Background Screening by cytology has been highly effective in reducing the incidence and mortality from squamous invasive cervical cancer (ICC), but the effectiveness is less established regarding non-squamous ICC and regarding women above screening ages and below 30 years of age. Cervical cancer still occurs despite the presence of an organised screening programme. A substantial proportion of screened women with ICC are reported to have had previous abnormal cytology findings. The significance of negative cytology with limited evaluation is not quite determined, the most effective management of women with low-grade abnormalities is controversial, and evaluation of long-term effect of different treatment methods is limited. Aims To identify possible areas of improvements in the prevention of cervical cancer by evaluating the effectiveness of the Swedish cervical screening programme, and by exploring risk factors for ICC in the cytological screening histories and in the management of women with abnormal cytology findings. Methods The screening histories of all ICC cases in Sweden 1999-2001 (n=1230) and of five population-based control women per case were reviewed, using data from the Swedish Cancer Registry, the national population register, the Swedish national cervical screening quality register, histopathological reports and questionnaires to clinicians. The risk of cervical cancer according to screening histories 0.5-6.5 years before cancer diagnosis was estimated as odds ratios (ORs) in logistic regression models with 95% confidence interval (CI) (Paper I). Risk related to different cytological reports was assessed in women below 67 years of age with cytology (n=572, n=3569) in Paper II. The initial follow-up of women with abnormal or unsatisfactory cytology reports (n=159, n=258) was evaluated in Paper III, and further investigation and treatment of abnormalities (n=143 cases, n=176 controls) in Paper IV. Results The cancer cases were above screening ages (31%), had not been screened according to recommendations (33%), had negative cytology (23%), or had previous positive screening tests (13%). No screening within the recommended interval increased the risk of squamous (OR 2.97, 95% CI 2.51-3.50) as well as non-squamous cancer (OR 1.59, 95% CI 1.20-2.11), and increased the risk in all ages. Negative cytology with partially obscuring factors and unsatisfactory cytology increased the risk of subsequent early stage ICC. All cytological abnormalities increased the risk of ICC, and women with glandular atypia or atypia in cells of uncertain origin carried a particularly high risk (OR 11.69, 95% CI 7.02-19.46). After a low-grade squamous abnormal smear finding, further investigation with biopsy was more effective than repeated cytology (OR 0.46, 95% CI 0.24-0.89). Lack of biopsy increased the risk in women with both low-grade and high-grade squamous abnormalities. Neither repeat cytology, nor biopsy, decreased the risk in women with glandular atypia or atypia in cells of uncertain origin. Treatment decreased the risk, even when the biopsy before treatment was negative or showed low-grade atypia only. Ablative therapy was less effective than excision and laser conisation was the most effective therapy. Conclusions Improved adherence to screening recommendations and including older women at increased risk in the programme would have significant cancer preventive gains. Women with negative cytology with limited evaluation and with unsatisfactory cytology may need further evaluation. Assessment with biopsy should be recommended for women with low-grade as well as high-grade squamous abnormalities. The diagnosing of precancer lesions and the identification of women in need of treatment warrant improvements, in particular in cases of glandular or “other” atypia in cytology. Treatment techniques need further evaluation.

2-Methoxyestradiol (2-ME), a metabolite of 17β-estradiol, is a potent antitumor and antiangiogenesis agent in vitro and in vivo. This study aimed to investigate the effects of 2-ME on human cervical and endometrial cancers in vitro and in vivo. Human cervical cancer HeLaS3 cells, endometrial cancer HEC-1-A and RL-95-2 cells, and severe combined immune deficient (SCID) mice were used. On cervical cancer HeLaS3 cells, 2-ME inhibited the cell growth which is accompanied by apoptosis via iNOS pathway and by G2/M cell cycle arrest. 2-ME had slight effects on normal cervical epithelial cells. In vivo on SCID mice, 2-ME (75 mg/kg p.o.) inhibited the growth of human cervical carcinoma by 34% (p < 0.05) and showed slight side effects to liver and spleen. On human endometrial cancer cells (HEC-1-A and RL-95-2 cells), 2-ME inhibited the growth by blocking cell cycle progress in S- and G2/M-phase in both cell types, and by inducing apoptosis in HEC-1-A cells and by causing necrosis in RL-95-2 cells. 2-ME had no effects on normal endometrial cells. The apoptotic effect, in HEC-1-A cells, was prevented by iNOS-inhibitor 1400W and eliminated by Caspase-inhibitor Z-VAD-FMK. The necrosis, on RL-95-2 cells, was due to a severe disruption of the mitochondrial membrane potential. Unfortunately, 2-ME had no significant effects on endometrial cancer xenografts. It showed slight toxicity to liver, spleen and proliferative effect on uterus. In conclusion, 2-ME inhibits the growth of human cervical and endometrial cancer cells in vitro. However, a weaker anti-tumor effect was observed in our animal model and 2-ME was slightly toxic to liver and spleen. Considering the proliferative effect on uterus, 2-ME might not be a suitable therapeutic agent in gynecological tumors.

Introduction. Sexually transmitted infections (STIs) continue to be highly prevalent among young women, and STIs continue to be a challenging health issue on college campuses. Studies have shown that the highest prevalence of human papillomavirus (HPV) is among young adult women, ages 20 to 24, including female college students. While the HPV vaccine has proven to be highly effective in preventing certain high-risk types of HPV, it is not effective in preventing all types of HPV or other STIs. Practicing other safer sex behaviors, in addition to condom use, also can help individuals protect themselves and their partners from acquiring HPV and other STIs. Purpose. Relationships between knowledge about HPV and the HPV vaccine, beliefs about HPV, acceptance of the HPV vaccine, and intentions to practice safer sex behaviors were assessed to determine if female college students who had a high acceptance of the HPV vaccine were also more likely to practice safer sex behaviors. Methods. A convenience sample of 2,706 undergraduate female college students, ages 18 to 24, from three U.S. public universities, completed an online survey that measured the following study variables: knowledge about HPV; knowledge about the HPV vaccine; acceptance of the HPV vaccine, specifically influential factors and barriers to vaccination; as well as attitudes, normative beliefs, control beliefs and intentions for practicing safer sex behaviors. Results. The majority of participants had a high level of knowledge of HPV (70.4%) and the HPV vaccine (73.7%). Over one-third of the participants (37.3%) received at least one dose of the HPV vaccine. Most participants thought they had a low susceptibility to HPV, as 54% thought they were unlikely to contract HPV; however, most (53.6%) thought that HPV would be a serious problem for them. The safer sex behavior that participants thought was the easiest was refusing to have sex with a partner that would not use a condom (51.8% “Strongly agree”) and the safer sex behavior that participants thought to be the most difficult was asking a partner to get tested for STIs (54.5% “Disagree”). Attitudes, normative beliefs, and control beliefs combined to strongly predict intentions (R = .730, p < .001), and attitudes was the strongest predictor for intentions to practice safer sex behaviors (β = .666), 95% CI [.649, .711]. There was a significant positive correlation between vaccine acceptance and intentions to practice safer sex behaviors (r = .087, p < .001), including likelihood of getting vaccinated against HPV (r = .098, p < .001). Conclusions. Findings from this study demonstrate the need for university student health centers to provide information about the HPV vaccine as part of broader STI prevention and social marketing campaigns, targeting female college students who are single, as well as those in monogamous relationships. Furthermore, because young men can be carriers of HPV and the HPV vaccine is now available to them, follow-up studies are needed to determine acceptance of the HPV vaccine among male college students as it relates to HPV knowledge, knowledge of the vaccine, and intentions to practice safer sex behaviors.

The overall aim of this thesis was to examine beliefs about human papillomavirus (HPV) prevention, especially vaccination, among parents, immigrant women, adolescents and school nurses, and to promote primary prevention among adolescents. The methods used in the thesis were focus group interviews, individual interviews, a web-based questionnaire, and finally, a randomised controlled intervention study. The immigrant women were largely in favour of HPV prevention, although barriers, such as logistic difficulties, and cultural or gender norms were found. Parents’ decision concerning vaccination of their daughters depended on several factors. Regardless of their final choice, they made the decision they believed was in the best interest of their daughter. The benefits outweighed the risks for parents choosing to vaccinate while parents declining made the opposite judgement. The majority of the school nurses reported that the governmental financial support given because of the vaccination programme had not been used for the intended purpose. Three out of four nurses had been contacted by parents who raised questions regarding the vaccine; most were related to side effects. The educational intervention had favourable effects on the adolescents’ beliefs regarding HPV prevention, especially among those with an immigrant background. Furthermore, the intention to use condom as well as actual vaccination rates among girls was slightly increased by the intervention. Trust in the governmental recommendations and the amounts of information given are important factors in the complex decision about HPV vaccination. Attention given to specific needs and cultural norms, as well as the possibility to discuss HPV vaccination with the school nurse and provision of extra vaccination opportunities at a later time are all strategies that might facilitate participation in the school-based HPV vaccination programme. School nurses need sufficient resources, knowledge and time to meet parents’ questions and concerns. The vaccinations are time-consuming and the governmental financial support needs to be used as intended, for managing the vaccination programme. A school-based intervention can have favourable effects on the beliefs and actual actions of young people and may possibly thus, in the long term, decrease the risk for HPV-related cancer.

Les papillomavirus humains (VPHs) sont reconnus comme les agents étiologiques du cancer du col de l’utérus. Notre étude a pour but de décrire le polymorphisme de la région régulatrice virale (LCR) et du gène E6 du VPH52 chez 216 femmes canadiennes avec différents grades de lésion du col et d’établir s’il existe une association entre les variantes décrites et la présence de lésions intraépithéliales de haut-grade (CIN2,3) du col de l’utérus ou de cancer invasif. L’âge (OR 1.1, 95% CI 1.02-1.17, p=0.005) fut significativement associé à la présence de cancer invasif. Une variante de la région régulatrice virale, MTL-52-LCR-02, présentant une substitution nucléotidique au niveau du nucléotide 7436, fut aussi associée à la présence de cancer du col de l’utérus (p=0.015). Dans une analyse multivariée, après ajustement pour l’âge, l’ethnicité et le site de recrutement, une délétion au niveau du nucléotide 7695 (OR 5.7, 95% CI 1.2-27.9) ainsi qu’une substitution au niveau du nucléotide 7744 (OR 8.3, 95% CI 1.1-61.0) du LCR, et la variante K93R de la protéine E6 (OR 9.5, 95% CI 1.3-68.9) furent associées de façon significative avec la présence de CIN2,3. Ainsi, le polymorphisme du LCR et du gène E6 du VPH52 est associé avec la présence de CIN2,3 et probablement avec celle d’un cancer invasif. / Human papillomaviruses (HPVs) are the main etiological agents of cervical cancer. Our study aims to describe HPV52 polymorphism in the long control region (LCR) and in the E6 gene, and to investigate the association between LCR and E6 polymorphism and high-grade cervical intraepithelial neoplasia (CIN2,3) or invasive cervical cancer in 216 canadian women with various grades of cervical disease. Age was significantly associated with cervical cancer (OR 1.1, 95% CI 1.02-1.17, p=0.005). The MTL-52-LCR-02 variant, with a nucleotide substitution in the LCR at position 7436, was also associated with cervical cancer. MTL-52-LCR-02 has been identified in 28.6% of women with cervical cancer and in 0.0% of women without cervical cancer or CIN2,3 (p=0.015). In a multivariate analysis, after adjusting for age, ethnicity, detection of HPV16 or 18, and study site, a deletion at nucleotide position 7695 (OR 5.7, 95% CI 1.2-27.9), a variation at nucleotide position 7744 (OR 8.3, 95% CI 1.-61.0) in the LCR and the K93R variant of the protein E6 (OR 9.5, 95% CI 1.3-68.9) were associated with CIN2,3. This study confirms that HPV52 polymorphism in the LCR and in the E6 gene is associated with risk of development of CIN2,3 and possibly invasive cancer of the uterine cervix.

Le VPH-16 de même que certains VPH, dont le VPH-18, causent le cancer du col utérin. Son intégration dans le génome humain pourrait être un marqueur de progression de l’infection. Les charges virales totale et intégrée sont présentement mesurées en quantifiant par PCR en temps réel les gènes E6 (RT-E6) et E2 (RT-E2-1) du VPH-16. Nous avons évalué l’impact du polymorphisme du gène E2 sur la quantification de l’ADN du VPH-16 dans des spécimens cliniques. Dans un premier temps, le gène E2 de 135 isolats de VPH-16 (123 appartenaient au clade Européen et 12 à des clades non- Européens) fut séquencé. Ensuite, un test de PCR en temps réel ciblant les séquences conservées dans E2 (RT-E2-2) fut développé et optimisé. Cent trente-neuf spécimens (lavages cervicaux et vaginaux) provenant de 74 participantes (58 séropositives pour le VIH, 16 séronégatives pour le VIH) ont été étudiés avec les trois tests E2 (RT-E2-2), E6 (RT-E6) et E2 (RT-E2-1). Les ratios de la quantité d’ADN de VPH-16 mesuré avec RT-E2-2 et RT-E2-1 dans les isolats Européens (médiane, 1.02; intervalle, 0.64-1.80) et Africains 1 (médiane, 0.80; intervalle, 0.53-1.09) sont similaires (P=0.08). Par contre, les ratios mesurés avec les isolats Africains 2 (médiane, 3.23; intervalle, 1.92-3.49) ou Asiatique- Américains (médiane, 3.78; intervalle, 1.47-37) sont nettement supérieurs à ceux obtenus avec les isolats Européens (P<0.02 pour chaque comparaison). Les distributions des quantités de E2 contenues dans les 139 échantillons mesurées avec RT-E2-2 (médiane, 6150) et RT-E2-1 (médiane, 8960) étaient statistiquement différentes (P<0.0001). Nous avons observé que les charges virales totale (odds ratio (OR) OR, 2.16 95% intervalle de confiance (IC) 1.11-4.19), et épisomale du VPH-16 (OR, 2.14 95% IC 1.09-4.19), mais pas la présence de formes intégrées (OR, 3.72 95% IC 1.03-13.4), sont associées aux néoplasies intraepitheliales cervicales de haut grade (CIN-2,3), et ce, en contrôlant pour des facteurs confondants tels que l’âge, le taux de CD4 sanguin, l’infection au VIH, et le polymorphisme de VPH-16. La proportion des échantillons ayant un ratio E6/E2 > 2 pour les femmes sans lésion intraépithéliale (7 de 35) est similaire à celle des femmes avec CIN-2,3 (5 de 11, p=0.24) ou avec CIN- 1 (4 de14, P=0.65). Le polymorphisme du gène E2 est un facteur qui influence la quantification des charges intégrées de VPH-16. / Episomal and integrated HPV-16 loads are currently estimated by quantitation with real-time PCR of HPV-16 E6 (RT-E6) and E2 (RT-E2-1) DNA. We assessed the impact of HPV-16 E2 polymorphism on quantitation of integrated HPV-16 DNA in clinical specimens. First, HPV-16 E2 was sequenced from 135 isolates (123 from European and 12 from non-European lineages). A novel assay targeting conserved HPV-16 E2 sequences (RT-E2-2) was optimized and applied with RT-E6 and RTE2- 1 on 139 HPV-16-positive cervicovaginal lavages collected from 74 women (58 HIV-seropositive, 16 HIV-seronegative). Ratios of HPV-16 DNA copies measured with RT-E2-2 and RT-E2-1 with European (median, 1.02; range, 0.64-1.80) and African 1 (median, 0.80; range, 0.53-1.09) isolates were similar (P=0.08). Ratios obtained with African 2 (median, 3.23; range, 1.92-3.49) or Asian-American (median, 3.78; range, 1.47-37) isolates were greater than those with European isolates (P<0.02 for each comparison). Distributions of HPV-16 E2 copies measured in 139 samples with RT-E2-2 (median, 6150) and RT-E2-1 (median, 8960) were different (P<0.0001). HPV-16 total (odds ratio (OR) OR, 2.16 95% confidence interval (CI) 1.11-4.19), episomal (OR, 2.14 95% CI 1.09-4.19) but not integrated (OR, 3.72 95% CI 1.03-13.4) load, were associated with high-grade cervical intraepithelial neoplasia (CIN-2,3) after controlling for age, CD4 count and HIV, and HPV-16 polymorphism. The proportion of samples with an E6/E2 ratio >2 in women without SIL (7 of 35) was similar to that of women with CIN-2,3 (5 of 11, P=0.24) or CIN-1 (4 of 14, P=0.65). E2 polymorphism was a factor that influenced measures of HPV-16 integrated load.

Tyrimo tikslas – Įvertinti moterų motyvaciją dalyvauti gimdos kaklelio vėžio profilaktikos programoje bei šeimos gydytojo institucijos vaidmenį vykdant šią programą Šilalės rajone. Tyrimo metodika. Tyrimas buvo atliekamas vykdant 25-60 m. amžiaus moterų, besikreipiančių į šeimos gydytoją, anketinę apklausą. Apklausa atlikta aštuoniose Šilalės rajono gydymo įstaigose. Bendras tiriamųjų skaičius N=250. Rezultatai. Įvertinus moterų, besikreipiančių į šeimos gydytoją Šilalės rajone, aktyvumą dalyvaujant gimdos kaklelio vėžio profilaktikos programoje, nustatyta, kad beveik visos (88 proc.) apklausoje dalyvavusios moterys buvo bent kartą gyvenime pasitikrinusios dėl gimdos kaklelio vėžio. Aktyviau tikrinosi moterys asmeniškai informuotos šeimos gydytojo apie vykdomą gimdos kaklelio vėžio profilaktikos programą telefonu, žinančios, kad pasitikrinimas dėl gimdos kaklelio vėžio moterims nuo 25 iki 60 metų amžiau moterims yra nemokamas, manančios, kad programa yra vykdoma tinkamai bei nurodžiusios, kad šeimos gydytojo vaidmuo vykdant gimdos kaklelio vėžio profilaktikos programą yra svarbus. Tepinėlis dėl gimdos kaklelio vėžio buvo daugiau kartų paimtas moterims, kurios asmeniškai buvo informuotos šeimos gydytojo apie gimdos kaklelio vėžio profilaktikos programą, per pastaruosius 12 mėn. pas savo šeimos gydytoją lankėsi 2-ą kartą ir daugiau, savo sveikatą vertino blogai ir buvo 45-60 metų amžiaus. Beveik pusė (45 proc.) apklaustųjų dėl gimdos kaklelio vėžio bent kartą gyvenime... [toliau žr. visą tekstą] / Aim of the study. To evaluate the motivation of women to participate in cervical cancer prevention program and the role of family physician’s in this program. Methods. Study was carried out among women, aged 25-60 years, who were seeking for family physician’s consultation. The survey was conducted in eight primary health care centers in Šilalė district. The total number of respondents was 250. Results of The Research. Almost all of the women (88%) who participated in the research were checked up for cervical cancer at least once in their life. More active women in cheek-up were those who were personally informed - by telephone, or were - informed by their family doctors, also those who knew that - the Prevention Programme of Cervical Cancer for women aged 25 – 60 is free of charge, who indicated that the role of family doctor‘s is very important in the context of this programme and that the programme is implemented properly. A smear of cervical cancer has been taken more times for women who were informed personally about the Prevention Programme of Cervical Cancer. 45% of the respondents decided to participate in this programme themselves. The main reason why women actively participate in the Prevention Programme of Cervical Cancer is the opportunity to protect themselves from the consequences of serious disease. The respondens pointed out some disadvantages of this programme: the lack of important information about the programme; insufficient public information; not... [to full text]

Abstract Malignancy Associated Changes are subtle alterations in the morphology and nuclear texture of cells in the vicinity of a malignant lesion. The phenomenon was first described in 1959, and has been the subject of considerable research in the four intervening decades, due to its potential utility to cancer screening programs. In this thesis the history of research into malignancy associated changes is reviewed, and the major findings of previous workers summarized. Original work aimed at improving the accuracy of classification of Pap smear slides is described in detail. A novel algorithm, which incorporates a genetic algorithm for feature selection and training of a neural network, is described. The algorithm was tested upon a large artificial dataset consisting of points from nested spheres in multiple dimensions. It was able to select the most discriminatory features and classify data with 99% accuracy on 80% of runs for two dimensional data, and on 90% of runs for three-dimensional data. The algorithm was also tested on two real data sets from the UCI Machine Learning Repository, the “sonar” data and the “ionosphere” data. On both of these datasets the algorithm produced a classifier using a subset of features which performed as well as previously reported classifiers using the full feature set. This algorithm was then tested on a large dataset of cell images, and its performance compared with that of the standard stepwise linear discriminant analysis approach. Both of these approaches produced similar results, which are comparable to those of previous workers in this field. Interestingly, runs of the genetic algorithm with different random number seeds tended to select different feature subsets, which produced approximately equivalent performance. This finding indicates that amongst the features used, which were selected from those previously identified in the literature as useful for MACs detection, many subsets exist which are equally discriminatory.

Η πρόληψη του καρκίνου του τραχήλου της μήτρας (ΚΤΜ) αποτελεί κυρίαρχη συνιστώσα της φροντίδας υγείας των γυναικών. Απαραίτητη προϋπόθεση για την πρόληψη του συγκεκριμένου καρκίνου είναι η εκτίμηση αναγκών υγείας του γυναικείου πληθυσμού, ιδιαίτερα στην Ελλάδα. Ο ΚΤΜ είναι κακοήθη νεοπλάσματα του τραχήλου της μήτρας ή του τραχήλου της περιοχής. Το τεστ Παπανικολάου μπορεί να εντοπίσει ενδεχομένως προκαρκινικές αλλαγές. Η θεραπεία των υψηλού βαθμού αλλαγών μπορεί να εμποδίσει την ανάπτυξη του καρκίνου. Στις ανεπτυγμένες χώρες, η διαδεδομένη χρήση των προγραμμάτων προσυμπτωματικού ελέγχου του τραχήλου της μήτρας έχει μειώσει την επίπτωση της διεισδυτικής του τραχήλου της μήτρας κατά 50% ή και περισσότερο. Μετά από μελέτες που διήρκησαν μία 20ετία αποδείχθηκε ότι υπάρχει αιτιολογική σχέση μεταξύ ΚΤΜ και του Ιού Ανθρωπίνων Θηλωμάτων. Ο Ιός των Ανθρωπίνων Θηλωμάτων είναι μέλος οικογένειας ιών που είναι ικανή να μολύνει. Τα εμβόλια κατά του HPV (Gardasil και Cervarix) εμποδίζoυν τη μόλυνση από τους HPV τύπους (16 και 18) που προκαλούν το 70% του ΚΤΜ και μπορούν να οδηγήσουν και σε περαιτέρω μειώσεις. Το εμβόλιο Gardasil ( Merck & Co ) είναι ένα εμβόλιο που έχει αποδειχθεί ότι αποτρέπει ορισμένους τύπους του ιού του HPV, ειδικότερα τους τύπους 16, 18, 6, και 11. Οι HPV τύποι 16 και 18 υπολογίζεται ότι προκαλούν το 70% του ΚΤΜ και είναι υπεύθυνες και για τον καρκίνο πρωκτού , του αιδοίου , του κόλπου και του πέους. Οι τύποι 6 και 11, υπολογίζεται ότι προκαλούν το 90% των περιπτώσεων των γεννητικών κονδυλωμάτων . Το Gardasil προλαμβάνει λοιμώξεις του ιού HPV, αλλά δεν αντιμετωπίζει υπάρχουσα λοίμωξη. Ως εκ τούτου, για να είναι αποτελεσματικός ο εμβολιασμός, πρέπει να δοθεί πριν από τη λοίμωξη. Το Cervarix (GlaxoSmithKline) είναι ένα εμβόλιο κατά ορισμένων μορφών καρκίνου που προκαλεί ο HPV. Το Cervarix έχει σχεδιαστεί για την πρόληψη της λοίμωξης από τους HPV τύπους 16 και 18, που προκαλούν περίπου το 70% του ΚΤΜ. Αυτοί οι τύποι επίσης μπορεί να προκαλέσουν και κάποια άλλα είδη καρκίνων, όπως των γεννητικών οργάνων και ορισμένων στοματοφαρυγγικών καρκίνων. Επιπλέον, κάποια διασταυρούμενη αντίδραση προστασίας από στελέχη του ιού 45 και 31 έχει αποδειχθεί σε κλινικές δοκιμές με τη χρήση του Cervarix. Σκοπός της παρούσας εργασίας είναι η εκτίμηση αναγκών υγείας για την πρόληψη του ΚΤΜ στο γυναικείο πληθυσμό που διαμένει στην Πάτρα και στον Πύργο. Επιμέρους στόχοι είναι η καταγραφή της συμμετοχής των γυναικών στον εμβολιασμό κατά του ΚΤΜ και η διερεύνηση παραγόντων που επηρεάζουν τη συμμετοχή τους. Ο σχεδιασμός ολοκληρωμένου προγράμματος πρόληψης με τον εμβολιασμό κατά του ΚΤΜ είναι εφικτός και βασίζεται στην εχέμυθη σχέση ασθενούς και γιατρού. / The prevention of cervical cancer constitutes a main component of women’s health care. A necessary precondition for this prevention is the health needs assessment of the female population, especially in Greece. Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes can prevent the development of cancer. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more. Human papillomavirus (HPV) infection is a necessary factor in the development of almost all cases of cervical cancer. After 20 years studies, the relationship between cervical cancer and human papillomavirus (HPV) was proved. A HPV is a member of the papillomavirus family of viruses that is capable of infecting humans. HPV vaccines (Cervarix and Gardasil), which prevent infection with the HPV types (16 and 18) that cause 70% of cervical cancer, may lead to further decreases. Gardasil (Merck & Co.) is a vaccine proven to prevent certain types of human papillomavirus (HPV), specifically HPV types 16, 18, 6, and 11. HPV types 16 and 18 cause an estimated 70% of cervical cancers and are responsible for many anal, vulvar, vaginal, and penile cancer cases. HPV types 6 and 11 cause an estimated 90% of genital warts cases. Gardasil prevents HPV infections, but does not treat existing infection. Therefore, to be effective it must be given before HPV infection occurs. Cervarix is manufactured by GlaxoSmithKline. It is a vaccine against certain types of cancer-causing human papillomavirus (HPV). Cervarix is designed to prevent infection from HPV types 16 and 18 that cause about 70% of cervical cancer cases. These types also cause some other genital cancers and some oropharyngeal cancers. Additionally, some cross-reactive protection against virus strains 45 and 31 were shown in clinical trials. The purpose of this study is to assess health needs for cervical cancer prevention concerning the female population living in Patras and Pyrgos. Partial purposes are: to record women’s participation in HPV vaccines and look into the factors that affect this participation. The planning of a preventive project concerning HPV vaccines is feasible and is based on a perfect relationship and trust between patient and doctor.

Background: A maioria dos métodos de rastreamento do câncer de colo de útero depende da colposcopia para a confirmação do diagnóstico. A colposcopia sofre com a falta de disponibilidade, a necessidade de longos deslocamentos por parte das pacientes e longas filas de espera. Objetivo: Avaliar o desempenho da Fotografia Cervical Digital como um método alternativo à colposcopia. Método: Foram realizadas colposcopies e Fotografias Digitais Cervicais em 228 pacientes. As Fotografias Digitais Cervicais foram avaliadas através da internet por três colposcopistas experientes. A concordância entre os métodos foi calculada através de Kappa e as porcentagens de concordância. Sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acuracia diagnóstica foram calculados para a colposcopia e a Fotografia Cervical Digital. A histologia foi utilizada como padrão-ouro. Resultados: A Fotografia Cervical Digital e a colposcopia concordaram em 89,9% dos casos (K=0,588). A Fotografia Cervical Digital e a colposcopia apresentaram desempenhos comparáveis, a sensibilidade foi de 52,5% e 35,0%, a especificidade de 91,86% e 91,28%, o valor preditivo positivo de 60,0% e 48,3%, valor preditivo negativo de 89,3% e 85,8%, e a acurácia diagnóstica de 84,4% e 80,7%, respectivamente. Conclusão: A Fotografia Cervical Digital é um método alternativo promissor à colposcopia. / Background: Most cervical cancer screening methods relies on colposcopy to confirm the diagnosis. Colposcopy suffers from the lack of availability, long patients’ displacement and waiting times. Objective: Evaluate the performance of the Cervical Digital Photography as an alternative method to colposcopy. Methods: Colposcopy and Cervical Digital Photography were performed in 228 women. The Cervical Digital Photographs were evaluated through internet by 3 colposcopy experts. The agreement between methods was calculated with kappa and percentages of agreement. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for colposcopy and Cervical Digital Photography. Histology was the gold standard. Results: Cervical Digital Photography and colposcopy agreed in 89.9% of the cases (K=0.588). Cervical Digital Photography and colposcopy had comparable performances, sensitivity was 52.5% and 35.0%, specificity was 91.86% and 91.28%, positive predictive value was 60.0% and 48.3%, negative predictive value was 89.3% and 85.8%, and diagnostic accuracy was 84.4% and 80.7%, respectively. Conclusion: Cervical Digital Photography is a promising alternative method to colposcopy.