Tuesday, April 2, 2019

About Cervical Cancer

About cervical crabmeatAbstractcervical crab louse is the endorse most common cause of pubic louse conclusion in developing countries. The cause of cervical disregardcer is the charitable villoma virus (HPV). cervical crabmeat has approximately former(a) risk factors, like having five-fold male intimate roleners, starting to start sexual intercourse at an early age, having other sexually transmitted disease, having weak insubordinate establishment and smoking.cervical crabby person eject be prevented by avoiding risk factors and undergoing symmetrical concealment sieves. The most common systems utilise in cervical test atomic number 18 knocker examination and HPV examen. World Health Organization estimated that most 510,000 b be-ass cases of cervical crabby person were diagnosed yearly. HPV exam is apply as a capital natural c everyplaceing manner in some true countries. some amounts of tests required and fail cost efficiency can be achi eved by doing HPV exam first and tit testing as a second test. Some studies suggested that HPV testing aptitudeiness be the in force(p) cervical c all over method and other studies did non suggest that. The correction HPV covering for cervical cancer in unpolished India indicated that HPV testing was the most objective and uniform of all other cervical check tests. It seems to be a skinny tuition with headspring designed methodology and reliable results and conclusions, just now it was criticized by R Marshall and Chengquan. They uttered soak uply that the study deflower by test conclave biases and respectable concerns. More puff up designed studies are essential to clarify this issue and to showing which method is proper to that coun sieve or to this geographical area. Introductioncervical cancer is the cancer of the lowest part of the uterus, which is known as cervix. cervical cancer is very slow growing, plainly in some cases it can grow and spread quick ly (Dolinsky Hill-Kayser, 2009). there are many types of cervical cancer. The most common type is called squamous cellular phone carcinoma (figure 1), which be in closely 80% of cervical cancer cases, whereas adenocarcinoma is the second most common type of cervical cancer (Dolinsky Hill-Kayser, 2009). cervical cancer is much(prenominal) common in developing countries than it is in developed countries. It is the second most common cause of cancer expiry in developing countries. It can affect young women who are 20 old age old or some time younger than that (Dolinsky Hill-Kayser, 2009).The cause of cervical cancer is the human papilloma virus (HPV) (figure 2) which was discovered by Harald zur white sturgeon who won the Nobel Prize in 2008 for this discovery (Nobel Prize organization, 2009). This virus is a sexually transmitted virus. It can cause genital warts which may or may not change to a cervical cancer (Dolinsky Hill-Kayser, 2009).The subtypes of HPV which have bee n confirmed to cause cervical cancer are 16, 18, 31 and 33 (Murray et al., 1998 Dolinsky Hill-Kayser, 2009). other researches suggested that subtypes 35 and 45 also can cause cervical cancer (NHS cancer book binding programmes, 2009). A woman has HPV transmittal does not mean that she is going to have a cervical cancer (Dolinsky Hill-Kayser, 2009).Other risk factors for cervical cancer are having multiple male sexual partners, starting to have sexual intercourse at an early age, having other sexually transmitted disease (herpes, syphilis, gonorrhea or Chlamydia), having weak immune system (HIV, organ transplantation or Hodgkins disease) and smoking (Dolinsky Hill-Kayser, 2009).The early stages of this disease usually do not have any symptoms, but as tumor increase in size, some non-specific symptoms for cervical cancer leave alone occur, like vicarious bleeding, subnormal vaginal discharge, pelvic or game pain, pain during urination and bloody stool or urine (Dolinsky Hi ll-Kayser, 2009).cervical cancer can be diagnosed by Pap testing, HPV testing, liquid-base cytology and by fetching a biopsy during Colposcopy. The biopsy is the only carriage to be sure if the patient has a cervical censer. Radiologic testing may also help in the analyse of this disease (Dolinsky Hill-Kayser, 2009).Cervical cancer can be treated by Surgery, radiotherapy and chemotherapy (Dolinsky Hill-Kayser, 2009). It can be prevented by avoiding risk factors which have been discussed previously and undergoing regular display tests (Dolinsky Hill-Kayser, 2009).In Islam religion for example, smoking and any sexual relationship not do amid wives and husbands (reducing sexually transmitted diseases) are strictly forbidden, this can reduce the chance of having cervical cancer deep down Muslim societies (Adam, 2009). In addition, male circumcision which is a part of Islam religion has found to be a good factor in cervical cancer stripe as researches have found that the wive s of circumcised men have little risk of getting this disease than the wives of uncircumcised (Mission Islam, 2009). Moreover, many countries have started to do cervical cancer screening to diagnose this disease in its early stages. Pap testing (cytologic testing), HPV testing and liquid-base cytology can be used in this screening programs which will be discussed later (Kufe et al., 2003 Jamison et al., 2006).Now a day, the vaccine Gardasil is used to prevent cervical cancer in women who are not loose to HPV (Dolinsky Hill-Kayser, 2009).This study is aimed to discus the importance of HPV screening in the come across of cervical cancer and clarifies the most appropriate method for cervical cancer screening. The spherical Burden of Cervical Cancer and the available Methods for Controlling the indispositionCervical cancer is the second most common cancer among females worldwide with about 493,000 new cases and 274,000 deaths in 2002. Cases occur in developing countries are estim ated to be about 83% (Bosch et al., 2009). Thomas Rohan and others utter that opportunities for cervical cancer prevention have been created by our understanding of the cause, particularly the role of HPV infection (Rohan et al., 2003). In addition, World Health Organization estimated that about 510,000 new cases of cervical cancer were diagnosed yearly. In Africa, about 68,000 new cases are reported every year, whereas 77,000 new cases are reported in Latin America and 245,000 in Asia (Pagliusi, 2009).In unify Kingdom, about 25.51 millions females who are 15 years old are at risk of having a cervical cancer during their life. This kind of cancer is ranked as the 11th most common cancer in females in UK and the 2nd most common cancer in females among 15 and 44 years old. In addition, about 8.9% of females in the commonwealth of UK are estimated to have HPV infection at a given time. shortly in UK, it is estimated that about 3181 females are reported with a cervical cancer yearly and about 1529 deaths (Bosch et al., 2009). umpteen researches suggested that the decline in incidence and deathrate of cervical cancer which have been observed in the last 50 years in developed countries can be connect to the initiation of screening programs (Kufe et al., 2003).The most common methods used in cervical screening are Pap (cytological) testing and HPV testing (Kufe et al., 2003). The most widely used method in the world is the Pap testing. This method is simple, cheap and some times is used as a secondary screening method. It basically involves exfoliating epithelial cells collection from the squamocolumnar junction of cervix or transformation partition off (Walker et al., 1990 Kufe et al., 2003).In addition, HPV testing is used as a primary screening method in some developed countries. It is used mostly to pock between a spicy risk women throng and others (Kufe et al., 2003).The study of Joakim Dillner and others suggested that HPV testing as a screening meth od is safe and effective when it is done every six years (Dillner et al., 2008) and it should be done for women who are 30 years old or older because they are ordinaryly early(prenominal) the peak age of self-limited infection (Castle, 2008).HPV DNA testing aptitude be a more clinically effective method than cervical smear, but its specificity is low because it could lead to unnecessary repeated screening and maintain up (Nelson (I), 2009).Fewer amounts of tests required and break out cost efficiency can be achieved by doing HPV testing first and Pap testing as a second test (Medscape Medical new-fashioneds, 2009 Nelson (I), 2009).Existing Randomized Controlled Trails examine the Use of HPV interrogatory in the Control of Cervical CancerMany randomised tone downled trails have been done to investigate the use of HPV testing in the ascendancy of cervical cancer. Some studies suggested that HPV testing might be the effective cervical cancer screening method (Grce and Davie s, 2008 Rebar, 2008 Nelson (II), 2009). On the other hand, other studies suggested that HPV testing does not improve cervical cancer screening (Brown, 2009 NHS cancer screening programs, 2009).In Italy, the second recruitment phase of the study title New Technologies for Cervical Cancer Screening (NTCC), women to conventional cytology (24,661 women) with referral to colposcopy if cytology indicated a typical squamous cells of undetermined significance or more sever abnormality or to HPV DNA testing alone by Hybrid Capture 2 (24,535 women) with referral to colposcopy if the test was controlling at a concentration of HPV DNA 1 pg/mL or greater were randomly charge. It has been concluded that HPV testing with a cutoff of 2 pg/mL achieves a substantial gain in sensitivity compared to cytology with only a small reducing in lordly Predictive Value among a multitude of women ancient 35 to 60 years. In contrast, for women aged 25 to 34 years, it is suggested that there is a ordinary regression of CIN2+ that is detected by direct referral of younger HPV testing-positive women to colposcopy as a result of the large relative sensitivity of HPV testing compared with conventional cytology (Ronco et al., 2008).In addition, the results from a 6-year prospective study in Rural China present that a single oncogenic HPV DNA testing is more effective than cytology in predicting future CIN2+ status (Shi et al., 2009).The study homophile Papillomavirus DNA versus Papanicolaou Screening tastes for Cervical Cancer which was done in Canada, conducted a randomized test examine the two methods, found that HPV testing has greater sensitivity than Pap testing for the spying of cervical intra-epithelial neoplasia (Mayrand et al., 2007).The Population Based Screening Study capital of The Netherlands (POBASCAM) which is a population based randomized controlled trial for implementation of hrHPV testing by GP5+/6+ PCR-enzyme immunoassay (EIA) with a classical cytology as a contro l concourse was done between January 1999 and September 2002. It was done among 44,102 women aged between 29 and 61 who participated in the regular Dutch screening program. This study (POBASCAM) indicated that large scale hrHPV testing is accepted by both participating women and general practitioners, is practically feasible and yield highly outranked results (Bulkmans et al., 2004). In 1997, a 10-year study Randomized Controlled Trial of Human Papillomavirus interrogatory in Primary Cervical Cancer Screening (SWEDESCREEN) was started. This study aimed to investigate whether HPV-based cervical cancer screening which is known to increase sensitivity for spotting of high grade cervical intraepithelial neoplasia (CIN) is represent over diagnosis or a protective(p) effect. It included 12,527 women aged between 32 and 38 years and were randomized (11) to HPV testing and cytology testing (intervention arm) or cytology only (control arm). Its conclusion indicated that HPV testing with a cytology testing is more sensitive than cytology testing alone (U.S. National imbed of Health, 2009).In another study, titled Randomized Controlled Trial of Human Papillomavirus Testing Versus Pap Cytology in the Screening for Cervical Cancer Precursors, the Canadian Cervical Cancer Screening Trial (CCCaST), randomized women aged between 30 and 69 years were categorized in to Pap testing classify and HPV testing pigeonholing. The findings at recruitment phase of this study indicated that HPV testing is more sensitivity and less specificity than Pap cytology testing (Mayrand et al., 2006).An Overview on the Methodology, Results and Conclusions of the Study HPV Screening for Cervical Cancer in Rural India Rengaswamy and others began their study HPV Screening for Cervical Cancer in Rural India in 1999 and finished after 8 years. In this study, 52 clusters of villages with a total of 131,746 healthy women aged between 30 and 59 years were randomly depute to 4 groups of 13 cluste rs each. These groups assigned to go through screening byHPV testing group (34,126 women) (27,192 were screened and 2812 (10.3%) had positive results).Cytology testing group (32,058 women) (25,549 were screened and 1787 (7.0%) had positive results).Visual Inspection of the neck with Acetic Acid (VIA) group (34,074 women) (26,765 were screened and 3733 (13.9%) had positive results).Standard care group (control) (31,488 women) (not offered screening but were advised on how to seek screening) (only 1946 (6.2%) requested screening and that means (93.8%) stayed without screening.Women who had positive results went through colposcopy and biopsies were taken and those with cervical precancerous lesions or cancer received appropriate treatment (Sankaranarayanan et al., 2009).The results of this study showed that In HPV testing group cervical cancer was diagnosed in 127 women and 34 deaths occurred.In Cytology testing group cervical cancer was diagnosed in 152 women and 54 deaths occurred.I n VIA group cervical cancer was diagnosed in 157 women and 56 deaths occurred.In Control group cervical cancer was diagnosed in 118 women and 64 deaths occurred.In addition, this study indicated that of the 131,806 women, 60 died or migrated before the study began. The study groups were equally distributed in hurt of household type, religion, occupation, marital status and number of pregnancies. The well balanced study will help to remove any biases to any group of the study. The results of this study showed alsoInvasive cervical cancer developed in 8 (0.033%) of 24,380 HPV negative results women.Invasive cervical cancer developed in 22 (0.093%) of 23,762 cytology negative results women.Invasive cervical cancer developed in 25 (0.109%) of 23,032 VIA negative results women (Sankaranarayanan et al., 2009).The protocol of this study was reviewed and approved by the scientific and ethical review committees of the International Agency for Research on Cancer (IARC), the Tata annals Cent er (TMC) and the Nargis Dutt Memorial Cancer Hospital (NDMCH). It was seconded by the pinnacle and Melinda Gates Foundation through the Alliance for Cervical Cancer streak (Sankaranarayanan et al., 2009).This study concluded that a single round of HPV testing was associated with a significant decline in the rate of advanced cervical cancers and associated deaths compared with the unscreened control group, whereas there was no significant reduction in the rate of death in either the cytology testing or the VIA group compared with the control group. anterior conclusions indicated that HPV testing was the most objective and reproducible of all other cervical screening tests (Sankaranarayanan et al., 2009).This study seems to be a good one with well designed methodology and reliable results and conclusions, but it is clear that about 93.8% of the control group did not do any cervical screening during the 8 years which may raised an ethical issue might touch the approval of this stu dy if it was done in antithetic country.Further more, the courses and develop period given to different staffs who participated in this study may be not enough to give them good experience in order to have less chance of error during the diagnosis.An Overview on the Criticizing Article title Test Group Biases and Ethical Concerns Mar New England Journal of music Articles Promoting HPV Screening for Cervical Cancer in Rural India A few months after the publication of previous study, R Marshall and Chengquan had criticized it. They suggested that unexpected biases might have occurred in some of the test groups of the study. The study stated that the positive predictive value for detecting CIN 2-3 was 19.3% in the cytology testing group, higher than 11.3% in the HPV testing group and the study results indicated that essentially the same number of cervical cancers was detected after positive screening test results in the cytology group (88 women) and in the HPV group (87 women) (Aus tin Zhao, 2009). Also, they observed that in the report of 2005, this study indicated that the detection rates of HPV testing did not show any improvement over cytology, but its conclusion of 2009 indicated different findings (Austin Zhao, 2009). I say this is not a problem as findings and conclusions of scientific studies usually change over time. In addition, of 54 cervical cancers related deaths in the cytology group, 27 deaths were in the assigned but not screened group and another 18 deaths were in patients who had abnormal cytology results. In HPV group, 19% fewer cervical cancer deaths (22 women) were in the assigned but not screened group and 33% fewer deaths (12 women) occurred in women with abnormal HPV testing results. These data supported the hypothesis that biases were introduced in the study groups. (Austin Zhao, 2009). I conceive it is possibly true, because these data can show that the follow up and treatments were not equally effective in the two groups. So, ev en when cytological detection is roaring, women can still die from cervical cancer due(p) to inappropriate management. In addition, these data also can show that the dominance of cytology as a cervical screening method is depended on its sufferance by women. R Marshall and Chengquan have raised questions about the confederation between AACPs coordinating organization and the HPV test manufacturer (Austin Zhao, 2009). I think this partnership if it is real, it can affect the final results and conclusion in way that show the advantages of HPV testing in order to increase the income of the manufacture. Also they stated that it is not fare to allow a large number of control group to go without any screening during the study (Austin Zhao, 2009). I think it is true that it is not fare to leave women in the control group without any screening and this can lead to ethical concerns.In addition, cytology screeners were instruct for only three months, which was very short period. They concluded that cytology screening is better than HPV screening according to the results of the previous study (Austin Zhao, 2009).In my opinion, the criticizing letter might be in the correct direction. From a brief reading and screening of the study, the reader might believe that its finding indicated that HPV testing as a cervical cancer screening method is better than other tests, but deep reading will show him the limitation errors of this study which were first published by R Marshal and Chengquan. They showed clearly that the study marred by test group biases and ethical concerns. The study might try to cover and exclude some facts which can show that cytology testing was better than HPV testing.Use or Not to Use HPV Testing as a Primary Screening Test for Cervical NeoplasiaIt has been argued that HPV testing is the best method for cervical cancer primary screening. I think that HPV testing is a good method to be used in cervical cancer primary screening in developing count ries as well as in developed countries to reduce the incidence and mortality rates of cervical cancer. Studies which concluded that HPV testing is better than cytology testing are more than those which showed the opposite.The high cost of HPV testing can be overcome by the support of WHO and privet sector companies in these developing countries. Also, the high cost of HPV testing can be overcome by the selective use of HPV testing, e.g. in the over 30s.Many studies suggested that Human Papillomavirus is found in most of cervical cancer cases if not all. So, the use of HPV DNA testing in a well designed screening program may help in diagnosis early stages of cervical cancer, giving better chance for treatment compared with Pap testing which may give false negative results. In conclusion, it is clear that different results and findings were gathered from different studies which try to find the proper method for cervical cancer screening. These differences may be occurred because the studies done in different countries. And is it known that each country has its own geography, rate of mortality, rate of incidence and other factors which may affect the burden of cervical cancer disease.So, more well designed studies are needed to clarify this issue and to show which method is proper to that country or to this geographical area in order to save womens lives. ReferencesAdam, A. (2009), Sexually Transmitted Diseases and Islam. Kuwait. on tap(predicate) from http//www.islamset.com/hip/anvir_adam.htmlAccessed 30-11-2009.Austin, R. M., Zhao, C. (2009), Test group biases and ethical concerns mar New England Journal of Medicine articles promoting HPV screening for cervical cancer in rural India. CytoJournal, 6 (12), pp. 1-5.Bosch, F. X., Castellsague, X., Sanjose, S., Alarcon, F., Albero, G., Bruni, L., Ferrer, E., Louie, K. S., Miralles, C., Monfulleda, N., Munoz, J., Perez, S., Rajo, C., Roura, E. (2009), Human papillomavirus and related cancers. 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