Práticas de enfermeiros na prevenção e rastreio do câncer de mama e de colo uterino / Practices performed by nurses in the prevention and screening of breast and cervical cancer / Prácticas de enfermería en la prevención y detección del cáncer de mama y cervicouterino

Objetivo: Identificar como ocorrem as práticas de prevenção e de rastreio do câncer de mama e de colo uterino realizadas por enfermeiros que atuam na Atenção Primária à Saúde do Rio Grande do Sul. Métodos: Trata-se de um estudo de abordagem qualitativa e de natureza analítica e compreensiva. Realizou-se entrevistas semiestruturadas. Os dados foram submetidos à análise de conteúdo do tipo temática proposta por Minayo. Os colaboradores foram 58 enfermeiros atuantes na Atenção Primária à Saúde. Resultados: Os resultados apontam que as práticas se desenvolvem em um contexto de crescente autonomia profissional e de protagonismo da Enfermagem. Aspectos como proximidade e vínculo com a comunidade, outros procedimentos e ações ofertadas nos atendimentos, incluindo a condução clínica/terapêutica, na vigência de sinais e sintomas de infecção, condizem com uma atenção mais ampla às necessidades de saúde e de cuidado às mulheres. Conclusão: O estudo evidencia a importância do respaldo de protocolos para a atuação segura das práticas dos enfermeiros da Atenção Básica, visando a prevenção e rastreio do câncer de mama e de colo uterino. Esses instrumentos devem ser de fácil acesso e constantemente atualizados a fim de garantir a padronização preconizada pelo Ministério da Saúde. (AU)

Objective: To identify how the breast and cervical cancer prevention and screening practices performed by nurses working in Primary Health Care in the state of Rio Grande do Sul occurs. Methods: This is a qualitative study with an analytical and comprehensive nature. The collaborators were 58 nurses working in Primary Health Care. Results: The results indicate that the practices are developed in a context of increasing professional autonomy and the role of Nursing. Aspects such as proximity and bonding with the community, other procedures and actions offered in the consultations, including clinical/therapeutic management in cases of signs and symptoms of infection, are consistent with a broader attention to women's health and care needs. Conclusion: The study highlights the importance of supporting protocols for the safe performance of Primary Care nurses' practices, aiming at the prevention and screening of breast and cervical cancer. These documents must be easily accessible and constantly updated in order to guarantee the standardization recommended by the Ministry of Health. (AU)

Objetivo: Identificar cómo las prácticas de prevención y detección del cáncer de mama y cervicouterino son realizadas por enfermeros que actúan en la Atención Primaria de Salud en Rio Grande do Sul. Métodos: Se trata de un estudio cualitativo de carácter analítico y comprensivo. Los colaboradores fueron 58 enfermeros que actuaban en la Atención Primaria de Salud. Resultados: Los resultados indican que las prácticas se desarrollan en un contexto de aumento de la autonomía profesional y del papel de la Enfermería. Aspectos como la proximidad y el vínculo con la comunidad, otros procedimientos y acciones que se ofrecen en las consultas, incluido el manejo clínico/terapéutico en casos de signos y síntomas de infección, son consistentes con una atención más amplia a las necesidades de salud y cuidado de las mujeres. Conclusión: El estudio destaca la importancia de protocolos para la actuación segura de las prácticas de los enfermeros de Atención Primaria, con el objetivo de la prevención y el tamizaje del cáncer de mama y de cuello uterino. Estos instrumentos deben ser de fácil acceso y constantemente actualizados para garantizar la estandarización recomendada por el Ministerio de Salud. (AU)

Distribuição de óbitos devido ao câncer do colo do útero nos municípios de extrema pobreza, Brasil, 2000 a 2018 / Distribution of deaths due to cervical cancer in extreme poverty municipalities, Brazil, from 2000 to 2018

Resumo Introdução: O câncer do colo uterino (CCU) permanece uma importante causa de morte nas regiões mais pobres do mundo. Objetivo: Analisar tendências da distribuição relativa de óbitos por CCU ocorridos nos municípios de extrema pobreza (EP) do Brasil, de 2000 a 2018. Método: A distribuição relativa de óbitos por CCU nos municípios de EP foi avaliada em relação ao total de óbitos observados em cada Unidade Federativa (UF). Uma modelagem autorregressiva foi usada para avaliar as tendências temporais da distribuição relativa de óbitos de 2000 a 2018. Resultados: De 2000 a 2018, houve 94.065 óbitos por CCU no Brasil, e 10,7% deles ocorreram nos municípios de EP. Seis estados (Amazonas, Roraima, Pará, Amapá, Tocantins e Mato Grosso do Sul) tiveram 100% dos seus municípios de EP reportando a ocorrência desses óbitos. As tendências na distribuição de óbitos nos municípios de EP em relação ao total de óbitos de cada UF seguiram em elevação em onze estados brasileiros. Conclusões: O CCU é doença prioritária das políticas públicas do Brasil, e as tendências desses óbitos observadas nos municípios mais pobres apontam que mais atenção deve ser dada a estas unidades de análise, a fim de melhorar a saúde das pessoas mais pobres.

Abstract Background: Cervical cancer (CC) remains a major cause of death in the poorest regions of the world. Objective: To analyze trends in relative distribution of CC deaths occurred in extreme poverty municipalities, Brazil, from 2000 to 2018. Method: The relative distribution of CC deaths occurred in extreme poverty municipalities was evaluated in relation to total number of CC deaths observed in each Federative Unit (FU). An autoregressive modeling was used to assess the temporal trends in the death distribution, 2000-2018. Results: From 2000 to 2018, there were 94,065 CC deaths, and 10.7% of them were recorded in extreme poverty municipalities. There were six states (Amazonas, Roraima, Pará, Amapá, Tocantins, and Mato Grosso do Sul) with 100.0% of extreme poverty municipalities reporting the occurrence of these deaths. The trends of death distribution in extreme poverty municipalities in relation to the total of deaths in each FU followed in increasing trends in eleven Brazilian FU. Conclusions: CC is a disease prioritized by public policies in Brazil, and the trends of these deaths observed in the poorest municipalities point out that more attention should be given to these units of analysis, in order to improve the health of the poorest people.

Iniquidade racial na mortalidade por câncer de colo de útero no Brasil: estudo de séries temporais de 2002 a 2021 / Racial iniquity in mortality from cervical cancer in Brazil: a time trend study from 2002 to 2021

Resumo O objetivo desse artigo é analisar séries temporais da mortalidade por câncer de colo do útero segundo raça/cor no Brasil de 2002 a 2021. Estudo ecológico de séries temporais com dados do Sistema de Informação sobre Mortalidade e informações populacionais do IBGE. Variações anuais das taxas de mortalidade ajustadas por idade de mulheres de 20 anos ou mais foram estimadas pelo modelo de regressão linear simples com correção de Prais-Winsten. Foram registrados 133.429 óbitos por câncer de colo de útero, destes, 51,2% foram de mulheres negras. As mulheres negras morrem mais e têm menor queda do coeficiente. Houve aumento da desigualdade racial ao longo dos anos. Em 2002, ocorriam 0,08 óbitos/100 mil mulheres a mais na população negra comparada com a população branca; em 2021 esse número é de aproximadamente 1 óbito. Para a elaboração de políticas de saúde da mulher devem ser consideradas as diferenças raciais na implementação de estratégias e metas.

Abstract This ecological study examined time series, from 2002 to 20121, of age-adjusted coefficients of cervical cancer mortality, in Brazil, in women aged 20 years or more, by race. The information sources were Brazil's mortality information system (Sistema de Informação sobre Mortalidade - SIM) and the official bureau of statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). Annual changes in age-adjusted mortality rates were calculated using the Prais-Winsten linear regression method. Black women die more and the rate is decreasing less. Racial inequality has increased over the years. In 2002, there were 0.08 more deaths per 100,000 women in the black population than among white women; in 2021, the number was one death. Health policymaking should consider racial differences in the implementation of strategies and goals.

Estandarización de PCR en tiempo real para detección y cuantificación de los oncogenes E7 de seis Virus del Papiloma Humano de Alto Riesgo

El cáncer de cuello uterino es causado por la infección persistente del epitelio cervical con los genotipos de alto riesgo del Virus del Papiloma Humano. Para su detección se realizan pruebas moleculares que detectan el gen L1 del VPH. Este gen puede perderse hasta en el 11 % de los casos durante la integración del ADN viral en el genoma del hospedero originando falsos negativos. Por otra parte, el oncogén E7 se expresa durante todas las etapas de progresión de la enfermedad. El objetivo de este trabajo fue estandarizar una PCR en tiempo real del oncogén E7 (E7-qPCR) para genotipificación y cuantificación de 6 VPH-AR. Los resultados muestran que la E7- qPCR amplificó VPH-16, -18, -31, -33, -35 y -45 con una alta sensibilidad con límites de detección desde 102 copias, eficiencias entre 90 y 110 %, valores R2 > 0,97 y análisis de curva de fusión que revelan productos específicos.

Cervical cancer is caused by persistent infection of the cervical epithelium with the high-risk genotypes of the Human Papilloma Virus (HR-HPV). For its detection, molecular tests are carried out that detect the L1 gene of HPV. This gene can be lost in up to 11 % of cases during the integration of viral DNA into the host genome, causing false negatives. On the other hand, the E7 oncogene is expressed during all stages of disease progression. The aim of this work was to standardize a real-time PCR of the E7 oncogene (E7-qPCR) for genotyping and quantification of 6 HR-HPV. The results show that the E7-qPCR amplified HPV-16, -18, -31, -33, -35 and -45 with high sensitivity with detection limits from 102 copies, efficiencies between 90 and 110 %, R2 values >0,97 and melting curve analysis revealing specific products.

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group? / Câncer cervical subestimado entre mulheres com mais de 65 anos: É hora de rever a faixa etária alvo do rastreamento?

Abstract Objective To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not. Methods The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not. Results Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188-15.932; p = 0.0002). Conclusion Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.

Resumo Objetivo Comparar os resultados citológicos e histológicos de mulheres > 64 anos que seguiram as diretrizes nacionais brasileiras de rastreamento do câncer do colo do útero com aquelas que não as seguiram. Método O presente estudo observacional retrospectivo analisou 207 resultados anormais de esfregaço cervical de mulheres > 64 anos de idade em uma cidade de médio porte no Brasil durante 14 anos. Todos os resultados foram relatados de acordo com o Sistema Bethesda. As mulheres foram divididas entre as que seguiram as diretrizes de rastreamento e as que não o fizeram. Resultados Resultados citológicos com células escamosas atípicas de significado indeterminado e lesão intraepitelial escamosa de baixo grau foram encontrados em 128 (62,2%) casos. Destes, 112 (87,5%) repetiram a citologia com resultados positivos. Os outros 79 (38,1%) com resultados anormais deveriam ter sido encaminhados para colposcopia e biópsia. Das 41 (51,9%) mulheres biopsiadas, 23 (29,1%) tiveram diagnóstico confirmado de neoplasia ou lesão precursora. Em contrapartida, entre as 78 (37,7%) pacientes biopsiadas, 40 (51,3%) seguiram as recomendações da diretriz, com 9 (22,5%) biópsias positivas. Entre as 38 (48,7%) mulheres que não seguiram as orientações, houve 24 (63,1%) resultados positivos. As mulheres que não seguiram as diretrizes demonstraram maiores chances de câncer e lesões precursoras (odds ratio [OR]: 5,904; intervalo de confiança [IC] de 95%: 2,188-15,932; p = 0,0002). Conclusão Mulheres > 64 anos que não seguiram a diretriz nacional de rastreamento apresentaram diferenças significativas na frequência de resultados anormais e gravidade do diagnóstico em comparação com aquelas que seguiram a diretriz.

Survival of patients living with HIV and cancer in Cali, Colombia

Background: People living with HIV have an increased risk of cancer compared to the general population. However, with the increase in life expectancy and advances in antiretroviral therapy, the survival of patients with cancer and HIV has changed. Objective: To determine the survival of patients living with HIV and cancer in Cali, Colombia Methods: A retrospective cohort study was conducted at the Fundación Valle del Lili, Cali, Colombia. Data from the HIV database was crossed with data from the hospital and population-based cancer registries between 2011-2019. Patients <18 years, limited available clinical information on the diagnosis and treatment of HIV and cancer, and non-oncological tumor diagnosis were excluded. Results: A total of 173 patients were included. The frequencies of AIDS-defining neoplasms were: Non-Hodgkin lymphoma (42.8%), Kaposi sarcoma (27.8%), and cervical cancer (4.6%). Overall survival was 76.4% (95% CI 68.9-82.3) at five years. Poorer survival was found in patients with AIDS-defining infections (56.9% vs. 77.8%, p=0.027) and non-AIDS-defining infections (57.8% vs. 84.2%, p=0.013), while there was better survival in patients who received antiretroviral therapy (65.9% vs. 17.9%, p=0.021) and oncological treatment (66.7% vs. 35.4%, p<0.001). The presence of non-AIDS-defining infections increases the risk of dying (HR = 2.39, 95% CI 1.05-5.46, p=0.038), while oncological treatment decreases it (HR = 0.33, 95% CI 0.14-0.80, p=0.014). Conclusions: In people living with HIV, Non-Hodgkin lymphoma and Kaposi sarcoma are the most common neoplasms. Factors such as AIDS-associated and non-AIDS-associated infections have been identified as determinants of survival. Cancer treatment seems to improve survival.

Antecedentes: Las personas que viven con VIH tienen un riesgo mayor de cáncer en comparación con la población general. Sin embargo, con el aumento de la esperanza de vida y los avances en la terapia antirretroviral, la supervivencia de los pacientes con cáncer y VIH ha cambiado. Objetivo: Determinar la supervivencia de los pacientes que viven con VIH y cáncer en Cali, Colombia. Métodos: Se realizó un estudio de cohorte retrospectivo en la Fundación Valle del Lili, Cali, Colombia. Los datos de la base de datos de VIH se cruzaron con los datos de los registros de cáncer de base hospitalaria y poblacional entre 2011-2019. Se excluyeron los pacientes <18 años, con información clínica limitada disponible sobre el diagnóstico y tratamiento del VIH y el cáncer y los casos con diagnóstico de tumor no oncológico. Resultados: Se incluyeron un total de 173 pacientes. Las frecuencias de neoplasias definitorias de SIDA fueron: linfoma no Hodgkin (42.8%), sarcoma de Kaposi (27.8%) y cáncer cervical (4.6%). La supervivencia global fue del 76.4% (IC 95% 68.9-82.3) a los cinco años. Se encontró una peor supervivencia en pacientes con infecciones definitorias de SIDA (56.9% vs. 77.8%, p=0.027) e infecciones no definitorias de SIDA (57.8% vs. 84.2%, p=0.013), mientras que hubo una mejor supervivencia en pacientes que recibieron terapia antirretroviral (65.9% vs. 17.9%, p=0.021) y tratamiento oncológico (66.7% vs. 35.4%, p<0.001). La presencia de infecciones no definitorias de SIDA aumentó el riesgo de morir (HR = 2.39, IC 95% 1.05-5.46, p=0.038), mientras que el tratamiento oncológico lo disminuyó (HR = 0.33, IC 95% 0.14-0.80, p=0.014). Conclusiones: En las personas que viven con VIH, el linfoma no Hodgkin y el sarcoma de Kaposi son las neoplasias más comunes. Se han identificado factores como las infecciones asociadas al SIDA y las infecciones no asociadas al SIDA como determinantes de la supervivencia. El tratamiento del cáncer parece mejorar la supervivencia.

Desmistificando a coleta citopatológica: uma forma de prevenir o câncer de colo do útero / Demystifying cytopathological collection: a way to prevent cervical cancer

Objetivo: Relatar uma ação de Educação em Saúde sobre a prevenção do câncer de colo uterino por meio da citologia. Método: Trata-se de um relato de experiência vivenciado por uma enfermeira durante uma ação a dez mulheres sobre a importância da coleta citopatológica para prevenção desse câncer. Foi realizada em maio de 2023, em uma unidade básica de saúde e dividida em três momentos: no primeiro, foi realizado um Brainstorm, no segundo um pré-teste utilizando uma dinâmica e o terceiro momento foi o pós-teste. Resultado: Foi evidenciado que as mulheres não tinham entendimento correto sobre a coleta citopatológica, as etapas do exame, ou seja, o conhecimento era insuficiente e não se sentiam preparadas para falar sobre o assunto. Conclusão: A ação permitiu um maior conhecimento das usuárias e das suas necessidades de entendimento e esclarecimentos sobre a coleta citopatológica, levando em consideração a sua importância no rastreio precoce de câncer de colo do útero.(AU)

Objective: To report a Health Education action on the prevention of cervical cancer through cytology. Method: This is an experience report lived by a nurse during an action with ten women on the importance of cytopathological collection for the prevention of this cancer. It was carried out in May 2023, in a basic health unit and divided into three moments: in the first, a Brainstorm was performed, in the second, a pre-test using a dynamic and the third moment was the post-test. Result: It was evidenced that the women did not have a correct understanding of the cytopathological collection, the examination steps, that is, the knowledge was insufficient and they did not feel prepared to talk about the subject. Conclusion: The action allowed for a greater knowledge of the users and their needs for understanding and clarification about the cytopathological collection, taking into account its importance in the early screening of cervical cancer.(AU)

Objetivo: Relatar un programa de educación sanitaria sobre la prevención del cáncer de cuello de útero mediante la citología. Método: Este es un informe de la experiencia de una enfermera durante una acción con diez mujeres sobre la importancia de la recolección citopatológica para prevenir este cáncer. Tuvo lugar en mayo de 2023 en una unidad básica de salud y se dividió en tres etapas: la primera fue una lluvia de ideas, la segunda fue un pre-test mediante dinámicas y la tercera fue el post-test. Resultados: Quedó claro que las mujeres no tenían una comprensión correcta de la colecta citopatológica y de las etapas del examen, o sea, sus conocimientos eran insuficientes y no se sentían preparadas para hablar del tema. Conclusión: La acción permitió una mayor concienciación de las usuarias y su necesidad de comprensión y aclaración sobre la colecta citopatológica, teniendo en cuenta su importancia en el cribado precoz del cáncer de cuello uterino.(AU)

Perfil sociodemográfico e citológico de mulheres em investigação de neoplasia cérvico-uterina em um serviço secundário / Sociodemographic and cytological profile of women undergoing investigation for cervical-uterine neoplasia in a secondary service

Objetivo: analisar o perfil sociodemográfico e comparar as diferenças das características de mulheres com alterações citológicas de alto grau em um serviço da atenção secundária. Método: estudo transversal retrospectivo de 2017 a 2021 realizado em 160 prontuários (CAAE 51800621.3.0000.5240). Resultados: predominaram mulheres com média de idade 40,7 anos, escolaridade abaixo do ensino médio, tiveram um a três filhos, não utilizavam preservativos e anticoncepcionais, não tabagistas e com alterações citopatológicas alto grau. As características com maiores percentuais para lesões citopatológicas de alto grau foram mulheres com quatro ou mais gestações, idade do parto menor ou igual a 18 anos, coitarca menor ou igual a 15 anos e tabagistas. Conclusão: serviços da rede de atenção, especialmente da atenção primária à saúde, devem capacitar permanentemente os profissionais visando cumprimento de fluxos assistenciais preconizadas pelas recomendações das diretrizes brasileiras de rastreamento da neoplasia cérvico-uterina atentando ao perfil encontrado de mulheres encaminhadas a atenção secundária.(AU)

Objective: analyzes the sociodemographic profile and compare the differences in the characteristics of women with high-grade cytological alterations in a secondary care service. Method: retrospective cross-sectional study from 2017 to 2021 carried out in 160 medical records (CAAE 51800621.3.0000.5240). Results: women predominated with a mean age of 40.7 years, education below high school, had one to three children, did not use condoms and contraceptives, non-smokers and with high-grade cytopathological alterations. The characteristics with the highest percentages for high-grade cytopathological lesions were women with four or more pregnancies, age at birth less than or equal to 18 years, coitarche less than or equal to 15 years, and smokers. Conclusion: services of the care network, especially primary health care, should permanently train professionals in order to comply with the care flows recommended by the recommendations of the Brazilian guidelines for screening cervical uterine neoplasia, paying attention to the profile found of women referred to secondary care.(AU)

Objetivo: analizar el perfil sociodemográfico y comparar las diferencias en las características de mujeres con alteraciones citológicas de alto grado en un servicio de segundo nivel de atención. Método: estudio transversal retrospectivo de 2017 a 2021 realizado en 160 historias clínicas (CAAE 51800621.3.0000.5240). Resultados: predominaron las mujeres con edad media de 40,7 años, escolaridad inferior a la secundaria, con uno a tres hijos, no usuarias de preservativo y anticonceptivos, no fumadoras y con alteraciones citopatológicas de alto grado. Las características con mayor porcentaje de lesiones citopatológicas de alto grado fueron mujeres con cuatro o más embarazos, edad al nacer menor o igual a 18 años, coitarquia menor o igual a 15 años y fumadoras. Conclusión: servicios de la red de atención, especialmente la atención primaria a la salud, deben capacitar permanentemente a los profesionales para cumplir con los flujos de atención recomendados por las recomendaciones de las directrices brasileñas para el tamizaje de la neoplasia cérvico-uterina, prestando atención al perfil encontrado de las mujeres referidas atención secundaria.(AU)

Impacto de una intervención educativa en el conocimiento de la prevención de la neoplasia del cuello uterino en estudiantes de enfermería y sus familias / Impact of an educational intervention on the knowledge of cervical cancer prevention in nursing students and their families

Resumen El objetivo fue evaluar el impacto de una intervención educativa en el conocimiento de la prevención de la neoplasia del cuello uterino en un grupo de estudiantes de enfermería y sus familias bajo el modelo de Nola Pender. El método fue un estudio cuasi-experimental con muestra no probabilística; se evaluó el conocimiento sobre la prevención y el control de la neoplasia del cuello uterino antes y después de una intervención educativa utilizando la encuesta validada por la Dra. Dina Rubio en 2009 con su previo consentimiento. La información fue tabulada mediante una hoja de cálculo del programa Microsoft Excel; se calcularon frecuencias específicas y frecuencias absolutas, y para el análisis se tomó el modelo de Nola Pender. Los resultados desde el punto de vista estadístico fueron que hay una información instalada en la estructura mental de las participantes sobre lo que es, implica y comporta como riesgo la neoplasia del cuello uterino. La percepción que está en el fondo de sus creencias denota un nivel favorable de conciencia y claridad, lo que posibilita que en las prácticas de autocuidado y la aplicación de la citología se reconozca frecuencia de uso, regularidad en el tiempo y atención a los resultados. En conclusión, al evaluar el impacto de la intervención educativa a través del modelo de Nola Pender se encontraron cambios en los conocimientos y un modelo ideal para utilizarse en grupos poblacionales heterogéneos en edades, niveles educativos, formación profesional y hábitos sexuales, porque integra la experiencia personal, el entorno y las prácticas de salud como tres elementos sin los cuales no es posible practicar el autocuidado y la cultura de intervención.

Abstract A large number of factors influence the level of information that people may have regarding cervical cancer and the way to prevent it, since education is not only provided by health personnel but also by the family. When making important decisions regarding self-care, people must have effective sex education, in which protection is of vital importance, since misinformation is one of the main factors that promotes cervical cancer. The objective of this study was to evaluate the impact of an educational intervention on the knowledge of cervical cancer prevention in a group of nursing students and their families under the Nola Pender model. The method used in the study was a quasi-experimental, non-probabilistic sample; the knowledge about cervical cancer prevention and control was evaluated before and after the intervention, using the survey validated by Dr. Dina Rubio in 2009 (with her consent). The information was included in a Microsoft Excel spreadsheet: the items were placed in columns and the subjects were included in the rows. Specific frequencies and absolute frequencies were calculated, the Nola Pender model was used for the analysis. The units of analysis were selected manually or randomly and these selections do not depend on probability but are generated based on the criteria of the researcher or the specific needs of the research. From a statistical point of view, information about what cervical cancer is, what it implies and how it behaves as a risk is engrained in the mental structure of the participants. To these implications of a technical and methodological nature, others of a structural and conceptual nature are added to build an integrative analysis of the results obtained in the field work. In this case, they include opinions, appraisals, judgments, and evaluations about cervical cancer. This research was organized in the following stages: (1) Evaluation of prior knowledge on cervical cancer prevention and control. The starting point of the investigation was the recognition that the participating women had a basic conceptual scaffolding, acquired through their own experience and self-training or by going to sources such as academia, social networks, specialized magazines, health institutions, medical staff and other specialists who help in the creation of an important background to consolidate an individual perspective. (2) Application of an educational intervention. In this stage, designed workshops were implemented and evaluated by the students with the advice of a teacher, and included the following topics: general concepts, signs and symptoms, associated risk factors, screening techniques, benefits, and exam precautions. The students contributed a theoretical, methodological and evaluative foundation to the design of each workshop, considering the expected training objectives, the characteristics included in its development, and a diversity of pedagogical actions that guarantee the efficiency of the transmitted message. (3) Reevaluation of the knowledge acquired. By applying a post-test, the knowledge acquired during the implementation of the workshops was recovered and resized. In this stage, the variability of the responses measured the transforming effect of the training, either by improving the knowledge acquired or by introducing new knowledge into the participant's cognitive model. The perception that participants have about self-care practices is linked to their beliefs, denoting a favorable level of awareness and clarity, which makes it possible for the application of cytology to recognize the frequency of use, regularity over time, and attention to the results. In conclusion, when evaluating the impact of educational intervention through the Nola Pender model, changes in knowledge were found. Results also indicate that this is an ideal model for employees in heterogeneous popu lation groups in ages, educational levels, professional training, and sexual habits, because it integrates personal experience, the environment and health practices as three elements without which it is not possible to practice self-care and the culture of intervention.

Perfil sociodemográfico de mulheres com câncer de colo do útero: avaliação da qualidade de vida / Sociodemographic profile of women with cervical cancer: quality of life evaluation / Perfil sociodemográfico de mujeres con cáncer de cuello uterino: evaluación de la calidad de vida

O câncer de colo do útero é um importante problema de saúde pública. Este trabalho objetiva avaliar a qualidade de vida de mulheres com câncer de colo do útero. Para tanto, foi realizado um estudo transversal com abordagem quantitativa, realizado com 175 mulheres em tratamento do câncer do colo do útero em um hospital de referência. Predominou a faixa etária de 40 a 59 anos (56%) com o diagnóstico, a maioria das pacientes eram pardas (69,8%), com ensino fundamental incompleto (44,7%) e casadas (42,3%). Com relação aos dados clínicos, a maioria referiu menarca aos > 12 anos (89,7%), coitarca aos < 18 (74,3%) e até cinco parceiros sexuais (88,6%). O tumor mais presente foi o carcinoma de células escamosas, com 90,3% dos casos; o estadiamento T3b/IIIB esteve em 41% dos registros; e 42,8% dos casos associaram radioterapia e quimioterapia para tratamento. A qualidade de vida pelo estado de saúde global foi satisfatória, com 72,1. Quanto aos domínios, na escala funcional a função social obteve média de 84,2, e, na escala de sintomas, a dificuldade financeira de 66,7. A qualidade de vida foi considerada satisfatória entre as pacientes, o que sinaliza melhoria das terapêuticas em saúde, planos de cuidado eficazes e trabalho em equipe multiprofissional que condiciona uma boa prática clínica.

Cervical cancer is an important public health problem. This work aims to evaluate the quality of life of women with cervical cancer. To that end, a cross-sectional study with a quantitative approach was carried out with 175 women undergoing treatment for cervical cancer at a reference hospital. There was a predominance of the age group between 40 and 59 years old (56%) at diagnosis, most patients were brown (69.8%), with incomplete primary education (44.7%), and married (42.3%). Regarding clinical data, most reported menarche > 12 years old (89.7%), coitarche with < 18 years old (74.3%), and had up to 5 sexual partners (88.6%). The most frequent tumor was squamous cell carcinoma, with 90.3% of the cases; the T3b/IIIB staging showed in 41% of the records; and 42.8% of the cases associated radiotherapy and chemotherapy for treatment. The quality of life by global health status was satisfactory, with 72.1. Regarding the domains, on the functional scale, the social function obtained a mean of 84.2 and, in the scale of symptoms, the financial difficulty, of 66.7. The quality of life was considered satisfactory among the patients, which indicates the improvement of the therapies in health, effective care plans, and multidisciplinary teamwork that conditions good clinical practice.

El cáncer de cuello uterino es un importante problema de salud pública. El objetivo de este trabajo fue evaluar la calidad de vida de mujeres con cáncer de cuello uterino. Para ello, se realizó un estudio transversal, de enfoque cuantitativo, con 175 mujeres en tratamiento por cáncer de cuello uterino en un hospital de referencia. Predominó el grupo etario de 40 a 59 años, con un 56% al momento del diagnóstico, la mayoría de las pacientes eran pardas (69,8%), el nivel de educación primaria incompleta (44,7%) y casadas (42,3%). Con respecto a los datos clínicos, la mayoría refirió menarquia > 12 años (89,7%), edad de coito < 18 años (74,3%) y tuvo hasta cinco parejas sexuales (88,6%). El tumor más frecuente fue el carcinoma epidermoide en el 90,3% de los casos, la estadificación T3b/IIIB estuvo presente en el 41% de los registros, y en el 42,8% de los casos se asoció radioterapia y quimioterapia para el tratamiento. La calidad de vida por estado de salud global fue satisfactoria en un 72,1. En cuanto a los dominios, en la escala funcional, la función social obtuvo el promedio del 84,2, y en la escala de síntomas, la dificultad financiera presentó el 66,7. La calidad de vida se consideró satisfactoria entre las pacientes, lo que señala la mejora de las terapias de salud, planes de atención efectivos y trabajo en equipo multidisciplinario que permite una buena práctica clínica.

Intervención educativa prevención del cáncer cérvico-uterino en mujeres del consultorio 7, Las Flores. Nuevitas

Fundamento: el cáncer cérvico-uterino representa el 10 % de todas las causas de cáncer. Su prevenciòn resulta imprescindible y educar al respecto es fundmaental. Objetivo: describir resultados de una intervención educativa sobre el cáncer cérvico-uterino en mujeres del Consultorio 7, Nuevitas. Métodos estudio de intervención que incluyó 86 mujeres de 18 a 55 años de edad, del Policlínico Comunitario Docente X Aniversario, de Nuevitas, Camagüey. Se aplicó una encuesta que permitió medir el nivel de conocimientos antes y después de la intervención educativa. Se analizaron las variables edad, nivel de escolaridad, conocimiento sobre factores de riesgo y manifestaciones sospechosas y sobre la prueba citológica. Resultados: predominaron las mujeres con nivel primario terminado y las menores de 44 años. Al inicio del estudio mostraron bajo conocimiento sobre factores de riesgo, sobre todo el inicio de relaciones sexuales tempranas (54,6 %) y las infecciones por el papiloma virus, VIH/sida y el herpes genital (56,9 %). El 65, 11 % no conocía que el flujo vaginal es una manifestación sospechosa, y el 82, 5 % poseía un conocimiento insuficiente sobre la prueba citológica. Todos estos parámetros aumentaron por encima del 80 % y la mayoría del 95 % después de la intervención, excepto el conocimiento sobre la dieta inadecuada como factor de riesgo, que solo ascendió a 70, 9 %. Conclusiones: se logró un incremento notable de los conocimientos sobre los factores de riesgo, las manifestaciones sospechosas y la importancia de la prueba citològica, lo cual implica un beneficio en la prevención del cáncer cérvico-uterino.

Background: cervical-uterine cancer represents 10% of all cancer causes. Its prevention is essential and educating about it is fundamental. Objective: to describe the result of an educational intervention on cervical-uterine cancer in women from doctor's office 7, Nuevitas. Methods: intervention study that included 86 women from 18 to 55 years of age, from the X Anniversary Community Teaching Polyclinic, in Nuevitas, Camagüey. A survey was applied that allowed measuring the knowledge level before and after the educational intervention. The analyzed variables were age, educational level, knowledge about risk factors and suspicious manifestations, and about the cytological test. Results: there was a predominance of women with completed primary level and those under 44 years of age. At the beginning of the study, they showed low knowledge about risk factors, especially the beginning of early sexual relations (54.6%) and infections by papilloma virus, HIV/AIDS and genital herpes (56.9%). 65.11% did not know that vaginal discharge is a suspicious manifestation, and 82.5% had insufficient knowledge about the cytological test. All these parameters increased above 80% and most of them 95% after the intervention, except knowledge about inadequate diet as a risk factor, which only rose to 70.9%. Conclusions: a notable increase in knowledge about risk factors, suspicious manifestations and the importance of the cytological test was achieved, which implies a benefit in the prevention of cervical-uterine cancer.

Condiciones que favorecen el desarrollo del cáncer cervicouterino en la adolescencia

La adolescencia es un período de la vida del ser humano caracterizado por diversos cambios biológicos, físicos y emocionales que condicionan las peculiaridades de la vida adulta posterior. El cáncer del cuello uterino tiene importancia médica, socioeconómica y humana. Es el más curable, más fácilmente diagnosticable y el más prevenible de todos los cánceres. Sus efectos negativos suelen ser devastadores para el estado de salud general de las mujeres que lo adquieren. Se realizó una revisión bibliográfica de artículos en el período comprendido desde enero a diciembre 2021. Se utilizaron las bases de datos científicas: Pubmed, Scielo y el buscador Google Académico. La indagación se realizó en artículos nacionales e internacionales, a texto completo, estos se sometieron a una lectura crítica y se utilizaron como métodos teóricos: análisis histórico-lógico y análisis-síntesis y entre los empíricos: el análisis documental. El objetivo de esta revisión es mostrar las condiciones biológicas y conductuales que favorecen el desarrollo del cáncer cervicouterino en la adolescencia.

Adolescence is a human life period characterized by various biological, physical and emotional changes that influence the later adult life. Cervical cancer has medical, socioeconomic, and human significance. It is the most curable, easily diagnosed and even the most preventable of all cancers. Its negative effects are often devastating for the women' general state of health who acquire it. A bibliographic review of articles was carried out from January to December 2021. The scientific databases used were: Pubmed, Scielo and the Google Scholar search engine. The search was made in national and international articles, with full texts, these were subjected to a critical reading using as theoretical methods: historical-logical analysis and analysis-synthesis and among the empirical ones: documentary analysis. The objective of this review is to show the biological and behavioral conditions that favor the development of cervical cancer in adolescence.

A New Brazilian Device for Cervical Cancer Screening: Acceptability and Accuracy of Self-sampling / Um Novo Dispositivo Brasileiro para Diagnóstico de Câncer Cervical: Aceitabilidade e Precisão da Autoamostragem

Abstract Objective To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix® - for detecting HPV-DNA. Methods A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling. Results HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling. Conclusion Self-sampling using the new Brazilian device SelfCervix® is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.

Resumo Objetivo Avaliar a acurácia e aceitabilidade da auto-coleta utilizando um novo coletor - SelfCervix® - para a detecção de DNA de HPV. Métodos Foram incluídas no estudo 73 mulheres com idade entre 25-65 anos que realizaram seu rastreamento regular do câncer de colo do útero entre Março e Outubro de 2016. Estas mulheres realizaram a auto-coleta, seguida de coleta profissional e as amostras foram analisadas paraa presença de DNA de HPV. Após, elas responderam um questionário sobre a experiência da auto-coleta. Resultados As taxas de detecção de DNA de HPV por auto-coleta foram altas e similares as da coleta profissional. Sessenta e quatro (87,7%) pacientes responderam o questionário de experiência. A maioria (89%) considerou a auto-coleta confortável, e 82,5% preferiram o método comparado a coleta profissional. As razões citadas foram economia de tempo e conveniência. Cinquenta e uma (79,7%) mulheres confirmaram que recomendariam a auto-coleta. Conclusão Auto-coleta utilizando o novo coletor desenvolvido no Brasil não é inferior na detecção de DNA de HPV quando comparada a coleta profissional, e apresenta uma boa aceitabilidade pelas mulheres. Desta maneira, pode ser uma opção para alcançar populações que não realizam o rastreamento padrão.

Prevenção do câncer de colo uterino em homens transgênero: desafios e novas perspectivas de rastreio / Prevention of cervical cancer in transgender men: challenges and new screening perspectives

O homem transgênero apresenta alta susceptibilidade às neoplasias de colo uterino devido à escassez de exames preventivos. O estudo objetiva levantar informações acerca dos desafios e estratégias para a promoção do rastreio e prevenção do câncer cervical em homens transgênero. Trata-se de uma revisão integrativa, desenvolvida em seis etapas a partir da pergunta norteadora: "Quais os desafios e estratégias atuais para a promoção do rastreio efetivo e prevenção de câncer de colo uterino em homens transgênero?". Utilizaram-se descritores combinados com operador booleano "cervical cancer" AND "transgender persons", e foram incluídos artigos completos de 2018 a 2022. Verificou-se que os desafios enfrentados incluem preconceito, despreparo profissional e susceptibilidade à disforia de gênero. Estudos mostraram benefícios relacionados ao uso de swabs vaginais autocolhidos para reduzir o impacto psicológico do exame Papanicolaou, com vistas a reduzir os desafios enfrentados por essa população, e a necessidade de implementar estratégias que aumentem a adesão aos serviços de saúde.

Transgender men are highly susceptible to cervical cancer due to the lack of preventive screening exams. This study aims to gather information about the challenges and strategies for promoting cervical cancer screening and prevention in transgender men. This is an integrative review, developed in six stages, based on the guiding question: "What are the current challenges and strategies for promoting effective screening and prevention of cervical cancer in transgender men?". Descriptors combined with Boolean operator "cervical cancer" AND "transgender persons" were used and full articles from 2018 to 2022 were included. It was found that the challenges faced include prejudice, professional unpreparedness and susceptibility to gender dysphoria. Studies have shown benefits related to the use of self-collected vaginal swabs to reduce the psychological impact of the Pap smear exam, aiming to reduce the challenges faced by this population and to implement strategies to increase adherence to health services.

Analysis of the expression levels of microRNA-205 and microRNA -24-3p in cervical cancer tissues and their correlation with survival prognosis / 中国医师进修杂志

Objective:To analyze the expression of microRNA(miR)-205 and miR-24-3p in cervical cancer tissues and their correlation with survival prognosis.Methods:A total of 82 patients with cervical cancer(cervical cancer group), 60 patients with uterine fibroids(uterine fibroids group) and 40 healthy women (healthy control group) treated in Hubei Hospital of Integrated Traditional Chinese and Western Medicine from March 2014 to March 2015 were enrolled. The expression levels of miR-205 and miR-24-3p in the tissues of the three groups were compared. The receiver operative characteristic (ROC) curve was used to analyze the diagnostic value and zero threshold of the two indicators for cervical cancer. Analyzed the 5-year survival status of cervical cancer patients at the upper and lower thresholds, and then further discuss the risk factors that affected the prognosis of cervical cancer.Results:The relative expression levels of miR-205 and miR-24-3p in the cervical cancer group were significantly higher than those in the uterine fibroids group and the healthy control group ( P<0.01). ROC curve analysis showed that the cut-off value was 1.13 and 1.35, the area under the curve was the biggest, and the sensitivity in diagnosis of cervical cancer were 83.87%, 84.38%, the specificity were 75.00%, 82.42%.The survival rate analysis based on these results showed that the 5-year survival rate of patients with miR-205≥1.13 was 69.05%, which was significantly lower than patients with miR-205<1.13 (87.50%) ( P<0.05); the 5-year survival rate of patients with miR-24-3p≥1.35 was 68.89%, which was significantly lower than that of patients with miR-24-3p<1.35 (89.19%)( P<0.05). The results of the Cox regression model showed that moderately and highly differentiated, FIGO stage Ⅱ, depth of invasion ≥1/2, combined lymph node metastasis, and high levels of miR-205 and miR-24-3p were risk factors affecting the prognosis of cervical cancer patients ( P<0.05). Conclusions:Serum miR-205 and miR-24-3p are at high levels in cervical cancer tissues, and are closely related to the prognosis of patients. They are expected to become auxiliary diagnosis and prognostic indicators for cervical cancer.

Expression and clinical significance of stanniocalcin-2 and cellular-mesenchymal epithelial transition factor in tumor tissues in patients with cervical cancer / 中国医师进修杂志

Objective:To investigate the expression of stanniocalcin-2 (STC-2) and cellular-mesenchymal epithelial transition factor (C-met) in tumor tissues of cervical cancer patients and their clinical significance.Methods:A total of 110 cervical cancer patients were selected in Foshan First People′s Hospital from January 2014 to December 2018. Patients′ cancer tissue samples and normal tissue samples were collected during modified radical resection to determine and compare the expression levels of STC-2 mRNA and C-met mRNA in the two tissues, and to analyze the correlation between the expression levels of STC-2, C-met and the clinicopathological characteristics of the patients as well as the multivariate analysis of tumor metastasis and recurrence in the patients. The correlation between the expression of STC-2 and C-met and the time of postoperative tumor metastasis and recurrence in cervical cancer patients were analyzed after 24 months of follow-up.Results:The expression levels of C-met mRNA and STC-2 mRNA in cancer tissues were higher than those in adjacent normal tissues: 4.51 ± 1.21 vs. 3.97 ± 1.14, 2.57 ± 0.21 vs. 2.12 ± 0.24, there were statistical differences ( t = 3.41, 14.80, P<0.05). The expression of STC-2 and C-met in cancer tissues had no significant difference with age, pathological type, federation international of gynecology and obstetrics (FIGO) stage and tumor size ( P>0.05), but had significant difference with tumor recurrence or metastasis ( P<0.05). The results of Logistic multivariate analysis showed that vascular emboli, lymph node metastasis, TNM stage, depth of tumor invasion, C-met expression and STC-2 expression were independent risk factors affecting the prognosis of cervical cancer patients ( P<0.05). The expression of STC-2 and C-met were negatively correlated with the time of tumor metastasis in patients with cervical cancer ( r = - 0.663, P<0.001; r = - 0.747, P<0.001). Conclusions:The expression levels of STC-2 and C-met in cancer tissues of cervical cancer patients are higher than those in adjacent normal tissues, and the expression levels of STC-2 and C-met are negatively correlated with the time of metastasis. The expression of C-met, the expression of STC-2, vascular emboli, lymph node metastasis, TNM stage, and the depth of tumor invasion are all independent risk factors affecting the prognosis of cervical cancer patients.

The status and influencing factors of the dyadic coping in spouses of young and middle-age cervical cancer patients undergoing synchronous radiotherapy and chemotherapy / 中国实用护理杂志

Objective:To analyze the status of the dyadic coping in spouses of young and middle-age cervical cancer patients undergoing synchronous radiotherapy and chemotherapy, and to explore the influencing factors in bi-directional of patients and their spouses.Methods:With the convenience sampling method, a total of 150 cervical cancer patients undergoing synchronous radiotherapy and chemotherapy who were hospitalized in the Radiotherapy Department of Tianjin Medical University Cancer Institute and Hospital from March 2021 to February 2022 and their spouses were selected. A cross-sectional study was conducted by the Dyadic Coping Inventory, the Lock-Wallace Marital Adjustment Test, the General Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, etc. Besides, multiple linear regression was used to identify predictors of the dyadic coping in spouses of cervical cancer patients undergoing synchronous radiotherapy and chemotherapy.Results:The total score of dyadic coping, marital quality, general self-efficacy, anxiety and depression in spouses of cervical cancer patients undergoing synchronous radiotherapy and chemotherapy were (121.69 ± 19.67), (97.23 ± 25.05), (25.13 ± 5.19), (9.98 ± 3.46), (8.19 ± 4.06) points. The scores of anxiety and depression of cervical cancer patients undergoing synchronous radiotherapy and chemotherapy were (10.57 ± 3.60), (9.10 ± 4.12) points. Multiple linear regression analysis showed that factors of the patients′ anxiety and depression, spouse′s perception of marital quality, spouse′s general self-efficacy, changes in family relationship, family income, and period of radiotherapy were the main influencing factors ( P<0.01), which accounted for 55.7% of total variation. Conclusions:The level of dyadic coping in spouses of cervical cancer patients undergoing synchronous radiotherapy and chemotherapy was medium, the marriage quality remains to be further improved,and its influence factors involved in the bi-directional of patient and spouse, including patients′ anxiety and depression, the changes of the family relationship, period of radiotherapy, spouses perception of marital quality and self-efficacy and family income. Clinical medical staff can improve the level of dyadic coping in spouses of cervical cancer patients undergoing synchronous radiotherapy and chemotherapy by improving their cognition of disease, reducing the incongruence of dyadic illness appraisals, and taking multiple measures to reduce the economic burden felt of the spouses.

Analysis on research hotspots and trends in the field of TCM for cervical cancer based on CiteSpace / 国际中医中药杂志

Objective:To analyze the research hotspots and trends in the field of Traditional Chinese Medicine (TCM) for cervical cancer at home and abroad in recent 30 years through visualization method.Methods:By setting "cervical cancer" and "TCM" as the research subjects, the articles were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, and Web of Science Core database (WoS) from January 1, 1992 to January 1, 2022. Citespace 5.8 R3 software was used to conduct visual analysis on the authors, institutions and keywords included in the articles.Results:A total of 1 123 Chinese articles and 573 English articles were included. The number of articles issued showed a gradual upward trend; the author with the largest number of Chinese publications was Jin Zhe, and the author with the largest number of English publications was Chen Guo. The institution with the largest number of Chinese publications was Beijing University of Chinese Medicine; the institution with the largest number of English publications was Chinese Academy of Medical Sciences. Keywords co-occurrence of the top 3 Chinese keywords in the network frequency (excluding the search words) were "cervical erosion", "urinary retention" and "Yunnan Baiyao"; English keywords were "HeLa cell", "bibliometric", and "information monitoring system". Chinese keywords formed 11 clusters and 25 emergent words; English keywords formed 9 clusters and 17 emergent words.Conclusions:The research content in the field of TCM of cervical cancer about knowledge map in the past 30 years at home and abroad is rich. TCM can play the role of antagonizing human papillomavirus, enhancing immune function, regulating TCM constitution, improving quality of life and so on. At present, the research hotspot is the mechanism exploration of cervical cancer and the curative effect research of clinical complications, and the research trend is clinical curative effect research.

Gut flora and cervical cancer / 国际肿瘤学杂志

The occurrence and progression of cervical cancer are influenced by gut flora. Patients with cervical cancer have different gut flora from healthy women, and the detection and evaluation of gut flora can help in the diagnosis, immunotherapy, assessment of radiotherapy efficacy and prognosis prediction of cervical cancer. Regulation of gut flora is of great clinical value in enhancing response to anti-tumor therapy, improving patients' quality of life and improving prognosis.

Advances in the immune microenvironment in cervical cancer / 国际肿瘤学杂志

Lymphocyte subsets and tumor-associated macrophages, which are the primary immune cells in the tumor microenvironment, interacts with its released cytokines to form the immunological microenvironment. It has grown to be a significant factor in the recurrence and metastasis of cervical cancer and influences the effectiveness of concurrent radiotherapy and chemotherapy for the disease, which in turn influences the prognosis and outcome of patients. Immunotherapy and targeted therapy for cervical cancer based on the immune microenvironment have grown in popularity as research topics in recent years.