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BACKGROUND. The objective of this study was to investigate whether the presence of vaginal Candida or dysbacteriosis predisposes women to an increased susceptibility for (pre)neoplasia over time. METHODS. A retrospective, longitudinal, cohort study was performed and was conducted in a population of 100,605 women, each of whom had 2 smears taken over a period of 12 years as part of the Dutch Cervical Screening Program. From these women, a cohort of 1439 women with Candida and a cohort of 5302 women with dysbacteriosis were selected as 2 separate study groups. The control cohort consisted of women who had completely normal cervical smears (n = 87,903 women). These groups were followed retrospectively over time. The odds ratios (OR) for squamous abnormalities in the follow-up smear for the women in these 3 cohorts were established. RESULTS. The dysbacteriotic cohort was significantly more likely to have low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL+) in their follow-up smear (OR, 1.85; 95% confidence interval [95% CI], 1.28–2.67 and OR, 2.00; 95% CI, 1.31–3.05, respectively) compared with women in the control group. In contrast, the Candida cohort had no significantly increased or decreased risk of developing SIL. The equivocal diagnosis ‘atypical squamous cells of undetermined significance’ was rendered significantly more often in the follow-up smear of both study cohorts (Candida cohort: OR, 1.42; 95% CI, 1.03–1.95; dysbacteriotic cohort: OR, 1.44; 95% CI, 1.22–1.71). CONCLUSIONS. The results from this study indicated that the presence of Candida vaginalis was not associated with an increased risk for SIL over time. In contrast, women with dysbacteriosis had a significantly increased risk of developing (pre)neoplastic changes. These findings should be taken into account in further research concerning predisposing factors for cervical carcinogenesis. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.

BACKGROUND. Neural network technology has been used for the daily screening of cervical smears in The Netherlands since 1992. The authors believe this method might have the potential to demarcate diagnoses of Grade 1-2 cervical intraepithelial neoplasia (CIN 1-2). METHODS. Of 133,196 women who were screened between 1992-1995, there were 2236 CIN 1-2 smears; 1128 of which were detected by means of neural network screening (NNS) (n = 83,404 women) and 1108 of which were diagnosed by conventional screening (n = 49,792 women). Cytologic and clinical outcomes (first cytologic or histologic follow-up diagnosis) were retrieved for all the women in the study population (n = 1920). Stratification based on clinical outcome resulted in the cases being grouped as overdiagnosed, concordant, or underdiagnosed. The smears were performed by general practitioners, whereas the biopsies were obtained by gynecologists. RESULTS. The prevalence rate for CIN 1-2 was 1.15% (95% confidence interval [95% CI], 1.08-1.23%) for NNS and 1.92% (95% CI, 1.80-2.04%) for conventional diagnosis (P

BACKGROUND. Nearly every Dutch woman will be exposed to genital human papillomavirus (HPV) at least once during her lifetime, and most likely several times. In the current study, the authors investigated the prevalence of high-risk–HPV (HR-HPV) infection and the likelihood of progression to cervical intraepithelial neoplasia (CIN). METHODS. In this study, the course of HR-HPV infection in 703 women was observed. From a database of 720,016 negative cytology smears, the authors selected 703 women based on the availability of at least 2 HR-HPV polymerase chain reaction tests. The authors database stores not only the HPV data but also all other cytologic and histologic data, allowing the detection of women who progressed from negative cytology to CIN within a period of 10 years. RESULTS. Of the 703 selected women, 159 were found to have alternating HR-HPV infection (change from a negative HR-HPV test to a positive test or vice versa), 40 had a persistently positive HR-HPV test, and 504 women had a persistently negative HR-HPV test. The percentage of alternating HPV infection declined over time from 37% to 7%. Of the women age older than 40 years, 17% had an alternating HR-HPV infection, 2 of whom developed CIN. These findings led the authors to conclude that all the women in the current study with an increased risk of developing type 2 or 3 CIN were identified using 2 HPV tests. Women age older than 40 years still have a significant risk of acquiring a HR-HPV. CONCLUSIONS. In light of the current study findings, the authors believe it is worth considering the inclusion of women age 40 years and older who have negative cytology for HPV testing as part of the Dutch national screening program. Cancer (Cancer Cytopathol) 2006. © 2006 American Cancer Society.

BACKGROUND. The large data bases of the Dutch cervical screening program can be exploited to establish the relation between urbanization and the incidence of abnormalities of the squamous and glandular epithelium, including mild or greater changes of the squamous and glandular epithelium of the cervix.METHODS. Six cytology laboratories in the context of the Dutch cervical screening program screened over 190,000 cervical smears. Urbanization (place of residence) data were derived from postal codes. All smears were coded with the Dutch national coding system, the Dutch national classification system KOPAC, in which squamous abnormalities are coded S4-S9, and glandular cell changes are coded G4-G9. From the scores per 1000 screened women, the relative risk (1111) of living in a large city compared with living in rural areas was calculated. To investigate a trend in incidence in relation to urbanization, the Schaafsma method was used.RESULTS. Of the smears with positive cytology, mild squamous dysplasia (S4) had the highest incidence per 1000 screened women (4.32), and the lowest incidence was found for adenocarcinoma (in situ; G7/G9; RR, 0.07). The RR for urban women ranged from 1.73 for moderate squamous dysplasia (S5) to 7.55 for adenocarcinoma (in situ; G7/G9). For smears with positive cytology for both squamous and glandular abnormalities, the Schaafsma method indicated a significant positive trend.CONCLUSIONS. The incidence of squamous and glandular abnormalities are maximal in women who live in a large city, which, in The Netherlands, is where there also is a population at high risk for human papillomavirus and bacterial vaginosis. Cancer (Cancer Cytopathol) 2003;99:4-8. (C) 2003 American Cancer Society.

The male partners of 20 women with human papilloma virus (HPV) infection (subtypes 6, 11, 16, and 18) were studied. These men were unsuspecting and allowed investigation "for scientific reasons" in the context of the abnormal findings in their female partners. Peniscopy (study of the penis with a colposcope) was abnormal in 17 cases. In the cytologic-brush preparations of the urethra, hyperkeratosis (visualized with the modified Papanicolaou technique) occurred in all cases, but koilocytosis in only one. Both urothelial cells and squamous cells in the urethral samples were positive for HPV, as shown in the immunocytochemistry. In the histologic sections taken from flat lesions there was hyperkeratosis, dyskeratosis, and abnormal nuclear maturation. The authors concluded that, using simple techniques, subtle disturbances in maturation of nuclei and cytoplasm can be established in penile epithelium of these sexual partners. Similar changes are established in other HPV lesions. It seems likely that a significant proportion of the male population is infected in countries were HPV an important factor in cervical carcinogenesis.

Epidemiologic, histologic and immunohistochemical data concerning male (penile) and female (cervical and vulvar/vaginal) genital carcinomas in a Hindu population are reported. The data are from Bali, an Indonesian Hindu island in a country with a predominantly Muslim population. In contrast to the surrounding Muslim population, circumcision is rare in the people of Bali, and the rate of phimosis in grown men is very high. The Balinese epidemiologic data of 1985 to 1986 were compared with 1986 data from The Netherlands. In Bali, cervical carcinoma was the most frequent carcinoma in women, and vulvar/vaginal carcinoma ranked seven. These carcinomas were much less frequent in The Netherlands. In Balinese men, penile carcinoma is the second most frequent carcinoma, whereas it is rarely diagnosed in The Netherlands. Penile carcinomas are found in Bali in younger age groups than in The Netherlands. Based on the immunohistochemical staining results, it is estimated that over 75% of the studied Balinese genital carcinomas contain human papillomavirus (HPV). The data presented in this paper may indicate that the cofactor of impeded postcoital hygiene can be of great importance for male and female HPV-associated genital carcinogenesis. It is clear that Balinese men, in particular men with extreme phimosis, are both vectors and victims of HPV. In The Netherlands the man is exclusively the vector of HPV.

The nationwide screening program for cervical carcinoma in The Netherlands was unique in that all women between the age of 35 and 55 years were individually invited to undergo a cervical spatula smear. The total rate of positive histologic findings in six regions of the country was 3.9 per thousand, and decreased in the second screening after 3 years with 48% of patients. Further analysis of the change in rates of the separate histologic subgroups in six regions revealed: 1 Severe dysplasia showed no change in rates. The rates of carcinoma in situ and invasive squamous cell carcinoma were influenced clearly by the screening. 2 The preinvasive stages of adenocarcinoma of the cervix were underdiagnosed in the first screening, and there was no decrease in the score of invasive adenocarcinoma. 3 The rates in the six regions differed significantly and were dependent on the degree of urbanization. Cervical screening using the Ayre spatula is not effective for detecting cervical adenocarcinomas. Cancer 59:862-866, 1987.