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| 2. |
- Bjerre, Pontus, et al.
(författare)
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A randomized trial of basing treatment on human papillomavirus and/or cytology results in low-grade cervical lesion triage
- 2008
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 199:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study was undertaken to compare management algorithms that base treatment with loop electrosurgical excision procedure on human papillomavirus and/or repeat Papanicolaou test smear results. STUDY DESIGN: A randomized trial that referred 674 women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions cytology results, detected in organized screening to treatment either (1) if they were positive in a repeat Papanicolaou test smear and/or a human papillomavirus test or (2) if they were positive in the repeat Papanicolaou test smear test only. Women who tested positive were treated, regardless of colposcopic findings. RESULTS: There were 208 of 337 (62%) women who were treated in the human papillomavirus /Papanicolaou test smear group (187/337 because of HPV positivity) and 138 of 337 (41%) in the Papanicolaou test smear only group. Histopathologically diagnosed cervical intraepithelial neoplasia grade 2 or worse was found among 112 of 337 (33.2%) women in the human papillomavirus/Papanicolaou test smear group compared with 85 of 337 (25.2%) women in the Papanicolaou test smear only group (P < .05). Twenty-one women with cervical intraepithelial neoplasia 2+ had normal colposcopy. CONCLUSION: For adequate cervical intraepithelial neoplasia 2+ sensitivity, the decision to use loop electrosurgical excision procedure needs to be based on human papillomavirus testing results and should not exclude women with normal colposcopy.
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| 3. |
- Ideström, M., et al.
(författare)
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Cervical cancer screening--"For better or worse...": women's experience of screening
- 2006
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Ingår i: Cancer Nurs. - 1538-9804. ; 29:6, s. 453-60
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, the population-based cervical cancer screening program has been in progress since the 1970s and is directed toward women between 23 and 60 years of age. The aim of this study was to explore women's experience of cervical screening after being diagnosed with cancer. A qualitative study inspired by Grounded Theory was used. Eleven women were interviewed. The interviews were analyzed using the constant comparative method. "Screening-For Better or Worse..." was identified as the core category, around which the categories "Unawareness," "Trust," "Search for Understanding," and "Making the Invisible Visible" were integrated and on which the conceptual model was built. The experience of screening had both a positive and a negative dimension for the women stricken by cervical cancer. The women had a positive experience of screening as such and they believed in its benefits. However, many women felt deceived and, because of their unawareness, questions arose for which they searched for understanding. The women requested adequate and understandable information. Their trust remained because the contact with healthcare professionals involved in screening and in the follow-up program had been reassuring.
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| 4. |
- Ideström, Monica, 1953, et al.
(författare)
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The cervical cancer screening program from a midwife's perspective
- 2007
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Ingår i: Acta Obstet Gynecol Scand. ; 86:6, s. 742-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Midwives in Sweden are responsible for taking Papanicolaou (Pap) smears as part of the cervical cancer screening program. The aim of this study was to investigate midwives knowledge, experience and management of the cervical cancer screening program, and their apprehension of women's knowledge about Pap-smear screening. METHODS: A postal questionnaire was sent to midwives working in primary health care in 3 different areas in Sweden. A total of 156 (77%) out of 201 midwives completed the questionnaire. RESULTS: Four of 5 midwives considered themselves to have the education they needed to manage the screening program. However, the study indicated that midwives lacked a basic structure when giving information. As many as every third midwife refrained from or had an irrelevant answer to the proposed question, what is meant by a cellular atypia? Almost all midwives saw themselves as the main informant about Pap-smear screening. At the same time, the midwives perceived that women lacked knowledge about cellular atypia, and thought it was the same as cancer. Some 38% of the midwives expressed a wish to terminate the 'assembly line-like' screening system. The remaining midwives were completely satisfied with the organisation. CONCLUSIONS: Many midwives lacked time and a structured guidance when discussing screening and cervical atypia. Improvement in the organisation and certified education for Pap-smear screening with access to recent research, could develop a more empowering exchange between the midwives and the women participating in cervical screening.
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| 5. |
- Lindh, Ingela, 1954, et al.
(författare)
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Contraceptive use and pregnancy outcome in three generations of Swedish female teenagers from the same urban population
- 2009
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Ingår i: Contraception. - : Elsevier BV. - 0010-7824. ; 80:2, s. 163-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The primary objective of the study was to describe contraceptive use, reasons for discontinuation of contraception and pregnancy outcome in three generations of female teenagers over a period of 20 years. The secondary objective was to describe the relationship between contraception, smoking, body mass index (BMI) and socioeconomic status (SES). STUDY DESIGN: A cross-sectional comparison of 19-year-old women born in 1962, 1972 and 1982 and living in the city of Gothenburg, Sweden, in 1981, 1991 and 2001 was conducted. Contraceptive use, pregnancy outcome, smoking and weight/height were assessed by a postal questionnaire. RESULTS: Current contraceptive use was unchanged between the 62 (60%) and 72 cohorts (62%) but had increased (p<.01) in the 82 cohort (78%); there was no difference in contraceptive use between SES groups at any time. Condom use alone increased over time (p<.01), and the use of oral contraception and a condom together had increased in the 72 and 82 cohorts compared to the 62 cohort (p<.01). Reasons given for using and discontinuing oral contraceptives in three generations of teenagers were studied over 20 years. In addition to contraception, oral contraception was used to reduce dysmenorrhea and heavy bleeding. Discontinuation due to bleeding disturbances decreased (p<.01) over time, whereas discontinuation due to mental side effects increased (p<.01). The percentage of women who had been pregnant at < or =19 years of age in the 82 cohort (7%) was lower (p<.01) than in the 1962 (11%) and 1972 (13%) cohorts. However, there was a successive increase (p<.001) in the percentage of women who had been pregnant more than once at < or =19 years of age (1962/1972/1982: pregnant more than once, 8%/21%/31%). Smoking decreased over time (p<.01) and was no longer related to SES in the 82 cohort. BMI increased (p<.01) over time. There was no difference in BMI between SES groups in the 62 and 72 cohorts but was higher in the low-SES group in the 82 cohort compared to the middle (p<.01) and high (p<.05) SES groups. CONCLUSIONS: Contraceptive use was higher in the 82 cohort where there was a corresponding reduction in the percentage of women who had been pregnant at < or =19 years of age compared with the 62 and 72 cohorts. Discontinuation of oral contraception due to mental side effects increased over time. The prevalence of smoking decreased and BMI increased, and there were changes in smoking prevalence and BMI in the different SES groups over time.
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| 7. |
- Strander, Björn, 1952, et al.
(författare)
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Does HPV-status 6-12 months after treatment of high grade dysplasia in the uterine cervix predict long term recurrence?
- 2007
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Ingår i: Eur J Cancer. ; 43:12, s. 1849-55
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Women once treated for high grade cervical dysplasia have a high long term risk for developing new dysplasia or cancer. OBJECTIVES: To investigate if human papilloma virus (HPV)-negativity after treatment of cervical dysplasia reduces the need for frequent long term follow up. DESIGN: Case/control study based on archival smears. METHODS: Women with cervical intraepithelial neoplasi (CIN)2-3, treated for dysplasia and with recurrence of CIN2+ more than 2 years after treatment were compared with controls without recurrence, matched for age and date of treatment. High risk-HPV-DNA were analysed with PCR from two archival smears per woman. Mean follow up time was 14.6 years. RESULTS: 24% (45/189) of cases and 11% (43/378) of controls were HPV-positive in any of two smears. Odds ratio (OR)=2.5 (1.6-3.8). CONCLUSION: HPV-status 6-12 months after treatment of high grade dysplasia is of limited value for the design of long term follow up.
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| 8. |
- Strander, Björn, 1952, et al.
(författare)
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Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program : a prospective randomized study
- 2007
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Ingår i: Cancer Cytopathology. ; 111
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND.: The objective of this study was to evaluate whether liquid-based cytology (LBC) can improve high-standard cervical cancer screening cytology further. The primary endpoint was histopathologic high-grade lesions in current and subsequent screening rounds. The secondary endpoints were cytologic diagnosis and inadequate samples. METHODS.: Women were randomized to smear taking by conventional Papanicolaou (Pap) smear or LBC according to the time of appointment. Eight thousand eight hundred ten conventional Pap smears and 4674 LBC samples were included. Evaluations of atypical cytology and referral to colposcopy and treatment were performed as routine procedures. Histopathologic diagnoses were retrieved from a regional database 8 months after the study was closed. The mean follow-up was 2 years and 9 months. RESULTS.: Inadequate samples were observed in 0.3% of LBC samples versus 0.7% of Pap smears (P = .002). The total fraction of nonbenign diagnoses in cytology was 4.5% versus 3.5%, respectively (P < .001). Histopathologic evaluation was made on 570 patients constituting 4.6% of the LBC samples and 4% of the Pap smears. Forty percent more high-grade lesions were identified as a result of LBC sampling (1.20% vs 0.85%; P = .05). The influence of the sampling method was significant for all variables (odds ratio [OR], 1.60; 95% confidence interval [95% CI], 1.12-2.28) for high-grade lesions that were identified by histology when adjusting for age and screening unit in a logistic regression model. At the second follow-up 2 years and 1 month later, the OR was decreased only slightly (1.51; 95% CI, 1.13-2.01). CONCLUSIONS.: In the ongoing cervical screening program of western Sweden, liquid cytology produced a significantly higher yield of histologic high-grade lesions compared with conventional Pap smears. Cancer (Cancer Cytopathol) 2007. (c) 2007 American Cancer Society.
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| 9. |
- Strander, Björn, 1952, et al.
(författare)
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Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study
- 2007
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Ingår i: British Medical Journal. - 1468-5833. ; 335:7629, s. 1077-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the long term risk of invasive cancer of the cervix or vagina after treatment for cervical intraepithelial neoplasia grade 3. DESIGN: Prospective cohort study. SETTING: Swedish cancer registry. PARTICIPANTS: All women in Sweden with severe dysplasia or cervical carcinoma in situ (equivalent to cervical intraepithelial neoplasia grade 3) treated during 1958-2002 (n=132 493) contributing 2 315 724 woman years. MAIN OUTCOME MEASURES: Standardised incidence ratios with risk of cancer in the Swedish general female population as reference, and relative risks in multivariable log-linear regression model, with internal references. RESULTS: Women with previous cervical intraepithelial neoplasia grade 3 had an increased risk of invasive cervical cancer compared with the general female population (standardised incidence ratio 2.34, 95% confidence interval 2.18 to 2.50). The increased risk showed a decreasing trend with time since diagnosis for women treated later than 1970 but the risk was still increased after 25 years. An effect of age was found, with an accentuated increase in risk for women aged more than 50. The excess risk for cervical cancer associated with previous cervical intraepithelial neoplasia grade 3 has steadily increased since 1958. For vaginal cancer the standardised incidence ratio was 6.82 (5.61 to 8.21) but this decreased to 2.65 after 25 years. Adjustments in the multivariable log-linear regression model did not substantially alter these results. CONCLUSIONS: Women previously treated for cervical intraepithelial neoplasia grade 3 are at an increased risk of developing invasive cervical cancer and vaginal cancer. This risk has increased since the 1960s and is accentuated in women aged more than 50. The risk is still increased 25 years after treatment.
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| 10. |
- Strander, Björn, 1952, et al.
(författare)
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The performance of a new scoring system for colposcopy in detecting high-grade dysplasia in the uterine cervix
- 2005
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Ingår i: Acta Obstet Gynecol Scand. - : Wiley. - 0001-6349. ; 84:10, s. 1013-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To construct a simple scoring system for colposcopic examination that can facilitate education of colposcopists and increase the accuracy of evaluation. DESIGN: Prospective clinical study. SETTING AND POPULATION: Two hundred ninety-seven examinations of women referred for colposcopy in western Sweden. METHODS: Five variables were scored: acetowhiteness, margins and surface, vessels, lesion size, and iodine staining. Each variable could be assigned one of three ordered values. Multiple logistic regression was used in order to assess the ability of each single score to predict high-grade lesions (HGL) in histology (cone or biopsy). MAIN OUTCOME MEASURES: Histopathology. RESULTS: All five variables independently predicted for HGL. The analysis resulted in an 'ideal' weighted scoring system, which showed good sensitivity and specificity. Rounding off of each weight gave a more useful and simpler scoring system with values of 0, 1, or 2 without any significant change in performance. The possible total score was then 0-10. A score of > or =5 points identified all HGL and > or =8 points had a specificity of 90%. CONCLUSIONS: The scoring system safely identified a group of patients with low-grade lesions or normal findings, thus allowing 17% to be followed only by colposcopy or cytology. Furthermore, it could select women for see-and-treat with only 10% of cases having less than HGL. With this strategy, only approximately 50% of the cases would have needed biopsy in the evaluation.
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