HPV and cervical cancer related knowledge, awareness and testing behaviors in a community sample of female sex workers in China

BACKGROUND: Limited data suggested that the prevalence of Human Papillomavirus (HPV) among female sex workers (FSW) is much higher than in the general female population. The current study aimed to examine the HPV and cervical cancer related awareness, knowledge, and behaviors among FSW in China. METHODS: A total of 360 FSW recruited from entertainment establishments in Beijing completed a self-administered survey including demographics, HPV related knowledge, and health-seeking and cervical cancer preventive behaviors. RESULTS: Approximately 70.8% of the participants ever heard of cervical cancer, and as few as 22.1% and 13.3% ever heard of HPV and HPV vaccine, respectively. The mean score on a 7-item knowledge scale was 2.2 (SD = 2.4). Less than 10% of FSW perceived any risk of cervical cancer, and only 15.3% ever had a Pap smear. About 40.8% of FSW would accept HPV vaccine if it is free, and 21.8% would accept it even with a charge. Multivariate regression suggested that women with better knowledge of cervical cancer were more likely to have a Pap smear (aOR = 1.35); women who had tested for HIV were 11 times more likely to have a Pap smear, and women who had worked longer in commercial sex (aOR = 1.01) and had regular health check-ups (aOR = 1.95) were more likely to accept HPV vaccine. CONCLUSIONS: Our study underscores the needs for effective cervical cancer prevention programs for FSW in China and other resource-limited countries. We specifically call for cervical cancer and HPV knowledge and awareness programs and regular screening as well as HPV risk-reduction programs for these vulnerable women

The prognostic impact of histological type on clinical outcomes of early-stage cervical cancer patients whom have been treated with radical surgery

The aim of this study was to determine the prognostic impact of histological type among squamous cell carcinoma (SCC), adenocarcinoma (AC) and adenosquamous carcinoma (ASC) on the treatment outcome of early-stage cervical cancer patients after radical hysterectomy. The cohort comprised of 626 patients, diagnosed with stages IA2-IB1 cervical cancer between 1987 and 2013. Four hundred and one patients had SCC, 190 had AC and 35 had ASC. The 5-year disease-free survival (DFS) rates for AC, SCC and ASC were 89.3% (95%CI 83.2–93.2), 88.7% (95%CI 84.8–91.7) and 82.1% (95%CI 61.9–92.2), respectively (p = .594). In multivariate analyses, only older age and deep stromal invasion were statistically significantly associated with DFS, whereas histologic cell type was not (p = .524). Subgroup analysis showed that in the intermediate-high-risk groups, the SCC group had a significantly longer DFS, compared with the AC group or the ASC group (p = .001) while there was no DFS difference in the low-risk group. We believe that histologic cell type had no impact in low-risk early-stage cervical cancer patients. However, in the intermediate-high-risk groups, SCC is a more favourable factor for survival than AC/ASC

The role of random cervical biopsies in addition to colposcopy-directed biopsies in detection of CIN2+

The aim of this study was to determine the additional values of multiple cervical biopsies when any colposcopy was performed. We developed a cross-sectional study of 92 women, who had been referred for a colposcopy because of their abnormal cervical cytology. Colposcopy-directed biopsies were taken from lesions and random non-directed biopsies were added, if their directed biopsies were fewer than four in number. The biopsy sites were ranked according to the impression of the clinicians. Among the 92 women, the first biopsy was normal in 29.4%, revealing CIN1 in 28.3% and CIN2+ in 42.3%. In the second and third biopsies, the CIN2+ was found to have increased to 35.8% and 36.8%, respectively. The accumulative sensitivity for detecting CIN2+ was 84.8%, for a single biopsy. This increased to 97.0%, after two biopsies and then to 100%, after three and four biopsies. To conclude, although the taking of the additional biopsies increased the CIN2+ detection, collecting three cervical biopsies might be sufficient.Impact Statement What is already known on this subject? The colposcopy is considered to be the standard procedure in the detection of precancerous lesions of the cervix. However, nowadays, colposcopic biopsy practices do not have any single, acceptable guideline for the number of biopsies performed, and whilst a single biopsy is the most commonly adopted practice, some centres have used a biopsy protocol with multiple biopsies. What the results of this study add? This study determined the rate of the detection of CIN2+ by using multiple biopsy protocols during colposcopy for women who were referred with their abnormal cervical cytology. We explored the benefit of collecting additional lesion-directed biopsies and additional biopsies of a normal-appearing cervix in addition to a single biopsy. We found that two or three biopsies from a colposcopy should be enough for increasing the detection of CIN2+. Also, multiple biopsies increased the sensitivity of CIN2+ detection, especially in colposcopic impression for the low grade lesions. What the implications are of these findings for clinical practice and/or further research? We suggest that colposcopy-directed biopsies should be supplied by one or two random biopsies from other quadrants of the cervix