Search Results (46)

(1) Background: After receiving an abnormal Papanicolaou smear result, very often women fail to adhere to further procedures due to depression. Using a neural network approach, this research aimed to predict pre- and post-diagnostic depressive symptoms in women with abnormal Pap screening tests. (2) Methods: The study was conducted at the Clinical Center of Kragujevac, Serbia, among 172 women with a positive Pap screening result before and after diagnostic procedures (colposcopy/biopsy/endocervical curettage). Just before and 2 to 4 weeks after the diagnostic procedures, women filled out a socio-demographic questionnaire and the Hospital Anxiety and Depression Scale (HADS). Multilayer perceptron neural networks were modeled. (3) Results: Depression was present in 37.2% of women before diagnostic procedures and in 48.3% after. Feature selection showed four variables that correlated with depression before diagnostic procedures—anxiety (according to the HADS), depression according to the CESD scale, worry score on the POSM scale and use of sedatives. Model for predicting pre-diagnostic depression yielded an accuracy of 79.41%, with a value of 0.842 for area under the receiver operating characteristic curve (AUROC). The HADS anxiety score, place of residence and CESD score were the most important attributes for predicting post-diagnostic depression, with an ANN model accuracy of 88.24% and AUROC 0.939. (4) Conclusions: This research revealed a possible way of predicting depression occurrence in those women who received a positive Pap screening test and who are undergoing follow-up diagnostics, aiding medical doctors in the provision of successful and on-time psychological assistance. Full article

Cervical cancer (CC) remains a critical global health issue which disproportionately affects low- and middle-income countries. In Chile, the Arica and Parinacota region experiences high CC mortality and low Papanicolaou (Pap) test coverage, with indigenous Aymara women facing significant screening barriers. Understanding health beliefs surrounding CC prevention is essential for improving adherence, particularly in under-represented populations. This study assesses the psychometric properties of the CPC-28, an instrument measuring beliefs about CC and Pap testing, among Aymara women in Chile. A cross-sectional survey of 299 Aymara women (25–64) was conducted using stratified probabilistic sampling. Confirmatory factor analysis (CFA) confirmed the CPC-28’s six-factor latent structure, demonstrating strong model fit (CFI = 0.969, TLI = 0.965, RMSEA = 0.058). Reliability indices ranged from acceptable to excellent (α = 0.585–0.921; ω = 0.660–0.923). Moderate correlations emerged between severity, susceptibility, and perceived benefits of Pap testing, although CPC-28 results did not predict adherence. These findings support CPC-28’s validity evidence for Aymara women but highlight cultural influences on screening behaviors. Structural barriers, including language and healthcare inaccessibility, are likely to affect perceived susceptibility. Future research should explore indigenous perspectives and socio-cultural determinants of Pap testing, incorporating mixed-method approaches to identify culturally relevant interventions and improve screening adherence. Full article

Background/Objectives: Low-grade squamous intraepithelial lesions (LSILs) of the cervix are known to have the ability to regress spontaneously. However, in cases where the patient is human immunodeficiency virus (HIV)-positive and has a weakened immune system, the ability to eliminate abnormal cells from the cervix may be impaired. The aim of this study was to determine whether there is an association between the spontaneous regression of histological LSIL and the HIV status of the patient by evaluating baseline characteristics and CD4 count. Methods: Women with a diagnosis of cervical histological LSIL were included. We analyzed the correlation between a group of women with LSIL who experienced complete spontaneous regression and those who did not regress based on factors such as HIV status, basic characteristics, and baseline Pap smear. As part of the surveillance program, all the women underwent a Papanicolaou (Pap) smear test every 6 months. Results: A total of 127 women were evaluated. The results showed that a higher percentage of women with HIV belonged to the non-regression group compared to the complete regression group ((51.35% vs. 26.67%) p = 0.007). After controlling for other factors, the multivariable analysis revealed that HIV-negative women were more likely to experience spontaneous regression of cervical LSIL than women with HIV [HR = 2.54, 95% confidence interval 1.31–4.49, p = 0.006)]. Conclusions: Cervical histological LSIL had a lower capacity for spontaneous regression in women with HIV. For women who wish to lower their risk of persistent or worsening disease associated with their HIV status, it may be beneficial to undergo active surveillance coupled with additional active treatment or surgery. A CD4 count of over 500 cells per μL is associated with the spontaneous regression of LSIL in women with HIV. Full article

Background: In prenatal genetic diagnostics, the detection of single-gene defects relies on chorionic villus sampling (CVS) and amniocentesis, which carry a miscarriage risk of 0.2–0.3%. To mitigate this risk, fetal trophoblasts have been isolated from a Papanicolaou smear using Trophoblast Retrieval and Isolation from the Cervix (TRIC). However, this method is labor-intensive and has been shown to be challenging to implement in clinical practice. Here, we describe our experiences in using semi-automated immunomagnetic cell sorting for isolating trophoblasts from clinically obtained Papanicolaou smears during ongoing pregnancies. Methods: Using HLA-G-positive Jeg-3 and HLA-G-negative HeLa cell lines in 10%, 1%, and 0.1% dilutions, we tested and optimized the isolation of HLA-G-positive cells using FACS and semi-automated immunomagnetic cell sorting. We used the latter technique for isolation of HLA-G-positive cells from Papanicolaou smears collected from 26 pregnant women, gestational age between 6 and 20 weeks, who underwent CVS. Results: In four independent dilution series, the mean percentages of Jeg-3 cells went from 7.1% to 53.5%, 0.9% to 32.6%, and 0.4% to 2.6% (7.5, 36, and 6.5-fold enrichment, respectively) using immunomagnetic cell sorting. After sorting of the Papanicolaou smears, HLA-G-positive cells were moderately increased in the positive (14.61 vs. 11.63%) and decreased in the negative fraction (7.87 vs. 11.63%) compared to baseline pre-sorting. However, we could not identify fetal cells using XY-chromosomal FISH in a male sample. Conclusions: Our study supports previous findings that careful sampling of fetal cells from Papanicolaou smears in a clinical context poses significant challenges to cell retrieval. Full article

Background: Understanding why Arab American women have lower adherence to cervical cancer screening compared to other racial/ethnic groups is important. The study aimed to understand attitudes and knowledge of cervical cancer prevention and HPV vaccination among Arab American women. Methods: A mixed-method approach was employed, including nine focus groups and an online questionnaire. Demographic characteristics, medical history, screening practices, and attitudes towards HPV vaccination and HPV self-sampling for cervical cancer screening were assessed. Results: Focus group participants (n = 22) demonstrated varying levels of knowledge about cervical cancer and HPV, including limited awareness of the Papanicolaou (Pap) test. Participants expressed mixed feelings about HPV self-sampling. Among questionnaire respondents (n = 25), who on average had a higher socioeconomic status than focus group participants, 73.9% had undergone a Pap test, with 94% up to date on screening. While 59% preferred self-sampling at home, almost two in five cited concerns about sample accuracy. Conclusions: Our study demonstrates the variability in attitudes and experiences towards cervical cancer screening among Arab American women, potentially driven by socioeconomic disparities. Our qualitative results suggest the need for targeted, culturally tailored health education in the Arab American community. Further research should explore effective strategies to engage this underserved group and enhance adherence to prevention programs. Full article

Background: Although cervical cancer (CC) is highly preventable through appropriate screening methods like the Papanicolaou (Pap) test, which enables early detection of malignant and precancerous lesions, access to such screening has not been equitable across social groups. Sex workers and people with records of incarceration are among the most under-screened populations in Ontario. Little is known about the acceptability and feasibility of HPV self-sampling (HPV-SS) as an alternative cervical cancer screening method for these groups. This online, community-based mixed-methods pilot study aimed to address this knowledge gap. Methods: Eighty-four under- and never-screened sex workers and ex-prisoners aged 25–69 years and residing in the Greater Toronto Area, were recruited by community peer associates. Participants completed an online survey and viewed short videos about CC and screening with Pap and HPV-SS. Those who opted for HPV-SS conducted the test at one of two collaborating organizations. Results: The median age of participants was 36.5 years. Most had limited knowledge about CC and screening. Approximately 13% identified as non-binary, and 5% as two-spirit or trans men, with the majority having completed secondary education. Of the participants, 88% chose HPV-SS, and one-third tested positive for high-risk HPV types. The ability to self-sample without judgment from healthcare providers was noted as a key advantage. However, there was a need for training on proper HPV-SS techniques. Conclusions: To improve cervical cancer screening among sex workers, increasing awareness through participatory community co-creation of sexual health education is essential. Additionally, offering HPV-SS as a screening option is crucial, given its demonstrated acceptability and feasibility within this population, many of whom lack a primary care provider and face discriminatory attitudes in healthcare settings. Full article

The Papanicolaou (Pap) test is one of the most effective methods for cervical cancer screening. However, women with disabilities are less likely to be screened. The objective of this study is to determine whether there is a difference in Pap test utilisation between women with and without disabilities and to analyse the demographic, socioeconomic, and health-related characteristics associated with Pap test uptake among women with disabilities in Chile. Data from the 2022 National Socioeconomic Characterization Survey were analysed, and 71,989 women between 18 and 75 years of age were included. The dependent variable was Pap test utilisation, and the exposure variable was disability. We used logistic regressions to control for demographic, socioeconomic, and health-related covariates. The results showed that women with disabilities were less likely to undergo a Pap test compared to those without disabilities. Characteristics such as being married, being aged between 25 and 64 years, and having secondary or tertiary education increased the likelihood of Pap test utilisation. Conversely, being single, having received special education, and being inactive decreased these odds. Effective public health policies are needed that will increase Pap test utilisation for all population subgroups, including women with disabilities and, therefore, promote health equity. Full article

Background: The humoral immune response against human papillomavirus (HPV) has been suggested as a source of biomarkers for the early detection of cervical cancer (CC). Therefore, we aimed to characterize the antibody response against HPV16 E5 in the natural history of cervical cancer and to determine its usefulness as a biomarker of HPV-associated cervical lesions. Methods: This study was conducted at the Cuautla General Hospital, Morelos, Mexico, with women (18 to 64 years) who agreed to participate. Samples were obtained from 335 women with cervical lesions and 150 women with negative Papanicolaou tests. HPV genotyping was performed by PCR and pyrosequencing, and anti-E5 antibodies were detected by slot blot. Results: The overall anti-E5 antibodies prevalence in the study was 17.9%, with the higher prevalence observed in the no lesion (NL, 49.4%) group, and with a downward trend according to the degree of the cervical lesion, from cervical intraepithelial neoplasia-1 (CIN1, 32.2%) to CIN2 (11.5%) and CIN3/CC (6.9%). The logistic regression model showed negative associations of anti-E5 antibodies with CIN1 (OR = 0.38), CIN2 (OR = 0.42), and CIN3/CC (OR = 0.32) groups, being statistically significant. Contrast analysis showed an inverse relationship between anti-E5 antibodies with HPV DNA and the CIN1 (OR = 0.35), CIN2 (OR = 0.39), and CIN3/CC (OR = 0.31) groups. Conclusions: These results suggest that anti-E5 antibodies could be associated with clearance of infection in women without lesions and with CIN1 lesions since an inverse relationship was observed between the presence of HPV DNA and anti-E5 antibodies. In contrast, with progression from CIN2/CIN3 to CC, the relationship was reversed, as the anti-E5 antibodies disappeared, and the frequency of the viral genome increased. Full article

Background: Ovarian cancer (OC) remains one of the most lethal cancers among women due to most cases going undiagnosed until later stages. The early detection and treatment of this malignancy provides the best prognosis, but the lack of an accurate and sensitive screening tool combined with ambiguous symptoms hinders these diagnoses. In contrast, screening for cervical cancer via Papanicolaou (Pap) tests is a widespread practice that greatly reduces the cancer’s mortality rates. Interestingly, previous studies show evidence of OC cells in Pap tests, suggesting that proteins, and potentially lipids, shed from ovarian tumors end up in the cervix. The goal of this study is to evaluate the practicality of using Pap tests as biospecimens for OC-screening-related metabolomics. Methods: To evaluate the effectiveness of using residual Pap test samples as biospecimens for potential metabolomics work, 29 Pap test samples, collected from women over the age of 50 with normal cytology and no visible blood contamination, were first obtained from the University of Minnesota, with IRB approval. These samples were centrifuged to recover the cell pellets from the supernatants. The cell pellets underwent a biphasic extraction, followed by an RP-LC-MS analysis, while the supernatants underwent two separate extractions and analyses, including RP-LC-MS and HILIC-LC-MS. Non-targeted features were detected in the range of 220–1000 m/z to determine the sensitivity and scope of the various extraction and analytical workflows, as well as evaluating residual Pap test samples as viable metabolomics biospecimens. Results: The biphasic extraction and subsequent RP-LC-MS analysis of the isolated cell pellets from all 29 samples yielded informative, exploratory data, highlighting the potential of using residual Pap test samples as biospecimens for metabolomics, specifically lipidomics, studies. Each sample was analyzed in both the positive and negative ion mode, yielding the detection of 7318 in the positive ion mode and 3733 in the negative ion mode. Using multiple reference libraries, 22.85% and 36.19% of these features were annotated in the positive and negative ion mode, respectively. Among these detected features, 453 unique lipids, representative of 20 different lipid subclasses, were annotated in all 29 samples. Of the various lipid subclasses represented from the detected lipids, ceramides, triacylglycerols, hexosylceramides, and phosphatidylcholines contributed to over half (53.3%) of the detected lipids at 16.2%, 13.0%, 12.8%, and 11.3%, respectively. Conclusions: The detection of these 453 common lipids across all patients establishes a relative lipidome baseline for women over the age of 50 with normal cervical cytology. This exploratory study is the first investigation to utilize residual Pap test samples as biospecimens in a metabolomics/lipidomics workflow. Full article

Background/Objectives: This study aimed to evaluate psychosocial burden and its associated factors in women who were referred for additional diagnostic procedures following receipt of a positive cervical-cancer-screening smear result. Methods: A cross-sectional study was performed in a consecutive cohort of only women who received an abnormal Papanicolaou screening result and therefore presented to a gynecologist for additional diagnostic examinations (colposcopy/biopsy/endocervical curettage) at the Clinic for Gynecology and Obstetrics of the Clinical Center. Multivariate linear regression was used for data analysis, with Bonferroni correction applied for multiple comparisons. Results: Significant independent predictors for the occurrence of psychosocial burden–worry in women with a positive Papanicolaou screening test before diagnostic procedures were the use of oral contraceptives (β = −0.174, p < 0.001), alcohol consumption (β = 0.188, p < 0.001), anxiety (β = −0.189, p = 0.001), high burden of depressive symptoms (β = 0.191, p = 0.001) and insufficient knowledge of the meaning of the term dysplasia/precancerous (β = −0.187, p < 0.001), according to the multivariate linear regression. The significant independent predictor for the occurrence of psychosocial burden–satisfaction with information/support in women with a positive Papanicolaou screening test before diagnostic procedures was psychological distress (β = −0.210, p = 0.001). Conclusions: Providing information in order to improve understanding of the term dysplasia/precancerous, as well as identifying which women are at risk of psychosocial burden, may help protect against this potential harm among women who receive a positive cervical-cancer-screening result and may facilitate their intention to undergo further diagnostic procedures. Full article

(1) Background: Cervical screening and additional diagnostic procedures often lead to depression. This research aimed to develop a prediction model for depression in women who received an abnormal Papanicolaou screening test, prior to and following the diagnostic procedures. (2) Methods: The study included women who had a positive Papanicolaou screening test (N = 172) and attended the Clinical Center of Kragujevac in Serbia for additional diagnostic procedures (colposcopy/biopsy/endocervical curettage). Women filled out a sociodemographic survey and the Center for Epidemiologic Studies Depression questionnaire (CES-D scale) before and after diagnostic procedures. A prediction model was built with multilayer perceptron neural networks. (3) Results: A correlation-based filter method of feature selection indicated four variables that correlated with depression both prior to and following the diagnostic procedures—anxiety, depression, worry, and concern about health consequences. In addition, the use of sedatives and a history of both induced and spontaneous abortion correlated with pre-diagnostic depression. Important attributes for predicting post-diagnostic depression were scores for the domains ‘Tension/discomfort’ and ‘Embarrassment’ and depression in personal medical history. The accuracy of the pre-diagnostic procedures model was 70.6%, and the area under the receiver operating characteristic curve (AUROC) was 0.668. The model for post-diagnostic depression prediction showed an accuracy of 70.6%, and an AUROC = 0.836. (4) Conclusions: This study helps provide means to predict the occurrence of depression in women with an abnormal Papanicolaou screening result prior to and following diagnostic procedures, which can aid healthcare professionals in successfully providing timely psychological support to those women who are referred to further diagnostics. Full article

Cervical cancer ranks among the leading causes of mortality in women worldwide, underscoring the critical need for early detection to ensure patient survival. While the Pap smear test is widely used, its effectiveness is hampered by the inherent subjectivity of cytological analysis, impacting its sensitivity and specificity. This study introduces an innovative methodology for detecting and tracking precursor cervical cancer cells using SIFT descriptors in video sequences captured with mobile devices. More than one hundred digital images were analyzed from Papanicolaou smears provided by the State Public Health Laboratory of Michoacán, Mexico, along with over 1800 unique examples of cervical cancer precursor cells. SIFT descriptors enabled real-time correspondence of precursor cells, yielding results demonstrating 98.34% accuracy, 98.3% precision, 98.2% recovery rate, and an F-measure of 98.05%. These methods were meticulously optimized for real-time analysis, showcasing significant potential to enhance the accuracy and efficiency of the Pap smear test in early cervical cancer detection. Full article

We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol. Full article

Human papilloma virus (HPV) infection and its progression still represent a great medical challenge worldwide. Clinical evidence has demonstrated the beneficial effects of polyhexamethylene biguanide (PHMB) on HPV clinical manifestations; however, evidence of the effect of this molecule on HPV viral load is still lacking. In this in vitro study, 13 ThinPrep Papanicolaou (Pap) tests were treated with a PHMB solution (0.10 g/100 mL) for 2 h. We observed no cytological changes but a significant reduction in the viral load of high-risk (HR) HPV after PHMB treatment, also revealing a dose-dependent antiviral effect. In addition, by stratifying the obtained results according to HR-HPV genotype, we observed a significant reduction in the viral load of HPV 16, P2 (56, 59, 66), 31, and P3 (35, 39, 68) and a strong decrease in the viral load of HPV 45, 52, and P1 (33, 58). Overall, 85% of the analyzed cervical cell samples exhibited an improvement in HPV viral load after PHMB exposure, while only 15% remain unchanged. For the first time, the data from this pilot study support the activity of PHMB on a specific phase of the HPV viral lifecycle, the one regarding the newly generated virions, reducing viral load and thus blocking the infection of other cervical cells. Full article

In 2020, the World Health Organization (WHO) reported 604,000 new diagnoses of cervical cancer (CC) worldwide, and over 300,000 CC-related fatalities. The vast majority of CC cases are caused by persistent human papillomavirus (HPV) infections. HPV-related CC incidence and mortality rates have declined worldwide because of increased HPV vaccination and CC screening with the Papanicolaou test (PAP test). Despite these significant improvements, developing countries face difficulty implementing these programs, while developed nations are challenged with identifying HPV-independent cases. Molecular and proteomic information obtained from blood or tumor samples have a strong potential to provide information on malignancy progression and response to therapy in CC. There is a large amount of published biomarker data related to CC available but the extensive validation required by the FDA approval for clinical use is lacking. The ability of researchers to use the big data obtained from clinical studies and to draw meaningful relationships from these data are two obstacles that must be overcome for implementation into clinical practice. We report on identified multimarker panels of serum proteomic studies in CC for the past 5 years, the potential for modern computational biology efforts, and the utilization of nationwide biobanks to bridge the gap between multivariate protein signature development and the prediction of clinically relevant CC patient outcomes. Full article