Journal of Lower Genital Tract Disease最新文献

{"title":"Lifetime Cervical Cancer Screening and Social Determinants of Health in the Canadian Longitudinal Study on Aging.","authors":"Melissa Lavecchia, Amanda Selk, Maura Marcucci, Andra Nica, Parminder Raina, Waldo Jimenez, Julie Mv Nguyen","doi":"10.1097/LGT.0000000000000895","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000895","url":null,"abstract":"<p><strong>Objectives: </strong>In Canada, cervical cancer rates remain well above the World Health Organization target, despite screening and vaccination programs. Modeling reveals that those who have never undergone screening represent one of the highest risk populations. The Canadian Longitudinal Study on Aging (CLSA) prospectively collected health outcomes on >50,000 individuals. We sought to identify the prevalence of Canadian female participants having never undergone cervical cancer screening and the association with social determinants of health.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis from CLSA data. The main outcome was self-report of ever having undergone a Pap smear. Regression analyses evaluated the association between demographic or social determinants of health and self-reported lifetime cervical cancer screening.</p><p><strong>Results: </strong>The population-based sample comprised 22,910 participants aged 45-85, of whom 99.8% had available information on cervical cancer screening (n = 22,720). The prevalence of never having undergone a Pap smear was 14.1%; weighted prevalence, 11.8% (95% CI = 11.0-12.6). The following factors were associated with never having undergone screening: older age(10-year) (OR = 1.5, 95% CI = 1.4-1.6), lower education(low vs. high) (OR = 1.5, 95% CI = 1.2-1.9), lower household income(low vs. high) (OR = 1.7, 95% CI = 1.3-2.3), having a religious affiliation (OR = 1.3, 95% CI = 1.1-1.5), and never being married/lived in common law (OR = 1.5, 95% CI = 1.2-1.9). Notably, not having a family physician was also associated (OR = 2.3, 95% CI = 1.6-3.3). However, among participants who never underwent a Pap smear, 97% reported having a family physician.</p><p><strong>Conclusions: </strong>Our analysis highlights inequities in cervical cancer screening in the Canadian context. These insights are critical in informing a more equitable approach to implementing human papillomavirus (HPV)-based screening.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awards Presented as Part of the ASCCP 2025 Scientific Meeting on Anogenital & HPV-Related Diseases.","authors":"","doi":"10.1097/LGT.0000000000000897","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000897","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASCCP Clinical Guidance Document Standardization.","authors":"Jenna Z Marcus, Christine Conageski, Akiva P Novetsky, David P Chelmow","doi":"10.1097/LGT.0000000000000896","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000896","url":null,"abstract":"<p><strong>Abstract: </strong>The American Society for Colposcopy and Cervical Pathology (ASCCP) provides practice guidance for clinicians caring for patients with lower genital tract conditions. The ASCCP wants to ensure that its library of guidance documents is current, evidence based, and easy for clinicians to use. Guidance documents should present clear, actionable evidence-based management recommendations where the quality of the evidence and the strength of the recommendation are clearly identified. This document explains ASCCP's new standard document types and the processes for their development and maintenance, as well as the process for selecting new topics.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Risk of Developing Cervical Cancer in the Elderly; Who Benefits From Screening After the Age of 60?","authors":"Renée M F Ebisch, Celine Buijssen, Nicole C M Visser, Albert G Siebers, Ruud L M Bekkers","doi":"10.1097/LGT.0000000000000893","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000893","url":null,"abstract":"<p><strong>Objectives: </strong>Population-based cervical cancer screening in the Netherlands ends at age 60. This retrospective cohort study aims to identify a subgroup of people over 60 years who are at increased cervical cancer risk, and may benefit from extended screening.</p><p><strong>Methods: </strong>People with a cervix, aged 59-61 with an abnormal exit smear (index smear), conducted as part of the screening program between 2000 and 2004, were identified from the Dutch nationwide pathology databank. A 1:3 matching was obtained with people without an abnormal screening smear at the same age. Incidence rate ratios (IRR) were calculated for the risk of developing cervical cancer or cervical intraepithelial neoplasia (CIN) later in life. Up to 22 years of follow-up was obtained.</p><p><strong>Results: </strong>A total of 10,368 people were identified. The IRR for CIN and cervical cancer was increased for people with an abnormal index smear. This risk was highest for people with a high-grade index smear, compared with a normal index smear; IRR of high-grade CIN of 104.05 (95% CI = 38.18-353.18) and IRR for cervical cancer of 18.58 (95% CI = 5.31-61.07). The majority (82%) of people with an abnormal index test showed normal cytology or histology preceding their CIN or cervical cancer.</p><p><strong>Conclusions: </strong>People with a cervix with abnormal cytology in their exit screening smear 59-61 years showed a 19 times increased lifelong risk of cervical cancer and more than 100 times increased risk for CIN. Because this increased risk was not limited to a specific timeframe, prolonged screening or adjusted diagnostic follow-up for this specific group should be considered.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Collected Swabs for Primary HPV Screening in an Underscreened Population in Hawaii.","authors":"Anna Ung, Jonathan Riel, Paris Stowers, Jeffrey Killeen, Singne Brown, Ann Chang","doi":"10.1097/LGT.0000000000000887","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000887","url":null,"abstract":"<p><strong>Objectives: </strong>This study assessed the feasibility and acceptability of Human Papillomavirus (HPV) self-swab collection at a Hawaii-based Federally Qualified Health Center in the United States with low cervical cancer screening rates.</p><p><strong>Methods: </strong>Patients with an indication for cervical cancer screening were approached during their scheduled primary care visit. Consenting participants self-collected a sample for primary HPV testing. After sample collection, participants completed a 5-minute written survey concerning their experience collecting the sample and knowledge of cervical cancer.</p><p><strong>Results: </strong>From August 2023 through May 2024, 20 participants enrolled and completed the study, including 5 participants who had never undergone any prior cervical cancer screening and 7 participants over the age of 65. The HPV analysis confirmed 1 positive result. Most (17 of 20) of the participants described the self-collection process as very easy or easy. Knowledge of HPV and cervical cancer prevalence was low with only 2 of 20 participants (10%) correctly identifying the prevalence of these conditions.</p><p><strong>Conclusions: </strong>Self-swab screening for HPV is feasible with high patient satisfaction in the studied population.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Significance of Extended HPV Genotyping for Detecting Endocervical Glandular Neoplasia for Atypical Glandular Cells.","authors":"Fangfang Zhong, Megan L Zilla, Yihua Sun, Xianxu Zeng, Hao Zhang, Jianan Xiao, Xiang Tao, Chengquan Zhao","doi":"10.1097/LGT.0000000000000886","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000886","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the risk of cervical glandular neoplasia with extended high-risk human papillomavirus (hrHPV) genotyping, in patients with atypical glandular cells (AGC) cytology.</p><p><strong>Methods: </strong>Cervical AGC cases with concurrent extended HPV genotyping between October 2017 and October 2023 were retrieved from the archives of Department of Pathology, Obstetrics, and Gynecology Hospital of Fudan University (OGHFU).</p><p><strong>Results: </strong>A total of 497 AGC cases with extended hrHPV genotyping showed an hrHPV-positive rate of 32.0%. The top 4 hrHPV types were HPV18, 16, 52, and 59. A total of 304 cases had histological follow-up. A total of 72 cases (23.7%) had cervical adenocarcinoma in situ/cervical intraepithelial neoplasia3 or worse (AIS/CIN3+) lesions with 43 endocervical carcinoma (EC-ADC), 28 AIS, and 1 CIN3. Cervical AIS/CIN3+ lesions were detected in 50.5% (55/109) of the hrHPV-positive group.Women with HPV18/16/45 positivity had 77.6% cumulative risk of cervical AIS/CIN3 + lesions (52/67), accounting for 94.6% (52/55) of the total hrHPV-associated cervical AIS/CIN3+ lesions. For all 15 other hrHPV types, the overall risk of AIS/CIN3+ was 7.1% (3/42 cases). The sensitivity, specificity, PPV, and NPV of the composite HPV18/16/45 group for detecting endocervical glandular neoplasia was 71.8%, 93.1%, 76.1%, and 91.6%, respectively. Endocervical carcinoma was found in 17 of 195 (8.7%) women with negative hrHPV testing, accounting for 39.5% EC-ADC (17/43) cases.</p><p><strong>Conclusions: </strong>Atypical glandular cells was rarely related to CIN3. Atypical glandular cells was strongly related to AIS and EC-ADC. Women aged 30-49 years had highest risk for AIS/CIN3+ lesions. Although HPV test can be helpful, there were still some cases of HPV-negative endocervical adenocarcinomas. Extended HPV genotyping in AGC cases identified certain HPV types associated with a higher risk of cervical glandular lesions, potentially assisting with risk stratification.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding \"A Narrative Review of the Vulvar Disease Literature With Images of Women of Color\".","authors":"Debra S Heller","doi":"10.1097/LGT.0000000000000872","DOIUrl":"10.1097/LGT.0000000000000872","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"204"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lichen Sclerosus in Cancer Patients.","authors":"Amaris N Geisler, Shivani Jain, Kara Long Roche, Deborah J Goldfrank, Alina Markova, Mario E Lacouture, Sarah J Noor","doi":"10.1097/LGT.0000000000000870","DOIUrl":"10.1097/LGT.0000000000000870","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the association between cancer therapies and the development of lichen sclerosus (LS) in a case series of patients.</p><p><strong>Methods: </strong>A retrospective chart review was performed to screen for patients who were diagnosed with LS while undergoing cancer therapy at Memorial Sloan Kettering Cancer Center between 2003 and 2019. Patients were excluded if they had been diagnosed with LS prior to starting cancer therapy. Clinical and treatment characteristics were analyzed.</p><p><strong>Results: </strong>The final study sample included 29 female patients who developed LS in the setting of systemic cancer therapy. Median time to LS onset after cancer therapy initiation was 420 days. Primary tumor types included breast (10, 34.5%), gynecologic (8, 27.6%), gastrointestinal (5, 17.2%), cutaneous (2, 6.9%), lung (2, 6.9%), and hematologic (2, 6.9%). Cancer therapy regimens included hormonal therapy (10, 34.5%), chemoradiation (7, 24.1%), cytotoxic chemotherapy (7, 24.1%), PD-1/PD-L1 inhibitors (3, 10.3%), local radiation (1, 3.4%), and allogeneic stem cell transplant (1, 3.4%). Across all patients, the mean number of treatments for LS was 2.8. Twenty-three (79.3%) patients received the first-line therapy of ultrapotent topical steroids, but 16 (69.6%) required additional topical and systemic treatment. Limitations include retrospective design and referral bias.</p><p><strong>Conclusions: </strong>Breast cancer was the most common primary tumor among patients in this study. The most common cancer therapy regimen was hormonal therapy. Most patients required an escalation in therapy to manage their LS. For patients undergoing cancer treatment, concomitant LS management can present unique challenges due to the biological mechanism of some anticancer therapies and the pathophysiology of LS. There is limited data to guide treatment of LS for this population. Some of the patients included in this analysis had progression of LS and recurrence of cancer while undergoing management of both conditions, necessitating close follow-up.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"186-189"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Collected Vaginal Specimens for HPV Testing: Recommendations From the Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee.","authors":"Nicolas Wentzensen, L Stewart Massad, Megan A Clarke, Francisco Garcia, Robert Smith, Jeanne Murphy, Richard Guido, Ana Reyes, Sarah Phillips, Nancy Berman, Jeffrey Quinlan, Eileen Lind, Rebecca B Perkins","doi":"10.1097/LGT.0000000000000885","DOIUrl":"10.1097/LGT.0000000000000885","url":null,"abstract":"<p><strong>Objective: </strong>The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for the use of self-collected vaginal specimens for human papillomavirus (HPV) testing in health care settings.</p><p><strong>Methods: </strong>A comprehensive literature search was performed, external systematic reviews were evaluated, and HPV genotype agreement between self-collected vaginal and clinician-collected cervical specimens was summarized. Recommendations considered available data, public comments, and expert consensus. Recommendations were ratified through a vote by the Consensus Stakeholder Group.</p><p><strong>Results: </strong>Clinician-collected cervical specimens are preferred and self-collected vaginal specimens are acceptable for primary HPV screening of asymptomatic average-risk individuals. Repeat testing in 3 years is recommended following HPV-negative screens using self-collected vaginal specimens. Colposcopy with collection of cytology and biopsies is recommended following positive tests for HPV types 16 and 18. Clinician-collected cytology or dual stain for triage testing is recommended following positive tests for HPV 45, 33/58, 31, 52, 35/39/68, or 51 or for pooled HPV other types but negative for HPV 16 or 18. Repeat HPV testing in 1 year is recommended following a positive test for HPV types 56/59/66 and no other carcinogenic types. Minimal data exist on use of self-collected vaginal specimens for surveillance following abnormal screening test results, colposcopy or treatment, and therefore, clinician-collected cervical specimens are preferred.</p><p><strong>Conclusions: </strong>Human papillomavirus testing of self-collected vaginal specimens expands cervical cancer screening options and has potential to increase access for currently underscreened individuals. Laboratory and clinical workflows will need to be modified to ensure adequate specimen processing and follow-up.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"144-152"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated Review for Guidelines for Cervical Cancer Screening in Immunosuppressed Women Without HIV Infection.","authors":"Anna-Barbara Moscicki, Lisa Flowers, Megan J Huchko, Margaret E Long, Kathy L MacLaughlin, Jeanne Murphy, Lisa Beth Spiryda, Caleb J Scheckel, Michael A Gold","doi":"10.1097/LGT.0000000000000866","DOIUrl":"10.1097/LGT.0000000000000866","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this review was to examine new evidence since the authors' 2019 guidelines for cervical cancer (CC) screening in non-HIV immunocompromised persons and to provide updated recommendations based on literature review and expert opinion. In addition, human papillomavirus (HPV) vaccine efficacy in these populations was reviewed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A literature search was performed similar to the authors' previous publication but was conducted through March 2023. Risk of CC, squamous intraepithelial lesions, and HPV infection in those living with solid organ transplant (SOT), end-stage renal disease (ESRD), hematopoietic stem cell transplant (HSCT), and autoimmune diseases (AID), specifically systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD) with addition of multiple sclerosis (MS) were researched. This update also summarizes data available on newer disease-modifying therapies (DMTs) including monoclonal antibodies (MABs). The authors then made recommendations for HPV vaccine administration, and screening using either general population guidelines or increased surveillance, the latter based on following current recommendations for women living with HIV. Additionally, the literature search included antibody response to HPV vaccines and recommendations for their administration for these same conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Based on the reviewed risks, evidence continued to support those persons living with SOT, ESRD, HSCT, and SLE, whether on immunosuppressant therapy or not, had an increased risk of HPV, squamous intraepithelial lesions, and CC whereas there was weak evidence that those persons with IBD, RA, and MS not on immunosuppressants were at risk. Data on persons using DMT/MAB were conflicting. Data showed that patients on certain immunosuppressants had lower antibody titers following HPV vaccination. There were no studies on HPV vaccine efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Following US Center for Disease Control and Prevention HIV Cervical cancer screening (CCS) guidelines is recommended for the following: SOT, ESRD, HSCT, and SLE whether on immunosuppressants or not, and IBD, RA, and MS on immunosuppressants. Shared decision-making about increased surveillance for IBD and RA not on immunosuppressants and persons on any DMT or MAB is reasonable based on conflicting data. Human papillomavirus vaccination should not change the recommendations for increased CC surveillance. A 3-dose series of the HPV vaccine is recommended for all age-eligible patients starting at 9 years of age, with catch-up to 26 years of age. Vaccination from age 27 up to age 45 years per Advisory Committee on Immunization Practices guidelines should be considered in shared decision-making. When possible, HPV vaccine series should be initiated and completed before SOT or initiation of DMT/MAB. For HSCT, the vaccine series should be readministered alon","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"168-179"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}