Cervical cancer screening in rural India: Status & current concepts

Cervical carcinoma is one of the most common and dreaded diseases of women, and in India, it accounts for 16 per cent of total cervical cancer cases occurring globally. The situation is more alarming in the rural areas where the majority of women are illiterate and ignorant about the hazards of cervical cancer. Different screening strategies such as rural cancer registries and camp approach for cancer detection have been found useful in minimizing the problem of cervical cancer in the villages. Various screening techniques such as visual inspection with acetic acid, visual inspection with Lugol's iodine, visual inspection with magnification devices-magnavisualizer, Pap smear and HPV-DNA testing have been suggested and tried under low-resource settings of our country, and cervical cytology screening has been found effective in reducing incidence of the disease. In the present review, feasibility of different screening methods has been assessed to find out the most suitable mode applicable at the rural level. Single lifetime screening particularly of high-risk women along with analysis of cost-effective tumour markers such as Argyrophilic nucleolar organizer regions (AgNOR) counts to discriminate high-risk dysplasia cases appears to be an appropriate approach in fighting against cervical cancer.

Incidence Trend and Clinical Characteristic Changes of Inpatients with Cervical Adenocarcinoma in the Last Decade / 实用妇产科杂志

Objective:To evaluate the incidence trend and clinical characteristic changes of inpatients with cervical adenocarcinoma in the last decade.Methods:A retrospective analysis was performed.99 patients diagnosed with adenocarcinoma of cervix and hospitalized at Peking University First Hospital(PUFH) from January 2006 to May 2016 were included.Patients were divided into two groups according to the year and the results of screening.The clinical characteristics including basic information,diagnostic way and cancer stage were recorded and analysed.Results:①The incidence ratio of cervical adenocarcinoma had been significantly increased in the last decade,while clinical stage was statistically different.②The top three symptoms of cervical adenocarcinoma were irregular vaginal bleeding,bleeding after intercourse,abnormal vaginal discharge,accounting for 37.37％,34.34％ and 8.08％,respectively.There were significant differences in the stage of cervical cancer and the diameter of the lesion(P ＜0.05) after the comparison between the symptomatic group and the asymptomatic group,but there were no differences in differentiation degree,pathological type,lymph node metastasis and resection margin.③ Cytological screening of cervical adenocarcinoma was still dominated by squamous cell changes (42.19％).HPV18 ranked first in HPV detection,accounting for 36.21％ (21/58),however,29.31％ cases were negative in HPV test.There was no significant difference in the age,pathological type,differentiation degree,resection margin and lymph node metastasis between HPV negative and positive patients with cervical adenocarcinoma (P ＞ 0.05).Conclusions:The incidence of cervical adenocarcinoma is increasing year by year.Some patients with cervical adenocarcinoma have negative screening results for cytology and HPV,easy to be missed diagnosis,therefore,more attention should be put into the screening for cervical adenocarcinoma in order to find the cancer earlier.

Comparison of the routine Papanicolaou staining technique with the rapid, economic, acetic acid, Papanicolaou (REAP) technique.

Background: The universal stain for oral cytological screening for precancer and cancer of oral cavity is Papanicolaou stain which has been used in different laboratories with many modifications. Objectives: To assess the superiority of staining of smears by REAP technique compared to PAP technique. Material and Methods: 100 smears were collected from 50 patients. One set of smears were stained with conventional PAP technique and the other set with the REAP technique. In the REAP technique, the ethanol bath in the pre Orange G6, post Orange G6 and post EA50 stages is replaced by 1% acetic acid; Tap water is used instead of Scott’s tap water and hematoxylin is pre heated in water bath to 60°C for rapid penetration. Methanol is used for final dehydration. The two sets of smears are observed by two independent observers and assessed for the optimal and suboptimal nuclear and cytoplasmic staining. The results are compared and analyzed statistically. Results: Good cytoplasmic transparency and optimal nuclear details were seen in REAP stained smears compared to the conventional PAP smears. The cost involved in REAP method was lesser compared to conventional PAP technique. REAP technique took 3 minutes for completion compared to PAP technique that involves a minimum of 20 minutes. Conclusion: REAP technique produces better stained smears that are cost effective and involve minimal time for mass screening of oral cancer as compared to conventional PAP smears.