Invasive carcinoma of the cervix was compared in women under and over 35 years of age in a 10-year cohort study for the period 1974 - 1983. The aim was to determine if there were any significant differences in disease characteristics and survival. A non-concurrent prospective study design was employed with a follow-up period of at past 5 years. All eligible young patients (n = 82) were studied out of a total patient population of 1522 and compared with a 13% random sample (n = 82) of equally eligible older patients. There were three study losses in each group (3,7%), giving a final comparison number of 79. Patient data included disease stage, treatment type and complications, recurrence time and site and survival time. Tumour pathological characteristics were reviewed and evidence of Human Papillomavirus (HPV) was sought on histology and cytology specimens. Life table analyses were performed on the survival data and compared by the logrank test. The covariates of disease stage, treatment type and tumour type were included in the analysis of the effect of age group on survival. Multivariate analysis with a proportional hazards general linear model was performed for simultaneous control of confounding factors. Other disease characteristics were compared using the Chi-square test. The overall proportion of young women was 11,6%. (This did not change for the period 1984 1988.) Five-year survival was 57% for the young and 46% for the older group (not statistically significant: p = 0,198). There was no statistically significant difference in a number of characteristics, including tumour size, endocervical site, grade or type. There were 8 non-squamous tumours in the young {10%). Residual disease, time to recurrence, rate and site of distant metastasis, and treatment of recurrent tumour did not differ significantly; nor did rate of spread to lymph nodes, adequacy of follow-up or treatment complications. Evidence of HPV was found in 35% of evaluable histology and 21% of malignant cytology. There was no significant excess of HPV in the young group. The same applied to the length of the preinvasive phase and the false negative cytology rate - no significant differences were found. There were significantly more Stage lB tumours in the young group (p = 0,01), surgery was used more often for treatment in young patients (p = 0,027) and the difference in survival between the disease stages was highly significant (p 0,0001). Multivariate analysis showed that the effect of age on survival was non-significant (p = 0,850). The conclusion of the study is that cervical carcinoma in young women is not a different disease with a worse prognosis than in older women. Furthermore, it is not becoming more common in the young locally. Young women tend more often to have early stage disease.

Despite the availability, accessibility and affordability of cervical cancer screening (CCS) in Malawi, many women do not utilize the CCS services. This research was conducted in Blantyre district, Malawi. The main objective of the study was to identify factors that act as barriers to the uptake of cervical cancer screening programs among urban and rural women in the Blantyre district of Malawi. A quantitative design was used and convenience sampling was applied in selecting a sample of 196 women from the population of women aged 18 and over in two Reproductive Health clinics, one urban clinic at Queen Elizabeth Central Hospital and one rural clinic at Mlambe hospital in Blantyre district, Malawi. A structured questionnaire was used to collect data. The questionnaire was translated from English into the local Chichewa language so that respondents were interviewed and responded in a language that they were able to comprehend. Analysis and discussion of findings are presented in five sections. Data were processed into numeric values using SPSS version 15.0 and Microsoft Excel to give meaning to the findings of the study. In order to test for statistically significant associations between variables, the Pearson correlation was applied. The study revealed that the main barrier to CCS was that women lack knowledge and information about cervical cancer and there is a lack of publicity about CCS services. Lack of knowledge was found in relation to - risk factors, prevention of, detection of and benefits of cervical cancer screening with a greater knowledge deficit being found in the rural women. Higher levels of education in both the urban and rural groups did not have a positive influence on the screening behaviours of the women. Commencing sexual intercourse at ages 15 to 19 years and having multiple sexual partners were the main risk factors to cervical cancer among the women in the study. It was also found that although rural women perceived themselves being very likely to be at risk of cervical cancer, this perception did not translate into CCS behaviour. v / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

Made available in DSpace on 2014-07-29T15:30:36Z (GMT). No. of bitstreams: 1 Dissertacao Andrea Alves Ribeiro.pdf: 1577076 bytes, checksum: 24bc7ace843786b03ff879da0df4f7aa (MD5) Previous issue date: 2009-12-15 / Human papillomavirus (HPV) is considered the central etiological agent involved in the genesis of cervical cancer. The HPV viruses are classified according to their biological niche, oncogenic potential and phylogenetic position. According to the criteria established by the International Committee on Taxonomy of Viruses (ICTV), the various groups of human papillomaviruses that infect the female genital tract are classified phylogenetically in the Alphapapillomavirus genus, including species classified among phylogenetic species 1 and species 15. The main high risk HPV are classified in species 9 (HPV 16, 31, 33, 35, 52, 58, 67), and in species 7 (18, 39, 45, 59, 56, 66, 68 and 70). HPV 16 is the most prevalent type irrespective of diagnosis, principally in more severe lesions. Coinfection with multiple-types HPV is a common finding of many molecular studies. Some HPV types might interact or act synergistically to induce progression. Few studies have investigated the interactions of viral genotypes or species in multiple-type HPV infections. Therefore, the objective of this study was to evaluate the effect of single or multiple-types HPV infections considering also the phylogenetic groups on the prevalence and severity of cervical intraepithelial neoplasia (CIN) among women undergoing colposcopy following a abnormal cervical smear. Methodology: In this analysis, 198 women attending at the colposcopic clinic, because of an abnormal cervical smear were included. Colposcopy was carried out in all cases and biopsies were done in 193 of 198 women included. All specimens were tested for 27 HPV genotypes by Roche s polymerase chain reaction reverse line blot assay. Results: The overall prevalence of HPV in women with an abnormal cervical smear was 86% (171/198). Of the total of HPV-positive women, 45% (77/171) were infected with HPV 16 as a single or multiple-type infections. HPV 31 and 35 were, respectively, the second and third most prevalent types. The prevalence of HPV 16 in high grade cervical intraepithelial neoplasia (CIN2/3) was 52% (40/76) and it was detected in 88.8% (8/9) in cases of invasive carcinoma. The prevalence of type 31 and 35 in high grade CIN was respectively 10.5% (8/76) and 6.6% (5/76). Single HPV infection for any type was significantly associated with neoplastic diagnosis. High grade neoplastic diagnosis (≥ CIN2) was significantly associated with HPV 16 in single or multiple infections. Also, there was significantly association between HPV 16 and others types of specie 9 and high grade neoplastic diagnosis, but no association was observed considering the HPV 16 and other of groups of species 7 or others types. Conclusion: These results indicated that the type 16 is the most important predictor of high grade cervical neoplasia. Multiple-type infections are predictors of high grade cervical neoplasia when the type 16 is present. / O Papilomavírus humano (HPV) é considerado o agente etiológico central envolvido na gênese do câncer cervical. O vírus HPV é classificado de acordo com seu nicho biológico, potencial oncogênico e classificação filogenética. De acordo com os critérios estabelecidos pelo Comitê Internacional de Taxonomia dos Vírus (ICTV), os diversos tipos de HPV que infectam o trato genital feminino são classificados filogeneticamente no gênero Alphapapillomavirus. Esta classificação inclui espécies filogenéticas classificadas entre a espécie 1 e a espécie 15, dentre as quais, as de maior interesse em relação ao potencial carcinogênico são a espécie 9 (HPV 16, 31, 33, 35, 52, 58, 67) e a espécie 7 (18, 39, 45, 56, 59, 66, 68, 70). O HPV 16 é tipo o mais predominante, independente do diagnóstico, presente principalmente nas lesões cervicais mais graves. A co-infecção com múltiplos tipos de HPV é um achado comum em muitos estudos moleculares, contudo, as interações dos genótipos virais ou espécies envolvidas nas infecções por múltiplos tipos de HPV têm sido pouco analisadas. Portanto, o objetivo deste estudo foi avaliar o efeito das infecções simples ou por múltiplos tipos de HPV, considerando também os grupos filogenéticos, sobre a prevalência e a gravidade das neoplasias cervicais. Metodologia: Este estudo de corte transversal incluiu 198 mulheres encaminhadas ao Ambulatório de Colposcopia da Santa Casa de Misericórdia de Goiânia por exame citopatológico anormal. Todas as mulheres foram esclarecidas quanto aos objetivos de estudo e assinaram o termo de consentimento livre e esclarecido. A colposcopia foi realizada em todos os casos e a biópsia em 193 das 198 mulheres incluídas. As amostras foram testadas para 27 genótipos de HPV, por reação em cadeia da polimerase (PCR); em seguida foi realizada a hibridização reversa em pontos da Roche Diagnósticos. Resultados: A prevalência de HPV em mulheres encaminhadas por exame citopatológico anormal foi de 86% (171/198). Do total de mulheres HPV-positivas, 45% (77/171) estavam infectadas por HPV 16 em infecções simples e múltiplas. Os tipos de HPV 31 e 35 foram respectivamente, o segundo e o terceiro mais prevalentes. A prevalência do HPV 16 foi de 52% (40/76) nas neoplasias intra-epiteliais cervicais de alto grau (NIC 2/3) e de 88,8% (8/9) nos casos de carcinomas invasivos. As prevalências dos tipos 31 e 35 em neoplasias intra-epiteliais cervicais de alto grau (NIC 2/3) foram de 10,5% (8/76) e 6,6% (5/76), respectivamente. A infecção simples por qualquer tipo de HPV foi significativamente associada com diagnósticos neoplásicos de alto grau (≥ NIC 2). Os diagnósticos neoplásicos de alto grau (≥ NIC 2) foram significativamente associados com o HPV 16 em infecções simples ou múltiplas, mesmo depois de ajustado pela positividade para DNA de HPV. Houve significativa associação entre o HPV 16 e outros tipos da espécie 9 e os diagnósticos neoplásicos de alto grau (≥ NIC 2), mas não foi observada associação, considerando o HPV 16 e outros tipos da espécies 7 ou outros tipos de HPV. Conclusão: Estes resultados indicam que o HPV 16 parece ser o mais importante preditor de diagnósticos neoplásicos de alto grau. As infecções múltiplas são preditoras das neoplasias cervicais de alto grau quando o HPV 16 está presente.