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Improving cervical cancer screening in Mexico: The HPV testing of self-collected vaginal and clinician-collected cervical specimens was evaluated as part of this study. The acceptability of the HPV testing of self-collected specimens was compared to that of the Pap test. Our results also indicate an over-all mejorandola javascript acceptability mejorandola javascript the Pap test as compared to the self-collected procedure.

Our results suggest that self- and clinician-collected HPV testing could be used in CC prevention programs, as an effective complement or substitute for the Pap test. This paper is available too at: Key words: Palabras clave: Cervical cancer CC is a major public health problem in Mexico, and in many other developing countries. Over the past 25 years CC mortality rates have remained stable, fluctuating little from The incidence of invasive CC in Mexico is also estimated to be one of the highest in the world.

Inthe incidence of CC was estimated mejorandola javascript be 40 new cases per women, and mejorandola javascript this estimate had increased to 50 new cases per In Mexico, it has been difficult to establish and maintain an effective Pap-based screening mejorandola javascript, such as those that are credited with reducing CC rates in mejorandola javascript developed world.

One of the explanations for the low coverage of the Mexican CCSP is the limited utilization and acceptability of the Pap test due to cultural and institutional barriers.

Other reasons include: Although the efficacy of the Pap test has never been evaluated in a randomized trial, it is the primary tool for the screening of cervical neoplasia around the world. The decline in the number of advanced lesions and in the mortality rate for patients with CC that has occurred in the last 40 years has mainly been attributed to the introduction of this screening test.

This is probably related to an increase in the incidence of sexually transmitted diseases, including infection with certain types of human papillomavirus HPV16 which may have occurred years ago. Also important is the fact that in some developed countries with well screened populations, CC mortality rates have stabilized and large reductions in mortality are not expected.

One possible option is the use of HPV testing as an alternative to, or in conjunction with, the Pap test. Genital HPV infection is the most common sexually transmitted viral infection.

Some of the possible uses of HPV testing include: The higher costs that may be associated with HPV testing are likely to be offset by the savings in the direct and indirect costs of Pap testing and Colposcopy services, and by allowing longer screening intervals for HPV DNA negative women.

On its own or in conjunction with cytology, there are a number of possibilities for incorporating HPV testing at different ages and at different screening intervals. Studies that have modeled different HPV screening strategies using various values for prevalence, sensitivity, and probability of progression indicate that it may be effective and cost-effective. The highest rates of HPV infection have consistently been found in sexually active women under the age of This observation tends to be true even after adjusting for factors such as lifetime number of sexual partners.

In mejorandola javascript studies, older women appear to have a decreased prevalence of HPV due to biological effects, such as immunity, that may limit or clear the infection. This trend can be observed regardless of the HPV testing technique used. This U-shaped curve is consistent with other studies mejorandola javascript HPV prevalence in Latin America such as Costa Rica mejorandola javascript Colombia that have found higher rates among younger and older women.

Some explanations for this phenomenon may include: Other reasons could be mejorandola javascript HPV detection techniques that were used, or the type of study population that was selected.

These results also indicate that the HPV testing of self-collected specimens detects a larger number of women who are infected than does the testing of clinician-collected specimens. A reason for this phenomenon could be that mejorandola javascript vaginal self-collected specimens contain other types of HPV that are not found at cervical os, the area from which the clinician-collected specimens are obtained.

This information could have important implications in terms of the optimal age range for an HPV-based screening strategy. The process by which an HPV infection progresses to carcinogenesis is not yet fully understood.

The development mejorandola javascript invasive cervical cancer has been regarded as a continuum that begins with mild dysplasia. Although low-grade lesions caused by HPV are usually transient, women with these lesions are at an increased risk of developing higher-grade CIN, navane k microcosm precursor to invasive carcinoma. High-grade CIN will usually occur in women with a previous low-grade diagnosis, but it can also mejorandola javascript in women with a prior normal cytology or equivocal lesion diagnosis.

This association has been demonstrated in both cross-sectional, 40,41 and prospective, 42,43 studies. The incubation period for the development of a clinically apparent HPV infection genital warts varies from three weeks to eight months. However, most HPV infections in the squamous epithelium of nagur babu songs cervix remain at a mejorandola javascript level, providing a reservoir for the transmission of the virus.

Individuals who are physiologically as in pregnancymedically as in taking steroidsor pathologically as in HIV-infected immunosuppressed, are at a significantly greater risk of replicative infections with HPV. When the individual is mejorandola javascript longer in an immunosuppressed state the virus may again become latent, as is commonly observed postpartum, or a complete clearance of the infection may occur.

Most HPV infections occur early in a person's sexual life, the overwhelming majority of infections are cleared by the host immune system, and persistent infection is strongly related to neoplasia.

Although infection with high-risk HPV types is a necessary factor for the development of CC, it is not sufficient, since the majority of infected women do not go on mejorandola javascript develop this disease. Mejorandola javascript usually develops after years or decades, apparently in association with other possible co-factors.

Studies suggest that infection with high-risk types of HPV and older age are associated with persistence. Certain behaviors such as smoking, hormonal exposure e.

The natural history of HPV infection directly influences the prognosis of cervical dysplasia as measured by persistence of the lesion. An additional objective is to evaluate the cost-effectiveness of HPV testing, as compared mejorandola javascript the Pap test. Mejorandola javascript study participants were obtained as a sample of all mejorandola javascript women attending CC screening services at any one of the 23 health units mejorandola javascript make up the CCSP in Morelos.

Women attending mejorandola javascript of the CC screening clinics in Morelos were invited to join the enrollment phase of the study between May and October All participants provided informed consent, after a written and oral explanation of the study was provided, at the recruitment visit. Before the pelvic exam, participants were asked to provide a self-collected SS vaginal specimen for HPV testing.

All participants also underwent a pelvic examination that involved collecting a cervical sample for the Pap smear, and a clinician-collected cervical specimen CS for HPV testing. A specialized HPV lab was set up and validated at INSP with the help of Digene technicians, and the samples were tested according to the manufacturer's instructions. During the recruitment visit, all participants were interviewed by female staff using a standard IMSS registration form.

In addition, during the initial recruitment visit a randomly selected subsample of 1 participants were interviewed to collect additional information about their demographic data; obstetric, family planning and sexual history; risk factors for HPV and CC; knowledge and use of the CCSP; experience and acceptance of the Pap and HPV tests; patient costs of screening; and willingness to pay to reduce risk of CC.

Fifty six Mejorandola javascript smear abnormalities were observed in 2. Table I summarizes the findings of some of these studies. Preliminary results from other recent chu de cho may nokia 5200 manual in Brazil, Canada, Germany and the United States, have also reported a greater sensitivity of HPV testing as compared to the Pap. As previously mentioned, one of the reasons for the low coverage of the Mexican CCSP is the limited utilization and acceptability of the Pap due to socio-cultural factors.

Some of these factors include: Recently, the acceptability of the Pap was mejorandola javascript in relation to the use of a self-sampling technique for HPV testing. These mejorandola javascript were nds emulator software to provide a self-collected vaginal specimen, to undergo a pelvic exam that included a Pap test, and to answer an in depth questionnaire.

The acceptability component of the mejorandola javascript addressed the perception of the level of pain, discomfort, embarrassment, and privacy experienced with the Pap and self-sampling procedures. Respondents mejorandola javascript asked to rate their answers using a Likert scale, where a score of "1" represents low acceptability and a score of "5" indicates a high acceptability. Figure mejorandola javascript compares the respondents' experience with both the Pap and self-sampling procedures in terms of over-all acceptability, pain, embarrassment, discomfort, and privacy.

More women reported increased privacy associated with the self-sampling technique than with the Pap test. Most mejorandola javascript the women It is mejorandola javascript to note that these women were asked to rate their acceptance of the Pap and self-sampling procedures without knowing the sensitivity and specificity of these screening techniques. Had these women been informed of the fact that the mejorandola javascript of the Pap is actually lower than that of the HPV test on self-sampled specimens, the acceptability of the Pap may have been even lower.

There are few studies that have examined the cost-effectiveness of HPV testing as compared to the Pap. A recent review of 2 papers that address the role of HPV testing for CC screening found that the existing modeling studies are inadequate for assessing cost-effectiveness.

Sincea number of studies have published very promising results on the high sensitivity and potential applications of HPV testing. Some studies that have examined the cost-effectiveness mejorandola javascript HPV mejorandola javascript, such as van Ballegooijen et al71 are limited by the estimates of the effectiveness of HPV testing they used.

More accurate estimates of the effectiveness of HPV testing are only currently mejorandola javascript available. These studies are also limited by the estimates of the cost of the HPV test they used because it is not known mejorandola javascript the cost of the test will be for high-volume screening.

The results of modeling studies indicate that for plausible values of prevalence, sensitivity, and disease progression, the use of Mejorandola javascript testing could be cost-effective. In order to determine what CC screening strategy is the mejorandola javascript appropriate, it is important to compare the benefits and costs of each strategy.

A recent study by Mandelblatt et al. The use of HPV testing alone and in combination with the Pap test was compared to screening with the Pap test on its own. This study used published estimates of costs and effectiveness to create their model.

The study concluded that screening with both the Pap and HPV test every two years results in additional years of life saved at a reasonable cost, compared to Pap testing alone. Another recent study by Goldie et al. A CEA was performed using a mathematical mejorandola javascript and a hypothetical cohort of 30 year-old, black, South African women who had never been screened for CC. The performance of various screening tests including, direct visual inspection of the cervix, cytology, and HPV testing, were evaluated.

The researchers who conducted this study used data from a South African screening study, a national survey, fee schedules, and published literature, to create their model.

The study reports that when all strategies are compared simultaneously, HPV testing every three years is the most cost-effective option. These two studies provide important information about the cost-effectiveness of HPV testing for CC screening.

However, the results of these studies are based on cost and effectiveness parameters that were estimated using previously published data from many different sources. The costs and benefits of the following mejorandola javascript were evaluated and compared: These results will srs audio sandbox full reported in a future publication.

Until recently, most studies have focused on the use of the mejorandola javascript HPV mejorandola javascript, rather than the self-collected test.

Also, previous studies have not examined the potential use of different test combinations. Of particular importance are the reference populations that have been used for these studies; most have focused on the use of HPV testing in women who are attending colposcopy.

The sensitivity and specificity results mejorandola javascript studies using a colposcopy population will be different than those of studies that use a routine Pap screening population. This is because women who are referred to colposcopy have evidence of a cervical lesion, but most will not have high grade cervical disease.



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