Abnormal Pap Smear

2020 ◽  
Author(s):  
Huma Farid
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Pap Smear ◽  
Cervical Dysplasia ◽  
The United States ◽  
Pap Smears ◽  
Low Grade ◽  
High Grade ◽  
Increased Risk ◽  
Risk Of Progression

Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 25 years, and these women should be followed closely.  This review contains 18 figures, 3 tables, and 43 references. Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia

Cervical Cancer Screening

2018 ◽  
Author(s):  
Huma Farid
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Pap Smear ◽  
Cervical Dysplasia ◽  
The United States ◽  
Pap Smears ◽  
Low Grade ◽  
High Grade

Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 20 years, and these women should be followed closely. This review contains 18 figures, 3 tables and 53 references Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia

scholarly journals Cumulative Impact of HIV and Multiple Concurrent Human Papillomavirus Infections on the Risk of Cervical Dysplasia

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
David H. Adler ◽  
Melissa Wallace ◽  
Thola Bennie ◽  
Beau Abar ◽  
Tracy L. Meiring ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Young Women ◽  
Pap Smear ◽  
Cervical Dysplasia ◽  
Pap Smears ◽  
Papillomavirus Infections ◽  
Cumulative Impact ◽  
Hiv Coinfection ◽  
Increased Risk ◽  
The Impact

Infection with HIV is known to increase the risk of cervical cancer. In addition, evidence suggests that concurrent infection with multiple human papillomavirus (HPV) genotypes increases the risk of cervical dysplasia more than infection with a single HPV genotype. However, the impact of the combination of HIV coinfection and presence of multiple concurrent HPV infections on the risk of cervical dysplasia is uncertain. We compared the results of HPV testing and Pap smears between HIV-infected and HIV-uninfected young women to assess the cumulative impact of these two conditions. We found that both HIV and the presence of multiple concurrent HPV infections are associated with increased risk of associated Pap smear abnormality and that the impact of these two risk factors may be additive.

Cervical Dysplasia and Human Papillomavirus

2018 ◽  
Author(s):  
Melissa K Frey ◽  
Cathleen E Matrai
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Invasive Cervical Cancer ◽  
Cervical Dysplasia ◽  
The United States ◽  
Hpv Infection ◽  
Low Grade ◽  
Human Papillomavirus Vaccine ◽  
Papanicolaou Test ◽  
Screening Programs

Human papillomavirus (HPV) affects the majority of sexually active individuals and accounts for approximately 5% of human cancers and nearly 100% of cervical cancer cases. The progression from persistent HPV infection to invasive cervical cancer takes at least 10 years and is preceded by epithelial dysplastic changes. Cytologic screening programs, which rely on disease detection during this precancerous interval, have successfully decreased the incidence of cervical cancer. The HPV vaccine, approved since 2006, effectively decreases cervical disease but remains underused in the United States and abroad, with the incidence of HPV-related cancers still on the rise. In this review, we discuss the epidemiology and molecular pathogenesis of HPV infections and cervical cancer development, cervical cancer screening and screening terminology, management of abnormal screening results, and HPV vaccination.   This review contains 4 figures, 8 tables and 49 references Key words: atypical squamous cells of undetermined significance, cervical cancer, cervical intraepithelial neoplasia, colposcopy, high-grade cervical dysplasia, human papillomavirus, human papillomavirus vaccine, low-grade cervical dysplasia, Papanicolaou test, papillomaviruses  

scholarly journals Point-of-care digital cytology with artificial intelligence for cervical cancer screening at a peripheral clinic in Kenya

2020 ◽  
Author(s):  
Oscar Holmstrom ◽  
Nina Linder ◽  
Harrison Kaingu ◽  
Ngali Mbuuko ◽  
Jumaa Mbete ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Point Of Care ◽  
Screening Method ◽  
Machine Learning Algorithms ◽  
Learning System ◽  
Pap Smears ◽  
Low Grade ◽  
High Grade ◽  
Predictive Values

Cervical cancer is highly preventable but remains a common and deadly cancer in areas without screening programmes. Pap smear analysis is the most commonly used screening method but is labour-intensive, subjective and requires access to medical experts. We developed a diagnostic system in which microscopy samples are digitized at the point-of-care (POC) and analysed by a cloud-based deep-learning system (DLS) and evaluated the system for the detection of cervical cell atypia in Pap smears at a peripheral clinic in Kenya. A total of 740 conventional Pap smears were collected, digitized with a portable slide scanner and uploaded over mobile networks to a cloud server for training and validation of the system. In total, 16,133 manually-annotated image regions where used for training of the DLS. The DLS achieved a high average sensitivity (97.85%; 95% confidence interval (CI) 83.95-99.75%) and area under the curve (AUCs) (0.95) for the detection of cervical-cellular atypia, compared to the pathologist assessment of digital and physical slides. Specificity was higher for high-grade atypia (95.9%; 95% CI 94.9-97.6%) than for low-grade atypia (84.2%; 95% CI 79.9-87.9%). Negative predictive values were high (99.3-100%), and no samples classified as high grade by manual sample analysis had false-negative assessments by the DLS. The study shows that advanced digital microscopy diagnostics supported by machine learning algorithms is implementable in rural, resource-constrained areas, and can achieve a diagnostic accuracy close to the level of highly trained experts.

Low Utility in Colposcopy-directed Biopsies for Non-high Grade Cytological Abnormalities on PAP Smear

2020 ◽  
Vol 16 (1) ◽  
pp. 18-22
Author(s):  
Eronmwon E. Gbinigie ◽  
Joshua Fogel ◽  
Maggie Tetrokalashvili
Keyword(s):  
Pap Smear ◽  
Multinomial Logistic Regression ◽  
Cervical Dysplasia ◽  
Outcome Variable ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion ◽  
Cytologic Abnormalities ◽  
Cytology Screening

Background: Clinicians commonly perform colposcopy directed biopsies on patients with low grade squamous intraepithelial lesion (LSIL) on PAP cytology even when not consistent with clinical guidelines. Objective: We study the association of PAP cytology screening results with cervical intra-epithelia neoplasia (CIN) 2-3 high-grade dysplasia, as confirmed by colposcopy-directed biopsy. Methods: A retrospective study of 263 women with an abnormality on the PAP smear. Multinomial logistic regression was performed with predictors of PAP cytology screening results with the outcome variable of colposcopy-directed biopsy. Results: High grade squamous intraepithelial lesion (HSIL) had significantly increased relative risk for CIN 2-3 (RR: 9.85, 95% CI: 1.84, 52.79, p=0.008). LSIL was not significantly associated with CIN 2-3. In the comparisons of negative with CIN-1, both HSIL and LSIL were not significantly associated with a negative biopsy. Conclusion: HSIL is associated with cervical dysplasia of CIN 2-3 while LSIL is not associated with cervical dysplasia of CIN 2-3. We do not recommend routine biopsies in patients with LSIL cytologic abnormalities unless additional compelling factors exist.

“A Pap smear saved my life”: Personal experiences of cervical abnormalities shape attitudes to cervical screening renewal

2019 ◽  
Vol 27 (4) ◽  
pp. 223-226 ◽  
Author(s):  
Helena M Obermair ◽  
Kirsten J McCaffery ◽  
Rachael H Dodd
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Screening Program ◽  
Cervical Screening ◽  
Personal History ◽  
Pap Smears ◽  
Increased Risk ◽  
Women's Lives ◽  
History Of ◽  
Screening Intervals

Objective In 2017, the Australian National Cervical Screening Program changed from two-yearly Pap smears between ages 18 and 69, to five-yearly human papillomavirus screening between ages 25 and 74 (the “Renewal”). This study investigated attitudes towards the changes, among individuals previously affected by cervical abnormalities/cervical cancer, personally or through a friend/relative. Methods We conducted a thematic analysis of comments expressing personal history or a family/friend history of cervical abnormalities/cervical cancer as a reason for opposing changes to the cervical screening program. The comments were taken from a 20% random sample of 19,633 comments posted on the “Change.org” petition “Stop May 1st Changes to Pap Smears – Save Women's Lives” in February–March 2017. Results There were 831 (20.8%) commenters who reported that they were concerned about a change in screening due to: feelings of increased personal vulnerability to cervical cancer due to their own personal history of cervical abnormalities; comparison of extended screening intervals and later age of first screening to their own experiences; and a perception of increased personal risk due to family history. Conclusion Women previously affected by cervical abnormalities or cervical cancer, personally or through a friend/relative, expressed concern about changes to cervical screening due to perceived increased risk and feeling vulnerable due to personal history.

scholarly journals Spectrum of cytological patterns in cervical PAP smears in a tertiary care center of Western region of Nepal

2019 ◽  
Vol 4 (1) ◽  
pp. 2-8
Author(s):  
Pragya Gautam Ghimire ◽  
Durga BC Rawat ◽  
Kavita Sinha ◽  
Kamar Jahan ◽  
Richa Shrestha
Keyword(s):  
Cervical Cancer ◽  
Epithelial Cell ◽  
Pap Smear ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Pap Smears ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion

Introduction: Cervical cancer is a common health problem in Nepal. There is paucity of data regarding the spectrum of findings in cervical Pap in western Nepal. This study was aimed to study the cytological patterns in cervical Pap smears in patients in a tertiary hospital of Nepal. Methods: This is a prospective, cross sectional, hospital based study. Clinical features of patients who had presented with Pap smear was noted in a structured proforma. Pap smears were studied by a senior pathologist and reported based on revised Bethesda system (2014). Results: Most of the cases belonged to 31-40 years 399 (42.8%). Unsatisfactory/ inadequate sample was present in 133(14.05%) with obscuration due to inflammatory exudate being most common cause. Negative for intraepithelial lesion or malignancy rate was noted in 798 (85.54%) with 477(51.2%) being normal findings. Epithelial cell abnormalities were noted in 116 (14.5 %) smears. Low-grade squamous intraepithelial lesion constituted 321(34.5%), High grade squamous intraepithelial lesion 273(29.3 %) and Atypical squamous cells of undetermined significance 153(16.4%) of epithelial cell abnormalities. Squamous cell carcinoma was present in 9(1%) of all reviewed smears. There was no statistical significance between the age and abnormalities of Pap smear (p=0.9). Conclusions: Pap smear is pivotal in cervical cancer screening in developing countries. It also identifies various inflammatory, infective, benign and malignant pathologies at the earliest thereby decreasing the morbidity and mortality.

Factors associated with regression of cervical dysplasia in adolescents: A retrospective study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5582-5582
Author(s):  
C. Chen ◽  
F. Campbell ◽  
J. Patruno ◽  
S. Kimmel ◽  
R. Boulay ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pap Smear ◽  
Demographic Data ◽  
Cervical Dysplasia ◽  
Smoking History ◽  
Pap Smears ◽  
Factors Associated ◽  
Increased Risk ◽  
Chi Square Analysis

5582 Background: Sexually active adolescents have high rates of infection with human papilloma virus (HPV) and abnormal pap smears. They are considered a special population as they are likely to regress to normal cytology. The aim of our study was to identify factors associated with regression of cervical dysplasia in adolescents. Methods: We identified adolescent patients (aged 12–21 years) who had abnormal pap smears at the Center for Women's Medicine at Lehigh Valley Hospital in Allentown, PA, by CPT code from a database between Jan 2004 and Dec 2006. A chart review was performed to capture demographic data, cytology, smoking history, number of sexual partners, parity, race, contraceptive choice, use of barrier contraception. Chi-square analysis with logistic regression and multivariate analysis were used to identify factors associated with regression of cervical dysplasia. Results: Two-hundred two patients were identified. Mean age was 18.84 years (14–22 years). One hundred twenty-two (57.8%) were Hispanic, 71 (33.6%) Caucasian, and 16 (7.6%) Black. Fifty-two (24.6%) were pregnant at the time of diagnosis. Seventy-six (36%) were smokers. There were 125 (61.9%) cases of ASCUS, 33.7% (68 cases) LGSIL and 4.5% (9 cases) HGSIL on initial pap smear. One hundred eighteen (55.9%) patients had colposcopy, and of these, 32 (15.2%) had surgical intervention. Follow-up demonstrated that 72 (57.6%) patients had disease regression, 24 (19.2%) persistence and 29 (23.2%) progression. On multivariate analysis, patients who did not smoke were significantly more likely to show regression of cervical dysplasia on pap smear than women who smoked (OR 2.17, 95% CI 1.03–4.55, p = 0.039). Other factors were not statistically significant in predicting regression of cervical dysplasia. Conclusions: Adolescents who smoke were more likely to have persistent cervical dysplasia than non-smoking adolescents, putting smokers at an increased risk of advanced disease. We suggest that this subset have follow-up at shorter intervals and be enrolled in a smoking cessation program. No significant financial relationships to disclose.

Pap Hub: A system to improve compliance with pap smear screening guidelines in a large health care system.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 193-193
Author(s):  
Deanna Gek Koon Teoh ◽  
Lisa A. Fall ◽  
Erin A. Beitelspacher ◽  
Charles W. Lais
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Tracking System ◽  
Invasive Cervical Cancer ◽  
The United States ◽  
Pap Smears ◽  
Health Maintenance ◽  
Screening Guidelines ◽  
Pap Smear Screening

193 Background: Cervical cancer is the most prevalent gynecologic cancer worldwide, but is third in the U.S. due to pap smear screening. However, American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines are complex and frequently changed, resulting in guideline adherence as low as 33-44%. We describe a centralized pap smear tracking system (“pap hub”) and report preliminary results. Methods: On 1/1/13 we implemented the pap hub, routing all screening pap smear results to a dedicated OB/Gyn nursing staff with a new Epic workbench. Epic Health Maintenance Modifier updated to recommend pap smears for women age 21-65 years (not younger or older per guidelines). Screening Pap/HPV results auto routed to Pap Pool Epic inbasket (not to individual providers). Centralized nurse reviews results alongside past pap results on Pathology flowsheet in Epic If normal Normal history -> appropriate follow-up interval per screening guidelines If abnormal history -> repeat pap as determined by previous history and treatment If abnormal -> manage per ASCCP guidelines Document plan in Epic Result Note Update Epic problems list If Normal: document “Pap Hub Normal History” If Abnormal: document “Pap Hub Abnormal History” with specifics in Overview History Communicate results/plan to the patient. Update Health Maintenance Modifier with next step. Review abnormal results to ensure proper follow-up, with reminders as indicated. Results: Guideline recommendations against pap smears for patients <21 years and >65 years have not changed since 2009. Comparison of first-quarter data for 2010 (pre-Pap Hub) to 2013 (post-Pap Hub) have shown a 63.86% reduction in pap smears in women <21 years. Pap smears in women >65 years has always been low, but has decreased slightly from 2.4% of all pap smears in 2010 to 1.5% of all pap smears in 2013. The 2012 ASCCP guidelines have changed recommended pap smear frequency and abnormal pap smear follow-up, and compliance with these new recommendations is being collected. Conclusions: Pap smear screening has decreased the incidence of invasive cervical cancer in the United States. The Pap Hub, a centralized pap smear tracking system, improves compliance with pap smear screening guidelines.

scholarly journals Vasectomy and Risk of Aggressive Prostate Cancer: A 24-Year Follow-Up Study

2014 ◽  
Vol 32 (27) ◽  
pp. 3033-3038 ◽  
Author(s):  
Mohummad Minhaj Siddiqui ◽  
Kathryn M. Wilson ◽  
Mara M. Epstein ◽  
Jennifer R. Rider ◽  
Neil E. Martin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Specific Antigen ◽  
Prostate Cancer Risk ◽  
The United States ◽  
Low Grade ◽  
High Grade ◽  
Follow Up Study ◽  
Increased Risk

Purpose Conflicting reports remain regarding the association between vasectomy, a common form of male contraception in the United States, and prostate cancer risk. We examined prospectively this association with extended follow-up and an emphasis on advanced and lethal disease. Patients and Methods Among 49,405 US men in the Health Professionals Follow-Up Study, age 40 to 75 years at baseline in 1986, 6,023 patients with prostate cancer were diagnosed during the follow-up to 2010, including 811 lethal cases. In total, 12,321 men (25%) had vasectomies. We used Cox proportional hazards models to estimate the relative risk (RR) and 95% CIs of total, advanced, high-grade, and lethal disease, with adjustment for a variety of possible confounders. Results Vasectomy was associated with a small increased risk of prostate cancer overall (RR, 1.10; 95% CI, 1.04 to 1.17). Risk was elevated for high-grade (Gleason score 8 to 10; RR, 1.22; 95% CI, 1.03 to 1.45) and lethal disease (death or distant metastasis; RR, 1.19; 95% CI, 1.00 to 1.43). Among a subcohort of men receiving regular prostate-specific antigen screening, the association with lethal cancer was stronger (RR, 1.56; 95% CI, 1.03 to 2.36). Vasectomy was not associated with the risk of low-grade or localized disease. Additional analyses suggested that the associations were not driven by differences in sex hormone levels, sexually transmitted infections, or cancer treatment. Conclusion Our data support the hypothesis that vasectomy is associated with a modest increased incidence of lethal prostate cancer. The results do not appear to be due to detection bias, and confounding by infections or cancer treatment is unlikely.

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