.

Material and methods

We carried out an observational retrospective study of conization procedures undertaken from January 2007 to December 2010. Eighty-six patients were included: 40 women who underwent conization from 2007-2008 and 46 who underwent the procedure from 2009-2010.

Results

The number of conization procedures showed no significant change but the number of high-grade lesions found in cytology (P=.017) and postsurgical histological analysis (P=.047) increased. The positive predictive value (PPV) of screening for high-grade lesions showed a nonsignificant increase (P=.059).

Conclusions

The PPV of cervical cancer screening increased in our province with the HPV test, without increasing the number of conization procedures.