Cervical cancer is the seventh most common cancer among women in Iraq. This study aimed to assess the factors influencing Pap smear practice among married primary school teachers in Diyala City, Iraq. A total of 222 teachers (aged 20 years to 63 years) residing in Diyala City were enrolled in a cross sectional study from 1st August till 30th September 2012. The sampling method was a self-administered survey using a multistage sampling technique. The prevalence of Pap smear practice was very low (12.6%). Relatives and friends were the main source of information about the Pap smear test for more than one third (41.9%) of the respondents. However, the medical doctor’s advice was the most important reason for undergoing a Pap smear test in more than two third (60.7%) of respondents. Only 32.4% of the teachers have good knowledge about cervical cancer and Pap smear test, but 76.1% of them showed a positive attitude toward learning about cervical cancer and Pap smear. Based on multiple logistic regression analysis results only the husband’s encouragement (p= 0.003, prevalence odds ratio [POR] = 0.256, 95%CI 0.10-0.63) was significantly associated with Pap smear practice. A more effective educational program is needed to educate Iraqi women about cervical cancer and screening tests, including Pap smear.
Papanicolaou Test

No abstract available.
Mass Screening* ; Papanicolaou Test* ; Uterine Cervical Neoplasms*

No abstract available.
Mass Screening* ; Papanicolaou Test* ; Uterine Cervical Neoplasms*

"To evaluate whether different qualifications of a cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS) predict a greater or lesser likelihood of tissue diagnosis of uterine cervix, we compared different cytologic qualifications of ASCUS with the tissue diagnosis. One hundred twenty-two con- secutive Papanicolaou smears showing ASCUS in women who had undergone cervical biopsy within nearest 30 days were collected. The 122 smears were qualified as ""favor reactive (25%), favor low grade squamous intraepithelial lesion (LSIL) (24%), favor squamous intraepithelial lesion (SIL) (16%), favor high grade squa- mous intraepithelial lesion (HSIL) (16%), and not otherwise specified (19%). Squamous intraepithelial or invasive lesion was pathologically confirmed by cervical biopsy in 13% of the favor reactive, 27% in favor LSIL, 70% in ""favor SIL, 75% in favor HSIL, and 35% in not otherwise specified smears. There were significant associations between the favor reactive smear and the benign biopsy finding and between the favor SIL smear and the biopsy showing a squamous intraepithelial or more severe lesion. Nevertheless, rnost of favor LSIL smears exhibit reactive process in tissue biopsy. Conclusively, qualified ASCUS stratifies women into different risk groups for SIL. The cytopathologist should make the cytologic diagnosis of ASCUS, favor LSIL circumspectly."
Biopsy ; Cervix Uteri ; Diagnosis ; Female ; Humans ; Papanicolaou Test ; Venous Thrombosis*

OBJECTIVE: To evaluate the efficacy of loop electrosurgical excision procedure (LEEP) combined with cold coagulation for treating cervical intraepithelial neoplasia (CIN). METHODS: We reviewed clinic-pathologic data of 498 patients treated with LEEP alone (n=354), and LEEP combined with cold coagulation (n=144) between January 2000 and December 2011. After LEEP, we followed up all patients by using Papanicolaou smear and human papillomavirus (HPV) test, and evaluated abnormal cervical cytology-free interval and high-risk HPV infection-free interval. Moreover, we investigated independent factors affecting abnormal cervical cytology or high-risk HPV infection after LEEP. RESULTS: Abnormal cervical cytology-free interval was longer in patients treated with LEEP combined with cold coagulation than in those treated with LEEP alone (mean, 92.4 vs. 84.4 months; P=0.01), and patients treated with LEEP combined with cold coagulation also showed longer high-risk HPV infection-free interval than those treated with LEEP alone (mean, 87.6 vs. 59.1 months; P=0.01). Moreover, CIN 3 and cold coagulation were factors affecting abnormal cervical cytology after LEEP (adjusted hazard ratios, 1.90 and 0.61; 95% confidence intervals, 1.27 to 2.84 and 0.39 to 0.96), and CIN 3, positive deep cervical margin and cold coagulation were also factors affecting high-risk HPV infection after LEEP (adjusted hazard ratios, 2.07, 4.11, and 0.64; 95% confidence intervals, 1.38 to 3.08, 1.63 to 10.39, and 0.43 to 0.96). When we performed subgroup analyses for patients with CIN 2 or CIN 3, the result were similar. CONCLUSION: LEEP combined with cold coagulation may be more effective for treating CIN than LEEP alone. Moreover, cold coagulation may decrease the risk of potential of recurrence after LEEP.
Cervical Intraepithelial Neoplasia* ; Cohort Studies* ; Humans ; Papanicolaou Test ; Recurrence

OBJECTIVE: This study aims to assess the knowledge and attitudes of female adolescents aged 14-19 years old seeking consult at Philippine Children's Medical Center regarding cervical cancer screening and HPV vaccine.

DESIGN: Cross-sectional survey of mid to late adolescents.

METHODOLOGY: The survey questionnaire consists of 18 items in the domain of knowledge, attitudes, practice behaviors, barriers and demographic information. Survey forms in a sealed envelope were given to adolescents 14 to 19 years old after obtaining their assent and parents/guardians' consent.

RESULTS: There were a total of 107 respondents; majority belonged to the mid adolescents (14-16 years old), high school level and non sexually active 57%, 64% and 62% respectively. Most of the respondents (60%) were in a relationship or had a boyfriend, 61% engaged in a monogamous sexual relationship with their partners, 10% had 2 partners and 15% had more than 3 partners. There were significantly more late adolescents who are sexually active compared to mid adolescents (67.4% and 14.8%). Awareness of cervical cancer screening is only 23% of the surveyed adolescents (mean age 16.36). Majority of the sexually active respondents knew that HPV infection is through vaginal intercourse, and that pap smear is necessary even if no history of cancer in the family. More respondents with high education knew that avoidance of sexual intercourse, using condom and vaccination are all effective methods of HPV infection prevention. 53% of the respondents heard about HPV vaccine. Sources of information were mostly from the mass media. Majority were willing to receive the vaccine especially if given for free.

CONCLUSION: Knowledge on HPV and Cervical cancer prevention especially through pap smear is poor. Health education and improvement of personal practices should be emphasized as necessary factors for preventing HPV infection acquisition.

This study was performed to compare manual liquid-based preparation with conventional Papanicolaou tests in view of the cytologic diagnoses and specimen adequacy. The specimens of 5,979 women from 33 local clinics and 1 general hospital were prepared by both manual liquid-based preparation and conventional Papanicolaou test. The cytologic diagnoses and specimen adequacy were evaluated in Department of Pathology in Kyoungpook National University School of Medicine. A conventional Papanicolaou test was always prepared first, after that residual material on the sampling device was rinsed into a liquid preservative, and then thin-layer slides were prepared using manual method of liquid-based cervicovaginal cytology. Conventional and liquid-based slides were read independently, and cytologic diagnoses and specimen adequacy were classified using the Bethesda System. Of the cases, 5,763(96.3%) had the same interpretation, and there was no significant diagnostic difference in 5,853(97.8%) cases. When evaluating cases with more than one diagnostic class difference, the manual liquid-based preparation demonstrated a statistically significant overall improvement(2.1%) in the detection of squamous intraepithelial lesion and invasive cancer. Using manual method of liquid- based preparation, there was 14.1% reduction in unsatisfactory slides through excellent cellular presentations. In conclusion, the manual liquid-based preparation produces standardized quality, superior sensitivity and improved adequacy as compared to the conventional method.
Diagnosis ; Female ; Hospitals, General ; Humans ; Papanicolaou Test* ; Pathology

To evaluate whether different qualifications of a cytologic diagnosis of "atypical squamous cells of undetermined significance(ASCUS)" predict a greater or lesser likelihood of tissue diagnosis of uterine cervix, we compared different cytologic qualifications of ASCUS with the tissue diagnosis. One hundred twenty-two con secutive Papanicolaou smears showing ASCUS in women who had undergone cervical biopsy within nearest 30 days were collected. The 122 smears were qualified as "favor reactive"(25%), "favor low grade squamous intraepithelial lesion (LSIL)"(24%), "favor squamous intraepithelial lesion(SIL)"(16%), "favor high grade squa mous intraepithelial lesion(HSIL)"(16%), and "not otherwise specified"(19%). Squamous intraepithelial or invasive lesion was pathologically confirmed by cervical biopsy in 13% of the "favor reactive", 27% in "favor LSIL", 70% in "favor SIL", 75% in "favor HSIL", and 35% in "not otherwise specified" smears. There were significant asso ciations between the favor reactive smear and the benign biopsy finding and between the favor SIL smear and the biopsy showing a squamous intraepithelial or more severe lesion. Nevertheless, most of favor LSIL smears exhibit reactive process in tissue biopsy. Conclusively, qualified ASCUS stratifies women into different risk groups for SIL. The cytopathologist should make the cytologic diagnosis of "ASCUS, favor LSIL" circumspectly.
Biopsy* ; Cervix Uteri ; Diagnosis* ; Female ; Humans ; Papanicolaou Test

The significance of cervical erosion with benign cellular change on Papanicolaou smear has not been evaluated. A retrospective review of 430 coloscopically directed punch biopsies performed over 15 months revealed 206 cases who had a benign cellular change on cytologic smear. Of these 206 smears, 48(23%) had clear cervix without erosion, 99(48%) had mild erosion on cervix, 41(20%) had moderate cervical erosion and 18(9%) had severe cervical erosion. The false negative rate that revealed more than mild dysplasia on histologic diagnosis was 2% in patients without cervical erosion, 3% in patients with mild cervical erosion, 5 % in patients with moderate cervical erosion, and 11% in patients with severe cervical er- osion. Koilocytotic change that suggested human papilloma virus infection was 17% in each group regardless cervical erosion. In conclusion, benign cellular change on Pap smears in patients with severe cervical erosion may be associated with significant cervical cancer pathology.
Biopsy ; Cervix Uteri ; Diagnosis ; Female ; Humans ; Papanicolaou Test* ; Papilloma ; Pathology ; Retrospective Studies ; Uterine Cervical Neoplasms

OBJECTIVE: This study was performed to evaluate the clinical efficacy of high risk HPV DNA test using PCR for the detection of high-grade CIN or invasive cancer from patients with ASCUS or LSIL on Papanicolaou smear. METHODS: Sixty one patients with a Papanicolaou smear report of atypical squamous cells of undetermined significance or a low-grade squamous intraepithelial lesion underwent Cervical colposcopy and directed cervical biopsy and human papillomavirus test by PCR. We compared the detection rate of the high grade CIN and invasive cancer by Papanicolaou smear method only with that of both Papanicolaou smear and HPV PCR method. and we decided to be significant when P value was below 0.05 by SAS (v 6.02) program. RESULTS: The detection rate of high risk HPV DNA was 50.8% (31/61). The detection rate of high risk HPV DNA in high grade CIN and invasive cancer was 84.2% (16/19). Higher the grade of biopsy, more the detection rate of high risk HPV DNA. False negative rate which appeared high grade CIN or invasive cancer by biopsy was 31.2% (19/61) in Papanicolaou smear method only and 4.9% (3/61) in both Papanicolaou smear and HPV DNA method. CONCLUSION: We thought that additional HPV DNA test was useful to dectect behind high grade CIN or invasive cancer when the Papanicolaou smear result was ASCUS or LSIL.
Biopsy ; Colposcopy ; Diagnosis* ; DNA ; Human Papillomavirus DNA Tests* ; Humans ; Papanicolaou Test ; Polymerase Chain Reaction