Uterine collision tumor. Case report and review of the literature / Tumor de colisión de útero. Reporte de caso y revisión de la literatura

Objectives: To report the case of a patient with a uterine collision tumor and to conduct a review of the literature. Material and methods: A 76-year-old patient who presented to the national cancer referral center in Bogota (Colombia), where she was diagnosed with a uterine collision tumor consisting of a seroustype endometrial adenocarcinoma and a cervical adenosarcoma. The patient underwent surgical treatment followed by chemotherapy and supplemental radiotherapy, and died 16 months later. A search was conducted in the Medline via PubMed and Embase databases, including reports and case series of women with a diagnosis of uterine collision tumor, with retrieval of information regarding diagnosis, treatment and prognosis. A narrative summary of the findings was made. Results: The search identified 36 titles, of which 14 studies with 17 patients were included. The most frequent histopathological diagnosis was endometrial adenocarcinoma and high and low grade endometrial sarcoma (47 %). Primary treatment was surgery and adjuvant treatment with chemotherapy and radiotherapy (15 %) was performed in close to 50 % of cases. One-year survival was 75 %. Conclusions: No cases of uterine collision tumors with the histopathology or in the location of the reported case were found in the literature. If this reported case is taken into account, 2-year mortality is 28 %. Further studies to describe the immunohistochemistry, treatment and prognosis of this condition are needed.

Objetivos: reportar el caso de una paciente con tumor de colisión del útero y realizar una revisión de la literatura respecto al diagnóstico histopatológico, tratamiento y pronóstico de esta condición. Materiales y métodos: mujer de 76 años que consultó al centro nacional de referencia del cáncer en Bogotá (Colombia), donde se hizo el diagnóstico de tumor de colisión del útero, compuesto por un adenocarcinoma de endometrio tipo seroso y adenosarcoma de cérvix. Recibió tratamiento quirúrgico más quimioterapia y radioterapia complementaria, falleció a los 16 meses. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed y Embase, que incluía reportes y series de caso de mujeres con diagnóstico de tumor de colisión del útero, y se extrajo información sobre el diagnóstico, tratamiento y pronóstico. Se realizó un resumen narrativo de los hallazgos. Resultados: la búsqueda identificó 36 títulos, de los cuales se incluyeron 14 estudios que incluían 17 pacientes. El diagnóstico histopatológico más frecuente fue el adenocarcinoma endometrioide de endometrio y sarcoma endometrial de alto y bajo grado (47 %). El tratamiento básico fue quirúrgico. Cerca del 50 % recibió tratamiento adyuvante con quimioterapia y radioterapia (15 %). La sobrevida a 1 año fue del 75 %. Conclusiones: en la literatura no se identificaron casos de tumores de colisión de útero con la histopatología y en la ubicación del caso presentado. La mortalidad a dos años es cercana al 28 % si se toma en cuenta el caso reportado. Se necesitan más estudios que describan la inmunohistoquímica, el tratamiento y el pronóstico de esta condición.

Tumor de colisión de útero. Reporte de caso y revisión de la literatura / Uterine collision tumor. Case report and review of he literature

Objetivos: Reportar el caso de una paciente con tumor de colisión del útero y realizar una revisión de la literatura respecto al diagnóstico histopatológico, tratamiento y pronóstico de esta condición. Materiales y métodos: Mujer de 76 años que consultó al centro nacional de referencia del cáncer en Bogotá (Colombia), donde se hizo el diagnóstico de tumor de colisión del útero, compuesto por un adenocarcinoma de endometrio tipo seroso y adenosarcoma de cérvix. Recibió tratamiento quirúrgico más quimioterapia y radioterapia complementaria, falleció a los 16 meses. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed y Embase, que incluía reportes y series de caso de mujeres con diagnóstico de tumor de colisión del útero, y se extrajo información sobre el diagnóstico, tratamiento y pronóstico. Se realizó un resumen narrativo de los hallazgos. Resultados: La búsqueda identificó 36 títulos, de los cuales se incluyeron 14 estudios que incluían 17 pacientes. El diagnóstico histopatológico más frecuente fue el adenocarcinoma endometrioide de endometrio y sarcoma endometrial de alto y bajo grado (47 %). El tratamiento básico fue quirúrgico. Cerca del 50 % recibió tratamiento adyuvante con quimioterapia y radioterapia (15 %). La sobrevida a un año fue del 75 %. Conclusiones: En la literatura no se identificaron casos de tumores de colisión de útero con la histopatología y en la ubicación del caso presentado. La mortalidad a dos años es cercana al 28 % si se toma en cuenta el caso reportado. Se necesitan más estudios que describan la inmunohistoquímica, el tratamiento y el pronóstico de esta condición.

Objectives: To report the case of a patient with a uterine collision tumor and to conduct a review of the literature. Material and methods: A 76-year-old patient who presented to the national cancer referral center in Bogota (Colombia), where she was diagnosed with a uterine collision tumor consisting of a serous-type endometrial adenocarcinoma and a cervical adenosarcoma. The patient underwent surgical treatment followed by chemotherapy and supplemental radiotherapy, and died 16 months later. A search was conducted in the Medline via PubMed and Embase databases, including reports and case series of women with a diagnosis of uterine collision tumor, with retrieval of information regarding diagnosis, treatment and prognosis. A narrative summary of the findings was made. Results: The search identified 36 titles, of which 14 studies with 17 patients were included. The most frequent histopathological diagnosis was endometrial adenocarcinoma and high and low grade endometrial sarcoma (47 %). Primary treatment was surgery and adjuvant treatment with chemotherapy and radiotherapy (15 %) was performed in close to 50 % of cases. One-year survival was 75 %. Conclusions: No cases of uterine collision tumors with the histopathology or in the location of the reported case were found in the literature. If this reported case is taken into account, 2-year mortality is 28 %. Further studies to describe the immunohistochemistry, treatment and prognosis of this condition are needed.

Primary HPV-DNA screening in women under 30 years of age: health technology assessment / Tamización primaria con prueba ADN-VPH en mujeres menores de 30 años: evaluación de tecnología sanitaria

Background: Primary screening with Human Papilloma Virus (HPV) testing was introduced in Colombia in 2014 for individuals between 30 and 65 years of age. When the result is positive, cytology triage is performed for colposcopy referral. The convenience of initiating HPV-DNA testing for screening at 25 years of age is currently a subject of discussion. Therefore, the objective of this health technology assessment (HTA) is to analyze the available evidence regarding safety, efficacy, cost-effectiveness, values and preferences, ethical dilemmas and considerations pertaining to the implementation of the HPV-DNA test as a cervical screening strategy in women under 30 years of age in the Colombian context. Domains to be assessed: Clinical efficacy and safety 1. Cumulative rate of cervical intraepithelial neoplasia (CIN) grade 2 or high-er after 2 screening rounds. 2. Cumulative rates of invasive cancer of the uterine cervix after 2 screening rounds. 3. Safety: referral to colposcopy. Cost-effectiveness Cost-effectiveness for Colombia. Other domains considered Ethical considerations associated with cervical screening in women under 30 years of age. Organizational and individual considerations. Barriers and facilitators pertaining to the implementation of cervical screening in women under 30 years of age in the Colombian context. Methods: Clinical efficacy and safety assessment A systematic literature search of systematic reviews and clinical trials was conducted in MEDLINE, Embase and CENTRAL. The body of evidence was rated using the GRADE approach. An interdisciplinary team was then convened to create a working group to review the retrieved evidence. This led to the discussion and construction of the conclusions following the guidelines of a formal consensus in accordance with the RAND/UCLA methodology. Economic study Systematic literature research of studies that had assessed cost-effectiveness for Colombia. Results: Clinical outcomes An integrative analysis of 5 randomized clinical trials that met the inclusion critera was performed. Compared with cytology, primary HPV-DNA testing in women under 30 years of age could be associated with a lower frequency of CIN+2 lesions during the first screening round (RR: 1.57; CI: 1.20 to 2.04; low evidence certainty), and a lower incidence of CIN+2 (RR: 0.67; CI: 0.48 to 0.92; low evidence certainty). Moreover, it is associated with a lower frequency of invasive carcinoma at the end of follow-up (RR: 0.19; CI: 0.07 to 0.53; high evidence certainty). Economic results From the financial point of view, the use of HPVDNA testing plus cytology-based triage starting at 25 years of age is perhaps the most cost-effective option for Colombia (incremental cost-effectiveness ratio, COP 8,820,980 in 2013). Other implications Two studies suggest that barriers to implementation attributable to intermediation, public unrest and geographic considerations could be overcome with the use of new screening technologies or strategies. It is important to consider administration and service provision alternatives in order to overcome some acceptability and access barriers. Any cervical screening program must take into consideration ethical principles of nonmaleficence, beneficence, autonomy and equity. Future studies should focus on analyzing new screening techniques with emphasis on the population under 30 years of age. Conclusions: The use of HPV-DNA testing as a screening strategy in women under 30 years of age is a potentially efficacious and cost-effective intervention for Colombia. Future studies should focus on analyzing new screening technologies, with emphasis on the population under 30 years of age.

Antecedentes: A partir del 2014 en Colombia se incorporó la Tamización primaria con prueba de Virus del Papiloma Humano (VPH) desde los 30 hasta los 65 años, cuando la prueba es positiva se hace triage con citología para remisión a colposcopia. Actualmente se discute la conveniencia de iniciar la tamización con prueba de ADN de VPH a partir de los 25 años. De esta manera, el objetivo de esta evaluación de tecnologías sanitarias es analizar la evidencia disponible en torno a la seguridad, efectividad, costoefectividad, valores y preferencias, dilemas éticos y aspectos relacionados con la implementación para el contexto colombiano de la prueba ADN-VPH como estrategia de tamización cervical en mujeres menores de 30 años. Dominios a evaluar: Eficacia clínica y seguridad 1. Tasa acumulada de neoplasia intraepitelial cervical (NIC) grado 2 o más avanzado luego de 2 rondas de tamización. 2. Tasas acumuladas de cáncer invasor de cérvix luego de 2 rondas de tamización. 3. Seguridad: remisión a colposcopia. Costo-efectividad Costo efectividad para Colombia. Otros dominios considerados Aspectos éticos asociados a la tamización cervical en mujeres menores de 30 años. Aspectos organizacionales y del individuo. Barreras y facilitadores relacionados con la implementación en el contexto colombiano de la tamización cervical en mujeres menores de 30 años. Métodos: Evaluación de efectividad y seguridad clínicas Se realizó una búsqueda sistemática de la literatura en MEDLINE, Embase y CENTRAL de revisiones sistemáticas y ensayos clínicos. Se calificó el cuerpo de la evidencia con la aproximación GRADE. Posteriormente, se convocó a un grupo interdisciplinario a una mesa de trabajo en donde se presentó la evidencia recuperada, dando paso a la discusión y a la construcción de las conclusiones, siguiendo los lineamientos de un consenso formal acorde a la metodología RAND/UCLA. Estudio económico Se hizo una búsqueda sistemática de la literatura de estudios que hubieran evaluado el costo-efectividad para Colombia. Resultados: De 7.659 referencias recuperadas se incluyeron 8 estudios. Resultados clínicos Se realizó un análisis integrativo de 5 ensayos clínicos aleatorizados que cumplieron con los criterios de inclusión. Cuando se compara frente a la citología, la tamización primaria con ADN-VPH en mujeres menores de 30 años, podría asociarse con una mayor frecuencia de detección de lesiones NIC2+ durante la primera ronda de cribado (RR: 1.57; IC: 1,20 a 2,04; certeza en la evidencia baja), con una menor incidencia de NIC2+ (RR:0,67; IC: 0,48 a 0,92; certeza en la evidencia baja) y se asocia con una menor frecuencia de carcinoma invasor al término del seguimiento (RR: 0,19; IC: 0,07 a 0,53; certeza en la evidencia alta). Resultados económicos Desde el punto de vista económico, la alternativa de ADN-VPH y triage con citología desde los 25 años quizás representa la alternativa más costo-efectiva para Colombia (razón costo-efectividad incremental $8.820.980 COP año 2013). Otras implicaciones Dos estudios sugieren que las barreras de implementación, atribuibles a circunstancias de intermediación, de orden público y de carácter geográfico, podrían ser solventadas por nuevas tecnologías o estrategias de cribado. Es importante considerar alternativas de forma de administración y de prestación de servicios para solventar algunas barreras de aceptabilidad y acceso. Todo programa de tamización cervical debe contemplar los principios éticos de no maleficencia, beneficencia, autonomía y equidad. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años. Conclusiones: El uso de la prueba ADN-VPH como estrategia de tamización en mujeres menores de 30 años es una intervención probablemente efectiva y costoefectiva para Colombia. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años.

Repercussões da braquiterapia na qualidade de vida e funcionalidade no tratamento do câncer de colo uterino / Effects of brachytherapy on quality of life and functionality in the treatment of cervix cancer / Efectos de la braquiterapia sobre la calidad de vida y la funcionalidad en el tratamiento del cáncer de cuello uterino

RESUMO Objetivo: avaliar a repercussão da braquiterapia sobre funcionalidade e qualidade de vida de mulheres com câncer de colo uterino. Método: estudo transversal descritivo, desenvolvido entre dezembro de 2019 e fevereiro de 2020, com 33 mulheres com neoplasia uterina em tratamento braquiterápico, acompanhadas no Centro Oncológico do Nordeste - Brasil. Foi aplicado o instrumento Funtional Assessment of Cancer Theraphy - Cervix Cancer. Foram comparadas as médias das subescalas e analisada a correlação entre elas por meio da aplicação dos testes ANOVA e t de Student. Resultados: foram evidenciadas demandas voltadas para a autoimagem, sexualidade e queixas urinárias. A média de preocupações adicionais foi menor na faixa de 50-59 quando comparada com a média da faixa de 31-49 (p=0,004) e com a de 60-75 (p=0,002). Conclusão: abordar assuntos voltados para sexualidade e queixas urinárias contribuem para a identificação precoce dos sintomas ocasionados pela braquiterapia, assim como implementação de medidas, proporcionando qualidade de vida à paciente.

ABSTRACT Objective: to assess the effect of brachytherapy on functionality and quality of life of women with cervix cancer. Method: a descriptive and cross-sectional study carried out between December 2019 and February 2020 with 33 women with uterine neoplasia undergoing brachytherapy, followed up at Centro Oncológico do Nordeste - Brazil. The Funtional Assessment of Cancer Therapy - Cervix Cancer instrument was applied. The means of the subscales were compared and their mutual correlation was analyzed by applying the ANOVA and Student's t tests. Results: requirements focused on self-image, sexuality and urinary complaints were evidenced. The mean of additional concerns was lower in the age group from 50 to 59 years old, when compared to the mean values in the age groups from 31 to 49 years old (p=0.004) and from 60 to 75 years old (p=0.002). Conclusion: addressing issues related to sexuality and urinary complaints contribute to early identification of the symptoms caused by brachytherapy, as well as the implementation of measures, providing quality of life for the patient.

RESUMEN Objetivo: evaluar el efecto de la braquiterapia sobre la funcionalidad y la calidad de vida de mujeres con cáncer de cuello uterino. Método: estudio transversal y descriptivo realizado entre diciembre de 2019 y febrero de 2020 con 33 mujeres con neoplasia uterina en tratamiento de braquiterapia, monitoreadas en el Centro Oncológico do Nordeste - Brasil. Se aplicó el instrumento Funtional Assessment of Cancer Therapy - Cervix Cancer. Se compararon las medias de las subescalas y se analizó la correlación entre ellas por medio de las pruebas ANOVA y t de Student. Resultados: se evidenciaron requerimientos centrados en la autoimagen, la sexualidad y las quejas urinarias. La media de preocupaciones adicionales fue menor en los grupos etarios de 31 a 49 años (p=0.004) y de 60 a 75 (p=0.002). Conclusión: abordar cuestiones relacionadas con la sexualidad y las molestias urinarias contribuyen a la identificación precoz de los síntomas causados por la braquiterapia, así como a la implementación de medidas, proporcionando calidad de vida a la paciente.

Tamización primaria con prueba ADN-VPH en mujeres menores de 30 años: evaluación de tecnología sanitaria / Primary HPV-DNA screening in women under 30 years of age: health technology assessment

Antecedentes A partir del 2014 en Colombia se incorporó la Tamización primaria con prueba de Virus del Papiloma Humano (VPH) desde los 30 hasta los 65 años, cuando la prueba es positiva se hace triage con citología para remisión a colposcopia. Actualmente se discute la conveniencia de iniciar la tamización con prueba de ADN de VPH a partir de los 25 años. De esta manera, el objetivo de esta evaluación de tecnologías sanitarias es analizar la evidencia disponible en torno a la seguridad, efectividad, costoefectividad, valores y preferencias, dilemas éticos y aspectos relacionados con la implementación para el contexto colombiano de la prueba ADN-VPH como estrategia de tamización cervical en mujeres menores de 30 años. Dominios a evaluar Eficacia clínica y seguridad 1. Tasa acumulada de neoplasia intraepitelial cervical (NIC) grado 2 o más avanzado luego de 2 rondas de tamización. 2. Tasas acumuladas de cáncer invasor de cérvix luego de 2 rondas de tamización. 3. Seguridad: remisión a colposcopia. Costo-efectividad Costo efectividad para Colombia. Otros dominios considerados Aspectos éticos asociados a la tamización cervical en mujeres menores de 30 años. Aspectos organizacionales y del individuo. Barreras y facilitadores relacionados con la implementación en el contexto colombiano de la tamización cervical en mujeres menores de 30 años. Métodos Evaluación de efectividad y seguridad clínicas Se realizó una búsqueda sistemática de la literatura en MEDLINE, Embase y CENTRAL de revisiones sistemáticas y ensayos clínicos. Se calificó el cuerpo de la evidencia con la aproximación GRADE. Posteriormente, se convocó a un grupo interdisciplinario a una mesa de trabajo en donde se presentó la evidencia recuperada, dando paso a la discusión y a la construcción de las conclusiones, siguiendo los lineamientos de un consenso formal acorde a la metodología RAND/UCLA. Estudio económico Se hizo una búsqueda sistemática de la literatura de estudios que hubieran evaluado el costo-efectividad para Colombia. Resultados De 7.659 referencias recuperadas se incluyeron 8 estudios. Resultados clínicos Se realizó un análisis integrativo de 5 ensayos clínicos aleatorizados que cumplieron con los citerios de inclusión. Cuando se compara frente a la citología, la tamización primaria con ADN-VPH en mujeres menores de 30 años, podría asociarse con una mayor frecuencia de detección de lesiones NIC2+ durante la primera ronda de cribado (RR: 1.57; IC: 1,20 a 2,04; certeza en la evidencia baja), con una menor incidencia de NIC2+ (RR:0,67; IC: 0,48 a 0,92; certeza en la evidencia baja) y se asocia con una menor frecuencia de carcinoma invasor al término del seguimiento (RR: 0,19; IC: 0,07 a 0,53; certeza en la evidencia alta). Resultados económicos Desde el punto de vista económico, la alternativa de ADN-VPH y triage con citología desde los 25 años quizás representa la alternativa más costo-efectiva para Colombia (razón costo-efectividad incremental $8.820.980 COP año 2013). Otras implicaciones Dos estudios sugieren que las barreras de implementación, atribuibles a circunstancias de intermediación, de orden público y de carácter geográfico, podrían ser solventadas por nuevas tecnologías o estrategias de cribado. Es importante considerar alternativas de forma de administración y de prestación de servicios para solventar algunas barreras de aceptabilidad y acceso. Todo programa de tamización cervical debe contemplar los principios éticos de no maleficencia, beneficencia, autonomía y equidad. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años. Conclusiones El uso de la prueba ADN-VPH como estrategia de tamización en mujeres menores de 30 años es una intervención probablemente efectiva y costoefectiva para Colombia. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años.

Background Primary screening with Human Papilloma Virus (HPV) testing was introduced in Colombia in 2014 for individuals between 30 and 65 years of age. When the result is positive, cytology triage is performed for colposcopy referral. The convenience of initiating HPV-DNA testing for screening at 25 years of age is currently a subject of discussion. Therefore, the objective of this health technology assessment (HTA) is to analyze the available evidence regarding safety, efficacy, cost-effectiveness, values and preferences, ethical dilemmas and considerations pertaining to the implementation of the HPV-DNA test as a cervical screening strategy in women under 30 years of age in the Colombian context. Domains to be assessed Clinical efficacy and safety 1. Cumulative rate of cervical intraepithelial neoplasia (CIN) grade 2 or high-er after 2 screening rounds. 2. Cumulative rates of invasive cancer of the uterine cervix after 2 screening rounds. 3. Safety: referral to colposcopy Cost-effectiveness Cost-effectiveness for Colombia. Other domains considered Ethical considerations associated with cervical screening in women under 30 years of age. Organizational and individual considerations. Barriers and facilitators pertaining to the implementation of cervical screening in women under 30 years of age in the Colombian context. Methods Clinical efficacy and safety assessment A systematic literature search of systematic reviews and clinical trials was conducted in MEDLINE, Embase and CENTRAL. The body of evidence was rated using the GRADE approach. An interdisciplinary team was then convened to create a working group to review the retrieved evidence. This led to the discussion and construction of the conclusions following the guidelines of a formal consensus in accordance with the RAND/UCLA methodology. Economic study Systematic literature research of studies that had assessed cost-effectiveness for Colombia. Results Out of the 7,659 references retrieved, 8 studies were included. Clinical outcomes An integrative analysis of 5 randomized clinical trials that met the inclusion critera was performed. Compared with cytology, primary HPV-DNA testing in women under 30 years of age could be associated with a lower frequency of CIN+2 lesions during the first screening round (RR: 1.57; CI: 1.20 to 2.04; low evidence certainty), and a lower incidence of CIN+2 (RR: 0.67; CI: 0.48 to 0.92; low evidence certainty). Moreover, it is associated with a lower frequency of invasive carcinoma at the end of follow-up (RR: 0.19; CI: 0.07 to 0.53; high evidence certainty). Economic results From the financial point of view, the use of HPVDNA testing plus cytology-based triage starting at 25 years of age is perhaps the most cost-effective option for Colombia (incremental cost-effectiveness ratio, COP 8,820,980 in 2013). Other implications Two studies suggest that barriers to implementation attributable to intermediation, public unrest and geographic considerations could be overcome with the use of new screening technologies or strategies. It is important to consider administration and service provision alternatives in order to overcome some acceptability and access barriers. Any cervical screening program must take into consideration ethical principles of nonmaleficence, beneficence, autonomy and equity. Future studies should focus on analyzing new screening techniques with emphasis on the population under 30 years of age. Conclusions The use of HPV-DNA testing as a screening strategy in women under 30 years of age is a potentially efficacious and cost-effective intervention for Colombia. Future studies should focus on analyzing new screening technologies, with emphasis on the population under 30 years of age.

Prevalência de alterações de exame citopatológico e sua relação com lesões compatíveis com a infecção pelo Papiloma Vírus Humano e as neoplasias do colo uterino / Prevalence of changes on cytopathological exams and their relationship with injuries compatible with human papilloma virus infection and uterine cervical neoplasms

Introdução: O objetivo deste estudo é identificar a frequência de exames citológicos de colo uterino alterados e sua relação com a infecção pelo Papiloma Vírus Humano (HPV) e neoplasias. Métodos: Foram estudadas mulheres residentes em zona urbana, que fizeram exame citopatológico entre 2015 e 2017, com registros no Sistema de Informações do Câncer. Resultados: Foram realizados 25.323 exames citopatológicos, reunindo 815 alterações (3,2%). A faixa etária mais acometida foi entre 30-40 anos. A principal alteração encontrada foi "ASC-US" (431 casos ­ 52,8%). A Lesão Intraepitelial de Baixo Grau, que compreende o efeito citopático pelo HPV e neoplasia intraepitelial cervical Grau I, foi encontrada em 164 casos (20,1%). Após exame de colposcopia, 181 pacientes realizaram biópsia, sendo mais prevalente "NIC I com Alterações Compatíveis com Ação pelo HPV" (21,5%). Conclusão: Elevada prevalência de alterações que podem evoluir para neoplasias de colo uterino, com ênfase naquelas sugestivas da presença de HPV em pacientes abaixo de 25 anos.

Introduction: This study aimed to identify the frequency of changes on cervix cytopathological exams and its relationship with Human Papilloma Virus (HPV) infection and neoplasms. Methods: Women living in the urban area who underwent cytopathological examination from 2015 to 2017 were assessed, based on records from the Cancer Information System. Results: A total of 25,323 cytopathological exams were performed, reporting 815 changes (3.2%). The most affected age group was from 30 to 40 years. The most frequent change was "ASC-US" (431 cases ­ 52.8%). Low-grade intraepithelial lesion, which encompasses the cytopathic effect of HPV and cervical intraepithelial neoplasm grade I, was found in 164 cases (20.1%). After being examined by colposcopy, 181 patients underwent biopsy, whose most prevalent finding was "grade I CIN with Changes Compatible With HPV Action" (21.5%). Conclusion: There was a high prevalence of changes that can evolve to uterine cervical neoplasms, with emphasis on those suggestive of presence of HPV in patients younger than 25 years.

Obesity and gynecological cancers: A toxic relationship.

Despite the evidence supporting the relevance of obesity and obesity-associated disorders in the development, management, and prognosis of various cancers, obesity rates continue to increase worldwide. Growing evidence supports the involvement of obesity in the development of gynecologic malignancies. This article explores the molecular basis governing the alteration of hallmarks of cancer in the development of obesity-related gynecologic malignancies encompassing cervical, endometrial, and ovarian cancers. We highlight specific examples of how development, management, and prognosis are affected for each cancer, incorporate current knowledge on complementary approaches including lifestyle interventions to improve patient outcomes, and highlight how new technologies are helping us better understand the biology underlying this neglected pandemic.

Intraepithelial cervical lesions in indigenous in Ecuador / Lesiones intraepiteliales cervicales en indígenas del Ecuador

The aim of this research was to determine the prevalence of cervical intraepithelial lesions in indigenous women of Ecuador 2017. A descriptive study was performed. Population was formed by 2489 indigenous women aged 15 to 64 years old, of which 396 users were chosen by spontaneous demand. Frequency values and percentages were taken from qualitative variables, while mean and standard deviation were taken from quantitative variables. Prevalence of intraepithelial lesions was 13,8%. Average age was 31 years old. Uncertain importance's squamous atypical cells were higher in 30-to-39-year-old group (46,7%). Non-specific atypical glandular cells were observed in 66,7% of 30-to-39-year-old group. Low-grade intraepithelial lesions were majorly found in 20-to-29-year-old group (43,8%). High-grade intraepithelial lesions were also seen in 20-to-29-year-old group. Conclusions were: prevalence of intraepithelial lesions in indigenous women of Ecuador was higher than 10% of reported in other studies, and more frequent in those aged 20 and 39 years old

El objetivo de esta investigación fue determinar la prevalencia de lesiones intraepiteliales cervicales en mujeres indígenas del Ecuador 2017. Se realizó un estudio descriptivo. La población estuvo compuesta por 2489 mujeres indígenas de 15 a 64 años, de las cuales 396 usuarias fueron elegidas por demanda espontánea. De las variables cualitativas se obtuvieron los valores de frecuencia y porcentajes, y de las cuantitativas la media y la desviación estándar. La prevalencia de las lesiones intraepiteliales fue del 13,8%. La edad promedio fue 31 años. Las células escamosas atípicas de importancia incierta fueron mayores en el grupo de edad de 30 a 39 años (46,7%). Se observaron células atípicas glandulares no específicas en el 66,7% en el grupo de 30 y 39 años de edad. Las lesiones intraepiteliales de bajo grado se presentaron más en el grupo de 20 y 29 años (43,8%). Las lesiones intraepiteliales de alto grado se identificaron también en el grupo de 20 a 29 años de edad. Las conclusiones fueron: la prevalencia de lesiones intraepiteliales en las mujeres indígenas del Ecuador fue superior al 10% de las reportadas en otros estudios, y más frecuente en aquellas de 20 y 39 años de edad

Diversity of human papillomavirus typing among women population living in rural and remote areas of Brazilian territory.

OBJECTIVES: Genotyping HPV from samples tested positive to careHPV™ assay in rural and remote areas of Brazilian territory. METHODS: A total of 5079 women were enrolled in an opportunistic screening from the Barretos Cancer Hospital, through mobile units or ambulatory unit. All careHPV™ hr-HPV positive samples were tested by a Luminex-based protocol in order to evaluate the HPV infecting types. RESULTS: Positive hr-HPV results were obtained in 10.6% (536/5068) of women. Among these cases, HPV-56 and HPV-51 were the most common types detected in 32.3% and 31.4%, respectively. HPV-53 (20.5%), HPV-18 (18.5%), HPV-58 (17.6%), HPV-52 (16.0%) and HPV-16.6%) were the other most frequent types detected. These frequencies represent prevalences of 2.35%, 2.12%, 2.02%, 1.84% and 1.80% respectively, within the population studied. Regarding low-risk HPVs, HPV-6 was detected in 12.9% of the samples. The less frequent types (<3%) were: HPV-70, HPV-11 and HPV-26. CONCLUSIONS: The most frequent types detected were: HPV-56, HPV-51, HPV-53, HPV-18, HPV-58, HPV-52 and HPV-16 according to decreasing rates.

Factores asociados al uso de la citología cervicouterina en estudiantes de enfermería de la ciudad de cartagena

Introducción: El uso adecuado del tamizaje cérvico-uterino se configura como la mejor estrategia para la detección temprana del cáncer. Objetivo: Determinar los factores asociados al uso de la citología cérvico-uterina en estudiantes de enfermería de la ciudad de Cartagena. Métodos: Estudio analítico, con población de 1 109 estudiantes y tamaño de muestra de 469, seleccionadas por muestreo polietápico. Se utilizó un modelo de regresión para determinar las variables explicativas de la utilización adecuada de la citología. Resultados: Participaron 469 estudiantes, promedio de edad 20.8 años (DE=3,4). El 50.7% (238) ha realizado la prueba alguna vez, solo 31.3% (147) tienen uso adecuado. Ser mayor de 20 años (OR: 3,3 CI: 2,2 - 5,0), pertenecer a semestres superiores (OR: 1,9 CI: 1,3 - 2,9), tener pareja (OR: 3,1 CI: 1,9 - 5,0), tener hijos (OR: 2,9 CI: 1,8 - 4,7), haber estado embarazada (OR: 3,4 CI: 2,2 - 5,3), haber sufrido abortos (OR: 2,8 CI: 1,3 - 5,8) se asocian al uso adecuado. Conclusiones: Factores personales, principalmente antecedentes gineco-obstétricos, son predictores de la utilización adecuada de la citología.

Introduction: The appropriate use of Cervic-uterine screening test is configured as the best strategy for the early detection of cancer. Objetive: To determine the factors associated with the use of cervical-uterine cytology test in nursing students in the city of Cartagena. Methods: Analytical study, with a population of 1,109 subjects and sample size of 469, selected by multi-stage sampling. A regression model to determine the explanatory variables of the adequate use of cytology test was applied. Results: 469 students on average age of 20.8 years (SD = 3.4) participated. 50.7% (238) have done the test at some time, only 31.3% (147) is used adequately. Being older than 20 years (OR: 3.3 CI: 2.2 - 5.0), belong to higher semesters (OR: 1.9 CI: 1.3 -2.9), having a partner (OR: 3, 1 CI: 1.9 - 5.0), having children (OR: 2.9 CI: 1.8 - 4.7), having been pregnant (OR: 3.4 CI: 2.2 - 5.3), having practiced abortions (OR: 2.8 CI: 1.3 - 5.8) are associated with an adequate use. Conclusions: Personal factors, mainly gynecological-obstetric history, are predictors of an adequate use of cytology test.

Introdução: O uso adequado da triagem cervical configura-se como a melhor estratégia para a detecção precoce do câncer. Objetivo: Determinar os fatores associados ao uso da citologia cervical em estudantes de enfermagem na cidade de Cartagena. Métodos: Estudo analítico, com uma população de 1.109 alunos e tamanho de amostra de 469, selecionados por amostragem em múltiplos estágios. Um modelo de regressão foi utilizado para determinar as variáveis explicativas do uso adequado da citologia. Resultados: Participaram 469 estudantes, com idade média de 20,8 anos (DP = 3,4). 50,7% (238) fizeram o teste em algum momento, apenas 31,3% (147) tiveram uso adequado. Ser maior de 20 anos (OR: 3,3 IC: 2,2 - 5,0), pertencer a semestres superiores (OR: 1,9 IC: 1,3 - 2,9), ter companheiro (OR: 3, 1 IC: 1,9 - 5,0), ter filhos (OR: 2,9 IC: 1,8 - 4,7), ter estado gravida (OR: 3,4 IC: 2,2 - 5,3), ter sofrido abortamentos (OR: 2,8 IC: 1,3 -5,8) estão associados ao uso adequado. Conclusões: Fatores pessoais, principalmente antecedentes gineco-obstétricos, são preditores do uso adequado da citologia.

Programa de detección del cáncer cervicouterino: políticas públicas y experiencias de los actores que implementan el programa en el estado de Veracruz, México / Screening program for cervical cancer: public policies and experiences of actors who implement the program in the state of Veracruz, Mexico

RESUMEN El propósito fue analizar cómo se desarrolla el Programa de Detección del Cáncer Cervicouterino en una clínica de displasias y algunos centros de salud en el estado de Veracruz, a través de las representaciones y prácticas de los actores sociales que implementan el programa. Para ello, se realizaron entrevistas en profundidad y observación de la práctica de estos prestadores de servicios durante varios periodos a lo largo de 3 años entre 2009 y 2011. A partir de la información obtenida pretendemos dar cuenta de las dificultades, aciertos y resultados que dicho programa tiene como parte de una política pública, sobre la base de que las políticas en salud tienen como prioridad que toda la población se vea beneficiada por los servicios de atención preventiva y curativa, y si bien la evidencia nos muestra que las poblaciones marginadas no se ven beneficiadas por dichos programas, pareciera que esta información no permea los saberes populares y médicos.

ABSTRACT The aim of this article is to analyze the way in which the Screening Program for Cervical Cancer is carried out in a dysplasia clinic and related health centers in the state of Veracruz, through the representations and practices of the social actors who implement the program. In order to do so, in-depth interviews and observations of the practices of health service providers were carried out during different periods over the course of three years, from 2009 to 2011. Through the information obtained, the article explores the difficulties, achievements and results of this program as part of a public policy. Although a priority of public health policy is to see the whole population benefit from preventive and curative health care services, evidence shows that marginalized populations are not benefitted by such programs; such information does not however seem to permeate popular and medical knowledge.

Cytopathologic evaluation of patients submitted to radiotherapy for uterine cervix cancer / Avaliação citopatológica no seguimento de pacientes submetidas à radioterapia por câncer de colo uterino

Summary Cervical cancer is an important public health problem. Pap smear is the leading strategy of screening programs for cervical cancer worldwide. However, delayed diagnosis leads to more aggressive and less effective treatments. Patients with uterine cervix malignancies who are referred for radiotherapy have advanced-stage disease, which results in high rates of locoregional recurrence. The use of radiotherapy as a treatment for cervical cancer causes morphological changes in neoplastic and non-neoplastic epithelial cells, as well as in stromal cells, which make it difficult to diagnose the residual lesion, resulting in a dilemma in cytopathological routine. Based on the difficulties of cytopathologic evaluation for the follow-up of patients treated with radiotherapy for cervical cancer, our objective was to describe the actinic cytopathic effects. Our paper was based on a structured review including the period from June 2015 to April 2016, aiming at an exploratory-descriptive study. Bibliographic investigations were carried out through selection and analysis of articles, list of authors and keywords, selection of new articles focused on the analysis of bibliographic references to previously selected documents, as well as textbooks of recognized merit. The most incident actinic cytopathological alterations as described in the literature are: cellular gigantism, nuclear and cytoplasmic vacuolization, dyskeratosis, bi- and multinucleated (B/M) cells, macro and multiple nucleoli, anisokaryosis, anisonucleolosis and nuclear pyknosis. To date, a protocol has not been established that can precisely differentiate the morphological characteristics between benign cells with actinic effects from recurrent malignant cells on post-radiotherapy smears.

Resumo O câncer de colo uterino configura-se como um importante problema de saúde pública. O teste citopatológico é a principal estratégia de programas de rastreamento dessa neoplasia maligna em todo o mundo. Entretanto, a demora no diagnóstico ocasiona tratamentos mais agressivos e menos efetivos. Pacientes com neoplasia maligna de colo uterino que são encaminhadas para radioterapia apresentam doença em estádios avançados, e esse fato determina altos índices de recidiva locorregional. A utilização da radioterapia como tratamento do câncer do colo uterino provoca alterações morfológicas não só nas células epiteliais neoplásicas e não neoplásicas como também nas células estromais, o que dificulta o diagnóstico da lesão residual e resulta em um dilema na rotina citopatológica. Com base nas dificuldades da avaliação citopatológica do seguimento das pacientes pós-radioterapia, o objetivo deste trabalho foi descrever os efeitos citopáticos actínicos. O trabalho teve como base uma revisão estruturada no período de junho de 2015 a abril de 2016, visando a um estudo exploratório-descritivo. As investigações bibliográficas foram realizadas por meio de seleção e análise dos artigos, lista de autores e palavras-chave; seleção de novos artigos focada na análise de referências bibliográficas dos documentos previamente selecionados e livros-texto de relevância conceitual. As alterações citopatológicas actínicas mais incidentes descritas na literatura são: gigantismo celular, vacuolização nuclear e citoplasmática, disceratose, bi e multinucleações, macro e múltiplos nucléolos, anisocariose, anisonucleolose e picnose nuclear. Até o momento, não se conseguiu estabelecer um protocolo que possa diferenciar precisamente as características morfológicas entre células benignas com efeitos actínicos das células malignas recidivantes em esfregaços pós-radioterapia.

INADEQUATE PRACTICE RELATED OF THE PAPANICOLAOU TEST AMONG WOMEN / PRÁCTICA INADECUADA DE MUJERES SOBRE LA PRUEBA DE PAPANICOLAOU / PRÁTICA INADEQUADA DE MULHERES ACERCA DO PAPANICOLAOU

ABSTRACT Objective: to identify the factors related to inadequate practice of the Papanicolaou test among women in northeastern Brazil. Method: cross-sectional study using a KNOWLEDGE, ATTITUDE AND PRACTICE inquiry, performed from June to October, 2013, with 240 women aged between 24 and 59 years. Results: inadequacies were observed, particularly in knowledge, because, despite having information about the examination, it was only used to detect sexually transmitted infections. Regarding the issue of practice, it was noted that single women and those up to 29 years of age were more likely to present inadequate practice than the older and married women, increasing the likelihood of developing cervical cancer. The greater difficulty for performing the examination was the lack of materials (68.1%). Conclusion: clarification for women regarding the examination requires effective communication between the users and health professionals, as well as guarantees and support for the continuity of care by managers.

RESUMO Objetivo: identificar os fatores relacionados à prática inadequada do exame Papanicolaou em mulheres do interior do Nordeste brasileiro. Método: estudo transversal, no qual se utilizou o inquérito conhecimento, atitude e prática, no período de junho e outubro de 2013, com 240 mulheres entre 24 e 59 anos. Resultados: observaram-se inadequações, principalmente no conhecimento, pois, apesar de possuírem informações sobre o exame, utilizavam-no apenas para detectar doenças sexualmente transmissíveis. No quesito prática, percebeu-se que mulheres solteiras de até 29 anos apresentam maiores chances de prática inadequada do que aquelas com maior idade/casadas, aumentando a probabilidade de desenvolver câncer do colo do útero. A maior dificuldade para a realização do exame foi devido à falta de material (68,1%). Conclusão: o esclarecimento às mulheres acerca do exame necessita de comunicação efetiva entre usuárias e equipe de saúde, além da garantia e suporte à continuidade do cuidado dos gestores.

Intervenções que favorecem a adesão ao exame de colpocitologia oncótica: revisão integrativa / Intervenciones que favorecen la adhesión a la Prueba de Papanicolau: revisión integrativa / Interventions that facilitate adherence to Pap smear exam: integrative review

RESUMO Objetivo: identificar produções científicas que apresentem intervenções relevantes para implementar o Programa de Prevenção do Câncer Cérvico-Uterino, aumentando a adesão à realização do exame. Método: revisão integrativa da literatura, realizada por busca on-line, nas bases de dados: LILACS, SciELO e Pubmed®, abrangendo artigos publicados de 2009 a 2014. Resultados: trinta e oito artigos compuseram a amostra final do estudo. Estes indicaram as seguintes intervenções: utilização de gerente de caso, contato telefônico, carta-convite, atividades educativas, divulgação na mídia, agentes de saúde da comunidade, parcerias, rastreamento de base populacional e múltiplas intervenções. Conclusão: as pesquisas concentram-se entre mulheres provenientes de países em desenvolvimento, e estas intervenções são eficazes no aumento da adesão e do conhecimento destas mulheres em relação à prevenção do câncer cérvico-uterino.

RESUMEN Objetivo: identificar producciones científicas que manifiesten intervenciones importantes para la implementación del Programa de Prevención del Cáncer Cervical-Uterino, aumentando la adhesión a la realización de la prueba. Método: revisión integrativa de la literatura, realizada mediante búsqueda online en bases de datos LILACS, SciELO y PubMed®, incluyendo artículos publicados de 2009 a 2014. Resultados: muestra final compuesta por 38 artículos, que indicaron las siguientes intervenciones: utilización de gestor de caso, contacto telefónico, carta de invitación, actividades educativas, difusión en medios, agentes de salud comunitarios, alianzas, rastreo en base poblacional y múltiples acciones. Conclusión: las investigaciones se concentran en mujeres de países en desarrollo. Las intervenciones consiguen aumentar la adhesión y el conocimiento de estas mujeres respecto de la prevención del cáncer cervical-uterino.

ABSTRACT Objective: to identify scientific productions showing relevant interventions to implement the Cervical Uterine Cancer Prevention Program increasing adherence to exams. Method: integrative literature review through an online search in the following databases: LILACS, SciELO, and PubMed® comprising articles published from 2009 to 2014. Results: thirty-eight articles made up the study's final sample. Results showed the following interventions: use of case manager; telephone call; invitation letter; educational activities; media outreach work; community health agents; partnerships; population database screening; and multiple interventions. Conclusion: studies are mainly focused on women from developing countries and interventions are efficacious to increase women's knowledge about and adherence to prevention of cervical uterine cancer.

Desigualdades socioeconômicas e regionais na cobertura de exames citopatológicos do colo do útero / Desigualdades socioeconómicas y regionales en la cobertura de exámenes citopatológicos del cuello uterino / Socioeconomic and regional inequalities of pap smear coverage

RESUMO Objetivos Identificar desigualdades socioeconômicas e regionais na cobertura de exames citopatológicos do colo do útero no Rio Grande do Sul. Métodos Estudo ecológico utilizou dados dos sistemas de informação em saúde de 2011-2012 para estimar coberturas anuais de exames para todas as mulheres residentes e para as não beneficiárias de planos privados de saúde. Desigualdades na cobertura foram estimadas conforme o Índice de Vulnerabilidade Social Municipal, macrorregiões e regiões de saúde. Resultados A prevalência de mulheres não beneficiarias de planos privados de saúde variou de 38,1% a 94,2% entre regiões de saúde. A cobertura estadual foi 17,3% para todas as residentes e 23,8% para as não beneficiárias de planos privados. As maiores coberturas ocorreram nos municípios em maior vulnerabilidade social e nas regiões com maior prevalência de planos privados. Conclusões A prevalência de planos privados de saúde deve ser considerada em estudos da cobertura de serviços pelo Sistema Único de Saúde.

RESUMEN Objetivos Identificar desigualdades socioeconómicas y regionales en la cobertura de exámenes citopatológicos del cuello uterino en Rio Grande do Sul. Métodos Estudio ecológico utilizó datos de los sistemas de información en salud de 2011-2012 para estimar coberturas anuales de exámenes para la totalidad de mujeres residentes y para no beneficiarias de planes privados de salud. Se estimaron las desigualdades según el Índice de Vulnerabilidad Social Municipal, las macroregiones y las regiones de salud. Resultados La prevalencia de mujeres no beneficiarias de planes privados de salud tuvo una variación de 38.1% a 94.2% entre las regiones de salud. La cobertura del estado fue de 17.3% para la totalidad de residentes y el 23.8% para no beneficiarias de planes privados. Las mayores coberturas sucedieron en los municipios de mayor vulnerabilidad social y regiones con mayor prevalencia de planes privados. Conclusiones La prevalencia de los planes privados de salud debe ser considerada en los estudios de cobertura de servicios del Sistema Único de Salud (SUS).

ABSTRACT Objectives To identify socioeconomic and regional inequalities of pap smear coverage in the state of Rio Grande do Sul. Methods An ecological study based on data of the 2011-2012 national health information system to estimate the annual coverage of pap smears for the overall female population of the state and for women without private health insurance. We estimated annual pap smear coverage according to the Municipal Social Vulnerability Index and health macro-regions and regions of the state. Results The percentage of women without private health insurance ranged from 38.1% to 94.2% in the health regions. Pap smear coverage was 17.3% for the overall female population and 23.8% for women without private health insurance. Pap smear coverage was higher in more socially vulnerable municipalities and regions with a higher percentage of women with private health insurance. Conclusions The prevalence of private health insurance should be considered in studies that address the coverage of the Brazilian Unified Health System (SUS).

Validation of the Adherence Determinants Questionnaire scale among women with breast and cervical cancer / Validação da escala Adherence Determinants Questionnaire entre mulheres com câncer de mama e cervical / Validación de la escala Adherence Determinants Questionnaire entre mujeres con cáncer de mama y cervical

Objectives: the aim was to translate and culturally adapt the Adherence Determinants Questionnaire scale for the Portuguese language in the Brazilian context, and to check its reliability and validity to analyze the elements of the adherence of patients to the clinical treatment for breast and cervical cancer.Method: this was a methodological study, carried out in two oncology reference centers. The sample consisted of 198 participants, with 152 being treated for breast cancer and 46 being treated for cervical cancer. The content validation was performed by a committee of experts. The construct validation was demonstrated through factor analysis and the reliability was analyzed using Cronbach's alpha.Results: the committee of experts made the necessary adjustments so that the scale was adapted to the Brazilian context. The factor analysis suggested a reduction from seven to five factors and the maintenance of 38 items similar to those of the original scale. The reliability, investigated through Cronbach's alpha, was .829, showing high internal consistency.Conclusion: it was concluded that the Brazilian version of the Adherence Determinants Questionnaire scale is a valid and reliable instrument that is able to measure the elements of adherence to the treatment for breast and cervical cancer.

Objetivos: objetivou-se traduzir e adaptar culturalmente a escala Adherence Determinants Questionnaire para a língua Portuguesa, no contexto brasileiro, e verificar a confiabilidade e a validade da mesma para analisar os elementos da adesão das pacientes ao tratamento clínico do câncer de mama e cervical.Método: trata-se de estudo metodológico, realizado em dois centros de referência em oncologia. A amostra foi composta por 198 participantes, sendo 152 em tratamento para câncer de mama e 46 em tratamento para câncer cervical. A validação de conteúdo foi realizada por um comitê de especialistas. Já a validação de construto se deu pela análise fatorial e a confiabilidade foi analisada por meio do alfa de Cronbach.Resultado: o comitê de especialistas fez os ajustes necessários para que a escala fosse adaptada ao contexto brasileiro. A análise fatorial sugeriu a redução de sete para cinco fatores, bem como a permanência dos 38 itens semelhantes à escala original. A confiabilidade averiguada pelo alfa de Cronbach foi de 0,829, revelando alta consistência interna.Conclusão: conclui-se que a escala Adherence Determinants Questionnaire - Versão Brasileira - é um instrumento válido, confiável e capaz de mensurar os elementos de adesão ao tratamento do câncer de mama e cervical.

Objetivos: se objetivó traducir y adaptar culturalmente la escala Adherence Determinants Questionnaire para la lengua Portuguesa, en el contexto brasileño, y verificar la confiabilidad y la validez de la misma para analizar los elementos de la adhesión de las pacientes al tratamiento clínico del cáncer de mama y cervical.Método: se trata de estudio metodológico, realizado en dos centros de referencia en oncología. La muestra fue compuesta por 198 participantes, siendo 152 en tratamiento para cáncer de mama y 46 en tratamiento para cáncer cervical. La validación de contenido fue realizada por un comité de especialistas. La validación de constructo se realizó por análisis factorial y la confiabilidad fue analizada por medio del Alfa de Cronbach.Resultado: el comité de especialistas hizo los ajustes necesarios para que la escala fuese adaptada al contexto brasileño. El análisis factorial sugirió la reducción de siete para cinco factores, así como la permanencia de los 38 ítems semejantes a la escala original. La confiabilidad averiguada por el Alfa de Cronbach fue de 0,829, revelando alta consistencia interna.Conclusión: se concluye que la escala Adherence Determinants Questionnaire - Versión Brasileña - es un instrumento válido, confiable y capaz de medir los elementos de adhesión al tratamiento del cáncer de mama y cervical.

Conización cervical más linfadenectomía pélvica radical bilateral comomanejo conservador del cáncer de cérvix IB 1: reporte de un caso y revisión de la literatura / Cervical conisation plus radical bilateral pelvic lymph node dissection as conservative treatment for cervical cancer IB1: case report and review of the literature

Objetivo: describir el caso de una paciente con cáncer de cérvix en estadio FIGO IB1, a quien se le realizó conización cervical más linfadenectomía pélvica para preservar su fertilidad, y hacer una revisión de la literatura sobre sus indicaciones, efectividad y seguridad en términos de resultados oncológicos y obstétricos.Materiales y métodos: se presenta el caso de una paciente de 26 años, con diagnóstico de adenocarcinoma infiltrante de cérvix estadio IB1, atendida en la Clínica Julio Enrique Medrano de SaludCoop, Barranquilla (Colombia), institución de alto nivel de complejidad que atiende pacientes pertenecientes al régimen contributivo del sistema de seguridad social. Se realizó conización cervical más linfadenectomía pélvica, para preservar fertilidad. Al segundo año de seguimiento logró embarazo a término y 48 meses después se encuentra libre de enfermedad. Se realizó una búsqueda electrónica, sin restricción de idioma, de la literatura publicada hasta julio de 2015 con las palabras claves: Uterine Cervical Neoplasms, Fertility Preservation, Conization, Gynecologic Surgical Procedures y Lymph Node Excision, en las bases de datos Medline, Embase, CINAHL y Cochrane, y en las referencias bibliográficas de estudios recuperados.Resultados: se identificaron nueve artículos: ocho estudios de cohorte y un de reporte de caso. La conización cervical más linfadenectomía pélvica radical bilateral, es un procedimiento menos radical, seguro y efectivo para el manejo conservador del cáncer de cérvix de bajo riesgo. En pacientes sometidas a conización se reportan recidivas en un 2,84 %; 38 % logran embarazo, de los cuales el 70,2 % llegan a término.Conclusiones: la conización cervical más linfadenectomía pélvica radical bilateral podría ser una opción para el manejo de pacientes con cáncer de cérvix en estadios iniciales considerados de bajo riesgo que deseen conservar su fertilidad

Objective: To describe the case of a patient with cervical cancer FIGO stage IB1 taken to conisation and pelvic lymphadenectomy with the aim of preserving fertility, and to conduct a search in the literature regarding indications, effectiveness and safety of this procedure in terms of obstetric and oncologic outcomes.Materials and methods: We present the case of a 26-year old female patient seen at the Julio Enrique Medrano SaludCoop Clinic (Barranquilla, Colombia), a high-complexity institution that serves a population belonging to the contributory regime of the social security system. The patient was diagnosed with infiltrating cervical carcinoma stage IB1. She was taken to cervical cone biopsy plus pelvic lymph node dissection in order to preserve fertility. Two years into follow-up she achieved a term pregnancy, and 48 months later she is disease-free. An online search was conducted of the literature published until July 2015, with no language restriction, using the key words Uterine Cer vical Neoplasms, Fertilit y Preser vation, Conization, Gynaecologic Surgical Procedures and Lymph Node Excision in the Medline, Embase, CINAHL and Cochrane databases and in the bibliographic references of retrieved studies.Results: Overall, 9 articles were identified: 8 cohort studies and 1 case report. Cervical conisation plus bilateral radical pelvic lymphadenectomy is a less radical, safer and effective procedure for the conservative management of low-risk cervical cancer. A relapse rate of 2.84 % has been reported in patients subjected to conisation, pregnancy is achieved in 38 % of cases and, of those, 70.2 % come to term.Conclusions: Cervical conisation plus bilateral radical pelvic lymphadenectomy may be a management option for patients with low-risk, early-stage cervical cancer who wish to preserve their fertility

Quimioterapia neoadyuvante como tratamiento para la preservación de la fertilidad en pacientes con cáncer de cérvix en estadio IB: reporte de un caso y revisión de la literatura / Neo-adjuvant chemotherapy as treatment for fertility preservation in patients with stage IB cervical cancer: Case presentation and review of the literature

Presentar el caso de una paciente con cáncer de cérvix en estadio IB1 mayor de dos centímetros, a quien se le administró quimioterapia neoadyuvante seguida de traquelectomía radical con linfadenectomía pélvica por laparoscopia, con el fin de preservar su fertilidad; hacer una revisión de los casos reportados en la literatura con énfasis en los resultados obstétricos y oncológicos.Materiales y métodos: presentación del caso y bésqueda en Medline vía PubMed de los artículos publicados en inglés, francés y español desde enero de 2000 hasta agosto de 2014, sobre la administración de quimioterapia neoadyuvante y cirugía conservadora de la fertilidad en pacientes con cáncer de cérvix en estadio IB.Resultados: se seleccionaron 12 artículos pertinentes, para un total de 55 pacientes. Con un seguimiento entre 14 y 69 meses, se reportaron 4 recaídas y solo una muerte por enfermedad. Resultados obstétricos: 30 embarazos, 24 nacimientos, 3 abortos, 1 embarazo ectópico y 2 embarazos en curso.Conclusión: la quimioterapia neoadyuvante, seguida de cirugía conservadora de la fertilidad, puede considerarse como una alternativa de manejo en pacientes seleccionadas con cáncer de cérvix en estadio IB, con tumores voluminosos, que deseen preservar su fertilidad...

To present the case of a patient with stage IB1 cervical cancer larger than 2 centimetres who received neo-adjuvant chemotherapy followed by laparoscopic radical cervicectomy and pelvic lymphadenectomy for fertility preservation; and to review the literature for case reports emphasizing obstetric and oncologic outcomes.Materials and methods: Case presentation and search of the literature in Medline through PubMed of articles published in English, French and Spanish between January 2000 and August 2014 on the topic of neo-adjuvant chemotherapy and fertility preservation surgery in patients with stage IB cervical cancer.Results: Overall, 12 relevant articles were selected totalling 55 patients. Over follow-up period ranging between 14 and 69 months there were 4 relapses and only one death attributable to the disease. Obstetric outcomes included 30 pregnancies, 24 births, 3 miscarriages, 1 ectopic pregnancy, and 2 on going pregnancies.Conclusion: Neo-adjuvant chemotherapy followed by conservative, fertility preservation surgery may be an option for the management of selected patients with stage IB cervical cancer involving large tumours sizes, who wish to preserve their fertility...

Positive endocervical margins at conization: repeat conization or colposcopic follow-up? A retrospective study.

BACKGROUND: The presence of residual cervical lesions was evaluated in patients submitted to repeat conization due to a finding of positive endocervical margins in a previous loop electrosurgical excision procedure (LEEP) specimen. In addition, the correlation between the presence of a residual lesion and risk factors for cervical cancer, and the use of repeat conization as first-choice treatment were analyzed. METHODS: This retrospective study included 44 patients submitted to repeat cervical conization or total hysterectomy following a finding of affected endocervical margins in LEEP specimens. The risk factors analyzed in relation to the presence of residual lesions were age, smoking, cone depth, glandular involvement and the histopathology findings of cervical intraepithelial neoplasia (CIN) 1, CIN 2 or CIN 3/carcinoma in situ. The Chi-square test and the Mann-Whitney t-test were used, with significance defined at P < 0.05. RESULTS: Residual lesions were found in 23/44 patients (52.3%), with 3/23 cases (13.0%) being compatible with invasive squamous cell carcinoma. Of the 23 patients, six (26.1%) were submitted to total hysterectomy, with one case being compatible with a moderately differentiated invasive squamous cell carcinoma. Two patients with a histopathology finding of CIN 3/carcinoma in situ in the previous LEEP specimen were diagnosed with invasive squamous cell carcinoma in the repeat conization specimen. Residual lesions were not significantly associated with the risk factors evaluated. CONCLUSIONS: In view of the high frequency of residual disease found when positive endocervical margins were found in LEEP specimens, the indication for repeat cervical conization rather than colposcopic follow-up is viable and justified. Indeed, since the presence of a residual lesion and its progression in the cervical canal are more difficult to screen and control, patients unable to comply with regular colposcopic follow-up could benefit from repeat conization when trying to avoid a potentially negative outcome.

Cervical cancer screening coverage in a high-incidence region / Cobertura do rastreamento do câncer de colo de útero em região de alta incidência

OBJECTIVE To analyze the coverage of a cervical cancer screening program in a city with a high incidence of the disease in addition to the factors associated with non-adherence to the current preventive program. METHODS A cross-sectional study based on household surveys was conducted. The sample was composed of women between 25 and 59 years of age of the city of Boa Vista, RR, Northern Brazil who were covered by the cervical cancer screening program. The cluster sampling method was used. The dependent variable was participation in a women’s health program, defined as undergoing at least one Pap smear in the 36 months prior to the interview; the explanatory variables were extracted from individual data. A generalized linear model was used. RESULTS 603 women were analyzed, with an mean age of 38.2 years (SD = 10.2). Five hundred and seventeen women underwent the screening test, and the prevalence of adherence in the last three years was up to 85.7% (95%CI 82.5;88.5). A high per capita household income and recent medical consultation were associated with the lower rate of not being tested in multivariate analysis. Disease ignorance, causes, and prevention methods were correlated with chances of non-adherence to the screening system; 20.0% of the women were reported to have undergone opportunistic and non-routine screening. CONCLUSIONS The informed level of coverage is high, exceeding the level recommended for the control of cervical cancer. The preventive program appears to be opportunistic in nature, particularly for the most vulnerable women (with low income and little information on the disease). Studies on the diagnostic quality of cervicovaginal cytology and therapeutic schedules for positive cases are necessary for understanding the barriers to the control of cervical cancer. .

OBJETIVO Analisar a cobertura do programa de rastreamento do câncer do colo uterino em município com alta incidência da doença e os fatores relacionados à não adesão ao programa preventivo vigente. MÉTODOS Foi realizado estudo transversal, com base em inquérito domiciliar. A amostra foi composta por mulheres entre 25 e 59 anos de idade do município de Boa vista, RR, Brasil, com cobertura pelo programa de rastreamento do câncer do colo uterino. Foi utilizado o método de amostragem por conglomerado. A variável dependente foi a adesão ao programa de saúde da mulher, definida como a realização de pelo menos um teste de Papanicolaou nos 36 meses anteriores à data da entrevista; as variáveis explicativas foram extraídas a partir de informações individuais. Foi utilizado modelo linear generalizado. RESULTADOS Foram analisadas 603 mulheres, com idade média de 38,2 anos (DP = 10,2). Quinhentas e dezessete mulheres realizaram o exame, sendo a prevalência de realização, nos últimos três anos, de 85,7% (IC95% 82,5;88,5). Renda familiar per capita elevada e consulta médica recente associaram-se à menor taxa de não realização do exame na análise multivariada. O desconhecimento da doença, das causas e dos meios de prevenção correlacionou-se com a chance de não adesão ao rastreamento. Vinte por cento das mulheres relataram realização do exame em caráter oportunístico, e não rotineiro. CONCLUSÕES A cobertura informada é elevada, acima do recomendado para controle do câncer do colo uterino. O programa preventivo apresenta caráter oportunístico, sobretudo para as mulheres mais vulneráveis (com baixa renda e pouca informação sobre a doença). Estudos sobre a qualidade diagnóstica da citologia cervicovaginal e dos itinerários terapêuticos dos casos positivos são necessários para compreensão das barreiras para o controle do câncer do colo uterino. .