#Cervical Smear Test

[ijcimr]

Prevalence of cervical epithelial cell dysfunction in Papanicolaou smears reports in low-risk population referred to Imam Reza hospital by Dr. Nahid Arian pour in International Journal of Clinical Images and Medical Reviews

Abstract

Background: Epithelial cell abnormality is the outcome of a viral infection. Human papilloma virus (HPV) is the main causative agent of cervical dysplasia. Cervical dysplasia caused as a consequence of infection by this sexually transmitted virus is characterized by abnormal cells on the cervix.

Various laboratory tests with varying specificity and sensitivity, have been set for diagnosis. The present study has been carried out in order to determine the prevalence rate of cervical epithelial cell dysfunction in Papanicolaou (Pap) smear reports in low risk population referred to Imam Reza hospital- Tehran- Iran from January 2019 till August 2020.

Methods: 676 women of low risk group referring to obstetrics and gynecology clinic - Imam Reza hospital- Tehran –Iran since January 2019 till August 2020 were the study cases. Information regarding presence of atrophy while examination, erosion, cervicitis, infection, Polyp, abnormal vascularity, candidiasis was collected from patients and were recorded in a check list. Patient's sample (pap smear) was collected for pathological examination. Data were analyzed by SPSS software.

Results: Pap smear examination revealed 662 out of 676 (97.5%) cases had no abnormality in cervical epithelial cells. In 12 cases abnormality was of ASCUS type (%1.77).

Conclusion: Results of Pap smear test revealed low frequency of cervical epithelial cell abnormality among low risk group. Out of the influencing factors, cervicitis, followed by erosion, abnormal vascularity and infection seem to be more common.

Key Words- Pap smear, Low risk group, Bethesda system, ASCUS, LSIL, HSIL, Cervical Dysplasia, Cervical Smear Test.

Introduction

Cervical cancer is one of the most preventable malignancies among human cancers. Infection of the uterine cervix with human papillomavirus (HPV) is the main causative agent of cervical cancer [1]. About 15 high-risk types of human papilloma virus have been identified, which are responsible for cervical neoplasia and other related cancers [2]. Cervical cancer with worldwide distribution, though a preventable disease, is one of the leading causes of cancer death in women [1]. High risk HPV types lead to higher risk of developing cervical cancer compared to low risk types or are not being infected with HPV, at all [1]. The main characteristics of cervical dysplasia following infection with human papilloma virus (HPV) is abnormal cells on the cervix. The main screening strategy to reduce cervical cancer incidence is to detect precancerous lesions that can be treated before evolving to cancer [3]. Detection of cervical pre-cancer lesions can be achieved on the basis of cytology, implemented decades ago, or by HPV screening for women aged 30 years or older [1]. In most industrial countries cytology-based prevention programs, led to a significant reduction in the incidence and mortality from cervical cancer [1]. In other words, screening reduced the incidence of cervical cancer by at least 60%, and cancer specific mortality by 20–60% [4]. Papanicolaou (Pap) test, both conventional and liquid type, is routinely used to detect cervical epithelial cell abnormality [5]. In spite of its merits as a diagnostic and screening test, Pap test is not 100% accurate [3]. The present study has been carried out in order to determine the prevalence rate of cervical epithelial cell dysfunction in Papanicolaou (Pap) smear reports in low risk population referred to Imam Reza hospital- Tehran- Iran from January 2019 till August 2020.

Materials and Methods

Patient selection: 676 patients referring to obstetrics and gynecology clinic of Imam Reza hospital, Tehran – Iran from January 2019 till August 2020 were the study cases. The patients were included in the study on the basis of the inclusion criteria.

Inclusion criteria: Absence of risk factors for cervical cancer including having single partnership, pap smear test performed by a particular pathology laboratory, low risk cases.

Exclusion criteria : Multiple sex partners of herself or husband, pap smear test performed by other pathology laboratories, immune-suppressed patients, patients diagnosed suffering genital wart, presence of previous epithelial cell abnormality in PAP tests performed earlier, use of vaginal lubricant, gel or any cream or having intercourse 48 hours prior to sample collection, previous positive HPV test.

Study cases: Patients' age ranged from 20 up to 79 years. All the cases were married with different number of children born by Normal Vaginal Delivery (NVD) or cesarean section or both.

Methodology: Patients were examined for the presence of infection and any macroscopic abnormality. A pap smear was collected from every patient. An expert performed the PAP test sampling and fixation throughout the study to minimize the errors. Patients were asked to get the pathological examination of the smear done from a specific laboratory.

A questionnaire containing questions regarding the age, marriage age, number of sex partners, number of deliveries and abortions, kind of contraceptives used, … was filled by every patient. Result of pap smear and cervix outlook are the parameters considered in this study. A consent form was signed by each patient. Patients̛ grouping and complications are presented in Table 1. SPSS software was used for statistical analysis of the data.

Table 1: Common complications of different age groups.

Results

Study cases: Patients' age ranged from 20 up to 79 years with mean and median of 40±13.62 and 40.69±13.62 years respectively. Kolmogorov-Smirnov [6] and Shapiro-Wilk [7] tests indicate a normal distribution of the data (p>0.05). All the patients were married. Mean and median of their marriage age were 20±3.987 and 19.97±3.987 years respectively. Their minimum and maximum marriage age were 12 and 43 years respectively. Kolmogorov-Smirnov and Shapiro-Wilk tests indicate a normal distribution of the data of this variable (p>0.05). 97.5% of patients had one sex partner while 2.4% cases had married for the second time (considered as 2 partners). One case did not answer this question. 46.4% of patients had normal cervix. According to the information obtained from the questionnaire, 163 cases had given birth to child by both vaginal (41.5%) as well as cesarean section (58.5%) and 37 cases (18.5%) had no history of delivery. Maximum and minimum normal vaginal delivery were 8 and 0 respectively. 77 cases had delivery one year after first intercourse, while 2, 56,17, 7, 3 and 1 cases delivered their first child one and half, 2, 3, 4, 5 and 6 years after the first intercourse, respectively. Total number of abortions reported was 170 out of 676 cases. Microscopic examination of pap smears revealed 662 out of 676 (97.5%) cases had no abnormality in cervical epithelial cells (Table 2). Microscopic findings of patients‘ sample are also illustrated in Table 2 revealing that 14 (%2.07) patients showed epithelial cell abnormality in their pap smears:  In 12 cases abnormality was of ASCUS type (%1.77). No patients had HSIL, 2 patients had LSIL, one in each age groups of 30-39 and 40-49 years. 16.1% of cases suffered cervical atrophy, 2 cases had vaginosis and 2 patients were infected with Candida. The commonest complication in this group was cervicitis which was observed in 6 cases, erosion was observed in 4 cases and infection due to Candidiasis in 2 cases, atrophy was observed by direct observation in 1 case. Out of these 14 cases, 3 had normal vaginal examination. The mean of ASCUS cases was 4.44 that was found in age group of 60-69 years. The marriage age was the only influencing variable on mild form (p<0.05) with about 9% increase in it.

Table 2: Cases with Normal epithelium

Different types of contraceptives used by patients are presented in Figure I. test was used to find out if the type of contraceptive used and inflammation caused while collecting sample for Pap smear are co-related. The statistical analysis using Phi test with Phi correlation coefficient of 0.175 and Cramer correlation coefficient of 0.087 indicates a non- significant relationship.

χ2 test was used to find out if the type of delivery and inflammation caused while collecting sample for Pap smear are co-related. The value of 5.36 indicates that there is non- significant relationship.

To find out if the number of deliveries and inflammation caused while collecting sample for Pap smear are co-related, χ2 test was used. Pearson Chi-Square test with 44 degrees of freedom is equal to 67.53 which is significant at 5% level. Their co-relation on the basis of Phi test with Phi correlation coefficient of 0.350 and Cramer correlation coefficient of 0.175 indicates a significant correlation.

To find out if the number of abortions and inflammation caused while collecting sample for Pap smear are co-related we used χ2 test. Pearson Chi-Square test shows a non- significant relationship. Their co-relation on the basis of Phi test with Phi correlation coefficient of 0.162 and Cramer correlation coefficient of 0.081 is non-significant.

To find out the relationship between patients' age and inflammation due to sample collection for PAP test using  relation coefficient, shows a weak significant relationship.

To find out the strongest relationship for a particular variable, scatter diagram – 1 is drawn. According to the scatter diagram - 1, age is the only determinant factor for ASCUS (p<0.05) and no other factor is so effective.  Also, by a single year increase in the age, the rate of ASCUS increases up to 8%; which is equal to 1.083 times its probability. Thereby, chance of infection increases by 8 percent for single unit increase in the age. 19.1% of all patients had mild inflammation, 23.8% had moderate and 7.2% suffered severe form of inflammation. Scatter diagram – 2 is drawn to study the correlations between the studied variables and to determine which variables are related. Logistic regression outcome reveals none of the studied variables has any effect on LSIL as the significance value of all the studied variables is more than 0.05. 50.1 percent had normal pap smear.

Figure 1: Type of contraceptive used by patients IUD= Intra Uterine Device OCP= Oral contraceptive pills, WD=withdrawal COND= condom TL= Tubal ligation VAS=Vasectomy

Scattered Diagram 1- Relationship between age and type of��epithelial abnormality

Scattered Diagram 2

Discussion

Cervical cancer with an estimated 604,000 new cases and 342,000 deaths is the fourth cause of cancer death worldwide in 2020 [8]. Globally,528 000 new cases of this cancer were diagnosed in 2012; of these, about 85%, occurred in less developed parts of the world and 266000 women died of it throughout the world. In another word, 231000 women who lived in low- to middle income countries died of this type of cancer. While, only 35 000, or just 1 in 10 women suffering from cervical cancer lived and died in high-income countries [3]. Cervical cancer is one of the preventable cancers involving primary (HPV vaccine) and secondary (screening) preventive measures. More than 30% of women of low middle income countries (LMICs) had received HPV vaccination programs compared with less than 80% of high-income countries [8]. In Iran, this viral infection and its resultant disease has also been reported and nation-wide screening program has been performed since 1980s. In the present study, out of 676 study cases, 97.8% had normal epithelial cell and 46.45 percent cases had normal cervix examination. Only 2.2% of our patients suffered from signs related to epithelial cell abnormality.

According to Majidi et al. (2016) incidence of cervical cancer is low in Iran [9]. Crosbie et al. (2013) estimated average prevalence rate of cervical infection with HPV at a given point, and at any time is about 10·4%, with higher prevalence rate (16·9%) in women younger than 25 years. [2]. In contrast to Crosbie et al s findings, our findings indicate a lower incidence rate as our patients are chosen from low-risk population i.e. almost all are of ASCUS type. In Iran, like many other countries, routine screening for cervical cancer is based on the microscopic examination of smears collected from the cervical mucosa, performed by conventional Pap smear test. Screening by cervical cytology in United States in the mid20th century reduced mortality from squamous cell cervical cancer [10]. More so, it led to increased number of women being identified with HPV-negative, ASCUS-cytology results [11], as is the case in the present study. Whilst cervical cancer, once the most frequent cause of cancer death in women, now ranks 14th for cancer deaths [11]. High-quality screening with cytology (Pap testing) has markedly reduced mortality from squamous cell cervical cancer, which comprises 80–90% of cervical cancers [9-11].

Screening interval that varies between countries, is an important issue. Cervical screening is performed every 3 years in the United States, New Zealand, and Norway, while its interval is 5 years in Denmark, Finland, and the Netherlands [12]. In Iran, annual cervical cancer screening program was performed for age range of 20 to 65 years. Since 2017, it changed to 3 year intervals for women at the age of 30 to 59, following three consecutive normal results. Sawaya and Smith-McCune (2007) suggested that molecular DNA test performed for HPV diagnosis every 10 years for women at the age of 35 years and more is preferred as DNA HPV test is a novel and effective screening method [13]. There is no doubt that such screening programs reduce the incidence and mortality rate of cervical cancer, globally [13].

Starting age of screening also varies in different countries. Screening starts at the age of 25 in United Kingdom, France, Italy and Portugal and at the age of 21 in the United States and Canada [12]. Cervical cancer screening in countries like Finland, Korea, the Netherlands and China begins at the age of 30 to 35 years [12]; while according to National Health service, cervical screening program is to be done every three years for women between the age of 25 - 49 years and every five years for women past 50 [14]. In spite of previous recommendation of annual or biannual cervical screening, as it seems that annual screening is of little benefit and leads to increased cost (15), some guidelines in Great Britain, recommended every three years for women under 50, and every five years for those who have passed fifty [14]. In the present study, patients' age ranged from 20 to 79 years. Based on the fact that the incidence of cervical cancer in Iran is low compared to other geographical areas, we recommend three-year interval for healthy women with no history of cytological screening.

CONCLUSIONS

Worldwide, cervical cancer is a common and deadly cancer among women. Screening programs and effective treatment of precancerous lesions are available to treat the patients. In most cases, slow progression of precancerous lesions, are accompanied by abnormal cells which are detected in Pap test. The cervical screening program using the Pap smear procedure has an influencing role in reducing the incidence and mortality rate of invasive cervical cancer in many countries, including Iran. The incidence of cervical cancer is low in Iran although its mortality is remarkable. In Iran, cervical cancer screening program was performed annually in the age range of 20 to 65 previously. Since 2017 screening is performed for women at the age of 30 to 59 at 3 year intervals after three consecutive normal results.

Conflict of interest

Authors declare no conflict of interest.

 Acknowledgments

Authors thank all patients who cooperated with us in publishing the data.

For more details: https://ijcimr.org/editorial-board/

[emmashouldbewriting]

Celebrating the second best outcome possible of my colposcopy with a strawberry éclair.

I have mild cell changes (first grade) in some awkward spots. If the biopsies show what she thinks, it's a discharge to yearly smears to monitor. For the first time in weeks, I can breathe a little.

So I will eat my cake, drink my wine, and work from the sofa for the next few days to be kind to myself. Shout out to my period for waiting until the actual procedure to show up 🫣😂

I also got a new reader in one of the nurses and you'd be surprised how often that happens 🤷‍♀️😂

Oh. AND GO GET YOUR SMEAR TEST.

[tv-taughtmehowtofeel]

“The smear test may be uncomfortable, but should not hurt.”

*literally experiences the worst pain I’ve ever experienced in my life, leaves appointment crying*

[drshwetamendirattagynae]

Cervical cancer prevention relies heavily on Pap smears and HPV screening. Despite their importance, misconceptions abound, causing unnecessary fear and confusion. This article aims to debunk common myths about Pap smears and HPV screening, promoting informed decision-making and encouraging women to take charge of their reproductive health.

[ganitsoni]

Understanding Breast Cancer Treatment: Exploring Surgeries and Therapies

Breast cancer is a serious illness that requires careful treatment. There are different ways to treat breast cancer, including surgeries and therapies. In this article, we'll look at the types of surgeries and therapies used to treat breast cancer. We'll explain what they are, how they work, and why they're important.

Types of Surgeries:

Lumpectomy: A lumpectomy is a surgery where doctors remove the tumor and a small amount of surrounding healthy tissue from the breast. It's often used for early-stage breast cancer to help keep as much of the breast as possible.

Mastectomy: Mastectomy is when doctors remove the whole breast to treat breast cancer. There are different types of mastectomy, depending on how much tissue is removed.

Sentinel Lymph Node Biopsy: This surgery helps doctors see if the cancer has spread to nearby lymph nodes. Doctors find and remove a few lymph nodes to check for cancer cells.

Types of Therapies:

Radiation Therapy: Radiation therapy uses special beams to kill cancer cells and shrink tumors. It's often used after surgery to make sure any leftover cancer cells are gone.

Chemotherapy: Chemotherapy is when patients take special drugs to kill cancer cells or stop them from growing. It's used before or after surgery to help get rid of cancer cells and prevent them from coming back.

Hormone Therapy: Hormone therapy blocks hormones that can make breast cancer grow. It's used for hormone-sensitive breast cancer to stop cancer cells from growing.

Targeted Therapy: Targeted therapy attacks specific parts of cancer cells to stop them from growing. It's a newer type of treatment that can be very effective for certain types of breast cancer. Combination Therapies:

Neoadjuvant Therapy: This therapy is given before surgery to shrink tumors and make them easier to remove. It helps make surgery more successful.

Adjuvant Therapy: Adjuvant therapy is given after surgery to help lower the risk of cancer coming back. It can include radiation therapy, chemotherapy, hormone therapy, or targeted therapy.

Conclusion: Breast cancer treatment is complex, but there are many ways to fight it. Surgeries and therapies play a big role in helping people beat breast cancer. By understanding the different types of surgeries and therapies available, patients and their doctors can work together to come up with the best treatment plan for each person. With the right treatment, many people with breast cancer can go on to live long, healthy lives.

[ganitsoni9951]

Understanding Cervical Cancer Treatment in Hyderabad

Cervical cancer is a significant health issue for women in Hyderabad, India. However, with advancements in medical science, there are more treatment options available. Dr. Chinnababu, a renowned oncologist, is leading the way in providing effective treatments for cervical cancer patients in Hyderabad.

What is Cervical Cancer?

Cervical cancer starts in the cells of the cervix, the lower part of the uterus. It is usually caused by the human papillomavirus (HPV), but other factors like smoking and weakened immune systems can also contribute. Early detection is crucial for successful treatment.

Diagnosis

In Hyderabad, doctors use various tests to diagnose cervical cancer. These include Pap smears, HPV testing, colposcopy, and biopsy. These tests help doctors determine the stage and severity of the cancer, which guides treatment decisions.

Treatment Options

Treatment for cervical cancer depends on the stage of the disease and the patient's overall health. In Hyderabad, patients have access to several treatment options:

Surgery: Surgery may be recommended for early-stage cervical cancer. It can involve removing the cancerous tissue or the entire uterus. Dr. Chinnababu specializes in minimally invasive surgeries, which have shorter recovery times and fewer complications.

Radiation Therapy: Radiation therapy uses high-energy rays to kill cancer cells. It can be delivered externally or internally through brachytherapy. Hyderabad has advanced radiation therapy equipment to deliver precise treatment.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It can be given alone or in combination with other treatments. Dr. Chinnababu designs personalized chemotherapy plans for each patient.

Targeted Therapy: Targeted therapy targets specific molecules involved in cancer growth. It can be used for advanced or recurrent cervical cancer. Immunotherapy is a type of targeted therapy that boosts the body's immune system to fight cancer cells.

Conclusion

Cervical cancer treatment in Hyderabad offers hope for patients. Dr. Chinnababu and his team are dedicated to providing the best care possible. If you or someone you know is diagnosed with cervical cancer, don't hesitate to seek medical advice and explore treatment options available in Hyderabad. Early detection and personalized treatment plans can improve outcomes and quality of life for cervical cancer patients.

[harmandip]

4 Essential Health Tests Every Woman Should Prioritize

Mammogram for Breast Health: Breast cancer is a significant health concern for women worldwide. Regular mammograms, typically recommended annually for women over 40, are vital for early detection. Early diagnosis significantly improves the chances of successful treatment. Women with a family history of breast cancer may need to start screenings earlier, and open communication with healthcare…

[reasonsforhope]

Article

"Every year, over 350,000 women die from cervical cancer and another 660,000 are diagnosed. [Note: Plus trans men and other trans people with a cervix.] As a consequence, children are orphaned, families impoverished and communities diminished by the loss of mothers, wives, daughters and sisters. 

And yet, unlike most other cancers, almost all these cases and deaths can be averted. We have powerful vaccines that can prevent infection with the human papillomavirus (HPV) that causes cervical cancer; we have diagnostics to detect it early; and we have treatments for those it strikes. With these tools, cervical cancer can not only be stopped; it could become the first cancer to be eliminated. Some high-income countries are already close to elimination, meaning fewer than four cases per 100,000 women.

But in many low- and middle-income countries, these tools are still not available, which is why 94% of cervical cancer deaths occur in those countries. 

In 2018, WHO launched a global call to action to eliminate cervical cancer, which was followed in 2020 by the adoption by all 194 WHO Member States of a Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. The strategy calls for countries to achieve three targets by 2030: 90% of girls fully immunised against HPV; 70% of women receiving timely screening; and 90% of those found with precancer or cancer accessing treatment.

These targets are not just aspirational, they are achievable, even in low- and middle-income countries.  Bhutan has already reached the targets, the first to do so in the South-East Asia region. 

Since introducing the HPV vaccine in 2011, Rwanda has reached vaccine coverage of 90%, and today announced its national goal to reach the 90-70-90 targets three years ahead of schedule, by 2027. Already, in two districts – Gicumbi and Karongi – Rwanda is meeting those goals. Nigeria, which introduced the HPV vaccine in October last year [2023], has already vaccinated 12.3 million girls.  

We have the tools and the opportunity to eliminate cervical cancer. 

Since WHO issued the global call to action in 2018, more than 60 countries have introduced the HPV vaccine into their immunisation programmes, bringing the total to 144 countries that are routinely protecting girls from cervical cancer in later life. With scientific advances, we can now prevent cervical cancer with just a single dose, which 60 countries are now doing.  

The largest provider of HPV vaccines to low- and middle-income countries is Gavi, the Vaccine Alliance, which plans to vaccinate 120 million children between now and 2030. But this plan requires that investments in health are sustained. We are also counting on manufacturers to confirm and honour their commitments to provide HPV vaccines to low- and middle-income countries in the coming years, to avoid the supply constraints that held back progress in the past.

But we cannot rely on vaccines alone. The impact of the rapid scale-up in vaccinating girls now will not be seen for decades, when they reach the adult years when cervical cancer typically appears. To save lives now, we must match the increase  in vaccination with increases in screening and treatment. 

Decades ago, as more women gained access to pap smears in developed countries, the mortality associated with cervical cancer dropped rapidly. Today, even better tests are available. Over 60 countries now include high-performance HPV tests as part of their screening programs. Women can even collect their own samples for HPV testing, removing more barriers to life-saving services. In Australia – which is on track to become one of the first countries in the world to achieve elimination – more than a quarter of all screening tests are now done this way...

Several countries are also investigating the use of artificial intelligence to enhance the accuracy of screening in resource-limited settings. When women are found with precancerous lesions, many are now treated with portable battery-powered devices, which can be operated in remote locations."

-via The Telegraph, November 18, 2024. Article written by Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO).

[kleefkruid]

Hey, so, medical update:

So as I told two weeks ago I had surgery where they cut part of my crevix because the cells where one stage away from turning cancerous (CIN3)

Today I received the results from the lab, where they analyzed the tissue in detail. and the first thing the doctor said was “so we got there in time!”

Turns out I had an adenocarcinoma in situ, which are non-invasive cancerous cells, which haven’t had the chance to break out of their protective membrane aka they couldn’t do real damage and all the things cancer does.

She showed me this image and pointed to the black line between CIN3 and cancer and said “we were here, right before the break out”

My specific situation was a 1 in a 100.000 apparently, which, eh, crazy

Very odd to hear you have cancerous cells after they got fully removed. Can’t compare my situation to someone who had to get full chemo, but it’s sure not a normal situation either so I’ll have to unpack this later.

But yeah as it stands now I have to get a pap smear every 6 months to make sure the HPV doesn’t try to start the party all over again.

Which brings me to repeat once again: if you’re eligible for getting a pap smear test please have them done bc cervical cancer doesn’t show symptoms until the very late stage, this is your only way to know!

[emmashouldbewriting]

It's Cervical Screening Awareness Week, which seems very fitting for me, so here's your reminder to book your smear test.

A few minutes of discomfort is better than the alternative.

[batmanisagatewaydrug]

Hello, hello! I have a few HPV questions that are kind of convoluted and I've never been given a straight answer, I'm hoping you can help (or at least point me in the right direction).

Is there a definitive pos/neg test for HPV, such as a blood test?

Can someone with one strain of HPV pass it to someone where it then becomes a different strain? For example, my ex had genital warts, which I did not get, but then I went on to have an abnormal pap, and as far as I'm aware it is two different strains of HPV that cause GW and cervical cancer.

If that can't happen, is it possible for someone to pass more than one strain to you where you're only symptomatic for one of them?

And lastly, since I never had GW, had my abnormal cells removed, and haven't been sexually active with anyone since my ex (close to 10 years ago), is it possible that I could have a GW outbreak now? I'm sort of worried about it but I also think it's probably fordyce spots.

Thank you!

hi anon,

thanks for the HPV questions!

for people with a cervix, an HPV test can be performed using cells gathered from the cervix. for people with a penis and prostate there isn't strictly a designated test to detect HPV, but visual inspections can be performed to find abnormalities, and people who have had anal sex can sometimes be tested with an anal Pap smear.

strains of HPV don't turn into different strains. there are nearly 200 stains of HPV, nearly all of which are harmless, but there are 2 that can (but don't always) cause genital warts and 13 that can (but don't always) cause cancers of the cervix, anus, vagina, vulva, penis, and throat. the genital warts strain and the cervical cancer strains do not overlap.

yes, you can have multiple concurrent HPV infections of different strains. not all will be symptomatic; it's possible that none of them will be. most people with HPV will be asymptomatic for the duration of their infection.

after ten years, it's unlikely that you still have HPV. most infections are resolved within about two years, and it sounds as if you haven't had an opportunity to pick up an infection from anyone else.

[soath]

Apropos of absolutely nothing at all, oral and throat cancers from HPV don’t only occur in guys; anyone who engages in oral sex should be on the lookout for them! Symptoms include sudden loss of taste, swelling, numbness, a persistent sore throat, and pain. HPV can also cause cancers of the phallus, vulva, and anus. Because it’s a viral related cancer it can be especially dangerous for those with immune conditions, including HIV or some autoimmune diseases treated with immunosuppressants.

However the HPV vaccine is effective at preventing all of these cancers. In countries with high uptake many forms of cervical cancers have vanished among young people. The vaccine is most effective for younger children between 10-13 so if you have kids, siblings, nieces or nephews, push for them to get it! It’s also now recommended for adults up to middle aged. Even if you’ve already contracted one HPV strain, the vaccine may still be helpful. Although there’s increasing evidence of efficacy at just one dose, it’s most effective if you get all three in the series so don’t wait.

And if you’re eligible for Pap smears, get them. They might not be comfortable but they are one of the most effective medical tests invented in the twentieth century.

[redbeardace]

For people who get pap smears/cervical cancer screening, this sounds like a game changer. Weren't they also looking at a blood test alone at one point?

Of course, a bigger game changer for a lot of people here would be if they just came out and said "You've never had sex? Maybe there's no reason to do this. Especially if you've also gotten the HPV vaccine."

[lightofraye]

In Memoriam

Before I proceed, I want to put warnings--content/trigger warnings. In this post, there will be references to cancer (also, fuck cancer), death, biological processes, grief/loss.

When we think of cancer, when we speak of it, I've noticed often times the phrase "evil", "monster", or some other dark term is used. Because it seems to be such a merciless, cruel thing to happen to people. It seems to strike without reason, taking the best and worst of us, young or old....

Today marks 18 years since my mother passed away from cervical cancer. She didn't have to die, not really. In a way, she chose to.

You see, my mother had an intense mistrust of "mainstream" medicine. I'm not sure where it came from, honestly. It was... it was a slow conversion. She kept turning to alternative means to treat problems, mainly our day-to-day diet (lord, we went vegan, Atkins-like before Atkins was widely known anyway), and various other kinds to "cure" our ailments, never accepting that some things can't be fixed by diet alone!). Then she kind of went off the deep end....

When she learned she had serious fibroids, she decided to try different "healing" creams to balance out her hormones, convinced it'd "dissolve" the fibroids. When she began to have heavy, intense bleeding, she chalked it up to the fibroids and not other issues.

Such as an abnormal pap smear test result... that she never followed up on.

It'd continue for years.

She even turned to an alternative doctor who told her yes, he saw the fibroids... but he also saw some seriously bad stuff. This doctor told my mother to go see her ob-gyn and get this checked out.

She wouldn't... up until she collapsed from the heavy bleeding in a grocery store bathroom stall. She finally turned to mainstream medicine, got it checked, got the biopsy....

It was Stage 2 cervical cancer.

She was referred to an oncologist. He, of course, brought up chemo and radiation. She refused, wanting to try alternative treatments first. He accused her of having a death wish (I was there, I wish I was joking!). He basically burned that bridge with that approach.

I can't help but think that... if he had said "Okay, I'll work with you. How about we monitor the cancer as you try it for a couple of months? If there's no improvement, will you try chemo and radiation then?"

Maybe she would've accepted it. I don't know.

So she turned to "mistletoe extract" injections. For a little bit, it looked like it was working. She was doing better.

Then... she developed increasing pain in her right leg. The doctor who originally told her to go see her ob-gyn stressed to her it was likely her cancer growing and getting worse. She didn't listen.

Then... she had increasing pain. Increasing issues. She got thinner... paler. She was so stubborn. There's numerous trips to the ER where they just prescribed her pain killers and sent her on her way. It took a referral to a specialist (I can't remember what they handled, maybe a different oncologist?)... and the blunt message.

"You're terminal."

I wept. My mother... she was just resigned. She transferred to home hospice care. She didn't want to die in a strange building. So my elder brother and I--we were living with her at the time--took turns caring for her.

She stopped eating. Stopped drinking. She's put on IV fluids and a kind of controlled dilaudid treatment. One night... it's as if she's aware. Her mind was going. She said her final goodbyes.

Then it's just her shell, her body, for two and a half weeks, that lingers, stubbornly. I'm the only one who was there who witnessed her last passage, the "death throes".

February 8, 2007. Just a few weeks shy of my 27th birthday.

She never got to see me graduate from college. She never got to see me married.... or divorced. She never saw me become a mother. She never saw me become a survivor, a fighter. So many things.

I have her eyes, I'm told. A deep brown with a starburst iris. My son has those eyes too. I resemble her greatly, I'm told. I don't have her curly hair... or her thinner nose.

Instead, she gave me her creativity, her love of art and writing. She loved books and reading. She loved cats as well, which I definitely inherited.

She had a lot of regrets... and sorrows.

I don't know if there is an afterlife. My relationship with God (or the Divine or whatever you want to call it) is complicated, to say the least. If there is, I hope I see her... and have the conversations we never had but should've while she was alive.

I miss you, mom. So very much.

[allthebrazilianpolitics]

DNA-based test for HPV has promising results

HPV screening in Brazil is set to undergo a major game-changer—the traditional routine cytology test, popularly known as the pap smear, will be gradually replaced by a DNA test.

The incorporation of the technology into Brazil’s public health care network, the SUS, was announced by the Ministry of Health following a study carried out by the State University of Campinas (Unicamp) in the municipality of Indaiatuba, São Paulo. However, it still requires the National Cancer Institute (INCA) to define guidelines and the target population, as well as how the tests will be carried out.

The first five-year round of the study shows promising results from the cervical cancer screening program run in the municipality from October 2017 to September 2022 using the HPV DNA test.

The figures indicate an increase in the detection of precancerous lesions by up to four times, with 83 percent of cancer cases detected at an early stage.

Continue reading.

[discopolice]

A Primer on Cancer Screenings For Trans People

rebloggable on its own now, hooray. I'm a healthcare quality guy, a preventive care navigator, and I've worked with trans health for almost a decade at this point. I anticipate this info will be harder to get shortly, so go forth, own it, spread it to your elders, etc

for transmascs and trans men:

- if you have not had top surgery or have only had a reduction, you should get mammograms as recommended for cis women. if you are at average risk, this is every 2 years starting at age 40.

- if you have not had top surgery / only reduction and you are at HIGH risk of breast cancer (for example, you have a BRCA mutation, received significant radiation to the chest, or a strong family history of breast cancer), ask your doctor. they will likely want you to start earlier, go more often, and/or get a breast MRI in addition to your mammogram. if you are interested in top surgery, please also talk to your surgeon! if you're at sufficiently high risk, especially if you have a BRCA mutation, it might change the way they do the surgery or the way your results look.

- if you have had top surgery that is NOT a risk-reducing mastectomy, your risk of breast cancer is reduced but not 100% eliminated. (if you have to ask, or if you haven't already discussed this all with your doctor, you didn't get a risk-reducing mastectomy.) it is not usually possible to do a mammogram on someone after masculinizing top surgery because of the limited amount of breast tissue remaining, and it might not be worth it given the reduced risk (not much data out there), so just keep a casual eye out for any lumps and ask your doctor if something pops up.

- if you have a cervix, you should get cervical cancer screening (Pap smears or HPV testing or both) as recommended for cis women. I recognize that pelvic exams suck for trans men for various reasons - if you find them difficult due to pain or dysphoria, consider asking your doctor if you can self-collect the sample, or if they can order just an HPV test so you only have to test every five years. another fun thing about pap smears: if you've been on testosterone for awhile, it may be challenging to interpret pap results - the cells can atrophy the longer you're on T.

- if you have had your cervix surgically removed and you have no history of abnormal pap smears, you no longer need cervical cancer screening - congrats! if you DO have a history of abnormal paps, you will need to continue getting smears of the cuff / vaginal vault left behind until you have three normal tests in a row. then you're free!

for transfems and trans women:

- if you have breasts, you will likely need breast cancer screening. if you are at average risk, as of 2016, the guidelines circulating were a mammogram every 2 years starting at age 50 after being on estrogen for 5 years or more. however, these are old guidelines, and the starting age for cis women was pushed back to age 40 (from 50) after they were released. I've also seen some interesting data that breast cancer risk increases from cis male levels relatively quickly after starting HRT, so

- my personal recommendation is that trans women and transfems, after a length of HRT determined by you and your doctor (5 years seems probably reasonable for average risk, maybe shorter for high risk), roughly follow guidelines for cis women. throw that Dutch study I just linked at them if they complain. trans women may also have a higher incidence of dense breast tissue, which is more challenging to image - make sure you're regular on screening so your medical team can better monitor changes.

- prostate cancer screening should be a discussion between you and your doctor because the risks may not outweigh the benefits for everyone. if you are at average risk and choose to be screened, you should get a PSA test (just a blood test) starting at age 55 and discontinuing at age 70. practically nobody does a digital rectal exam (the physical exam where they stick fingers up you) anymore because the evidence just isn't there for it and a PSA test is easier.

for everyone:

- colorectal cancer screening is so important. especially for Black people and other people of color, who are at higher risk, but for everyone! screening should start at age 45-50 and can be a colonoscopy every 10 years or a FIT (stool sample) test every year.

- you may need other tests depending on other risk factors you might have, your mileage may vary.

- your insurance might complain about paying for a screening that isn't "congruent" with your gender marker. trans women may benefit from strategically changing their gender marker with insurance to F, if it is possible. trans men may benefit from strategically leaving theirs as F, if it is possible and desirable (altho, if you follow my next step, may not be desirable... your mileage may vary). a doctor's office competent in trans care probably knows how to argue your case successfully to insurance in any case.

- in preparation for the possibility that insurance stops covering HRT for trans people, you may wish to ask your doctor to prescribe your HRT under a diagnosis code that is NOT "gender dysphoria." this was commonly done in the past to get hormones covered by insurance. happy to provide some possible codes for you on request, but would prefer not to blast my strategies all over the internet for obvious reasons.

- stop smoking cigarettes, damn it! that is one of the best things you can do to reduce your cancer risk. I know they look cool and they're a way to soothe yourself from the horrors, but get a vape if you must continue using tobacco. (also, most surgeons want you to quit before you have surgery, so if you want surgeries in the future there's no time like the present.)