Prevalence of epithelial squamous cell abnormalities and associated factors in women of a rural town of Colombia
Keywords:
uterine cervical neoplasms/epidemiology, epithelial cells, cervical cancer, vaginal smears, cytology, control and prevention, cervical intraepithelial neoplasia/prevention and control, Colombia
Abstract
Introduction. In spite of implementation of cytology-based cervical cancer screening in Colombia, mortality rates remain stable. The description of factors associated to cervical pre-neoplasic lesions is needed to establish strategies for mortality prevention.Objective. The prevalence of epithelial squamous cell abnormalities was determined to explore the association of cytology abnormalities with described risk factors.
Materials and methods. This population-based, cross-sectional study included 739 women randomly selected by age. A validated face-to-face questionnaire and conventional cervical cytology were used to collect the information. To establish the association between cervical abnormalities and some qualitative variables, the independent chi squared test was used. We also calculated prevalence ratio with their 95% confidence intervals. A logistic regression model was used to explore variables that potentially explain cytology abnormalities.
Results. The prevalence of squamous cell abnormality was 15.8%. Among women with abnormal cytology, 10% presented atypical squamous cells of undetermined significance, 3.9% low grade squamous intra-epithelial lesion and 1.9% high grade squamous intra-epithelial lesion. The adjusted logistical regression analysis showed that history of sexual transmitted disease, two or more sexual partners during entire life and previous abnormal cytology were associated with cytology abnormalities.
Conclusion. The relation of epithelial squamous cell abnormalities with sexual behavior history reflexes the link between human papiloma virus infection and cervical cancer pre-neoplasic lesions. The frequency of use and knowledge about the purpose of cytology were factors that suggested other diagnostic limitations such as quality of cervical cytology or barriers to access health care. These latter factors may be the underlying basis for the high cervical cancer mortality rates.
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References
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25. Hildesheim A, Herrero R, Wacholder S, RodríguezAC, Solomon D, Bratti MC, et al. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial. JAMA. 2007;298:743-53.
26. Markowitz LE. HPV vaccines prophylactic, not therapeutic. JAMA. 2007;298:805-6.
27. Hanisch R, Gustat J, Hagensee ME, Baena A, Salazar JE, Castro MV, et al. Knowledge of Pap screening and human papillomavirus among women attending clinics in Medellin, Colombia. Aceptado. Int J Gynecol Cancer. 2007. doi: 10.1111/j.1525- 1438.2007.01131.
28. Flores Y, Bishai D, Lazcano E, Shah K, Lorincz A, Hernández M, et al. Improving cervical cancer screening in Mexico: results from the Morelos HPV Study. Salud Pública Mex. 2003;45(Suppl.3):S388-98.
2. Parkin DM, Bray F. The burden of HPV-related cancers. Vaccine. 2006;24(Suppl.3):S11-25.
3. Piñeros M, Ferlay J, Murillo R. Cancer incidence estimates at the national and district levels in Colombia. Salud Pública Mex. 2006;48:455-65.
4. Piñeros M, Cendales R, Murillo R, Wiesner C, Tovar S. Pap test coverage and related factors in Colombia, 2005. Rev Salud Pública (Bogotá). 2007;9:327-41.
5. Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12-9.
6. Burchell AN, Winer RL, de Sanjose S, Franco EL. Chapter 6: Epidemiology and transmission dynamics of genital HPV infection. Vaccine. 2006;24 (Suppl. 3):S52-61.
7. Moscicki AB, Schiffman M, Kjaer S, Villa LL. Updating the natural history of HPV and anogenital cancer. Vaccine. 2006;24(Suppl.3):S42-51.
8. Solomon D, Davey D, Kurman R, Moriarty A, OConnor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114-9.
9. Kitchener HC, CastlePE, Cox JT. Achievements and limitations of cervical cytology screening. Vaccine. 2006;24(Suppl.3):S63-70.
10. Almonte M, Ferreccio C, Winkler JL, Cuzick J, Tsu V, Robles S, et al. Cervical screening by visual inspection, HPV testing, liquid-based and conventional cytology in Amazonian Peru. Int J Cancer. 2007;121:796-802.
11. Goldie SJ, Kim JJ, Kobus K, Goldhaber-Fiebert JD, Salomon J, Oshea MK, et al. Cost-effectiveness of HPV 16, 18 vaccination in Brazil. Vaccine. 2007;25:6257-70.
12. Arbyn M, Sasieni P, Meijer CJ, Clavel C, Koliopoulos G, Dillner J. Clinical applications of HPV testing: A summary of meta-analyses. Vaccine. 2006;24(Suppl.3):S78-89.
13. Herrero R, Hildesheim A, Bratti C, ShermanME, Hutchinson M, Morales J, et al. Population-based study of human papillomavirus infection and cervical neoplasia in rural Costa Rica. J Natl Cancer Inst. 2000;92:464-74.
14. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: Wiley Interscience, John Wiley & Sons, Inc; 2000.
15. Lazcano-Ponce E, Herrero R, Muñoz N, Cruz A, Shah K, Alonso P, et al. Epidemiology of HPV infection among Mexican women with normal cervical cytology. Int J Cancer. 2000;91:412-20.
16. Molano M, Posso H, Weiderpass E, van den Brule AJ, Ronderos M, Franceschi S, et al. Prevalence and determinants of HPV infection among Colombian women with normal cytology. Br J Cancer. 2002;87: 324-33.
17. Ferreccio C, Prado RB, Luzoro AV, Ampuero SL, Snijders PJ, Meijer CJ, et al. Population-based prevalence and age distribution of human papillomavirus among women in Santiago, Chile. Cancer Epidemiol Biomarkers Prev. 2004;13:2271-6.
18. Molano M, van den Brule AJ, Posso H, Weiderpass E, Ronderos M, Franceschi S, et al. Low grade squamous intra-epithelial lesions and human papillomavirus infection in Colombian women. Br J Cancer. 2002;87:1417-21.
19. Stoler MH, Schiffman M. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study. JAMA. 2001;285:1500-5.
20. Confortini M, Carozzi F, Dalla Palma P, Ghiringhello B, Parisio F, Prandi S, et al. Interlaboratory reproducibility of atypical squamous cells of undetermined significance report: a national survey. Cytopathology. 2003;14:263-8.
21. Castellsague X, Bosch FX, Munoz N. The male role in cervical cancer. Salud Pública Mex. 2003;45 (Suppl.3):S345-53.
22. Profamilia. Encuesta Nacional de Demografía y Salud-ENDS 2005. Consultado: 16 de agosto de 2007. Disponible en: http://www.profamilia.org.co/encuestas/01encuestas/2005resultados_generales.htm
23. Paavonen J, Jenkins D, Bosch FX, Naud P,Salmeron J, Wheeler CM, et al. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomized controlled trial. Lancet. 2007;369:2161-70.
24. Ault KA, Future II Study Group. Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomized clinical trials. Lancet. 2007;369:1861-8.
25. Hildesheim A, Herrero R, Wacholder S, RodríguezAC, Solomon D, Bratti MC, et al. Effect of human papillomavirus 16/18 L1 viruslike particle vaccine among young women with preexisting infection: a randomized trial. JAMA. 2007;298:743-53.
26. Markowitz LE. HPV vaccines prophylactic, not therapeutic. JAMA. 2007;298:805-6.
27. Hanisch R, Gustat J, Hagensee ME, Baena A, Salazar JE, Castro MV, et al. Knowledge of Pap screening and human papillomavirus among women attending clinics in Medellin, Colombia. Aceptado. Int J Gynecol Cancer. 2007. doi: 10.1111/j.1525- 1438.2007.01131.
28. Flores Y, Bishai D, Lazcano E, Shah K, Lorincz A, Hernández M, et al. Improving cervical cancer screening in Mexico: results from the Morelos HPV Study. Salud Pública Mex. 2003;45(Suppl.3):S388-98.
How to Cite
1.
Arbeláez MP, Grisales H, Vanegas Ángela P, Gaviria Ángela M, Castaño J, Mora MA, et al. Prevalence of epithelial squamous cell abnormalities and associated factors in women of a rural town of Colombia. biomedica [Internet]. 2008 Jun. 1 [cited 2024 May 19];28(2):271-83. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/98
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