Search PubMed⌕ Search

Biomedical subjects

G Medley

Publications and source records attributed to G Medley.

At least 37 records · Page 2Linked to original sources
PubMed1991

Longitudinal study of women with negative cervical smears according to endocervical status.

A longitudinal study of 20,222 women who received negative cervical smear reports in 1987 showed that the incidence of definite or equivocal cervical intraepithelial neoplasia (CIN) was not significantly different between those whose first smear lacked an endocervical component and those whose smear included an endocervical component. The incidence of definite cytological evidence of CIN was significantly lower in women whose first smear did not include an endocervical component. It is concluded that women whose smears are reported as negative but lack an endocervical component should not be rescreened any earlier than women with negative smears that include an endocervical component.

Adolescent↗
PubMed1991

Reporting of an endocervical component after a previous cervical biopsy.

The rate of reporting endocervical cells in the Papanicolaou smears of 579 women with a past history of cervical biopsy was compared with an age matched control group of women. During a time period when only spatulae (Ayre Lerner and Aylesbury) were used for sampling, 55% of the cases and 53% of the controls had the presence of endocervical cells reported. When cytobrushes as well as spatulae were used, the proportion rose to 70% for cases and 73% for controls. We conclude that the probability of endocervical cells being reported is not influenced by a past history of cervical biopsy, but is substantially improved if a combination of cytobrush and spatula is provided for sampling.

Adult↗
PubMed1990

Cervical cancers diagnosed after negative results on cervical cytology: perspective in the 1980s.

OBJECTIVES: To assess the magnitude of the problem of interval cancers of the cervix (those that are diagnosed within a short time after negative screening test results) in the 1980s, to compare the nature of interval cancers in younger women with that in older women, and, by reviewing negative cervical smears, to determine the proportion of interval cancers that might represent the development of malignancy anew compared with the proportion that might be associated with difficulties in sampling or errors in reporting. DESIGN: An audit of the interval cases of cervical cancer that had been diagnosed within 36 months of a smear having been reported as negative by the Victorian Cytology Gynaecological Service among women registered with cervical cancer during 1982-6. SETTING: The Victorian Cytology Gynaecological Service, a free public sector cytology laboratory in Victoria, Australia. SUBJECTS: 138 Women, all of whom had had cervical cancer diagnosed during the 36 months after having had a negative cervical smear. Subjects were divided into two age groups: younger women, aged less than 35; older women, aged 35-69. INTERVENTIONS: Negative slides were reviewed for evidence of optimal sampling and for the presence of cellular abnormalities that had been missed at the time of the original reporting. MAIN OUTCOME MEASURES: The number of interval cases of cancer of the cervix registered during 1982-6. The proportion of interval cases occurring in younger women and the proportion occurring in older women. Division of women into three risk categories based on clinical history and screening history that broadly corresponded to the probability that a diagnosis of cervical cancer might be expected during the 36 months after the issuing of a negative smear report. RESULTS: 138 Of 1044 (13.2%) women who had been registered with cervical cancer during 1982-6 had had one or more negative smears during the 36 months preceding the diagnosis of cancer. Interval cancers comprised a larger proportion of registrations of cervical cancer in women aged less than 35 years than in women aged 35-69 (21.1% v 11.0%, p less than 0.01). Women with interval cancer who had had at least three negative smears during the 10 years before the diagnosis of cancer were commoner in the younger age group than in the older age group (7.0% v 2.5%, p less than 0.01). When, however, the number of observed cases of squamous cell carcinoma was related to the number of expected cases in the absence of screening, no significant difference was found between the two age groups (6.8% v 4.8%, p greater than 0.10). The rate of diagnosis of interval cancer per 100,000 negative tests was lower among younger women than among older women (10/100,000 v 16/100,000). Review of the negative slides showed that 11.9% were again considered to be negative with an optimal sample having been obtained as evidenced by the presence of endocervical cells or metaplastic cells, or both. CONCLUSIONS: Interval cancers might comprise a larger proportion of all registered cases of cervical cancer among younger women owing to the larger proportion of such cancers being prevented in this age group. Among women with interval cancer review of the negative slides showed that most were accounted for by suboptimal sampling or by errors of reporting.

Adult↗
PubMed1990

Age and time trends in the prevalence of cervical intraepithelial neoplasia on Papanicolaou smear tests, 1970-1988.

Substantial increases in the prevalence of cervical intraepithelial neoplasia (CIN) in women of all age groups are apparent from Papanicolaou smear test reports issued by the Victorian Cytology (Gynaecological) Service between 1970 and 1988. Most of the change in prevalence is due to an increase in reports of neoplasia of a lesser severity than CIN III. A progressive lowering of the age group having the highest prevalence of "definite" CIN is evident, from women aged 40-49 years in 1970-1973 to women aged 25-29 years in 1982-1988. The prevalence of "possible" CIN has consistently been highest among the youngest age groups screened. While 6.7% of screened women from the age group 20-24 years received a report of "definite" or "possible" CIN in 1988, only 0.08% of women in this group received a report of CIN III. Cohort analysis revealed that for women born between 1949 and 1958, the prevalence of CIN III continued to increase during 1988.

Adolescent↗
PubMed1990

Risk of subsequent cytological abnormality and cancer among women with a history of cervical intraepithelial neoplasia: a comparative study.

A longitudinal study of 1,281 women with a histological diagnosis of cervical intraepithelial neoplasia (CIN) during 1974-76 is presented. After 12 years of follow-up, 30 percent of the women had further cytological abnormalities reported. The rate of subsequent abnormality was highest during the first 12 months of follow-up; thereafter, there was no evidence of any decline in the rate of subsequent abnormality with increasing duration of follow-up. Women from the CIN cohort had twice as many later cytological abnormalities as an age-matched cohort of women who were negatively screened during 1974-76 (excluding abnormalities within 12 months of entry to the study and after adjustment for smear frequency). The CIN cohort remained at substantially greater risk for a subsequent diagnosis of squamous cell carcinoma of the cervix compared with the control group of negatively-screened women (rate ratio 19.8, 95 percent confidence interval 2.4-163.6, P less than 0.01). These results indicate that women who have received surgical intervention for CIN continue to have substantial morbidity from cervical abnormalities during medium-term follow-up.

Adult↗
PubMed1990

An evaluation of a campaign to increase cervical cancer screening in rural Victoria.

This paper reports on the second of four regionally-based campaigns co-ordinated in rural Victoria by the Anti-Cancer Council of Victoria. The campaign encompassed community-based activities, general practitioner involvement and screening clinics. The impact of the campaign on Pap test rates and on the profile of women whose tests were reported by the Victorian Cytology Gynaecological Service is examined. We conclude that the campaign was successful in achieving its primary objective of attracting older and relatively underscreened women into having a Pap test. The special screening clinics were considered particularly effective in reaching women in the target audience. As a result of this campaign, new initiatives, were incorporated into subsequent programs.

Adult↗
PubMed1989

Adherence to recommendations for early repeat cervical smear tests.

OBJECTIVE: To assess adherence to recommendations for an early repeat cervical smear test in women with reports of cytological abnormalities, and to evaluate the impact of reminder letters to medical practitioners when such smear tests are overdue. DESIGN: Observational study. SETTING: Cytology (gynaecological) service for Victoria, Australia. SUBJECTS: Two groups of women who had abnormal cervical smears during 1985. Women in group A had some evidence of an important dysplasia and were advised to have a repeat smear in three months' time whereas women in group B had a less serious abnormality and were advised to have a repeat smear test in six months' time. In all, 971 of the 1036 women in group A and 1401 of the 1464 women in group B were eligible to have a repeat smear analysed by the service. INTERVENTION: If a repeat smear had not been received within three months of the recommended date a reminder letter generated by the service's computer was sent to the medical practitioner who had taken the smear. END POINT: Thirty six months after the report on the abnormal smear was issued. MEASUREMENTS AND MAIN RESULTS: In all, 870 (90%) of the women in group A and 1154 (82%) of the women in group B had a repeat smear test. The mean time to a repeat test was 3.0 months (95% confidence interval 0.5 to 16.4) in group A and 6.0 months (1.2 to 30.3) in group B. The reminder letter to the practitioner potentially increased the rate of return for a repeat smear test by 18% in group A and 24% in group B. Adherence to the recommendation for a repeat test increased with increasing age. CONCLUSIONS: Achieving high rates of follow up smear tests and appropriate management in women with cytological abnormalities is critical to the impact of a screening programme for cervical cancer. The reminder system used in this study was not labour intensive or expensive and provided a fail safe mechanism for ensuring that reports of abnormal smears were not overlooked.

Adult↗
PubMed1989

Evidence against diathermy as a beneficial treatment for human papillomavirus infection of the cervix.

An observational study of the influence of diathermy on the rate of subsequent cytological evidence of cervical intraepithelial neoplasia and/or human papillomavirus infection among women with a histological diagnosis of cervical human papillomavirus infection is presented. After the histological diagnosis of human papillomavirus infection, 35% (23/65) of women who were not diathermied had persistence/recurrence of cytological abnormalities compared with 30% (60/203) of the women who were diathermied at the time of the biopsy. The rate ratio for further abnormality among women who did not have a diathermy relative to those who did was not significantly different at 1.25 (95% confidence interval 0.77-2.03). This study had a power of 77% to detect a true rate ratio of 2 at the 0.05 level of significance. This data does not provide strong evidence that diathermy is appropriate management for women with cervical human papillomavirus infection without evidence of dysplasia.

Adolescent↗
PubMed1988

Pap smear results of Victorian teenagers, 1980-1987.

Pap smears reported by the Victorian Cytology (Gynaecological) Service between 1980 and 1987 for teenagers show a profile of abnormality which is similar to that for women for all ages. More than 90% of the cytology report have consistently been reported as normal or showing minor benign abnormalities only. No evidence of an increasing rate of infection with human papillomavirus is apparent, with the infection rate as determined cytologically being constant at around 4% to 5% during 1981 to 1987. Some increase in the proportion of women having associated changes of CIN is apparent. No case of invasive cancer in teenagers has yet been confirmed. These data suggest that the teenagers in Victoria who are having Pap smears reported by the Victorian Cytology (Gynaecological) Service are not a high risk group for cervical cancer during their teenage years, but may be a high risk group during later years.

Adolescent↗
PubMed1987

Human papillomavirus infection of the cervix in Victoria, 1982-1985.

Cytological evidence of human papillomavirus infection was present in 4.1% of the smear-tests that were received by the Victorian Cytology (Gynaecological) Service during 1982-1985. The prevalence rate among women was estimated to be 2.6% in 1984; for one-third of the women this was a change from their previous cytological status. The prevalence of papillomavirus infection was noted to vary with age and referral source; higher proportions were seen in the age group, 20-24 years, and in the cytological results of women who were attending either a sexually-transmitted diseases clinic or Aboriginal health cooperatives.

Adult↗
PubMed1987

Delay times to definitive diagnosis after an abnormal Pap smear.

The delay between the issuing of an abnormal cytology report and the subsequent histological diagnosis has been studied for women diagnosed with carcinoma in situ, microinvasive cancer and invasive cancer in Victoria during 1985-1986. The median delay was 0.75 weeks for women with invasive cancer, 6.2 weeks for women with microinvasive cancer and 4.9 weeks for women with carcinoma in situ. Little variation was apparent with the type of practitioner taking the smear or with the area of residence of the woman. Ten of the 235 women in this study had delays of greater than 20 weeks. Five of these women were ultimately shown to have microinvasive or invasive cancer where the cytology report had indicated a lesser degree of neoplastic change. It is possible that the lesions progressed during this time.

Carcinoma in Situ↗
PubMed1987

Cytologic detection of human papillomavirus infection.

In recent years there has been a dramatic increase in the incidence of human papillomavirus infection of the female genital tract. Since the primary diagnosis of this condition is almost invariably based on cytologic observations, the diagnostic criteria are of paramount importance. The diagnosis is usually based on the presence of koilocytes, or balloon cells, and dyskeratotic cells. Although these cells remain fundamental to the diagnosis, it is important to recognize other possible cytologic manifestations of the disease. Follow-up studies indicate clearly that any woman with cytologic evidence of HPV infection has a greatly increased risk of developing cervical intraepithelial neoplasia. Morphologic attempts to quantify this risk are unreliable. The studies described and quoted in this paper would suggest that all women with the cytologic changes of HPV infection, with or without evidence of cervical intraepithelial neoplasia, should be managed with extreme caution.

Cervix Uteri↗
PubMed1986

Association between anorectal dysplasia, human papillomavirus, and human immunodeficiency virus infection in homosexual men.

Cells from the anorectal mucosa of 61 homosexual men were examined microscopically for evidence of papillomavirus infection and dysplastic changes. There was cytological evidence of dysplasia with concomitant features of human papillomavirus (HPV) infection on at least one occasion in 24 men and of papillomavirus infection without dysplasia on at least one occasion in a further 26: dysplasia was present for over one year in 9 of 14 men who were re-examined. Dysplasia was associated with a history of anal warts, frequent receptive anal intercourse, presence of serum antibody to human immunodeficiency virus (HIV), and immune dysfunction as judged by a low CD4/CD8 ratio, but not with the lifetime number of sexual partners. The association of longlasting dysplasia with anti-HIV was independent of the association with immune dysfunction. Thus infection of anorectal mucosal cells with papillomavirus seems to be frequent among homosexual men and may predispose to dysplasia.

Acquired Immunodeficiency Syndrome↗