Evidence for benefits from treating cervical ectopy: literature review

Machado, Luís Carlos; Dalmaso, Ana Sílvia Whitaker; Carvalho, Heráclito Barbosa

doi:10.1590/s1516-31802008000200014

Cited by 32 publications

(38 citation statements)

References 42 publications

(73 reference statements)

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“…Diagnosis and treatment of cervical glandular ectropion in Poland is very common and relatively costly despite the fact that this lesion is currently regarded as a physiological condition (19). It is also possible that services provided for collection and evaluation of opportunistic Pap smears and diagnostic procedures in CIN cases were erroneously coded with N86 code and therefore overvalued treatment of ectropion in Poland and undervalued costs of opportunistic screening and management of CIN.…”

Section: Discussionmentioning

confidence: 99%

Reimbursed Costs of Management of Uterine Cervical Lesions in Poland - a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health

Nowakowski

Śliwczyński²,

Seroczyński

et al. 2016

Cent Eur J Public Health

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SUMMARYBackground: Despite implementation of organised screening programme in 2006/2007, cervical cancer (CC) incidence and mortality in Poland are still higher than the average in the European Union. CC and preceding cervical intraepithelial neoplasia (CIN) caused by human papillomaviruses (HPVs) can be prevented by vaccines which are reimbursed in around 20 European countries but not in Poland. CC and CIN can be also detected with the use of HPV tests which are not included in the Polish screening programme. Reimbursement for HPV vaccines and HPV testing requires cost-effectiveness analyses which include country-specific data on the burden and costs of management of cervical neoplasia. Therefore, we investigated the burden of cervical neoplasia and direct costs associated with its detection and management in Poland in 2012 reimbursed by the National Health Fund (NHF) -the only public healthcare insurance institution. We also report administrative costs of the organised screening programme covered by the Ministry of Health.Methods: Data on the burden and reimbursed costs of organised and opportunistic screening as well as management of cervical neoplasia were drawn from the NHF databases. Numbers of women reported with CIN and CC were ascertained.Results: In 2012, there were 765,266 and 1,288,358 reimbursed Pap smears collected within and outside the organised screening programme, respectively. Expenditures on medical and administrative procedures in organised screening reached PLN (Polish Zloty) 41,470,664 and 12,150,398 respectively. The number of women with particular diagnosis and reimbursement for the management of these lesions were as follows: glandular ectropion 208, 033 and PLN 37,349,515; CIN1 10,521 and PLN 6,616,375; CIN2 5,812 and PLN 5,071,155; CIN3 6,487 and PLN 7,611,062; unspecified grade CIN 36,575 and PLN 12,352,034; and CC 33,482 and PLN 52,377,006, respectively. In women with ectropion and CIN the total number of local excision/ablative therapeutic procedures on the cervix reached 47,658 and the total number of hysterectomies was 1,321.Conclusion: In 2012, management of approximately 93 thousand women with HPV-related cervical lesions reimbursed in Poland amounted to PLN 84,027,632 which makes it a considerable public health problem. The number of women managed for glandular ectropion is considerable and related costs are high. Total reimbursement for detection, treatment and follow-up of all cervical lesions reaches at least PLN 137 million annually.

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Section: Discussionmentioning

confidence: 99%

Reimbursed Costs of Management of Uterine Cervical Lesions in Poland - a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health

Nowakowski

Śliwczyński²,

Seroczyński

et al. 2016

Cent Eur J Public Health

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“…This condition has many names in medical terminology: ectropion, erythroplakia, macula rubra and erosion. [1] Cervical ectopy is a condition where the ectocervix contains columnar cells. Squamous cells which cover the cervix are multiple layers thick.…”

Section: Introductionmentioning

confidence: 99%

“…It is likely that most women, if not all, will have ectopy at some point during their lifetimes. [1] There are many factors associated with cervical ectopy conditions such as: the use of oral contraceptive pills (OCPs) and intra-uterine contraceptive devices (IUCDs) has been implicated as a cause of cervical ectopy. A prevalence study in China among female users of family planning services reported that 43.2% of women had cervical ectopy.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies demonstrated a negative association with the number of years of sexual activity and number of partners. [1] Cervical ectopy and the associated squamous metaplasia are now considered to be physiological phenomena. However, its management has historically consisted of interventions with the purpose of inducing or accelerating its regression.…”

Section: Introductionmentioning

confidence: 99%

“…Cauterization, in its several variants, is the treatment most often used and its efficacy is around 90%. [1] Diagnosis of cervical ectopy with VIA test: conventional cytology or the (PAP) smear is the first method for detection of cervical abnormalities. However, it has many limitations e.g., lack of trained technicians, lack of follow up of the results.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of visual inspection with acetic acid in cervical ectopy evaluation

Sheesha

Mansour

Kheder

et al. 2015

JNEP

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Background: Cervical erosion is one of the most common pathological conditions encountered in outpatient gynecological clinics in middle-aged women. A simple method for diagnosis and treatment can play a tremendous role to comfort these women. Methods: The study includes fifty female patients attended the outpatient clinic of obstetrics & gynecology department in Mansoura University hospitals. All patients selected according to inclusion and exclusion criteria. The study was undertaken during the period from June 2014 to December 2014. Tools: Two tools were used for data collection: (1) Interviewing questionnaire schedule divided into three parts which were used to assess general characteristics of women, obstetric and gynecological history and the presence of cervical ectopy symptoms. (2) Local cervical assessment by vinegar acetic acid (VIA) test. Results: The study results revealed that 30 subjects (60%) were VIA positive and 20 subjects (40%) were VIA negative. VIA sensitivity was 100%, specificity 45%, PPV 71% and NPV 75%. There was a statistically significant relation between duration of marriage, high parity, IUDs use and VIA positivity. Conclusions: Using VIA test was an accurate and effective method for detection of cervical ectopy. VIA test should be performed in all the women attending outpatient gynecological clinics even in the presence of Pap smear facility to improve detection rate of cervical lesions and provide better patient counseling and treatment.

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Uterine cervical ectopy during reproductive age: Cytological and microbiological findings

Eleutério

Giraldo

Gonçalves

et al. 2013

Diagnostic Cytopathology

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Cervical ectopy is common in adolescents, pregnant women, and those taking high doses of estrogen-containing contraceptives. The majority of cases have spontaneous reversion, but some cases can be persistent. Studies suggested that the adequacy of a Pap smear could be affected and there is an increased risk cervical infections. This study is a cross-sectional study conducted from December 2009 to February 2011 with 457 women with cervical ectopy and 736 without ectopy. Cervical samples were collected in vials for analysis by ThinPrep cytology (Hologic, Marlborough, MA). The Mann-Whitney test and Fisher's exact test (95% CI) were applied. The study was approved by the ethics committee of the Federal University of Ceará. The mean ages of the study group and control group were 28.7 (±14.8) and 33.6 (±7.5) years old, respectively (P < 0.0001). Negative diagnosis for malignancy and intraepithelial lesion was present in 399 (87%) cases and 705 (96%) in the study and control groups, respectively (P < 0.0001). Shift in the flora suggestive of bacterial vaginosis (BV) was observed more frequently in the study group: 74 (16.2%) than in the control group: 86(11.7%) (P = 0.017). The differences among the other morphotypes showed no significance. The smears were atypical in 12.7% (58/457) of the patients from the study group and in 4.2% (31/736) in the control group (P < 0.001; RR = 3 [2.033-4.712]). The association between ectopy and inflammatory cytology, the presence of the shift in the flora suggestive of BV and cytological atypia is evident.

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Evidence for benefits from treating cervical ectopy: literature review

Cited by 32 publications

References 42 publications

Reimbursed Costs of Management of Uterine Cervical Lesions in Poland - a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health

Reimbursed Costs of Management of Uterine Cervical Lesions in Poland - a Descriptive Analysis of Data from the National Health Fund and the Ministry of Health

Accuracy of visual inspection with acetic acid in cervical ectopy evaluation

Uterine cervical ectopy during reproductive age: Cytological and microbiological findings

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