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Abramson Cancer CenterNCI CANCERLIT® Search: Diagnosis-Histopathology-Pathogenesis of Cervical Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 21277317
AU - Reid J
TI -
Women's knowledge of Pap smears, risk factors for cervical cancer, and
cervical cancer.
SO - J Obstet Gynecol Neonatal Nurs 2001 May-Jun;30(3):299-305
AD - Indiana University Southeast, New Albany 47150, USA.
OBJECTIVE: To review the literature on women's knowledge of Pap smears,
risk factors for cervical cancer, and cervical cancer. DATA SOURCES: The
review was based on a search of the relevant literature over a 10-year
period using MEDLINE and CINAHL. DATA EXTRACTION: Articles from
relevant, indexed journals and textbooks published within the past
decade were included. Seminal articles were included as appropriate.
DATA SYNTHESIS: Risk factors for the development of cervical cancer have
been reevaluated. The case for human papillomavirus as the cause of
cervical neoplasms has been strengthened. CONCLUSIONS: Cervical cancer
is associated with early sexual debut, number of lifetime sexual
partners, nonuse of condoms, and infection with human papillomavirus.
Cigarette smoking facilitates development of cervical cancer.
2
UI - 21353209
AU - Khunamornpong S; Raungrongmorakot K; Siriaunkgul S
TI -
Loop electrosurgical excision procedure (LEEP) at Maharaj Nakorn Chiang
Mai Hospital: problems in pathologic evaluation.
SO - J Med Assoc Thai 2001 Apr;84(4):507-14
AD - Department of Pathology, Faculty of Medicine, Chiang Mai University,
Thailand.
BACKGROUND: Loop electrosurgical excision procedure (LEEP) is widely
used in diagnosis and management of cervical lesions. Difficulties in
histopathologic evaluation of LEEP specimens, particularly for the
margin status, have been reported to be a significant disadvantage of
the procedure. METHOD: The histologic slides of the specimens from 163
patients who underwent LEEP at Maharaj Nakorn Chiang Mai Hospital from
degree of thermal artefact and the margin status. Follow-up data after a
6-month-period were correlated with the margin status. RESULTS: Thermal
artefact was present in all cases (mild 51.5%, moderate 36.2%, and
severe 12.3%). In only one case, histologic diagnosis of the lesion was
not possible due to severe thermal artefact. Nine cases (5.5%) had
non-evaluable margins due to either thermal artefact (7 cases) or
improper orientation of fragmented tissue (2 cases). Of 90 cases with
subsequent surgical specimens, residual diseases were present in 4 of 21
(19.0%) with negative LEEP margins, in 31 of 64 (48.4%) with positive
margins, and in 4 of 5 (80.0%) with non-evaluable margins. CONCLUSIONS:
Pathologic evaluation of the specimens from LEEP was limited in only a
minority of cases. Thermal artefact was not a critical disadvantage of
LEEP. The positive or negative margin status was correlated with the
risk of residual disease.
3
UI - 21372586
AU - Sironi S; Villa G; Rossi S; Bocciolone L; Maggioni A; Sonzogni A;
TI -
Bellomi M
[Magnetic resonance imaging in the evaluation of parametrial invasion of
carcinoma of the cervix uteri: optimization of the study protocol]
SO - Radiol Med (Torino) 2001 Jun;101(6):477-84
AD - Divisione di Radiologia Diagnostica, Istituto Europeo di Oncologia,
Milan, Italy.
PURPOSE: To determine the efficacy of three different MR sequences in
the evaluation of parametrial invasion by early-stage cervical cancer.
MATERIAL AND METHODS: Eighteen consecutive patients with cervical cancer
clinically assessed as stage IB1 underwent MR imaging examination with
the use of the following sequences: FSE T2-weighted, FSE fat-suppressed
T2w, and SE fat-suppressed Gadolinium-enhanced T1w. In all cases, the
presence or absence of parametrial invasion on both sides per each
sequence used was evaluated. Subsequently all the sequences have been
considered together for the evaluation of tumor invasion. Gold standard
of the study was the histopathologic analysis of the surgical specimens.
RESULTS: At histological examination, parametrial invasion by tumor was
found in 6 out of 36 parametria evaluated. The accuracy achieved with
each of the sequences used was as follows: 94% with FSE T2w; 86% with
FSE fat-suppressed T2w; and 67% with SE fat-suppressed
Gadolinium-enhanced T1w. The simultaneous evaluation of all 3 sequences
obtained an accuracy level similar to that achieved with FSE T2w. The
difference between the accuracy of T2w sequences and that of
fat-suppressed contrast-enhanced T1w sequences was statistically
significant (p<0.01). DISCUSSION AND CONCLUSIONS: Our data suggest that
the MR imaging protocol for the evaluation of parametrial tumor invasion
could be restricted to FSE T2w sequences. These proved to have the
highest negative predictive value (97%) which allows a reliable
selection of patients who can be surgically treated.
4
UI - 21411911
AU - Narayan K; Hicks RJ; Jobling T; Bernshaw D; McKenzie AF
TI -
A comparison of MRI and PET scanning in surgically staged
loco-regionally advanced cervical cancer: potential impact on treatment.
SO - Int J Gynecol Cancer 2001 Jul-Aug;11(4):263-71
AD - Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia, Monash
Medical Center, Melbourne, Victoria, Australia.
The aim of this study was to assess whether positron emission tomography
(PET) or magnetic resonance imaging (MRI) could obviate the need for
surgical staging in patients with locally advanced cervical carcinoma
being planned for radiotherapy (RT). Imaging findings were compared to
surgical staging in 27 patients including three with recent resection of
the primary tumor. Both PET and MRI visualized all 24 residual cervical
tumors. Primary tumor volume, as measured by MRI scan, ranged from 1.25
cc to 140 cc. In 24 patients evaluable for pelvic nodal status, PET had
sensitivity, specificity, and positive and negative predictive values of
83%, 92%, 91% and 85%, respectively, with 88% accuracy. MRI detected
only six in 12 (50%) patients with confirmed pelvic nodal disease, all
of which were also seen by CT and PET, with an overall accuracy of 75%.
PET detected only four in seven (57%) cases with confirmed para-aortic
(PA) involvement. All histologically confirmed sites not visualized on
PET were <1 cm. Without surgical staging, six in 10 (60%) patients with
histologically proven pelvic nodal disease would not have received
pelvic boost if guided by MRI alone, compared to two in 10 (20%)
patients guided by PET alone or in combination with MRI. All four
patients with positive PA on PET were confirmed on histology or clinical
follow-up, including one case that proved to be a false negative one on
surgery. However, in three cases, PET would have yielded an inadequate
radiation volume. In conclusion, the positive predictive value of PET in
the pelvis and para-aortic region appears sufficient to obviate lymph
nodal sampling, but sampling is still required to exclude small-volume
disease cranial to sites of abnormality on PET. MRI has insufficient
accuracy for nodal staging to impact management.
5
UI - 21413351
AU - Vilchez RA; Kozinetz CA; Butel JS
TI -
The changing incidence of four AIDS-related malignancies in a large
urban center.
SO - AIDS Patient Care STDS 2001 Aug;15(8):405-6
6
UI - 21415883
AU - Krivak TC; Rose GS; McBroom JW; Carlson JW; Winter WE 3rd; Kost ER
TI -
Cervical adenocarcinoma in situ: a systematic review of therapeutic
options and predictors of persistent or recurrent disease.
SO - Obstet Gynecol Surv 2001 Sep;56(9):567-75
AD - Department of Obstetrics and Gynecology, Walter Reed Army Medical
Center, Washington, DC 20307-5001, USA. TomKrivak@aol.com
The incidence of cervical adenocarcinoma in situ is increasing in
frequency, and our limited knowledge about this lesion presents the
physician with a therapeutic dilemma. Treatment for this lesion has
included conservative therapy, large loop excision or cold-knife cone
biopsy, or definitive therapy consisting of hysterectomy. But, rates of
residual adenocarcinoma in situ after cone biopsy with negative margins
vary from 0% to 40%, and residual disease rates as high as 80% have been
noted when the margins are positive. Despite these recent data on
follow-up after conservative therapy such as cone biopsy, it seems that
this method is safe and gaining acceptance by many physicians and
patients. However, the short follow-up duration and small number of
patients limit the conclusions of many studies. The relative infrequency
of this diagnosis has precluded extensive clinical experience with the
natural history of this lesion.
7
UI - 21440183
AU - Khunamornpong S; Maleemonkol S; Siriaunkgul S; Pantusart A
TI -
Well-Differentiated villoglandular adenocarcinoma of the uterine cervix:
a report of 15 cases including two with lymph node metastasis.
SO - J Med Assoc Thai 2001 Jun;84(6):882-8
AD - Department of Pathology, Faculty of Medicine, Chiang Mai University,
Thailand.
Well-differentiated villoglandular adenocarcinoma is a recently
described subtype of cervical adenocarcinoma. The tumor of this type is
reported to have distinct clinicopathologic features and excellent
prognosis. However, lymph node metastases of this tumor have been
described in few reports. Fifteen cases of well-differentiated
villoglandular adenocarcinoma treated at Maharaj Nakorn Chiang Mai
Hospital were retrospectively reviewed for both clinical and
histopathological features. All patients underwent radical hysterectomy
with pelvic lymphadenectomy. In the cases with lymph node metastasis,
adjuvant radiation therapy was also given. The patients ranged in age
from 22 to 53 years (mean, 39.3). Fourteen patients were FIGO stage IB
and one was stage IIA. All patients had exophytic friable cervical
masses. Tumor size known in 14 cases ranged from 1.5 to 4 cm (mean,
2.3). Eleven tumors (73.3%) were confined to the inner third of the
cervical stroma with 9 of these (60%) showing only superficial invasion
(depth < or = 3 mm). The tumors invaded deeply to the middle third in 3
cases (20.0%), and to the outer third in one (6.7%). Lymphatic invasion
was observed in 3 cases, two of them had pelvic lymph node metastasis.
Both patients had tumors involving deeper than the inner third of the
cervical wall. The follow-up duration ranged from 21 to 144 months
(mean, 67.5). Four of thirteen cases without nodal metastasis were lost
to follow-up 36 to 59 months after surgery. All patients showed no
evidence of disease at the last visit. Presence of lymphatic invasion
and deep stromal involvement appeared to be the risk factors for lymph
node metastasis of well-differentiated villoglandular adenocarcinoma.
8
UI - 21439137
AU - Kodama J; Hashimoto I; Seki N; Hongo A; Yoshinouchi M; Okuda H; Kudo T
TI -
Thrombospondin-1 and -2 messenger RNA expression in invasive cervical
cancer: correlation with angiogenesis and prognosis.
SO - Clin Cancer Res 2001 Sep;7(9):2826-31
AD - Department of Obstetrics and Gynecology, Okayama University Medical
School, Okayama 700-8558, Japan. kodama@cc.okayama-u.ac.jp
PURPOSE: TSP association with clinicopathological features, including
microvessel count, regarding prognostic significance was examined in
patients presenting with invasive cervical cancer. EXPERIMENTAL DESIGN:
Gene expression of TSP-1 and TSP-2 was assessed by reverse
transcription-PCR in 10 normal cervix and 78 invasive cervical cancer
samples. RESULTS: TSP-1 and TSP-2 mRNA expression was detected in seven
(70.0%) of the normal cervical specimens. TSP-2 mRNA expression in
normal cervix was significantly higher than that in cases involving
cervical cancer (P = 0.032). TSP-1 mRNA expression was significantly
lower in tumors characterized by advanced stage (P = 0.047). Fifty-three
patients displaying stage Ib-IIb cervical cancer underwent radical
hysterectomy and pelvic lymphadenectomy. Expression of TSP-1 and TSP-2
mRNA was significantly lower in tumors exhibiting parametrial invasion
(P = 0.016 and P = 0.049, respectively). Microvessel counts were
significantly higher when decreased TSP-1 expression was evident (P =
0.029). The microvessel count in patients lacking TSP-2 mRNA expression
was higher than that observed in patients displaying TSP-2 mRNA
expression, although it was not statistically significant (P = 0.062).
Subjects demonstrating TSP-1 mRNA expression exhibited significantly
better prognosis than those lacking TSP-1 mRNA expression (P = 0.0038).
Furthermore, TSP-1 mRNA expression was an independent prognostic factor
in the multivariate analysis. CONCLUSIONS: These findings provide
evidence that TSP-1 expression is of value as a prognostic factor in
cervical cancer. The inverse correlation between TSP expression and
microvessel count also indicates that decreased TSP expression may be
associated with an angiogenic phenotype in this class of neoplasm.
9
UI - 21448902
AU - Green JA; Kirwan JM; Tierney JF; Symonds P; Fresco L; Collingwood M;
TI -
Williams CJ
Survival and recurrence after concomitant chemotherapy and radiotherapy
for cancer of the uterine cervix: a systematic review and meta-analysis.
SO - Lancet 2001 Sep 8;358(9284):781-6
AD - Department of Medicine, University of Liverpool, L69 3GA, Liverpool, UK.
J.A.Green@liverpool.ac.uk
BACKGROUND: The US National Cancer Institute alert in February, 1999,
stated that concomitant chemotherapy and radiotherapy should be
considered for all patients with cervical cancer. Our aim was to review
the effects of chemoradiotherapy on overall and progression-free
survival, local and distant control, and acute and late toxicity in
patients with cervical cancer. METHODS: With the methodology of the
Cochrane Collaboration, we did a systematic review of all known
randomised controlled trials done between 1981 and 2000 (17 published,
two unpublished) of chemoradiation for cervical cancer. FINDINGS: The
trials included 4580 randomised patients, and 2865-3611 patients
(62-78%) were available for analysis. Cisplatin was the most common
agent used. The findings suggest that chemoradiation improves overall
survival (hazard ratio 0.71, p<0.0001), whether platinum was used (0.70,
p<0.0001) or not (0.81, p=0.20). A greater beneficial effect was seen in
trials that included a high proportion of stage I and II patients
(p=0.009). An improvement in progression-free survival was also seen
with chemoradiation (0.61, p<0.0001). Thus, the absolute benefit in
progression-free and overall survival was 16% (95% CI 13-19) and 12%
(8-16), respectively. A significant benefit of chemoradiation on both
local (odds ratio 0.61, p<0.0001) and distant recurrence (0.57,
p<0.0001) was also recorded. Grade 3 or 4 haematological (odds ratio
1.49-8.60) and gastrointestinal (2.22) toxicities were significantly
greater in the concomitant chemoradiation group than the control group.
There was insufficient data to establish whether late toxicity was
increased in the concomitant chemoradiation group. INTERPRETATION:
Concomitant chemotherapy and radiotherapy improves overall and
progression-free survival and reduces local and distant recurrence in
selected patients with cervical cancer, which may give a cytotoxic and
sensitisation effect.
10
UI - 99247953
AU - Sasieni P; Adams J
TI -
Effect of screening on cervical cancer mortality in England and Wales:
analysis of trends with an age period cohort model.
SO - BMJ 1999 May 8;318(7193):1244-5
AD - Department of Mathematics, Statistics and Epidemiology, Imperial Cancer
Research Fund, London WC2A 3PX.
11
UI - 21270631
AU - Sasieni P; Cuzick J
TI -
Routine audit is an ethical requirement of screening.
SO - BMJ 2001 May 12;322(7295):1179
12
UI - 21190914
AU - Virmani AK; Muller C; Rathi A; Zoechbauer-Mueller S; Mathis M; Gazdar AF
TI -
Aberrant methylation during cervical carcinogenesis.
SO - Clin Cancer Res 2001 Mar;7(3):584-9
AD - Hamon Center for Therapeutic Oncology Research, and Department of
Pathology, University of Texas Southwestern Medical Center, Dallas
85930, USA.
We studied the pattern of aberrant methylation during the multistage
pathogenesis of cervical cancers. We analyzed a total of 73 patient
samples and 10 cervical cancer cell lines. In addition, tissue samples
[peripheral blood lymphocytes (n = 10) and buccal epithelial cells (n =
12)] were obtained from 22 healthy volunteers. On the basis of the
results of preliminary analysis, the cervical samples were grouped into
three categories: (a) nondysplasia/low-grade cervical intraepithelial
neoplasia (CIN; n = 37); (b) high-grade CIN (n = 17); and (c) invasive
cancer (n = 19). The methylation status of six genes was determined
(p16, RARbeta, FHIT, GSTP1, MGMT, and hMLH1). Our main findings are as
follows: (a) methylation was completely absent in control tissues; (b)
the frequencies of methylation for all of the genes except hMLH1 were
>20% in cervical cancers; (c) aberrant methylation commenced early
during multistage pathogenesis and methylation of at least one gene was
noted in 30% of the nondysplasia/low-grade CIN group; (d) an increasing
trend for methylation was seen with increasing pathological change; (e)
methylation of RARbeta and GSTP1 were early events, p16 and MGMT
methylation were intermediate events, and FHIT methylation was a late,
tumor-associated event; and (f) methylation occurred independently of
other risk factors including papillomavirus infection, smoking history,
or hormone use. Although our findings need to be extended to a larger
series, they suggest that the pattern of aberrant methylation in women
with or without dysplasia may help identify subgroups at increased risk
for histological progression or cancer development.
13
UI - 21268054
AU - Lenczewski A; Terlikowski S; Famulski W; Sulkowska M; Kulikowski M
TI -
Angiogenesis as a prognostic factor in invasive carcinoma of the uterine
cervix.
SO - Folia Histochem Cytobiol 2001;39(2):165-6
AD - Department of Gynecology and Septic Obstetrics, Medical Academy,
Bialystok, Poland.
The aim of the study was to evaluate angiogenesis as an independent
prognostic factor and to determine the correlation between the
angiogenic index (AI) and histologic grade of the neoplastic process in
patients operated on for invasive carcinoma of the uterine cervix.
Angiogenesis was assessed with immunohistochemical technique using a
monoclonal antibody against human factor VIII--(F8/86 M0616, DAKO,
Denmark). A positive correlation was revealed between the
intensification of angiogenesis and the incidence of lymph node
involvement and survival rate.
14
UI - 21371462
AU - Sapy T; Szikszay A; Konya J; Borsos A; Hernadi Z
TI -
[Prevalence of human papillomavirus infections in our five-year data]
SO - Orv Hetil 2001 Jun 17;142(24):1265-8
AD - Debreceni Egyetem, Orvos- es Egeszsegtudomanyi Centrum, Altalanos
Orvostudomanyi Kar, Szuleszeti- es Nogyogyaszati Klinika.
Human papillomavirus infection proved to be the most important risk
factor for the development of cervical cancer and its preblastomatosis.
Human papillomavirus was detected from 1996. June to 2000. September at
1635 patients, who had been positive by colposcopy and/or cytology in an
earlier examination. The place of the study were our outpatients'
departments and consultations by specialists of Debrecen University,
Department of Obstetrics and Gynecology. Hybrid capture system was used
to demonstrate the presence of the virus and managed to prove it in the
28.9% of cases. 3.1% of the patients (51 persons) had acquired low-risk,
and 23.6% (386 persons) high risk virus types, however 2.1% of the woman
(35 patients) were infected with both low-risk and high-risk human
papillomavirus types at the same time. Long time decrease of virus
prevalence was observed after the age of 35 year, and the significant
degree and timing decrease of after the age of 30 year at patients
infected with combination of low-risk and high-risk virus types,
respectively. This observation is indicative of the correlation between
colposcopic-, cytologic abnormalities and the persisting high-risk human
papillomavirus infections.
15
UI - 21372301
AU - Sbragia L; Paek BW; Feldstein VA; Farrell JA; Harrison MR; Albanese CT;
TI -
Farmer DL
Outcome of prenatally diagnosed solid fetal tumors.
SO - J Pediatr Surg 2001 Aug;36(8):1244-7
AD - Fetal Treatment Center and the Department of Surgery, University of
California San Francisco, CA 94143-0570, USA.
BACKGROUND/PURPOSE: In the last 10 years, the ability to diagnose fetal
tumors in the prenatal period has improved greatly because of technical
advances in imaging. Early diagnosis and determination of tumor may
affect prognosis. METHODS: The authors retrospectively reviewed the
records of 1316 fetuses who underwent sonographic evaluation for
congenital defects at University of California-San Francisco over a
6-year period. Of these, 16 had fetal tumors and were followed up at our
institution. There were solid or predominantely solid with small cystic
component masses in one of 3 locations: cervical, mediastinal, or
abdominal. Excluded from our study were those fetuses with either
sacrococcygeal teratoma, congenital cystic adenomatoid malformation of
the lung, or ovarian cyst, because these defects have been extensively
reviewed elsewhere. In addition, masses that were primarily cystic also
were excluded. Data collected included diagnosis, gestational age at
diagnosis and at delivery, mode of delivery, fetal and neonatal
survival, and disease confirmation. RESULTS: Of the 16 fetuses, 4 had
mediastinal tumors: 2 with pericardial teratomas (both of whom died in
utero) and 2 with cardiac rhabdomyomas (1 died; the other presented
tuberous sclerosis and is alive at 2 years of age). Four patients had
cervical tumors (3 died; 1 survived and is alive and well), and 8 had
abdominal tumors (3 with liver tumors, 4 with a left adrenal mass, and 1
with retroperitoneal teratoma). All eight patients with an abdominal
tumor are alive and well. CONCLUSIONS: Fetal tumors are rare, and the
prognosis seems to depend on their location and size. Although easier to
detect, cervical and mediastinal tumors have a worse prognosis.
Abdominal masses are more difficult to detect but have a better
prognosis. Copyright 2001 by W.B. Saunders Company.
16
UI - 21427139
AU - Follen M; Meyskens FL Jr; Atkinson EN; Schottenfeld D
TI -
Why most randomized phase II cervical cancer chemoprevention trials are
uninformative: lessons for the future.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1293-6
AD - Department of Gynecologic Oncology, The University of Texas M. D.
Anderson Cancer Center, Houston 77030, USA. mfollen@manderson.org
17
UI - 21427143
AU - Berumen J; Ordonez RM; Lazcano E; Salmeron J; Galvan SC; Estrada RA;
TI -
Yunes E; Garcia-Carranca A; Gonzalez-Lira G; Madrigal-de la Campa A
Asian-American variants of human papillomavirus 16 and risk for cervical
cancer: a case-control study.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1325-30
AD - Laboratorio Multidisciplinario de Investigacion, Escuela Militar de
Graduados de Sanidad y Escuela Medico Militar, Universidad del Ejercito
y Fuerza Aerea, Mexico D.F. jaimeberumen@hotmail.com
BACKGROUND: Human papillomavirus 16 (HPV16) has a number of variants,
each with a different geographic distribution and some that are
associated more often with invasive neoplasias. We investigated whether
the high incidence of cervical cancer in Mexico (50 cases per 100 000
women) may be associated with a high prevalence of oncogenic HPV16
variants. METHODS: Cervical samples were collected from 181 case
patients with cervical cancer and from 181 age-matched control subjects,
all from Mexico City. HPV16 was detected with an E6/E7 gene-specific
polymerase chain reaction, and variant HPV classes and subclasses were
identified by sequencing regions of the E6 and L1/MY genes. Clinical
data and data on tumor characteristics were also collected. All
statistical tests were two-sided. RESULTS: HPV16 was detected in
cervical scrapes from 50.8% (92 of 181) of case patients and from 11%
(20 of 181) of control subjects. All HPV16-positive samples, except one,
contained European (E) or Asian-American (AA) variants. AA and E
variants were found statistically significantly more often in case
patients (AA = 23.2% [42 of 181]; E = 27.1% [49 of 181]) than in control
subjects (AA = 1.1% [two of 181]; E = 10% [18 of 181]) (P<.001 for case
versus control subjects for either E or AA variants, chi2 test).
However, the frequency of AA variants was 21 times higher in cancer
patients than in control subjects, whereas that ratio for E variants was
only 2.7 (P =.006, chi2 test). The odds ratio (OR) for cervical cancer
associated with AA variants (OR = 27.0; 95% confidence interval [CI] =
6.4 to 113.7) was higher than that associated with E variants (OR = 3.4;
95% CI = 1.9 to 6.0). AA-positive case patients (46.2 +/- 12.5 years
[mean +/- standard deviation]) were 7.7 years younger than E-positive
case patients (53.9 +/- 12.2 years) (P =.004, Student's t test). AA
variants were associated with squamous cell carcinomas and
adenocarcinomas, but E variants were associated with only squamous cell
carcinomas (P =.014, Fisher's exact test). CONCLUSIONS: The high
frequency of HPV16 AA variants, which appear to be more oncogenic than E
variants, might contribute to the high incidence of cervical cancer in
Mexico.
18
UI - 21427149
AU - Bosch FX; Munoz N; de Sanjose S; Franco EL; Lowy DR; Schiffman M;
TI -
Franceschi S; Kjaer SK; Meijer CJ; Frazer IH; Cuzick J
Re: Cervical carcinoma and human papillomavirus: on the road to
preventing a major human cancer.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1349-50
19
UI - 21433768
AU - Philips Z; Whynes DK
TI -
Early withdrawal from cervical cancer screening: the question of
cost-effectiveness.
SO - Eur J Cancer 2001 Sep;37(14):1775-80
AD - Health Economics Unit, Trent Institute for Health Services Research,
University of Nottingham, Nottingham, UK.
In countries such as the UK, mass population screening for cervical
cancer has been undertaken since the 1960s. Although of established
effectiveness, no formal evaluation of the screening protocol was
carried out prior to its implementation. On the basis of a published
mathematical modelling exercise, it has been speculated that withdrawing
women from the screening programme at an earlier age than at present,
whilst leading to a higher rate of invasive cervical cancer (ICC), could
reduce resource use. Using estimates of screening and treatment costs,
and of expected life-years lost following earlier withdrawal, we
simulated cost-effectiveness ratios for various scenarios described by
the model. Median cost savings resulting from a life-year lost never
exceeded pound10000 for any scenario, although the estimates were
particularly sensitive to the assumed age at cancer presentation and the
rate of cancer progression. Our findings seem to offer little economic
support for the early withdrawal of subjects from the cervical screening
programme.
20
UI - 21461554
AU - Golijow CD; Abba M; Mouron SA; Gomez MA; Guercci A; Dulout FN
TI -
Detection of c-erbB-2 gene amplification in cervical scrapes positive
for human papillomavirus (HPV).
SO - Cancer Invest 2001;19(7):678-83
AD - Centro de Investigaciones en Genetica Basica y Aplicada (CIGEBA),
Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata,
Argentina. cgolijow@fcv.medvet.unlp.edu.ar
c-erbB-2 gene amplification has been described in a variety of human
cancers, but it has been poorly studied in noncancerous cytological
samples from genital specimens positive for human papillomavirus (HPV).
Furthermore, the relationship between this genetic event and the
presence of high-risk and low-risk HPV types is poorly studied.
Eighty-four noncancerous cytological samples from exocervical specimens
that were positive for HPV types 6, 16, and 18 were analyzed for
c-erbB-2 gene amplification using the genomic differential polymerase
chain reaction with the single copy reference gene. An association
between c-erbB-2 gene amplification and the group corresponding to HPV
type 6 was found. Within the low-risk HPV group, c-erbB-2 amplification
was associated to cervical intraepithelial neoplasia of grade I (CIN I).
Because in the samples analyzed, most of the CIN I stage was
characterized by a koilocytotic pattern, c-erbB-2 amplification could be
related to this kind of cellular alteration. It would be important to
study c-erbB-2 gene amplification and also gene expression in different
CIN stages in order to determine its role and significance in cervical
cancer.
21
UI - 21463152
AU - Esajas MD; Duk JM; de Bruijn HW; Aalders JG; Willemse PH; Sluiter W;
TI -
Pras B; ten Hoor K; Hollema H; van der Zee AG
Clinical value of routine serum squamous cell carcinoma antigen in
follow-up of patients with early-stage cervical cancer.
SO - J Clin Oncol 2001 Oct 1;19(19):3960-6
AD - Department of Obstetrics and Gynecology, University Hospital Groningen,
Groningen, The Netherlands.
PURPOSE: To investigate the contribution to recurrence detection and
survival of serum squamous cell carcinoma antigen (SCC-ag) analysis in
the follow-up of early-stage cervical cancer patients. PATIENTS AND
METHODS: Follow-up data were evaluated in patients with early-stage
squamous cell cervical cancer treated by radical hysterectomy and pelvic
lymphadenectomy with or without radiotherapy. Routine serum SCC-ag
determination was performed at each follow-up visit. RESULTS: Recurrent
disease occurred in 35 (16%) of 225 patients and was preceded or
accompanied by serum SCC-ag elevation 26 times (sensitivity, 74%). In
five (14%) of these 35 patients, elevated serum SCC-ag was the first
measured clinical indicator. Desite salvage therapy, all five patients
died of disease. In the other 31 patients (21 with serum SCC-ag
elevation), either symptoms and/or positive signs led to recurrence
detection. Median survival time after recurrence was worse (9 months;
range, 2 to 112+) for patients with an elevated serum SCC-ag value at
recurrence in comparison with patients with normal serum SCC-ag values
(20 months; range, 4 to 96; P <.01). In 23 of the 190 patients without
recurrences, serum SCC-ag values became falsely elevated. In 16 of these
23 patients, the repeat sample after 6 weeks showed a normal SCC-ag, and
in seven patients benign (especially skin) disorders were found.
CONCLUSION: Serum SCC-ag analysis results in earlier recurrence
detection in a small proportion (14%) of patients but did not contribute
to better survival. As long as treatment possibilities for recurrent
cervical cancer patients are not improved, serum SCC-ag analysis should
not be carried out in routine follow-up.
22
UI - 21154420
AU - Stoler MH; Schiffman M; Atypical Squamous Cells of Undetermined
TI -
Significance-Low-grade Squamous Intraepithelial Lesion Triage Study
(ALTS) Group
Interobserver reproducibility of cervical cytologic and histologic
interpretations: realistic estimates from the ASCUS-LSIL Triage Study.
SO - JAMA 2001 Mar 21;285(11):1500-5
AD - University of Virginia Health System, Division of Surgical Pathology and
Cytopathology, Box 800214, Charlottesville, VA 22908, USA.
mhs2e@virginia.edu
CONTEXT: Despite a critical presumption of reliability, standards of
interpathologist agreement have not been well defined for interpretation
of cervical pathology specimens. OBJECTIVE: To determine the
reproducibility of cytologic, colposcopic histologic, and loop
electrosurgical excision procedure (LEEP) histologic cervical specimen
interpretations among multiple well-trained observers. DESIGN AND
SETTING: The Atypical Squamous Cells of Undetermined
Significance-Low-grade Squamous Intraepithelial Lesion (ASCUS-LSIL)
Triage Study (ALTS), an ongoing US multicenter clinical trial. SUBJECTS:
From women enrolled in ALTS during 1996-1998, 4948 monolayer cytologic
slides, 2237 colposcopic biopsies, and 535 LEEP specimens were
interpreted by 7 clinical center and 4 Pathology Quality Control Group
(QC) pathologists. MAIN OUTCOME MEASURES: kappa Values calculated for
comparison of the original clinical center interpretation and the first
QC reviewer's masked interpretation of specimens. RESULTS: For all 3
specimen types, the clinical center pathologists rendered significantly
more severe interpretations than did reviewing QC pathologists. The
reproducibility of monolayer cytologic interpretations was moderate
(kappa = 0.46; 95% confidence interval [CI], 0.44-0.48) and equivalent
to the reproducibility of punch biopsy histopathologic interpretations
(kappa = 0.46; 95% CI, 0.43-0.49) and LEEP histopathologic
interpretations (kappa = 0.49; 95% CI, 0.44-0.55). The lack of
reproducibility of histopathology was most evident for less severe
interpretations. CONCLUSIONS: Interpretive variability is substantial
for all types of cervical specimens. Histopathology of cervical biopsies
is not more reproducible than monolayer cytology, and even the
interpretation of LEEP results is variable. Given the degree of
irreproducibility that exists among well-trained pathologists, realistic
performance expectations should guide use of their interpretations.
23
UI - 21295298
AU - Mulkey DA
TI -
Interobserver agreement about cervical cytologic and histologic
diagnosis.
SO - JAMA 2001 Jun 13;285(22):2855-6
24
UI - 21246254
AU - Ferriman A
TI -
Audit shows weaknesses in cervical cancer screening.
SO - BMJ 2001 May 12;322(7295):1141
25
UI - 21359126
AU - Anonymous
TI -
Cervical cytology practice guideline. American Society of Cytopathology.
SO - Diagn Cytopathol 2001 Jul;25(1):3-24
26
UI - 21405252
AU - Brenna SM; Hardy E; Zeferino LC; Namura I
TI -
[Knowledge, attitudes, and practices related to the Pap smear among
women with cervical cancer]
SO - Cad Saude Publica 2001 Jul-Aug;17(4):909-14
AD - Divisao Medica, Hospital-Maternidade Leonor Mendes de Barros, Secretaria
de Estado da Saude, Sao Paulo, SP, 03015-000, Brasil.
brenna.ops@zaz.com.br
Despite screening programs, Brazil has a high cervical cancer mortality
rate. The objective of this cross-sectional study was to analyze
knowledge, attitudes, and practices related to the Pap smear and to
understand why women fail to submit to this screening test. A structured
questionnaire was used to interview 138 women: 90 with high grade
intraepithelial neoplasia and 48 with invasive cervical cancer.
Inadequate practices were more frequent among women with invasive
cancer. In terms of difficulties in obtaining medical care, more than
80% of women reported lack of motivation, 60% reported that physicians
failed to conduct a complete physical examination, and some 50% reported
that physicians' schedules were busy. Having a Pap smear usually
depended on a physician's request and the woman being symptomatic. Women
over than 56 years old showed more frequent inadequate knowledge,
attitudes and practices. However, those with more schooling were more
knowledgeable of the Pap smear procedure. Age and less schooling could
be barriers against women participating in screening programs, but
socioeconomic problems must also be considered for improving practices
related to the Pap smear.
27
UI - 21414282
AU - Hiatt RA; Pasick RJ; Stewart S; Bloom J; Davis P; Gardiner P; Johnston
TI -
M; Luce J; Schorr K; Brunner W; Stroud F
Community-based cancer screening for underserved women: design and
baseline findings from the Breast and Cervical Cancer Intervention
Study.
SO - Prev Med 2001 Sep;33(3):190-203
AD - Northern California Cancer Center, Union City, California 94587, USA.
BACKGROUND: Underutilization of breast and cervical cancer screening has
been observed in many ethnic groups and underserved populations.
Effective community-based interventions are needed to eliminate
disparities in screening rates and thus to improve prospects for
survival. METHODS: The Breast and Cervical Cancer Intervention Study was
a controlled trial of three interventions in the San Francisco Bay Area
from 1993 to 1996: (1) community-based lay health worker outreach; (2)
clinic-based provider training and reminder system; and (3) patient
navigator for follow-up of abnormal screening results. Study design and
a description of the interventions are reported along with baseline
results of a household survey conducted in four languages among 1599
women, aged 40-75. RESULTS: Seventy-six percent of women ages 40 and
over had had at least one mammogram, and most had had a clinical breast
examination (88%) and Pap smear (89%). Rates were significantly lower
for non-English-speaking Latinas and Chinese women (56 and 32%,
respectively, for mammography), and maintenance screening (three
mammograms in the past 5 years) varied from 7% (non-English-speaking
Chinese) to 53% (Blacks). Pap smear screening in the past 3 years was
low among non-English-speaking Latinas (72%) and markedly lower among
non-English-speaking Chinese women (24%). The strongest predictors of
screening behavior were having private health insurance and frequent use
of medical services. Having a regular clinic and speaking English were
also important. Race/ethnicity, education, household income, and
employment status were, overall, not significant predictors of screening
behavior. CONCLUSIONS: These baseline results support the importance of
cancer screening interventions targeted to persons of foreign origin,
particularly those less acculturated. Copyright 2001 American Health
Foundation and Academic Press.
28
UI - 21435379
AU - Egbert N; Parrott R
TI -
Self-efficacy and rural women's performance of breast and cervical
cancer detection practices.
SO - J Health Commun 2001 Jul-Sep;6(3):219-33
AD - School of Communication Studies, Kent State University, Kent, Ohio
44242, USA. negbert@kent.edu
Self-efficacy has become an important variable in multiple areas of
human performance, including health behavior modification (Bandura,
1997). This study explores variables that lead to women's perceived
self-efficacy in performing regular detection practices for breast and
cervical cancer. A sample of southeastern U.S. farm women (N = 206)
completed surveys that assessed their perceived and actual knowledge of
women's cancer detection practices, as well as their perceived social
norms and perceived barriers related to obtaining these tests.
Regression analyses of these data revealed that perceived peer norms and
the barriers of time and embarrassment were significant predictors of
women's confidence in their ability to follow through with cancer
detection practices. Perceived knowledge and perceived family norms
significantly predicted women's perceptions of difficulty associated
with cancer detection practices as well as women's confidence in their
skills to perform breast self-examination (BSE). Time was also a
significant barrier to confidence in performing BSE. Implications for
health communication campaigns are discussed.
29
UI - 21429178
AU - Bener A; Denic S; Alwash R
TI -
Screening for cervical cancer among Arab women.
SO - Int J Gynaecol Obstet 2001 Sep;74(3):305-7
AD - Department of Community Medicine, Faculty of Medicine & Health Sciences,
United Arab Emirates University, Al Ain, United Arab Emirates.
abener@uaeu.ac.ae
30
UI - 21438051
AU - Pannu HK; Corl FM; Fishman EK
TI -
CT evaluation of cervical cancer: spectrum of disease.
SO - Radiographics 2001 Sep-Oct;21(5):1155-68
AD - Russell H. Morgan Department of Radiology and Radiological Science,
Johns Hopkins University, Baltimore, Md, USA. hpannu@jhmi.edu
Invasive cervical cancer is the third most common gynecologic
malignancy. The prognosis is based on the stage, size, and histologic
grade of the primary tumor and the status of the lymph nodes. Assessment
of the stage of disease is important in determining whether the patient
may benefit from surgery or will receive radiation therapy. The official
clinical staging system of the International Federation of Gynecology
and Obstetrics has led to errors of 65%-90% in stage III and IV disease;
the result has been unofficial extended staging with cross-sectional
imaging modalities such as computed tomography (CT). CT is useful in
staging advanced disease and in monitoring patients for recurrence. The
primary tumor is heterogeneous and hypoattenuating relative to normal
stroma on contrast material-enhanced scans. Obliteration of the
periureteral fat plane and a soft-tissue mass are the most reliable
signs of parametrial extension. Less than 3 mm separation of the tumor
from the pelvic muscles and vascular encasement are signs of pelvic side
wall invasion. Lymphatic spread is along the external and internal iliac
nodal chains and the presacral route to the paraaortic nodes. Distant
metastases are seen with primary or recurrent disease and can involve
the liver, lung, and bone.
31
UI - 21454918
AU - Anonymous
TI -
Cervical cancer and the Pap test.
SO - N C Med J 2001 Sep-Oct;62(5):277-8
32
UI - 21459467
AU - Gupta DK; Komaromy-Hiller G; Raab SS; Nath ME
TI -
Interobserver and intraobserver variability in the cytologic diagnosis
of normal and abnormal metaplastic squamous cells in pap smears.
SO - Acta Cytol 2001 Sep-Oct;45(5):697-703
AD - Department of Pathology, Shadyside Hospital and University of Pittsburgh
Medical Center, Pennsylvania 15213, USA. dgupta@mail.magee.edu
OBJECTIVE: Interoberver variability has important implications for
patient care, diagnostic error and medical litigation. In the management
of any cervical epithelial abnormality, its biologic significance as
well as diagnostic reproducibility is very important. Interobserver
variability has not been measured adequately for metaplastic squamous
lesions. We analyzed interobserver and intraobserver variability and
diagnostic accuracy in the diagnosis of dysplastic metaplastic cells.
STUDY DESIGN: Sixty Pap smears from patients with abnormalities of
metaplastic squamous cells of varying severity were selected from the
files of Lankenau Hospital, Wynnewood, Pennsylvania, U.S.A., diagnosed
between 1990 and 1996. These were reviewed by four observers with
different levels of cytology experience. Each of the observers blindly
and independently reviewed all Pap smears. Tabulated results were
analyzed to determine interobserver and intraobserver variability and
diagnostic accuracy. RESULTS: Statistically significant interobserver
reproducibility was found between both inexperienced observers as well
as between observers 1 (experienced) and 3 (inexperienced) and between
observers 2 (experienced) and 4 (inexperienced). The observed degree of
agreement between both experienced observers (1 and 2) reflected random
rating rather than reproducibility. There was no difference in
interobserver reproducibility in low vs. high grade lesions.
Intraobserver reproducibility had no significant correlation with
experience of the observer. The sensitivity ranged from 0.69 to 0.97
(mean, 0.79), while the specificity ranged from 0.09 to 0.46 (mean,
0.30). Mean diagnostic accuracy was better in benign and low grade
squamous intraepithelial lesions in comparison to high grade squamous
intraepithelial lesions. CONCLUSION: There was good interobserver
agreement in classifying squamous metaplastic lesions. The agreement did
not correlate with grade of dysplasia or experience of the
cytopathologists. These findings should be considered in making
treatment, quality assurance and legal decisions. A larger study is
indicated to study interobserver and in
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