Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [114]-135).

Thesis (Ph.D.)--University of Tennessee Health Science Center, 2009. / Title from title page screen (viewed on August 27, 2009). Research advisor: Donna Hathaway, PhD. Document formatted into pages (ix, 43 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 34-37).

Orientador: Paulo Traiman / Resumo: Objetivando estudar a prevalência de neoplasia intra-epitelial cervical (NIC) em mulheres soro-positivas para o vírus da imunodeficiência humana (HIV) ao compará-las com um grupo controle de mulheres soro-negativas, foi realizado um trabalho retrospectivo em que foram avaliadas 86 mulheres HIV positivas e 86 mulheres HIV negativas, que freqüentaram um serviço público de acompanhamento em DST/AIDS na cidade de Campo Grande, Mato Grosso do Sul, Brasil. Foram realizadas avaliações citológicas pelo Papanocolaou, colposcopias e biópsias quando indicadas. Encontrou-se uma prevalência maior de NIC no grupo de mulheres HIV positivas em comparação ao grupo de mulheres HIV negativas, e esta diferença foi estatisticamente significativa. Conclui o autor que, sendo o câncer do colo uterino uma patologia previnível e com o atual aumento da expectativa de vida das pacientes HIV positivas, este grupo de mulheres merece atenção ginecológica diferenciada com consultas mais frequentes e livre acesso à colposcopia. / Abstract: Objetiving to study the prevalence of cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus (HIV) - infected women and to compar with a group control of seronegative women, it was realized a retrospective study being assessed 86 HIV - infected and 86 HIV - unifected women, who were attended in a public service of accompaniment in TSD/AIDS in Campo Grande City, Mato Grosso do Sul, Brazil. Were realized evolution cytologic for the Papanicolaou test, colposcopy and biopsies, when indicated. It was found a prevalence of CIN significantly greater in HIV - seropositive women than in seronegative women. In conclusion, being the cervical cancer a pathology that can be prevented and with the current increase of the life's expectative of the HIV - seropositive women, this group of women needs a better gynecologic atenttion with visits and Papanicolaou smears more often and free access to colposcopy. / Mestre

INTRODUCTION: Approximately 6 million couples in the United States experience infertility. Because few risk factors for infertility are known, identification of modifiable determinants is an important public health goal. Cervical intraepithelial neoplasia, CIN, occurs when the surface cells of the cervical tissue begin to change, and is caused by infection with a high-risk type of human Papillomavirus (HPV). CIN may affect the cervix’s immunological function, resulting in changes in mucus production, reduced protection against infections, and alterations in sperm transport through the cervical canal. CIN can also progress to invasive cervical cancer. There are four main CIN treatment procedures that aim to remove pre-cancerous cells from the cervix; loop excisions, commonly known as electrosurgical excision procedure (LEEP) or large loop excision of the transformative zone (LLETZ); cryosurgery; conization; and laser ablation. Because the goal of these procedures is to remove abnormal cells, healthy cervical cells may inadvertently be removed as well, leading to further changes in cervical mucus production, sperm motility, and reduced protection against infection. Because of the changes to the cervical tissue and its function, CIN and its surgical treatments may affect fecundability. METHODS: We analyzed data from Pregnancy Study Online (PRESTO), a preconception cohort of 5,594 North American pregnancy planners enrolled and followed between 2013 and 2018. At baseline, participants reported whether they had abnormal Pap tests and their age at their first abnormal Pap test, as well as cervical procedures and their age at the procedure. We estimated fecundability ratios (FR) and 95% confidence intervals (CI) using proportional probabilities models adjusted for sociodemographics, smoking, number of sexual partners, history of sexually transmitted infections/ pelvic inflammatory disease, and HPV vaccination. RESULTS: A history of abnormal Pap test, which we used as a proxy for cervical dysplasia, was positively associated with current and past smoking, gravidity, parity, irregular menses, number of sexual partners, history of chlamydia, genital warts and herpes, as well as a history of pelvic inflammatory disease. Of the women with an abnormal Pap test, the average age at first abnormal Pap test was 23.0 (std=4.5) years and the average number of abnormal Pap tests was 2.1 (std=1.7). We found little association overall between a history of abnormal Pap test and fecundability (FR=1.03, 95% CI: 0.96, 1.11). The results did not differ when the data were examined by number of abnormal Pap tests, or type of procedure. There was also little association between time since the diagnosis or procedure and pregnancy attempt and fecundability. There was however a slight decrease in fecundability within the first 2 years of diagnosis/ procedure, with FRs that tended to increase with increasing time since diagnosis/procedure. DISCUSSION: We found little association overall between a history of abnormal Pap test or cervical dysplasia, including excisional surgeries, and fecundability. These results are consistent with most other studies demonstrating no clear adverse effects of CIN and treatments. Recency of diagnosis or procedure did not appreciably affect these findings. Although we found a very slight decrease in fecundability within the first two years since diagnosis or procedure, fecundability became similar to that of undiagnosed/untreated women after 2 years, and then increased slightly. CONCLUSION: We found little association between a history of abnormal Pap and CIN treatments and fecundability. A major limitation of our study is that the data were self-reported, which may have resulted in non-differential exposure misclassification.

BACKGROUND: Cervical cancer has historically been a major cause of mortality for women worldwide. Over the last 50 years, thanks to advances in screening technologies and the implementation of standardized management algorithms, the incidence of cervical cancer in the United States has been declining. LITERATURE REVIEW: In the most recent set of algorithms, the 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors, the authors conclude that there is high-level evidence to support extended screening intervals for women who are at average-risk for cervical cancer and who have a history of negative screening tests. However, there is large population of women with a history of abnormal screening tests, and their risk of recurrent disease is not well understood. Additionally, the predictive value of the available screening tests for this cohort of women is unknown. The authors of the 2012 Guidelines warn that there is insufficient evidence for optimal management of these women, the current guidelines are based on expert opinion only, and studies providing high-level evidence are lacking. PROPOSED PROJECT: This thesis proposes a systematic literature review of the existing evidence regarding to what extent women who are treated for cervical abnormalities at baseline are at an increased risk for persistent or recurrent disease in the future. Journal articles will be gathered from three different databases and abstracts will be screened for duplicity and relevancy. After article selection, the quality of evidence presented in each paper will be evaluated using the GRADE system to facilitate a methodical and accurate comparison of the existing evidence. Finally, a scheme for data abstraction from the articles will be outlined. CONCLUSIONS: The results of this systematic literature review will serve multiple purposes, including identifying what research has been done since the latest revision of management guidelines, and aiding in the revision of the algorithms for the population of women who have had abnormal screening test results. It will also identify persistent gaps in the body of knowledge regarding this cohort of patients, and guide the development of additional research studies to fill those gaps. SIGNIFICANCE: Determining the risk of recurrent disease in women with abnormal cervical cancer screening tests will serve to more optimally manage this cohort of women. This will allow providers to effectively monitor patients for the recurrence of cervical disease, while also minimizing the risks associated with overscreening.

No description available.

Objective. To assess the acceptability of cervical screening using direct visual inspection after acetic acid application followed by immediate cryotherapy for cervical intraepithelial neoplasia among women in rural Guatemala. Materials and Methods. An unselected group of 1,052 women voluntarily registered to undergo cervical screening using direct visual inspection of the cervix after acetic acid application. Women with acetowhite changes consistent with cervical intraepithelial neoplasia were offered immediate cryotherapy. Results. Cervical screening was deferred in 80 (7.6%) registrants, and 18 (1.7%) refused to undergo an examination. Among the 954 registrants screened, 125 (13%) had findings consistent with cervical intraepithelial neoplasia. Cryotherapy was deferred in three patients. A total of 121 (99%) women agreed to immediate cryotherapy. Conclusion. Direct cervical visualization after acetic acid application followed by immediate cryotherapy for acetowhite changes consistent with cervical intraepithelial neoplasia would be a well-accepted method of cervical screening in rural Guatemala.

In the normal ectocervix, mitoses are rare and are usually confined to the basal layers. In contrast, they occur more frequently in cervical intraepithelial neoplasia (CIN) and are seen at higher levels, suggesting that CIN may be associated with a progressive dysfunction in proliferative activity of cervical cells. The objective of this study was to use proliferating cell nuclear antigen (PCNA) immunohistochemistry to examine the proliferative activity of cervical epithelial cells in CIN lesions. Sixty- eight cervical biopsies were examined; 20 were totally benign, 14 had CIN I, 21 CIN II, and 13 CIN III. In benign epithelia, PCNA staining was usually confined to the basal layers, whereas in CIN the staining was seen at progressively higher levels of the epithelium. There was a statistically significant correlation between the CIN grade and the highest level of PCNA staining (PCNA grade, r = 0.746, P < 0.001). In addition, the PCNA grade showed significant correlation with the highest level at which mitoses were seen (mitosis grade, r = 0.706, P < 0.001), and a strong direct correlation between the mitosis and CIN grades was also observed (r = 0.955, P < 0.001). These data demonstrate that (1) PCNA immunoreactivity in neoplastic cervical epithelium is different from that seen in the normal cervix, suggesting that CIN is associated with a dysfunctional proliferation of cervical epithelium, (2) that there is a significant correlation between the PCNA grade and CIN grades, and (3) the 'mitosis grades' have a strong correlation with the CIN grades.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 71-78).

The aim of this research was to study the correlation between tissue tumor marker expression and HR-HPV infection, smoking, hormonal contraceptive use and sex steroids in women with cervical intraepithelial neoplasia or normal epithelium. The study investigated the expression of 11 tumor markers in cervical biopsies obtained from 228 women with different diagnoses ranging from normal cervical epithelium to various stages of CIN. 188 women were recruited at our colposcopy clinic (out-patient surgery, Department of Obstetrics and Gynecology, Falun Hospital) for laser cervical conization or a directed punch biopsy, either because of a vaginal smear (Pap smear) that showed cytological findings suggesting CIN, or because of repeated findings showing atypical squamous cells of undetermined significance (ASCUS). For 40 volunteers, punch biopsies were taken from the normal cervical epithelium. The time period for this study was 2005-2007. Study I :  228 women, of whom 116 were tested, 64 were positive to HR-HPV. The results showed that Ki67 tumor cell proliferation index was the only marker that independently correlated to both the presence of HR-HPV and the severity of cervical lesions. Study II:  228 women, of whom 83 were smokers (36, 9%). Smokers showed lower expression of p53, FHIT (tumor suppressor markers) and interleukin-10 .Higher expression of Cox-2 and Ki-67 (tumor proliferation markers). Study III:  195 women who were premenopausal. There was increased p53 expression (tumor suppressor) in the progestin-IUD users compared to non-users. Decreased IL-10 expression (immunological marker) was observed in both COC users and any progestin-only users. Study IV: Serum from 80 premenopausal women was available. The main finding was that the increased levels of serum progesterone and estradiol were associated with increased Cox-2 expression (proliferation marker). Serum progesterone and estradiol levels influence cellular and extracellular proteins which have been associated with neoplastic development in normal epithelium and CIN. Conclusion: The results of these studies support previous epidemiological findings on the role of smoking, contraceptive use and sex steroids as co-factors in development of CIN and that tumor marker expression varies in different grades of CIN.