Socio-economic Determinants Influencing Cervical Cancer Screening in Buea: A Cross-Sectional Study

Introduction: Cervical cancer remains a huge burden in scarce resource communities as Cameroon. The morbidity and mortality are huge, despite the preventable nature of this pathology.This study set to explorethe socio-economic variables which could help influence positively presentation for screening and lessen the pressure on our fragile heath system.Methodology: A one-day free screening campaign was carried out at the Buea regional hospital on the 2ndof November, 2019. The study population consisted of women aged 16 to 66 years old. After thorough explanation of the exercise to the potential participants to this study, a questionnaire was distributed to them. Assurance was given about the confidentiality of this study, and they were also informed that, they could opt out at any moment, if they so wish.Results:Some of the socio-economic variables influencing presentation for cervical cancer screening were identified and they seem to modulate individual behaviour towards cervical cancer screening. They were namely: age, level of education, residence, marital status, age at first sexual intercourse, number of sexual partners, number of pregnancies and number of deliveries.Conclusion:The key contributors influencing presentation at screening in this study were: age, level of education, residence, age at first sexual intercourse, number of sexual partners, number of pregnancies and number of deliveries. Understanding and acting on these variables could help curb down morbidity and mortality, thus alleviating the burden on our fragile heath system

Significados atribuídos à vacinação contra o HPV por responsáveis legais de meninas / Meanings attributed to HPV vaccination by girls legal guardians

Trata-se de pesquisa descritiva e qualitativa, cujo objetivo foi descrever os significados atribuídos à vacinação contra HPV por responsáveis legais de meninas, a partir do processo de interação social no contexto do câncer do colo do útero. Realizada em locais próximos a escolas, ruas, praças, residências, no período entre maio e julho de 2018. Foram entrevistadas 10 responsáveis legais de meninas. Foram atendidas as exigências do Conselho Nacional de Saúde e o projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade do Estado do Rio de Janeiro sob o n.º 2.449.934. A análise foi baseada nos pressupostos da Grounded Theory, por oferecer elementos para a discussão dos dados de modo comparativo constante dos resultados, e do interacionismo simbólico, que possibilita que a pesquisa qualitativa atinja o objetivo de pesquisar o sentido que os indivíduos propõem aos objetos, pessoas e símbolos com os quais interagem no meio social. Emergiram cinco categorias: Categoria 1 Aderindo à vacinação contra HPV, Categoria 2 Sentindo preocupação e medo em relação a comentários sobre reações adversas pela vacina contra HPV, Categoria 3 Considerando escassas as informações veiculadas sobre a vacinação contra HPV, Categoria 4 Preferindo vacinar por conhecer a gravidade da doença, e Categoria 5 - Escolhendo esperar a criança amadurecer para tratar de assuntos relacionados ao sexo, assim como, optar pela vacinação contra HPV. Evidenciou-se que a vacinação contra HPV causa preocupações e inseguranças nas pessoas por a considerarem uma vacina recente, o que gera muita especulação social, contribuindo para veiculação de boatos. Observou-se também a carência de informações que os responsáveis legais de meninas alegam ter acerca da vacinação no contexto do câncer uterino, trazendo à tona diversas solicitações de mais informação sobre o tema. Trata-se de um assunto delicado, pois se refere a prevenção de uma doença sexualmente transmissível em crianças e adolescentes, o que é tabu para alguns responsáveis legais. Evidenciou se maior dificuldade de articulação do diálogo e de adesão na idade de 9 anos, pois os responsáveis legais consideram suas crianças muito jovens para tratar assuntos inerentes ao sexo. Por outro lado, muitos responsáveis legais mantiveram a decisão de vacinar suas filhas, referindo satisfação da implementação da campanha pelo Ministério da Saúde.

This is a descriptive and qualitative research, whose objective was to describe the meanings attributed to HPV vaccination by legal guardians of girls, from the process of social interaction in the context of cervical cancer. Held in places close to schools, streets, squares, residences, in the period between May and July 2018. Ten legal guardians of girls were interviewed. The requirements of the National Health Council were met, and the project was approved by the Research Ethics Committee of the State University of Rio de Janeiro under Number 2,449,934. The analysis was based on the Grounded Theory assumptions, as it offers elements for the discussion of data in a constant comparative way of results, and symbolic interactionism, which enables qualitative research to reach the objective of researching the sense that individuals propose to objects, people and symbols with which they interact in the social environment. Five categories emerged: Category 1 adhering to HPV vaccination, Category 2 feeling concern and fear in relation to comments on adverse reactions by HPV vaccine, Category 3 Considering scarce the information conveed about the Vaccination against HPV, category 4 preferring to vaccinate for knowing the severity of the disease, and category 5-choosing to wait for the child to mature to deal with sex-related subjects, as well as , opt for HPV vaccination. It was evidenced that vaccination against HPV causes concerns and insecurities in people because they consider it a recent vaccine, which generates a lot of social speculation, contributing to the dissemination of rumors. It was also observed the lack of information that legal guardians of girls claim to have about vaccination in the context of uterine cancer, bringing to the fore several requests for more information on the subject. This is a delicate matter, as it refers to the prevention of a sexually transmitted disease in children and adolescents, which is taboo for some legal guardians. It was evidenced that greater difficulty in articulating dialogue and adherence at the age of 9 years, because legal guardians consider their children to be very young to treat issues inherent to sex. On the other hand, many legal guardians maintained the decision to vaccinate their daughters, referring to the satisfaction of the implementation of the campaign by the Ministry of Health

Depresión y calidad de vida en mujeres con cáncer de cérvix del Hospital Regional de Encarnación / Depression and quality of life in women with cervical cancer at the Regional Hospital of Encarnación

Introducción: la depresión a consecuencia del cáncer de cérvix es un tema poco investigado a pesar de la relevancia que posee. Objetivo: determinar la calidad de vida y el grado de depresión en estas pacientes con cáncer de cérvix que acuden al Hospital Regional de Encarnación en periodo 2012-2015. Materiales y Métodos: estudio observacional descriptivo con componente analítico. Fueron seleccionadas 58 pacientes que cumplieron los criterios de inclusión. La calidad de vida se medió con la escala de Mezzich y Cohen y la depresión con el inventario de Beck. Resultados: 46% presentó altibajos normales del estado de ánimo, 5% depresión severa y 12% depresión moderada. En cuanto a la calidad de vida, 79% conservó un nivel de vida alto. La edad mayor a 47 años y no recibir tratamiento oncológico influyeron en un descenso de la calidad de vida de las pacientes. La edad promedio de las pacientes con depresión fue 51 años y en su mayoría agravada por la etapa del climaterio y menopausia. Conclusión: la calidad se vio afectada en 21% y la depresión severa se constató en 5%.

Introduction: depressive symptoms as a consequence of cervical cancer is a subject which has not been researched, enough despite its relevance. Objective: to determine the quality of life and degree of depression in patients with cervical cancer attended to Regional Hospital of Encarnación in the period of 2012-2015. Materials and methods: Prospective and cross-sectional observational study. A total of 58 patients were selected who met the inclusion criteria. Quality of life was measured with the Mezzich and Cohen scale, and depression with Beck's questionnaire. Results: 46% presented normal variabilities of mood, 5% severe depression and 12% moderate depression. In terms of quality of life, 79% kept a high standard of life. Age over 47 years and not receiving cancer treatment had a decrease in patients quality of life. The average age of patients with depression was 51 years and mostly worsen by climacteric and menopause stage. Conclusion: quality was affected in 21% and severe depression was found in 5%.

Adenocarcinoma de células glassy de colo de útero em paciente jovem com HPV: relato de caso / Glassy cells adenocarcinoma of the uterine cervix in young patient with HPV: case report

Introdução: o câncer de colo uterino é a segunda neoplasia mais comum em mulheres no mundo e a terceira entre a população feminina brasileira. O HPV desempenha um importante papel no desenvolvimento de neoplasias cervicais, estando presente em 95% dos casos de câncer de colo de útero. O carcinoma de células glassy é um carcinoma adenoescamoso misto pouco diferenciado, raro, de comportamento agressivo e altamente resistente à radioterapia. Atinge tipicamente mulheres jovens, com pico de incidência entre a 3a e a 4a década de vida. Está associado aos tipos 16 e 18 de HPV e sua evolução é aceleradana gravidez. O tempo médio de sobrevida após o diagnóstico é de 10 meses. Relato de caso: mulher, 26 anos, multípara, com história prévia de condiloma acuminado, apresentou lesões genitais que agravaram em sua última gestação, tendo evoluído com massas exofíticas diagnosticadas como carcinoma de células glassy, com curso agressivo e metástases precoces, não responsivo à radioterapia e progressão ao óbito em 16 meses. Conclusão: o carcinoma de células glassy destaca-se pela agressividade e rapidez de seu desenvolvimento, levando ao óbito mulheres jovens, em idade fértil e produtiva. Diante da sua baixa resposta às terapias antineoplásicas, destaca-se a importância de sua prevenção, seu diagnóstico e tratamento precoces, possíveis mediante o usode preservativos, da vacina contra o HPV e do exame colpocitológico regular, com coleta de material endocervical e acompanhamento eficaz.

Introduction: cervical cancer is the second most common cancer in women worldwide and the third among the female population in Brazil. HPV plays an important role in the development of cervical cancer, being present in 95% of cases of cancer of the cervix. Glassy cells carcinoma is a poorly differentiated mixed adenosquamous carcinoma, rare, aggressive and highly resistant to radiotherapy. It typically affects young women, with peak incidence between the third and fourth decades of life. It is associated with types 16 and 18 of HPV and its evolution is acelerated during pregnancy. The average survival time after diagnosis is 10 months.Case Report: woman, 26 years old, multiparous, with a history of condyloma acuminata, genital lesions that had increased in their last pregnancy, having evolved with exophytic masses diagnosed as glassy cell carcinoma, and aggressive course with early metastases not responsive to radiation therapy and progression to death in 16 months. Conclusion: glassy cells carcinoma is distinguished by aggressiveness and speed of its development, leading child-bearing age and productive young women to death. In view of its low response to anticancer therapies, we highlight the importance of its prevention, early diagnosis and treatment, possible through the use of condoms, the vaccine against HPV and cervical cytology at regular collection of endocervical material and effective monitoring.

Epidemiología de la infección cervical por virus Papiloma humano en Ushuaia: Argentina / Cervical infection epidemiology of human papillomavirus in Ushuaia: Argentina

El virus Papiloma humano (HPV) es un factor necesario para el desarrollo del cáncer cervical. El objetivo del estudio fue conocer la epidemiología de dicha infección en Ushuaia, Provincia de Tierra del Fuego, Argentina. Se realizó un estudio de caso-control de 132 cepillados endocervicales. La detección y tipificación del genoma viral fue realizada por la reacción en cadena de la polimerasa, con posterior análisis de polimorfismos de fragmentos de restricción o hibridación. La prevalencia general de la infección fue 41%, correspondiendo 26% a los controles y 71% a los casos. El grupo etario con mayor prevalencia de HPV fue el de 14 a 24 años. Los tipos virales más frecuentes en la población infectada fueron HPV16 (23%), HPV18 (11%) y HPV33/35 (8% cada uno), resultando infectados con tipos virales de alto riesgo el 30% de las muestras, 16% de los controles y 60% de los casos. El trabajo aporta los primeros datos sobre los tipos virales predominantes en Ushuaia. Los resultados demostraron una prevalencia menor que en regiones con alta incidencia de cáncer cervical, siendo el HPV16 el más frecuente. La información obtenida permitiría estimar la efectividad de las vacunas en vías de aprobación, en la población estudiada.

Genital infection with human papillomavirus (HPV) is decisive in the causation of cervical cancer. In order to evaluate the epidemiology of HPV infection in Ushuaia, Province of Tierra del Fuego, Argentina, 132 endocervical cytobrushes from preneoplastic and neoplastic cases and controls were studied. Detection and typing of the viral genome was performed by polymerase chain reaction, combined with a restriction fragment length polymorphism assay or hybridization. The overall prevalence of HPV infection was 41% in the population examined, with a frequency of 26% in the controls and 71% in the cases under study. The 14-24 age group showed the highest HPV prevalence. The most common viral types in the infected population were HPV 16 (23%), HPV 18 (11%), HPV 33 (8%) and HPV 35 (8%), while high risk viral types were detected in 30% of the samples, 16% of the controls and 60% of the cases. This study provides the first data on the predominant viral types in Ushuaia. Our results show lower levels of infection than in regions with a high incidence of cervical cancer, HPV 16 being the most prevalent viral type. This research may be useful for selecting a specific vaccine targeting the population examined.

Clinical Profiles and Survivals of 489 patients with Invasive Cancer of the Cervix ; A Review of One-year Experience / 대한산부인과학회잡지

OBJECTIVES: This non-randomized retrospective study was to investigate the clinical characteristics and to evaluate the actual 5-year survival rate of the patients with invasive cancer of the cervix. METHODS: 489 evaluable patients with invasive cancer of the cervix were treated at Korea Cancer Center Hospital from January to December 1992. In this retrospective study, we studied the clinico-pathologic characteristics(age, FIGO stage, histologic type, nodal metastasis) and treatment modalities by the review of medical records. Especially, the survival was confirmed by the support of the police and government office. RESULTS: The most common subsets of patients were found in the group of FIGO stage IIb(32.5%) and age between 51 and 60(33%). Surgery was the main treatment in stage Ib/IIa(65%) and radiation in stage IIb or more(97%). Nodal metastasis were surgically identified in 6% of stage Ib, 29% of stage IIa and 36% of stage IIb. Overall actual 5-year survival rate was 72.2%; stage Ia(100%), Ib(94%), IIa(82%), IIb(63%), IIIa(36%), IIIb(47%), and IV(0%). The five-year survival rate according to LN status in surgically confirmed FIGO stage Ib-II patients were 91.9% in negative patients and 73.1% in positive patients respectively. Five-year survival rate was significantly different according to stage(P < 0.02) and nodal metastasis(p < 0.01). However, age and histologic type did not show any significant differences in survival. CONCLUSION: Overall actual five-year survival rate of 489 evaluable patients with invasive cancer of the cervix who were treated at Korea Cancer Center Hospital from January to December 1992 was 72.2%. Five-year survival rate was different according to stage and nodal metastasis.

Evaluación de la histerectomía radical en el tratamiento del cáncer de cerviz estadio IB, en el Hospital San Vicente de Paúl de Medellín, 1980-1990 / Evaluation of radical hysterectomy for treatment of stage IB cancer of the cervix, at Hospital San Vicente, Medellín, Colombia, 1980-1990

Se revisaron las historias clínicas de 139 pacientes con cáncer de cérvix estadio 18 sometidas a histerectomía radical tipo Wertheim-Meigs, en el Hospital San Vicente de Paúl de Medellín entre 1980 y 1990, con el fin de evaluar los resultados en lo referente a complicaciones derivadas de la cirugía, presencia de lesión cervical residual y recurrencias. La edad promedio de las pacientes fue 39.3 :!: 9.4 años. El tiempo de seguimiento varió entre 0 y 181 meses. El 87.8 por ciento de los tumores fueron epidermoides y el 12.2 por ciento adenocarcinomas. En 101 casos se logró determinar el grado de diferenciación del tumor; fueron bien diferenciados 43 (42.6 por ciento), moderadamente diferenciados 29 (28.7 por ciento) y mal diferenciados 29 (28.7 por ciento). Se encontró compromiso ganglionar pélvico metastásico en 13 pacientes (9.4 por ciento); en 11 de ellas unilateral y en dos bilateral. Quedaron con lesión cervical residual seis pacientes (4.3 por ciento) de las cuales 4 recibieron radioterapia como tratamiento complementario. Las recurrencias se presentaron en 12 de las 100 pacientes seguidas durante un período igualo superior a dos años; siete de ellas aparecieron en los dos primeros años y una se presentó 13 años después de la cirugía. Las recurrencias sucedieron más frecuentemente en las pacientes con tumores mal diferenciados y moderadamente diferenciados. Presentaron complicaciones 43 de las 139 pacientes (30.9 por ciento), entre las cuales predominó la morbilidad infecciosa, expresada en infección urinaria (17 casos), infección de la herida quirúrgica (15 casos) e infección de la cúpula vaginal (14 casos).

A review was made of clinical charts of 139 patients with cancer of the cervix stage IB, treated by Wertheim-Meigs radical hysterectomy, at Hospital San Vicente, Medellín, Colombia, between 1980 and 1990, in order to evaluate results concerning complications derived from surgery, recurrences and residual cervicallesions. Average age was 39.3 ::!: 9.4 years. Follow-up period fluctuated between 0 and 181 months. One hundred and twenty two tumors (87.8%) were epidermoid and 17 (12.2%) adenocarcinomas. The degree of differentiation was determined in 101 cases: 43 (42.6%) were well differentiated, 29 (28.7%) moderately differentiated and 29 (28.7%) poorly differentiated. Metastatic pelvic Iymphnodes involvement was present in 13 patients (9.4%): In 11 of them involvement was unilateral. Residual cervicallesion was left in 6 patients (4.3%) of which 4 received additional treatment with radiotherapy. Recurrences appeared in 12 of the 100 patients followed for 2 or more years; in seven of these the recurrence ocurred in the first two years; there was a recurrence 13 years after surgery. Recurrences happened more often when tumors were poorly or moderately differentiated. Complications, mostly infectious, occurred in 43 patients (30.9%): Urinary tract infections (17 cases), wound infection (15 cases) and infection of the vaginal dome (14 cases) were the most frequently found.

A Study on an Automatic Detection of Uterine Cervical Pap-smears by Image Processing / 대한세포병리학회지

Cancer of the cervix is the most common malignancy in women in developing countries and the second most common cancer in women throughout the world with approximately 500,000 new cases each year. Prevention of this large number of premature deaths among women is, therefore, a goal worthy of urgent and serious consideration. In this thesis, an automatic cancerous nucleus detection method essential to a screening system with Papanicolaou stained specimens called Pap-smear is proposed which employs image processing techniques. It uses edge information to segment objects and morphologic as well as densitometric information to distinguish cancerous nuclei from dirts or normal nuclei. It has produced useful results in our study.