• Cultural basis for differences between US and French clinical recommendations for women at increased risk of breast and ovarian

• Back to the negative Pap test: behind the scenes at Bethesda 2001.

• The effect of phytoestrogens on the female genital tract.

• Population-based cancer screening.

• [Should estrogen replacement therapy be questioned?]

• Is screening for cervical cancer effective?

• A current perspective on genetic testing for breast and ovarian cancer: the oral contraceptive decision.

• Micronutrients and ovarian cancer: a case-control study in Italy.

• [Nursing and midwifery for Health 21--control of non-transmissible diseases]

• Effects of weight control and physical activity in cancer prevention: role of endogenous hormone metabolism.

• Caffeine, cajoling, and other strategies to maximize clinician survey response rates.

• Prophylactic oophorectomy comes of age.

• Peritoneal lavage cytology: an assessment of its value during prophylactic oophorectomy.

• New Pap test terminology, management guidelines published.

• Frequency of cervical cancer screening by age group, 2000.

• Guidelines for abnormal Pap tests: do physicians follow them?

• Association of dairy products, lactose, and calcium with the risk of ovarian cancer.

• Familial ovarian cancer.

• The promise and peril of surrogate end points in cancer research.

• Effect of type of screening laboratory on population-based occurrence of cervical lesions in Finland.

• Cervical cancer audit: and what is quality?

• Equity in prevention and health care.

• Effect of fenretinide on ovarian carcinoma occurrence.

• Breast and cervical carcinoma screening practices among women in rural and nonrural areas of the United States, 1998-1999.

1
UI - 10094000
AU - Eisinger F; Geller G; Burke W; Holtzman NA
TI - Cultural basis for differences between US and French clinical recommendations for women at increased risk of breast and ovarian cancer.
SO - Lancet 1999 Mar 13;353(9156):919-20
AD - Department of Cancer Control and INSERM CRI 9703, Paoli-Calmettes Institute, Marseille, France.

2
UI - 11933263
AU - Young NA
TI - Back to the negative Pap test: behind the scenes at Bethesda 2001.
SO - Diagn Cytopathol 2002 Apr;26(4):207-8

3
UI - 12037019
AU - Burton JL; Wells M
TI - The effect of phytoestrogens on the female genital tract.
SO - J Clin Pathol 2002 Jun;55(6):401-7
AD - Section of Oncology and Pathology, Division of Genomic Medicine, University of Sheffield Medical School, Beech Hill Road, S10 2RX, UK. j.l.burton@shef.ac.uk
Environmental oestrogens have been implicated in the pathogenesis of hormonally treated cancers (such as breast and prostate cancer), male infertility, and abnormalities of the male and female reproductive tracts. They may be derived from plants (phytoestrogens), pharmaceuticals, or other synthetic compounds not originally intended to have oestrogenic activity (including soy based infant formulas). This review will discuss the evidence from both animal studies and humans for an effect of these ubiquitous compounds on the development of the human female genital tract, in addition to prolonging the menstrual cycle, alleviating symptoms of the menopause, and protecting against the development of endometrial carcinoma.

4
UI - 12058160
AU - Champion VL; Rawl SM; Menon U
TI - Population-based cancer screening.
SO - Oncol Nurs Forum 2002 Jun;29(5):853-61
AD - Indiana University of Indianapolis, Indianapolis, IN, USA. vchampio@iupui.edu
PURPOSE/OBJECTIVES: To provide an overview of current issues surrounding the prevention of and screening for lung, breast, cervical, colorectal, ovarian, prostate, and skin cancer. DATA SOURCES: Original research, review articles, and published guidelines. DATA SYNTHESIS: Although morbidity and mortality rates have decreased for these cancers, prevention and early detection still require increased funding and research. CONCLUSIONS: More behavioral scientists must be trained in prevention and early detection of cancer, and increased research funding is necessary to encourage advances in primary and secondary prevention. IMPLICATIONS FOR NURSING: Oncology nurses should incorporate appropriate prevention and early-detection strategies into practice.

5
UI - 12001440
AU - Tiitinen A
TI - [Should estrogen replacement therapy be questioned?]
SO - Duodecim 2000;116(16):1669-71

6
UI - 11824890
AU - Symonds RP
TI - Is screening for cervical cancer effective?
SO - Clin Oncol (R Coll Radiol) 2001;13(6):473-5
AD - University of Leicester, Leicester Royal Infirmary, UK. psymonds@uhl.trent.nhs.uk

7
UI - 11965197
AU - Friedenson B
TI - A current perspective on genetic testing for breast and ovarian cancer: the oral contraceptive decision.
SO - MedGenMed 2001 Nov 2;3(6):2
AD - Department of Biochemistry and Molecular Biology at the University of Illinois at Chicago, Chicago, Illinois, USA. molmeddoc@Yahoo.com.
A clinician faces a problem in how best to counsel the woman with a family history of breast or ovarian cancer about her options for pregnancy prevention. The physician must guide her as she makes new and complex decisions. Recent data strongly support an amplified effect of the estrogens in oral contraceptives for the woman with a genetic risk for breast cancer. Nonetheless, a woman's immediate need to prevent pregnancy may be much more important to her than worrying about the long-term risk of breast cancer. Another factor is that oral contraceptives prevent ovarian cancer, so the physician may wish to prescribe them to protect her from ovarian cancer. In some genetic backgrounds, however, oral contraceptives not only do not prevent ovarian cancer, but they may raise the risk of breast cancer so significantly that they should not be taken. With other genetic backgrounds, oral contraceptives will protect the woman from ovarian cancer without much effect on her breast cancer risk. When does each of these cancer risks or benefits become significant? The clinician can provide an important benefit to a woman who must prevent pregnancy yet worries about her cancer risk. The physician can help her evaluate the evidence, with its gaps and uncertainties, in the context of her own preferences. To assist in this evaluation, this decision aid provides base-line estimates of the cancer risk that accompanies each of a woman's options. In some cases, genetic testing is likely to provide valuable information as she makes choices about contraception and the risks vs. benefits of different alternatives available to her.

8
UI - 11822759
AU - Bidoli E; Lavecchia C; Talamini R; Negri E; Parpinel M; Conti E;
TI - Montella M; Carbone MA; Franceschi S Micronutrients and ovarian cancer: a case-control study in Italy.
SO - Ann Oncol 2001 Nov;12(11):1589-93
AD - Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano Italy. epidemiology@cro.it
BACKGROUND: The role of selected micronutrients, vitamins and minerals in the aetiology of epithelial ovarian cancer was investigated using data from a case-control study conducted between 1992 and 1999 in five Italian areas. PATIENTS AND METHODS: Cases were 1,031 patients with histologically confirmed incident epithelial ovarian cancer. Controls were 2,411 subjects admitted for acute, non-neoplastic diseases to major hospitals in the same catchment areas. Dietary habits were elicited using a validated food frequency questionnaire including 78 food groups and recipes. Odds ratios (OR) and 95% confidence intervals (95% CI) were computed by quintiles of intake of nutrients. RESULTS: Inverse associations emerged for vitamin E (OR = 0.6; 95% CI: 0.5-0.8), beta-carotene (OR = 0.8; 95% CI: 0.6-1.0), lutein/zeaxanthin (OR = 0.6; 95% CI: 0.5-0.8 for the highest vs. the lowest quintile of intake), and calcium intake (OR = 0.7; 95% CI: 0.6-1.0). When the combined effect of calcium and vitamin E was considered, the OR reached 0.4 (95% CI: 0.3-0.7) for subjects in the highest compared to those in the lowest intake tertile of both micronutrients. Results were consistent across strata of menopausal status, parity and family history of ovarian or breast cancer. CONCLUSIONS: The intake of selected micronutrients, which were positively correlated to a diet rich in vegetables and fruits, was inversely associated with ovarian cancer.

9
UI - 11995063
AU - Anonymous
TI - [Nursing and midwifery for Health 21--control of non-transmissible diseases]
SO - Osterr Krankenpflegez 2000 Oct;53(10):26-7

10
UI - 12095952
AU - Kaaks R; Lukanova A
TI - Effects of weight control and physical activity in cancer prevention: role of endogenous hormone metabolism.
SO - Ann N Y Acad Sci 2002 Jun;963():268-81
AD - International Agency for Research on Cancer, 69372 Lyon Cedex 08, France. kaaks@iarc.fr
Excess body weight and/or lack of physical activity are increasingly recognized as major risk factors for cancer of the colon, breast, endometrium, and prostate. This paper reviews the effects of excess body weight and physical inactivity on endogenous hormone metabolism (insulin, the IGF-I/IGFBP system, and sex steroids) and of endocrine alterations with risk of cancer of the endometrium, breast, prostate, and colon.

11
UI - 12026751
AU - Puleo E; Zapka J; White MJ; Mouchawar J; Somkin C; Taplin S
TI - Caffeine, cajoling, and other strategies to maximize clinician survey response rates.
SO - Eval Health Prof 2002 Jun;25(2):169-84
AD - University of Massachusetts, USA.
An ongoing objective in health services research is to increase response rates to clinician surveys to ensure generalizability of findings. Three HMOs in the Cancer Research Network participated in a primary care clinician survey to better understand organizational characteristics affecting adoption and implementation of breast and cervical cancer screening guidelines. A four-stage data collection strategy was implemented to maximize response. This included careful attention to survey design and layout, extensive piloting, choice of token incentive, use of "local champions," and denominator management. An overall response rate of 91% was attained, ranging from 83 to 100% among the plans (N = 621). Although the response rate after the second stage of data collection met commonly used standards, the authors argue for the four-stage method due to the possibility of differences when comparing early and late responders. This is important when multiple plans with differing structure and internal characteristics are surveyed.

12
UI - 12051864
AU - Rubin SC
TI - Prophylactic oophorectomy comes of age.
SO - Gynecol Oncol 2002 Jun;85(3):395-6

13
UI - 12051865
AU - Colgan TJ; Boerner SL; Murphy J; Cole DE; Narod S; Rosen B
TI - Peritoneal lavage cytology: an assessment of its value during prophylactic oophorectomy.
SO - Gynecol Oncol 2002 Jun;85(3):397-403
AD - Department of Laboratory Medicine and Pathology, Mount Sinai Hospital, Toronto, Canada. tcolgan@mtsinai.on.ca
OBJECTIVE: Prophylactic oophorectomy (PO) is an accepted treatment strategy for women who are at high risk for the development of ovarian carcinoma, particularly women who are BRCA mutation-positive. This study sought to assess the utility of peritoneal lavage cytology at the time of PO in detecting occult malignancy in this group of patients. METHODS: Thirty-five high-risk women, who were not suspected of having any malignancy or ovarian mass, underwent peritoneal lavage at the time of PO. Thirty-one of the thirty-five women had undergone BRCA mutation analysis (BRCA1+, 18; BRCA2+, 10; BRCA-, 3). Intensive histopathologic examination was used in all 35 cases to identify occult carcinoma. Lavage specimens were reviewed for the presence of malignant cells and endosalpingiosis. The cytologic review was conducted without knowledge of either the histopathologic or BRCA results. RESULTS: In 32 of the 35 lavage specimens no malignancy was detected. In the remaining three cases malignant cells were detected; in two of these cases histopathologic examination confirmed an ovarian/tubal occult carcinoma. Two of these women were BRCA1 mutation positive. Endosalpingiosis was detected in the peritoneal lavage specimens of 7 of the 32 cases showing no evidence of malignancy. All of these 7 women were BRCA mutation positive or unknown. CONCLUSION: Peritoneal lavage cytology can detect occult carcinoma at the time of PO and should be performed at PO. The significance of occult carcinoma detected by either histopathologic or cytopathologic examination is uncertain. Whether the prevalence of endosalpingiosis detectable by lavage cytology is increased in BRCA mutation-positive patients requires further study.

14
UI - 12072539
AU - Twombly R
TI - New Pap test terminology, management guidelines published.
SO - J Natl Cancer Inst 2002 Jun 19;94(12):878-80

15
UI - 12072540
AU - Anonymous
TI - Frequency of cervical cancer screening by age group, 2000.
SO - J Natl Cancer Inst 2002 Jun 19;94(12):879

16
UI - 12072541
AU - Arnold K
TI - Guidelines for abnormal Pap tests: do physicians follow them?
SO - J Natl Cancer Inst 2002 Jun 19;94(12):880-1

17
UI - 12117706
AU - Goodman MT; Wu AH; Tung KH; McDuffie K; Kolonel LN; Nomura AM; Terada K;
TI - Wilkens LR; Murphy S; Hankin JH Association of dairy products, lactose, and calcium with the risk of ovarian cancer.
SO - Am J Epidemiol 2002 Jul 15;156(2):148-57
AD - Cancer Etiology Program, Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI 96813, USA. marc@crch.hawaii.edu
Epidemiologic findings have been inconsistent regarding the association of dietary fat, dairy products, and lactose with risk of ovarian cancer. The authors conducted a case-control study in Hawaii and Los Angeles, California, to examine several dietary hypotheses regarding the etiology of ovarian cancer in a population with a broad range of dietary intakes. A total of 558 patients with ovarian cancer diagnosed in 1993-1999 and 607 controls were interviewed regarding their diet. Consumption of all dairy products, all types of milk, and low-fat milk, but not consumption of whole milk, was significantly inversely related to the odds of ovarian cancer. Similar inverse gradients in the odds ratios were obtained for intakes of lactose and calcium, although these nutrients were highly correlated (r = 0.77). The odds ratio for ovarian cancer was 0.46 (95% confidence interval: 0.27, 0.76) among women in the highest quartile of dietary calcium intake versus the lowest (p for trend = 0.0006). The significant dietary association was limited to dairy sources of calcium (p for trend = 0.003), although a nonsignificant inverse gradient in risk was also found in relation to calcium supplement intake. These results suggest that intake of low-fat milk, calcium, or lactose may reduce the risk of ovarian cancer.

18
UI - 12112981
AU - Volm T
TI - Familial ovarian cancer.
SO - Curr Womens Health Rep 2002 Feb;2(1):34-8
AD - Universitats-Frauenklinik Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany. tanja.volm@medizin.uni-ulm.de
Women with mutations in the BRCA1 or BRCA2 genes are at increased risk for the development not only of breast, but of ovarian cancer. The estimated lifetime risk of contracting ovarian cancer for women bearing the mutation is 16% for Ashkenazi Jews and up to 60% for high-risk populations. If a woman is at high familial risk of getting ovarian cancer, an intense screening with transvaginal ultrasound or determination of CA 125 can be done, although these methods have not proved beneficial so far. It is thought by some that the use of the contraceptive pill can prevent up to 50% of family-associated ovarian cancers, but the few existing studies have yielded contradictory results. That prophylactic oophorectomy can prolong the lives of healthy women with a family history or who bear a germline BRCA mutation is quite sure, but it is not helpful in preventing peritoneal carcinoma. The clinicopathologic behavior of mutation-associated ovarian cancer differs from the growth pattern of sporadic ovarian cancer. The hope is to develop suitable therapies for both types.

19
UI - 11902582
AU - Schatzkin A; Gail M
TI - The promise and peril of surrogate end points in cancer research.
SO - Nat Rev Cancer 2002 Jan;2(1):19-27
AD - Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892-7232, USA. schatzka@mail.nih.gov
Both experimental and observational studies of cancer need to have an end point. Traditionally, in aetiological and prevention studies, that end point has been the incidence of cancer itself, whereas in therapeutic trials, the end point is usually time to cancer recurrence or death. But cancer takes a long time to develop in an individual and is rare in the population. Therefore, aetiological studies and prevention trials must be large and lengthy to be meaningful. Similarly, many therapeutic trials require a long follow-up of large numbers of patients. Surrogate end points--markers of preclinical cancer or of imminent recurrence--are therefore an attractive alternative. But how can we be sure that a study with a surrogate outcome gives us the right answer about the true end point?

20
UI - 12115508
AU - Nieminen P; Hakama M; Tarkkanen J; Anttila A
TI - Effect of type of screening laboratory on population-based occurrence of cervical lesions in Finland.
SO - Int J Cancer 2002 Jun 10;99(5):732-6
AD - Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland. pekka.nieminen@hus.fi
The incidence of cervical cancer decreased in Finland over a 30-year period because of an effective screening program, but in the beginning of the 1990s it began to increase. Reasons for such an increase are variable: changes in sexual habits, shortcomings in attendance for screening and possibly variation in laboratory quality. We evaluated the impact of 3 laboratories in the greater Helsinki area on screening performance and on the incidence of invasive cervical cancer and preinvasive cervical lesions in the target population. We studied time trends, geographic differences in attendance and detection rates from screening and the incidence of invasive cancer in the greater Helsinki area (population about 1 million) during the 1990s, when screening was reorganized from the Cancer Society of Finland laboratory to the municipal one (Helsinki) and to a private laboratory (Espoo), while in Vantaa screening remained with the same Cancer Society laboratory. The attendance rate for screening increased during the study period in all 3 cities. The numbers of cytologically suspected and histologically confirmed precancerous lesions found, including severe lesions, decreased significantly with the change of laboratory in Espoo; but in Helsinki and Vantaa, they increased. The overall incidence of invasive cervical cancer increased in all cities in the age groups screened but mostly in Espoo. The rather rapid changes and variation in trends in the number of screening findings cannot be explained by changes in etiologic factors or attendance. They may be related more to the quality of the laboratory performance and perhaps to the criteria used in cytology and colposcopy. A well-organized auditing system is proposed to maintain high quality in screening. Copyright 2002 Wiley-Liss, Inc.

21
UI - 12060075
AU - Wilson PO
TI - Cervical cancer audit: and what is quality?
SO - Cytopathology 2002 Jun;13(3):141-4

22
UI - 12080158
AU - Lorant V; Boland B; Humblet P; Deliege D
TI - Equity in prevention and health care.
SO - J Epidemiol Community Health 2002 Jul;56(7):510-6
AD - Health Sociology and Economics, School of Public Health, Faculty of Medicine, Universite Catholique de Louvain, Brussels, Belgium. lorant@sesa.ucl.ac.be
STUDY OBJECTIVE: There is an increasing body of evidence about socioeconomic inequality in preventive use, mostly for cancer screening. But as far as needs of prevention are unequally distributed, even equal use may not be fair. Moreover, prevention might be unequally used in the same way as health care in general. The objective of the paper is to assess inequity in prevention and to compare socioeconomic inequity in preventive medicine with that in health care. DESIGN: A cross sectional Health Interview Survey was carried out in 1997 by face to face interview and self administered questionnaire. Two types of health care utilisation were considered (contacts with GPs and with specialists) and four preventive care mostly delivered in a GP setting (flu vaccination, cholesterol screening) or in a specialty setting (mammography and pap smear). SETTING: Belgium. PARTICIPANTS: A representative sample of 7378 residents aged 25 years and over (participation rate: 61%). Outcome measure: Socioeconomic inequity was measured by the HI(wvp) index, which is the difference between use inequality and needs inequality. Needs was computed as the expected use by the risk factors or target groups. MAIN RESULTS: There was significant inequity for all medical contacts and preventive medicine. Medical contacts showed inequity favouring the rich for specialist visits and inequity favouring the poor for contacts with GPs. Regarding preventive medicine, inequity was high and favoured the rich for mammography and cervical screening; inequity was lower for flu immunisation and cholesterol screening but still favoured the higher socioeconomic groups. In the general practice setting, inequity in prevention was higher than inequity in health care; in the specialty setting, inequity in prevention was not statistically different from inequity in health care, although it was higher than in the general practice setting. CONCLUSIONS: If inequity in preventive medicine is to be lowered, the role of the GP must be fostered and access to specialty medicine increased, especially for cancer screening.

23
UI - 12079295
AU - De Palo G; Mariani L; Camerini T; Marubini E; Formelli F; Pasini B;
TI - Decensi A; Veronesi U Effect of fenretinide on ovarian carcinoma occurrence.
SO - Gynecol Oncol 2002 Jul;86(1):24-7
AD - Unit of Preventive Medicine and Cancer Family Clinic, Istituto Nazionale Tumori, Milan, Italy.
OBJECTIVE: The aim of this study was to update the effect of fenretinide, a synthetic vitamin A analogue proposed for chemoprevention, on the occurrence of ovarian carcinoma. METHODS: Data were obtained from a randomized clinical trial for the prevention of second breast cancer. For the present investigation, events of interest were new primary carcinomas of the ovary arising in the fenretinide or the no-treatment (control) arm. The probability of carrying a BRCA germ-line mutation was assessed in women with ovarian carcinoma according to G. Parmigiani et al. (1998, Am J Hum Genet 62, 145-58). RESULTS: Fenretinide reduced ovarian carcinoma occurrence during the 5-year intervention period (0 versus 6 cases in the fenretinide and control arm, P = 0.0327). This effect was no longer evident after the 5-year intervention period (6 versus 4 cases, P = 0.7563). Therefore with median observation time of 121 months, a total of 6 carcinomas of the ovary occurred in the fenretinide group and 10 in the control group. The probability of carrying a BRCA mutation was lower for women with ovarian carcinoma in the treatment arm. CONCLUSION: Fenretinide treatment was associated with a lower incidence of ovarian carcinoma during the intervention period but such a protective effect seems to disappear after treatment. Furthermore, a possible protective effect of fenretinide in BRCA-mutated women was suggested. Further studies on fenretinide for the prevention of ovarian carcinoma particularly in women with genetic susceptibility appear necessary. (c) 2002 Elsevier Science (USA).

24
UI - 12115366
AU - Coughlin SS; Thompson TD; Hall HI; Logan P; Uhler RJ
TI - Breast and cervical carcinoma screening practices among women in rural and nonrural areas of the United States, 1998-1999.
SO - Cancer 2002 Jun 1;94(11):2801-12
AD - Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341,USA. sic9@cdc.gov
BACKGROUND: Prior studies have suggested that women living in rural areas may be less likely than women living in urban areas to have had a recent mammogram and Papanicolau (Pap) test and that rural women may face substantial barriers to receiving preventive health care services. METHODS: The authors examined both breast and cervical carcinoma screening practices of women living in rural and nonrural areas of the United States from 1998 through 1999 using data from the Behavioral Risk Factor Surveillance System. The authors limited their analyses of screening mammography and clinical breast examination to women aged 40 years or older (n = 108,326). In addition, they limited their analyses of Pap testing to women aged 18 years or older who did not have a history of hysterectomy (n = 131,813). They divided the geographic areas of residence into rural areas and small towns, suburban areas and smaller metropolitan areas, and larger metropolitan areas. RESULTS: Approximately 66.7% (95% confidence interval [CI] = 65.8% to 67.6%) of women aged 40 years or older who resided in rural areas had received a mammogram in the past 2 years, compared with 75.4% of women living in larger metropolitan areas (95% CI = 74.9% to 75.9%). About 73.0% (95% CI = 72.2% to 73.9%) of women aged 40 years or older who resided in rural areas had received a clinical breast examination in the past 2 years, compared with 78.2% of women living in larger metropolitan areas (95% CI = 77.8% to 78.7%). About 81.3% (95% CI = 80.6% to 82.0%) of 131,813 rural women aged 18 years or older who had not undergone a hysterectomy had received a Pap test in the past 3 years, compared with 84.5% of women living in larger metropolitan areas (95% CI = 84.1% to 84.9%). The differences in screening across rural and nonrural areas persisted in multivariate analysis (P < 0.001). CONCLUSIONS: These results underscore the need for continued efforts to provide breast and cervical carcinoma screening to women living in rural areas of the United States. Copyright 2002 American Cancer Society.

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