The established infrastructure of an HIV treatment program was successfully used to build capacity for cervical screening in a low-resource setting. By using task-shifting and evidence-based, low-cost approaches, population-based cervical screening in a rural African clinical network was found to feasible; however, loss to follow-up and poor pathology infrastructure remain important obstacles.
Objective To determine the accuracy of visual inspection with Acetic Acid (VIA) versus conventional Pap smear as a screening tool for cervical intraepithelial neoplasia (CIN)/cancer among HIV-infected women. Materials and Methods 150 HIV-infected women attending the Moi Teaching and Referral Hospital HIV clinic in Eldoret underwent conventional Pap smear, VIA, colposcopy and biopsy. VIA and Pap smears were done by nurses while colposcopy and biopsy were done by a physician. Receiver Operating Characteristic (ROC) analysis was conducted to compare the accuracies between VIA and Pap smear in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results Among the study participants: VIA was abnormal in 55.3% (83/150, CI=47.0–63.5%); Pap smear showed atypical squamous cells of undetermined significance (ASCUS) or worse in 43.7% (59/135, CI=35.2–52.5%) and 10% (15/150) of the Pap smears were unsatisfactory. Of the abnormal Pap smears, 3% (2/59) had ASCUS, 7% (4/59) had ASC-high grade, 60% (35/59) had low-grade squamous intraepithelial lesions (SIL), 29% (17/59) had high grade SIL, and 2% (1/59) was suspicious for cervical cancer. Using cervical intraepithelial neoplasia (CIN) 2 or higher disease on biopsy as an end point, VIA has a sensitivity of 69.6% (CI=55.1–81.0%), specificity of 51.0% (CI=41.5–60.4%), PPV of 38.6% (CI=28.8–49.3%) and NPV of 79.1% (CI=67.8–87.2%). For conventional Pap smear, sensitivity was 52.5% (CI=42.1–71.5%), specificity 66.3% (CI=52.0–71.2%), PPV 39.7% (CI=27.6–51.8%), and NPV 76.8% (CI=67.0–85.6%). Conclusion VIA is comparable to Pap smear and acceptable for screening HIV-infected women in resource limited settings such as Western Kenya.
Objective To assess the contemporary incidence of cancers using American Samoa as a learning set for insights into similar populations. Methods A retrospective observational analysis of de‐identified data held in public‐access databases (2004–2014) and data on uterine cancer from a hospital, both in American Samoa (2015–2016). Results There were 341 new cases of cancer in 2004–2014 (111 per 100 000 women/year), including breast (20.2%), uterine (19.4%), and cervical (5.0%); and 287 in 2011–2015 (103 per 100 000 women/year), including uterine (24.0%), breast (18.5%), and cervical (5.2%). Uterine cancer increased from 21.4 to 60.3 per 100 000 women/year, becoming the most common cancer in American Samoa. In 2011–2015, the incidence‐rate ratio of uterine cancer to other cancers in American Samoa was 1.3‐, 3.8‐, 4.6‐, 7.7‐, and 23‐fold higher than breast, colon, cervical, ovarian, and lung cancer, respectively. Among the most recent cases (n=33), median age was 55 years (10 [30.3%] <50 years), median BMI was 38.2; and 11 (33.3%) cases had grade 3 histology. Conclusion The pattern of cancers in American Samoa differs from that in the US mainland. The findings reflect significant changes in cancer incidence. Cancer control programs should evaluate the potential of uterine screening in accordance with their community's needs and characteristics.
Fetal seizures are relatively rare and most often associated with anomalies or adverse neonatal outcome. We describe a patient who presented in both her G1 and G2 pregnancies with fetal seizures. The second pregnancy was a twin gestation in which only one twin was affected. The fetal seizures were noted by the patient as "extreme rhythmic movement" and were observed on ultrasound. Both neonates were diagnosed with a seizure disorder within 1 day of life. Currently, the seizures are controlled by medication; however, both children have some developmental delay. Additionally, the patient and her partner are consanguineous, suggesting a likely genetic etiology. In utero diagnosis of fetal seizures warrants a multidisciplinary approach to attempt to further define prognosis and provide appropriate treatment and counseling.
e17126 Background: Uterine cancer (UC) is being considered for screening by the CDC due to its relative ascendancy in incidence. We sought to determine its potential for screening using a vanguard of contemporary cancer risk with high non-communicable disease rates (American Samoa [AS]) as a model sample set, and then Grady Hospital (GH) as a test population for screening. Methods: Public access de-identified databases covering the entire national population of AS over several time periods and de-identified GH tumor registry data. Results: In 2014 AS reported 258 new cancers (9.4/10,000 women/yr) including UC (36%), breast (37.6%), cervix (6.6%), ovary (5.1%), and others (14.7%). UC was the leading cause of gynecologic deaths (1.6x > ovarian or cervical). From 2004 - 14 the incidence of UC increased 78.9% to 3.4 cases/10,000 women/yr while breast cancer increased 52.2% to 3.5 cases/10,000. In the most recent 24 months, UC was 2.5x more likely to be diagnosed than breast, 3.6x more than colon, 8x more than cervical and 10.7x more than ovarian cancers. Gyn cancers were the leading cause of cancer death among women after lung. Based on this high incidence of UC, we sought to determine if it would be possible to reach US patients for potential screening using an urban population with health disparities in a test sample of potential beneficiaries of screening for UC the GH Morehouse service (79% black; mean age 58 (33 - 88). From 2010-6, 197 UCs were treated at GH; 96% were GH patients prior to diagnosis with an average time from earliest hospital encounter to the UC diagnosis of 1.75 years (0 – 5.5). Changes from 1st GH encounter to UC diagnosis and treatment including BMI, age, co-morbidities, etc will be presented. Conclusions: Uterine cancer has similar characteristics to currently screened cancers with an incidence in some high-risk population just under breast and prostate, but ahead of lung and colon. An enriched population, eg. BMI combined with age, especially with disparities, could benefit most from changes in screening strategy and management. Patients with UC are accessible in the hospital of their treatment for potential screening years before diagnosis. This may be an opportunity to reduce cost and morbidity from a rapidly increasing cancer.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.