Browsing by Author "Denny, Lynette"

Now showing 1 - 17 of 17
  • Thumbnail Image
    Item
    Open Access
    An audit of the management of women with Borderline Ovarian Tumours treated at Groote Schuur Hospital between 1984-2008
    (2017) Hendricks, Aneeqah; Denny, Lynette; van Wijk, Leon
    Background: Borderline ovarian tumours (BOT) are an intermediate form of neoplasia, between benign and malignant and have been classified as epithelial tumours of low malignant potential. These particular tumours affect a younger age group than their invasive counterparts with an overall survival of 90 - 100%. The present study aims to document the experience of a single centre on the management of women with borderline ovarian tumours (BOT). Methods: Two hundred and thirteen patients diagnosed and treated with BOT between 1984 and 2008 were identified through the Gynaecology Oncology database that has been in existence since 1984. Details of management, outcome and survival were retrieved and data were analysed descriptively and for survival. Results: The median age at diagnosis was 45 years old, with 34 % of patients > 40 years old. The incidence of serous BOT (SBOT) was 47.9% (102/213) and 49.3 % (105/213) were mucinous BOT (MBOT). Most of the patients were diagnosed in Stage I 83.6% (178/213), 6.1%( 13/213) were in stage II and 10.0% (22/213) were stage III. There were no patients in stage IV. At the end of the study period 73% (156/213) of the women were alive with no evidence of disease. Univariate analysis, indicated that the histological subtype of tumour, the type of surgery, the presence of residual disease, advanced stage disease, the presence of ascites were all statistically significant in affecting survival. Multivariate analysis, however, revealed that only the presence of residual disease was statistically significant as a prognostic predictor of poor outcome.
  • Thumbnail Image
    Item
    Open Access
    Chemoradiation in advanced vulval carcinoma
    (2008) Rogers, Linda Joy; Denny, Lynette; Van Wijk, A L
    Vulval carcinoma is uncommon, affecting approximately 2 per 100 000 women annually. The treatment of choice is radical vulvectomy and inguinal lymph node dissection. ‘Advanced’ vulval carcinomas involve midline structures (such as clitoris, urethra or anus) and/or adjacent pelvic organs or bone, and adequate excision may require urinary diversion, colostomy or pelvic exenteration. Less morbid and less mutilating therapeutic alternatives have been investigated, particularly chemoradiation, which has shown significant success in the management of anal carcinomas. Primary chemoradiation has been used, instead of primary radical surgery, to treat advanced vulval carcinomas at Groote Schuur Hospital (GSH) since1982. Aims: 1) To assess the survival of women with advanced vulval carcinoma treated with primary chemoradiation. 2) To examine the role of surgery after treatment with primary chemoradiation.
  • Thumbnail Image
    Item
    Open Access
    Clients' returning for cervical screening results : a focus group study exploring the reasons why women spontaneously return for their results at the Khayelitsha Cervical Cancer Screening Project
    (2004) Honikman, Simone; Denny, Lynette
    Cervical cancer is integrally associated with the problems of poverty in the developing world. It is the most common cancer cause of death among women in these regions. In South Africa, the lifetime risk for black African women developing this cancer is 1 in 26. Rates for white women are 1 in 80. Cervical cancer is largely preventable by screening for its precursor stages. However, cervical cancer screening in low-resource settings has only rarely been initiated and sustained. There are many barriers to the establishment of mass, organised screening programmes. This study focuses on one aspect of the screening process: the clients' receiving of their screening results. For the most part, health providers in resource-poor settings rely on the clients themselves to return to the health service to receive their results and consequent arrangements for further care. Understanding those factors that impact upon clients' returning is therefore crucial to the success of the screening. The Khayelitsha Cervical Cancer Screening Project (KCCSP) was established in 1996 to evaluate alternative screening tests to cytology. In addition, the Project has evaluated alternative screening algorithms to the traditional approach of cytology, colposcopy, biopsy and treatment, specifically, a "screen and treat" approach. This approach is expected to overcome some of the many barriers to women participating in screening programmes. This study aims to investigate the phenomenon of the high spontaneous return rate in the setting of the KCCSP. Motivating and deterring factors are sought, both logistical and psychological, in the clients' personal contexts, as well as those related to their experiences of the Project. Exploratory study in the interpretive research paradigm located in a peri-urban informal settlement outside Cape Town, South Africa. Volunteer sample of women enrolled in the KCCSP returning for their first set of screening results. Four focus groups were conducted in Xhosa, facilitated by a Xhosa-speaking social worker from Khayelitsha who has experience in focus group work. Discussion guidelines were followed. The discussions were tape recorded and later transcribed before being translated into English by the facilitator. Analysis of the data draws on elements of both the grounded theory and the systems theory paradigms. The findings reveal that, for the most part, women present to the KCCSP in order to have general gynaecological problems addressed. Returning for results represents an extension of this need. Obstacles to returning include problems with access to the clinic, the need to care for dependents at home and the competing priorities of housework and generating income. Factors that promote the returning for results are the imperative to understand the cause of, and have treatment for pre-existing gynaecological symptoms which cause high levels of anxiety. Related to this, women are motivated to have confirmed or refuted the diagnosis of a fatal disease, including cancer and HIV. Certain qualities and design features of the KCCSP facilitate women returning fOr their results. These include the perceived superior quality of interpersonal communication between Project staff and clients and the efficient manner in which results are made available to clients. Other promotive or obstructive factors that playa role in cervical screening service utilisation include; client attitudes towards traditional healers, a prevalent fear of hysterectomy, concern about privacy and gossip and a suspicious attitude toward caring health workers. Women enrolled in the KCCSP have a personal health agenda with a different focus to that of the Project. Chronic gynaecological problems are frequently experienced and give rise to levels of anxiety about their being signs of serious pathology. Women have not had these fears or the symptoms adequately addressed at other health services. The need to have these issues properly managed represents a large enough motivating force to overcome many of the practical and psychological obstacles to utilisation of the KCCSP. The Project represents for women a general women's health service.
  • Thumbnail Image
    Item
    Open Access
    The costs of reducing loss to follow-up in South African cervical cancer screening
    (BioMed Central Ltd, 2005) Goldhaber-Fiebert, Jeremy; Denny, Lynette; De Souza, Michelle; Wright, Thomas; Kuhn, Louise; Goldie, Sue
    BACKGROUND:This study was designed to quantify the resources used in reestablishing contact with women who missed their scheduled cervical cancer screening visits and to assess the success of this effort in reducing loss to follow-up in a developing country setting. METHODS: Women were enrolled in this Cape Town, South Africa-based screening study between 2000 and 2003, and all had scheduled follow-up visits in 2003. Community health worker (CHW) time, vehicle use, maintenance, and depreciation were estimated from weekly logs and cost accounting systems. The percentage of women who attended their scheduled visit, those who attended after CHW contact(s), and those who never returned despite attempted contact(s) were determined. The number of CHW visits per woman was also estimated. RESULTS: 3,711 visits were scheduled in 2003. Of these, 2,321 (62.5%) occurred without CHW contact, 918 (24.8%) occurred after contact(s), and 472 (12.7%) did not occur despite contact(s). Loss to follow-up was reduced from 21% to 6%, 39% to 10%, and 50% to 24% for 6, 12, and 24-month visits. CHWs attempted 3,200 contacts in 530 trips. On average, 3 CHWs attempted to contact 6 participants over each 111 minute trip. The per-person cost (2003 Rand) for these activities was 12.75, 24.92, and 40.50 for 6, 12, and 24-month visits. CONCLUSION: CHW contact with women who missed scheduled visits increased their return rate. Cost-effectiveness analyses aimed at policy decisions about cervical cancer screening in developing countries should incorporate these findings.
  • Thumbnail Image
    Item
    Open Access
    Distribution of high-risk human papillomavirus genotypes among HIV-negative women with and without cervical intraepithelial neoplasia in South Africa
    (Public Library of Science, 2012) McDonald, Alicia C; Denny, Lynette; Wang, Chunhui; Tsai, Wei-Yann; Jr, Thomas C Wright; Kuhn, Louise
    Objective Large studies describing the profile of high-risk Human papillomavirus (hrHPV) genotypes among women in sub-Saharan Africa are lacking. Here we describe the prevalence and distribution of hrHPV genotypes among HIV-negative women in South Africa, with and without cervical intraepithelial neoplasia (CIN). METHODS: We report data on 8,050 HIV-negative women, aged 17-65 years, recruited into three sequential studies undertaken in Cape Town, South Africa. Women had no history of previous cervical cancer screening. Cervical samples were tested for hrHPV DNA using the Hybrid Capture 2 (HC2) assay and all positive samples were genotyped using a PCR-based assay (Line Blot). Women underwent colposcopy and biopsy/endocervical curettage to determine CIN status. The prevalence and distribution of specific hrHPV genotypes were examined by age and CIN status. RESULTS: Overall, 20.7% (95% CI, 19.9-21.6%) of women were hrHPV-positive by HC2, with women with CIN having the highest rates of positivity. Prevalence decreased with increasing age among women without CIN; but, a bimodal age curve was observed among women with CIN. HPV 16 and 35 were the most common hrHPV genotypes in all age and CIN groups. HPV 45 became more frequent among older women with CIN grade 2 or 3 (CIN2,3). Younger women (17-29 years) had more multiple hrHPV genotypes overall and in each cervical disease group than older women (40-65 years). CONCLUSION: HPV 16, 35, and 45 were the leading contributors to CIN 2,3. The current HPV vaccines could significantly reduce HPV-related cervical disease; however, next generation vaccines that include HPV 35 and 45 would further reduce cervical disease in this population.
  • Thumbnail Image
    Item
    Open Access
    An evaluation of alternative strategies for the prevention of cervical cancer in low-resource settings
    (2000) Denny, Lynette; Wright, Thomas; Soeters, Robbert
    Includes bibliographical references.
  • Thumbnail Image
    Item
    Open Access
    HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study
    (BioMed Central Ltd, 2006) Moodley, Jennifer; Hoffman, Margaret; Carrara, Henri; Allan, Bruce; Cooper, Diane; Rosenberg, Lynn; Denny, Lynette; Shapiro, Samuel; Williamson, Anna-Lise
    BACKGROUND:Cervical cancer and infection with human immunodeficiency virus (HIV) are both major public health problems in South Africa. The aim of this study was to determine the risk of cervical pre-cancer and cancer among HIV positive women in South Africa. METHODS: Data were derived from a case-control study that examined the association between hormonal contraceptives and invasive cervical cancer. The study was conducted in the Western Cape (South Africa), from January 1998 to December 2001. There were 486 women with invasive cervical cancer, 103 control women with atypical squamous cells of undetermined significance (ASCUS), 53 with low-grade squamous intraepithelial lesions (LSIL), 50 with high-grade squamous intraepithelial lesions (HSIL) and 1159 with normal cytology. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multiple logistic regression. RESULTS: The adjusted odds ratios associated with HIV infection were: 4.4 [95% CI (2.3 - 8.4) for ASCUS, 7.4 (3.5 - 15.7) for LSIL, 5.8 (2.4 - 13.6) for HSIL and 1.17 (0.75 - 1.85) for invasive cervical cancer. HIV positive women were nearly 5 times more likely to have high-risk human papillomavirus infection (HR-HPV) present compared to HIV negative women [OR 4.6 (95 % CI 2.8 - 7.5)]. Women infected with both HIV and high-risk HPV had a more than 40 fold higher risk of SIL than women infected with neither of these viruses. CONCLUSION: HIV positive women were at an increased risk of cervical pre-cancer, but did not demonstrate an excess risk of invasive cervical cancer. An interaction between HIV and HR-HPV infection was demonstrated. Our findings underscore the importance of developing locally relevant screening and management guidelines for HIV positive women in South Africa.
  • Thumbnail Image
    Item
    Open Access
    Hygiena Study: audit of women managed with Cone Biopsy at Groote Schuur Hospital from 1st April 2013 to 31st October 2015
    (2017) Kadwa, Khatija; Denny, Lynette; Mbatani, Nomonde
    INTRODUCTION: Cervical cancer is the second commonest cancer in South Africa and the commonest amongst Black females with a Lifetime Risk (LR) of 1:35. In South Africa the problem has been compounded by the HIV epidemic as well as a lack of resources and infrastructure to offer an adequate screening and treatment programme. Cone biopsies are one of the diagnostic and sometimes therapeutic modalities used to assess and treat cervical precursors and cervical cancer. Unfortunately, cone biopsy of the cervix remains a morbid procedure often performed on young women in the reproductive age group and has resultant complications. OBJECTIVE: To audit the demographics, indications, histology and post cone management and outcome of women requiring cone biopsies of the cervix, at Groote Schuur Hospital Colposcopy Clinic between 1st April 2010 and 31st October 2013. METHODS: A group of women attending the colposcopy clinic, and requiring cone biopsies between 1st April 2010 and 31st October 2013 were identified from a computerized database, known as the Hygiena Database. Women who had an incomplete dataset were excluded. Folder review and review of the National Health Laboratory Services was also conducted. Patient demographics, indications, cone histology and follow up at 4-6 months, 10-12 months and > 12 months were analysed. Age, parity, HIV status, CD4 count, ARV status and cone margin involvement were included in the univariate and multivariate analysis to determine predictors of persistent disease RESULTS: Three hundred and seventy six cone biopsies were performed during the study period, with a mean age of 42.3 years, mean parity of 2. The majority of women [56,7% (213/376)] were HIV positive. The final histology indicated that 65,2% (246/376) of the women had high-grade disease (CIN 2/3 or HSIL) and 12,5% (47/376) had microinvasion. Ectocervical margins were clear in 57,6% (212/368) of cases and endocervical margins were clear in 54,6% (201/368) of specimens. Fifty-one cancers were detected during the study period. In the multivariate analysis age 40-49yrs (RR 1.4, 95% CI 1.01-2.0: p=0,043), ectocervical margin involvement with CIN 2/3 (RR 1.8, 95% CI 1.1-3.0: p-0.017) and endocervical margin involvement with CIN 2/3 (RR 1.5, 95% CI 1.04-2.3; p=0,031) and microinvasion ( RR 2.4, 95% CI 1.4-4.3; p=0.003) were all predictors of persistent disease. CONCLUSION: The use of cone biopsy is a valid diagnostic and sometimes therapeutic procedure at Groote Schuur Hospital with significant detection of high grade disease and cervical cancer. Women aged 40-49 years and positive cone margins are strong predictors of persistent disease. Improved compliance and a reduction in positive margins are two areas that need to be addressed to improve the current treatment programme. Use of cone biopsy as surgical therapy for early stage cancer appears promising but needs further study.
  • Thumbnail Image
    Item
    Open Access
    Long-term outcomes of women treated for high-grade squamous intraepithelial lesions at a University Hospital colposcopy unit in South Africa. A 5-year retrospective cohort study
    (2019) Guzha, Bothwell Takaingofa; Denny, Lynette; Rogers, Linda
    INTRODUCTION: Worldwide, there is a paradigm shift in the screening for cervical cancer with the use of high-risk human papillomavirus (hrHPV) molecular testing. Before South Africa (SA) adopts this technology in the public sector, health funders will need data on the performance of the current cytology and colposcopy-based programmes. This study was done to establish baseline data on the performance of the cytology and colposcopy based cervical cancer screening programme at the Groote Schuur Hospital (GSH) colposcopy clinic. METHODS: This was a retrospective cohort study of all the women with high grade squamous intraepithelial lesion (HSIL) Pap smears seen at GSH colposcopy clinic between 01 January 2010 and 31 December 2015. The outcome measures were; diagnostic concordance between cytology, colposcopy and histology, large loop excision of the transformation zone (LLETZ) and cone biopsy complication rates, cure rate, treatment failure and invasive cervical cancer rates, median time from treatment to recurrence, follow-up default rates. Data were managed and analysed using IBM SPSS Statistics Version 25 and Microsoft Structured Query Language (SQL) version 2014. Regression methods were used to assess the independent effect of baseline sociodemographic characteristics and clinical covariates on treatment failure and clearance of disease in those who had persistent disease after treatment. Kaplan-Meier curves were used to represent the time from treatment to recurrence and from persistence to cure. Time-to-event methods were applied to determine factors associated with treatment to recurrence and persistence to cure. RESULTS: A total of 7601 women were referred to the GSH colposcopy clinic during the study period. HSIL or worse lesions (≥HSIL) were confirmed histologically in 74.1% (2282/3081) women. At the four-month follow-up visit, 61.2% (742/1213) of the women were considered cured, and 17.0% (206/1213) had persistent/residual disease. In women considered cured at four months, recurrence was very low, and it peaked at ten months at 1.5% (11/740). By 24 months the cumulative recurrence rate was 4.6% (34/742). In women with persistent disease at the four-month follow-up visit, only 0.5% (1/202) developed invasive cervical cancer. The default rate for follow-up was very high, at 81% at 24 months. LLETZ and cone biopsy complication rate was 7.2% (117/1628). Log-rank analysis showed that parity ≥ four was significantly associated with a higher risk of disease recurrence (p=0.0004). In a Coxregression model, taking HAART was the only factor associated with a reduced risk of disease recurrence (p=0.0261). CONCLUSION: LLETZ and cone biopsy are safe procedures. After cure, recurrence rates are low. In women who are treated for HSIL, cervical cancer is very rare. Taking HAART was associated with a reduced risk of disease recurrence. There is a need to mitigate on higher default rates to follow up.
  • Thumbnail Image
    Item
    Open Access
    Maternal and neonatal outcomes in late preterm prelabour rupture of membranes: a retrospective study
    (2018) Leelodharry, Vakil Kumar; Petro, Gregory; Denny, Lynette
    Background: The management of late preterm prelabour rupture of membranes (PPROM) is associated with an increased risk of neonatal prematurity related morbidity due to many obstetric care guidelines which favour delivery at 34 weeks or immediately upon diagnosis of ruptured membranes after 34 weeks gestation. However, expectant management of this group of patients (i.e delayed delivery) between 34+0 and 36+6 weeks of gestation is associated with an increased risk of neonatal and maternal infectious morbidities. Aim of Study: The aim of this study was to evaluate the impact of the latency period on maternal and neonatal outcomes in late preterm prelabour rupture of membranes in a regional perinatal service in Cape Town, South Africa. The latency period was defined as the time from rupture of membranes to the time of delivery. In addition, we sought to investigate whether immediate induction of labour in the absence of overt signs of infection or fetal compromise should be prioritised in women who present with late preterm prelabour rupture of membranes. Methods: This was a retrospective cohort study carried out over a period of two years in two secondary level hospitals of the Metro West area of Cape Town. The subjects were low risk HIV negative women with singleton pregnancies with ruptured membranes in the late preterm period. Maternal and neonatal outcomes were studied between two latency periods, namely short latency (< 48 hours) and long latency period (≥ 48 hours) after ruptured membranes. Results and Conclusion: There were no significant differences in maternal and neonatal outcomes between the two groups of latency periods when latency was defined as the time from ruptured membranes to delivery. The study favoured a delayed induction thereby improving neonatal outcomes by decreasing the complications of prematurity. There were more adverse maternal outcomes, including an increase likelihood of augmentation of labour and more operative delivery along with its major risk, that of obstetric haemorrhage, were noted in the short latency period group. Therefore, a delayed induction policy appeared to be more appropriate. Preterm delivery places the newborn at risk of prematurity. Therefore, the risk of prematurity must be balanced with the risks of intrauterine infection and antepartum haemorrhage, the two major complications of expectant management if delayed induction is to be adopted. Proper monitoring of both the pregnant woman and fetus is essential when expectant management is carried out to avoid these adverse maternal and neonatal outcomes.
  • Thumbnail Image
    Item
    Open Access
    More men than women make mucosal IgA antibodies to Human papillomavirus type 16 (HPV-16) and HPV-18: a study of oral HPV and oral HPV antibodies in a normal healthy population
    (BioMed Central Ltd, 2006) Marais, Dianne; Sampson, Candice; Jeftha, Anthea; Dhaya, Dherendra; Passmore, Jo-Ann; Denny, Lynette; Rybicki, Edward; Van Der Walt, Eric; Stephen, Lawrence; Williamson, Anna-Lise
    BACKGROUND:We have previously shown the high prevalence of oral anti-human papillomavirus type 16 (HPV-16) antibodies in women with HPV-associated cervical neoplasia. It was postulated that the HPV antibodies were initiated after HPV antigenic stimulation at the cervix via the common mucosal immune system. The present study aimed to further evaluate the effectiveness of oral fluid testing for detecting the mucosal humoral response to HPV infection and to advance our limited understanding of the immune response to HPV. METHODS: The prevalence of oral HPV infection and oral antibodies to HPV types 16, 18 and 11 was determined in a normal, healthy population of children, adolescents and adults, both male and female, attending a dental clinic. HPV types in buccal cells were determined by DNA sequencing. Oral fluid was collected from the gingival crevice of the mouth by the OraSure method. HPV-16, HPV-18 and HPV-11 antibodies in oral fluid were detected by virus-like particle-based enzyme-linked immunosorbent assay. As a reference group 44 women with cervical neoplasia were included in the study. RESULTS: Oral HPV infection was highest in children (9/114, 7.9%), followed by adolescents (4/78, 5.1%), and lowest in normal adults (4/116, 3.5%). The predominant HPV type found was HPV-13 (7/22, 31.8%) followed by HPV-32 (5/22, 22.7%). The prevalence of oral antibodies to HPV-16, HPV-18 and HPV-11 was low in children and increased substantially in adolescents and normal adults. Oral HPV-16 IgA was significantly more prevalent in women with cervical neoplasia (30/44, 68.2%) than the women from the dental clinic (18/69, 26.1% P = 0.0001). Significantly more adult men than women displayed oral HPV-16 IgA (30/47 compared with 18/69, OR 5.0, 95% CI 2.09-12.1, P < 0.001) and HPV-18 IgA (17/47 compared with 13/69, OR 2.4, 95% CI 0.97-6.2, P = 0.04). CONCLUSION: The increased prevalence of oral HPV antibodies in adolescent individuals compared with children was attributed to the onset of sexual activity. The increased prevalence of oral anti-HPV IgA in men compared with women was noteworthy considering reportedly fewer men than women make serum antibodies, and warrants further investigation.
  • Thumbnail Image
    Item
    Open Access
    The natural history of low grade squamuous intra-epithelial lesions (LSIL) in women attending Groote Schuur Hospital Colposcopy Clinic
    (2015) Govender, Kamendran; Denny, Lynette
    Aims and Objectives : To identify risk factors affecting rates of progression and regression of LSIL To determine the rates of progression and regression of disease in women with LSIL To compare the natural history of LSIL in HIV positive and negative women to determine patient adherence to colposcopy clinic in women with LSIL Methods: This is a retrospective, descriptive, cohort study of women who were referred to the colposcopy clinic with a cytological diagnosis of LSIL and followed for a minimum period of 2 years. Data was extracted from the colposcopy clinic data. Women who were referred and attended the clinic between 1st January 2009 and 31st December 2013 were included in the analysis. Statistical analysis was performed using Stata version 13.1 (StataCorp LP, 4905 Lakeway Drive, College Station, TX 77845, USA). All p-values <0.05 were deemed statistically significant. Results: The study population was 154 women with LSIL (N=154). Of these, 27 (17%) women were HIV negative, 106 (69%) were HIV positive and 18 had an unknown HIV status. The overall regression rate from LSIL to normality was 88.5% [95% CI = 83.9 - 92.1%], with 128 of the 154 women having had regression of disease. The overall progression to higher grade lesions included 31 women, giving a progression rate of 17.7% [95% CI = 15.4 -22.8%]. None of these women progressed to invasive cancer. HIV positive women made up 69% of the study population but there was no significant difference in regression and progression between the HIV positive and negative women. The mean age of the group was 37.8 years with 60% of women screened at this clinic falling between 30-49 years of age. All age groups had similar trends of regression and progression, but those over 60 years of age were 12 times more likely to regress and none of them progressed to HSIL [p=0.002]. Those using an IUCD made up 141 person-months studied, they were shown to have a 6 times greater likelihood to result in regression (p=0.01) compared to women on no contraception. Conclusion: The high regression and low progression rates of LSIL are in keeping with global data and substantiate the need for surveillance rather than surgical intervention i.e. LSIL is a risk factor rather than a precursor for cervical cancer. The lack of difference in regression-progression rates despite HIV status means we can follow-up positive and negative women similarly (12 monthly). Older women (60+) are most likely over-called during diagnosis due to genital atrophy and thus follow-up interval can be longer than 12 months. More research is required to assess IUCDs' effect on LSIL regression and to ascertain the possible reasons for patient adherence.
  • Thumbnail Image
    Item
    Open Access
    Prognostic factors in women with stage IIIB cervical cancer
    (2001) Hinz, Stefanie; Denny, Lynette
    This study was designed to identify specific patient and tumour related factors which could be used as prognostic parameters in women with stage IIIB cervial cancer, and to investigate the relationship between these factors and treatment outcome. Primary endpoints were overall survival, disease-free and pelvic recurrence-free survival rates.
  • Thumbnail Image
    Item
    Open Access
    Reduced acquisition and reactivation of human papillomavirus infections among older women treated with cryotherapy: results from a randomized trial in South Africa
    (BioMed Central Ltd, 2010) Taylor, Sylvia; Wang, Chunhui; Wright, Thomas; Denny, Lynette; Tsai, Wei-Yann; Kuhn, Louise
    BACKGROUND:Treatment of women for high-grade cervical cancer precursors frequently results in clearance of the associated high-risk human papillomavirus (hrHPV) infection but the role of treatment among women without hrHPV is unknown. We investigated whether cervical cryotherapy reduces newly detected hrHPV infections among HIV-positive and HIV-negative women who were hrHPV negative when treated. METHODS: The impact of cryotherapy on newly detected hrHPV infections was examined among 612 women of known HIV serostatus, aged 35 to 65 years, who were negative for hrHPV DNA, and randomized to either undergo cryotherapy (n = 309) or not (n = 303). All women underwent repeat hrHPV DNA testing 6, 12, 24, and 36 months later. RESULTS: Among 540 HIV-negative women, cryotherapy was associated with a significant reduction in newly detected hrHPV infections. Women in the cryotherapy group were 55% less likely to have newly detected hrHPV than women in the control group (95% CI 0.28 to 0.71). This association was independent of the influence of changes in sexual behaviors following therapy (adjusted hazards ratio (HR) = 0.49, 95% CI 0.29 to 0.81). Among 72 HIV-positive women, similar reductions were not observed (HR = 1.10, 95% CI 0.53 to 2.29). CONCLUSIONS: Cervical cryotherapy significantly reduced newly detected hrHPV infections among HIV-negative, but not HIV-positive women. These results raise intriguing questions about immunological responses and biological mechanisms underlying the apparent prophylactic benefits of cryotherapy.
  • Thumbnail Image
    Item
    Open Access
    The agreement between cervical abnormalities identified by cytology and detection of high-risk types of human papillomavirus
    (2006) Allan, Bruce R; Marais, Dianne J; Denny, Lynette; Hoffman, Margaret; Shapiro, Samuel; Williamson, Anna-Lise
    Objectives and design. Human papillomavirus (HPV) is causally associated with cervical cancer. Using the Digene Hybrid Capture 2 high-risk HPV test (HC2), we investigated the prevalence of high-risk HPV in cervical specimens, and compared results with those of Papanicolaou (Pap) smears taken concurrently Subjects and setting. Cervical specimens were obtained from women attending hospitals/community health centres in the Western Cape province of South Africa. They were participating in a case-control study of the association of hormonal contraceptives and invasive cervical cancer. Results. Of 1 491 women tested, 254 (17%) were HPV DNA positive. The age-specific prevalence of HPV was 36/97 (37.1%) in those aged < 30 years, 78/369 (21.1%) in those aged 30 - 39 years, 78/603 (12.9%) in those aged 40 - 49 years and 62/422 (14.7%) in those aged 50 - 59 years. In women with normal cytology the prevalence of HPV was 10.9% (138/1 264); in those with abnormal squamous cells of unknown significance (AS-CUS) it was 30.8% (36/117); in those with low-grade squamous intraepithelial lesions (LSIL) it was 63.2% (36/57), and in those with high-grade squamous intraepithelial lesions (HSIL) it was 83% (44/53). The odds ratio between HPV and HSIL in women aged 40 - 59 years was 57.1 (confidence interval 22.4 - 170.7). Conclusions. HC2 detected a high prevalence of HPV (17%) in this population. Most women with HSIL (83%) were positive, indicating that HPV testing of AS-CUS women may aid in management. When costs decrease, HC2 could be introduced as an adjunct to Pap smears in identifying women at risk for high-grade cervical disease and could be useful in the maintenance of cervical health in those who remain Pap smear negative.
  • Thumbnail Image
    Item
    Open Access
    Utilisation and outcomes of cervical cancer prevention services among HIV-infected women in Cape Town
    (2010) Batra, Priya; Kuhn, Louise; Denny, Lynette
    Objective. An audit of outcomes of cervical cancer screening and prevention services for HIV-positive women in Cape Town, South Africa. Design. Retrospective review of clinic registers, patient records and pathology databases at three HIV primary health clinics and a tertiary colposcopy referral centre. Subjects. Women recently diagnosed with HIV at three primary health clinics between 2006 and 2008 (N=2 240); new patients seen for colposcopy at a tertiary referral centre between 2006 and 2009 (N=2 031). Outcome measures. The proportion of women undergoing cervical cancer screening after HIV diagnosis at primary health clinics, demographic characteristics of women referred for colposcopy at a tertiary centre, and outcomes of therapy for precancerous lesions of the cervix. Results. The proportion of women undergoing at least one Pap smear at HIV primary health clinics after HIV diagnosis was low (13.1%). Women referred for colposcopy tended to be HIV-positive and over the age of 30 years, and in most (70.2%) cytological examination revealed high-grade cervical dysplasia. HIV-positive women treated with excision for precancerous lesions of the cervix were significantly more likely than their HIV-negative counterparts to undergo incomplete excision, experience persistent cervical disease after treatment, and be lost to follow-up. Conclusion. Cervical cancer screening efforts must be scaled up for women with HIV. Treatment and surveillance guidelines for cervical intraepithelial neoplasia in HIV-positive women may need to be revised and new interventions developed to reduce incomplete treatment and patient default.
  • Thumbnail Image
    Item
    Open Access
    Women's journey of recovery from sexual assault trauma : a grounded theory
    (2006) Duma, Sinegugu; Mekwa, JN; Denny, Lynette
    Thousands of women and children experience sexual assault trauma annually in South Africa. The challenge posed by recovery from sexual assault trauma is a reality that confronts the victims and survivors of sexual assault, their families and the larger community of service providers in the context of the threat of HIV/AIDS. Yet, little research has been conducted on recovery from sexual assault as a phenomenon. There are even fewer studies about the women's response to or recovery from sexual assault trauma. The purpose of the study was to explore and analyse the journey of recovery which is undertaken by women who have been sexually assaulted, with the aim of discovering and developing the grounded theory of recovery from sexual assault trauma within the first six months following the event of rape. The main research question was: What constitutes the journey of recovery undertaken by women within the first six months following sexual assault?