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Multifactoriality of cervical intraepithelial neoplasia

Relevance. According to the Kazakh Research Institute of Oncology and Radiology of the Ministry of Health of the Republic of Kazakhstan, in 2018, about 1,700 new cases of cervical cancer were detected in the country [1]. Almost 650 women die each year from the disease [2]. In 2018 alone, 69 thousand new cases of the disease will be registered in European countries [3]. The highest incidence of cervical cancer in Russia is 20.2-100 cases per 14.7 thousand [4]. Cervical cancer is most common in people aged 40-44 years. Every year, more than 10 million people in the world are diagnosed with CIN III / CIS, which is 20 times more than invasive cancer [5]. CIN I has a worldwide circulation of 30 million, but the actual number of CIN IIIs is higher than recorded. Cervical cancer today is clearly associated with HPV infection, as oncogenic forms of HPV 16/18 are found in 99% of patients. There is no cure for HPV, but in 85-90% of infected women, the virus disappears from the body within 1-2 years due to the immune system [6].

On August 14, 2020, the WHO adopted a global strategy to eradicate cervical cancer, which outlines the steps to be taken to achieve specific goals for each WHO member state by 2030: - 90% of girls should be fully vaccinated by the age of 15; - 70% of women must be screened at least twice through a high performance test; - 90% of women with cancer should receive appropriate treatment, including polyclinic care. In Kazakhstan, from 2020, vaccination against APV is included in the vaccination schedule with the voluntary consent of parents. Prophylactic vaccination against high-risk APV is an effective way to protect against cervical cancer at the global level.

The purpose of the study was to identify risk factors for cervical intraepithelial neoplasia.

Objectives: 1. To study the vital, somatic, obstetric and gynecological anamnesis of patients. 2. Study of the results of cytological screening.

Materials: The study was conducted on the basis of LLP "Central Family Polyclinic" in Almaty. During the first 9 months of 2020, 900 retrospective analyzes were performed based on the results of cytology. A 20-question survey was conducted among the selected women. The obtained indicators were selected based on the age, somatic anamnesis, obstetric and gynecological anamnesis of women.

Results of the study: Out of 900 women cytological screening results, 107 women (12%) were diagnosed with mild, moderate or severe cervical dysplasia, confirmed by cytologists on the basis of cytology. Analysis of special questionnaires of all women allowed to determine the clinical features of the study group of patients.

Early onset of sexual activity (under 18 years) was detected in 7 (6.5%) cases. 89 (83%) women had one sexual partner in marriage, 16 (15%) had two partners, and more than 2 (2%) women. 19 (17.8%) women smoked. Among gynecological diseases, vaginal infections accounted for 42 (39%), chronic genital inflammatory disease for 35 (32.7%), cervical erosion rate for 22 (20.5%), abortion and spontaneous abortion for 17. (15.8%), fibroids - 5 (4.7%), endometriosis - 3 (2.8%), mastopathy - 2 (1.9%), breast cancer - 1 (1.9%). Somatic history: first place - obesity (22%), second and third - chronic arterial hypertension (20%), chronic pyelonephritis (17%).

All patients were divided into 3 groups depending on the results of cytological examination. Depending on the results of cytological examination, the distribution of patients by age is shown. In the 40-50 age group, SIL was predominant in 71 (66.4%) women. HSIL 19 (17.8%) was detected in the majority of patients aged 50 to 60 years. LSIL was more common in 17 (15.8%) women aged 40 to 50 years. Thus, some age and clinical features of patients with different degrees of cervical epithelial dysplasia were identified. In-depth study of patient data included in the study plan allows the effective diagnosis of HPV DNA for the effective diagnosis of dysplasia and microinvasive cervical cancer, as well as expanding the tactics of management, as traditional cytological examination is not sufficiently sensitive as the main tool for CIN and MSMR screening.

Referring to the analysis, the following conclusions were drawn:

The maximum dose of SIL / LSIL is between 40 and 50 years. HSIL -50-60 years old.

Gynecological history of sexually transmitted diseases, chronic diseases of the appendages, cervical erosion.

Somatic history of obesity (22%) and chronic arterial hypertension (20%).

Clinical findings include mild lower abdominal pain, genital discharge during intercourse, and some patients may have no complaints.

Cytology is normal, cytology after 1 year.

Cytology atypia and HCV positive colposcopy and biopsy (CIN I, CIN II).

CIN III only conization

List of used literature:

  1. Kaidarova DR, Chingisova Zh.K., Shatkovskaya OV and others. Indicators of oncological services of the Republic of Kazakhstan for 2017 // Statistical materials. Almaty: 2018. S. 99-182.
  2. Kaidarova DR, Kairbaev MR, Bolatbekova RO Strategies for primary and secondary prevention of cervical cancer. // Oncology and Radiology of Kazakhstan. 2017. № 43 (1). С. 7-11.
  3. Cervix. Estimated age-standardized incidence rates (World) in 2018, worldwide, females, all ages. International Agency for Research on Cancer. Cancer Today URL: http://gco.iarc.fr/today/online-analysis-mult
  4. Ershov FI, Romantsov MG Drugs used in viral diseases: Manual for doctors. - М .: ГЭОТАР-Медиа, 2007. Е.А. Межевитинова, П.Р. Абакарова, Ю.С. Хлебкова. “Precancerous lesions of the cervix. Tactics of knowledge. // MEDICAL COUNCIL • №12, 2016 pp. 112-115
  5. Teinberg J, Caruana M et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modeling study. Lancet Oncol 2019; 20: 394–407.
  6. Kairbaev MR, Shibanova AI, Zhylkaidarova AJ, and others. Early diagnosis of uterine cancer of the cervix at the level of primary medical care. Cytological screening. Methodical recommendations - Edited by Dr. Nurgazieva K.Sh.- Almaty, 2012.
  • Year: 2020
  • City: Shymkent
  • Category: Medicine

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International relations

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