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.

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.

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.

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.

Progress of circulating tumor DNA in cervical cancer / 肿瘤研究与临床

Cervical cancer is a leading cause of cancer death in women. There are no reliable noninvasive indicators to predict the recurrence, metastasis and prognosis of cervical cancer. Circulating tumor DNA (ctDNA) is a kind of DNA fragment released from tumor cells into the blood circulation, which has the advantages of being non-invasive, real-time, and of reflecting the genetic characteristics of tumors. With the improvement of ctDNA detection technology and in-depth research on ctDNA, ctDNA has shown more obvious advantages in early diagnosis, tumor molecular typing, treatment monitoring and recurrence prediction of cervical cancer compared with traditional histological, serological and imaging detection methods. This paper reviews the detection methods of ctDNA and its latest research progress of ctDNA in cervical cancer.

Efficacy analysis of different adjuvant treatments for cervical cancer patients with postoperative intermediate-risk factors / 肿瘤研究与临床

Objective:To investigate the efficacy and adverse reactions of concurrent chemoradiotherapy (CRT) and radiotherapy (RT) alone in the treatment of cervical cancer patients with intermediate-risk factors after operation.Methods:The clinical data of 210 patients with cervical cancer patients after operation in Shanxi Province Cancer Hospital between August 2014 to March 2016 were retrospectively analyzed. The postoperative pathology met the Sedlis standard. All patients were divided into RT alone group (100 cases) and CRT group (110 cases) according to the different adjuvant treatment regimens; and the efficacy and adverse reactions of both groups were also analyzed.Results:The 3-year progression-free survival (PFS) rate was 82.8%, 81.5%, respectively in RT alone group and CRT group ; 5-year PFS rate was 80.6%, 77.4%, respectively in RT alone group and CRT group; and there were no statistically significant differences in the PFS of both groups ( χ2 = 0.29, P = 0.591). The 3-year overall survival (OS) rate was 88.5%, 86.7%, respectively in RT alone group and CRT group; 5-year OS rate was 86.4%,82.6%, respectively in RT alone group and CRT group; and there were no statistically significant differences in the OS of both groups ( χ2 = 0.59, P = 0.443). The local recurrence rate was 8.0% (8/100) and 9.1% (10/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 0.08, P = 0.778); the distant metastasis rate was 11.0% (11/100) and 12.7% (14/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 0.15, P = 0.699); the incidence of bone marrow suppression was 42.0% (42 /100) and 61.8% (68/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 8.25, P < 0.01). The incidence of gastrointestinal reactions was 23.0% (23/100) and 77.3% (85/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 49.94, P < 0.01);the incidence of radiation cystitis was 3.0% (3/100) and 3.6% (4/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 0.06, P = 0.798). The incidence of radiation proctitis was 5.0 %(5/100) and 4.5% (5/110), respectively in RT alone group and CRT group, and the difference was statistically significant ( χ2 = 0.02, P = 0.877). Conclusions:For cervical cancer patients with intermediate-risk factors, CRT shows no survival benefit and increases the incidence of adverse reactions compared with RT alone.

Correlation of preoperative peripheral blood neutrophil-lymphocyte ratio and blood platelet-lymphocyte ratio and immune indexes with the prognosis of cervical cancer patients / 肿瘤研究与临床

Objective:To evaluate the value of preoperative peripheral blood neutrophil-lymphocyte ratio (NLR) and blood platelet-lymphocyte ratio (PLR) and immune indexes in the evaluation of the prognosis of cervical cancer patients.Methods:The clinical data of 283 patients with cervical cancer who underwent radical surgery in Shanxi Province Cancer Hospital from May 2017 to September 2018 were retrospectively analyzed, and 100 healthy people who underwent physical examination during the same period were collected as the healthy control group. Test results of blood cells and immune cells expressions of all subjects were collected. Peripheral blood NLR and PLR of cervical cancer patients, people in the healthy control group and cervical cancer patients with different pathological characteristics were compared. Kaplan-Meier method was used to make survival analysis and Cox regression risk model was used to analyze the factors influencing the prognosis of patients with cervical cancer.Results:The preoperative peripheral blood NLR and PLR in patients with cervical cancer was higher than that of the healthy control group (NLR: 2.53±1.35 vs. 2.00±1.21, t = 5.35, P < 0.001; PLR: 163±57 vs.144±38, t = 4.71, P = 0.006). Pathological results showed that there were no statistically significant differences in NLR and PLR in peripheral blood of cervical cancer patients with different pathological types, tumor diameter, vascular invasion, and nerve invasion (all P > 0.05), while there were statistically significant differences in NLR and PLR in peripheral blood of cervical cancer patients with different clinical staging and muscle wall invasion (all P < 0.05). When the proportions of the expression levels of preoperative CD3 positive cells, CD4 positive cells, CD8 positive cells, CD19 positive cells, CD56 positive cells, and CD127 positive cells were 60%-85%, 30%-40%, < 25%, 8%-15%, 15%-25% and < 5%, respectively, the overall survival of cervical cancer patients was the best. Univariate analysis showed that pathological type, clinical staging, vascular invasion, preoperative NLR, preoperative PLR,CD3 positive cells, CD4 positive cells, CD8 positive cells, CD19 positive cells, CD56 positive cells and CD127 positive cells were influencing factors of the overall survival of cervical cancer patients (all P < 0.05). Multivariate analysis showed that clinical staging, vascular invasion, preoperative NLR, preoperative PLR, and preoperative CD4 positive cells were independent influencing factors for the overall survival of cervical cancer patients (all P < 0.05). Conclusions:Preoperative high NLR and PLR in peripheral blood have a certain impact on the clinicopathological characteristics and poor prognosis of cervical cancer patients. When the immune cells in peripheral blood are in dynamic balance, the prognosis of cervical cancer patients is the best.

Clinical characteristics and survival comparison between human immunodeficiency virus-positive and human immunodeficiency virus-negative patients with cervical cancer / 肿瘤研究与临床

Objective:To summarize the clinical features and survival differences between human immunodeficiency virus (HIV)-positive and HIV-negative cervical cancer patients, and to explore the factors influencing the prognosis.Methods:The clinical data of patients with cervical cancer diagnosed and treated in Zhongnan Hospital of Wuhan University from January 2015 to January 2022 were retrospectively analyzed. There were 46 HIV-positive cases and 587 HIV-negative cases; all 46 HIV-positive patients had squamous cell carcinoma, while 504 HIV-negative patients had squamous cell carcinoma. According to age and clinical staging, 230 HIV-negative squamous cell carcinoma patients were screened to match with 46 HIV-positive squamous cell carcinoma patients according to 1∶5. The clinical features of HIV-positive and HIV-negative patients were compared in all matched patients with pathological type of squamous cell carcinoma; the Kaplan-Meire method was used to analyze the overall survival (OS) and the comparison of OS was made by using log-rank test. Multivariate Cox proportional risk model was used to analyze the independent factors affecting the OS of patients with cervical squamous cell carcinoma.Results:The differences in the age, pathological types, clinical staging between 46 HIV-positive patients and 587 HIV-negative patients were statistically significant (all P < 0.05). There were statistically significant differences in age and clinical staging between 46 HIV-positive squamous cell carcinoma patients and 504 HIV-negative squamous cell carcinoma patients (all P < 0.05). After 1∶5 matching, there were no statistically significant differences in the age, clinical staging between 46 patients with HIV-positive squamous cell carcinoma and 230 patients with HIV-negative squamous cell carcinoma. The OS of HIV-positive patients in the entire group,pathological type of squamous cell carcinoma or after pairing was worse than that of HIV-negative patients (all P < 0.001). The median OS time of HIV-positive patients was 63 months (95% CI 61-109 months), while the median OS time of HIV-negative patients was not reached (95% CI 165-178 months, 164-178 months, 143-173 months, respectively). Multivariate Cox regression analysis showed that clinical staging Ⅲ-Ⅳ was an independent risk factor for OS in patients with cervical squamous cell carcinoma (Ⅲ-Ⅳ vs. Ⅰ-Ⅱ: HR = 1.573, 95% CI 1.032-2.397, P = 0.035); HIV infection was an independent protective factor for OS (HIV-positive vs. HIV-negative: HR = 0.087, 95% CI 0.042-0.182, P < 0.001), indicating that HIV-positive patients had an advantage in OS compared to HIV-negative patients at the same age and clinical staging. Age was not an independent influencing factor for OS ( P > 0.05). Conclusions:The onset age of HIV-positive cervical cancer tends to be younger and the clinical staging is late when patients are diagnosed. HIV-positive patients have poor prognosis.

Expressions of peripheral blood lymphocytes in high-grade squamous intraepithelial lesions of the cervix and early cervical cancer and their significances / 肿瘤研究与临床

Objective:To investigate the expression levels of peripheral blood lymphocytes in patients with high-grade squamous intraepithelial lesions (HSIL) of the cervix and early cervical cancer, and to analyze their correlation with the clinicopathological characteristics of cervical cancer.Methods:The clinical data of 65 patients with HSIL and 78 patients with early cervical cancer (2018 International Federation of Gynecology and Obstetrics stage ≤ stage Ⅱ A) treated in Shanxi Province Cancer Hospital from October 2020 to November 2021 were retrospectively analyzed, and 31 healthy people undergoing physical examination during the same period were treated as the healthy control group. The expressions of CD3 + T cells, CD4 + T cells, CD8 + T cells, NK cells, NK/T cells and other immune cells in fasting peripheral blood of the patients were detected by using flow cytometry. Results:The expression levels of CD3 + T cells, CD4 + T cells, CD4 +/CD8 + and NK cells were 71±8, 39±7, 1.5±0.5, 16±7, respectively in HSIL group, and 73±9, 41±9, 1.5±0.6, 16±9, respectively in early cervical cancer group, which were lower than those in the healthy control group (76±9, 45±10, 2.0±1.3, 20±7) (all P < 0.05). The expression levels of CD8 + T cells was 28±7, 29±8, respectively in HSIL group and early cervical cancer group, which were higher than those in the healthy control group (24±7) (all P < 0.05). The expression level of total B cells in early cervical cancer group was lower than that in healthy control group (10±4 vs.12±3, P < 0.05). The expression level of CD3 + T cells in peripheral blood of early cervical cancer patients with tumor diameter >4 cm and nerve/vascular invasion was 71±10 and 72±8, which was lower than that of patients with tumor diameter 2-4 cm, ≤2 cm and without nerve/vascular invasion (72±8, 75±8, 78±7); the expression level of CD8 + T cell was 32±8 and 35±4, which was higher than that of patients with tumor diameter 2-4 cm, ≤2 cm, and without nerve/vascular invasion (28±8, 28±7, 29±8) (all P < 0.05). The levels of CD3 + T cells and total B cells were negatively correlated with the tumor diameter (all P < 0.05), while the level of CD8 + T cells was positively correlated with tumor diameter ( P < 0.05); the levels of CD3 + T cells and NK cells were negatively correlated with nerve/vascular invasion (all P < 0.05). Conclusions:The immune function of the body starts to change in the early progression of cervical cancer, and is related to the tumor diameter and nerve/vascular invasion of cervical cancer.

T helper cell and regulatory T-cell related cytokines changes in vaginal lavage fluid of patients with high risk-human papilloma virus 16 positive and the predictive effect on the development of cervical neoplasms / 肿瘤研究与临床

Objective:To investigate the changes of T helper cell (Th), regulatory T-cell (Treg cell) related cytokines in vaginal lavage fluid of patients with high risk-human papilloma virus 16 (HR-HPV16) positive and its predictive effect on the development of cervical neoplasms.Methods:A total of 200 cases of HR-HPV16 positive patients who admitted to Xingtai People's Hospital from January 2022 to December 2022 were selected as the experimental group. According to the results of pathological examination, all patients in the experimental group were divided into non pathological group (78 cases), low grade squamous intraepithelial lesion (LSIL) group (49 cases), high grade squamous intraepithelial lesion (HSIL) group (39 cases) and cervical cancer group (34 cases); and 100 healthy people undergoing the physical examination in the same period were taken as the healthy control group. Enzyme-linked immunosorbent assay (ELISA) double-antibody sandwich method was used to detect the levels of interleukin (IL)-2, IL-4, IL-6, IL-10, IL-12, IL-17, tumor necrosis factor α (TNF-α), interferon γ (IFN-γ) and transforming growth factor β (TGF-β) in vaginal lavage fluid of patients in different groups. Multivariate logistics regression was used to analyze the risk factors of cervical cancer, and a nomogram model was established. The receiver operating characteristics (ROC) curve was drawn with pathological results as the gold standard, and the area under the curve (AUC) was calculated to evaluate the predictive ability of the nomogram model.Results:The levels of IL-6, IL-10, IL-17, TNF-α, TGF-β in vaginal lavage fluid of patients in the experimental group were higher than those in the healthy control group, while the levels of IL-2, IL-12 and IFN-γ in the experimental group were lower than those in the healthy control group, and the differences were statistically significant (all P < 0.05); the difference in IL-4 level of both groups was not statistically significant ( P > 0.05). There were statistically significant differences in IL-6, IL-10, IL-17, TNF-α, TGF-β, IL-2, IL-12 and IFN-γ among non pathological group, LSIL group, HSIL group and cervical cancer group (all P < 0.05); the levels of IL-6, IL-10, IL-17, TNF-α, TGF-β in cervical cancer group were the highest, the levels of IL-2, IL-12 and IFN-γ were the lowest; the level of IL-4 in non pathological group, LSIL group, HSIL group and cervical cancer group had no statistically significant difference ( P > 0.05). Logistics regression analysis showed that low IL-2, high IL-4, high IL-6, high IL-10, low IL-12, high IL-17, high TNF-α, low IFN- γ and low TGF-β expressions in vaginal lavage fluid of patients with HR-HPV16 positive were independent risk factors for the development of cervical cancer (all P < 0.05). The results of nomogram analysis showed that IL-6, IL-10, IL-17, TNF-α, TGF-β in vaginal lavage fluid were the factors predicting the development of cervical cancer in HR-HPV16 positive patients. The ROC curve analysis showed that the AUC of nomogram model in predicting the development of cervical cancer in HR-HPV16 positive patients was 0.945 (95% CI 0.901-0.988), and the predictive efficacy was good. Conclusions:Th and Treg cell related cytokines levels in vaginal lavage fluid of patients with HR-HPV16 positive show pathological changes in cervical cancer patients and the above indicators have a high value in predicting the development of cervical cancer.

The trend and challenge of DNA methylation clinical application in cervical cancer / 中华检验医学杂志

According to the current cervical cancer screening strategy and the World Health Orgnization cervical cancer diagnosis/screening guidelines, gene methylation will be included in the new guidelines in the future. However, the value of detecting DNA methylation at specific sites in the clinical specimens during the cervical cancer treatment remains to be discussed. This article summarised the role of DNA methylation in the development of cervical cancer and discusses the potential clinical application of methylation detection in the management of high-risk human papillomavirus (hrHPV) positive female patients. It is believed that methylation test can not only be used for the preliminary classification of hrHPV positive female patients, but also for the secondary triage of female patients with slight cytological abnormalities to determine the high risk of cervical intraepithelial neoplasia 3(CIN3) or cancer. It can also be used for the withdrawal test of women in the screening program to support the management of CIN.

Research and application progress of molecular detection technology in female tumor diagnosis / 中华检验医学杂志

The molecular detection technology shows a better application prospect and broad development in the early screening of female tumors, guiding the selection of therapeutic drugs, predicting prognosis and monitoring the efficacy of treatment. Numerous studies have demonstrated that molecular detection has great impact on the diagnosis and treatment strategies of female tumors such as breast cancer, cervical cancer, endometrial cancer and ovarian cancer. Previously, human papilloma virus detection has laid a foundation for clinical application for cervical cancer screening and breast cancer 1/2 mutation susceptibility gene detection to predict the risk of breast cancer and give drug guidance. These studies show the clinical application prospect of new molecular detection in the diagnosis and treatment of female tumors in the future.

Clinical analysis of cervical lesions in 1 337 postmenopausal women diagnosed during screening / 中华老年医学杂志

Objective:To screen and diagnose cervical lesions in middle-aged and elderly postmenopausal women and analyze the characteristics of cervical lesions in middle-aged and elderly women.Methods:A retrospective analysis was conducted on the screening data of 1 337 postmenopausal women aged between 50 and 86 years who visited the outpatient clinics of the gynecology department of Beijing Hospital between January, 2015 and December, 2019.Participants were divided into groups based on age, with 787 in the 50-59 years old group, 483 in the 60-69 years old group, 60 in the 70-79 years old group, and 7 in the 80-89 years old group.Exfoliated cervical cells were collected, and high-risk human papillomavirus(HPV)detection and liquid-based cervical cytology examination were performed to confirm the diagnosis based on the pathological results of cervical biopsy.Cervical lesions were analyzed.Results:53.0%(708)of the 1 337 enrolled patients made their hospital visits because of symptoms.There were 666 patients(49.8%)with cervical lesions, including 357 with low-grade squamous intraepithelial lesions(LSIL), 252 with high-grade squamous intraepithelial lesions(HSIL)and 57(4.3%)with cervical cancer.The 70-79 group showed the highest incidence of HSIL at 30.0%(18/60), while the 50~59 group had the highest incidence of LSIL at 30.6%(241/787), and there were significant differences in different types of cervical lesions between different age groups( χ2=28.919, P<0.01). Liquid-based cervical cytology examination revealed a positive rate of 51.6%(166/322)for LSIL, a positive rate of 70.8%(143/202)for HSIL, and a rate of 71.4%(25/35)for cervical cancer.There were significant differences in LSIL, HSIL and other above-mentioned positive rates of lesions( P<0.05). In the cervical malignancy group, cytological high-grade squamous epithelial lesions made up 51.4%(18/35). Intraepithelial lesions or cancerous lesions represented 29.2%(59/202)in the HSIL group.The rate of intraepithelial lesions or cancerous lesions in the LSIL group was 48.4%(156/322), with statistically significance in these differences( χ2=118.806, P<0.01). Chronic cervicitis was found in 52.9%(109)of 206 patients with atypical squamous cells and positive HPV, and in 76.2%(16)of 21 patients without HPV.HPV examination was completed in 1 301 patients, with 69.4%(903)having infections by one HPV strain and 30.6%(398)having infections by mixed HPV strains.Biopsy results showed that the rates of HPV infections in LSIL, HSIL and cancer patients were 84.6%(302/357), 95.9(185/193)and 100%(54/54), respectively, and the differences in these pathological results were statistically significant( P<0.01). HPV16 was the most common subtype in single HPV strain infections.The most common subtypes of HPV infections in cervical lesions with HSIL and above were HPV16 and HPV18.The agreement rate was 52.4%(187/357)for LSIL, 60.7%(153/252)for HSIL, and 64.9%(37/57)for cervical cancer between diagnoses based on cervical biopsy and those based on colposcopy.As the severity of lesions increased, the accuracy of colposcopy also increased.Differences between colposcopic diagnosis and pathological diagnosis on different types of cervical lesions were statistically significant( χ2=550.382, P<0.01).1 310 patients underwent endocervical curettage, identifying 120 cases of HSIL and 39 cases of cervical cancer, with a detection rate of 55.8%(159/285). Conclusions:The incidence of cervical cancer is high in elderly women.The incidences of high-grade lesions and cervical cancer in patients with atypical squamous cells plus HPV infections in the cervix are also high.Postmenopausal patients with cervical lesions are mainly infected by a single HPV subtype, with subtype 16 being the most common one.With increasing severity of lesions, the accuracy of colposcopy-based diagnosis increases and the rate of missed diagnosis decreases.Cervical curettage is an important means to reduce missed diagnosis with colposcopy.

Influencing factors of anxiety and depression in patients with secondary lower extremity deep venous thrombosis after radical cervical cancer surgery / 中华健康管理学杂志

Objective:To investigate the influencing factors of anxiety and depression in patients with secondary lower extremity deep venous thrombosis (LEDVT) after radical cervical cancer surgery.Methods:Retrospective analysis method was used, a total of 92 patients with anxiety and/or depression secondary to LEDVT after radical cervical cancer surgery admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from June 2019 to June 2022 were included as the observation group, according to the presence of anxiety or depression, they were divided into anxiety group (65 cases) and depression group (58 cases) (some patients had both anxiety and depression). Another 90 patients who did not have anxiety or depression after radical cervical cancer surgery with secondary LEDVT were selected as the control group in the same period. The questionnaires of clinical data and disease cognition were designed to investigate the clinical data and disease cognition of patients, social support rating scale (SSRS) was used to assess the level of social support of patients, and univariate analysis was performed to identify the influencing factors of depression and anxiety in patients with secondary LEDVT after radical cervical cancer surgery.Results:The percentage of patients with self-pay, no children, unemployed or jobless, monthly family income <5 000 CNY, less social support, and disease awareness <80 scores in the anxiety group and depression group (36.92%, 67.69%, 69.23%, 66.15%, 46.15%, 70.77% and 34.48%, 68.97%, 72.41%, 65.52%, 44.83%, 68.97%) were higher than the control group (14.44%, 40.00%, 33.33%, 32.22%, 11.11%, 23.33%) (all P<0.01). The percentage of mixed thrombus, central thrombus, peripheral thrombus, bilateral thrombus, right thrombus, and left thrombus in the anxiety group and depression group (30.77%, 20.00%, 49.23%, 16.92%, 35.38%, 47.69% and 32.76%, 15.52%, 51.72%, 12.07%, 37.93%, 50.00%) were not significantly different from those in the control group (32.22%, 17.78%, 50.00%, 10.00%, 36.67%, 53.33%) (all P>0.05). Univariate analysis showed that self-pay, unemployed or jobless, no children, monthly family income <5 000 CNY, less social support, and disease awareness <80 scores were correlated with depression and anxiety status in patients with secondary LEDVT after radical cervical cancer surgery (all P<0.01). Conclusion:Depression and anxiety in patients with secondary LEDVT after radical cervical cancer surgery are related to self-pay, unemployed or jobless, no children, low monthly family income, less social support, and low disease awareness.