Cervical cancer screening in the Czech Republic

Cytological diagnosis of atypical cells of cervix uteri by the Papanicolaou method was introduced in the Czech Republic (CR) very early - in 1947. The first data on the incidence of cervical cancer in CR are available from 1960 when the rate was 32.3 cases/10(5) women. In 1966 the Czech National Health Law was passed that guaranteed women a yearly preventive examination by a gynaecologist including screening for cervical carcinoma that would be covered by the compulsory health insurance. Notwithstanding high frequency of screening visits and the fact that all women are eligible, the incidence of CC has not changed in the last 34 years. The reasons for this include the coverage of Czech women, which is estimated to be low (50% at the most), and that none of the cytology laboratories are accredited for screening, there are no national registries for any aspect of screening and there are no mechanisms for evaluation of the screening process. As a result, it is likely that the majority of cervical screening activity that is undertaken is ineffective and the implementation of an organised and quality controlled screening programme, in compliance with the recommendations of many European Institutions, is urgently required to ensure that Czech women are properly protected against this disease and that scarce healthcare resources are used in the most cost-effective manner.     

Knowledge about Cervical Cancer and Barriers of Screening Program among Women in Wufeng County,a High-Incidence Region of Cervical Cancer in China

Purpose

Cervical cancer screening is an effective method for reducing the incidence and mortality of cervical cancer, but the screening attendance rate in developing countries is far from satisfactory, especially in rural areas. Wufeng is a region of high cervical cancer incidence in China. This study aimed to investigate the issues that concern cervical cancer and screening and the factors that affect women’s willingness to undergo cervical cancer screening in the Wufeng area.

Participants and Methods

A cross-sectional survey of women was conducted to determine their knowledge about cervical cancer and screening, demographic characteristics and the barriers to screening.

Results

Women who were willing to undergo screenings had higher knowledge levels. “Anxious feeling once the disease was diagnosed” (47.6%), “No symptoms/discomfort” (34.1%) and “Do not know the benefits of cervical cancer screening” (13.4%) were the top three reasons for refusing cervical cancer screening. Women who were younger than 45 years old or who had lower incomes, positive family histories of cancer, secondary or higher levels of education, higher levels of knowledge and fewer barriers to screening were more willing to participate in cervical cancer screenings than women without these characteristics.

Conclusion

Efforts are needed to increase women’s knowledge about cervical cancer, especially the screening methods, and to improve their perceptions of the screening process for early detection to reduce cervical cancer incidence and mortality rates.     

Characterization of Campylobacter jejuni strains occurring in the USSR and the Czech Republic

In 1986-1989 the microbiological laboratory in Prague obtained 100 Campylobacter jejuni strains while its counterpart in Moscow gained 120 such strains. The strains were primarily isolated from humans with diarrheal disease, from domestic and wild animals and from the environment. Most C. jejuni strains were successfully specified and classified using a Czechoslovak serotyping scheme proposed by Kahlich. Serotypes 1, 2, 7, 15, 22 and 24 occurred most frequently in the Czech Republic whereas in the Soviet Union the most common serotypes were 7, 16, 5, 2, 1. The proportion of strains which could not be identified in the serotyping scheme was about 10% in the USSR and 20% in the Czech Republic. Our findings suggest differences between the USSR and the Czech Republic in the prevalence and incidence particular serotypes of C. jejuni strains.     

Correlation between human papillomavirus-associated cervical cancer and p53 codon 72 arginine/proline polymorphism

High-risk mucosal human papillomaviruses encode an E6 oncoprotein, which binds the cellular p53 tumor suppressor protein, thereby marking it for degradation through the ubiquitin-mediated pathway. A common p53 polymorphism at codon-72 of exon 4 results in translation to either arginine or proline. Recently reported data suggested an increased susceptibility to E6/ubiquitin-mediated degradation of the Arg72-p53 isoform and an over-representation of the homozygous Arg72-p53 genotype in cervical cancer patients. We have analyzed this polymorphism in a larger series of patients with cervical cancer and in controls in the Czech Republic. We found no statistically significant differences between the codon-72 p53 genotypes of cervical cancer patients and the control women. Based on these results, it is unlikely that Arg72-p53 is associated with an increased risk for human papillomavirus-associated cervical tumor development in Czech women.     

Laboratory performance measures: evidence against low-risk women explaining low detection rates of high-grade abnormalities

OBJECTIVE: When a laboratory has a low reporting rate of high-grade abnormality for its cervical cytology specimens, the question arises whether this is due to the laboratory screening a low-risk group of women. This study was undertaken to explore the hypothesis that a low-risk group of women were screened by Victorian laboratories not meeting the recommended minimum standard for the detection of high-grade abnormalities. METHODS: A cohort of 28 094 women was established comprising women whose cervical cytology was reported in 2000 by laboratories not meeting the recommended standard of 0.5% high-grade abnormalities in their reporting of community smears. Outcome measures included the prevalence of high-grade abnormality on the next cytology test for the women, the positive predictive value of the cytology reports of high-grade abnormality, and the standardized incidence ratio for a later diagnosis of cervical cancer. RESULTS: The prevalence of high-grade abnormality was 0.36% on the index cytology compared with 0.68% on the first subsequent cytology report. Sixty-nine per cent (60/87) of the index cytology reports of high-grade abnormality were confirmed as high-grade abnormalities on histology, compared with 70.8% (121/171) for the first subsequent reports of high-grade abnormality. During 70 015 person-years at risk, nine cases of cervical cancer were observed compared with 5.21 expected cases, giving a standardized incidence ratio of 1.73 (95% CI 0.79-3.28). CONCLUSIONS: These results do not support a hypothesis that the low detection rate for high-grade abnormalities is due to the women comprising a low-risk group for cervical neoplasia.     

Human Papillomavirus Genotype Distribution in Czech Women and Men with Diseases Etiologically Linked to HPV

Background

The HPV prevalence and genotype distribution are important for the estimation of the impact of HPV-based cervical cancer screening and HPV vaccination on the incidence of diseases etiologically linked to HPVs. The HPV genotype distribution varies across different geographical regions. Therefore, we investigated the type-specific HPV prevalence in Czech women and men with anogenital diseases.

Methods

We analyzed 157 squamous cell carcinoma samples, 695 precancerous lesion samples and 64 cervical, vulvar and anal condylomata acuminate samples. HPV detection and typing were performed by PCR with GP5+/6+ primers, reverse line blot assay and sequencing.

Results

Thirty different HPV genotypes were detected in our study, HPV 16 being the most prevalent type both in precancerous lesions (45%) and squamous cell carcinomas (59%). In benign lesions, HPV 6 (72%) was the most common type. Altogether, 61% of carcinoma samples and 43% of precancerous lesion samples contained HPV 16 and/or 18. The presence of HPV types related to the vaccinal ones (HPV 31, 45, 33, 52, 58) were detected in 16% of carcinoma samples and 18% of precancerous lesion samples. HPV 16 and/or 18 were present in 76% of cervical cancer samples, 33% of CIN1, 43% CIN2 and 71% of CIN3 samples. HPV types 6 and/or 11 were detected in 84% samples of condylomata acuminate samples.

Conclusions

The prevalence of vaccinal and related HPV types in patients with HPV-associated diseases in the Czech Republic is very high. We may assume that the implementation of routine vaccination against HPV would greatly reduce the burden of HPV-associated diseases in the Czech Republic.     

Predictors of behavioral cancer risk factors and preventive behaviors among Nebraskans

BackgroundThe overall incidence rate of cancer in Nebraska is higher than the national average with cancer being the second leading cause of death in the state. Interventions are required to reduce the cancer burden; however, further research is first needed to identify behavioral cancer risk factors and preventive behaviors among Nebraskans that can be targeted.MethodsA statewide cross-sectional survey of Nebraskans aged 19 and older was conducted in 2019 using an address-based sampling method (n = 1640). Multivariable logistic regression was used to examine factors associated with being up-to-date on cancer screening and with behavioral cancer risk factors and preventive behaviors.Results93.42% of Nebraskans did not meet the daily recommended consumption of fruits and vegetables, and 71.51% did not meet weekly physical activity guidelines. The proportion of adults up to date on cancer screening was 64.57% for breast, 68.83% for cervical, 69.01% for colorectal, and 24.07% for skin cancers. Individuals 65–74 (OR: 3.40, 95% CI: 1.52–7.62) and 75 or older (OR: 3.30, 95% CI: 1.35–8.07) were more likely to be current with their colorectal cancer screening compared to ages 50–64. Hispanics were less likely to be current with mammograms (OR: 0.06, 95% CI: 0.01–0.71) and ever screened for cervical cancer (OR:0.13, 95% CI: 0.02–0.94) compared to Non-Hispanic Whites.ConclusionsDisparities in cancer screening and risk and preventive behaviors exist in Nebraska.ImpactThe study highlights a need for continuing efforts to improve preventive cancer behaviors for the entire population as well as some high-risk populations in Nebraska.     

Frequency of mutations in BRCA genes and other candidate genes in high-risk probands or probands with breast or ovarian cancer in the Czech Republic

Molecular Biology Reports - Breast cancer is currently the most common form of malignant tumour in womenboth in the Czech Republic and in most countries of the western world, and its incidence is...     

County-level characteristics associated with incidence,late-stage incidence,and mortality from screenable cancers

BackgroundCancer screening differs by rurality and racial residential segregation, but the relationship between these county-level characteristics is understudied. Understanding this relationship and its implications for cancer outcomes could inform interventions to decrease cancer disparities.MethodsWe linked county-level information from national data sources: 2008–2012 cancer incidence, late-stage incidence, and mortality rates (for breast, cervical, and colorectal cancer) from U.S. Cancer Statistics and the National Death Index; metropolitan status from U.S. Department of Agriculture; residential segregation derived from American Community Survey; and prevalence of cancer screening from National Cancer Institute’s Small Area Estimates. We used multivariable, sparse Poisson generalized linear mixed models to assess cancer incidence, late-stage incidence, and mortality rates by county-level characteristics, controlling for density of physicians and median household income.ResultsCancer incidence, late-stage incidence, and mortality rates were 6–18% lower in metropolitan counties for breast and colorectal cancer, and 2–4% lower in more segregated counties for breast and colorectal cancer. Generally, reductions in cancer associated with residential segregation were limited to non-metropolitan counties. Cancer incidence, late-stage incidence, and mortality rates were associated with screening, with rates for corresponding cancers that were 2–9% higher in areas with more breast and colorectal screening, but 2–15% lower in areas with more cervical screening.DiscussionLower cancer burden was observed in counties that were metropolitan and more segregated. Effect modification was observed by metropolitan status and county-level residential segregation, indicating that residential segregation may impact healthcare access differently in different county types. Additional studies are needed to inform interventions to reduce county-level disparities in cancer incidence, late-stage incidence, and mortality.     

Age trends in pre‐cancerous and cancerous lesions of the uterine cervix in a cytology screening programme: what should be the target age group for a major thrust of screening in resource‐limited settings?

Objective:  To identify the target age group where screening efforts may be concentrated in order to reduce the incidence of cervical cancer in resource-limited countries.
Study design:  The results of cyto-screening in a hospital-based screening programme for early detection of cervical cancer were analysed retrospectively. The frequency of epithelial cell abnormalities (ECAs) was computed in different age groups.
Observations and results:  A total of 5.6% ECAs were detected on cyto-screening. The peak age incidence for squamous intraepithelial lesions (SILs) was in the 30–39 age group while that for malignancies was age >60 years. The mean ages for LSIL, HSIL and cancer were 34.7, 37.7 and 51.8 years respectively. Around 43% LSILs and 48% HSILs presented in the fourth decade. If both fourth and fifth decade are covered by screening we could detect almost two-thirds of SILs.
Conclusions:  A distinct latent period of more than a decade between the onset of SIL and development of frank cancer provides us with ample opportunity to prevent cervical cancer through screening. Our data validate the WHO recommendation of once in a lifetime screening of women in their fourth decade, for low-resource settings. If resources permit, screening can be extended to include women in the fifth decade. This approach would enable us to pick up maximum SILs within the available resources and prevent their progression to cancer.     

Accuracy of registration of invasive cervical cancer.

The quality of the data recorded by the British Columbia Cancer Registry for 521 new cases of invasive cervical cancer was evaluated. The registry''s pathological diagnosis in all new registrations of invasive cervical cancer diagnosed in British Columbia between 1977 and 1979 was compared with a best estimate of the true diagnosis, which was determined from the results of the provincial cervical cytology screening program and the clinical charts at the Cancer Control Agency of British Columbia. The registry''s data overestimated the true incidence of invasive cervical cancer by approximately 55%, since 184 (35%) of the cases were incorrectly registered. Of the 184, 141 (77%) were cases of preinvasive cervical cancer, 26 (14%) did not meet the criteria for a true case (i.e., they were not newly diagnosed in British Columbia between 1977 and 1979) and 17 (9%) were cases of invasive cancer of another primary site. In addition, 28 cases of invasive cervical cancer diagnosed in the province during the study period had not been reported to the registry. Thus, both over-reporting and under-reporting occurred. There is a need for constant evaluation of registry data if cancer registries are to fulfil their potential contribution to cancer control programs and research.     

Large performance variation does not affect outcome in the Finnish cervical cancer screening programme

S. Lönnberg, P. Nieminen, L. Kotaniemi‐Talonen, H. Kujari, J. Melkko, G. Granroth, M. Vornanen, T. Pietiläinen, J. Arola, J. Tarkkanen, T. Luostarinen and A. Anttila Large performance variation does not affect outcome in the Finnish cervical cancer screening programme Objective: Cytology screening for prevention of cervical cancer can reduce incidence and mortality by more than 80% in settings with good organization and rigorous quality control. Audit studies are essential for reaching and maintaining a high quality of screening. The aim of this study was to evaluate variation in performance indicators by screening laboratory and assess the impact on the effectiveness of screening as indicated by cervical intraepithelial neoplasia grade 3 and above (CIN3+) rates after a negative screen. Methods: Seven cytology screening laboratories operating during 1990–1999 with a total of 953 610 screening tests performed were included in the study. By linking screening and cancer register files, all cases of CIN3+ diagnosed in the screened population were identified. For 395 CIN3+ cases with a preceding negative screen and 787 controls, a re‐evaluation of smears was undertaken to uncover false negative screening tests. Performance parameters and rates of CIN3+ after a negative screen were analysed for interlaboratory heterogeneity. Results: The rates of follow‐up recommendations and referrals varied by up to 3.6‐ (2.8–10.2%) and 4.0‐fold (0.03–0.12%), respectively. CIN1, CIN2 and CIN3+ screen detection rates differed by up to 8.5‐ (0.02–0.17%), 5.4‐ (0.05–0.25%) and 3.3‐fold (0.05–0.18%). False negative rates determined by re‐evaluation showed up to 2.1‐fold differences (29–62%). Rates of CIN3+ after a negative screen (0.023–0.048%) and as a proportion of total CIN3+ (15–31%) in the screened population were low and did not vary significantly. Conclusions: There were large variations in the sensitivity–specificity trade‐off between laboratories, reflected in all performance indicators as well as in the test validity estimates of the re‐evaluation phase, but not in screening effectiveness. Even though performance variations do not always have an impact on the effectiveness of screening, they lead to variations in cost, treatment and psychological burden, and should be addressed.     

Cervical cancer in Croatia: state of the art and possibilities for prevention

In Croatia, there are about 355 incident cases and about 100 deaths from cervical cancer every year. The aim of this study is to present the trends of cervical cancer incidence and mortality and to propose preventive strategies for cervical cancer in Croatia. Age-standardised and age-specific cervical cancer incidence rates were calculated for the period 1985-2004. For cervical cancer mortality data, the WHO Mortality Database was used. After an early decrease of cervical cancer incidence and mortality following the introduction of opportunistic screening in Croatia, no further decrease has been observed since the 1990s. An increase in incidence over the last 20 years was observed in the age-groups 40-44 and 45-49 years. To reduce cervical cancer rates, an organised cervical cancer screening programme is essential. In addition, HPV vaccination should be introduced in the school vaccination programme to achieve further reductions in cervical cancer incidence in the future.     

Dark or short nights: differential latitudinal constraints in nestling provisioning patterns of a nocturnally hunting bird species

In diurnal bird species, individuals breeding at high latitudes have larger broods than at lower latitudes, which has been linked to differences in the daily time available for foraging. However, it remains unclear how latitude is linked with parental investment in nocturnal species. Here, we investigate nestling provisioning rates of male Tengmalm's owls in two populations at different latitudes (Czech Republic 50 °N; Finland 63 °N) with the help of cameras integrated into nest boxes. Clutch sizes were smaller in the Czech population (CZ: 5.1 ± 0.1; FIN: 6.6 ± 0.1), but given the higher nestling mortality in the Finnish population, the number of fledglings did not differ between the two populations (CZ: 3.5 ± 0.3; FIN: 3.9 ± 0.2). Nestling provisioning patterns varied within days, over the reproductive season and between the two sites. Males delivered most food at dusk and dawn, having peak delivery rates at sun angles of -11° to -15° at both sites, and males increased the prey delivery rates with higher nestling requirements. Given the longer nights during summer in the Czech Republic compared to Finland, Czech males only showed a small shift in their delivery peak during the night from -17° in April to -14° in July. In contrast, Finnish males shifted their peak of prey delivery from -11° in April to -1° in July. Consequently, Czech males had a longer hunting time per night around midsummer when feeding young (360 min) than Finnish males (270 min). This suggests that nocturnal owl species in northern populations are constrained by the short nights during the breeding season, which can limit the number of young they can raise. Moreover, owls in northern populations are additionally constrained through the unpredictable changes in food availability between years, and both these factors are likely to influence the reproductive investment between populations.     

Determining the cost-effectiveness of mass screening for cervical cancer using common analytic models

OBJECTIVE: To estimate the cost per life-year saved (cost-effectiveness ratio [CER]) for cervical cancer and to evaluate the influence of the decreased incidence upon the cost per life-year saved. STUDY DESIGN: We established hypothetical cohorts at 10-year intervals between 30 and 79 years of age, each of which consisted of 100,000 asymptomatic female subjects, and estimated the cost and effect of single mass screening for cervical cancer. To investigate the influence on CER, we performed a sensitivity analysis of each item, including the consultation rate for further examination, prevalence rate and cost of medical treatment. RESULTS: The estimated CER per one expected life-year of survival was lowest for subjects in their 30s and highest for those in their 70s. The difference between the two was more than five-fold. Sensitivity analysis was rarely affected by changes in the cost of medical treatment and the prevalence rate, but the effectiveness rate could be fairly affected by the consultation rate for closer examination. CONCLUSION: Mass screening for cervical cancer is acceptable in terms of economic effectiveness. Moreover, mass screening for cervical cancer could decrease the morbidity rate for scores of years thereafter.     

Cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in four US-Affiliated Pacific Islands between 2007 and 2015

BackgroundCervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from the Centers for Disease Control (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to implement cervical cancer screening to low-income, uninsured or under insured women. The USAPI grantees report data on screening and follow-up activities to the CDC.Materials and methodsWe examined cervical cancer screening and follow-up data from the NBCCEDP programs in the four USAPIs from 2007 to 2015. We summarized screening done by Papanicolaou (Pap) and oncogenic human papillomavirus (HPV) tests, follow-up and diagnostic tests provided, and histology results observed.ResultsA total of 22,249 Pap tests were conducted in 14,206 women in the four USAPIs programs from 2007–2015. The overall percentages of abnormal Pap results (low-grade squamous intraepithelial lesions or worse) was 2.4% for first program screens and 1.8% for subsequent program screens. Histology results showed a high proportion of cervical intraepithelial neoplasia grade 2 or worse (57%) among women with precancers and cancers. Roughly one-third (32%) of Pap test results warranting follow-up had no data recorded on diagnostic tests or follow-up done.ConclusionThis is the first report of cervical cancer screening and outcomes of women served in the USAPI through the NBCCEDP with similar results for abnormal Pap tests, but higher proportion of precancers and cancers, when compared to national NBCCEDP data. The USAPI face significant challenges in implementing cervical cancer screening, particularly in providing and recording data on diagnostic tests and follow-up. The screening programs in the USAPI should further examine specific barriers to follow-up of women with abnormal Pap results and possible solutions to address them.     

Long-term yersiniosis surveillance project in Czechoslovakia

The paper presents an epidemiological analysis of 8,232 cases of yersiniosis caused by Y. enterocolitica 03 over 1972-1988 as reported by Hygienic Stations. The steady epidemiological characteristics of yersiniosis were the prevalence of children and boys and a typical seasonal pattern with differences between the Czech and Slovak Republics. In the Czech Republic, there were several incidence peaks following, when summarized, the incidence curve of other alimentary infections, whereas in the Slovak Republic morbidity reached its peak during winter months. The numbers of isolated strains oscillated significantly between districts and by years. It appears that the number of positive findings in different districts is not only an objective value reflecting a mosaic-like pattern of incidence but also depends on the quality of microbiological diagnostics.     

Serum levels of selenium, manganese, copper, and iron in colorectal cancer patients

This article describes a study in which four trace elements (Se, Mn, Cu, and Fe) were analyzed in the blood serum of the patients with colorectal cancer from the Moravian region of the Czech Republic. Atomic absorption spectrometry with graphite furnace atomization was used for analysis of selenium and manganese and with flame atomization for analysis of copper and iron. The observed serum concentrations in adenocarcinoma colorectal patients of selenium were significantly lower (41.8 ± 11.6 μg/L) and those of manganese (16.3 ± 4.5 μg/L) and iron (2.89 ± 1.23 mg/L) were significantly higher as compared to the age-matched control group. Copper serum content (0.95 ± 0.28 mg/L) did not significantly differ as compared to healthy population.     

Origin and genetic structure of white-tailed sea eagles (<Emphasis Type="Italic">Haliaeetus albicilla</Emphasis>) in the Czech Republic: an analysis of breeding distribution,ringing data and DNA microsatellites

The population of white-tailed sea eagles (Haliaeetus albicilla) in the Czech Republic declined dramatically during the twentieth century. None were observed in the area for more than 60 years until population recoveries were observed beginning in the 1980s. It is currently estimated that 25–30 breeding pairs of white-tailed sea eagles nest in the Czech Republic. This article analyses surveillance data from three periods between 1973 and 2003 on the occurrence and nesting of white-tailed sea eagles in the Czech Republic. We investigated recolonization of European white-tailed sea eagles in the Czech Republic in terms of migration patterns and population structures. Bird ringing data suggest the Czech population may be recovered from various areas encompassing northern Europe. Using data collected by DNA microsatellite, no population structure was revealed through Bayesian and cluster analyses with an existing Hardy–Weinberg equilibrium, which suggests mixed panmictic populations of white-tailed sea eagles in the Czech Republic and Slovakia. While analysis of genetic diversity showed no difference between recovered populations in the southeastern Czech Republic and those persisting in Slovakia, there was genetic diversity between eagles of the southeastern subpopulation and eagles in other parts of the Czech Republic. Taken together, these observations on the population structure of white-tailed sea eagles in the Czech Republic imply that other European birds contributed to the recovery of the Czech population, likely through breeding mixture with an identifiable centre in the southeastern Czech Republic.