title: High-grade cervical lesions among women attending a reference clinic in Brazil: associated factors and comparison among screening methods.
abstract: BACKGROUND
  Although screening for cervical cancer is recommended for women in most countries, the incidence of cervical cancer is greater in developing countries. Our goal was to determine the prevalence and factors associated with high-grade lesions/cervical cancer among women attending a reference clinic in Brazil and evaluate the correlation of histology with cytology, colposcopy and the high-risk HPV (HR-HPV) tests.
  
  
  METHODS
  A cross-sectional study of women attending a colposcopy clinic was carried out. The patients were interviewed to collect demographic, epidemiological and clinical data. Specimens were collected for cervical cytology, Chlamydia trachomatis and HPV testing using the Hybrid Capture (HC) and PCR tests. Colposcopy was performed for all patients and biopsy for histology when cell abnormalities or cervical intraepithelial neoplasia (CIN) were present.
  
  
  RESULTS
  A total of 291 women participated in the study. The median age was 38 years (DIQ: 30-48 years). The prevalence of histologically confirmed high-grade lesions/cervical cancer was 18.2% (95%, CI: 13.8%-22.6%), with 48 (16.5%) cases of CIN-2/CIN-3 and 5 (1.7%) cases of invasive carcinoma. In the final logistic regression model, for ages between 30 and 49 years old [OR = 4.4 (95%: 1.01-19.04), history of smoking [OR = 2.4 (95%, CI: 1.14-5.18)], practice of anal intercourse [OR = 2.4 (95%, CI: 1.10-5.03)] and having positive HC test for HR-HPV [OR = 11.23 (95%, CI: 4 0.79-26, 36)] remained independently associated with high-grade lesions/cervical cancer. A total of 64.7% of the cases CIN-3\Ca in situ were related to HPV-16. Non-oncogenic HPV were only found in CIN-1 biopsy results. Compared to histology, the sensitivity of cytology was 31.8%, the specificity 95.5%; the sensitivity of colposcopy for high-grade lesions/cervical cancer was 51.0%, specificity was 91.4% and the concordance with HPV testing was high.
  
  
  CONCLUSIONS
  The results confirm an association of HR-HPV with precursor lesions for cervical cancer. These data emphasize that cytological screening to detect precursor lesions is still important in some regions and that HR-HPV should be included for screening.
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo - UFES), Vitória-Espírito Santo (ES), Brazil.
authors.forename: Neide T
authors.initials: NT
authors.lastname: Boldrini
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo - UFES), Vitória-Espírito Santo (ES), Brazil.
authors.forename: Luciana B
authors.initials: LB
authors.lastname: Freitas
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo - UFES), Vitória-Espírito Santo (ES), Brazil.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Coutinho
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo - UFES), Vitória-Espírito Santo (ES), Brazil.
authors.forename: Flavia Z
authors.initials: FZ
authors.lastname: Loureiro
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo - UFES), Vitória-Espírito Santo (ES), Brazil.
authors.forename: Liliana C
authors.initials: LC
authors.lastname: Spano
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo - UFES), Vitória-Espírito Santo (ES), Brazil.
authors.forename: Angélica E
authors.initials: AE
authors.lastname: Miranda
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D060787:Neoplasm Grading; D011247:Pregnancy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*