Life-saving training in the Amazon: An update on the management of cervical cancer precursor lesions

Damasceno, Helane Conceição; Silva, Caio Vinicius Soares da; Cavalcante, Rosiane Luz; Silva, Erika Patricy Serrão da; Monteiro, José Rogério Souza; Pinheiro, Maria da Conceição Nascimento

doi:10.1590/2177-9465-EAN-2025-0057pt

person Helane Conceição Damasceno

study design · data acquisition · data analysis and interpretation of the results · writing and critical review of the manuscript · approval of the final version of the manuscript · responsibility for all aspects of the content and integrity of the published article

schoolUniversidade Federal do Pará, Programa de Pós-Graduação do Núcleo de Medicina Tropical. Altamira, PA, Brasil.

0000-0002-3451-9797

person Caio Vinicius Soares da Silva

study design · data acquisition · data analysis and interpretation of the results · writing and critical review of the manuscript · approval of the final version of the manuscript · responsibility for all aspects of the content and integrity of the published article

schoolUniversidade Federal do Pará, Faculdade de Medicina. Altamira, PA, Brasil.

0000-0001-6223-7511

person Rosiane Luz Cavalcante

study design · data acquisition · data analysis and interpretation of the results · writing and critical review of the manuscript · approval of the final version of the manuscript · responsibility for all aspects of the content and integrity of the published article

schoolUniversidade Federal do Pará, Programa de Pós-Graduação do Núcleo de Medicina Tropical. Altamira, PA, Brasil.

0000-0002-0637-4770

person Erika Patricy Serrão da Silva

study design · data acquisition · data analysis and interpretation of the results · writing and critical review of the manuscript · approval of the final version of the manuscript · responsibility for all aspects of the content and integrity of the published article

schoolUniversidade Federal do Pará, Programa de Pós-Graduação do Núcleo de Medicina Tropical. Altamira, PA, Brasil.

0009-0003-0671-1380

person José Rogério Souza Monteiro

study design · data acquisition · data analysis and interpretation of the results · writing and critical review of the manuscript · approval of the final version of the manuscript · responsibility for all aspects of the content and integrity of the published article

schoolUniversidade Federal do Pará, Programa de Pós-Graduação do Núcleo de Medicina Tropical. Altamira, PA, Brasil.

0000-0002-4511-7312

person Maria da Conceição Nascimento Pinheiro

study design · data acquisition · data analysis and interpretation of the results · writing and critical review of the manuscript · approval of the final version of the manuscript · responsibility for all aspects of the content and integrity of the published article

schoolUniversidade Federal do Pará, Programa de Pós-Graduação do Núcleo de Medicina Tropical. Altamira, PA, Brasil.

0000-0002-2904-9583

personCorresponding author: Helane Conceição Damasceno E-mail:
helanehd@hotmail.com

CONFLICT OF INTEREST

No conflict of interest.

ASSOCIATED EDITOR

Gerson Luiz Marinho https://orcid.org/0000-0002-2430-3896

SCIENTIFIC EDITOR

Marcelle Miranda da Silva https://orcid.org/0000-0003-4872-7252

Lesion	Actions after the first abnormal Pap smear result	1st response	2nd response	p
Lesion	Actions after the first abnormal Pap smear result	N	N	p
ASCUS*	< 25 years: request repeat colpocytopathological examination in three years or upon reaching 25 years of age. If atypia persists, continue cytological follow-up every three years.	21 (12.1)	151 (86.8)	< 0.001
	25 and 29 years old: request a repeat colpocytopathological examination in 12 months; if ASCUS persists, request a colposcopy.	64 (36.8)	154 (88.5)	< 0.001
	< 30 years: request repeat Pap smear in 6 months; if ASCUS persists, request colposcopy.	84 (48.3)	154 (88.5)	< 0.001
	Immunosuppressed women: refer for colposcopy after the first abnormal test.	55 (31.6)	151 (86.8)	< 0.001
	Responses not consistent with Brazilian guidelines.	55 (38.3)	9 (5.2)	0.0039
LSIL†	< 25 years: repeat colpocytopathological examination in 3 years or upon reaching 25 years of age. If atypia persists, maintain triennial cytological follow-up.	25 (14.4)	141 (81)	< 0.001
	< 25 years old: request repeat colpocytopathological examination in 6 months; if LSIL persists, request colposcopy.	91 (52.3)	141 (81)	< 0.001
	Immunosuppressed women should be referred for colposcopy after the first abnormal exam.	61 (35.1)	130 (74.7)	< 0.001
	Responses not consistent with Brazilian guidelines.	92 (52.9)	20 (11.5)	< 0.001
HSIL‡	Refer for colposcopy regardless of age.	146 (83.9)	165 (94.8)	< 0.001
HSIL‡	Responses not consistent with Brazilian guidelines.	41 (23.6)	11 (6.3)	< 0.001
ASCH§	Refer for colposcopy regardless of age group.	126 (72.4)	163 (93.7)	< 0.001
ASCH§	Responses not consistent with Brazilian guidelines.	78 (44.8)	20 (11.5)	< 0.001
AGC-US** /AGC-H††	Refer for colposcopy regardless of age group.	113 (64.9)	163 (93.7)	< 0.001
AGC-US** /AGC-H††	Responses not consistent with Brazilian guidelines.	86 (49.4)	15 (8.6)	< 0.001
AOI‡‡	Referral for colposcopy regardless of age group.	115 (66.1)	162 (93.1)	< 0.001
AOI‡‡	Responses not consistent with Brazilian guidelines.	73 (42)	9 (5.2)	0.0039
LIE AG Mic. Inv§§	Refer for colposcopy regardless of age.	144 (82.8)	168 (96.6)	< 0.001
LIE AG Mic. Inv§§	Responses not consistent with Brazilian guidelines.	28 (16.1)	4 (2.3)	0.125
(AIS) or invasive***	Refer for colposcopy regardless of age.	149 (85.6)	166 (95.4)	< 0.001
(AIS) or invasive***	Responses not consistent with Brazilian guidelines.	29 (16.7)	1 (0.6)	0.1

Lesion	Actions after a negative colposcopy or CIN I result	1st Response	2nd Response	p
Lesion	Actions after a negative colposcopy or CIN I result	N, %	N, %	p
ASCUS*	25 and 29 years old: repeat Pap smear in 12 months; if normal, return to triennial screening after 2 consecutive negative tests.	99 (56.9)	154 (88.5)	< 0.001
	< 30 years: repeat Pap smear in 6 months; if normal, return to triennial screening after 2 consecutive negative tests.	87 (50)	158 (93.8)	< 0.001
	Responses not consistent with Brazilian guidelines.	28 (16.1)	8 (4.6)	< 0.001
LSIL†	< 25 years: repeat Pap smear in 6 months; if normal, return to triennial screening after 2 consecutive negative tests; if abnormal, continue follow-up.	78 (44.8)	147 (84.5)	< 0.001
LSIL†	Responses not consistent with Brazilian guidelines.	80 (46)	16 (9.2)	< 0.001
HSIL‡	Colposcopy without abnormal findings, request review of the slide or new cytopathological examination.	110 (63.2)	131 (75.3)	< 0.001
	< 25 years: repeat cytopathology and colposcopy in 6 months; if negative, repeat cytology after 6 months and return to triennial screening after 2 consecutive negative Pap smears every six months.	38 (21.8)	144 (82.8)	< 0.001
	Responses not consistent with Brazilian guidelines.	42 (24.1)	15 (8.6)	< 0.001
ASCH§	Repeat cytopathology and colposcopy in 6 months; if negative, repeat cytology in 6 months and return to triennial screening after 2 consecutive negative Pap smears.	103 (59.3)	155 (83.1)	< 0.001
ASCH§	Responses not consistent with Brazilian guidelines.	75 (43.1)	22 (12.6)	< 0.001
AGC-US**/ AGC-H††	Repeat cytopathology in 6 months regardless of age group and return to triennial screening after 4 consecutive negative semiannual exams.	75 (43.1)	161 (92.5)	< 0.001
AGC-US**/ AGC-H††	Responses not consistent with Brazilian guidelines.	131 (75.3)	31 (17.8)	< 0.001
AOI‡‡	Maintain cytology and colposcopy every six months at 6 and 12 months.	123 (70.7)	167 (96)	< 0.001
AOI‡‡	Responses not consistent with Brazilian guidelines.	41 (23.6)	4 (2.3)	< 0.001

Lesion	Actions in accordance with Brazilian guidelines for cervical cancer screening	1st Response	2nd Response	p
Lesion		N, %	N, %	p
LIE AG Mic. Inv*	Cytology and colposcopy every six months for up to two years, followed by annual cytology for five years at the basic health unit (UBS); if a new test shows abnormal results, proceed according to the new results.	91 (52.3)	168 (96.6)	< 0.001
LIE AG Mic. Inv*	Responses not consistent with Brazilian guidelines.	81 (46.6)	8 (4.6)	< 0.001
AIS or invasive †	If histopathological with clear margins or with CIN I: cytology at 6 and 12 months, followed by annual cytology for 5 years at the UBS.	63 (36.2)	159 (91.4)	< 0.001
	If histopathological with margins with CIN II and III: refer for consultation.	108 (62.1)	155 (89.1)	< 0.001
	Women who have undergone hysterectomy should undergo annual cytological follow-up for five years and triennial follow-up thereafter.	44 (25.3)	141 (81)	< 0.001
	Responses not consistent with Brazilian guidelines.	34 (19.5)	3 (1.7)	< 0.001

[TFN100] ^**
AGCUS: Atypical glandular cells of undetermined significance, possibly non-neoplastic

[TFN200] ^††
AGCH: Atypical glandular cells of undetermined significance, possibly non-neoplastic, for which a high-grade lesion cannot be ruled out.

[TFN300] ^***
AIS or invasive: Adenocarcinoma in situ (AIS) and invasive adenocarcinoma.

[TFN400] ^§
ASCH: Atypical squamous cells of undetermined significance, cannot exclude high-grade lesion

[TFN500] ^*
ASCUS: Atypical squamous cells of undetermined significance, possibly non-neoplastic

[TFN600] ^‡‡
AOI: Atypical cells of undetermined significance of undefined origin, possibly non-neoplastic or unable to rule out high-grade lesion.

[TFN700] ^‡
HSIL: High-grade squamous intraepithelial lesion.

[TFN800] ^†
LSIL: Low-grade squamous intraepithelial lesion.

[TFN900] ^§§
LIE AG Mic. Inv: High-grade intraepithelial lesion, cannot exclude microinvasion or invasive squamous cell carcinoma.

Life-saving training in the Amazon: An update on the management of cervical cancer precursor lesions

ABSTRACT