Associação entre lesões de hpv e os carcinomas genitais e da cavidade oral: uma revisão narrativa / Association between hpv lesions and genital and oral cavity carcinomas: a narrative review / Asociación entre lesiones por vph y carcinomas genitales y de cavidad oral: una revisión narrativa

Os Papilomavírus Humano (HPVs) são membros da família Papilomaviridae. O vírus destaca-se pelo seu tropismo por células epiteliais, infectando exclusivamente mucosa epitelial e cutânea. O HPV-16 e HPV-18 são subtipos classificados como de alto risco, conhecidos por sua oncogenicidade, fortemente associados aos cânceres anais, genitais e de orofaringe. Lesões por HPV representam um grande grupo de doenças sexualmente transmissíveis. O objetivo do presente estudo consistiu em realizar uma revisão narrativa sobre a associação entre lesões por HPV e carcinomas genitais e da cavidade oral. Realizamos uma busca na base de dados eletrônicos PubMed, Lilacs, Scielo, Medline e Google Scholar, sendo utilizados artigos publicados entre os anos de 2017-2021, ao fim, foram selecionados 36 artigos. Grande parte das infecções por HPV são subclínicas, ou seja, não apresentam sintomatologia importante e tendem a desaparecer espontaneamente. Desta forma, faz-se necessário ter conhecimento a respeito dos aspectos clínicos e comportamentais dessas lesões, possibilitando o diagnóstico precoce, evitando a evolução para estágios mais invasivos, favorecendo um tratamento efetivo e melhor prognóstico.

Human Papillomaviruses (HPVs) are members of the Papilomaviridae family. The virus stands out for its tropism for epithelial cells, exclusively infecting epithelial and cutaneous mucosa. O HPV-16 and HPV-18 are subtypes classified as high risk, known for their oncogenicity, strongly associated with anal, genital and oropharyngeal cancers. HPV lesions represent a large group of sexually transmitted diseases. The objective of this study was to carry out a narrative review on the association between HPV lesions and genital and oral cavity carcinomas. We carried out a search in the electronic databases PubMed, Lilacs, Scielo, Medline and Google Scholar, using articles published between the years of 2017-2021, at the end, foram selected 36 articles. A large part of HPV infections are subclinical, or seem to, do not present significant symptoms and tend to disappear spontaneously. In this way, it is necessary to be aware of the two clinical and behavioral aspects of these injuries, enabling early diagnosis, avoiding evolution to more invasive stages, favoring effective treatment and better prognosis.

Los virus del papiloma humano (VPH) son miembros de la familia Papillomaviridae. El virus destaca por su tropismo por las células epiteliales, infectando exclusivamente mucosas epiteliales y cutáneas. El VPH-16 y el VPH-18 son subtipos clasificados como de alto riesgo, conocidos por su oncogenicidad, fuertemente asociados con cánceres anales, genitales y orofaríngeos. Las lesiones por VPH representan un gran grupo de enfermedades de transmisión sexual. El objetivo del presente estudio fue realizar una revisión narrativa sobre la asociación entre las lesiones por VPH y los carcinomas genitales y de cavidad oral. Realizamos una búsqueda en la base de datos electrónica PubMed, Lilacs, Scielo, Medline y Google Scholar, utilizando artículos publicados entre los años 2017-2021, al final se seleccionaron 36 artículos. La mayoría de las infecciones por VPH son subclínicas, es decir, no presentan síntomas importantes y tienden a desaparecer espontáneamente. Por lo tanto, es necesario tener conocimiento sobre los aspectos clínicos y conductuales de estas lesiones, que permitan un diagnóstico precoz, evitando la progresión a estadios más invasivos, favoreciendo un tratamiento eficaz y un mejor pronóstico.

Age, period and cohort effects on mortality from cervical cancer in Colombia between 1985 and 2014 / Efectos de edad, periodo y cohorte en la mortalidad por cáncer de cuello uterino en Colombia entre 1985 y 2014

Abstract Objective: To analyze the cervix cancer mortality in Colombia, based on age, period and cohort effects. Methods: The mortality and population data were taken from the official databases of the National Administrative Department of Statistics, DANE. Five models were adjusted, the significance of the effects was obtained by comparing them through the likelihood ratio test. Results: The age-adjusted mortality rate, in deaths was 15.09/100,000 woman, at 1985-1989 period, and 10.21 at 2010-2014 period. The annual percentage average change was -1.45% (95% CI: -1.57% to -1.34%). Age, period and cohort effects were found. Conclusions: Demographic factors could explain the behavior of cervical cancer mortality in Colombia, as well as the establishment of public health measures in the last two decades.

Resumen Objetivo: Analizar las tendencias de la mortalidad por cáncer de cuello uterino en Colombia, teniendo en cuenta los efectos de edad, periodo y cohorte. Métodos: Los datos de mortalidad y de población se tomaron de las bases oficiales del Departamento Administrativo Nacional de Estadísticas, DANE. Se ajustaron cinco modelos, la significancia de los efectos se obtuvo comparándolos a través de la prueba de razón de verosimilitud. Resultados: La tasa de mortalidad ajustada por edad, en muertes fue de 15.09/100,000 mujeres, para el periodo 1985-1989 y 10.21 para el periodo 2010-2014. El cambio promedio porcentual anual fue de -1.45% (IC 95%: -1.57% a -1.34%). Se encontraron efectos de edad, periodo y cohorte. Conclusiones: Los factores demográficos podrían explicar el comportamiento de la mortalidad por cáncer de cuello uterino en Colombia, al igual que la instauración de medidas de salud pública en las dos últimas décadas.

Mobile colposcopy by trained nurses in a cervical cancer screening programme at Battor, Ghana

Objectives: Cervical precancer screening programs are difficult to establish in low resource settings partly because of a lack of human resource. Our aiming was to overcome this challenge. We hypothesized that this could be done through task shifting to trained nurses. Design: Descriptive retrospective cross-sectional review. Setting: Training was at the Cervical Cancer Prevention and Training Center (CCPTC) and screening was carried out at the clinic and at outreaches / peripheral facilities.Participants: All women who reported to the clinic for screening or were recruited during outreaches Interventions: All 4 nurses were trained for at least 2weeks (module 1). A total of 904 women were screened by the trained nurses using the EVA system. Quality assurance was ensured. Main outcome measures: Primary screening and follow-up were carried out by the trained nurses with quality assured through image sharing and meetings with peers and experienced gynaecologists. Results: 828 women had primary screening and 76 had follow-up screening. 739 (89.3%) were screened at the clinic and 89 (10.7%) at outreaches/peripheral facilities. Of all screened, 130 (14.5%) had cervical lesions, and 25 (2.8%) were treated, 12 (48.0%) by Loop Electrosurgical Excision Procedure (LEEP) performed by a gynaecologist, 11 (44.0%) with thermal coagulation by trained nurses except one, and 2 (8.0%) with cryotherapy by trained nurses. Conclusion: We demonstrate the utility of a model where nurses trained in basic colposcopy can be used to successfully implement a cervical precancer screening and treatment program in low-resource settings

Barriers and innovative interventions for early detection of cervical cancer / Barreras e intervenciones innovadoras para la detección temprana del cáncer cervicouterino

Abstract: Cervical cancer has decreased significantly over the past 30 years in some countries. However, it remains among the leading causes of cancer deaths in low-income, and racial/ethnic minority women. Cervical cancer prevention technologies are not always available. Laboratories are often not well equipped to use them. HPV information has not been widely disseminated. WHO guidelines, and US and Latin American data provide context for strategies on effective interventions to reduce cervical cancer disparities. Systemic, personal and cultural barriers, combined with decision-making guidelines, and impactful messaging can accelerate reductions in cervical cancer health inequities in the Americas.

Resumen: El cáncer cervicouterino ha disminuido significativamente en los últimos 30 años, pero sigue siendo una de las principales causas de muerte entre mujeres de bajos recursos y minorías raciales/étnicas. Las tecnologías preventivas del cáncer cervicouterino no están siempre disponibles y los laboratorios no están siempre bien equipados para utilizarlas. La información sobre el VPH no ha sido difundida ampliamente. La OMS y datos de EEUU y Latinoamérica ofrecen estrategias para reducir el cáncer cervicouterino. El entendimiento de las barreras sistémicas, personales y culturales, dentro de un marco de toma de decisiones, y mensajes innovadores puede reducir las barreras asociadas con el cáncer cervicouterino en las Américas.

A Study of Two-field, Three-field, and Four-field Techniques using Rainbow and Thermoluminescent Dosimetry for Radiotherapy Treatment of Cervix Cancer

The aim of the present study is to investigate the rectal dose during three different radiotherapy techniques of dosimeter cervicalcancer. The study was carried out using a Anderson Rando female phantom. The thermoluminescent dosimetry (TLD) capsulesand detectors of rainbow dosimeter were employed for rectal and target volume dose determination. Several techniques ofexternal beam radiation therapy such as two field (AP-PA), three field, and four field with equal applied dose were planned.During application of different radiotherapy techniques, the maximum dose received by rectum is due to the two-field technique.The results of two dosimetry types were compared with each other. The mean and standard deviation values of two field, threefield, and four field for rectum are 1.97 ± 0.01, 1.68 ± 0.026, and 1.35 ± 0.05, respectively, whereas the mean and standarddeviation values of two field, three field, and four field for cervix are 2.03 ± 0.01, 1.98 ± 0.02 and 1.92 ± 0.01, respectively. Theresults were evaluated by the paired t-test. The P values calculated from data are as follows: Two field, cervix, P = 0.02; threefield, cervix, P = 0.0016; and four field, cervix, P = 0.0026, demonstrates that four field significantly reduces the rectum dose.This study showed that using TLD and rainbow dosimetry during radiotherapy could have a useful role as a predictor of choosingappropriate technique for preventing future rectal complications. Dose limitation to the rectum could possibly be achieved byusing three-field and four-field techniques with equal tumor dose while maintaining a high dose to the tumor.

Factors Affecting HPV Vaccination Rates of Daughters Aged 12 years

PURPOSE: The purpose of this study was to investigate the rate of human papilloma virus (HPV) vaccinations among 12-year-old daughters and to analyze factors influencing the mothers' decisions to vaccinate their daughters. METHODS: A cross sectional descriptive study was conducted using a convenience sample of 139 mothers. Data was analyzed using SPSS WIN 23.0. Descriptive statistics and a logistic regression analysis were conducted. RESULTS: The vaccination rate of HPV among children was 43.9%. Mothers showed a higher knowledge of the HPV vaccination than of cervical cancer and of human papilloma virus. In self-efficacy scores, the subscores of self-regulation efficacy were higher than self-confidence and task difficulty preference. The factors influencing the vaccination of daughters included the age of the daughters at the time of the vaccination, the provision of information on the HPV vaccine, knowledge of the HPV vaccination, and self-confidence. CONCLUSION: In order to increase the HPV vaccination rate, it is necessary to provide accurate scientific knowledge to mothers. A variety of intervention strategies should be developed to enhance the confidence of mothers so that mothers who want to provide the HPV vaccination to their daughters are able to follow through and provide the vaccination.

Asociación entre polimorfismos de Glutation s-transferasa y cáncer cérvico uterino / Association between polymorphisms of Glutathione s-transferase and cervical cancer

Introducción: entre los factores de riesgo que favorecen la aparición de las lesiones cérvico uterinas, se encuentran la infección por virus de papiloma humano, la promiscuidad, el uso de anticonceptivos orales y el hábito de fumar. No obstante, varias investigaciones refieren que los polimorfismos genéticos podrían contribuir al desarrollo y progresión del cáncer cérvico uterino. Objetivo: identificar en la bibliografía revisada, la frecuencia de asociación de los polimorfismos de Glutation s - transferasa con el cáncer cérvico uterino y con factores de riesgo que inciden en la patología. Métodos: se realizó una extensa revisión de la literatura especializada a través de los buscadores en base de datos de PubMed, EBSCO, NCBI y BVS. Resultados: se constató la variabilidad en los reportes de las frecuencias alélicas de los genotipos GSTM1 y T1 en distintas poblaciones. Se corroboró en varios estudios revisados el hallazgo de asociación entre los genotipos GSTM1 y T1 nulos y cáncer cérvico uterino y, de igual forma con el consumo de tabaco y anticonceptivos orales por tiempo prolongado. Conclusiones: la bibliografía sobre el tema pone en evidencia que los genes que codifican la enzima Glutation s - transferasa intervienen en la protección celular contra los efectos citotóxicos, de manera que cuando éstos presentan alteración se afecta la actividad enzimática, lo que predispone a una mayor susceptibilidad al cáncer(AU)

Introduction: Among risk factors that lead to uterine cervix lesions we can find the human papilloma virus infection, promiscuity, use of oral contraceptive and smoking habit. However, several researches refer that genetic polymorphism could be related to the development and progression of the uterine cervix cancer. Objective: Identify the association of glutathione S- transferases polymorphism with uterine cervix cancer and risk factors relate with this disease, in the revise bibliography. Method: An extensive review was made of the specialized literature using web search in database PubMed, EBSCO, NCBI and BVS. Result: The variability of the allelic frequency of the GSTM1 and T1 genotypes in different populations was confirmed. Besides the association between null GSTM1 and T1 with uterine cervix cancer was corroborated. In addition, this association with smoking habit and the use of oral contraceptive for long time was corroborated. Conclusions: Consulted bibliography shows that genes encoding glutahione S- transferases enzyme contribute to the cellular protection against cytotoxic effects, therefore, alterations in these genes affect the enzymatic activity lead to a major susceptibility to suffer cancer(AU)

Geometría fractal y euclidiana aplicada al diagnóstico de grados de lesión de células de cuello uterino

Previamente, se desarrolló una metodología diagnóstica para lesiones preneoplásicas y neoplásicas de células de cuello uterino, a partir de medidas euclidianas y fractales simultáneas. En este trabajo, el objetivo era confirmar la concordancia diagnóstica de la metodología en células normales y en diferentes estadios de lesión celular. Se tomaron fotografías de 60 células del epitelio escamoso cervical: 10 normales, 10 ASCUS, 20 con lesión intraepitelial de bajo grado (LEIBG) y 20 con lesión de alto grado (LEIAG). Se realizaron medidas de dimensión fractal y del espacio de ocupación de la superficie y el borde del núcleo y citoplasma en el espacio fractal de Box Counting, estableciendo su diagnóstico físico-matemático. Las medidas de la superficie del núcleo estuvieron para normalidad, entre 305 y 651; para ASCUS, entre 1293 y 4588; para LEIBG, entre 986 y 4873 y para LEIAG, entre 567 y 2311. La resta de las fronteras Citoplasma-Núcleo, se encontró entre 238 y 477, para normalidad; entre 185 y 417, para ASCUS; entre 131 y 342, para LEIBG y entre 43 y 117, para LEIAG. Fueron hallados valores de sensibilidad y especificidad del 100%; la razón de probabilidad fue de 0 y el coeficiente kappa de 1. Se confirmó la concordancia diagnóstica a nivel clínico del método físico-matemático, cuantificando de manera objetiva y reproducible el grado de lesión de células de cérvix y estableciendo un diagnóstico objetivo para las células ASCUS, a partir de medidas fractales y euclidianas simultáneas, que mejora los métodos cualitativos de clasificación.

A diagnostic methodology for preneoplastic and neoplastic lesions of cervical cells from simultaneous fractals and euclidean measures was developed. In this work the objective was to confirm the diagnostic concordance of the methodology in normal cells and in different stages of progression to disease. For this, 60 photographs of cervical squamous epithelium cells were taken: 10 normal, 10 ASCUS, 20 with low grade - squamous intraepithelial lesion (L-SIL) and 20 high-grade lesion (H-SIL). Measures of fractal dimension and space occupancy of the surface and the edge of the nucleus and cytoplasm were performed in Box Counting Fractal space, establishing their physical-mathematical diagnosis. Measurements of the nucleus surface for normality were between 305 and 651, for ASCUS between 1293 and 4588, for L-SIL, between 986 and 4873 and for H-SIL between 567 and 2311. The subtraction of Cytoplasm-Nucleus border was found between 238 and 477 for normality; between 185 and 417 for ASCUS; between 131 and 342 for L-SIL and between 43 and 117 for H-SIL, finding sensitivity and specificity of 100%, likelihood ratio of 0 and kappa coefficient of 1. Conclusions: the diagnostic concordance at clinical level of the physical-mathematical method was confirmed, objective and reproducible quantifying the degree of injury of cervical cells and establishing an objective diagnosis for ASCUS cells from simultaneous fractals and euclidean measures, which improves qualitative classification methods.

Clinical efficacy and safety observation of bevacizumab combined with docetaxel in treatment of advanced cervix cancer / 药物评价研究

Objective To explore the clinical efficacy and safety of bevacizumab combined with docetaxel in treatment of advanced cervix cancer.Methods Seventy-five patients with advanced cervix cancer accepted in our hospital from April 2011 to April 2016 were selected and divided into observation group with 43 cases and control group with 32 cases according to different treatment methods.Patients in control group were given docetaxel,and patients in observation group were combined with bevacizumab on the basis of control group.The clinical efficacy,adverse reactions,life quality and pharmacoeconomics of two groups were observed and compared.Results The total efficacy and clinical control rate of observation group were all higher than control group with statistically significance (P ＜ 0.05).The adverse reaction rate of two groups had no difference.Total efficacy of life quality improvement was 83.72％,which was obviously higher than control group 62.50％ with statistically significance (P ＜ 0.05).The average cost of observation group was (83 ± 10) thousands,of control group was (18± 6) thousands.The cost of observation group was obviously higher than control group with statistically significance (P ＜ 0.05).Conclusion Using bevacizumab combined with docetaxel in treatment of advanced cervix cancer has better effect clinical but costs much than docetaxel.We should set on treatment according to patients' own situation.

Herramienta alternativa para la clasificación de células cervicales utilizando solo rasgos del núcleo / Alternative tool for classification of cervical cells using only features of the nucleus

El cáncer de cérvix uterino representa una de las mayores amenazas de muerte por cáncer entre las mujeres. Con el avance continuo en la medicina y la tecnología, las muertes por esta enfermedad han disminuido significativamente. Las investigaciones referentes a este tema han podido determinar síntomas claves que permiten detectar a tiempo esta enfermedad para darle un tratamiento oportuno. La citología convencional es una de las técnicas más utilizadas, siendo ampliamente aceptada, de bajo costo, y con mecanismos de control. Con el objetivo de aliviar la carga de trabajo a los especialistas, algunos investigadores han propuesto el desarrollo de herramientas de visión computacional para detectar y clasificar las transformaciones en las células de la región del cuello uterino. La presente investigación tiene como objetivo proveer a los investigadores de una herramienta de clasificación automática, aplicable a las condiciones existentes en los centros médicos y de investigación del país. Esta herramienta debe ser capaz de clasificar las células del cuello del útero, basándose solamente en las características extraídas de la región del núcleo y sin utilizar las características del citoplasma, de manera que se reduzca la tasa de falsos negativos en la prueba de Papanicolaou. A partir del estudio realizado, se obtuvo una herramienta haciendo uso de la técnica k-vecinos más cercanos con la distancia manhattan, el cual mostró un alto desempeño manteniendo valores de AUC superiores al 91 por ciento y llegando hasta un 97.1 por ciento con respecto a los clasificadores SVM y RBF Network, los que también fueron analizados(AU)

Cervix cancer is one of the biggest threats of cancer death among women. With continued advances in medicine and technology, deaths from the disease have fallen significantly. The investigations concerning this issue have determined key symptoms to detect the disease in time to give timely treatment. Conventional cytology is one of the most widely used techniques, being widely accepted, inexpensive, and with control mechanisms. In order to alleviate the workload of specialists, some researchers have proposed the development of computer vision tools to detect and classify the changes in the cells of the cervical region. This research aims to provide a tool for automatic classification, applicable to medical conditions and research centers of the country. This tool should be able to classify the cells of the cervix, based solely on the features extracted from the core region without using the characteristics of the cytoplasm, so that the rate of false negative Pap test is reduced. From the study, a tool is obtained using the k nearest-neighbors manhattan distance technique, which showed a high performance maintaining AUC values greater than 91 percent and reaching 97.1 percent over classifiers SVM and RBF Network, which were also analyzed(AU)

Cribado para cáncer cervicouterino y de mama en la población femenina de la ciudad de cipolletti / Screening for cervix cancer and breast cancer in the female population of the city ofcipolletti

INTRODUCCIÓN: la detección precoz del cáncerde mama y cuello de útero en la mujer ha permitido aumentarla sobrevida y aun la curación en estas dos afecciones. Tanto lamamografía como la realización del Papanicolau (PAP) tienen unaadecuada sensibilidad y especificidad para la detección de tumoresincipientes. OBJETIVOS: conocer las prevalencias de utilizaciónde mamografía y PAP en la población femenina de la ciudad deCipolletti. MÉTODOS: Se realizó un estudio de prevalencia. Seincluyeron mujeres mayores de 18 años, no institucionalizadasy con más de 10 años de residencia. Los principales indicadoresfueron: realización de PAP y mamografía en los últimos dos años.RESULTADOS: Participaron del estudio 642 mujeres encuestadasefectivamente con edad promedio 50,24 +/-16,73 años y un rangoentre 18 y 91 años. El 76,7% (IC95%: 67,1-84,1%) de entre 50 y70 años había utilizado la mamografía, y el 74,9% (IC95%: 66,7-81,6%) de entre 25 y 65 se había realizado el Pap en los últimos 2años. Ambos indicadores resultaron mejores que en la Provinciade Río Negro. CONCLUSIONES: Si bien no todas las diferenciasdetectadas fueron estadísticamente significativas, se observa unatendencia a mayor prevalencia de realización de mamografía enCipolletti que en el resto de la provincia, la región y el país.

INTRODUCTION: early detection of breast cancer andcervix cancer in women has led to increased survival and evencure these diseases. Both mammography and Papanicolau (Pap)smear have adequate sensitivity and specificity for detection at earlystage these tumors. OBJECTIVES: To know the prevalence of use ofmammography and Pap smear in screening for breast cancer andcervix cancer in female population of the city of Cipolletti. METHODS:A cross sectional study was carried out. The population includedresidents of city of Cipolletti, older than 18 years, not institutionalizedand more than 10 years of residence. The main indicators wereperformed Pap smear and mammogram in the past two years.RESULTS: The study surveyed 642 women with an average age of50.24 +/- 16.73 years, with a range of age between 18 and 91 years.Mammogram was used in group included in current recommendationsin Argentina between 50 and 70 years in 76.7% (95% CI67.1% -84.1%) and Pap smear was used in 74.9% (CI95 % 66.7%-81.6%) of participants between 25 and 65 years, in the past 2years. Both indicators were better than they were in the Provinceof Río Negro. CONCLUSIONS: Although not all detected differencesare statistically significant, there is a higher use of mammographyin Cipolletti than in the province, the region and also the country.

Tendências e projeções da mortalidade pelos cânceres específicos ao gênero no Brasil / Trends and projections of mortality for specific cancers gender in Brazil

Os cânceres que acometem os órgãos genitais masculinos e femininos, em conjunto com o câncer de mama, são responsáveis por cerca de 20% dos óbitos por câncer no mundo. Conhecer os padrões de mortalidade por esses cânceres no Brasil, as mudanças que se produziram ao longo do tempo, os grupos mais vulneráveis e a carga de mortalidade que se apresentará no futuro são elementos básicos para a estruturação das ações assistenciais e de vigilância do câncer. O objetivo desse estudo foi analisar as tendências de mortalidade pelos cânceres que acometem órgãos que são específicos a cada gênero e projetar a mortalidade por esses cânceres até o ano de 2030, para o Brasil, regiões e estados da federação. Trata-se de um estudo ecológico de base populacional que analisou os óbitos, ocorridos no período 1996 a 2010, decorrentes dos cânceres de colo do útero, corpo do útero, mama feminina, ovários, vulva, vagina, próstata, pênis e testículos, registrados no Sistema de Informação sobre Mortalidade; as informações sobre população foram obtidas do Instituto Brasileiro de Geografia e Estatística. Foi aplicada a Regressão loglineal (Joinpoint regression) com taxas padronizadas (população mundial: ASR-W) para estimar o Annual Percentage Change (APC), o Average Annual Percentage Change (AAPC), o intervalo de confiança 95% e os pontos de inflexão da curva; as projeções foram calculadas através do programa Nordpred, inscrito no programa R, utilizando o modelo idade-período-coorte, analisando posteriormente se as mudanças que se produzirão no futuro serão decorrentes da exposição aos fatores de risco e/ou da estrutura da população exposta ao risco. Todas as análises também foram aplicadas para o conjunto de todos os óbitos por câncer (com exceção dos cânceres de pele não-melanoma).

Para o Brasil, a mortalidade pelos cânceres de pênis (APC=1,5% IC95% 0,7;2,3 p<0,05), testículos (APC=1,6% IC95% 0,5;2,8 p<0,05) e ovários (APC=0,8% IC95% 0,1; 1,5 p<0,05), mostraram tendência de aumento, enquanto os cânceres de vulva e vagina (APC=-0,1% IC95% -0,9; 0,7 p=0,8), corpo de útero (APC= -0,3 IC95% -1,0; 0,5 p=0,4), mama (APC=0,4% IC95% -0,2;1,0 p=0,2) e de próstata (AAPC= 1,1% IC95% -0,2; 2,4 p=0,1) apresentaram tendência de estabilidade. A mortalidade por câncer de colo de útero apresentou tendência de redução (APC=-1,7% IC95%-2,2; -1,1 p<0,05). A análise do agrupamento de todos os óbitos por câncer observou tendência de aumento na mortalidade para o sexo masculino até o ano de 2006 (APC= 1,2% IC95% 0,6;1,8 p<0,01), seguido de um período de estabilidade. Para o sexo feminino, a tendência é de estabilidade (APC=0,4% IC95% -0,2;-1,8 p=0,2). As taxas de mortalidade para todos os cânceres analisados mostraram, de maneira geral, tendência de redução nas regiões sul e sudeste, tendência de aumento nas regiões norte e nordeste, e estabilidade para a região centro oeste. Na projeção da mortalidade para o ano 2030, as regiões norte e nordeste responderão pelas maiores taxas de mortalidade para os cânceres analisados; todavia, para as demais regiões, será observada redução nas taxas em comparação com o último período observado. Destacase o câncer de testículo, para o qual será observado aumento de 33% na carga da mortalidade até o ano 2030. Para os demais cânceres, não serão observadas variações consideráveis nas taxas de mortalidade para o Brasil entre o último período observado e o último período projetado. A estrutura e o tamanho da população brasileira serão os fatores que explicarão os padrões de mortalidade por esses cânceres no futuro, embora para a região nordeste, as variações serão explicadas, em maior medida, pelo aumento do risco para esses cânceres.

Conclui-se, portanto, que existe uma marcante desigualdade na distribuição da mortalidade pelos cânceres específicos ao gênero no Brasil, onde as regiões mais pobres apresentam um quadro de aumento significativo do número de óbitos ao longo de uma série histórica, e que em 2030, essas regiões responderão pelas maiores taxas de mortalidade no país, com ênfase para os cânceres de pênis, testículos e ovários. (AU)

Cancers that attack male and female genital organs, along with breast cancer, are responsible for approximately 20% of cancer-related deaths in the world. Knowledge on the mortality patterns for these cancers in Brazil, the changes produced throughout time, the most vulnerable groups and the mortality burden in the future are basic elements for structuring assistance and vigilance actions for cancer. The objective of this study was to analyze the mortality trends of cancers that attack gender-specific organs, and project mortality until the year 2030, for Brazil, its geographic regions, and federation states. A population-based ecological study is presented herein, which analyzed deaths occurring within the period 1996-2010, due to cancers of the uterine cervix, uterine corpus, female breast, ovary, vulva, vagina, prostrate, penis and testicles, registered in the Mortality Information System. Data on population was obtained from the Brazilian Institute of Geography and Statistics. Joinpoint regression was applied with standardized rates (world population: ASR-W) to estimate the Annual Percentage Change (APC), the Average Annual Percentage Change (AAPC), the confidence interval 95% and the inflection points of the curve. The projections were calculated by the Norpred program, inscribed within the R program, utilizing the age-period-cohort model, with posterior analysis of whether the changes produced in the future will be consequences of exposition to risk factors and/or structure of the population exposed to risk. The analyses were also applied to the set of all cancer-related deaths (with exception for non-melanoma skin cancers). For Brazil, mortality due to cancers of penis (APC=1.5% CI95% 0.7;2.3 p<0.05), testicles (APC=1.6% CI95% 0.5;2.8 p<0.05) and ovary (APC=0.8% CI95% 0.1; 1.5 p<0.05) showed increasing trends, while cancers of vulva and vagina (APC=-0.1% IC95% -0.9; 0.7 p=0.8), uterine corpus (APC=-0.3 CI95% - 1.0; 0.5 p=0.4), breast (APC=0.4% CI95% -0.2;1.0 p=0.2) and prostrate (AAPC= 1.1% CI95% -0.2; 2.4 p=0.1) presented stable trends. Mortality due to cervical cancer presented reducing trends (APC=-1.7% ICI95%-2.2; -1.1 p<0.05). Analysis of the grouping of all cancer-related deaths presented increasing mortality trends for the male gender until the year 2006 (APC= 1.2% CI95% 0.6; 1.8 p<0.01), followed by a stability period. For females, the trend was stable (APC=0.4% CI95% -0.2;-1.8 p=0.2). The mortality rates for all analyzed cancers revealed, generally, reducing trends for the South and Southeast regions, increasing trends for the North and Northeast regions, and stability for the Midwest region. Mortality projections for the year 2030 indicate that the North and Northeast regions will suffer the highest mortality rates for the analyzed cancers; however, for the remaining regions, reduced rates will be observed in comparison with the last period analyzed. It must be highlighted that, for testicle cancer, there will be an increase of 33% in mortality burden until the year 2030. For the remaining cancers, significant variations will not be observed in mortality rates for the last observed period and the last projected period in Brazil. The structure and size of the Brazilian population are the factors explaining the mortality patterns for these cancers in the future, although for the Northeast region, the variations will be explained mostly by the increase in risk for these cancers. It is concluded that there is a pronounced inequality in the distribution of gender-specific cancer mortality in Brazil, where the poorer regions present a significant increasing situation of the number of deaths throughout a historical series. In 2030, these regions will present the highest mortality rates in the country, with emphasis on penis, testicle and ovarian cancers. (AU)

Conocimientos, actitudes y prácticas sobre virus de papiloma humano (VPH) y cáncer de cuello uterino en mujeres de 30 y más años de edad, de un barrio ribereño de Asunción, (Bañado Sur). 2012 / Knowledge, attitudes and practice on human papilloma virus (HPV) and cervix cancer in women who were 30 years old or more, from a riverside neighborhood of Asuncion, (Bañado Sur). 2012

Introducción: El cáncer de cuello uterino es un problema de salud pública en Paraguay. Objetivo: Determinar conocimientos, actitudes y prácticas sobre virus del papiloma humano (VPH) y cáncer de cuello uterino en mujeres de 12 Unidades de Salud Familiar (USF) de Bañado Sur-Asunción, periodo abril-octubre 2012. Metodología: Estudio descriptivo de corte transversal, utilizando cuestionario estructurado autoadministrado. Resultados: La edad promedio de las encuestadas fue 42 años, la mayoría en unión libre o casadas (70%); 65% tienen educación básica y media, 56% son amas de casa. El 83% tienen seguro médico; 78% escuchó hablar sobre cáncer de cuello uterino, 74% de éstas en los centros de salud. El 10% de las encuestadas conoce el VPH y lo relaciona con la enfermedad, 90 % escuchó hablar sobre la prueba de Papanicolaou, el 27 % de ellas sabe en qué consiste; 90% de las mujeres demostró actitud favorable y 56% prácticas favorables respecto a la prevención de la enfermedad. Conclusiones: El estudio permite conocer la percepción que tiene una población de mujeres de un barrio marginal de la capital del país, respecto al cáncer de cuello uterino y el principal factor de riesgo que lo produce, a fin de incrementar la prestación de servicios de prevención de este tipo de cáncer, además de propiciar el trabajo interinstitucional e intersectorial en la prevención y control de la enfermedad en el país.

Introduction: Cervix cancer is a public health problem in Paraguay. Objective: To determine knowledge, attitudes and practices on human papilloma virus (HPV) and uterine cervix cancer in women from 12 Family Health Units (FHU) of the Bañado Sur- Asunción, April-October 2,012 period. Methodology: Descriptive cross-sectional study that used self-administered structured questionnaires. Results: The mean age was 42 years, most of them cohabitated or were married (70%); 65% had elementary and secondary education and 56% was housewife; 83% had medical insurance and 78% heard about uterine cervix cancer, 74% of them in health posts. Only 10% knew HPV and related it to a disease, 90% heard about Papanicolaou test, but only 27% knew what is, 90% showed favorable attitude and 56% favorable practices in relation to the disease prevention. Conclusions: The study provided information on the perception that a population of women from a marginal zone of the capital have in relation to cervical cancer and its main risk factor. This will allow increasing the supply of prevention services for this type of cancer, along with promoting inter-institutional and inter-sectorial work on the prevention and control of this disease in the country.

Comparison of graphical optimization and inverse planning simulated annealing for brachytherapy of cervix cancers / 中华放射医学与防护杂志

Objective To compare the differences and characteristics of the dose distribution of the two optimization methods in the three dimensional brachytherapy,and provide the basis for clinieal treatment.Methods Excel 2007 was used to generate random number.And a total of 21 patients of cervical cancer were selected from those who have completed the treatment.Inverse simulated annealing optimization (IPSA) plans were designed for graphical optimization (GO) plans.The dose volume histogram (DVH) parameters of the targets (V100％,V150％) and the organs (D1 cm3,D2cm3) of the two methods were analyzed.Results The targets dose of both plans could meet the prescription requirements.There was no statistically significant difference in the dose parameters of all targets (P ＞ 0.05).The closes of D1 cm3 and D2cm3 in the bladder of IPSA plan were significantly lower than that of the GO plan (t =3.596,3.490,P ＜ 0.05).There was no statistically significant difference in the dose parameters of rectum (P ＞ 0.05).Conclusions For cervix brachytherapy,the GO and IPSA have no effect on targets dose,but IPSA optimization can reduce the maximum dose of bladder.

Metastatic adenocarcinoma of the cervix presenting as a choroidal mass: A case report and review of literature of cervical metastases to the eye.

Cervical cancer is the most common cancer among females in India. Cervical cancer usually spreads by local extension and through the lymphatic drainage to the lymph nodes. Hematogenous spread, the mechanism responsible for distant metastases, is rarely seen in cervical malignancies. In this communication, we report a case of a 45-year-old woman who presented with unilateral decrease in vision of 3 months duration. She was found to have a serous retinal detachment with underlying diffuse, subretinal yellowish-cream colored infiltrates in the right eye, suspicious of choroidal metastases. Systemic evaluation showed disseminated systemic metastases arising from a primary adenocarcinoma of the cervix. In this communication, we review all the documented cases of metastases to the eye and adnexa arising from cervical cancer and their clinical characteristics. Unilateral choroidal metastasis arising from an adenocarcinoma of the cervix is extremely rare with only one previous documented case. Although uncommon, choroidal metastasis may be the presenting feature of primary cervical malignancy. Furthermore, cervical malignancy must be ruled out in women who present with orbital or choroidal metastases arising from unknown primary.

Value of diffusion weighted magnetic resonance imaging in the monitoring of neoadjuvant chemotherapy efficacy for uterine cervical cancer / 实用肿瘤学杂志

Objective To analyze the value of diffusion weighted imaging ( DWI) in assessing the effect of neoadjuvant chemotherapy of uterine cervix cancer .Methods Thirty one patients with LACC confirmed by pa-thology received conventional magnetic resonance imaging and DWI before and after neoadjuvant chemotherapy . The variation of DWI image and ADC was evaluated before and after chemotherapy .Results The correlation be-tween maximum diameter of the tumor before treatment (37.10 ±11.23) and pretreatment ADC value (0.83 ± 0.12)was not statistically significant(correlation coefficient r=-0.1746,P=0.3475);the correlation between the maximum diameter of the tumor(24.03 ±5.65)and ADC value(1.10 ±0.16)after treatment was not statisti-cally significant(correlation coefficient r=-0.2077,P=0 2621.);the degree of tumor size before and after the treatment was correlated with the degree of ADC increase (P0.05).Conclusion DWI sequence may be useful for early prediction and evaluation of curative effect to neoadjuvant chemotherapy for uterine cervical cancer .

Comparative evaluation of human papilloma virus-DNA test verses colposcopy as secondary cervical cancer screening test to triage screen positive women on primary screening by visual inspection with 5% Acetic acid.

INTRODUCTION: Visual inspection with 5% Acetic acid (VIA) as a low cost screening method has good sensitivity with the limitation of low specificity and low positive predictive values. The present study therefore evaluates the performance of secondary testing by human papillomavirus (HPV) test and Colposcopy in a single‑visit screening approach to increase program effectiveness in limited health‑care resources settings. MATERIALS AND METHODS: In a cross‑sectional cervical cancer screening trial, 3629 women (30‑65 years) were screened by primary screening test VIA. VIA test positive women were subsequently tested for the presence of oncogenic HPV types by hybrid capture II and with colposcopy. The reference investigation histopathology was performed for all primary screen positive women. RESULTS: Data for 3613 evaluable women showed 352 (9.7%) women positive on primary screening by VIA. VIA had a sensitivity of 93% (95% confidence interval (CI): 0.76‑0.99) and specificity of 91% (95% CI: 0.90‑0.92) respectively to detect the cervical intraepithelial neoplasia grade 2+ . HPV DNA and colposcopy as secondary tests to triage VIA positive women had a sensitivity of 61% (95% CI: 0.41‑0.78), 43% (95% CI: 0.24‑0.63) and specificity of 99% (95% CI: 0.99‑1.00), 99% (95% CI: 0.99‑0.99) respectively for detecting CIN2+ lesions. CONCLUSION: Two step screening model combining highly sensitive low cost test like VIA for primary screening followed by more specific HPV DNA test as triage test for primary screen positive can be a cost‑effective cervical screening strategy in resource constrained settings.

Preservación de la fertilidad en estadios iniciales de cáncer de cuello uterino

La incidencia de cáncer cervical ha aumentado en mujeres jóvenes, en quienes se requiere prestar atención a la preservación de la fertilidad. Se presenta dos casos de pacientes con cáncer temprano de cuello uterino, en estadios iniciales IA2 e IB1 sin metástasis en ganglios pélvicos, y se analiza nuestra experiencia en la aplicación de la técnica quirúrgica de traquelectomía radical abdominal, de manera de preservar la fertilidad.

The incidence of cervical cancer has increased in young women in whom it is important to preserve fertility. Two cases of patients with early cervical cancer stages IA2 e IB1 and no pelvic lymph nodes metastasis are presented, and experience with abdominal radical trachelectomy in order to preserve fertility is analized.

Factores asociados al uso adecuado de la citología cérvico-uterina por mujeres de cartagena (Colombia) / Factors associated to the adequate use of pap smears by women in cartagena (Colombia) / Fatores associados ao uso adequado da citologia cérvico-uterina por mulheres de cartagena (Colombia)

Objetivo: Determinar los factores asociados al uso de la citología en mujeres de la ciudad de Cartagena. Metodología: Se realizó un estudio analítico de corte transversal, en una población de referencia de 237.751 mujeres. Se solicitó consentimiento informado a cada participante de acuerdo a las normas éticas nacionales e internacionales Fueron incluidas mujeres del área urbana de la ciudad de Cartagena, seleccionadas mediante un muestreo polietápico. Se aplicó una encuesta socio-demográfica y el apartado relacionado con cáncer de cuello uterino de la Encuesta Nacional de Demografía y Salud (ENDS - 2010). A los datos se aplicó estadística descriptiva e inferencial. Resultados: Participaron 915 mujeres con una edad promedio de 40 años (DE = 12,9 años). La prevalencia de uso de la citología fue del 85,9%; solo el 39,8% (313) cumple el esquema propuesto por la norma técnica nacional. Las variables que explican el uso adecuado de la citología por parte de las mujeres de Cartagena son: ser mayor de 29 años (OR: 2,1 - IC: 1,3-3,4), reclamar el resultado (OR: 2,5 - IC: 1,1-5,7), tener un resultado anormal (OR: 0,5 - IC: 0,2-0,9) y pertenecer al régimen subsidiado o no tener afiliación en salud (OR: 0,5 - IC: 0,4-0,8). Conclusiones: Los factores asociados al uso de la citología en mujeres de la ciudad de Cartagena, de acuerdo al esquema propuesto por la norma técnica nacional, se explica por factores demográficos, económicos y sociosanitarios.

Objective: To determine factors associated with the use of cytology in women in the city of Cartagena. Methods: A cross-sectional analytical study, with a population of 237,751 women was carried out. Informed consent was requested from each participant as national and international ethic norms request. Women from the urban area of the city of Cartagena were included, selected through multistage sampling. A social-demographic survey and the section related to cervical cancer in the National Demographic and Health Survey (ENDS - 2010) was used. Descriptive and inferential statistics analysis were applied to the data. Results: A total of 915 women with an average age of 40 years (SD = 12.9 years) participated. The prevalence of cytology was 85.9%, only 39.8% (313) which meets the scheme proposed by the national standard. The variables explaining the proper use of cytology by women from Cartagena are: be over 29 years old (OR: 2.1 - CI: 1.3-3.4), pick up the result of the test (OR: 2.5 - CI: 1.1-5.7), have an abnormal result (OR: 0.5 CI 0.2 to 0.9) and belong to the subsidized health care coverage or not having health care coverage (OR: 0.5 - CI: 0.4-0.8). Conclusions: Factors associated with the use of cytology in women in the city of Cartagena according to the scheme proposed by the national standard is explained by, demographic, economical and social health factors.

Objetivo: Determinar os fatores associados ao uso da citologia em mulheres da cidade de Cartagena. Metodologia: Realizou se um estudo analítico de corte transversal, em uma povoação de referencia de 237.751 mulheres. Solicitou se consentimento informado a cada participante de acordo às normas éticas nacionais e internacionais Foram incluídas mulheres da área urbana da cidade de Cartagena, selecionadas mediante uma amostragem polietápico (Nesta as unidades que finalmente compõem a amostragem se determinam em etapas sucessivas). Aplicou-se uma enquete sócia - demográfica e o apartado relacionado com câncer de colo uterino da Enquete Nacional de Demografia e Saúde (ENDS - 2010). Aos dados se aplicou estadística descritiva e inferencial. Resultados: Participaram 915 mulheres com uma idade média de 40 anos (DE = 12,9 anos). A prevalência de uso da citologia foi do 85,9%; só 39,8% (313) faz o esquema proposto pela norma técnica nacional. As variáveis que explicam o uso adequado da citologia por parte das mulheres de Cartagena são: ser maior de 29 anos (OR: 2,1 - IC: 1,3-3,4), reclamar o resultado (OR: 2,5 - IC: 1,1-5,7), ter um resultado anormal (OR: 0,5 - IC: 0,2-0,9) e pertencer ao regime subsidiado ou não ter afiliação e saúde (OR: 0,5 - IC: 0,4-0,8). Conclusões: Os fatores associados ao uso da citología em mulheres da cidade de Cartagena, de acordo ao esquema proposto pela norma técnica nacional, se explicam por fatores demográficos, econômicos e sócio -sanitários.

Comparison Between Pap Smear and Via As Screening For Cervical Lesions.

An important reason for higher cervical cancer incidence in developing countries is lack of effective screening programs like pap smear, aimed at detecting precancerous conditions before they progress to invasive cancer. The potential difficulties in implementing cervical cytology based screening in low-resource settings have prompted the investigation of accuracy of alternative low technology tests such as Visual inspection with acetic acid application [VIA], Visual inspection with acetic acid application with magnification [VIAM], visual inspection on Lugol’s Iodine application [VILI] in early detection of cervical neoplasia .In our study we compared pap smear with VIA to study the accurarcy of VIA as it is simpler and easier technique to be used as screening in low resource settings. Aim: This is a hospital based descriptive, prospective study to evaluate validity of pap smear and VIA techniques as screening tests in identifying cervical lesions. Materials And Methods: After general and systemic examination as a routine,visual local pelvic examination including visualisation of cervix and vagina per speculum and the findings are documented in the proforma .Then VIA and pap smear are done in that order, if any of these tests are positive then cervical biopsy will be taken and further advise to the subject is given. Results: A total of 313 women were involved in the study. The sensitivity of pap smear is 54.5% specificity is 98.9% while that of VIA 95.4% and 97.9%respectively. We found that VIA accuracy was comparatively more than that of pap smear. Conclusion: In low resource settings, usefulness of VIA is more than that of pap smear. We suggest to perform VIA in all the women inspite of having pap smear facility to improve detection rate of cervical lesions and provide better patient councelling and treatment.