Delayed cervical cancer diagnosis: a systematic review.

OBJECTIVE: Cervical cancer (CC) is a preventable women's cancer. Vaccination and routine Pap smear screening have reduced cervical cancer-related mortality by 70-80% in the world. The eradication of CC depends on identifying the disease early and removing barriers to its timely detection. This review study was designed to determine diagnostic delay and factors related to delayed CC diagnosis in the world. MATERIALS AND METHODS: A comprehensive search was carried out in databases including Medline, Web of Science, Core Collection (Indexes = SCI-EXPANDED, SSCI, A & HCI Timespan), and Scopus for articles published up to December 2021. Publications were included if they reported data on the delayed CC, and factors related to diagnosis of CC in women. There was no time restriction in this review. RESULTS: In total, 45 articles were entered into the study. In studies, advanced stages of CC (IIB to IV) varied from 10.2% to 87.9% due to delayed diagnosis. A delayed CC diagnosis was reported in 4.3%-89.1% of patients. The median and mean days of delayed diagnosis were 59-210 days and 2.92-10.5 months, respectively. Factors related to delayed CC diagnosis were categorized into three components including patient, medical history, and health system delay. Patient delay included socio-demographic, husband/ partner, and knowledge. Medical history included medical issues, obstetrics, and family history. Health system delays included health facilities and levels of accessibility. CONCLUSIONS: There is an urgent need to shorten the diagnostic journey of CC patients by addressing all the components of diagnostic delay and developing strategies to modify the factors associated with these delays.

Is cryotherapy effective in all women with low-grade cervical intraepithelial neoplasia?

OBJECTIVE: This study was designed to investigate the incidence the premalignant and malignant cervical lesions at the 12-month follow-up investigation between cryotherapy and non-cryotherapy groups. PATIENTS AND METHODS: A prospective cohort study was performed in women with CIN 1 and PCB, who were referred to the gynecology clinic at Imam Hospital affiliated to Mazandaran University of Medical Sciences (MAZUMS), Sari, Iran, from February 2015 to November 2019. Of 232 patients, 131 consented to cryotherapy and underwent the treatment, while 101 were unwilling to undergo the treatment. After 12 months, we performed a Pap smear, a colposcopy, and a histopathological investigation of the cervix in both groups. Primary and secondary outcomes were compared between groups. The primary outcome was the comparison of incidence premalignant and malignant cervical lesions in cryotherapy and non-cryotherapy groups. The secondary outcome was a comparison of the accuracy of the Pap smear test versus colposcopy for the detection of premalignant and malignant cervical lesions in women with or without a history of cryotherapy. PATIENTS: Totally, abnormal cytological, positive colposcopic, and positive histopathological findings were reported in 41.56%, 20.26%, and 13.79 %, respectively. By histology biopsy, premalignant and malignant cervical lesions were reported in 28.24% (37/131) and 36.63% (32/101) of women in the cryotherapy and the non-cryotherapy group, respectively. This statistic did not differ significantly between groups (p = 0.78). Pap smears were abnormal in 39.7% and 44.5% of women in the cryotherapy and the non-cryotherapy group, respectively. A positive colposcopy was obtained in 27 (20.6%) and 19 (18.8%) women in the cryotherapy and the non-cryotherapy group, respectively. The diagnostic accuracy of the Pap smear test and colposcopy in detecting cervical neoplasia did not differ in women who had undergone cryotherapy and those who had not (p>0.05). CONCLUSIONS: This prospective study showed that cryotherapy is no appropriate treatment for patients with CIN1 and PCB.

A time for psycho-spiritual transcendence: The experiences of Iranian women of pain during childbirth.

BACKGROUND: The description of women's experiences of childbirth improves our understandings of the nature of childbirth, women's suffering and pain during childbirth. AIM: This study aimed to explore women's experiences of pain during childbirth. METHOD: A qualitative study was conducted using a conventional content analysis method proposed by Graneheim and Lundman (2004). In-depth face to face semi-structured interviews were held with 17 women who met inclusion criteria for participation in this study. FINDINGS: The women's experiences of pain during childbirth was described as 'a time for psycho-spiritual transcendence'. Categories developed during the data analysis were 'conflicting emotions towards pain', 'new insight towards labor pain', 'self-actualization' and 'spiritual development'. CONCLUSION: Most participants had positive experiences and attitudes towards pain during childbirth influenced by cultural, context and religious factors. According to this study, 'transcendental progression' was an eminent feeling that created positive inner feelings along with self-actualization in women. This provides a new insight on labor pain and helps healthcare providers understand the effect of pain during childbirth on women's spiritual, mental and psychological needs.