Journals Watch - Cervical cancer, HPV and sleep

Missed the latest research papers? Dr Gwen Lewis brings you up to date with the current journals.

Cervical intaepithelial neoplasia: HPV-based screening detected high-grade lesions earlier
Cervical intaepithelial neoplasia: HPV-based screening detected high-grade lesions earlier

Is HPV testing better than cytology for the detection of cervical cancer?
Lancet Oncol 2010 doi;10,1016/S1470-2045(09)70360-2

HPV testing is more sensitive but less specific than cytology for detecting cervical intraepithelial neoplasia (CIN). Is it more effective in diagnosing invasive cervical cancer?

This 2004 Italian study randomly assigned women to conventional cytology screening or to HPV testing in combination with liquid-based cytology in the first round of testing and then to HPV testing alone in the second round.

More than 47,000 women were assigned to each of the two groups. Referral for colposcopy was made as appropriate.

It was found that HPV-based screening was more effective in preventing invasive cervical cancer by detecting high-grade lesions earlier, although it also led to over-diagnosis of regressive CIN2 in younger women.

Genital warts since the introduction of HPV vaccination Sex Transm Infect 2010; 85: 499-502
Australia provided free quadrivalent HPV vaccine to 12-18-year-old girls from April 2007, and to women aged 26 years and younger through general practices from July 2007.

A retrospective study was undertaken of 36,055 new patients at the Melbourne Sexual Health Centre, of whom 3,826 were diagnosed with genital warts.

The proportion of women under 28 years with warts diagnosed decreased by 25.1 per cent per quarter in 2008.

This compared with a negligible increase of 1.8 per cent per quarter from the start of 2004 to the end of 2007.

This suggests a rapid decrease in the incidence of warts among women vaccinated with the quadrivalent HPV vaccine.

In the UK, the bivalent HPV vaccine is used, which protects only against HPV 16 and 18, so it would be interesting to see comparable results in the UK.

Threatened miscarriage and pregnancy outcome BJOG 2010; 117: 245-57
Threatened miscarriage is a complication of early pregnancy that causes much anxiety.

We try to be reassuring and allay this anxiety, but does a threatened miscarriage have an effect on pregnancy outcome?

A review of the literature was undertaken to explore the effects of threatened miscarriage on maternal and perinatal outcomes. Fourteen studies met the inclusion criteria.

Women with threatened miscarriage had a higher incidence of antepartum haemorrhage due to placenta praevia or haemorrhage of unknown origin, compared with those without first trimester bleeding.

This did not surprise me. They were also more likely to suffer premature rupture of membranes, pre-term delivery and to have babies with intrauterine growth retardation.

Babies born to women who suffered a bleed in early pregnancy had higher rates of perinatal mortality and be of low birth weight.

High exercise levels improve sleep J Adolesc Health 2010; 46: 133-41
We often see patients complaining of insomnia, although not many insomnia patients fall into the younger age group.

A total of 434 Swiss students (mean age: 17 years) were studied via a self-rating questionnaire and sleep log.

These provided information on their sleep patterns and psychological functioning. The students were divided into athletes and controls. The athletes undertook an average of 17 hours exercise per week while the controls averaged four hours.

The athletes reported better sleep patterns, including higher sleep quality, shortened sleep onset latency and fewer awakenings, as well as less tiredness and increased concentration during the day.

Athletes also reported lower anxiety levels and displayed fewer depressive symptoms.

I am just not sure I can persuade my insomnia patients to undertake 17 hours of exercise every week.

Association of MI and stroke with different antihypertensive regimens BMJ 2010; 340:c103
Untreated hypertension is strongly associated with MI, stroke and heart failure.

The findings of the ALLHAT trial suggested that low-dose diuretics are superior to other antihypertensive agents as first-line treatment for prevention of one or more of these events.

A case-control study of patients aged 30-79 years with treated hypertension between 1989 and 2005 was undertaken to look at drug combinations and risk of cardiovascular events.

A total of 353 cases had first fatal or non-fatal MI or stroke during this period, while a control group had no cardiovascular event.

Patients studied were taking a combination of two drugs: a low-dose diuretic with either a calcium-channel blocker, a beta-blocker or an ACE inhibitor or ARB.

Patients taking diuretics plus calcium-channel blockers had a higher risk of MI but not stroke, compared with those on diuretics and beta-blockers, while risks of MI and stroke were lower in those on diuretics plus an ACEi inhibitor or ARB.

How safe is a home birth? MJA 2010; 192: 76-80
In this study, perinatal data on all births in Australia from 1991 to 2006 were studied.

Planned home births accounted for 0.38 per cent of 300,011 births during this period.

The perinatal mortality rate was similar for home and hospital births, but there was a seven-fold higher risk of intrapartum death in the planned home births and a 27-fold higher risk of intrapartum asphyxia.

It was, however, noted that women with risk factors for home birth were included and there was poor surveillance during labour and delivery.

  • Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals.

The quick study

  • HPV-based screening for cervical cancer detects high-grade lesions earlier.
  • Genital wart incidence has decreased rapidly since introduction of HPV vaccination in Australia.
  • Threatened miscarriage increases the risk of pregnancy complications.
  • Sleep pattern and quality is improved by regular strenuous exercise in the young.
  • Hypertensive patients are more likely to have an MI when taking a diuretic and calcium channel blocker than on other combination treatments.
  • Intrapartum death is more likely during a home birth.

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