Christine Luis

Evaluation of anal cytology and dysplasia in women with a history of lower genital tract dysplasia and malignancy.

OBJECTIVE To compare the prevalence of abnormal anal cytology, high-risk anal HPV and biopsy proven anal dysplasia among women with a history of lower genital tract malignancy compared to those with dysplasia. METHODS A prospective cohort study was performed from December 2012 to February 2014 at outpatient clinics at an academic medical center. Women with a history of high-grade cervical, vulvar, or vaginal dysplasia, or malignancy were recruited. Anal cytology and HPV genotyping were performed. All women with abnormal anal cytology were referred for high-resolution anoscopy and biopsy. RESULTS Sixty-seven women had a lower genital tract malignancy and 123 had a history of genital dysplasia. Average age in the malignancy group was 52.6years (range 27-86) versus 43.5years (range 21-81) in the dysplasia group (p<0.0002). Similar rates of anal dysplasia were seen in both groups, 12.99% (10 cases) in the malignancy group, versus 12.20% (15) in the dysplasia group (p=1.0). Six women in the malignancy group had anal intraepithelial neoplasia (AIN2+) compared to 2 in the dysplasia group (p=0.03). CONCLUSIONS We found high rates of abnormal anal cytology and HPV in women with lower genital tract dysplasia and malignancy. We also found high rates of anal dysplasia in both groups with a trend towards increased rate in those women with history of genital malignancy. Since precancerous anal lesions are detectable and treatable, anal cancer screening may be potentially useful in both of these higher risk groups.

Anal Cytology and Human Papillomavirus Genotyping in Women With a History of Lower Genital Tract Neoplasia Compared With Low-Risk Women.

OBJECTIVE: To compare the prevalence of abnormal anal cytology and high-risk human papillomavirus (HPV) among women with a history of HPV-related genital neoplasia with women without a history of HPV-related genital neoplasia. METHODS: A cross-sectional cohort study was performed from December 2012 to February 2014. Women were recruited from outpatient clinics at an academic medical center. Women with a history of high-grade cervical, vulvar, or vaginal cytology, dysplasia, or cancer were considered the high-risk group. Women with no history of high-grade anogenital dysplasia or cancer were considered the low-risk group. Human immunodeficiency virus–positive women were excluded. Anal cytology and HPV genotyping were performed. Women with abnormal anal cytology were referred for high-resolution anoscopy. RESULTS: There were 190 women in the high-risk group and 83 in the low-risk group. The high-risk group was slightly older: 57 years compared with 47 years (P=.045); 21.7% of low-risk women had abnormal anal cytology compared with 41.2% of high-risk women (P=.006). High-risk HPV was detected in the anal canal of 1.2% of the low-risk group compared with 20.8% of the high-risk group (P<.001). Among women who underwent anoscopy, no anal dysplasia was detected in the low-risk group, whereas 13.4% in the high-risk group had anal dysplasia with 4.2% having anal intraepithelial neoplasia 2 or greater (P<.001). CONCLUSION: Human immunodeficiency virus–negative women with a history of lower genital tract neoplasia are more likely to have positive anal cytology, anal high-risk HPV, and anal intraepithelial neoplasia. Anal cancer screening should be considered for these high-risk women. LEVEL OF EVIDENCE: II

A change in the balance between personal and professional life among female gynecologic oncologists

Background: Female representation in gynecologic oncology has increased over the last two decades. Our objective was to compare work-life balance issues faced by female gynecologic oncologists between 1998 and 2015. Material/Methods: We conducted a cross-sectional survey of physician members of the Society of Gynecologic Oncology. A survey sent to female gynecologic oncologists in 1998 was expanded, piloted with 10 volunteers, and administered in electronic format (DatStat Illume) in February 2015. There were 75 fixed response questions regarding 4 domains: demographics, mentoring issues, work-life balance, and caregiving responsibilities. We compared 2015 responses to the 1998 aggregate survey data. Data were analyzed using Stata 10 (Statacorp, College Station TX) with Chi-square/Fisher’s exact tests using aggregate data functions. Results: 172 of 643 female gynecologic oncologists (26.7% response rate) completed the 2015 survey. The historical comparison group included 82 females (56.2% response rate). While more women in 2015 versus 1998 reported starting a family during residency or fellowship (57.7% vs. 36.0%, p<0.009), 42% still waited until after training. More than half (55.9%) of respondents in 2015 said the timing of becoming a parent led to some or a great deal of relationship stress compared to only 20% in 1998 (p<0.0001). The majority of divorces were in fellowship for both groups with 8 (50.0%) in 2015 compared to 5 (45.5%) in 1998 (p=0.8). In 2015, 5 (83.4%) women divorced after fellowship and felt their career had a moderate to great influence on their divorce. Conclusions: Despite changes in work-life balance and caregiving responsibilities in female gynecologic oncologists between 1998 and 2015, challenges still exist today. Correspondence to: Ashley R Stuckey, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905, USA, Tel: (401) 453-7520; Fax: (401) 453-7529; E-mail: astuckey@wihri.org

Understanding the Sexual Behaviors of Women That May Put Them at Risk for HPV-Related Neoplasias [21J]

INTRODUCTION: The human papilloma virus (HPV) is a multifocal infection that can involve the cervix, vagina, vulva, anus, and oropharynx. The objective of our study was to determine if standard sexual history questions capture the sexual behaviors of women that put them at increased risk for HPV-related neoplasias. METHODS: We conducted a cross-sectional survey study at the Colposcopy Clinic at Women and Infants Hospital. Women who presented with HPV-related cervical, vulvar, or vaginal abnormalities were eligible. All eligible women were offered enrollment, signed informed consent and a sexual history questionnaire was self-administered. Additional demographic information was obtained from chart review. RESULTS: Interim analysis was conducted half way through recruitment. Seventy one eligible women were approached, 63 (89%) consented and all 63 enrolled (ages 22–64). Sixty-five percent of women reported receiving oral penetration of the vagina, 81% reported receiving vaginal fingering and 100% participated in vaginal intercourse. Forty-six percent reported participating in some type of anal-related sexual practice, including anal fingering, oral penetration on the anus and anal intercourse. Of those participating in anal-related practices, 10% reported only anal fingering or oral-anal penetration. Forty-eight percent of respondents said they used sex toys, 100% vaginal and 13% anal. CONCLUSION: We found women are willing to report their participation in a wide range of sexual practices. Ten percent of women only participated in anal play and not anal intercourse, which would be missed by the standard sexual history questions. These results will enable clinicians to better counsel their patients on risky sexual behaviors.