Programa De Rastreamento Populacional De Câncer De Colo Uterino Organizado: é Um Bom Momento Para O Brasil De Hoje

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Infection By The Human Papillomavirus In Teenagers Sexually Active: Clinic And Subclinic Manifestations.

This research studies the association of the cervical condyloma with the intraepithelial neoplasia, during sex activity, pregnancy, diagnose methods, cytology and colposcopy in teenagers. The objective of this research is to study the propaedeutics for the uterine coli condyloma diagnose in a group of teenagers. For this purpose, we have studied 131 teenagers sexually active with ages between 14 and 19 years and presenting histologically confirmed uterine coli condyloma. Association with intraepithelial neoplasia, sexual activity duration, method of diagnose, pregnancy analysis, cytology and colposcopy results and association with vulva and vagina injuries were evaluated. The high association rate with condyloma and intraepithelial neoplasia after a short time of sexual activity and the none presence of macroscopic warts in the genital organs in 80% of cases presenting cervical condyloma, demonstrate that: a more careful investigation with colposcopy and biopsy of the inferior genitals of the women-teenagers sexually active is needed, when presenting modified cervical cytology.113494895

Hormonal contraceptives and the length of their use are not independent risk factors for high-risk HPV infections or high-grade CIN

AIMS: To evaluate the role of hormonal contraceptives as a risk factor of high-risk human papillomavirus (HR-HPV), cervical intraepithelial lesions (CIN) and cervical cancer in our multi-center population-based LAMS (Latin American Screening) study. METHODS: A cohort study with >12,000 women from Brazil and Argentina using logistic regression to analyze the covariates of hormonal contraception (HOC - oral, injections, patches, implants, vaginal ring and progesterone intrauterine system) use followed by multivariate modeling for predictors of HR-HPV and CIN2+. RESULTS: HR-HPV infection was a consistent risk factor of high-grade CIN in all three groups of women. The length of HOC use was not significantly related to high-grade squamous intraepithelial lesions (HSIL)+ Pap (p = 0.069), LSIL+ Pap (p = 0.781) or ASCUS+ (p = 0.231). The same was true with the length of HOC use and histology CIN3+ (p = 0.115) and CIN2+ (p = 0.515). Frequently, HOC users have previously shown more HPV-related lesions, as well as lower HPV prevalence if they were current smokers. But HOC use and time of usage were not independent risk factors of either HR-HPV infection or high-grade CIN using multiple logistic regressions. CONCLUSIONS: No evidence was found for an association between the use of HOC with an increased risk for HR-HPV infection or high-grade CIN in this cohort.This study is a part of the ongoing LAMS (Latin American Screening) study, entitled: Improving Health Systems Towards Equality-Based Control of Cervical Cancer in Latin America, and is supported by the INCO-DEV Program of the European Commission (Project No. ICA4-CT-2001-10013). The generous contribution of Digene Corporation (USA) who donated the HCII tests at our disposal is gratefully acknowledged

Up-regulation of 14-3-3sigma (Stratifin) is associated with high-grade CIN and high-risk human papillomavirus (HPV) at baseline but does not predict outcomes of HR-HPV infections or incident CIN in the LAMS study

To assess whether the potentially high-risk (HR) human papillomavirus (HPV)-related up-regulation of 14-3-3sigma (stratifin) has implications in the outcome of HPV infections or cervical intraepithelial neoplasia (CIN) lesions, cervical biopsy specimens from 225 women in the Latin American Screening Study were analyzed for 14-3-3sigma expression using immunohistochemical analysis. We assessed its associations with CIN grade and HR HPV at baseline and value in predicting outcomes of HR-HPV infections and the development of incident CIN 1+ and CIN 2+. Expression of 14-3-3sigma increased in parallel with the lesion grade. Up-regulation was also significantly related to HR-HPV detection (P = .004; odds ratio, 2.71; 95% confidence interval, 1.37-5.35) and showed a linear relationship to HR-HPV loads (P = .003). 14-3-3sigma expression was of no value in predicting the outcomes (incident, persistent, clearance) of HR-HPV infections or incident CIN 1+ and CIN 2+. 14-3-3sigma is not inactivated in cervical carcinoma and CIN but is up-regulated on transition from CIN 2 to CIN 3. Its normal functions in controlling G(1)/S and G(2)/M checkpoints are being bypassed by HR HPV.LAMS, Latin American Screening Study, funded by European Commission, INCO-DEV contract ICA4-CT-2001-10013

Up-Regulation of Plasminogen Activator Inhibitor-2 Is Associated With High-Risk HPV and Grade of Cervical Lesion at Baseline but Does Not Predict Outcomes of High-Risk HPV Infections or Incident CIN

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Association between age at first sexual intercourse and subsequent human papillomavirus infection: results of a Brazilian screening program

Objetivo: descrever a idade de início da atividade sexual (sexarca) e a sua associação com a idade das mulheres com a infecção por papilomavírus humano (HPV) e com as alterações citológicas no exame de papanicolaou. Métodos: mulheres da população geral foram recrutadas para participar de um estudo de rastreamento de câncer cervical e lesões pré-malignas. Após a aplicação de questionário comportamental, foram submetidas ao rastreamento com gia cervical e teste para DNA de HPV de alto risco, por meio de Captura Híbrida 2. Este projeto faz parte do Latin American Screening Study, que envolve mulheres do Brasil e da Argentina, e os dados aqui apresentados referem-se aos centros brasileiros nas cidades de Porto Alegre, São Paulo e Campinas. Resultados: de 8.649 mulheres entrevistadas, 8.641 relataram atividade sexual prévia e foram incluídas na análise. A média de idade no momento da entrevista foi de 38,1±11,04 anos, com início da atividade sexual em média aos 18,5±4,0 anos. Identificamos que a idade do início da atividade sexual aumenta de acordo com o aumento da faixa etária no momento da entrevista, isto é, mulheres mais novas relataram sexarca mais precoce que mulheres mais velhas (p<0,001). Em relação à infecção por HPV de alto risco, do total de mulheres que haviam iniciado as relações sexuais, 3.463 foram testadas, com 17,3% de positividade para HPV. Notadamente, em todos os centros, as mulheres com idade ao início da atividade sexual abaixo da média da população entrevistada apresentaram positividade maior para HPV (20,2%) do que as mulheres com sexarca em idade acima da média (12,5%) – Odds Ratio (OR)=1,8 (IC95%=1,5-2,2; p<0,001). Em relação à citologia, mulheres com sexarca abaixo da média de idade apresentaram também maior percentual de citologia alterada ≥ ASC-US (6,7%) do que mulheres com sexarca em idade maior que a média (4,3%) – OR=1,6 (IC95%=1,3-2,0; p<0,001). Conclusões: a infecção por HPV e a presença de alterações citológicas identificadas no rastreio de lesões cervicais em uma população assintomática estiveram significativamente associadas à idade mais precoce no início das relações sexuais. Ademais, identificamos também que as mulheres desta amostra apresentaram diminuição da idade ao início da atividade sexual, nas últimas décadas, sugerindo importante causa para o acréscimo da prevalência de HPV e as lesões decorrentes desta infecção.Purpose: to investigate women’s age at their first sexual intercourse and its correlation with their present age, human papillomavirus (HPV) infection and cytological abnormalities at Pap smear. Methods: women from the general population were invited to be screened for cervical cancer and pre-malignant lesions. After answering a behavior questionnaire, they were submitted to screening with cervical cytology and high-risk HPV testing with Hybrid Capture 2 (HC2). This report is part of the Latin American Screening (LAMS) study, that comprises centers from Brazil and Argentina, and the data presented herein refer to the Brazilian women evaluated at the cities of Porto Alegre, São Paulo and Campinas. Results: from 8,649 women that answered the questionnaire, 8,641 reported previous sexual activity and were included in this analysis. The mean age at the interview was 38.1±11.0 years and the mean age at the first sexual intercourse was 18.5±4.0 years. The age at the first sexual intercourse increased along with the age at the interview, i.e., younger women reported they had begun their sexual life earlier than older women (p<0.001). From the total of women who had already begun having sexual intercourse, 3,643 patients were tested for high-risk HPV infection and 17.3% of them had positive results. In all the centers, it became clear that the women with the first sexual intercourse at ages below the mean age of all the population interviewed presented higher rates of HPV infection (20.2%) than the women with the first sexual intercourse at ages above the mean (12.5%) – Odds Ratio (OR) 1.8 (IC95% 1.5-2.2;p<0,001). According to the cytology, the women with first sexual intercourse at ages under the mean, presented higher percentage of abnormal cytology ≥ ASC-US (6.7%) than the women with the first sexual intercourse at ages above the mean (4.3%) – OR 1.6 (IC95% 1.3-2.;p<0.001). ConclusionS: the high-risk HPV infection and cytological abnormalities identified during the asymptomatic population screening were significantly associated to the women’s age at the first sexual intercourse. Additionally, we have also identified that the women’s age at the first sexual intercourse has decreased during the last decades, suggesting an important contribution to the increase of HPV infection and the subsequent cervical lesions.Comissão Europeia - programa INCO-DEV (International Cooperation Development) Contrato #ICA4-2001-10013

Clinicopathological Aspects And Their Relation To Prognosis In Adult-type Granulosa Cell Tumor Of The Ovary [aspectos Clinicopatológicos E Sua Relação Com O Prognóstico Em Tumor De Células Da Granulosa Do Tipo Adulto Do Ovário]

Introduction and objective: The adult granulosa cell tumors (AGCT) correspond to less than 5% of ovarian neoplasias. They are considered low malignant potential tumors and may recur after many years. The differential diagnosis must be made with other primary or metastatic ovarian neoplasias. The aim was to analyze clinical and pathological aspects of AGCT and relate them to its evolution. Method: in a 10- year (1995-2004) review of the files from University of Campinas Clinical Hospital, Brazil, 20 AGCT cases were found. The clinical records and slides were reviewed and age, symptoms, macro and microscopic aspects, diagnostic staging and recurrence were considered. When there was intraoperative biopsy, its accuracy was evaluated. Results: Age ranged from 27 to 79 years (mean: 53) and the follow-up from 12 to 96 months (mean: 42). The main symptoms were post-menopause bleeding (45%), abdominal pain (35%) and palpable mass (25%). Most tumors were yellowish (60%) and the solid aspect (40%) was more common than the cystic or solid-cystic. The histological patterns were 40% solid, 15% macrofollicular and 45% combined forms. All of them with low mitotic index. Only three out of nine intraoperative frozen sections were accurately diagnosed. The clinical staging was 13 cases in Ia (65%), one case Ic and 6 IIIc. In three out of 14 hysterectomies there was simple endometrial hyperplasia with no atypia. Only the disease staging was significantly associated with recurrence (p < 0.0001). Conclusion: ACGT generally occurs after menopause and intraoperative biopsies are commonly inconclusive. Only advanced staging was related to the worst prognosis.455395400Auranen, A., Prognostic factors of ovarian granulosa cell tumor: A study of 35 patients and review of the literature (2007) Int J Gynecol Cancer, 17, pp. 1011-1018Brooks, S.E., Zweizig, S.L., Wakeley, K., Ovarian cancer: A clinician's perspective (2006) Pathology Case Reviews, 11 (1), pp. 3-8Fox, H., Agrawal, K., Langley, F.A., A clinicopathologic study of 92 cases of granulosa cell tumor of the ovary with special reference to the factors influencing prognosis (1975) Cancer, 35, pp. 231-241Fujimoto, T., Histopathological prognostic factors of adult granulosa cell tumors of the ovary (2001) Acta Obstet Gynecol Scand, 80, pp. 1069-1074Kim, Y.M., Adult granulosa cell tumor of the ovary: 35 cases in a single Korean Institute (2006) Acta Obstet Gynecol Scand, 85, pp. 112-115Mccluggage, W.G., Immunohistochemical and functional biomarkers of value in female genital tract lesions (2006) Int J Gynecol Pathol, 25, pp. 101-120Miller, K., Mccluggage, W.G., Prognostic factors in ovarian adult granulose cell tumor (2008) J Clin Pathol, 61 (8), pp. 881-884Pinto, P.B.C., Andrade L, A.L.A., Derchain, S.F.M., Accuracy of intraoperative frozen section diagnosis of ovarian tumors (2001) Gynecol Oncology, 81, pp. 230-232Roth, L.M., Recent advances in the pathology and classification of ovarian sex cord-stromal tumors (2006) Int J Gynecol Pathol, 25, pp. 199-215Scully, R.E., Young, R.H., Clement, P.B., Tumors of the ovary, maldeveloped gonads, Fallopian tube and broad ligament (1998) Atlas of Tumor Pathology, , Fascicle 23, Washington, DC: AFIPSingh-ranger, G., Sharp, A., Crinnion, J.N., Recurrence of granulosa cell tumor after thirty years with small bowel obstruction (2004) Int Semin Surg Oncol, 1 (1), p. 4Stuart, G.C.E., Dawson, L.M., Update on granulosa cell tumors of the ovary (2003) Curr Opinion Obstet Gynecol, 15, pp. 33-37Tavassoli, F.A., Deville, P., Tumors of the breast and female genital organs (2003) World Health Organization Classification of Tumors, , TAVASSOLI, F. A. DEVILLE, P. (eds.). Lyon: IARC Pres

Safety of screening with Human papillomavirus testing for cervical cancer at three-year intervals in a high-risk population: experience from the LAMS study

To assess whether human papillomavirus (HPV) testing is a safe enough approach to warrant extension of the screening intervals of baseline Papanicolaou (Pap)-/HPV- women in low-income settings.European Commission, INCO-DEV Programme (Contract # ICA4-CT-2001-10013). The generous contribution from DIGENE Inc. (USA) donating the HC 2 test

Evaluation of visual inspection with acetic acid (VIA), Lugol’s iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America

Objectives: To assess the performance indicators of visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI) in four Latin American centres participating in the ongoing Latin AMerican Screening (LAMS) study, in settings with moderate incidence of cervical disease and with poorly to moderately well-organized cervical cancer screening. Setting: Three Brazilian centres (São Paulo, Campinas and Porto Alegre) and one Argentine centre (Buenos Aires) recruited a total of 11,834 healthy women to undergo VIA, VILI, conventional Pap smear and Hybrid Capture II (HCII). Methods: Women who had a positive result from any of these tests were subjected to colposcopy and biopsies (if necessary), and women with high-grade cervical intraepithelial neoplasia (CIN) were properly treated. To control for verification bias, 5% of women with normal tests were referred for colposcopy, as were 20% of HCII-negative women. Results: Data on VIA (n = 11,834), VILI (n = 2994), conventional Pap smear (n = 10,138) and HCII (n = 4195) were available for test comparisons, calculating sensitivity, specificity, and positive and negative predictive values. Overall test positivity was 11.6% for VIA, 23.0% for VILI, 2.2% for Pap smear (LSIL threshold), 1.1% for Pap smear (HSIL threshold) and 17.1% for HCII. VIA was positive in 61.8% of the women with CIN 1, 57.0% of those with CIN 2, 35.0% of women with CIN 3 and in 21 of 28 (75%) of women with cancer. Approximately 10% of women with no detectable disease had an abnormal VIA. Regarding VILI, 83.3% of women diagnosed with CIN 1 and 62.5% of those with CIN 3 had an abnormal test. VILI failed to detect one of three cases of cancer. Both the sensitivity, specificity and positive predictive value of VIA and VILI in detecting CIN 2 or CIN 3 could be significantly improved depending on the combination with Pap smear or HCII (sensitivity up to 100.0% and specificity up to 99.8%). Conclusions: The LAMS study failed to reproduce the performance figures obtained with VIA and VILI (as stand-alone tests) in some other settings, where the prevalence of cervical disease was higher. However, a combined use of VIA or VILI with the Pap test or HCII allowed specific detection of cervical abnormalities.European Union (EU) - INCO-DEV Programme - Contract# ICA4-CT-2001-10013

Human papillomavirus testing as an optional screening tool in low-resource settings of Latin America: experience from the Latin American Screening study

Hybrid capture II (HC II) test for oncogenic human papillomaviruses (HPV) was carried out in a cohort of 4284 women at their first clinical visit. Overall prevalence of HPV was 17.1%, decreasing with age from 33.9% among women below 20 years to only 11.0% among those older than 41 years. HPV prevalence was significantly higher among current smokers (odds ratio [OR] ¼ 1.31; 95% CI 1.1–1.6), in women with two or more lifetime sexual partners (OR ¼ 1.9; 95% CI 1.6–2.4), and those women with two or more sexual partners during the past 12 months prior to examination (OR ¼ 1.6; 95% CI 1.2–2.2). HPV detection increased in parallel with increasing cytologic abnormality, being highest in women with high-grade squamous intraepithelial lesion (P ¼ 0.001). Specificity of the HPV test in detecting histologically confirmed cervical disease was 85% (95% CI 83.9–86.1). Sensitivity of the HPV test in detecting histologic abnormalities increased in parallel with disease severity, ranging from 51.5% for cervical intraepithelial neoplasia (CIN) 1 to 96.5% for CIN 3 and 100.0% for cancer, with respective decline of positive predictive value. These data suggest that HPV testing with HC II assay might be a viable screening tool among this population with relatively high prevalence of cervical disease