Prevención del cáncer de cuello uterino mediante la inspección con ácido acético y crioterapia / Cervical cancer prevention by inspection with acetic acid and cryotherapy

El cáncer cervicouterino es el cáncer más frecuente en las mujeres tailandesas. Su incidencia es de 24.7 por cada 100 000 mujeres o 6 000 a 7 000 nuevos casos por año. Es un cáncer que se puede prevenir y se puede tratar cuando se detecta precozmente, en un estadio precanceroso. Sin embargo, continúa siendo un importante problema de salud pública en Tailandia debido a que su incidencia se mantiene alta pese a las iniciativas de salud pública. Recientemente se han introducido dos nuevos métodos de detección con el fin de mejorar su prevención. La inspección visual con ácido acético (IVA) y crioterapia, como un programa de prevención de cáncer cervicouterino en una sola visita, se llevó a cabo como una demostración del proyecto S.A.F.E. (acrónimo de Programa de Seguridad, Accesibilidad, Factibilidad y Esfuerzo) en el año 2000, y se realiza formalmente desde 2005 en Tailandia. Los resultados de diversas pruebas indican su eficacia. El siguiente artículo es una revisión de la bibliografía publicada al respecto...

Knowledge, attitudes and practices vis-a-vis cervical cancer among registered nurses at the Faculty of Medicine, Khon Kaen University, Thailand.

BACKGROUND: Cervical cancer is the most common cause of death from cancer among women in Thailand and in almost all patients, human papillomavirus (HPV) has been found. Various international studies indicate that the knowledge level vis-à-vis cervical cancer and HPV in the general population as well as healthcare professionals is low, but no such study has yet been done in Thailand. OBJECTIVES: Our study's aim was to ascertain the level of knowledge, the attitudes and practices regarding cervical cancer among registered nurses working in Srinagarind (university) Hospital in an urban setting in Northeast Thailand. MATERIALS AND METHODS: Systematic sampling was used and self-administered questionnaires were sent to 149 registered nurses; 133 (89.3%) of whom responded. Data were processed using descriptive statistics including frequency, percentages and the 95% CIs. RESULTS: The respondents' averaged 34.6 years of age (median, 33; range, 21-56) while 54.6% had sexual partners and 61.4% had had normal deliveries. The respective median knowledge score, interquartile range and mean knowledge score and range for cervical cancer vs. HPV vs. cervical cancer prevention were: 11.00, 5.0, 10.14 (95%CI 9.6, 10.7), 0-15 vs. 4.00, 2.0, 3.58 (95%CI 3.5-4.2), 0-7 vs. 8, 3.00, 7.5 (95%CI 7.1-7.9), 1-11. 66.2% would like to have prophylactic HPV vaccines because they thought that it would prevent HPV infection (77.3%) or prevent cervical cancer (39.1%), which are major misunderstandings. CONCLUSION: Almost all of the registered nurses working at Srinagarind Hospital have a moderate level of knowledge regarding cervical cancer and HPV but there are still some major misunderstandings; thus, educational pamphlets, notices and hospital announcements would be useful in increasing their knowledge.

Primary non-gestational uterine cervical choriocarcinoma with metaplastic transformation from squamous cells.

BACKGROUND: Primary non-gestational uterine cervical choriocarcinoma is very unusual and although it has been hypothesized that it can arise by metaplastic transformation of cervical epithelium, solid evidence has been lacking. CASE: Primary non-gestational uterine cervical choriocarcinoma was diagnosed in a 47-year-old, woman undergoing tubal resection 17 years previously. A histologically- and immunohistochemically-confirmed, non-gestational cervical choriocarcinoma could be diagnosed in which there was metaplastic transformation from squamous cells . The patient underwent 5 courses of an actinomycin-D chemotherapeutic regimen and radical hysterectomy with bilateral pelvic lymphadenectomy. CONCLUSION: Primary non-gestational uterine cervical choriocarcinoma may indeed arise from metaplastic transformation of epithelial tissue.

Can an appointment-letter intervention increase pap smear screening in Samliem, Khon Kaen, Thailand?

Our objective was to assess the efficiency of an appointment-letter intervention aimed to increase uptake of cervical cancer screening in women between 35 and 65 years of age. From January, 2007, we randomly recruited 320 women, not screened for at least 5 years, from the Samliem inner-city community, Khon Kaen, Northeast Thailand. A total of 150 women 35, 40, 45, 50, 55, 60 and 65 years of age were assigned to the intervention group according to Thai National Cancer Institute's ( TNCI) strategy. A further 170 women between 36-39, 41-44, 46-49, 51-54, 56-59 and 61-64 years of age were assigned to the control group. Baseline interviews were conducted for all women in both groups by one of the researchers in January, who also provided culturally-sensitive health education emphasizing the need for screening. Then appointment letters were sent only to women in the intervention group in February, with the last date for an appointment being March 31st. In April of 2007, immediately post-intervention, screening-coverage interviews were performed in both groups for comparison. There was a significant increase in the Pap smear screening-coverage rate in the intervention group compared with the control group (44.67% vs. 25.88%, p=0.001). Therefore, the appointment-letter intervention produced a significant effect on increasing Pap smear coverage in this group of women.

Can a home-visit invitation increase Pap smear screening in Samliem, Khon Kaen, Thailand?

Our objective was to assess the efficiency of a home-visit invitation aimed to increase uptake of cervical cancer screening in women between 35 and 60 years of age. From May, 2006, we conducted a quasi-randomized trial to determine if an in-home education and invitation intervention would increase uptake of cervical cancer screening. We randomly recruited 304 women from the Samliem inner-city community, Khon Kaen, Northeast Thailand, and assigned participants to either the intervention or control zone. Baseline screening coverage interviews were then performed: 58 of 158 women in the intervention zone and 46 of 146 in the control zone were excluded from the study because of having had a Pap smear within 5 years, but these were included in the final analysis. First, 100 women in the intervention group were visited in their homes by one of the researchers, who provided culturally-sensitive health education that emphasized the need for screening. Four months later, post-intervention, screening-coverage interviews were again performed in both groups, in combination with the same health education for 100 women in the control group for a comparison. There was no difference in the baseline Pap smear screening-coverage rate in the intervention vs. control zones (36.7 vs. 31.5%, p=0.339). One hundred women in the intervention group completed the intervention interviews and after four months, 100 women in the intervention group and 100 in the control group also completed the post-intervention interviews. The increased screening-coverage rate in the intervention zone was similar to that of the control zone (43.6 vs. 34.9%, p=0.119); however, there was a borderline significant increase in the intervention zone compared with baseline (36.7 to 43.6%, p=0.070). Therefore, home visit education and invitation intervention produced only a nominal effect on increasing Pap smear coverage within a 4-month study period.

VIA and cryotherapy: doing what's best.

Cervical cancer kills about 6,000 Thai women annually and has been for decades. The age-standardized incidence ratio (ASR) is 20.9 per 100,000 women-years. A multi-province survey by the Thai National Cancer Institute found that coverage of the previous cervical cancer screening program (i.e. the opportunistic Pap smear) was only 5%. Visual inspection with acetic acid (VIA) and cryotherapy, a secondary prevention program, could be a more practical approach for cervical cancer prevention, particularly in low resource, rural, and remote settings. The authors are expanding this program throughout Thailand (in conjunction with the use of the Pap smear when appropriate) with an 80% coverage target. Using both approaches in a complementary fashion should significantly reduce the incidence and mortality of cervical cancer among Thai women.

Weekly versus three-weekly cisplatin as an adjunct to radiation therapy in high-risk stage I-IIA cervical cancer after surgery: a randomized comparison of treatment compliance.

OBJECTIVES: To compare weekly and three-weekly cisplatin as an adjunct to radiation therapy in high-risk early-stage cervical cancer after surgery with regard to treatment compliance. MATERIAL AND METHOD: From June 1st, 2003 to February 29th, 2004, the authors performed a randomized trial of radiotherapy in combination with two concurrent chemotherapy regimens - weekly or three-weekly cisplatin--in patients with high-risk cervical cancer FIGO stage I-IIA after surgery. Women with primary invasive squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix were enrolled. The patients also had to have an absolute neutrophil count of at least 1,500 cells per cubic millimeter, a platelet count of at least 75,000 cells per cubic millimeter, a creatinine clearance higher than 40 milliliter per minute, and adequate hepatic function. All patients received external-beam radiotherapy according to a strict protocol. Patients were randomly assigned to receive one of two chemotherapy regimens: 75 mg per square meter of cisplatin on days 1, 22, 43 and 64 or every three weeks for 4 cycles (group 1) or 40 mg per square meter of cisplatin per week for six cycles (group 2). RESULTS: The analysis included 40 women. The first group that received three-weekly cisplatin had a higher rate of incomplete and delayed treatments than the second group that received weekly cisplatin (p < 0.001 and p = 0.0236 respectively). The relative risks of delayed courses were 2.06 (95 percent confidence interval, 1.15 to 3.68) for group 1, compared with group 2. The toxicity-related incomplete treatments rate and G-CSF doses used were significantly higher in group 1 than in group 2. CONCLUSION: Concurrent chemoradiation with weekly cisplatin regimen has more complete treatment rate and less delayed courses than that with three- weekly cisplatin among women with high-risk cervical cancer after surgery.