Levels of anxiety in women aged ≥45 years undergoing diagnostic large loop excision of the transformation zone: A longitudinal study

Gustafson, Line Winther; Larsen, Mette Bach; Hammer, Anne; Petersen, Lone Kjeld; Andersen, Berit; Bor, Pınar

doi:10.1111/1471-0528.17299

Cited by 4 publications

(3 citation statements)

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“…Referral for colposcopy is a known harm of screening as it can lead to psychological distress and anxiety [29][30][31]. However, a previous study has found lower anxiety levels in older women undergoing colposcopy and treatment (median age 67.7 years) compared to women aged 23-50 [32,33]. Additionally, a recent Danish qualitative study demonstrated that older post-menopausal women preferred diagnostic LEEP over continued surveillance, even if this would result in increased risk of overtreatment [34].…”

Section: Discussionmentioning

confidence: 99%

“…From April 17 through December 31, 2017, women born before 1948 (i.e., aged 69 + at that time) were invited for one additional HPV screening test [4,15]. HPV DNA testing was performed using the clinically validated COBAS 4800 assay (Roche Diagnostics), which allows for individual detection of HPV16 and HPV18, and pooled detection of 12 other high-risk HPV types (31,33,35,39,45,51,52,55,56,58,66,68). Women were referred directly for colposcopy if they were positive for HPV16 and/or HPV18, or if they were positive for other HPV types than HPV16/18 and had atypical squamous cells of undetermined significance or worse (ASC-US +) on reflex cytology.…”

Section: Methodsmentioning

confidence: 99%

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Risk of cervical intraepithelial neoplasia grade 2 or worse in women aged ≥ 69 referred to colposcopy due to an HPV-positive screening test

et al. 2023

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Background Cervical cancer incidence and mortality rates are high in older women in many developed countries, including Denmark. Therefore, Danish women aged 69 and older were invited for one additional human papilloma virus (HPV) based screening test in 2017. Here, we describe the clinical management and detection rate of cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) in screen-positive women referred for colposcopy. Methods We conducted an observational study in public gynecology departments in Central Denmark Region, Denmark. Women were eligible for enrolment if they were aged 69 + in 2017, HPV positive on a screening test taken between April 20th, 2017, and December 31st, 2017, and had been referred for direct colposcopy. Data on participants’ characteristics, colposcopic findings, and histological outcomes were collected from medical records and the Danish Pathology Databank. We estimated the proportion of women with CIN2 + at the first colposcopy visit and at end of follow up including 95% confidence intervals (CIs). Results A total of 191 women were included with a median age of 74 years (IQR: 71—78). Most women (74.9%) did not have a fully visible transformation zone at colposcopy. At the first visit 170 women (89.0%) had a histological sample collected, 34 of whom (20.0%, 95% CI 14.3–26.8%) had CIN2 + diagnosed, 19 had CIN3 + , and two had cervical cancer). During follow-up additional CIN2 + were detected resulting in a total of 42 women (24.4%, 95% CI: 18.2–31.5%) being diagnosed with CIN2 + , 25 with CIN3 + , and three with cervical cancer. When restricting to women with paired histologic results (i.e., biopsies and a loop electrosurgical excision procedure (LEEP) specimen), we found that CIN2 + was missed in 17.9% (95% CI 8.9–30.4%) of biopsies compared to the LEEP. Conclusion Our findings suggest a potential risk of underdiagnosis in older postmenopausal women referred to colposcopy. Future studies should explore potential risk-markers for discrimination of women at increased risk of CIN2 + from those at low risk, as this would reduce risk of underdiagnosis and overtreatment.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Risk of cervical intraepithelial neoplasia grade 2 or worse in women aged ≥ 69 referred to colposcopy due to an HPV-positive screening test

et al. 2023

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“…10 TZ type 3 poses a problem during colposcopies: studies revealed inadequate colposcopy in up to 67% of postmenopausal women (mean age: 62 years), mostly due to TZ type 3. 8 9 11 This challenge may result in prolonged follow-up involving repeated colposcopies to obtain representative biopsies, causing psychological distress and anxiety among patients, [12][13][14] as well as an increased risk of missing disease in the cervical canal. 8 11 This risk is considerable and is supported by a Danish study among screen-positive older women (median age 67.7 years) with TZ type 3 showing that more than half (54.5%) of the CIN grade 2 or higher (CIN2+) (CIN2, CIN3/Adenocarcinoma in Situ (AIS), cancer) cases detected in the cone biopsy were missed by colposcopyguided biopsies.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Improving diagnostic of cervical dysplasia among postmenopausal women aged ≥50 years using local vaginal oestrogen treatment prior to colposcopy: study protocol for a multicentre randomised controlled trial (the IDEAL study)

Bertelsen,

Tranberg,

Petersen

et al. 2024

BMJ Open

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IntroductionColposcopy is the most important diagnostic tool to detect cervical precancerous lesions and thereby prevention of cervical cancer. Due to age-dependent changes of the cervix, colposcopy is challenging in postmenopausal women, as the majority will have a non-visible transformation zone, resulting in increased risk of missing disease, a diagnostic cone biopsy and prolonged follow-up with repeated colposcopies. This study will be among the first to investigate, if treatment with vaginal oestrogen prior to colposcopy will improve the colposcopy performance, to ensure accurate and timely diagnosis of precancerous cervical lesions among postmenopausal women.Methods and analysisA randomised blinded controlled multicentre study. Enrolment will be performed at gynaecology departments in Central Denmark Region and Region of Southern Denmark. A total of 150 postmenopausal women aged ≥50 years referred for colposcopy due to abnormal cervical screening results will be randomised 1:1 to either pretreatment with vaginal application of Vagifem 30 µg or placebo once a day for 14 days prior to colposcopy. The primary outcome will be to compare the percentage of women in the two groups with a visible transformation zone at colposcopy, and biopsies representative of the transformation zone. Secondary outcomes will be the proportion of detected cervical intraepithelial neoplasia grade 2 or higher in the cervical biopsies; the proportion of diagnostics cone biopsies; the patients’ report on possible side effects and compliance to the pretreatment.Ethics and disseminationThe study has been approved by the Central Denmark Region Committee on Biomedical Research Ethics (1-10-72-34-22), the Central Denmark Regions’ Research Unit (1-16-02-72-22) and The Danish Health Authority (Danish Medicine Agency; 2022015030). The study’s EudraCT number is (1-23-456; 2022-000269-42) and it is registered onwww.clinicaltrials.gov. The local Good Clinical Practice (GCP) unit will supervise and monitor the study closely before, during and after the study period. Findings will be disseminated in peer-reviewed scientific journals and presented in relevant conferences.Trial registration numberNCT05283421.

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A systematic review and research recommendations on artificial intelligence for automated cervical cancer detection

Khare,

Blanes‐Vidal,

Booth

et al. 2024

WIREs Data Min & Knowl

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Early diagnosis of abnormal cervical cells enhances the chance of prompt treatment for cervical cancer (CrC). Artificial intelligence (AI)‐assisted decision support systems for detecting abnormal cervical cells are developed because manual identification needs trained healthcare professionals, and can be difficult, time‐consuming, and error‐prone. The purpose of this study is to present a comprehensive review of AI technologies used for detecting cervical pre‐cancerous lesions and cancer. The review study includes studies where AI was applied to Pap Smear test (cytological test), colposcopy, sociodemographic data and other risk factors, histopathological analyses, magnetic resonance imaging‐, computed tomography‐, and positron emission tomography‐scan‐based imaging modalities. We performed searches on Web of Science, Medline, Scopus, and Inspec. The preferred reporting items for systematic reviews and meta‐analysis guidelines were used to search, screen, and analyze the articles. The primary search resulted in identifying 9745 articles. We followed strict inclusion and exclusion criteria, which include search windows of the last decade, journal articles, and machine/deep learning‐based methods. A total of 58 studies have been included in the review for further analysis after identification, screening, and eligibility evaluation. Our review analysis shows that deep learning models are preferred for imaging techniques, whereas machine learning‐based models are preferred for sociodemographic data. The analysis shows that convolutional neural network‐based features yielded representative characteristics for detecting pre‐cancerous lesions and CrC. The review analysis also highlights the need for generating new and easily accessible diverse datasets to develop versatile models for CrC detection. Our review study shows the need for model explainability and uncertainty quantification to increase the trust of clinicians and stakeholders in the decision‐making of automated CrC detection models. Our review suggests that data privacy concerns and adaptability are crucial for deployment hence, federated learning and meta‐learning should also be explored.This article is categorized under: Fundamental Concepts of Data and Knowledge > Explainable AI Technologies > Machine Learning Technologies > Classification

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Levels of anxiety in women aged ≥45 years undergoing diagnostic large loop excision of the transformation zone: A longitudinal study

Abstract: Objective: To measure anxiety levels in women aged ≥45 years undergoing diagnostic large loop excision of the transformation zone (LLETZ) at the first colposcopy visit.

Cited by 4 publications

References 36 publications

Risk of cervical intraepithelial neoplasia grade 2 or worse in women aged ≥ 69 referred to colposcopy due to an HPV-positive screening test

Risk of cervical intraepithelial neoplasia grade 2 or worse in women aged ≥ 69 referred to colposcopy due to an HPV-positive screening test

Improving diagnostic of cervical dysplasia among postmenopausal women aged ≥50 years using local vaginal oestrogen treatment prior to colposcopy: study protocol for a multicentre randomised controlled trial (the IDEAL study)

A systematic review and research recommendations on artificial intelligence for automated cervical cancer detection

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