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Abstract
In the past several years, a few cervical Pap smear datasets have been published for
use in clinical training. However, most publicly available datasets consist of pre-segmented
single cell images, contain on-image annotations that must be manually edited out,
or are prepared using the conventional Pap smear method. Multicellular liquid Pap
image datasets are a more accurate reflection of current cervical screening techniques.
While a multicellular liquid SurePath™ dataset has been created, machine learning
models struggle to classify a test image set when it is prepared differently from
the training set due to visual differences. Therefore, this dataset of multicellular
Pap smear images prepared with the more common ThinPrep® protocol is presented as
a helpful resource for training and testing artificial intelligence models, particularly
for future application in cervical dysplasia diagnosis. The “Brown Multicellular ThinPrep”
(BMT) dataset is the first publicly available multicellular ThinPrep® dataset, consisting
of 600 clinically vetted images collected from 180 Pap smear slides from 180 patients,
classified into three key diagnostic categories.
Background Tracking progress and providing timely evidence is a fundamental step forward for countries to remain aligned with the targets set by WHO to eliminate cervical cancer as a public health problem (ie, to reduce the incidence of the disease below a threshold of 4 cases per 100 000 women-years). We aimed to assess the extent of global inequalities in cervical cancer incidence and mortality, based on The Global Cancer Observatory (GLOBOCAN) 2020 estimates, including geographical and socioeconomic development, and temporal aspects. Methods For this analysis, we used the GLOBOCAN 2020 database to estimate the age-specific and age-standardised incidence and mortality rates of cervical cancer per 100 000 women-years for 185 countries or territories aggregated across the 20 UN-defined world regions, and by four-tier levels of the Human Development Index (HDI). Time trends (1988–2017) in incidence were extracted from the Cancer Incidence in Five Continents (CI5) plus database. Mortality estimates were obtained using the most recent national vital registration data from WHO. Findings Globally in 2020, there were an estimated 604 127 cervical cancer cases and 341 831 deaths, with a corresponding age-standardised incidence of 13·3 cases per 100 000 women-years (95% CI 13·3–13·3) and mortality rate of 7·2 deaths per 100 000 women-years (95% CI 7·2–7·3). Cervical cancer incidence ranged from 2·2 (1·9–2·4) in Iraq to 84·6 (74·8–94·3) in Eswatini. Mortality rates ranged from 1·0 (0·8–1·2) in Switzerland to 55·7 (47·7–63·7) in Eswatini. Age-standardised incidence was highest in Malawi (67·9 [95% CI 65·7 –70·1]) and Zambia (65·5 [63·0–67·9]) in Africa, Bolivia (36·6 [35·0–38·2]) and Paraguay (34·1 [32·1–36·1]) in Latin America, Maldives (24·5 [17·0–32·0]) and Indonesia (24·4 [24·2–24·7]) in Asia, and Fiji (29·8 [24·7–35·0]) and Papua New Guinea (29·2 [27·3–31·0]) in Melanesia. A clear socioeconomic gradient exists in cervical cancer, with decreasing rates as HDI increased. Incidence was three times higher in countries with low HDI than countries with very high HDI, whereas mortality rates were six times higher in low HDI countries versus very high HDI countries. In 2020 estimates, a general decline in incidence was observed in most countries of the world with representative trend data, with incidence becoming stable at relatively low levels around 2005 in several high-income countries. By contrast, in the same period incidence increased in some countries in eastern Africa and eastern Europe. We observed different patterns of age-specific incidence between countries with well developed population-based screening and treatment services (eg, Sweden, Australia, and the UK) and countries with insufficient and opportunistic services (eg, Colombia, India, and Uganda). Interpretation The burden of cervical cancer remains high in many parts of the world, and in most countries, the incidence and mortality of the disease remain much higher than the threshold set by the WHO initiative on cervical cancer elimination. We identified substantial geographical and socioeconomic inequalities in cervical cancer globally, with a clear gradient of increasing rates for countries with lower levels of human development. Our study provides timely evidence and impetus for future strategies that prioritise and accelerate progress towards the WHO elimination targets and, in so doing, address the marked variations in the global cervical cancer landscape today. Funding French Institut National du Cancer, Horizon 2020 Framework Programme for Research and Innovation of the European Commission; and EU4Health Programme.
Cervical cancer is the fourth most common cancer amongst women worldwide. In the United States, its incidence and mortality have been declining due to the wide scale implementation of cytological screening programs. However, there have been geographic disparities in cervical cancer, particularly in the US.
Screening programs using conventional cytology have successfully reduced cervical cancer, but newer tests might enhance screening. To systematically review the evidence on liquid-based cytology (LBC) and high-risk human papillomavirus (HPV) screening for U.S. Preventive Services Task Force use in updating its 2003 recommendation. MEDLINE, Cochrane Central Register of Controlled Trials, and PsycINFO from January 2000 through September 2010. Two independent reviewers selected fair- to good-quality English-language studies that compared LBC or HPV-enhanced primary screening with conventional cytology in countries with developed population-based screening for cervical cancer. At least 2 independent reviewers critically appraised and rated the quality of studies and used standardized abstraction forms to extract data about test performance for detecting cervical intraepithelial neoplasia (CIN) and cancer and screening-related harms. On the basis of 4 fair- to good-quality studies (141 566 participants), LBC had equivalent sensitivity and specificity to conventional cytology. Six fair- to good-quality diagnostic accuracy studies showed that 1-time HPV screening was more sensitive than cytology for detecting CIN3+/CIN2+ but was less specific. On the basis of 2 fair- to good-quality randomized, controlled trials (RCTs) (120 533 participants), primary HPV screening detected more cases of CIN3 or cancer in women older than 30 years. Four fair- to good-quality diagnostic accuracy studies and 4 fair- to good-quality RCTs showed mixed results of cotesting (HPV plus cytology) in women aged 30 years or older compared with cytology alone, with no clear advantage over primary HPV screening. Incomplete reporting of results for all screening rounds, including detection of disease and colposcopies, limits our ability to determine the net benefit of HPV-enhanced testing strategies. Resources were insufficient to gather unpublished data, short-term trial data showed possible ascertainment bias, and most RCTs used protocols that differed from current U.S. practice. Evidence supports the use of LBC or conventional cytology for cervical cancer screening, but more complete evidence is needed before HPV-enhanced primary screening is widely adopted for women aged 30 years or older.
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