Burden of cervical neoplasia in mid-western rural Nepal: a population-based study

Thapa, Niresh; Shrestha, Girishma; Maharjan, Muna; Lindell, Deborah; Maskey, Ninu; Shah, Rajiv; Ge, Caiyun; Cai, Hongwei

doi:10.3802/jgo.2018.29.e64

Cited by 8 publications

(8 citation statements)

References 18 publications

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“…The screenings consisted of Papanicolaou smear and visual screening tests. The details of the screening tests were described in our previously published article 19…”

Section: Methodsmentioning

confidence: 99%

<p>Infiltrating CD4 and CD8 lymphocytes in HPV infected uterine cervical milieu</p>

Maskey¹,

Thapa²,

Maharjan³

et al. 2019

CMAR

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Purpose Tumor infiltrating lymphocytes (TILs) have been extensively described in anti-tumor immunity, but their functional alterations in the immunoediting processes during neoplastic progression in the uterine cervix are still not clear. Our aim was to gain insight into cervical tissue T cell populations, determine if there are any differences in the localization and quantity distribution of T lymphocytes, and to evaluate their role in disease regression or progression in the cervical neoplastic milieu. Patients and methods Serial section analysis of immunohistochemically stained CD4 and CD8 lymphocytes was performed on a total number of 72 samples, categorized into four cohorts: 23 HPV non-infected (HPV-) normal cervix, 20 HPV infected (HPV+) normal cervix, 17 HPV+ low grade cervical intraepithelial neoplasia (CIN), and 12 HPV+ high grade CIN. Results Low infiltrating lymphocytes (ILs) in normal cervix and high ILs in CIN were observed, while the trend of ILs increased with increasing grade of CIN, which was statistically significant ( P <0.0001). Quantitative and localization analysis between the subsets of T cells showed that, in the epithelial layer, infiltrating CD8+ lymphocytes (CD8+ ILs ) were significantly higher than CD4+ ILs in HPV+ normal cervix, while the trend decreased with increasing grade of CIN ( P =0.011). Whereas, in the stromal layer, CD4+ ILs were predominant in all study groups and no statistical difference was found between these groups. However, tumor infiltrating CD8+ lymphocytes (CD8+ TILs ) were noted to be significantly higher than CD4+ TILs in severe dysplastic cases. Conclusion T cell infiltrates were predominant as the grade of the lesion progressed into more advanced lesions, which likely represent the lesions that have persisted over time. The variation in the infiltration rate and the location of CD4+ ILs and CD8 ILs may suggest the efficacious role of CD8 T cells in eliminating HPV infected cervical epithelial cells and also provides insight into the complex role of TILs in facilitating and mediating sustained anti-tumor responses, hence preventing tumor outgrowth.

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“…The screenings consisted of Papanicolaou smear and visual screening tests. The details of the screening tests were described in our previously published article 19…”

Section: Methodsmentioning

confidence: 99%

<p>Infiltrating CD4 and CD8 lymphocytes in HPV infected uterine cervical milieu</p>

Maskey¹,

Thapa²,

Maharjan³

et al. 2019

CMAR

Self Cite

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“…Even though the Papanicolaou (Pap) test has been used as a primary method of cervical cancer screening (CCS) in Nepal, the feasibility of its introduction among the target population is often questioned due to the lack of human and financial resources and restrictions in the availability of infrastructure (Sherpa, 2007; Thapa et al, 2018b). The human papillomavirus (HPV) test gives highly sensitive test results in identifying high‐risk HPV in women (Sherpa et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…The high cost associated with HPV testing affects its use in low resource settings like Nepal. At present, visual inspection with acetic acid (VIA) is the most promising alternative CCS test in Nepal (Dhaubhadel, Vaidya, & Choudhary, 2008; Thapa, Shrestha, et al, 2018b).…”

Section: Introductionmentioning

confidence: 99%

Health beliefs and practices regarding cervical cancer screening among women in Nepal: A descriptive cross‐sectional study

Maharjan

Thapa

Panthi³

et al. 2020

Nursing & Health Sciences

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The health beliefs and practices regarding cervical cancer screening among women in the mountainous and Terai region of Nepal were investigated and examined for the differences. A descriptive cross-sectional study was conducted with a purposive sample of 216 in mountainous and 294 in Terai. The interview tools were a sociodemographic scale, a Nepalese Health Belief Model Scale for Cervical Cancer followed by the Screening Test. Chi-square test, binary logistic regression, Mann-Whitney U, and Kruskal-Wallis were used to analyze the data. The results showed that the screening rate was low for both regions with a significant difference in the benefit of screening and health motivation. Being older and having a positive family history of cervical cancer were shown to be predictors screening practice. Women from both groups preferred female doctors for screening. Culturally appropriate educational interventions focused on the benefits and obstacles of screening is needed to improve the beliefs of cervical cancer and screening and increase the screening rate. Nurses need to be aware of health beliefs regarding cervical cancer during cervical screening and education.

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“…The detailed methodology including flow diagram was explained in our previous study. 7 An educational program was conducted to raise awareness of cervical cancer and encourage participation in the screenings. Written informed consent was obtained from the respondents who were willing to participate.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal

et al. 2018

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Introduction: In Nepal, cervical cancer is the most common female cancer. Unfortunately, there is no uniform effective screening system available all around the country. The objective of this study is to evaluate the cytology, Visual Inspection with Acetic Acid and with Lugol’s Iodine alone or in combination to detect a pre-cancerous lesion in rural Nepal.Methods: It is an analytical cross-sectional study. Convenience sampling technique was used to select participants who were apparently healthy, married, non- pregnant women of aged 20-65 years for cervical cancer screening program. Screening tests were performed on all eligible women (n=2143) after socio-demographic and reproductive health data collection. A biopsy was applied as a gold standard test. Cross-tabulations were used to describe the test sensitivity, specificity, positive predictive value, and negative predictive value at a 95% confidence interval. Diagnostic odds ratio was also calculated. Results: A majority, 2143 (94%), of women accepted and participated in this study. The sensitivity vs specificity of cytology, VIA, and VILI was 57.1% vs 98.3%, 71.4% vs 88.8% and 78.6% vs 85.1%, and of the co-testing of ‘Both positive VIA and VILI’ and ‘Either positive VIA or VILI’ was 64.3% vs 85.7% and 90.1% vs 83.7% respectively. Negative predictive value of all tests exceeded 99.7%. Cytology had the highest Diagnostic odds ratio (64.9), followed by the co-test ‘Either positive VIA or VILI’ (27.7).Conclusions: Cervical cancer screening by co-testing ‘Either positive VIA or VILI’ is more useful than cytology; VIA and or VILI are easy, safe, feasible and well-accepted tests in a low resource setting, Nepal.

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Burden of cervical neoplasia in mid-western rural Nepal: a population-based study

Cited by 8 publications

References 18 publications

<p>Infiltrating CD4 and CD8 lymphocytes in HPV infected uterine cervical milieu</p>

<p>Infiltrating CD4 and CD8 lymphocytes in HPV infected uterine cervical milieu</p>

Health beliefs and practices regarding cervical cancer screening among women in Nepal: A descriptive cross‐sectional study

Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal

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