INTRODUÇÃO: O câncer do colo uterino é a terceira neoplasia maligna que mais afeta as mulheres brasileiras e, quando não detectada precocemente, apresenta prognóstico reservado. O câncer do colo uterino é consequência da infecção pelo Papilomavírus humano (HPV). Pouco é conhecido sobre a influência dos genótipos do HPV na apresentação clínica e o seu impacto na taxa de sobrevida no câncer do colo uterino. Os objetivos do estudo foram identificar os genótipos de HPV no tecido tumoral da população atendida no Instituto do Câncer do Estado de São Paulo e associar os genótipos de HPV aos fatores de risco conhecidos para o câncer do colo uterino. MÉTODOS: Foram incluídas mulheres com diagnóstico de câncer do colo uterino atendidas no Instituto do Câncer do Estado de São Paulo (ICESP) entre maio de 2008 e junho de 2012. A análise do material tumoral parafinado confirmou histologicamente o diagnóstico de câncer do colo uterino. O DNA tumoral foi extraído de três fragmentos de 10?m de espessura do bloco de parafina de carcinoma do colo uterino e submetido ao ensaio clínico Onclarity (sistema automatizado da BD Viper LT) para detecção e genotipagem do HPV. Idade ao diagnóstico, estadiamento clínico, tipo histológico e tempo de sobrevida foram obtidos a partir de registros do prontuário até dezembro de 2015. RESULTADOS: Foram analisadas 414 pacientes. As frequências dos genótipos estudados foram HPV16 (54%) HPV18(9%), HPV33-­58 (6%), HPV45 (5%), HPV31 (3%), HPV39-­68-­ 35 (3%), HPV59-­56-­66(3%), HPV52 (2%) e HPVnegativo (14%). A idade da população estudada variou de 17 a 87 anos, com média etária de 50,8 (DP=13,8 anos). Os tipos histológicos foram carcinoma de células escamosas (75%), adenocarcinoma (21%) e outros tipos histológicos (4%). Conforme o estadiamento clínico adotado pela FIGO (2009), 35% foi classificado como 1A1, 1A2 e 1B1, 17% como 1B2 e 2A e 48% como 2B a 4B. O genótipo do HPV apresentou distribuição diferente quanto à idade ao diagnóstico, tipo histológico e estadiamento. A mediana do tempo de sobrevida global desta coorte de pacientes com câncer do colo uterino foi de 37 meses [12-­53 meses]. A sobrevida global acumulada em 5 anos após o diagnóstico de câncer do colo uterino foi de 55%. Ocorreram 119 (38%) óbitos no período e 133 (42%) recidivas subdivididas em três grupos: local (12%), regional (30%) e à distância (58%). Curvas de sobrevida de Kaplan-­Meier e estatística de Log-­rank demonstraram que os genótipos de HPV 16 e 18 (59%) não se relacionaram a um pior prognóstico em comparação com outros genótipos de HPV (41%) (P=0,17). Idade ao diagnóstico, estadiamento clínico, tipo histológico, invasão vascular, metástase linfonodal, tamanho do tumor e os genótipos HPV16, HPV18 e HPVoutros foram analisados individualmente em um modelo de regressão de Cox. O genótipo do HPV se associou a pior taxa de sobrevida global apenas quando detectado mais de um HPV no material tumoral analisado. CONCLUSÃO: Apesar das diferentes distribuições dos os genótipos do HPV quanto à idade ao diagnóstico, tipo histológico e estadiamento, o genótipo do HPV não se mostrou como fator prognóstico independente no câncer do colo uterino / INTRODUCTION: Uterine cervical cancer is the third most common malignant neoplasm affecting Brazilian women. Prognosis is poor when diagnosis is delayed. Cervical cancer is a consequence of human papillomavirus (HPV) infection. Little is known about the influence of HPV genotypes in Brazil and its impact on cancer survival rate The purpose of the present study were to identify HPV genotypes of tumoral tissue from the affected population and to examine the association between HPV genotype and traditional cervical cancer risk factors. METHODS: Women diagnosed with cervical cancer at the Cancer Institute of the State of São Paulo (ICESP) between May 2008 and June 2012 were included in the study. Tumor specimens were reviewed to confirm the diagnosis of cervical cancer. Tumor DNA was extracted from three 10?m-­thick paraffin block fragments of each subject. HPV genotype was detected using the Onclarity system (BD Viper LT automated system). Age at diagnosis, clinical staging, histological type and survival time were obtained from the hospital electronic data records until December 2015. RESULTS: 414 patients were analyzed. The HPV genotypes studied were HPV16 (54%) HPV18 (9%), HPV33-­58 (6%), HPV45 (5%), HPV31 (3%), HPV39-­68-­35 (3%), HPV59-­56-­ 66(3%), HPV52 (2%) and HPVnegative (14%). The age of the study population ranged from 17 to 87 years, mean age= 50.8 (SD=13.8 years). Histological types were classified as squamous cell carcinoma (75%), adenocarcinoma (21%) and other histological types (4%). According to the 2009 FIGO clinical staging, 35% were classified as 1A1, 1A2 and 1B1, 1B2 and 17% as 2A and 48% as 2B the 4B. HPV genotypes showed different distributions regarding age, histologic tumor types and clinical staging. The median overall survival time was 37 months [12-­53 months]. The cumulative overall survival at 5 years after diagnosis of cervical cancer was 55%. There were 119 (38%) deaths during the study period and 133 (42%) recurrences subdivided into three groups: local (12%), regional (30%) and distant (58%). Kaplan-­Meier survival curves and Log-­rank statistics showed that HPV 16/18 (59%) did not influence prognosis compared to other HPV subtypes (41%) (P=0.17). Age at diagnosis, clinical stage, histological type, vascular invasion, lymph node metastasis, tumor size and HPV16 genotypes, HPV18 and HPVothers were individually analyzed in a Cox regression model. HPV genotype was associated with poorer overall survival rate only when multiple HPV infection was detected in the tumoral specimen. CONCLUSION: Although HPV genotype showed different distribution regarding age at diagnosis, histological type and clinical staging, HPV genotype was not an independent prognostic factor of cervical cancer in the study population

Estudo transversal, descritivo e exploratório, com abordagem metodológica qualitativa, cujo objetivo foi identificar e avaliar a percepção da vulnerabilidade à doença, entre mulheres com diagnóstico avançado do câncer do colo do útero, tendo como referencial teórico, a vulnerabilidade, baseada no conceito proposto por Ayres et al. (2003). Os sujeitos do estudo foram doze mulheres que estavam em atendimento no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, para tratamento do câncer do colo do útero avançado, entre 08 de abril e 28 de maio de 2009. Os dados foram coletados por entrevistas. A análise dos dados se deu segundo os pressupostos da análise de conteúdo, proposta por Bardin (2006). Os resultados revelaram-se em 2 categorias centrais: Percebendo-se vulnerável e Enfrentando a doença e o tratamento. A vulnerabilidade se apresentou para as participantes deste estudo a partir do aparecimento dos primeiros sinais e sintomas da doença, crescendo à medida que o diagnóstico foi descoberto e o tratamento se fez necessário, trazendo dificuldades e sofrimento. Ao mesmo tempo, proporcionou a oportunidade de as mulheres encontrarem formas de enfrentamento e superação dos problemas, à medida do possível. Os componentes individual, social e programático da vulnerabilidade, contidos no conceito proposto por Ayres et al. (2003), mostraram-se nos fatores relacionados à cliente, aos profissionais, aos serviços, entre outros, e tornaram a mulher suscetível aos problemas e danos de sua saúde, relativos ao câncer cérvico-uterino, exacerbando sua vulnerabilidade à doença. Ficou clara a necessidade de se superar algumas deficiências no modelo de assistência e na humanização do atendimento, no grau de compromisso e na qualidade das instituições, dos recursos, do gerenciamento e do monitoramento dos programas de prevenção e detecção do câncer do colo do útero, nos diferentes níveis de atenção. / This cross-sectional, descriptive, exploratory and qualitative study aimed to identify and evaluate the perception of the vulnerability to the disease among women with delayed diagnosis of uterine cervical cancer. The theoretical framework used was the vulnerability, based in the concept proposed by Ayres et al. (2003). The subjects of the study were twelve women who were under follow-up at the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School, for treatment of advanced uterine cervical cancer, between April 08th and May 28th 2009. Data were collected by interviews. The data analysis was done according to the presuppositions of content analysis, proposed by Bardin (2006). Two central categories emerged from the results: Perceiving yourself vulnerable and Facing the disease and the treatment. The vulnerability arose to the participants of this study through the emergence of the first signs and symptoms of the disease, increasing as the diagnosis was determined and treatment was needed, bringing difficulties and suffering. At the same time, women had the opportunity to find ways to face and overcome problems, to the extent possible. The individual, social and programmatic compounds of the vulnerability, included in the concept proposed by Ayres et al. (2003), were shown in the factors related to clients, professionals and services, among others, and made the women susceptible to the problems and damages of their health, related to the uterine cervical cancer, aggravating their vulnerability to the disease. The need to overcome some deficiencies in the model of care and in the humanization of care was evidenced, as well as in the level of commitment and in the quality of the institutions, resources, management, and monitoring of the programs of prevention and detection of uterine cervical cancer, in the different levels of care.

Luk, Chun Shui. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 174-189). / Abstract also in Chinese. / Declaration --- p.I / Acknowledgements --- p.II / Funding Support --- p.IV / Abstract of thesis entitled --- p.V / 論文摘要 --- p.VII / Abbreviations --- p.IX / Table of Contents --- p.XIII / List of Figures --- p.XVIII / List of Tables --- p.XX / List of Appendix --- p.XXI / Chapter Chapter One - --- Literature Review --- p.1 / Chapter 1.1 --- History of Knowledge on Human Papillomavirus --- p.1 / Chapter 1.2 --- Virology of Human Papillomavirus --- p.2 / Chapter 1.2.1 --- Taxonomic Classification of Human Papillomavirus --- p.2 / Chapter 1.2.2 --- Morphology of Human Papillomavirus --- p.3 / Chapter 1.2.3 --- The Viral Genome --- p.3 / Chapter 1.2.4 --- The Viral Gene Products --- p.5 / Chapter 1.2.4.1 --- E1 and E2 Proteins --- p.5 / Chapter 1.2.4.2 --- E4 Protein --- p.6 / Chapter 1.2.4.3 --- "E5，E6, E7 Proteins" --- p.7 / Chapter 1.2.4.4 --- L1 and L2 Proteins --- p.8 / Chapter 1.3 --- Evolution of Human Papillomavirus --- p.9 / Chapter 1.3.1 --- Rates of Evolution --- p.11 / Chapter 1.3.2 --- Co-evolution Between Human Papillomavirus and Human --- p.11 / Chapter 1.4 --- Human Papillomavirus Infection and Disease --- p.13 / Chapter 1.4.1 --- Human Papillomavirus and Cervical Cancer --- p.13 / Chapter 1.4.1.1 --- Disease Burden of Cervical Cancer --- p.13 / Chapter 1.4.1.2 --- Epidemiology of Cervical Cancer --- p.14 / Chapter 1.4.1.3 --- Distribution of HPV types in Cervical Precancerous Lesions --- p.14 / Chapter 1.4.2 --- Human Papillomavirus and Non-cervical Diseases --- p.15 / Chapter 1.5 --- Human Papillomavirus Type 58 --- p.15 / Chapter 1.5.1 --- Biology of Human Papillomavirus Type 58 --- p.15 / Chapter 1.5.2 --- Epidemiology of Human Papillomavirus Type 58 Infections --- p.16 / Chapter Chapter Two - --- Background and Objectives of Study --- p.17 / Chapter 2.1 --- Background of study --- p.17 / Chapter 2.1.1 --- The Need for Research on HPV58 --- p.17 / Chapter 2.1.2 --- Intratypic Classification System for HPV --- p.17 / Chapter 2.2 --- Implication and Impact of Study --- p.19 / Chapter 2.2.1 --- Implication on HPV Virology --- p.19 / Chapter 2.2.2 --- HPV58 Classification --- p.19 / Chapter 2.2.3 --- Improvement on in the Detection of HPV58 --- p.20 / Chapter 2.2.4 --- Implication on Vaccine Development --- p.20 / Chapter 2.3 --- Objectives of Study --- p.21 / Chapter 2.3.1 --- To Generate a Database for Intratypic Variation of Different Gene Regions of HPV58 --- p.21 / Chapter 2.3.2 --- To Study the Variability of Seven Gene Regions of HPV58 --- p.21 / Chapter 2.3.3 --- To Study the Geographical Distribution of HPV58 Variants --- p.22 / Chapter 2.3.4 --- To Study the Phylogeny of HPV58 --- p.22 / Chapter 2.3.5 --- To Develop an Intratypic Classification System for HPV58 --- p.22 / Chapter 2.3.6 --- To Predict the Effectiveness of Commonly Used Primers on the Detection of HPV58 --- p.22 / Chapter Chapter Three - --- Materials and Methods --- p.24 / Chapter 3.1 --- Overall Study Design --- p.24 / Chapter 3.2 --- Study Population --- p.25 / Chapter 3.3 --- Sample Processing and Storage --- p.25 / Chapter 3.4 --- Primer Design --- p.26 / Chapter 3.5 --- Specimen Quality Assessment and Sample Selection --- p.30 / Chapter 3.6 --- Amplification of Gene Region --- p.30 / Chapter 3.7 --- Agarose Gel Electrophoresis --- p.34 / Chapter 3.8 --- Sequencing Reaction --- p.34 / Chapter 3.8.1 --- Purification of PCR Product --- p.34 / Chapter 3.8.2 --- Sequencing Reaction --- p.35 / Chapter 3.8.3 --- Purification of Fluorescence-labelled Product --- p.35 / Chapter 3.8.4 --- Sequence Identification --- p.35 / Chapter 3.9 --- Sequence Analysis --- p.36 / Chapter 3.9.1 --- Sequence Editing --- p.36 / Chapter 3.9.2 --- Criteria for Confirming the identity of HPV58 --- p.36 / Chapter 3.9.3 --- Identification of Variants --- p.38 / Chapter 3.9.4 --- Identification of Conserved and Variable Regions --- p.39 / Chapter 3.9.5 --- Phylogenetic Analysis --- p.40 / Chapter 3.9.5.1 --- Construction of Maximum Likelihood Tree --- p.40 / Chapter 3.9.5.2 --- Bootstrap Analysis --- p.41 / Chapter 3.9.5.3 --- Bayesian Phylogenetic Analysis --- p.42 / Chapter 3.9.5.4 --- Non-synonymous to Synonymous Substitution Rate Ratio (dN/dS) --- p.42 / Chapter 3.9.6 --- Evaluation of Performance of Commonly Used Primers --- p.43 / Chapter Chapter Four - --- Results --- p.44 / Chapter 4.1 --- Specimen Quality Assessment and HPV58 Confirmation --- p.44 / Chapter 4.2 --- HPV58 Genome Variability --- p.44 / Chapter 4.2.1 --- E6 Open Reading Frame --- p.45 / Chapter 4.2.2 --- E7 Open Reading Frame --- p.51 / Chapter 4.2.3 --- E2 Open Reading Frame --- p.56 / Chapter 4.2.4 --- E4 Open Reading Frame --- p.61 / Chapter 4.2.5 --- E5 Open Reading Frame --- p.66 / Chapter 4.2.6 --- L1 Open Reading Frame --- p.71 / Chapter 4.2.7 --- Long Control Region --- p.88 / Chapter 4.2.8 --- Whole HPV genome --- p.94 / Chapter 4.3 --- Evaluation of Commonly Used Primers --- p.99 / Chapter 4.3.1 --- PGMY09/11 Primers --- p.99 / Chapter 4.3.2 --- MY09/11 Primers --- p.99 / Chapter 4.3.3 --- GP5+/6+ Primers --- p.100 / Chapter 4.3.4 --- SPF Primers --- p.100 / Chapter 4.3.5 --- L1F/L1R Primers --- p.101 / Chapter Chapter Five - --- Discussion --- p.111 / Chapter 5.1 --- Overall Variation of HPV58 Genome --- p.111 / Chapter 5.2 --- Variability of Each Gene Region --- p.114 / Chapter 5.2.1 --- E6 Open Reading Frame --- p.115 / Chapter 5.2.2 --- E7 Open Reading Frame --- p.116 / Chapter 5.2.3 --- E2 Open Reading Frame --- p.117 / Chapter 5.2.4 --- E4 Open Reading Frame --- p.118 / Chapter 5.2.5 --- E5 Open Reading Frame --- p.119 / Chapter 5.2.6 --- L1 Open Reading Frame --- p.120 / Chapter 5.2.7 --- Long Control Region --- p.121 / Chapter 5.3 --- Phylogenetics of HPV58 --- p.122 / Chapter 5.3.1 --- Natural Selection Pressure --- p.122 / Chapter 5.3.2 --- HPV58 Lineage Using the L1 Gene --- p.124 / Chapter 5.3.3 --- Methods for Lineage Identification --- p.125 / Chapter 5.3.4 --- Geographical Distribution of the Four Lineages --- p.126 / Chapter 5.3.5 --- Recombination --- p.127 / Chapter 5.4 --- Evaluation of Commonly Used Primers --- p.128 / Chapter 5.5 --- Limitations of the Current Study --- p.129 / Chapter 5.6 --- Future Studies --- p.130 / Appendix --- p.133 / References --- p.174

Die in der Bundesrepublik Deutschland übliche Therapie für das Zervixkarzinom der FIGO-Stadien IB-IIB ist die Wertheim-Meigs-Operation. Bei bestimmten Risikofaktoren wird häufig eine adjuvante Bestrahlung, gegebenenfalls eine postoperative Radioche-motherapie angeschlossen. Die Folge können zahlreiche Einschränkungen der gesund-heitsbezogenen Lebensqualität sein. Zur Verbesserung der postoperativen gesund-heitsbezogenen Lebensqualität wurde eine neue nervenschonende Operationsmetho-de, die totale mesometriale Resektion (TMMR), von Höckel und Kollegen der Universi-tätsfrauenklinik Leipzig entwickelt. Die vorliegende retrospektive Querschnittsstudie untersucht erstmals die Auswirkungen der TMMR im Vergleich zur Wertheim-Meigs-Operation in Bezug auf die postoperative gesundheitsbezogene Lebensqualität. Dazu wurden 110 Zervixkarzinompatientinnen mit der Hilfe der Fragebögen EORTC-QLQ-C30 und EORTC-QLQ-CX24 befragt. Die Ergebnisse dieser Pilotstudie deuten daraufhin, dass Patientinnen nach einer TMMR-Operation im Vergleich zu Frauen nach einer Wert-heim-Meigs-Operation in einigen Teilaspekten eine bessere Lebensqualität haben. So fanden sich bezüglich der postoperativen körperlichen Funktionsfähigkeit und der Rol-lenfunktion sowie der postoperative Ausprägung der Symptome Fatigue, Schmerzen, Diarrhö, Appetitlosigkeit und Dyspnoe in der vorliegenden Untersuchung signifikant bessere Werte in der Gruppe der mittels TMMR operierten Frauen im Vergleich zur Wertheim-Meigs-Gruppe. Dies kann zum Anlass genommen werden große multizentri-sche prospektive Studien durchzuführen.

The Papanicolaou Smear is a screening test which detects premalignant lesions of the uterine cervix. By treating these lesions, cervical cancer can be evaded. In 1988, a cytological diagnosis which communicated a state of uncertainty in the atypicality of cervical cells was first created in the Bethesda Cytology Classification scheme. This diagnosis is now known as atypical squamous cells of undetermined significance (ASC-US) and still little is known about its natural history. / This paper analyzes the results of a longitudinal study incorporating repeated regular measurements of viral and cytological endpoints as well as lifestyle and behavioural aspects, to understand the natural history of an ASC-US Pap smear and identify determinants of ASC-US acquisition and clearance. / Overall, the median duration of ASC-US is short, and is dependent on the definition of clearance since most lesions regress to normal. The factors most predictive of ASC-US acquisition but not clearance relate to HPV infection.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed on June 29, 2009). Includes bibliographical references (p. 88-97).

Made available in DSpace on 2015-07-22T20:50:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-30. Added 1 bitstream(s) on 2015-08-11T03:26:07Z : No. of bitstreams: 1 Publico-12661a.pdf: 1894354 bytes, checksum: 39e63c18340aaa8ae1aee1ec0b447c39 (MD5). Added 1 bitstream(s) on 2015-08-11T03:26:08Z : No. of bitstreams: 2 Publico-12661a.pdf: 1894354 bytes, checksum: 39e63c18340aaa8ae1aee1ec0b447c39 (MD5) Publico-12661b.pdf: 1881342 bytes, checksum: 92081544fa53e07e990b31d9fe71e6a8 (MD5) / Objetivo: O Papillomavirus humano (HPV) é o agente etiológico do câncer cervical, mas isoladamente é incapaz de induzir a oncogênese. A progressão para as lesões invasoras está associada à imunidade do hospedeiro, dentre as quais, a interferência no processo de apoptose celular. Entre os vários genes associados à morte celular, o gene FAS parece ser um elemento importante. O objetivo deste estudo foi avaliar se há uma associação do polimorfismo da região promotora -670 do gene FAS com a NIC 3 e o carcinoma invasivo do colo do útero. Métodos: A avaliação da presença do polimorfismo do gene FAS foi realizada através da Técnica de PCR e RFLP em amostras de sangue para o grupo controle (225 amostras) e de tecido cervical para o grupo de casos, com NIC 3 (75 casos) e carcinoma invasor (214 casos). A análise estatística foi realizada através do cálculo do Teste Exato de Fisher, Kruskal-Wallis, Mann-Whitney e Qui-Quadrado, sendo considerado o valor de significância de 5% ou p<0,05. Resultados: O genótipo heterozigoto (AG) do gene FAS -670 foi significativamente mais frequente no grupo de mulheres com NIC 3, com um risco estimado de 3 vezes (OR=3,0; 95% IC: 1,29-7,16), quando ajustado a idade. Não houve diferença, porém, tanto no grupo controle quanto nas mulheres com carcinoma cervical. Nenhum genótipo esteve associado a um maior risco de NIC 3 ou câncer quando comparamos idade e etnia. Nas mulheres com câncer, os genótipos foram semelhantes nos diferentes tipos histológicos (epidermóide e adenocarcinoma) e grau de diferenciação tumoral. Avaliando a distribuição alélica (A e G), não observamos diferença na frequência dos alelos nos grupos estudados. Conclusão: O polimorfismo da região promotora do gene FAS -670 esteve associado a um risco maior de lesão intraepitelial de alto grau (NIC 3), mas não para o câncer invasor do colo do útero, quando comparados ao grupo controle. / Objective: The human papillomavirus (HPV) is the etiologic agent of cervical cancer, but alone it is incapable of inducing oncogenesis. Rather, progression to invasive lesions is associated with host immunity and interference in the process of cellular apoptosis. Among the several genes involved in cell death, the FAS gene appears to be an important factor. The aim of this study was to evaluate whether there is an association between polymorphisms of the FAS -670 gene promoter region and preinvasive and invasive lesions of the cervix. Methods: The FAS gene was evaluated for the presence of polymorphisms using polymerase chain reaction and restriction fragment length polymorphism techniques in 225 blood samples for the control group, as well as cervical tissue from patients with cervical intraepithelial neoplasia grade 3 (CIN 3; 75 cases) or invasive carcinoma (214 cases). Results: The heterozygous genotype (AG) of the FAS -670 gene promoter region was significantly more frequent in women with CIN 3, with an estimated risk of three times (OR=3.0; 95% CI: 1.29 to 7.16). No difference, however, was observed in the control group and women with cervical cancer. In women with cancer, the genotypes were similar in the different histological types and degree of tumor differentiation. Assessing allelic distribution (A or G), we observed no difference in frequency of allele in studied groups. Conclusion: Polymorphism of the promoter region of the FAS -670 gene was associated with increased risk of CIN 3, but not for invasive cancer of the cervix when compared to the control group. / TEDE / BV UNIFESP: Teses e dissertações

O Lúpus eritematoso sistêmico (LES) é uma doença auto-imune, mais prevalente em mulheres, com marcante aumento da sobrevida nos últimos anos, principalmente relacionado ao avanço do ratamento com terapia imunossupressora / citotóxica. Este estudo visa identificar a prevalência de alterações em esfregaços cervicais nesse grupo de pacientes. Participaram do estudo 80 pacientes do grupo com LES e 101 pacientes do grupo controle. Observou-se que a prevalência de alterações no grupo de paciente com LES foi de 31,3% contra 5,0% do grupo controle (p = 0,000). Não foram encontradas associações estatisticamente significativas entre a presença de alteração no esfregaço cervical e as variáveis: história de DST, sexarca com idade &#8804; 17 anos, parceiros múltiplos (&#8805; 4), história de HPV prévio, uso de ACO, tabagismo, estrato social ou com droga imunossupressora específica. Encontrou-se associação estatisticamente significativa apenas para a variável grupo, tendo paciente pertencente ao grupo LES chance 8,2 vezes maior (IC 95% = 2,7 24,9) de ter alterações no esfregaço cervical que uma paciente do grupo controle. Tais dados demonstram que pacientes com LES em terapia imunossupressora apresentam mais alterações em exames preventivos ginecológicos, merecendo atenção especial quanto à prevenção do câncer de colo do útero. / Systemic Lupus Erythematosus (SLE) is an autoimmune disease with higher prevalence over women. There has been a significant increase in survival time over the years resulting from the improvement of citotoxic and immunosuppressant therapy. This study aims at identifying the prevalence of altered results for cervical smears in this group of patients. 80 patients of the SLE group and 101 patients of the control group were part of the study. The prevalence of alterations in the SLE group was 31.3%, and 5% in the control group (p=0.000). No statistically significant association was found between the presence of alterations in pap smears and the variables STD history, first sexual intercourse at age &#8804; 17, multiple partners (&#8805; 4), previous history of HPV, use of oral contraceptives, tobacco smoking, social class and cancer presence in the family. Statistically significant association was found only in the group variable; patients in the SLE group had a 8.2 higher chance (IC 95% = 2.7 24.9) of showing alterations in the pap smears than those in the control group. These numbers show that SLE patients in immunosuppressant therapy have more alterations in pap smear exams, deserving special attention with regards to cervical cancer prevention.

O Lúpus eritematoso sistêmico (LES) é uma doença auto-imune, mais prevalente em mulheres, com marcante aumento da sobrevida nos últimos anos, principalmente relacionado ao avanço do ratamento com terapia imunossupressora / citotóxica. Este estudo visa identificar a prevalência de alterações em esfregaços cervicais nesse grupo de pacientes. Participaram do estudo 80 pacientes do grupo com LES e 101 pacientes do grupo controle. Observou-se que a prevalência de alterações no grupo de paciente com LES foi de 31,3% contra 5,0% do grupo controle (p = 0,000). Não foram encontradas associações estatisticamente significativas entre a presença de alteração no esfregaço cervical e as variáveis: história de DST, sexarca com idade &#8804; 17 anos, parceiros múltiplos (&#8805; 4), história de HPV prévio, uso de ACO, tabagismo, estrato social ou com droga imunossupressora específica. Encontrou-se associação estatisticamente significativa apenas para a variável grupo, tendo paciente pertencente ao grupo LES chance 8,2 vezes maior (IC 95% = 2,7 24,9) de ter alterações no esfregaço cervical que uma paciente do grupo controle. Tais dados demonstram que pacientes com LES em terapia imunossupressora apresentam mais alterações em exames preventivos ginecológicos, merecendo atenção especial quanto à prevenção do câncer de colo do útero. / Systemic Lupus Erythematosus (SLE) is an autoimmune disease with higher prevalence over women. There has been a significant increase in survival time over the years resulting from the improvement of citotoxic and immunosuppressant therapy. This study aims at identifying the prevalence of altered results for cervical smears in this group of patients. 80 patients of the SLE group and 101 patients of the control group were part of the study. The prevalence of alterations in the SLE group was 31.3%, and 5% in the control group (p=0.000). No statistically significant association was found between the presence of alterations in pap smears and the variables STD history, first sexual intercourse at age &#8804; 17, multiple partners (&#8805; 4), previous history of HPV, use of oral contraceptives, tobacco smoking, social class and cancer presence in the family. Statistically significant association was found only in the group variable; patients in the SLE group had a 8.2 higher chance (IC 95% = 2.7 24.9) of showing alterations in the pap smears than those in the control group. These numbers show that SLE patients in immunosuppressant therapy have more alterations in pap smear exams, deserving special attention with regards to cervical cancer prevention.

Estudo transversal, descritivo e exploratório, com abordagem metodológica qualitativa, cujo objetivo foi identificar e avaliar a percepção da vulnerabilidade à doença, entre mulheres com diagnóstico avançado do câncer do colo do útero, tendo como referencial teórico, a vulnerabilidade, baseada no conceito proposto por Ayres et al. (2003). Os sujeitos do estudo foram doze mulheres que estavam em atendimento no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, para tratamento do câncer do colo do útero avançado, entre 08 de abril e 28 de maio de 2009. Os dados foram coletados por entrevistas. A análise dos dados se deu segundo os pressupostos da análise de conteúdo, proposta por Bardin (2006). Os resultados revelaram-se em 2 categorias centrais: Percebendo-se vulnerável e Enfrentando a doença e o tratamento. A vulnerabilidade se apresentou para as participantes deste estudo a partir do aparecimento dos primeiros sinais e sintomas da doença, crescendo à medida que o diagnóstico foi descoberto e o tratamento se fez necessário, trazendo dificuldades e sofrimento. Ao mesmo tempo, proporcionou a oportunidade de as mulheres encontrarem formas de enfrentamento e superação dos problemas, à medida do possível. Os componentes individual, social e programático da vulnerabilidade, contidos no conceito proposto por Ayres et al. (2003), mostraram-se nos fatores relacionados à cliente, aos profissionais, aos serviços, entre outros, e tornaram a mulher suscetível aos problemas e danos de sua saúde, relativos ao câncer cérvico-uterino, exacerbando sua vulnerabilidade à doença. Ficou clara a necessidade de se superar algumas deficiências no modelo de assistência e na humanização do atendimento, no grau de compromisso e na qualidade das instituições, dos recursos, do gerenciamento e do monitoramento dos programas de prevenção e detecção do câncer do colo do útero, nos diferentes níveis de atenção. / This cross-sectional, descriptive, exploratory and qualitative study aimed to identify and evaluate the perception of the vulnerability to the disease among women with delayed diagnosis of uterine cervical cancer. The theoretical framework used was the vulnerability, based in the concept proposed by Ayres et al. (2003). The subjects of the study were twelve women who were under follow-up at the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School, for treatment of advanced uterine cervical cancer, between April 08th and May 28th 2009. Data were collected by interviews. The data analysis was done according to the presuppositions of content analysis, proposed by Bardin (2006). Two central categories emerged from the results: Perceiving yourself vulnerable and Facing the disease and the treatment. The vulnerability arose to the participants of this study through the emergence of the first signs and symptoms of the disease, increasing as the diagnosis was determined and treatment was needed, bringing difficulties and suffering. At the same time, women had the opportunity to find ways to face and overcome problems, to the extent possible. The individual, social and programmatic compounds of the vulnerability, included in the concept proposed by Ayres et al. (2003), were shown in the factors related to clients, professionals and services, among others, and made the women susceptible to the problems and damages of their health, related to the uterine cervical cancer, aggravating their vulnerability to the disease. The need to overcome some deficiencies in the model of care and in the humanization of care was evidenced, as well as in the level of commitment and in the quality of the institutions, resources, management, and monitoring of the programs of prevention and detection of uterine cervical cancer, in the different levels of care.