Bulletin of the Pan American Health Organization最新文献

Use of health services is usually associated with a variety of factors, including the socioeconomic characteristics of the users, their familiarity with the usefulness of the services provided, and the acceptability and accessibility of those services. To study the factors associated with women's familiarity with the Pap test, a population-based study was carried out in Mexico City and two rural areas in the state of Oaxaca by means of household interviews. The sample consisted of 4208 women 15 to 49 years of age. Univariate, bivariate, and multivariate analyses were done using unconditional logistic regression; the independent variables were access to social security health services, age, education, housing quality, and place of residence (urban or rural); the dependent variable was the interview subject's familiarity with the purpose of the Pap test. The results were expressed as odds ratios with 95% confidence intervals. It was found that 41.5% of the women surveyed did not know the purpose of the Pap test, and that within this latter group, 97% had never had one. Factors found to be associated with not knowing the test's purpose were lack of access to the social security health services (OR = 1.9; 95% CI: 1.5-2.3); illiteracy (OR = 36.1; 95% CI: 17.9-72.7); and low socioeconomic level (OR = 2.9; 95% CI: 2.3-3.7). Also, rural dwellers had less familiarity with the Pap test than urban dwellers (OR = 0.5; 95% CI: 0.4-0.7). These results highlight the need to develop strategies for making the benefits of the Pap test known, bearing in mind the socioeconomic and cultural diversity of the populations involved.

From August 1994 to June 1995, laboratories in 28 Mexican states and the Federal District submitted a total of 10098 diagnosed Pap test slides to Mexico's National Institute of Epidemiologic Diagnosis and Reference (INDRE) for reexamination by conventional methods and also by the automated PAPNET system in Suffern, New York, U.S.A. The aim was to determine the degree of agreement obtained by these various methods. Most of the slides examined (at least 78%) yielded negative results or merely indicated an inflammatory process; 8% to 14% indicated mild or moderate cervical dysplasia; and 2% to 3% indicated conditions ranging from severe dysplasia to invasive cervical cancer. Comparison of the state laboratory and INDRE diagnoses yielded a Kappa correlation coefficient of 0.62, near the lower limit of agreement, the agreement being poorest in cases where it was necessary to distinguish between degrees of abnormality. Although state laboratory underestimation appeared lowest with respect to cases of atypia and of mild, moderate, and severe dysplasia (between 12% and 20%), these percentages are alarming because it is at these stages that the patient may be treated to prevent evolution to carcinoma. While the Kappa correlation coefficient was better (0.80) when the INDRE and PAPNET diagnoses were compared, PAPNET showed only limited ability to distinguish between various pathologic alterations, and the percentages of underestimates (false negatives) obtained with PAPNET were also high. Overall, the results indicate a need to improve the quality of cervical cytology diagnoses at state public health laboratories in Mexico through stepped-up training and supervision. They also indicate that the use of PAPNET involves greater difficulty than does manual microscopic examination of cervical smears, and that a way still needs to be found to detect and review the false negative results generated by PAPNET before approving use of this technology.

The study reported here sought to assess Pap test coverage of a group of asymptomatic Argentine women from the poor urban district of La Matanza in the Buenos Aires metropolitan area Initially, all 2495 women who voluntarily enrolled in a program for early detection of breast cancer between January 1991 and June 1993 were included. After removing those who did not meet various study criteria, there remained 779 study subjects with no gynecologic or mammary symptomatology. Two subgroups of these 779 were established-women who had received a Pap test at any time and those who had received such a test within the previous three years. Using these subgroups, the influence of certain sociodemographic and other variables upon the likelihood of Pap testing was assessed. The results indicated significant associations between past Pap testing and age, formal education, parity, and a family history of cancer Likewise, significant associations were found between Pap testing within the preceding three years and age, formal education, and parity. The study findings affirm the idea that it would be advisable to seek Pap testing for all study population women once every three years instead of every year. Since the study population was not necessarily representative of Buenos Aires population, however, and the findings could have been affected by self-selection and other biases, additional studies are needed to determine actual Pap test coverage among women of the metropolitan area.

This article reviews epidemiologic evidence linking human papillomavirus (HPV) to cervical cancer. The authors conclude that over 90% of all cervical cancers can be attributed to certain HPV types-HPV 16 accounting for the largest proportion (roughly 50%) followed by HPV 18 (12%), HPV 45 (8%), and HPV 31 (5%). Recognition of this circumstance has far-reaching implications for primary and secondary prevention of this malignancy. At present, prophylactic and therapeutic HPV vaccines are under development, and HPV typing is being integrated into pilot study screening programs in a few developed countries. In developing countries, well conducted conventional screening programs remain the best approach for the control of cervical cancer until a safe and efficient HPV vaccine can be developed for use by the general population.