Banca de DEFESA: MARIANE VIEIRA VILIONI

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : MARIANE VIEIRA VILIONI
DATE: 31/10/2022
TIME: 09:00
LOCAL: Plataforma Teams
TITLE:

 CYTOPATHOLOGICAL EXAMINATION OF THE CERN IN THE POPULATION ELIGIBLE FOR VACCINATION AGAINST HPV-COMPARATIVE STUDY BETWEEN UNVACCINATED AND VACCINATED

KEY WORDS:

HPV, câncer, vacina, microbiologia, exame citopatológico.

PAGES: 48
BIG AREA: Ciências da Saúde
AREA: Farmácia
SUMMARY:

Resumo em inglês: Cervical cancer is the third most common cancer in incidence and mortality in women. The natural history of cervical cancer initially involves HPV infection with progression to pre-cancer and invasive cancer. Vaccination against HPV was implemented in the Federal District in 2013, with the quadrivalent vaccine, which targets only high-risk types 16 and 18, unlike the ninth-valent vaccine, which also protects against high-risk types 31, 33, 45, 52 and 58. In Brazil, after the implementation of the vaccine, there was a reduction in the incidence only of HPV types associated with the quadrivalent vaccine and there are no studies showing the impact of HPV vaccination on the development of precancer and cervical cancer. Cervical cancer screening in Brazil is still performed by cytopathological examination, thus, the objective of this study is to compare the frequency of altered cervical cytopathological exams in vaccinated and unvaccinated patients against HPV in the Federal District. Results of tests performed in the years 2018 to 2021 of patients eligible for HPV vaccination in the Federal District since the beginning of the campaigns in 2013 were included, that is, patients born after the year 2000. The vaccination status of the patients was obtained in list made available by the Health Department of the Federal District. Data analysis was performed by calculating the percentage of the difference for less or for more, using the Fisher test, to compare frequencies, and using the t test, to compare the mean age of the patients, using the Graphpad Prism program for Windows. A total of 9629 cervical Pap smears from the population eligible for HPV vaccination were analyzed from 2018 to 2021. Only 48.17% of the exams were from vaccinated patients and most (93.05%) of them received 3 or 2 doses of the vaccine. Thus, 44.83% of the cervical cytopathological exams were from patients who received at least 2 doses of the vaccine.The frequency of abnormal cervical cytopathological examinations in the population eligible for HPV vaccination was 6.93%. The most frequent diagnostic categories of abnormal exams in both groups, vaccinated and unvaccinated, were atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL), corresponding to 53.67% and 38.41% of the abnormal exams in unvaccinated and 60.50% and 30.89% in vaccinated. The frequency of abnormal exams was 7.09% and 6.76%, respectively, in unvaccinated and vaccinated patients, being 4.65% lower in exams of vaccinated patients, but this difference was not significant. The frequency of LSIL was 23.16% lower in vaccinated. The number of exams with LSIL was significantly lower in vaccinated, but there was no significant difference between vaccinated and nonvaccinated regarding the number of exams with high-grade squamous intraepithelial lesion (HSIL) and other diagnostic categories. The total frequency of examinations in the diagnostic categories for which colposcopy is recommended (ASC-H, HSIL and AGC) was not different between unvaccinated and vaccinated (0.56% vs. 0.56%). The age of patients in the population eligible for HPV vaccination when undergoing cervical cytopathological examination in the years 2018 to 2021 ranged from 9 to 22 years, with a mean (± SD) of 18.21 (±0.01) years . The mean age of vaccinated patients when undergoing cervical cytopathological examination was significantly higher when compared to that of unvaccinated patients (18.45± 0.02 x 17.98 ± 0.02 x, t test, p<0 .0001), regardless of the test result (negative or positive). The types and respective frequency of microorganisms were similar in vaccinated and unvaccinated and in accordance with previous studies carried out before the introduction of vaccination. Lactobacillus sp was the most frequent organism regardless of vaccination status. Regarding the abnormal findings of organisms considered endogenous, supracytoplasmic bacilli and Candida sp were the most frequent and there was no significant difference in frequency between vaccinated and unvaccinated. In terms of abnormal findings in the microbiology suggestive of STIs, presence of Trichomonas vaginalis and cytopathic effect by the Herpes virus, no significant difference was observed between vaccinated and unvaccinated When comparing abnormal and negative tests for malignancy within the same group (vaccinated or unvaccinated), in vaccinated, Lactobacillus sp were significantly more frequent in negative while cocci and other bacilli were more frequent in abnormal ones; and, in unvaccinated, supracytoplasmic bacilli were more frequent in abnormal tests than in negative ones. Abnormal microbiology findings analyzed together (excluding the finding of Lactobacillus sp without other microorganisms) were more frequent in abnormal tests than in negative tests in vaccinated and unvaccinated, but the difference was significant in vaccinated. When analyzed by diagnostic category, a significant difference in the frequency of abnormal findings in microbiology was observed only when comparing the ASCUS category with negative for malignancy. Abnormal findings were significantly more frequent in ASCUS category than in negative test in vaccinated . It can therefore be concluded that: i) the frequency of vaccinated and unvaccinated patients in the population eligible for vaccination against HPV and who underwent cervical cytology examination in the last 4 years is similar to vaccination coverage, which suggests that the vaccination status did not change the search for care; ii) the greatest impact after 9 years of initiation of HPV vaccination in the cytopathological examination for cervical cancer screening is in the development of low-grade squamous intraepithelial lesion (LSIL) which was less frequent in vaccinated, indicating a vaccine protection against HPV in the development of this type of lesion; iii) the diagnosis of intraepithelial lesion in the cytopathological examination of the cervix of vaccinated patients, mainly in the diagnostic category of high squamous intraepithelial lesion (HSIL), emphasizes the importance of defining which types of HPV not associated with the quadrivalent vaccine are the most commonresponsible for the development of these lesions and, consequently, what would be the cost/benefit of implementing the nonavalent vaccine in Brazil; iv, HPV vaccination did not change the frequency of microbiological findings, including those associated with with sexually transmitted infections and, consequently, it can be concluded that vaccination did not result in an increase in risky sexual behavior in vaccinated women; v, the association of abnormal findings in microbiology with abnormal result, in both vaccinated and unvaccinated groups, suggests a possible effect of other microorganisms, in addition to HPV, on the appearance of pre-cancer lesions; considering that the difference in abnormal microbiology findings between abnormal and negative is significant only in the ASCUS category, it can be said that the reactive alterations caused by certain microorganisms resulted in diagnostic difficulty; vi) the higher mean age of vaccinated patients compared to unvaccinated patients, which was observed regardless of the test result (negative or altered) and the most frequent findings in microbiology, suggests a later search for care at the UBS, which may be associated to a feeling of protection from the vaccine. Palavras chaves em português: HPV, câncer, v

BANKING MEMBERS:
Externo à Instituição - LIANNA MARTHA SOARES MENDES - UFPI
Externa ao Programa - 1562125 - ANDREA BARRETTO MOTOYAMA
Interna - 2499462 - FABIANA PIRANI CARNEIRO
Externa ao Programa - 3123142 - SALETE DA SILVA RIOS CHEN