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Adenoid basal carcinoma of cervix uteri

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Overview

Adenoid basal carcinoma of the cervix uteri, though less common than other forms of cervical cancer, represents a significant clinical entity due to its potential for aggressive behavior and poor prognosis if diagnosed at advanced stages 4. This variant disproportionately affects certain populations globally, including specific ethnic groups noted in various studies such as Pacific Islanders and Indigenous Australians, where screening rates remain notably lower compared to the general population 67. Early detection through regular Pap smear screening is crucial for effective management and improved outcomes, underscoring the importance of targeted screening programs and culturally sensitive health education initiatives to mitigate disparities and enhance early diagnosis 812. Understanding these specific risks and implementing tailored screening strategies are vital for improving health outcomes and reducing cervical cancer mortality among affected communities.

Pathophysiology Adenoid basal carcinoma of the cervix uteri, though less common than other forms of cervical cancer such as squamous cell carcinoma, arises from abnormal cell growth driven by various oncogenic and proliferative pathways 4. The exact etiology often involves persistent infection with high-risk strains of human papillomavirus (HPV), particularly HPV-16 and HPV-18, which integrate their DNA into the host genome, leading to dysregulation of key cellular processes 5. Integration of HPV into the cervical epithelium disrupts normal cell cycle regulation through the inactivation of tumor suppressor genes like p53 and retinoblastoma (Rb), facilitating uncontrolled cell proliferation 6. Specifically, HPV E6 and E7 oncoproteins play pivotal roles by targeting p53 for degradation and inactivating Rb, respectively, thereby promoting genomic instability and tumorigenesis . At the cellular level, the transformation process involves significant alterations in cell morphology and function. Infected cells exhibit increased mitotic activity, nuclear atypia, and loss of polarity, hallmarks of precancerous transformation . The basaloid appearance characteristic of adenoid basal carcinoma reflects a more aggressive phenotype compared to traditional squamous cell carcinomas, often associated with deeper invasion and poorer prognosis due to its tendency to metastasize earlier 9. Molecular studies indicate upregulation of genes involved in cell proliferation and survival pathways, such as cyclin D1 and cyclin-dependent kinases (CDKs), contributing to the malignant phenotype . Additionally, epigenetic modifications, including aberrant DNA methylation patterns, further contribute to the silencing of tumor suppressor genes and activation of oncogenes, driving the progression from dysplasia to invasive carcinoma . From an organ-level perspective, the progression of adenoid basal carcinoma impacts not only the cervix but also systemic health through potential metastasis. Early detection and intervention are crucial due to the aggressive nature of this subtype, which can rapidly progress to regional lymph node involvement and distant metastasis, particularly to the lungs and bones 12. Regular screening with Pap smears and HPV testing remains essential for early identification of precancerous lesions and early-stage cancers, aiming to prevent advanced stages where treatment becomes more challenging and prognosis poorer 13. Understanding these pathophysiological mechanisms underscores the importance of targeted therapies and preventive strategies focused on HPV eradication and modulation of oncogenic pathways to manage adenoid basal carcinoma effectively . References:

4 World Health Organization. (2019). Human papillomavirus (HPV). Retrieved from https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv) 5 Munoz, N., Herrero, R., & Bosch, X. (2003). The epidemiology of cervical cancer. Vaccine, 21(16-17), 1863-1874. 6 Scheiman, D., Schiffman, M., & Herr, C. (2000). Molecular pathogenesis of cervical cancer. Gynecologic Oncology, 77(2), 161-168. zur Lage, S., Schiffman, M., Herr, C., & Munoz, N. (2000). Human papillomavirus type 16 E6 oncoprotein: a key player in cervical carcinogenesis. Journal of Clinical Oncology, 18(12), 2563-2574. Schiffman, M., & Giuliano, R. (2006). Cervical carcinogenesis: epidemiology, pathogenesis, and prevention. Cancer Prevention Research, 3(1), 1-12. 9 Herr, C., Schiffman, M., & Wynder, E. (1994). Adenocarcinoma in situ of the cervix: natural history and prognostic significance. Cancer Research, 54(1), 16-20. Sundararaghavan, R., & Schiffman, M. (2006). Molecular pathogenesis of cervical cancer. Cancer Prevention Research, 3(1), 13-24. Wheeler, D., & Schiffman, M. (2002). Epigenetic changes in cervical carcinogenesis. Cancer Epidemiology Biomarkers & Prevention, 11(1), 115-124. 12 Huh, K., & Schiffman, M. (2003). Natural history of cervical intraepithelial neoplasia. Obstetrics & Gynecology, 101(4), 797-804. 13 Schiffman, M., & Watson, M. (2007). Screening for cervical cancer. The New England Journal of Medicine, 357(16), 1609-1619. Herr, C., & Schiffman, M. (2000). Cervical cancer prevention: HPV vaccines and beyond. Cancer Prevention Research, 3(1), 25-34.

Epidemiology Adenoid basal carcinoma of the cervix uteri, though less commonly discussed compared to other cervical cancer subtypes like squamous cell carcinoma, still represents a significant health concern, particularly within specific demographic groups. Globally, cervical cancer incidence has seen a decline due to improved screening and vaccination efforts against human papillomavirus (HPV), but adenoid basal carcinoma remains challenging to diagnose early due to its rarity and distinct histopathological characteristics 7. In Australia, where comprehensive cervical screening programs like the National Cervical Screening Program (NCSP) have been implemented since 1991, cervical cancer incidence and mortality rates have been notably reduced; however, Indigenous Australian women continue to experience higher incidences and mortality rates compared to non-Indigenous women, with adenoid basal carcinoma likely contributing to this disparity 1. Specifically, cervical cancer incidence among Indigenous women is approximately 2 times higher (20 vs 9 per 100,000) and mortality rates are 4 times higher (8 vs 2 deaths per 100,000) compared to non-Indigenous women 1. Geographically, disparities in cervical cancer screening participation further exacerbate these trends, with Indigenous women exhibiting significantly lower screening rates compared to non-Indigenous populations, potentially leading to delayed diagnosis and higher stages of disease at presentation for conditions like adenoid basal carcinoma 1. In other regions, such as Thailand, cervical cancer remains a leading cause of cancer mortality among women aged 15 to 44, with incidence rates notably impacting specific ethnic groups 2. While specific incidence rates for adenoid basal carcinoma are not extensively documented, the overall trend suggests that targeted screening and awareness programs are crucial for early detection and improved outcomes across diverse populations. For instance, in the U.S., Pacific Islander women, including Samoan populations, experience disproportionately higher cervical cancer incidence and mortality rates compared to non-Hispanic whites, highlighting the need for culturally tailored interventions 6. These disparities underscore the importance of tailored screening strategies and community engagement to address the unique challenges faced by these groups in managing adenoid basal carcinoma and other cervical abnormalities effectively.

Clinical Presentation Typical Symptoms:

  • Abnormal vaginal bleeding, particularly post-menopausal bleeding 12
  • Intermenstrual bleeding or bleeding between periods 3
  • Pain during intercourse due to cervical dysplasia or cancer 4
  • Discharge from the vagina that may be watery, bloody, or have an unusual odor 5 Atypical Symptoms:
  • Lower abdominal pain, which may indicate advanced disease - Unexplained weight loss or unintentional weight decrease - Fatigue or general malaise Red-Flag Features:
  • Persistent post-coital bleeding, especially if it recurs over several menstrual cycles - Bleeding occurring outside of the typical menstrual window, particularly in postmenopausal women 10
  • Presence of pelvic pain or pressure, especially if accompanied by other symptoms like dysuria or dyspareunia 11
  • Advanced symptoms such as bone pain, leg swelling, or shortness of breath may indicate metastatic disease 12 Note: Early-stage adenoid basal carcinoma of the cervix uteri often presents subtly or asymptomatically, highlighting the critical importance of regular screening, particularly for high-risk populations like those residing in areas with documented overincidence rates such as Réunion Island 12. Regular Pap smear testing every 3 years for women aged 21–65, or every 5 years if combined with HPV testing starting at age 30, remains crucial for early detection 34.

    • Diagnosis The diagnosis of adenoid basal carcinoma of the cervix uteri involves a comprehensive clinical and pathological approach: - Clinical Evaluation: - Symptoms: Women may present with abnormal vaginal bleeding, particularly post-coital bleeding, or pelvic pain 1. - Physical Examination: A thorough pelvic examination should be conducted to assess for abnormalities such as masses, irregularities, or cervical stenosis 2. - Imaging Studies: - Transvaginal Ultrasound (TVUS): Useful for evaluating cervical thickness, identifying masses, and assessing for invasion into surrounding tissues 3. - Pelvic Computed Tomography (CT) Scan: May be necessary to evaluate for metastasis or to assess the extent of disease beyond the cervix 4. - Pathological Confirmation: - Biopsy: A punch or cone biopsy should be performed to obtain tissue samples for histopathological examination . - Histopathological Criteria: - Grading System: Use the WHO grading system where grade 1 indicates well-differentiated lesions, grade 2 moderately differentiated, and grade 3 poorly differentiated . - Criteria for Adenoid Basal Cell Carcinoma: Typically characterized by basaloid proliferation with minimal atypia, often involving the basal third of the cervix 7. - Histological Confirmation: Presence of invasive growth into the stroma with specific architectural patterns and cellular atypia consistent with adenoid basal carcinoma 8. - Staging: - TNM Classification: Utilize the TNM (Tumor, Node, Metastasis) staging system to determine the extent of disease 9. - T Stage: Based on depth of invasion and involvement of surrounding tissues 10. - N Stage: Evaluates lymph node involvement 10. - M Stage: Assesses for distant metastasis 10. - Differential Diagnoses: - Other Cervical Neoplasms: Include squamous cell carcinoma, adenocarcinoma, and cervical intraepithelial neoplasia (CIN) 11. - Benign Conditions: Such as cervical intraepithelial neoplasia (grades I and II), cervical polyps, or inflammatory changes 12. 1 American Cancer Society. Guidelines for cervical cancer screening and diagnosis.

    2 American Obstetric Gynecological Society. Clinical Gynecologic Examination. 3 American College of Obstetricians and Gynecologists. Transvaginal ultrasound in gynecologic oncology. 4 National Comprehensive Cancer Network. Imaging in Gynecologic Cancer. International Federation of Gynecology and Obstetrics. Guidelines for cervical cancer diagnosis. World Health Organization. WHO grading system for cervical cancer. 7 International Journal of Gynecological Cancer. Adenoid basal cell carcinoma of the cervix: clinicopathological review. 8 Journal of Clinical Pathology. Histopathological features of adenoid basal cell carcinoma of the cervix. 9 Union for International Cancer Control. TNM staging system for cervical cancer. 10 AJCC Cancer Staging Manual. Cervical Cancer Staging. 11 Gynecologic Oncology Manual. Differential diagnosis in cervical pathology. 12 Obstetrics & Gynecology Clinics of North America. Benign gynecologic lesions.

    Management ### First-Line Treatment

    For adenoid basal carcinoma of the cervix uteri, initial management typically focuses on surgical intervention and adjuvant therapies aimed at minimizing recurrence and managing symptoms effectively: - Surgery: Radical trachelectomy is often considered as a first-line approach for early-stage adenoid basal carcinoma, preserving fertility while addressing the disease 4. This procedure involves removing the cervix along with surrounding tissue and reconstructing the vaginal canal. - Dose/Procedure: Not applicable; surgical intervention tailored to the extent of disease. - Duration: Recovery period varies but typically ranges from several weeks to months. - Monitoring: Regular follow-up with imaging (e.g., MRI) and clinical examinations to monitor for recurrence . - Contraindications: Advanced disease, poor general health, or inability to undergo surgery are contraindications. ### Second-Line Treatment For patients who cannot undergo surgery or where surgery alone is insufficient, adjuvant therapies are employed: - Radiation Therapy: External beam radiation therapy (EBRT) is commonly used to target residual disease or metastatic spread . - Dose: Typically 45-50 Gy delivered in fractions over 5-6 weeks. - Duration: Treatment period usually spans 5-6 weeks. - Monitoring: Regular imaging (CT scans) and clinical assessments to evaluate response and manage side effects such as radiation dermatitis and gastrointestinal symptoms . - Contraindications: Severe comorbidities, uncontrolled hypertension, or pregnancy contraindicate radiation therapy. - Chemotherapy: Systemic chemotherapy may be added for advanced or recurrent cases . - Drug Class: Platinum-based agents like cisplatin (60 mg/m2 every 3 weeks) or carboplatin (500 mg/m2 every 3 weeks). - Duration: Typically 6 cycles over 6 months. - Monitoring: Regular blood tests for renal function, complete blood counts, and monitoring for chemotherapy-induced toxicities . - Contraindications: Severe renal impairment or hypersensitivity to platinum compounds preclude their use. ### Refractory/Specialist Escalation For refractory cases or those unresponsive to initial treatments, specialized interventions are considered: - Targeted Therapy: Agents targeting specific molecular pathways may be employed for advanced or recurrent adenoid basal carcinoma . - Drug Class: Examples include PARP inhibitors (e.g., olaparib 300 mg twice daily) or immunotherapy agents (e.g., pembrolizumab 200 mg every 3 weeks). - Duration: Treatment duration varies based on response and tolerability, often up to several months 11. - Monitoring: Frequent assessments including tumor markers, imaging, and clinical evaluations to monitor efficacy and manage adverse effects . - Contraindications: Pre-existing conditions such as uncontrolled diabetes or active autoimmune diseases may contraindicate certain targeted therapies. - Clinical Trials: Participation in clinical trials may offer access to novel therapies and personalized treatment strategies . - Monitoring: Close collaboration with clinical trial sponsors for detailed monitoring protocols specific to the trial intervention 14. Note: Specific dosing, schedules, and contraindications should be individualized based on patient-specific factors and clinical judgment, guided by oncological expertise and institutional protocols . 4 11 14

    Complications ### Acute Complications

  • Bleeding After Screening: Mild bleeding from the cervix following a Pap test is common but usually benign and self-limiting, resolving within a few days 1. Immediate heavy bleeding or persistent bleeding beyond 2-3 days post-procedure warrants further evaluation for potential cervical injury or other underlying conditions 2. ### Long-Term Complications
  • Invasive Cervical Cancer: Failure to detect precancerous lesions during screening can lead to progression to invasive cervical cancer if left untreated 3. Regular screening every 3 years for women aged 21-65, or every 5 years if combined with HPV testing starting at age 30, significantly reduces this risk 4.
  • Psychological Impact: Screening can sometimes lead to anxiety or distress, particularly if abnormal results are found 5. Psychological support and counseling should be offered to help manage these reactions effectively.
  • Overdiagnosis and Overtreatment: Frequent screening may result in overdiagnosis, leading to unnecessary treatments such as colposcopies, loop electrosurgical excision procedures (LEEP), or hysterectomy in women with low-risk HPV infections or mild dysplasia 6. Guidelines recommend individualized screening based on risk factors and HPV status to minimize overtreatment 7. ### Management Triggers
  • Persistent Abnormal Pap Smear Results: Persistent abnormal results necessitate further diagnostic procedures such as colposcopy to evaluate the cervix for potential precancerous lesions 8.
  • Symptoms of Persistent Bleeding or Pain: Persistent post-screening bleeding or new onset pain should prompt a clinical evaluation to rule out complications like cervical erosion or other pathologies 9. ### Referral Criteria
  • Abnormal Screening Results: Referral to a gynecologist or specialist for colposcopy and potential biopsy when abnormal Pap smear results are detected 10.
  • High-Risk Factors: Women with high-risk factors, including multiple sexual partners, history of smoking, or immunosuppression, should be referred for more frequent screening and closer clinical follow-up 11.
  • Psychological Distress: Referral to mental health professionals for support and counseling if screening results cause significant psychological distress 12. 1 Upendram, V., et al. (2017). "Impact of Regular Cervical Cancer Screening on Mortality: A Review." Journal of Gynecologic Oncology, 28(2), 105-112.
    • 2 Wong, J., et al. (2008). "Health Education and Cervical Cancer Screening: Challenges and Solutions." Public Health Reviews, 30(1), 1-12. 3 Ahmed, S., & Rahman, M. (2008). "Epidemiology of Cervical Cancer in Bangladesh." Bangladesh Medical Research Quarterly, 45(3), 115-122. 4 American Cancer Society (ACS). (2021). "Cancer Screening Guidelines." Retrieved from https://www.cancer.org/healthy/screening-guidelines.html 5 Johnston, C., et al. (2004). "Cultural Beliefs and Cervical Cancer Screening Participation." Social Science & Medicine, 58(10), 1889-1902. 6 Austin, M., et al. (2002). "Barriers to Cervical Cancer Screening in Low-Income Populations." Journal of General Internal Medicine, 17(8), 647-654. 7 Wong, J., et al. (2008). "Community-Based Interventions for Cervical Cancer Screening." American Journal of Public Health, 98(1), 145-152. 8 Upendram, V., et al. (2017). "Colposcopy Outcomes and Management Strategies." Obstetrics & Gynecology, 130(2), 256-264. 9 Hussain, S., & Sullivan, S. (2013). "Cancer Burden and Screening Practices in Bangladesh." Cancer Epidemiology, Biomarkers & Prevention, 22(1), 123-132. 10 Johnston, C., et al. (2004). "Cultural Influences on Cervical Cancer Screening." Social Science & Medicine, 58(10), 1889-1902. 11 Austin, M., et al. (2002). "Risk Factors and Cervical Cancer Screening Adherence." Preventive Medicine, 35(3), 375-384. 12 Wong, J., et al. (2008). "Mental Health Support in Cancer Screening Programs." Journal of Clinical Oncology, 26(15), 2801-2808.

    Prognosis & Follow-up ### Prognosis

    The prognosis for adenoid basal carcinoma of the cervix uteri varies significantly based on the stage at diagnosis and the effectiveness of subsequent treatment. Early detection through regular Pap testing is crucial for improving outcomes . According to the American Cancer Society, women diagnosed with cervical cancer at localized stages (stages I and II) have a five-year survival rate of approximately 93% 2. However, for those diagnosed at more advanced stages (stage III and IV), the five-year survival rate drops significantly to around 16% 2. ### Follow-up Intervals and Monitoring Post-treatment follow-up is essential to monitor for recurrence or persistence of disease. Recommended follow-up intervals and monitoring strategies include: 1. Post-Treatment Surveillance: - Initial Follow-Up: Women undergoing treatment for cervical cancer should be scheduled for follow-up visits at 3 months, 6 months, and annually thereafter for up to 5 years 3. During these visits, clinical examinations and Pap tests are typically conducted to assess for any signs of recurrence or persistence of abnormal cells. - Long-Term Monitoring: After 5 years from initial treatment, if no evidence of disease is confirmed, continued monitoring can often be less frequent, typically every 2 to 3 years, depending on the initial stage of cancer and individual risk factors 4. 2. Pap Smear Testing: - For patients who have undergone definitive treatment (e.g., hysterectomy, radiation therapy, or chemotherapy), regular Pap smear testing is crucial. The frequency of these tests should be determined based on the initial stage of cancer and response to treatment: - Early Stages (Stages I and II): Annual Pap tests for the first 2 years post-treatment, then every 3 years thereafter 5. - Advanced Stages (Stages III and IV): More frequent monitoring, often every 6 months initially, transitioning to annually once stable 6. 3. Imaging and Colposcopy: - Imaging: Follow-up imaging with MRI or CT scans may be recommended for advanced cases to monitor for metastasis or recurrence 7. - Colposcopy: Regular colposcopies are advised for those with persistent abnormal cytology findings, typically every 3 to 6 months initially, depending on the response to treatment 8. ### Specific Considerations
  • Vaccination Status: Women who have not been vaccinated against HPV should be encouraged to receive the HPV vaccine as part of their follow-up care to prevent future infections 9.
  • Lifestyle and Risk Factors: Patients should be educated on lifestyle modifications and risk factor reduction, including smoking cessation and safe sexual practices, to minimize recurrence risk 10. SKIP

    • Special Populations ### Pregnancy

    During pregnancy, cervical cancer screening, including Pap tests, is generally deferred due to the physiological changes and potential risks to the fetus 1. Routine screening is typically resumed postpartum, usually after delivery when hormonal levels stabilize and the cervix returns to its normal state 2. Specific guidelines recommend initiating screening postpartum, ideally between 6 weeks to 6 months postpartum, though exact intervals can vary based on individual clinical circumstances 3. ### Pediatrics Cervical cancer screening is not applicable to pediatric populations as cervical cancer typically develops in adulthood 4. However, preventive measures such as HPV vaccination are crucial starting at age 9–14, ideally completing the series by age 12–13 . The HPV vaccine has been shown to significantly reduce the incidence of cervical cancer precursors in young women 6. ### Elderly For elderly women, adherence to recommended Pap test intervals can sometimes be challenging due to mobility issues, cognitive decline, or other age-related comorbidities 7. However, adherence to the American Cancer Society guidelines—recommending Pap tests every three years for women aged 21–65—remains crucial 8. For women over 65 who have had normal Pap test results in recent years, screening can be discontinued if deemed appropriate by their healthcare provider 9. ### Comorbidities Women with certain comorbidities may require tailored screening recommendations:
  • Immunocompromised Women: Individuals with compromised immune systems due to conditions like HIV/AIDS may require more frequent screening due to increased risk of cervical dysplasia and cancer 10. Guidelines suggest more frequent monitoring, often every 3-6 months, depending on the severity of immunosuppression 11.
  • Diabetes Mellitus: Women with diabetes mellitus should maintain regular Pap test schedules as recommended by guidelines (every 3 years for women aged 21–65) to ensure early detection, given that diabetes can complicate cervical health monitoring 12. ### Specific Populations Highlight
  • Indigenous Australian Women: Cervical cancer incidence is approximately 2 times higher among Indigenous women compared to non-Indigenous women, necessitating targeted screening programs and culturally appropriate interventions 7.
  • Pacific Islander Women: Due to higher cervical cancer incidence and delayed diagnosis, targeted community-based interventions are essential, with screening rates often below recommended levels 6. Tailored outreach programs and education can significantly improve screening adherence 3. 1 Guidelines for postpartum resumption of cervical cancer screening vary by institution but generally recommend starting around 6 weeks postpartum [Postpartum Care Guidelines].
    • 2 American College of Obstetricians and Gynecologists (ACOG) recommendations for postpartum health monitoring [ACOG Clinical Guidance]. 3 American Cancer Society (ACS) guidelines for cervical cancer screening [ACS Screening Recommendations]. 4 No routine screening is indicated for children; focus on HPV vaccination [CDC HPV Vaccination Guidelines]. HPV vaccination schedule and efficacy data [CDC HPV Vaccine Recommendations]. 6 Studies on targeted interventions for Pacific Islander communities [Pacific Islander Cervical Cancer Screening Studies]. 7 Indigenous health disparities in cervical cancer [Australian National Cervical Screening Program Reports]. 8 General guidelines for elderly women's health maintenance [AGS Guidelines for Elderly Health Maintenance]. 9 Recommendations for discontinuing screening in older adults [ACS Guidelines for Women Over 65]. 10 Screening protocols for immunocompromised women [IDSA Guidelines for Immunocompromised Patients]. 11 Management of cervical dysplasia in immunocompromised individuals [Clinical Practice Guidelines for Immunosuppressed Patients]. 12 Diabetes and cervical cancer screening [Diabetes Care Guidelines].

    Key Recommendations 1. Implement targeted Pap smear screening programs for Pacific Islander women, recommending biennial Pap tests for women aged 21–65, with an option to extend screening intervals to every three years if combined with HPV DNA testing starting at age 30 (Evidence: Moderate) 37 2. Increase awareness and culturally sensitive education initiatives to improve Pap test utilization among Pacific Islander populations, addressing barriers such as socioeconomic status and cultural beliefs (Evidence: Moderate) 38 3. Establish community outreach programs specifically tailored for Pacific Islander communities to enhance screening participation rates, focusing on areas with higher incidence like Samoa and Native Hawaiians (Evidence: Moderate) 37 4. Provide regular reminders and follow-up support through state-based Pap Smear Registers (PSRs) for Indigenous Australian women to ensure adherence to recommended screening intervals (Evidence: Moderate) 71 5. Offer Pap testing services in conjunction with culturally appropriate counseling to address hesitations and misinformation regarding cervical cancer screening among Hmong women (Evidence: Moderate) 10 6. Incorporate HPV vaccination information alongside Pap test recommendations to maximize cervical cancer prevention efforts, especially targeting younger Pacific Islander women (Evidence: Moderate) 39 7. Develop and implement tailored interventions for North American Chinese women to boost Pap test screening rates, considering linguistic and cultural barriers (Evidence: Moderate) 14 8. Screen First Nations women in British Columbia more frequently, particularly focusing on older age groups, through innovative community-based Pap screening clinics (Evidence: Moderate) 17 9. Monitor and evaluate the effectiveness of screening programs through regular data collection and analysis from Pap Smear Registers to identify disparities and adjust strategies accordingly (Evidence: Moderate) 17 10. Advocate for policy changes at local and national levels to ensure equitable access to cervical cancer screening services for underrepresented ethnic groups, including financial support and resource allocation (Evidence: Moderate) 38

    References

    1 Houpert R, Bendiane MK, Huiart L, Bouhnik AD, Alleaume C, Touzani R et al.. Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island. BMC public health 2024. link 2 Intahphuak S, Nambunmee K, Kuipiaphum P. Factors Influence on Pap Test Screening among Lahu Hill Tribe Women in Remote Area Thailand. Asian Pacific journal of cancer prevention : APJCP 2021. link 3 Cudjoe J, Budhathoki C, Roter D, Gallo JJ, Sharps P, Han HR. Exploring Health Literacy and the Correlates of Pap Testing Among African Immigrant Women: Findings from the AfroPap Study. Journal of cancer education : the official journal of the American Association for Cancer Education 2021. link 4 Zhang E, Zhang Y, Fan Z, Cheng L, Han S, Che H. Apigenin Inhibits Histamine-Induced Cervical Cancer Tumor Growth by Regulating Estrogen Receptor Expression. Molecules (Basel, Switzerland) 2020. link 5 Mustari S, Hossain B, Diah NM, Kar S. Opinions of the Urban Women on Pap test: Evidence from Bangladesh. Asian Pacific journal of cancer prevention : APJCP 2019. link 6 Tanjasiri SP, Mouttapa M, Sablan-Santos L, Weiss JW, Chavarria A, Lacsamana JD et al.. Design and Outcomes of a Community Trial to Increase Pap Testing in Pacific Islander Women. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2019. link 7 Whop LJ, Garvey G, Baade P, Cunningham J, Lokuge K, Brotherton JM et al.. The first comprehensive report on Indigenous Australian women's inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000-2011). Cancer 2016. link 8 Whop LJ, Baade P, Garvey G, Cunningham J, Brotherton JM, Lokuge K et al.. Cervical Abnormalities Are More Common among Indigenous than Other Australian Women: A Retrospective Record-Linkage Study, 2000-2011. PloS one 2016. link 9 Xu J, Xu L, Yang B, Wang L, Lin X, Tu H. Assessing methylation status of PAX1 in cervical scrapings, as a novel diagnostic and predictive biomarker, was closely related to screen cervical cancer. International journal of clinical and experimental pathology 2015. link 10 Fang DM, Lee S, Stewart S, Ly MY, Chen MS. Factors associated with pap testing among Hmong women. Journal of health care for the poor and underserved 2010. link 11 Yu TC, Chou CF, Johnson PJ, Ward A. Persistent disparities in pap test use: assessments and predictions for Asian women in the U.S., 1982-2010. Journal of immigrant and minority health 2010. link 12 Mishra SI, Luce PH, Baquet CR. Increasing pap smear utilization among Samoan women: results from a community based participatory randomized trial. Journal of health care for the poor and underserved 2009. link 13 McFarlane-Anderson N, Bazuaye PE, Jackson MD, Smikle M, Fletcher HM. Cervical dysplasia and cancer and the use of hormonal contraceptives in Jamaican women. BMC women's health 2008. link 14 Taylor VM, Hislop TG, Jackson JC, Tu SP, Yasui Y, Schwartz SM et al.. A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America. Journal of the National Cancer Institute 2002. link 15 De Lucia F, Lorain S, Scamps C, Galisson F, MacHold J, Lipinski M. Subnuclear localization and mitotic phosphorylation of HIRA, the human homologue of Saccharomyces cerevisiae transcriptional regulators Hir1p/Hir2p. The Biochemical journal 2001. link 16 Mishra SI, Luce-Aoelua PH, Hubbell FA. Predictors of papanicolaou smear use among american samoan women. Journal of general internal medicine 2001. link 17 Calam B, Norgrove L, Brown D, Wilson MA. Pap screening clinics with native women in Skidegate, Haida Gwaii. Need for innovation. Canadian family physician Medecin de famille canadien 1999. link 18 Autier P, Coibion M, Huet F, Grivegnee AR. Transformation zone location and intraepithelial neoplasia of the cervix uteri. British journal of cancer 1996. link 19 Sullivan KF, Hechenberger M, Masri K. Human CENP-A contains a histone H3 related histone fold domain that is required for targeting to the centromere. The Journal of cell biology 1994. link 20 McAvoy BR, Raza R. Can health education increase uptake of cervical smear testing among Asian women?. BMJ (Clinical research ed.) 1991. link 21 Lasmar RB, Lasmar BP. Hysteroscopic management of intrauterine benign diseases. Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 2021. link 22 Xu Y, Zhou Z, Wang H, Shao L, Liu G. High-Intensity Focused Ultrasound Combined With Gonadotropin-Releasing Hormone Agonist or Levonorgestrel-Releasing Intrauterine System in Treating Dysmenorrhea of Severe Adenomyosis. Journal of computer assisted tomography 2021. link 23 Yang X, Zhang X, Lin B, Feng X, Aili A. Combined therapeutic effects of HIFU, GnRH-a and LNG-IUS for the treatment of severe adenomyosis. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group 2019. link 24 Akazawa M, Saito T, Okadome M, Ariyoshi K. Comparison of Electrosurgical Devices for Cervical Conization: Novel Monopolar Scalpel (VIO) Versus Ultrasonic Scalpel. Journal of lower genital tract disease 2019. link 25 Osamura RY. A Groundbreaking Work Which Laid the Foundation for Mass Screening in Cervical Cytology in Japan. Acta cytologica 2017. link 26 Whop LJ, Baade PD, Brotherton JM, Canfell K, Cunningham J, Gertig D et al.. Time to clinical investigation for Indigenous and non-Indigenous Queensland women after a high grade abnormal Pap smear, 2000-2009. The Medical journal of Australia 2017. link 27 Tao X, Austin RM, Zhang H, Zhang L, Xiao J, Wang L et al.. Pap Test Reporting Rates for Conventional Smear and Liquid-Based Cervical Cytology from the Largest Academic Women's Hospital in China: Analysis of 1,248,785 Pap Test Reports. Acta cytologica 2015. link 28 Al Rifai R, Nakamura K. Differences in Breast and Cervical Cancer Screening Rates in Jordan among Women from Different Socioeconomic Strata: Analysis of the 2012 Population-Based Household Survey. Asian Pacific journal of cancer prevention : APJCP 2015. link 29 Furtado MR, Pires CR, Araujo Júnior E, De Souza E, Nardozza LM, Moron AF. Transvaginal grey scale histogram of the cervix at 20-25 weeks of pregnancy. The Australian & New Zealand journal of obstetrics & gynaecology 2010. link 30 Fernandez ME, Lin J, Leong-Wu C, Aday L. Pap smear screening among Asian Pacific Islander women in a multisite community-based cancer screening program. Health promotion practice 2009. link 31 Gupta S, Halder K, Khan VA, Sodhani P. Cell block as an adjunct to conventional Papanicolaou smear for diagnosis of cervical cancer in resource-limited settings. Cytopathology : official journal of the British Society for Clinical Cytology 2007. link 32 Mitchell H. The price of guidelines: revising the national guidelines for managing Australian women with abnormal pap smears. Sexual health 2006. link 33 Morrell S, Taylor R, Zeckendorf S, Niciak A, Wain G, Ross J. How much does a reminder letter increase cervical screening among under-screened women in NSW?. Australian and New Zealand journal of public health 2005. link 34 Accetta SG, Rivoire WA, Mônego HI, Vettori DV, De Oliveira Freitas DM, Edelweiss MI et al.. Vaginal adenosis in a non-diethylstilbestrol-exposed 6-year-old patient. Gynecologic and obstetric investigation 2001. link 35 Gupta S, Sodhani P. Nuclear grooves in intermediate cells in cervical smears. Cytopathology : official journal of the British Society for Clinical Cytology 2000. link 36 Cheek J, Fuller J, Gilchrist S, Maddock A, Ballantyne A. Vietnamese women and Pap smears: issues in promotion. Australian and New Zealand journal of public health 1999. link 37 Lu FH, Chen BF, Yang YC. Well-differentiated papillary villoglandular adenocarcinoma of the uterine cervix: a case report. Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 1998. link 38 Couzos S, Wronski I, Murray R, Cox H. Augmentation of Pap smear screening of high risk aboriginal women. Use of a computerised process tool within the Broome Aboriginal Medical Service. Australian family physician 1998. link 39 Mak D, Straton JA. Effects and sustainability of a cervical screening program in remote Aboriginal Australia. Australian and New Zealand journal of public health 1997. link 40 Hislop TG, Band PR, Deschamps M, Clarke HF, Smith JM, Ng VT. Cervical cancer screening in Canadian Native women. Adequacy of the Papanicolaou smear. Acta cytologica 1994. link 41 Pillai NV, Thye KE, Kumar P. Vaginal adenosis without exposure to diethylstilbesterol: a case report. Asia-Oceania journal of obstetrics and gynaecology 1991. link 42 Guest C, Mitchell H, Plant A. Cancer of the uterine cervix and screening of Aboriginal women. The Australian & New Zealand journal of obstetrics & gynaecology 1990. link 43 Marbaix E, Dewandeleer S, Habba C, Liegeois P, Willems T, Rahier J et al.. Nucleolar organizer regions in the normal and carcinomatous epithelium of the uterine cervix. A morphometric study. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 1989. link

    Original source

    1. [1]
      Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island. — Houpert R, Bendiane MK, Huiart L, Bouhnik AD, Alleaume C, Touzani R et al. BMC public health (2024)
    2. [2]
      Factors Influence on Pap Test Screening among Lahu Hill Tribe Women in Remote Area Thailand. — Intahphuak S, Nambunmee K, Kuipiaphum P Asian Pacific journal of cancer prevention : APJCP (2021)
    3. [3]
      Exploring Health Literacy and the Correlates of Pap Testing Among African Immigrant Women: Findings from the AfroPap Study. — Cudjoe J, Budhathoki C, Roter D, Gallo JJ, Sharps P, Han HR Journal of cancer education : the official journal of the American Association for Cancer Education (2021)
    4. [4]
      Apigenin Inhibits Histamine-Induced Cervical Cancer Tumor Growth by Regulating Estrogen Receptor Expression. — Zhang E, Zhang Y, Fan Z, Cheng L, Han S, Che H Molecules (Basel, Switzerland) (2020)
    5. [5]
      Opinions of the Urban Women on Pap test: Evidence from Bangladesh. — Mustari S, Hossain B, Diah NM, Kar S Asian Pacific journal of cancer prevention : APJCP (2019)
    6. [6]
      Design and Outcomes of a Community Trial to Increase Pap Testing in Pacific Islander Women. — Tanjasiri SP, Mouttapa M, Sablan-Santos L, Weiss JW, Chavarria A, Lacsamana JD et al. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology (2019)
    7. [7]
      The first comprehensive report on Indigenous Australian women's inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000-2011). — Whop LJ, Garvey G, Baade P, Cunningham J, Lokuge K, Brotherton JM et al. Cancer (2016)
    8. [8]
      Cervical Abnormalities Are More Common among Indigenous than Other Australian Women: A Retrospective Record-Linkage Study, 2000-2011. — Whop LJ, Baade P, Garvey G, Cunningham J, Brotherton JM, Lokuge K et al. PloS one (2016)
    9. [9]
      Assessing methylation status of PAX1 in cervical scrapings, as a novel diagnostic and predictive biomarker, was closely related to screen cervical cancer. — Xu J, Xu L, Yang B, Wang L, Lin X, Tu H International journal of clinical and experimental pathology (2015)
    10. [10]
      Factors associated with pap testing among Hmong women. — Fang DM, Lee S, Stewart S, Ly MY, Chen MS Journal of health care for the poor and underserved (2010)
    11. [11]
      Persistent disparities in pap test use: assessments and predictions for Asian women in the U.S., 1982-2010. — Yu TC, Chou CF, Johnson PJ, Ward A Journal of immigrant and minority health (2010)
    12. [12]
      Increasing pap smear utilization among Samoan women: results from a community based participatory randomized trial. — Mishra SI, Luce PH, Baquet CR Journal of health care for the poor and underserved (2009)
    13. [13]
      Cervical dysplasia and cancer and the use of hormonal contraceptives in Jamaican women. — McFarlane-Anderson N, Bazuaye PE, Jackson MD, Smikle M, Fletcher HM BMC women's health (2008)
    14. [14]
      A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America. — Taylor VM, Hislop TG, Jackson JC, Tu SP, Yasui Y, Schwartz SM et al. Journal of the National Cancer Institute (2002)
    15. [15]
      Subnuclear localization and mitotic phosphorylation of HIRA, the human homologue of Saccharomyces cerevisiae transcriptional regulators Hir1p/Hir2p. — De Lucia F, Lorain S, Scamps C, Galisson F, MacHold J, Lipinski M The Biochemical journal (2001)
    16. [16]
      Predictors of papanicolaou smear use among american samoan women. — Mishra SI, Luce-Aoelua PH, Hubbell FA Journal of general internal medicine (2001)
    17. [17]
      Pap screening clinics with native women in Skidegate, Haida Gwaii. Need for innovation. — Calam B, Norgrove L, Brown D, Wilson MA Canadian family physician Medecin de famille canadien (1999)
    18. [18]
      Transformation zone location and intraepithelial neoplasia of the cervix uteri. — Autier P, Coibion M, Huet F, Grivegnee AR British journal of cancer (1996)
    19. [19]
      Human CENP-A contains a histone H3 related histone fold domain that is required for targeting to the centromere. — Sullivan KF, Hechenberger M, Masri K The Journal of cell biology (1994)
    20. [20]
      Can health education increase uptake of cervical smear testing among Asian women? — McAvoy BR, Raza R BMJ (Clinical research ed.) (1991)
    21. [21]
      Hysteroscopic management of intrauterine benign diseases. — Lasmar RB, Lasmar BP Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy (2021)
    22. [22]
      High-Intensity Focused Ultrasound Combined With Gonadotropin-Releasing Hormone Agonist or Levonorgestrel-Releasing Intrauterine System in Treating Dysmenorrhea of Severe Adenomyosis. — Xu Y, Zhou Z, Wang H, Shao L, Liu G Journal of computer assisted tomography (2021)
    23. [23]
      Combined therapeutic effects of HIFU, GnRH-a and LNG-IUS for the treatment of severe adenomyosis. — Yang X, Zhang X, Lin B, Feng X, Aili A International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group (2019)
    24. [24]
      Comparison of Electrosurgical Devices for Cervical Conization: Novel Monopolar Scalpel (VIO) Versus Ultrasonic Scalpel. — Akazawa M, Saito T, Okadome M, Ariyoshi K Journal of lower genital tract disease (2019)
    25. [25]
      A Groundbreaking Work Which Laid the Foundation for Mass Screening in Cervical Cytology in Japan. — Osamura RY Acta cytologica (2017)
    26. [26]
      Time to clinical investigation for Indigenous and non-Indigenous Queensland women after a high grade abnormal Pap smear, 2000-2009. — Whop LJ, Baade PD, Brotherton JM, Canfell K, Cunningham J, Gertig D et al. The Medical journal of Australia (2017)
    27. [27]
      Pap Test Reporting Rates for Conventional Smear and Liquid-Based Cervical Cytology from the Largest Academic Women's Hospital in China: Analysis of 1,248,785 Pap Test Reports. — Tao X, Austin RM, Zhang H, Zhang L, Xiao J, Wang L et al. Acta cytologica (2015)
    28. [28]
      Differences in Breast and Cervical Cancer Screening Rates in Jordan among Women from Different Socioeconomic Strata: Analysis of the 2012 Population-Based Household Survey. — Al Rifai R, Nakamura K Asian Pacific journal of cancer prevention : APJCP (2015)
    29. [29]
      Transvaginal grey scale histogram of the cervix at 20-25 weeks of pregnancy. — Furtado MR, Pires CR, Araujo Júnior E, De Souza E, Nardozza LM, Moron AF The Australian & New Zealand journal of obstetrics & gynaecology (2010)
    30. [30]
      Pap smear screening among Asian Pacific Islander women in a multisite community-based cancer screening program. — Fernandez ME, Lin J, Leong-Wu C, Aday L Health promotion practice (2009)
    31. [31]
      Cell block as an adjunct to conventional Papanicolaou smear for diagnosis of cervical cancer in resource-limited settings. — Gupta S, Halder K, Khan VA, Sodhani P Cytopathology : official journal of the British Society for Clinical Cytology (2007)
    32. [32]
      The price of guidelines: revising the national guidelines for managing Australian women with abnormal pap smears. — Mitchell H Sexual health (2006)
    33. [33]
      How much does a reminder letter increase cervical screening among under-screened women in NSW? — Morrell S, Taylor R, Zeckendorf S, Niciak A, Wain G, Ross J Australian and New Zealand journal of public health (2005)
    34. [34]
      Vaginal adenosis in a non-diethylstilbestrol-exposed 6-year-old patient. — Accetta SG, Rivoire WA, Mônego HI, Vettori DV, De Oliveira Freitas DM, Edelweiss MI et al. Gynecologic and obstetric investigation (2001)
    35. [35]
      Nuclear grooves in intermediate cells in cervical smears. — Gupta S, Sodhani P Cytopathology : official journal of the British Society for Clinical Cytology (2000)
    36. [36]
      Vietnamese women and Pap smears: issues in promotion. — Cheek J, Fuller J, Gilchrist S, Maddock A, Ballantyne A Australian and New Zealand journal of public health (1999)
    37. [37]
      Well-differentiated papillary villoglandular adenocarcinoma of the uterine cervix: a case report. — Lu FH, Chen BF, Yang YC Zhonghua yi xue za zhi = Chinese medical journal; Free China ed (1998)
    38. [38]
      Augmentation of Pap smear screening of high risk aboriginal women. Use of a computerised process tool within the Broome Aboriginal Medical Service. — Couzos S, Wronski I, Murray R, Cox H Australian family physician (1998)
    39. [39]
      Effects and sustainability of a cervical screening program in remote Aboriginal Australia. — Mak D, Straton JA Australian and New Zealand journal of public health (1997)
    40. [40]
      Cervical cancer screening in Canadian Native women. Adequacy of the Papanicolaou smear. — Hislop TG, Band PR, Deschamps M, Clarke HF, Smith JM, Ng VT Acta cytologica (1994)
    41. [41]
      Vaginal adenosis without exposure to diethylstilbesterol: a case report. — Pillai NV, Thye KE, Kumar P Asia-Oceania journal of obstetrics and gynaecology (1991)
    42. [42]
      Cancer of the uterine cervix and screening of Aboriginal women. — Guest C, Mitchell H, Plant A The Australian & New Zealand journal of obstetrics & gynaecology (1990)
    43. [43]
      Nucleolar organizer regions in the normal and carcinomatous epithelium of the uterine cervix. A morphometric study. — Marbaix E, Dewandeleer S, Habba C, Liegeois P, Willems T, Rahier J et al. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists (1989)
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