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Objectives: To study the distribution of human papillomviruses (HPV) in women in Kuwait using hybrid capture assay and their correlation with the severity of cervical lesions based on cytological diagnosis and to establish the relationship if any between the quantity of the viral load and the degree of severity of cervical lesions. Methods: Study sample included 181 women in the age range of 20–68 years, attending the Out-Patient Department of Gynaecology of the Al-Farwaniya Hospital and six polyclinics in Kuwait during the years 1997–1998. Cervical smears were interpreted according to the modified Bethesda System. HPV DNA was detected using a chemiluminescent-based Digene hybrid capture assay. Results: Of the 181 women studied, the cytodiagnosis was as follows: normal and inflammation 139 (76.8%), atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGUS) 26 (14.4%) and squamous intra-epithelial lesion (SIL) 16 (8.8%). High-risk HPV DNA had a very low prevalence in women with normal and inflammation cytology, i.e. 1.4% in contrast to women with SIL lesions which had a positivity of 68.8%. ASCUS and AGUS group had 7.7% high-risk HPV DNA positivity. The quantity of viral load was directly related to the increase in the severity of the lesions. Conclusion: High-risk HPV DNA was detected in a significantly higher proportion of women with SIL lesions as compared to those with normal cytology (p < 0.0001). Furthermore, the viral load of high-risk HPV DNA was directly related to the severity of the cervical lesions, relative light unit ratios being >20 in the majority of SIL lesions.

Background. The role of male behavior in the genesis of cervical cancer was examined. In India, where the incidence of cervical cancer is among the highest in the world, promiscuity among women is virtually unknown. In this study, the authors investigated the role of male behavior in cervical carcinogenesis among Indian women who had one lifetime sexual partner. Methods. A case-control study was used. Results. Premarital sexual relationships (relative risk [RR], 1.9; confidence interval, 1.2–3.2) and extramarital sexual relationships (RR, 2.7; confidence interval, 1.5–4.9) of husbands were risk factors. When husbands had sexual relationships both before and during the marriage, their wives' risk of getting cervical cancer increased by 6.9 (CI, 2.3–20.7). Risk also increased with husbands having three or more extramarital sexual partners (RR, 3.05; CI, 1.25–12.6). Sexual contact with prostitutes before or after marriage, however, did not increase the risk. History of sexually transmitted disease before marriage (RR, 2.9) or after marriage (RR, 5.9) was an important risk factor, which persisted after controlling for other factors. Sexual abstinence for 40 or more days after a wife's giving birth or having an abortion provided protection. Sex with uncircumcised men or men circumcised after age 1 year increased the risk of cervical cancer (RR, 4.1). Bidi smoking (bidi is a cheap smoking stick of 4–8 cm, consisting of a rolled piece of dried temburni leaf [Diospyres melanoxylon] containing 0.15–0.25 g of coarsely ground tobacco) for more than 20 years was a significant risk factor (RR = 2.4), whereas cigarette smoking was not a risk factor. Conclusions. Male sexual partners play a role in cervical carcinogenesis.

Background. Infection with human papillomavirus (HPV) is considered to be the principal causal agent in the development of squamous cell carcinoma of the uterine cervix. Although adenocarcinoma of the cervix originates adjacent to the squamous epithelial neoplastic lesions, the etiopathogenesis of adenocarcinoma is not yet clearly understood. Recent studies have raised more controversy, rather than answering the question of whether specific HPV infection also plays a role in the development of adenocarcinoma of the cervix. Molecular DNA hybridization techniques were used to detect HPV types prevalent in both adenocarcinoma and squamous cell carcinoma of the uterine cervix, which is the most common cancer in Indian women. Methods. Histologically confirmed, formaldehydefixed, paraffin-embedded tissue sections from 12 cases of adenocarcinoma and 30 cases of squamous cell carcinoma of the uterine cervix were analyzed retrospectively for the presence of HPV DNA types 6b, 11,16, and 18 by both Southern blot hybridization and in situ hybridization. Of 12 adenocarcinomas, 5 (41.67%) tumors were positive for HPV DNA. All five cases were positive for HPV 16, and two (16.6%) of these were hybridized again to the HPV 18-specific DNA probe. All tumors were negative for HPV 6b and 11. In addition, no biopsy specimens were positive after hybridization with a mixed probe of HPV 31, 33, 35, 39, and 45. These results were compared to those obtained for 30 squamous cell carcinomas of the cervix. Although 20 (66%) were exclusively positive for HPV 16 and 6 (20%), more tumors were of HPV 16 related types as detected under nonstringent conditions of hybridization, only one (3%) was positive for

In a study of factors related to cervical carcinogenesis, a cohort of 1,107 cervical dysplasia along with 1,077 controls matched for age and parity were followed up prospectively. During the follow up 75 dysplasia cases progressed to carcinoma in situ. The overall rate of progression of dysplasia to malignancy was observed to be 15.7% at the end of 108 months of follow-up. The analysis of progression rates in relation to various factors revealed significantly higher progression rates for initially higher grade of dysplastic lesions, and early age at consummation of marriage (ACM). The other factors, such as religion, literacy status of the patient, number of pregnancies, presence of cervical erosion, history of fetal loss and positivity to HSV-II antibodies, did not reveal statistical significance. The case-control comparison for detection of HPV 16/18 by in situ hybridisation revealed the presence of HPV 16/18 sequences in 67.3% of the dysplasia subjects progressed to carcinoma in situ while 27.3% of precancerous cases regressed to normalcy. The difference was found to be statistically significant (P less than 0.001).

OBJECTIVE--To assess the efficacy of visual screening for cervical cancer in the maternal and child health setting. DESIGN--Clinical and cytological screening. SETTING--Maternal and child health centres, Delhi. SUBJECTS--44,970 women attending the centres from May 1988 to March 1991. RESULTS--238 cancers in early stages (0-IIa) were detected cytologically and proved through biopsy. Prevalence of cancer in women defined as high risk through examination by speculum was 29/1000 as compared to 1.53/1000 among women with a normal looking cervix. Though only 11.4% women belonged to the high risk category, 63% had early stage cancer. If all women with bleeding symptoms were included in the high risk category, the yield of cancer would be 71.4% (170/238) by referring only 15.6% of women attending maternal and child health centres for further evaluation through cytology or colposcopy. CONCLUSION--Though visual screening is a suboptimal strategy in comparison to the cytological screening, it may be useful where there is a heavy load of prevalent cancer and where cytological screening may not be available for years to come.

There is no invasive cancer which at one stage was not cancer-in-situ. The cervical cancer if detected at its pre-invasive stage is amenable to treatment with 100% survival rate. The knowledge that cancer is preventable if detected in its precancerous stage or is curable if detected in its early stage strongly supports the need for routine cytological examination of all young females from time to time for detection of cervical neoplastic lesion in its early stage and a follow-up of all the dysplastic lesions of cervix. Present study comprises of an examination of vaginal smears of 39,587 women aged 14 to 80 years. Malignancy of female genital tract was observed in 693 cases. On cytological and histological examination the cancer of the cervix was diagnosed in 64 clinically unsuspected cases giving a pick up rate of 1.62/1000. In each of these cases the initial clinical impression of the cervix was other than carcinoma, the first indication of malignancy being the result of cytological examination. Cervical dysplasia was detected in 927 cases. A follow-up study of progression or regression of dysplastic changes was done.

Nucleolar organizer regions (Ag-NORs) were studied in patients with cervical precancerous and cancerous lesions along with controls. The data revealed a statistically significant decrease of Ag-NORs in cancer patients, as well as in women with severe precancerous lesions as compared with controls. A similar decrease in the amount of Ag-staining was also observed in both cancer and severe dysplasia cases. The study suggests a possible relationship of Ag-NOR activity to malignancy.

Double-minute chromosomes (DMs) were observed in repeated samples in the leukocytes of a patient with a previous history of cervical carcinoma. The most interesting cytogenetic finding was the coexistence of DMs and a dicentric chromosome along with chromosome- and chromatid-type breaks and gaps. This observation suggests that DMs might originate through the breakage of existing chromosomes. The presence of DMs in leukocytes may also indicate the possibility that certain common agents cause DMs in tumor cells as well as in normal cells.

The frequency of sister chromatid exchange (SCE) was investigated in 13 women with cervical cancer together with 11 control women. The SCE frequencies were found to be 10.05 +/- 2.35 and 6.95 +/- 1.53 in cancer cases and controls, respectively. The SCE values of cancer cases deviate significantly from that of controls. The SCE in chromosome groups E, F, and G was found to be more in comparison to controls (P less than 0.001). This preliminary study indicates the possibility of using SCE as a preclinical marker.