Self-sampling is a method by which the subject collects the own specimens for disease detection. It has the advantages of strong privacy, convenient and simple operation, free time and place, etc. It can improve the compliance of people in remote areas, affected by traditional concepts, limited by working hours and underdeveloped transportation and medical treatment to participate in disease detection and screening. With the development of "Internet+health care" and "Internet+nursing service", home-based self-sampling testing will become a developing situation for disease detection and screening. Human immunodeficiency virus and Human papillomavirus infection bring a heavy burden to individuals and society. In the absence of effective and widespread primary prevention, secondary prevention, namely "early detection, early diagnosis and early treatment" is an effective measure to control the adverse consequences. At present, there are many researches on HPV and HIV self-sampling test, whose test results are highly reliable and highly accepted in the population, and is of great significance for improving the coverage rate of cervical cancer screening and the diagnosis rate of HIV carriers.
Female ; Humans ; Papillomaviridae ; Early Detection of Cancer/methods* ; Uterine Cervical Neoplasms/prevention & control* ; Alphapapillomavirus ; Self Care/methods* ; Papillomavirus Infections/prevention & control* ; Specimen Handling/methods* ; Mass Screening/methods* ; HIV Infections/diagnosis* ; HIV ; Vaginal Smears/methods*

OBJECTIVE: Human papillomaviruses (HPVs) are among the agents responsible for infection and cancer of the skin and mucous membranes in the human body. The aim of this study was to investigate the frequency and type distribution of HPVs in married female patients with gynecological complaints, who had visited the Maternity Hospital in Erzurum, Turkey. METHODS: In this study, 263 cervical swab samples were taken from married women using the Pap smear method and were investigated for positive reactivity against HPV. The L1 gene region of HPV was investigated using molecular methods. For this purpose, polymerase chain reaction (PCR) assays and sequence analysis of positive samples were performed. Phylogenetic analyses were performed using a bioinformatics approach after sequencing. RESULTS: HPV-DNA was detected in 17 (6.5%) samples. Highest positive reactivity to HPV-DNA was found in the 35–44 age group at 9.2%. Fourteen out of seventeen positive samples were included in the phylogenetic analysis. All isolates clustered in the Alphapapillomavirus genus. Six samples were found to be HPV 70 positive, four were HPV 16 positive, and the rest were HPV 54, 72, 81, and 114 positive. When genotyping data were evaluated according to the risk group, we found that 28.6% of the 14 samples were found to be high risk-HPV, and 71.4% were low risk-HPV. CONCLUSIONS: As per our knowledge, this is the first report on the phylogenetic analysis of HPV genotypes isolated from women in Turkey. The prevalence of low- and-high risk HPV was determined in married women in Erzurum, and these results contribute to the epidemiological data on the distribution of HPV types for this region.
Alphapapillomavirus ; Computational Biology ; Female ; Genotype ; Hospitals, Maternity ; Human Body ; Human papillomavirus 16 ; Humans ; Methods ; Mucous Membrane ; Papanicolaou Test ; Papillomavirus Infections ; Polymerase Chain Reaction ; Prevalence ; Sequence Analysis ; Skin Neoplasms ; Turkey ; Vaginal Smears

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).
Adult ; Age Factors ; Aged ; Early Detection of Cancer/adverse effects/*methods/standards ; Evidence-Based Medicine ; False Positive Reactions ; Female ; Humans ; Hysterectomy ; Middle Aged ; Papillomavirus Infections/diagnosis ; Papillomavirus Vaccines ; Patient Selection ; Pregnancy ; Pregnancy Complications, Neoplastic/diagnosis ; Republic of Korea ; Review Literature as Topic ; Uterine Cervical Neoplasms/*diagnosis ; Vaginal Smears/adverse effects/methods/standards ; Young Adult

Female ; Greece ; History, 20th Century ; Humans ; Papanicolaou Test ; history ; Philately ; United States ; Uterine Cervical Neoplasms ; diagnosis ; Vaginal Smears ; methods

OBJECTIVETo evaluate the performance of computer-assisted imaging system in the detection of cervical squamous intraepithelial lesion and quality-assurance.

METHODSManual PAP screening (n = 140 580) and image-assisted screening (n = 32 885) were compared for the detection rates of squamous cell abnormalities, the atypical squamous cells (ASC) to squamous intraepithelial lesion (SIL) ratio, the positive rates of high risk human papillomavirus (HR-HPV) test in the case of atypical squamous cells of undetermined significance (ASC-US), and the correlation between cytopathology and histopathology.

RESULTSCompared with manual screening, computer-assisted imaging system showed increased overall positive detection by 0.32%, decreased detection of ASC by 0.21%, increased detection of low-grade squamous intraepithelial lesion (LSIL) by 0.22%, increased detection of high-grade squamous intraepithelial lesion or worse (HSIL) by 0.31%, and decreased ASC to SIL ratio from 2.59 to 1.60. Computer-assisted imaging system did not change the HR-HPV positive rate of the patients who were ASC-US, or the coincidence rate between cytopathology and histopathology. Moreover, the productivity of the laboratory operation increased 58.33%.

CONCLUSIONComputer-assisted imaging system significantly increases the overall positive detection rate of cervical SIL, improves accuracy and work efficiency of screening, decreases the ASC/SIL rate, and strengths the quality-assurance of laboratory testing.

Carcinoma, Squamous Cell ; pathology ; Cervical Intraepithelial Neoplasia ; pathology ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Papillomaviridae ; isolation & purification ; Papillomavirus Infections ; pathology ; Uterine Cervical Dysplasia ; pathology ; Uterine Cervical Neoplasms ; pathology ; Vaginal Smears ; methods

OBJECTIVETo evaluate the clinical performance of careHPV16/18/45 DNA testing of cervical specimens as a triage testing for women with positive findings during the cervical cancer screening.

METHODSEligible women aged 25-65 years were enrolled from two high-risk communities in Yangcheng County,Shanxi Province.After providing written informed consent on a voluntary base,women underwent questionnaire-based interview,gynecological examination,and sample collection.Hybrid capture 2 technology(HC2),careHPV,Avantage HPV E6 test,and visual inspection with acetic acid(VIA)were conducted as the primary screening tests at the enrollment visit.Women with any positive finding were invited to receive a second VIA and colposcopy.careHPV16/18/45 was performed as a triage testing.Any visible lesion under colposcopy was directly biopsied.Women with pathology confirmed cervical intraepithelial neoplasia grade 2 and worse(CIN2+)were treated with standard procedures.

RESULTSFor the self-collected and doctor-collected samples,the application of careHPV16/18/45 as a triage testing decreased the colposcopy referral to 3.2% and 3.1%,respectively.Meanwhile,the sensitivity,specificity,and positive predictive value(PPV)for CIN2+were 50.0%,97.6%,and 26.7% for women with positive self-sampling careHPV results and 63.0%,97.9%,and 34.0% for women with positive doctor-sampling careHPV results.

CONCLUSIONcareHPV16/18/45 is promising as a triage testing among women with positive screening findings in low-resource settings.

Adult ; Aged ; Colposcopy ; DNA, Viral ; analysis ; Early Detection of Cancer ; methods ; Female ; Human papillomavirus 16 ; genetics ; isolation & purification ; Human papillomavirus 18 ; genetics ; isolation & purification ; Humans ; Mass Screening ; methods ; Middle Aged ; Uterine Cervical Neoplasms ; diagnosis ; virology ; Vaginal Smears

INTRODUCTIONCervical cancer is the third most common cancer among Malaysian women. However, the uptake of cervical cancer screening--Pap smear--by women in Malaysia has been low and remains a challenge. This study was conducted to assess the cervical screening practices of rural women in Malaysia and to examine the factors associated with such practices.

METHODSA cross-sectional survey was conducted in five rural districts in Perak, Malaysia. 1,000 households were selected through multistage random sampling. Women aged 20-64 years were interviewed by trained enumerators using structured questionnaires. Binomial logistic regression was used to identify predictors of cervical screening through univariate and multivariate analyses.

RESULTSAmong the 959 respondents, only 48.9% had undergone Pap smear at least once in the past three years. Women in the age group 40-49 years (odds ratio 3.027, 95% confidence interval 1.546-5.925; p < 0.005) were found to be significantly more likely to attend cervical cancer screening as compared to those in the age group 20-29 years. Other significant predictors were being married with children, having knowledge of cervical cancer symptoms, receiving relevant information regarding cervical cancer from health personnel or campaigns, being engaged in family planning and receiving encouragement from husbands.

CONCLUSIONEfforts to boost the uptake of Pap smear screening among the rural population should be targeted toward the predictors of positive uptake.

Adult ; Cross-Sectional Studies ; Early Detection of Cancer ; statistics & numerical data ; Female ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Malaysia ; Mass Screening ; methods ; Middle Aged ; Papanicolaou Test ; utilization ; Patient Acceptance of Health Care ; statistics & numerical data ; Risk Factors ; Rural Population ; Social Class ; Uterine Cervical Neoplasms ; diagnosis ; epidemiology ; Vaginal Smears ; utilization ; Young Adult

INTRODUCTIONA retrospective observational study was performed to evaluate the effectiveness of CervicalScreen Singapore (CSS), a National Cervical Cancer Screening Programme.

METHODSNational trends on incidence, mortality of cervical cancer and carcinoma in situ of the cervix before and after the launch of CSS were examined. Linear regression was used to calculate the average annual percentage change in age-standardised incidence and mortality rates. We also examined the operational measures of CSS, such as the women who joined the CSS programme and the diagnostic accuracy of Pap smears. The study was confined to women who consented to join CSS at government-funded polyclinics.

RESULTSNationally, there was a greater decline in the age-standardised incidence and mortality rates in the period 2004-2008 as compared to the period 1987-2003. Under CSS, a total of 99,759 Pap smears were performed on 81,087 women in the period 2004-2008. However, the number of first screens decreased from 18,434 in 2004 to 11,624 in 2008. Among women aged 25-69 years who had their first Pap smear screening and who were recommended for routine rescreen in three years, 10% had a subsequent rescreen within three years. Overall, the CSS programme was able to detect 0.37 invasive cancers per 1,000 screens in women aged 25-69 years.

CONCLUSIONThe CSS programme has contributed to a decline in the mortality and incidence of cervical cancer in Singapore. However, the challenges of increasing the screening uptake among eligible women need to be addressed.

Adult ; Age Factors ; Aged ; Early Detection of Cancer ; methods ; Female ; Humans ; Incidence ; Mass Screening ; methods ; Middle Aged ; Papanicolaou Test ; Registries ; Retrospective Studies ; Singapore ; Uterine Cervical Neoplasms ; diagnosis ; epidemiology ; prevention & control ; Vaginal Smears

OBJECTIVETo explore the appropriate strategies which are suitable for the areas with diverse health and economic resource settings in China by estimating the life outcomes and cost-effectiveness of several cervical cancer screening strategies.

METHODSMarkov model was used to calculate the long-term effectiveness, utility, benefit and cost among screened and unscreened cohorts in rural and urban areas, and then analyses of cost-effectiveness, cost-utility and cost-benefit were performed. The assessed screening strategies were acetic acid of visual inspection combined with Lugol's iodine staining (VIA/VILI), conventional Pap smear and simple HPV DNA testing (careHPV) in rural areas, and conventional Pap smear, simple HPV DNA testing (careHPV), HPV DNA testing (HC2) and liquid-based cytology (LBC) alone or combined with HPV DNA testing (LBC+HC2) in urban areas. We estimated the life outcomes and cost-effectiveness of the above screening strategies at one-year, 3-year and 5-year intervals.

RESULTSAll of the screening strategies were effective to decrease cervical cancer mortality and to increase life years, with a trend of shorter screening interval having better effectiveness. However, no matter in urban or rural areas, compared with careHPV testing at 5-year interval, the costs of other screening strategies were 1.28 - 13.86 folds, 1.31 - 14.14 folds, and 1.27 - 12.80 folds higher to avoid one death, to save a year of life, and a QALY, and the benefit per cost of other screening strategies was 9.9%-90.2%.

CONCLUSIONScareHPV testing at 5-year interval has the best cost-effectiveness performance and the highest benefit-cost ratio with the moderate life outcomes. It is the optimal cervical cancer screening strategy to be generalized in our country. careHPV testing at 3 years interval can be considered in more developed areas to achieve better effectiveness.

Acetic Acid ; Adult ; Cervical Intraepithelial Neoplasia ; diagnosis ; economics ; epidemiology ; virology ; China ; epidemiology ; Cost-Benefit Analysis ; Cytological Techniques ; DNA, Viral ; analysis ; Early Detection of Cancer ; economics ; methods ; Female ; Human Papillomavirus DNA Tests ; Humans ; Iodides ; Markov Chains ; Mass Screening ; economics ; methods ; Middle Aged ; Models, Biological ; Models, Statistical ; Papanicolaou Test ; Quality-Adjusted Life Years ; Rural Population ; Urban Population ; Uterine Cervical Neoplasms ; diagnosis ; economics ; epidemiology ; virology ; Vaginal Smears

BACKGROUNDThe management of atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesions (ASCUS/LSIL) is still controversial and it is advisable to make a triage for these two cytological abnormalities. P16(INK4) (P16) has been shown to be a potential biomarker for predicting high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer. The aim of the study was to determine the value of P16 expression by immunostaining method compared with high-risk human papillomavirus (HR-HPV) DNA test in the triage of ASCUS/LSIL women.

METHODSTotally 86 eligible residual liquid-based cytological specimens with ASCUS and 45 with LSIL were obtained. All specimens were submitted to HR-HPV DNA test (HC2) and P16 immunocytochemical staining simultaneously. And all women underwent colposcopy and biopsy after cytology.

RESULTSThe positive rate of P16 staining was 32.6% in ASCUS and 42.2% in LSIL, which was significantly lower than that of HR-HPV test in both ASCUS (P < 0.05) and LSIL (P < 0.05). Moreover, the positive rate of P16 staining was 12.7% in normal histology, 61.5% in CIN 1, 87.0% in CIN 2-3, and 100.0% in cancer, in which P16 positive rate was significantly lower than HR-HPV positive rate in normal group. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of P16 staining for predicting CIN 2 or more were 87.5%, 68.6%, 38.9%, 96.0%, and 72.1%, respectively in the ASCUS; while 90.0%, 71.4%, 47.4%, 96.2% and 54.7%, respectively in the LSIL, in which the specificity and accuracy of P16 staining were significantly higher than those of HR-HPV test in both ASCUS and LSIL (P < 0.05).

CONCLUSIONP16 immunostaining had significantly higher specificity and accuracy than HR-HPV DNA test for predicting for high-grade CIN and cervical cancer in ASCUS and LSIL and can be used for the triage of women with ASCUS/LSIL cytological abnormality.

Adult ; Aged ; Cervical Intraepithelial Neoplasia ; diagnosis ; metabolism ; Cyclin-Dependent Kinase Inhibitor p16 ; metabolism ; DNA, Viral ; genetics ; Female ; Humans ; Immunohistochemistry ; Middle Aged ; Papillomavirus Infections ; diagnosis ; virology ; Triage ; methods ; Uterine Cervical Neoplasms ; diagnosis ; metabolism ; Vaginal Smears ; Young Adult