Clinical research progress and implications of therapeutic vaccines for cervical cancer and precancerous lesions: a qualitative systematic review / 中华肿瘤杂志

Objective: To systematically summarize and analyze the clinical research progress of therapeutic vaccines for cervical cancer or precancerous lesions. Methods: English databases (PubMed, Embase, Web of Science, Cochrane library, Proquest, and ClinicalTrails.gov) and Chinese databases (SinoMed, CNKI, WanFang, and VIP Database) were systematically searched to collect literature on therapeutic vaccines for cervical cancer or precancerous lesions from inception to February 18, 2021. After screening, we evaluated the risk of bias of included studies, and combed the basic information of the literature, research designs, information of vaccines, study patients, outcome indicators and so on, qualitatively summarized the clinical research progress. Results: A total of 71 studies were included in this systematic review, including 14 random controlled trials, 15 quasi-random controlled trials, 4 cohort studies, 1 case-control study, 34 case series studies and 3 case reports. The study patients included women aged 15~79 with cervical cancer or precancerous lesions in 18 countries from 1989 to 2021. On the one hand, there were 40 studies on therapeutic vaccines for cervical precancerous lesions (22 867 participants), involving 21 kinds of vaccines in 6 categories. Results showed 3 marketed vaccines (Cervarix, Gardasil, Gardasil 9) as adjuvant immunotherapies were significant effective in preventing the recurrence of precancerous lesions compared with the conization only. In addition, MVA E2 vaccine had been in phase Ⅲ clinical trials as a specific therapeutic vaccine, with relative literature showing it could eliminate most high-grade precancerous lesions. Therapeutic vaccines for precancerous lesions all showed good safety. On the other hand, there were 31 studies on therapeutic vaccines for cervical cancer (781 participants), involving 19 kinds of vaccines in 7categories, with none had been marketed. 25 studies were with no control group, showing the vaccines could effectively eliminate solid tumors, prevent recurrence, and prolong the median survival time. However, the vaccines effectiveness couldn't be statistically calculated due to the lack of a control group. As for the safety of therapeutic vaccines for cervical cancer, 9 studies showed that patients experienced serious adverse events after treatments, where 7 studies reported that serious adverse events occurred in patients couldn't be ruled out as the results of therapeutic vaccines. Conclusions: The literature review shows that the literature evidence for the therapeutic vaccines for cervical precancerous lesions is relatively mature compared with the therapeutic vaccines for cervical cancer. The four kinds of vaccines on the market are all therapeutic vaccines for precancerous lesions, but they are generally used as vaginal infection treatments or adjuvant immunotherapies for cervical precancerous lesions, not used for the specific treatments of cervical precancerous lesions. Other specific therapeutic vaccines are in the early stage of clinical trials, mainly phase Ⅰ/Ⅱ clinical trials with small sample size. The effectiveness and safety data are limited, and further research is still needed.

Calidad de vida después del tratamiento del cáncer cervical / Quality of life after treatment for cervical cancer / Qualidade de vida após o tratamento do câncer do colo do útero

Objective: Identify the quality of life of women treated for cervical cancer according to their clinical and socioeconomic characteristics. Methods: This was a analytical study on women who were treated for cervical cancer by means of surgery, radiotherapy and chemotherapy. To evaluate their quality of life, the WHOQOL-bref questionnaire was applied. The Mann-Whitney test was used to investigate associations between domains and variables. Results: There were associations (p < 0.05) between the WHOQOL-bref domains and the variables of income, conjugal situation, leisure activities and treatment undergone. The physical and psychological domains were associated with overall quality of life (R = 0.54 and R = 0.63, respectively). Conclusions: Socioeconomic conditions and the type of treatment undergone influenced the quality of life of these women after their treatment. There is a need to increase the reach of cervical cancer screening among women who are less economically favored; and, after treatment, to offer alternative measures that soften the secondary effects.

Objetivo: Identificar la calidad de vida de las mujeres tratadas por cáncer de cuello uterino según sus características clínicas y socioeconómicas. Métodos: Este fue un estudio analítico sobre mujeres que fueron tratadas por cáncer de cuello uterino mediante cirugía, radioterapia y quimioterapia. Para evaluar su calidad de vida, se aplicó el cuestionario WHOQOL-bref. La prueba de Mann-Whitney se utilizó para investigar asociaciones entre dominios y variables. Resultados: Hubo asociaciones (p < 0.05) entre los dominios WHOQOL-bref y las variables de ingreso, situación conyugal, actividades de ocio y tratamiento. Los dominios físicos y psicológicos se asociaron con la calidad de vida general (R = 0.54 y R = 0.63, respectivamente). Conclusiones: Las condiciones socioeconómicas y el tipo de tratamiento sufrido influyeron en la calidad de vida de estas mujeres después de su tratamiento. Es necesario aumentar el alcance de las pruebas de detección del cáncer cervicouterino entre las mujeres económicamente menos favorecidas; y, después del tratamiento, ofrecer medidas alternativas que suavicen los efectos secundarios.

Objetivo: Identificar a qualidade de vida de mulheres após o tratamento de câncer do colo uterino, de acordo com suas características clínicas e socioeconômicas. Métodos: Trata-se de um estudo analítico com mulheres com câncer que foram tratadas com cirurgia, radioterapia e quimioterapia. Para avaliar a qualidade de vida, aplicou-se o questionário WHOQOL-bref. O teste de Mann-Whitney foi utilizado para investigar associações entre domínios e variáveis. Resultados: Houve associações (p < 0,05) entre os domínios do WHOQOL-bref e as variáveis renda, situação conjugal, atividades de lazer e tratamento realizado. Os domínios físico e psicológico foram associados à qualidade de vida global (R = 0,54 e R = 0,63, respectivamente). Conclusões: Condições socioeconômicas e o tipo de tratamento influenciaram a qualidade de vida dessas mulheres após o tratamento. É preciso aumentar o alcance do rastreio do câncer de colo do útero entre as mulheres que são menos favorecidas economicamente; e, após o tratamento, oferecer medidas alternativas que minimizam os efeitos secundários.

Lesões precursoras de câncer cervical: significado para mulheres em um centro de referência no Brasil / Lesiones precursoras de cáncer cervical: significado para mujeres en un centro de referencia en Brasil / Cervical cancer precursor lesions: significance for women in a referral center in Brazil

Objetivo: compreender a vivência de mulheres com lesões precursoras de câncer cervical. Método: estudo fenomenológico, com as etapas de redução, construção e destruição. A interpretação dos dados foi realizada por meio da análise compreensiva heideggeriana. Resultados: os fenômenos desvelados eram relativos às dúvidas das mulheres, devido ao desconhecimento do diagnóstico; mudanças no relacionamento com parceiros; dificuldades em ter amigos; importância da família; estratégias de enfrentamento;relacionamento com profissionais da saúde e descrédito na assistência; vergonha e constrangimento na realização do teste de Papanicolau; e medo da morte. Conclusão: constatou-se que urge redimensionar o cuidar da mulher com lesões precursoras de câncer cervical, tendo em vista o desafio de compreender a necessidade do profissional da saúde cuidar sob a perspectiva heideggeriana, estabelecendo uma relação de ser-com-o-outro, valorizando-o como sujeito de possibilidades.

Objective: understand the experience of women with cervical cancer precursor lesions. Method: phenomenological study, with the reduction, construction, and destruction steps. Data interpretation was performed through Heidegger’s comprehensive analysis. Results: the phenomena unveiled were related to women’s doubts, due to lack of diagnosis; changes in relationships with partners; difficulties in making friends; family importance; coping strategies; relationship with health professionals and distrust in care; shame and embarrassment to undergo the Pap test; and fear of death. Conclusion: it was found that there is an urgent need to resize the care for a woman with cervical cancer precursor lesions, given the challenge of understanding the need that a health professional provides care from the Heideggerian perspective, establishing a relationship of being-with-the-other, appreciating her as a subject of possibilities.

Objetivo: comprender la experiencia de mujeres con lesiones precursoras de cáncer cervical. Método: estudio fenomenológico, con las etapas de reducción, construcción y destrucción. La interpretación de los datos se realizó mediante el análisis comprensivo de Heidegger. Resultados: los fenómenos desvelados eran relativos a las dudas de las mujeres, debido a la falta de diagnóstico; cambios en la relación con compañeros; dificultades para tener amigos; importancia de la familia; estrategias de afrontamiento; relación con los profesionales de la salud y desconfianza en la atención; vergüenza y timidez al someterse a la prueba de Papanicolaou; y miedo a la muerte. Conclusión: se constató que hay una necesidad urgente de redimensionar la atención a una mujer con lesiones precursoras del cáncer cervical, dado el reto de comprender la necesidad de que un profesional de la salud cuide bajo la perspectiva heideggeriana, estableciendo una relación de ser-con-el-otro, valorándolo como un sujeto de posibilidades.

¿Por qué no se vacunan nuestras pacientes?: motivos por los que las pacientes fuera de los programas de vacunación sistemática, con infección por el virus del Papiloma Humano, deciden decir no a la vacuna / Reasons for non-vaccination in women outside the routine immunization programs

Objetivo: Conocer los motivos de la no vacunación en mujeres fuera de los programas de vacunación sistemática. Metodología: Se evaluaron mediante cuestionario 226 mujeres con infección por VPH. A todas ellas se les había informado de su patología, del VPH y de la vacuna y se les había recomendado el uso del preservativo previamente. Resultados: El 66,7 por ciento tenían pareja estable; 75 por ciento utilizaban preservativo. La edad de inicio de relaciones sexuales fue 17,8 años y el 47,3 por ciento de las pacientes habían tenido 5 ó más parejas a lo largo de su vida. El 72 por ciento conocía su infección por VPH y el 48,8 por ciento su lesión. El 63,7 por ciento no se vacunó: principalmente rechazaron la vacuna por el precio (49,5 por ciento), información insuficiente (18,7 por ciento) u otras causas como la disparidad de opiniones entre los médicos que la atendieron (15 por ciento). Conclusiones: El coste de la vacuna y el conocimiento sobre el VPH son determinantes para la aceptación de la vacunación.

Objective: The aim of the study was to determine the reasons for non-vaccination in women outside the routine immunization programs. Method: There were evaluated by questionnaire 226 women with HPV infection. All of them had been informed of their disease and type of HPV infected by. We all had recommended the vaccine and the condom use previously. Results: 66.7 percent had a steady partner, 75 percent used condoms. The age of first sexual relationship was 17.8 years old and 47.3 percent of patients had 5 or more partners during their lifetime. 72 percent knew their HPV infection and 48.8 percent knew their injury. 63.7 percent were not vaccinated: they rejected the vaccine mainly for the price (49.5 percent), insufficient information (18.7 percent) or other causes such as primary care opposite point of view (15 percent). Conclusions: The prize of the vaccine and the HPV knowledge are crucial to the acceptance of vaccination.

O papel da inflamação na carcinogênese induzida pelo HPV / The role of inflammation in HPV carcinogenesis

A inflamação é uma estratégia de defesa inata que evoluiu nos organismos superiores, contra agentes invasores externos e moléculas nocivas. Estudos recentes mostram que a inflamação opera como um sistema muito mais complexo do que se imaginava antes, em termos moleculares, envolvendo diversos processos na sua iniciação, regulação e resolução. Na última década, tornou-se evidente que a inflamação crônica está fortemente associada com câncer, desempenhando um papel importante na tumorigênese. Uma das causas de inflamação crônica são as infecções persistentes por agentes patogênicos virais, com destaque para o papilomavírus humano (HPV). A ligação entre a inflamação crônica decorrente da infecção persistente por agentes infecciosos e o câncer está atualmente sendo apontada como um dos mecanismos-chave para o controle do surgimento de novos casos de carcinomas. Por esse motivo, consultamos os bancos de dados eletrônicos PubMed/Medline, Lilacs, Embase e SciELO, sem restrição linguística, à procura de artigos que abordassem avanços recentes sobre os mecanismos envolvidos na inflamação, sua participação no processo de carcinogênese, com ênfase na correlação entre inflamação e o desenvolvimento do câncer associado ao HPV, os quais foram incluídos na presente revisão.(AU)

Inflammation is an innate defense strategy that evolved in higher organisms against external invaders and harmful molecules. Recent studies show that inflammation operates as a much more complex system than imagined before, in molecular terms, involving many processes in its initiation, regulation and resolution. In the very last decade, it has become evident that chronic inflammation is strongly associated with cancer and plays an important role in tumorigenesis. One of the causes of chronic inflammation are persistent infections by viral pathogens, particularly human papillomavirus (HPV). The link between chronic inflammation resulting from persistent infection by infectious agents and cancer is currently being suggested as a key mechanism for controlling the appearance of new cases of carcinoma. Therefore, we consult electronic databases such as PubMed/Medline, Lilacs, Embase and SciELO, without language restriction, looking for papers discussing recent advances on the mechanisms involved in inflammation, their participation in the process of carcinogenesis, with emphasis on the correlation between inflammation and the development of cancer associated with HPV, which were included in this review.(AU)

Historia natural de la infección por el virus del papiloma humano: una actualización / Natural history of the infection for human papillomavirus: an actualization

Durante los últimos años, se han sucedido grandes avances en nuestro entendimiento acerca de la biología e historia natural del Virus del Papiloma Humano (VPH). La mayoría de las infecciones por papiloma virus son transmitidas por un contacto cercano bien sea de piel a piel o mucosa a mucosa. La relación sexual con penetración no es un requerimiento para la transmisión del VPH. Las infecciones orales y digitales por VPH ocurren, y existe evidencia de que el contacto digital-genital y genital-oral puede resultar en la transmisión del VPH, aunque en un porcentaje relativamente bajo. La transmisión vertical de la madre al feto es una vía frecuente de infección, de hecho, se reconoce que más del 80% de los neonatos nacido de madres infectadas con VPH genital serán positivos a la determinación del ADN del VPH en la región naso-faríngea y mucosa oral. Mujeres con infecciones transitorias frecuentemente desarrollan anormalidades citológicas mientras ocurra una replicación activa del VPH. Esto ocurre debido a que las infecciones productivas de VPH resultan en anormalidades citológicas en las células epiteliales infectadas. La fuerte asociación entre el riesgo de infección por VPH y el incremento en la supresión inmune apoya un efecto biológico directo de la infección por VIH en la historia natural del VPH.

In recent years, there have been major advances in our understanding of the biology and natural history of Human Papilloma Virus (HPV). Most papillomavirus infections are transmitted by close contact of either skin to skin or mucosa to mucosa. Sexual intercourse is not a requirement for genital HPV infection. Digital-oral infections occur and there is evidence that digital-genital and oral-genital contacts can result in the transmission of HPV, although in a relatively low percentage. Vertical transmission from mother to fetus is a common route of infection; in fact, it is recognized that more than 80% of infants born from mothers infected with genital HPV will be positive for HPV DNA determination in the nasal-pharyngeal region and oral mucosa. Women with transient infections often develop cytological abnormalities that take place while there is active HPV replication. This occurs because productive HPV infections result in cytological abnormalities in infected epithelial cells. The strong association between the risk of HPV infection and increased immune suppression, supports a direct biological effect of Human Immunodeficiency Virus (HIV) infection on the natural history of HPV.

Detección de virus papiloma humano en la prevención del cáncer cérvico-uterino / Human papilomavirus detection in cervical cancer prevention

El cáncer cérvico-uterino (CCU), que está fuertemente asociado a la infección por virus papiloma humano de alto riesgo (VPH-AR), sigue siendo un problema de salud pública en Latinoamérica. El uso de la citología para la detección de lesiones pre-cancerosas no ha tenido mayor impacto en las tasas de incidencia y mortalidad del CCU, que aún se mantienen altas en la región. La disponibilidad de nuevas técnicas de tamizaje para la detección de lesiones pre-cancerosas y de vacunas altamente eficaces que previenen casi todas las lesiones relacionadas con los VPH-AR de alto potencial oncogénico VPH 16 y 18, en mujeres no expuestas previamente al virus brindan una gran oportunidad para la prevención del CCU. La detección de VPH-AR representa actualmente un valioso componente de las guías clínicas para el tamizaje, manejo y tratamiento del CCU y sus lesiones precursoras. Se han desarrollado estrategias metodológicas que detectan un amplio espectro de tipos de VPH-AR; sin embargo, solo un pequeño subgrupo de ellas ha documentado la validación clínica para cualquiera de las indicaciones habituales de la detección de estos virus. Las pruebas de VPH que no estén validadas y que no hayan demostrado confiabilidad, reproducibilidad y exactitud no deben ser usadas en el manejo clínico. Una vez incorporada una prueba de VPH en el laboratorio, es esencial que el procedimiento completo sea sometido a un continuo y riguroso control de calidad para evitar prácticas subóptimas, potencialmente dañinas. Este artículo discute los recientes progresos y el estado actual de estos métodos.

Cervical cancer (CC), which is strongly associated to high-risk human papillomavirus (hr-HPV) infection, continues being a significant health problem in Latin America. The use of conventional cytology to detect precancerous cervical lesions has had no major impact on reducing CC incidence and mortality rates, which are still high in the region. New screening tools to detect precancerous lesions became available, which provide great opportunities for CC prevention, as do highly efficacious HPV vaccines able to prevent nearly all lesions associated with HPV-16 and -18 when applied before viral exposure. Currently, hr-HPV testing represents an invaluable component of clinical guidelines for screening, management and treatment of CC and their precursor lesions. Many testing strategies have been developed that can detect a broad spectrum of hr-HPV types in a single assay; however, only a small subset of them has documented clinical performance for any of the standard HPV testing indications. HPV tests that have not been validated and lack proof of reliability, reproducibility and accuracy should not be used in clinical management. Once incorporated into the lab, it is essential to submit the whole procedure of HPV testing to continuous and rigorous quality assurance to avoid sub-optimal, potentially harmful practices. Recent progress and current status of these methods are discussed in this article.

Neoplasia intraepitelial cervical en un área de salud / Cervical intraepithelial neoplasia in a health area

INTRODUCCIÓN: El cáncer cérvicouterino es la segunda neoplasia maligna más frecuente en mujeres, cuya solución debe sustentarse en la aplicación de medidas organizativas, el conocimiento de la epidemiología de la afección y el perfeccionamiento de los métodos de detección temprana y tratamiento. OBJETIVOS: Determinar el comportamiento de factores de riesgo de neoplasia intraepitelial cervical en los estratos suburbano y rural de Santa Cruz del Norte. Identificar en los grupos caso y control el comportamiento de algunos factores en las áreas seleccionadas. Comparar el comportamiento de los factores seleccionados entre los estratos suburbano y rural. MÉTODOS: Se realizó un estudio analítico de casos y controles donde se incluyó una muestra constituida por 126 mujeres. Las variables estudiadas estuvieron relacionadas con la esfera sexual y conductual. Se evaluaron los factores de riesgo a través del odds ratio y el cálculo del Test chi-cuadrado. RESULTADOS: Los factores relacionados con los antecedentes de infecciones de transmisión sexual (OR= 3,1 y 9), y el tabaquismo (OR= 6,1 y 7,5) se comportaron como factores de riesgo para ambos estratos. El número de parejas sexuales, solo resultó factor de riesgo para las mujeres de la población suburbana (OR= 4,5). Las diferencias entre las pacientes de los estratos suburbano y rural fueron significativas en todos los factores analizados excepto para la de "el número de partos" (p< 0,05). CONCLUSIONES: Se evidenció que las infecciones de transmisión sexual, y el tabaquismo se comportaron como factores de riesgo para las poblaciones de ambos estratos, a diferencia del uso de anticonceptivos orales, la edad del primer parto, la paridad y el tipo de parto. El número de parejas sexuales, solo resultó factor de riesgo para las mujeres de la población suburbana

INTRODUCTION: The cervicouterine cancer is the second malignant neoplasia more frequent in women, whose solution must to be based in implementation of organizing measures, the knowledge of affection epidemiology and the improvement of early detection methods and of treatment. OBJECTIVES: To determine the behavior of risk factors related to cervical intraepithelial neoplasia in suburban and rural strata of Santa Cruz del Norte municipality. To identify in case-control groups the behavior of some factors in selected areas. To compare the behavior of factors selected among the suburban and rural strata. METHODS: A analytical study of case-controls was conducted including a sample of 126 women. The study variables were related to this sexual and behavioral sphere and the risk factors by odds ratio and the chi² test calculus were assessed. RESULTS: Factors related to a history of sexual transmitted infections (OR= 3.1 and 9) and smoking (OR= 6.1 and 7.5) were considered as risk factors for both sexes. The number of sexual partners only was a risk factor for the suburban female population (OR= 4.5). The differences among patients of suburban and rural strata were significant in all factors analyzed except for that related to the "number of labors" (p< 0.05). CONCLUSIONS: It was evidenced that the sexual transmission infections and smoking were considered as risk factors for populations of both strata unlike the use of oral contraceptives, age in the first labor, parity and the type of labor. The number of sexual partners only was considered a risk factor for the women from the suburban population

Vacunación para virus papiloma humano: prevención de entidades precursoras del cáncer de cuello uterino / Human papiloma virus vaccination: prevention of preinvasive disease

El cáncer de cuello uterino es el segundo más frecuente en mujeres en el mundo y constituye una importante causa de mortalidad en Chile. Sin embargo, el programa de pesquisa precoz ha disminuido exitosamente la incidencia y mortalidad del cáncer escamoso de cervix (1). Las dos vacunas contra los virus VPH que más frecuentemente se asocian con cáncer invasor han sido desarrolladas y evaluadas en ensayos clínicos controlados. Numerosos estudios han sido publicados en relación a la eficacia de éstas y su política de implementación. Este artículo revisa varios de los aspectos que al médico clínico general le son de utilidad para la mejor indicación de las vacunas.

Cancer of the uterine cervix is the second most frequent cancer in woman worldwide and represents an important cause of mortality in Chile. However, the screening program has successfully diminished the incidence of mortality, mainly of the squamous cell type (1).Two vaccines against HPV that are most frequently associated with invasive cancer have been developed and evaluated in controlled clinical trials. Numerous studies have been published in relation with efficacy of these vaccines and the implementation policy. This article reviews several espects that are useful for the clinicians, in order to make a wise prescription of the vaccines.

Neoplasias intraepiteliales cervicales (NIC) tratadas con cono leep en la modalidad de ver y tratar en el instituto regional de enfermedades neoplásicas norte, del 2008 al 2009 / Cervical intraepithelial neoplasia (CIN) treated with leep in the mode of seeing and dealing in the regional institute of infection north, from 2008 to 2009

Objetivos: Evaluar los casos con LESIONES INTRAEPITELIALES CERVICALES DE ALTO GRADO (NIC II, III, CIS) y tratarlas mediante el Procedimiento de Escisión con Asa Electro quirúrgica del Cuello uterino (CONO LEEP) en la modalidad de VER Y TRATAR en el IREN Norte - Trujillo; para determinar la efectividad del tratamiento, frecuencia, grados, complicaciones y recurrencia de la enfermedad. Materiales y Métodos: Se realizó un estudio prospectivo, descriptivo llevado a cabo del 05 de Enero del 2008 al 30 de Diciembre del 2009, de todas las pacientes que presentaban a su ingreso Diagnóstico de NIC AG, quienes fueron sometidas en la primera y única consulta a CONO LEEP (PROCEDIMIENTO DE ESCISIÓN CON ASA ELECTROQUIRÚRGICA), en la modalidad de VER y TRATAR. Se incluyeron los casos con Citología positiva, biopsia positiva o Colposcopia sugestiva de NIC de AG, que afectan el 50% o menos del cérvix. Resultados: El 79.0% (151) de las pacientes con NIC alto grado, cumplieron con los criterios y fueron sometidas a CONO LEEP modalidad de VER y TRATAR. El 21% (40 casos) no cumplieron con los criterios de inclusión y fueron sometidas a otros procedimientos. La edad media fue 39.29 años y la desviación estándar de 9.96. Los resultados histológicos fueron: CIS: 23%(34), NIC III: 25 %(37) y NIC II: 46%(70); Cáncer microinvasor: 2%(3) y NIC I + VPH: 4%(7). El Test Chi square fue aplicado para determinar que variables afectan la recurrencia, obteniendo un valor de p= 0.038, 0.03, 0.019 significativo para los NIC endocervical, borde comprometido y tipo de cono. Las complicaciones del procedimiento son mínimas. Durante el seguimiento, 146 casos (96.7 %) se encuentran sin evidencia de enfermedad y 05 casos (3.3%) presento recurrencia. Las pacientes con recurrencia fueron reconizadas.Conclusión: El cono LEEP en la Modalidad de VER Y TRATAR, en la consulta ambulatoria, es segura, de bajo costo, efectiva, fácil de reproducir en servicios de salud, con una curva de aprendizaje corta...

Objectives: To evaluate the cases with cervical intraepithelial lesions high grade (CIN II, III, CIS) and treated by loop excision procedure Electro surgical cervix (LEEP) in the form of seeing and dealing in the North IREN - Trujillo, to determine the effectiveness of treatment, frequency, degree, complications and recurrence. Materials and Methods: We conducted a prospective, descriptive study conducted from January 5, 2008 to December 30, 2009, all patients presentingto joining NIC Diagnostics AG, who were subjected in the first and only LEEP CONE consultation (PROCEDURE loop electrical excision procedure), in the form of seeing and dealing. We included cases with positive cytology, positive biopsy or colposcopy suggestive of CIN AG, affecting 50% or less of the cervix. Results: The 79.0% (151) of patients with high grade CIN, met the criteria and underwent LEEP CONE see and treat modality. 21% (40 cases) did not meet the inclusion criteria and were subjected to other procedures. The mean age was 39.29 years and standard deviation of 9.96. Histological findings were: CIS: 23% (34), CIN III: 25% (37) and CIN II: 46% (70), microinvasive cancer: 2% (3) and CIN I + HPV: 4% (7). The Chi square test was applied to determine which variables affect recurrence, yielding a value of p = 0.038, 0.03, 0.019 significant to the endocervical CIN, positive margins and type of cone. Complications of the procedure are minimal. During follow up, 146 cases (96.7%) are free of disease and 05 cases (3.3%) had recurrence. Patients with recurrence were reconized. Conclusion: The cone LEEP in the mode of viewing and treatment in the outpatient department, is safe, inexpensive, effective, easy to play in health services, with a short learning curve and beneficial for younger patients who wish to preserve fertility. This mode is useful in the regions and peripheral health facilities where people have difficulty to attend several appointments and thus avoiding the drop.

Seguimiento de mujeres con anormalidad citológica de cuello uterino, en Colombia / Following-up females having an abnormal Pap smear in Colombia

Objetivo Evaluar el acceso y la oportunidad al diagnóstico y al tratamiento que tienen las pacientes con lesiones cervicales de alto grado o cáncer de acuerdo con el reporte citológico, en Colombia entre junio 2005 a junio del 2006. Metodología Estudio retrospectivo mediante encuestas a una muestra de mujeres con anormalidad citológica residentes de cuatro departamentos de Colombia seleccionados por conveniencia en relación con diferentes tasas de mortalidad. Se realizó análisis descriptivo y se compararon las diferencias entre los departamentos. Resultados El 27 por ciento de las mujeres con lesiones de alto grado o invasoras no tuvieron acceso a alguno de los servicios diagnósticos o terapéuticos por razones de tipo administrativo de los servicios de salud, razones clínicas y culturales de las mujeres. Discusión Un elemento crítico que explica el bajo impacto en la mortalidad por cáncer de cuello uterino en la mayoría de los países de Latino América es la disociación entre actividades de tamización y las de tratamiento.

Objective Evaluating the opportunity and access to diagnosis and treatment for females having had an abnormal Pap smear (high-grade epithelial lesion and cervical cancer) in Colombia from June 2005 to June 2006. Materials and Methods This was a retrospective appraisal using a semi-closed survey of females having had an abnormal Pap smear with high squamous intraepithelial lesions or cervical cancer living in four Colombian departments. These areas were conveniently selected according to their different mortality rates. A descriptive analysis was made and the departments differences compared. Results It was found that 27 percent of females having high-grade squamous intraepithelial lesion or cervical cancer had no access to any of the diagnostic or therapeutic services. Health service administration problems and clinical and cultural ones affecting the females in the study could explain such results. Discussion Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.

Risk-factors and strategies for control of carcinoma cervix in India: hospital based cytological screening experience of 35 years.

PURPOSE: Role of risk factors in cervical carcinogenesis and strategies for control of the disease have been assessed from the accumulated cytological data, derived from 35 years of hospital-based screening in Lucknow, North India. MATERIALS AND METHODS: A total of 36,484 women have been cytologically screened during a span of 35 years (April 1971 - June 2005) in the Gynaecology out patient department (OPD) of Queen Mary's Hospital. RESULTS: The frequency of Squamous Intraepithelial Lesion (SIL) and carcinoma was found to be 7.2% and 0.6%, respectively, in the present study. The study revealed high age and parity as a predominant factor in cervical carcinogenesis, while viral sexually transmitted disease (STDs) -human papilloma virus (HPV) and Herpes simplex virus (HSV) were also largely associated with SIL cases. The study emphasized great value of clinically downstaging the cervical cancer by detecting cervical cancer in the early stage. The study also revealed a significant difference in the frequency of SIL in symptomatic and asymptomatic women. CONCLUSION: Based on the analyzed data, it was felt that single lifetime screening, which appears to be the most feasible and affordable mode for control of carcinoma cervix in developing countries like India, should be carried out in all women of high parity irrespective of age (with three or more children) and in older women above the age of 40 years irrespective of parity.

Prevalencia de anormalidades de células epiteliales y factores asociados en mujeres de un municipio rural colombiano / Prevalence of epithelial squamous cell abnormalities and associated factors in women of a rural town of Colombia

Introducción. A pesar de la existencia de los programas de tamización basados en la citología, las tasas de cáncer de cuello uterino permanecen estables en Colombia. La descripción de los factores asociados a las lesiones precursoras de cáncer de cuello uterino es necesaria para establecer estrategias para su prevención.Objetivo. Determinar la prevalencia de las anormalidades de células epiteliales escamosas y su asociación con los factores de riesgo descritos. Materiales y métodos. Estudio transversal de población en 739 mujeres, seleccionadas en forma aleatoria. La información se recolectó mediante la citología y un cuestionario previamente validado. La medida de asociación fue la razón de prevalencia con su respectivo intervalo de confianza del 95 por ciento. Las variables de confusión fueron controladas en un modelo de regresión logística multivariado. Resultados.La prevalencia del evento fue de 15,8 por ciento. Entre las mujeres con citología anormal, 10 por ciento presentó células escamosas atípicas de significado indeterminado; 3,9 por ciento, lesión escamosa intraepitelial de bajo grado, y 1,9 por ciento, lesión escamosa intraepitelial de alto grado. La regresión logística ajustada sugiere que los antecedentes de enfermedades de transmisión sexual, una citología anormal y tener dos o más parejas regulares/ocasionales durante la vida se asocian con la presencia del evento. Conclusiones. La relación de anormalidades de células escamosas con conducta sexual refleja la asociación entre el virus del papiloma humano y lesiones preneoplásicas de cáncer de cuello uterino. El uso frecuente y el adecuado conocimiento sobre la citología, sugiere que aspectos tales como las dificultades con la calidad de la citología o el acceso al diagnóstico y tratamiento, pudieran explicar las altas tasas de cáncer de cuello uterino.

Evidence for benefits from treating cervical ectopy: literature review / Evidências de benefícios no tratamento de ectopia do colo do útero: revisão de literatura

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

CONTEXTO E OBJETIVO: A ectopia do colo do útero é hoje considerada um fenômeno fisiológico, mas parece ainda haver uma forte tendência no sentido da intervenção (tratamento). Este estudo se propõe a realizar revisão da literatura buscando evidências de benefícios conseqüentes ao tratamento da ectopia. MÉTODOS: Pesquisa nas bases Medical Literature Analysis and Retrieval Sysem Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americane e do Caribe em Ciências da Saúde (Lilacs), Biblioteca Cochrane e seis livros especializados. RESULTADOS: A revisão mostrou que: 1) existe provavelmente associação de ectopia com infecção cervical por Chlamydia trachomatis, pelo vírus HPV e maior risco de soroconversão para HIV; 2) existe provavelmente associação entre ectopia e neoplasia intra-epitelial cervical; 3) existe associação com mucorréia e nictúria; 4) não existem evidências sobre associação entre ectopia e câncer de colo do útero nem sobre proteção contra este câncer proporcionada pelo tratamento da ectopia. CONCLUSÕES: 1) Não foram encontrados na literatura dados que justifiquem o tratamento rotineiro da ectopia; 2) O tratamento pode ser utilizado para tratar sintomas associados à ectopia, porém mais sintomas são atribuídos à ectopia do que se pôde confirmar em um estudo controlado; 3) Seriam necessários novos estudos para testar a hipótese de proteção contra o câncer de colo proporcionada pelo tratamento.

Lesiones intraepiteliales escamosas del cervix: diagnóstico y tratamiento / The squamous intraepithelial lesions the cervix: diagnosis and treatment

El cáncer cérvico-uterino es actualmente una enfermedad que puede , al menos teóricamente, prevenirse haciendo screening a la población en riesgo, detectando sus lesiones precursoras y tratándolas apropiadamente, evitando así el desarrollo del cáncer invasor. Hay una relación etiológica establecida entre la infección por virus papiloma con genotipo de alto riesgo oncogénico (VPH-AR) y el cáncer del cuello uterino, así como sus lesiones precursoras. Se describen las técnicas de screening poblacional, los métodos diagnósticos, conductas y manejo de las lesiones intraepiteliales escamosas (LIE), así como las modalidades terapéuticas actuales.

Interpretacion del informe de la citologia cervical de acuerdo al Sistema Bethesda 2001 / Interpretation of the report of the cervical cytology according to the System Bethesda 2001

Se revisa la versión 2001 del informe citológico cervical de Bethesda con el fin de aclarar sus términos de manera que su comprensión permita una adecuada interpretación de los informes citológicos por los clínicos, y por lo tanto, puedan tomar una conducta apropiada con las pacientes para prevenir las neoplasias invasoras.Palabras claves: citología, neoplasia, ASC-US, ASC-H, LIE-BG, LIE-AG, AGC, AIS, NOS, Bethesda