National Cancer Institute®
Last Modified: November 21, 2001
UI - 21284034
AU - Gibbons WE; Thorneycroft IH
TI - Protecting the endometrium. Opposing the hyperplasia/malignancy potential of ERT.
SO - J Reprod Med 1999 Feb;44(2 Suppl):203-8
AD - Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 601 Colley Avenue, Suite 229, Norfolk, VA 23507-1627, USA.
Many trials have examined the clinical and histologic effects of various hormone replacement therapy combinations with the objective of minimizing the incidence of hyperplasia and the potential for subsequent development of adenocarcinoma. Reviewing the results of these trials, it appears that high-dose, long-term progestogen therapy is effective in protecting the endometrium, with duration having a greater impact than dose. Among women given 0.625 mg conjugated equine estrogen (CEE), sequential regimens should include 5 or 10 mg medroxyprogesterone acetate (MPA) or 200 mg micronized progesterone for 12 days or more. Continuous combined regimens require 2.5-5 mg MPA. With women who are taking 1.25 mg CEE the data are less clear, but recommendations include administration with 10 mg MPA for 12-14 days or 5 mg MPA continuous combined therapy.
UI - 21284035
AU - Thorneycroft IH; Gibbons WE
TI - Vaginal bleeding patterns in women receiving hormone replacement therapy. Impact of various progestogen regimens.
SO - J Reprod Med 1999 Feb;44(2 Suppl):209-14
AD - Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, 2451 Fillingim Street, Mobile, AL 36617-2238, USA.
Postmenopausal bleeding is more prevalent than was previously thought, occurring in women regardless of whether or not they are on hormone replacement therapy. While estrogen-only regimens have been used for several beneficial effects, bleeding patterns associated with these regimens can be irregular and unpredictable, causing discomfort to the patient as well as increasing the risk of both endometrial hyperplasia and carcinoma. Studies in recent years have examined the effects of estrogen-only regimens as compared to different estrogen-plus-progestogen combination therapies to help regulate and minimize postmenopausal bleeding while providing endometrial protection.
UI - 21454124
AU - Gjorgov AN
TI - Tubal ligation and risk of ovarian cancer.
SO - Lancet 2001 Sep 8;358(9284):843-4; discussion 844
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.
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.
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. email@example.com
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
UI - 97358029
AU - Scott JR; Sharp HT; Dodson MK; Norton PA; Warner HR
TI - Subtotal hysterectomy in modern gynecology: a decision analysis.
SO - Am J Obstet Gynecol 1997 Jun;176(6):1186-91; discussion 1191-2
AD - Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City 84132, USA.
OBJECTIVE: Our purpose was to compare the risks and benefits of subtotal (supracervical) hysterectomy with those of total hysterectomy in women at low risk for cervical cancer. STUDY DESIGN: A decision analysis was performed. Baseline probabilities for operative and postoperative morbidity, mortality, and long-term quality of life were established for subtotal and total hysterectomy. RESULTS: Operative complication rates and ranges for total abdominal hysterectomy were infection 3.0% (3.0% to 20.0%), hemorrhage 2.0% (2.0% to 15.4%), and adjacent organ injury 1.0% (0.7% to 2.0%). Those for subtotal hysterectomy were infection 1.4% (1.0% to 5.0%), hemorrhage 2.0% (0.7% to 4.0%), and adjacent organ injury 0.7% (0.6% to 1.0%). Operative mortality, the risk for development of cervicovaginal cancer, and long-term adverse effects on sexual or vesicourethral function were low in both groups. CONCLUSIONS: Recently proposed benefits from subtotal hysterectomy are not well proven. Total hysterectomy remains the procedure of choice for most women.
UI - 21277673
AU - Foxall MJ; Barron CR; Houfek JF
TI - Ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices.
SO - Oncol Nurs Forum 2001 May;28(4):727-38
AD - Science Department, College of Nursing, University of Nebraska Medical Center, Omaha, USA. firstname.lastname@example.org
PURPOSE/OBJECTIVES: To examine ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices. DESIGN: Descriptive, correlational secondary analysis. SETTING: Urban and rural home and community populations. SAMPLE: 233 women: 138 (59%) Caucasian, 37 (17%) African American, 29 (12%) Hispanic, and 29 (12%) American Indian women (X = 46.86 years) were recruited through mailings, churches, and community organizations. METHODS: Structured questionnaires. MAIN RESEARCH VARIABLES: Body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices. FINDINGS: Ethnicity predicted breast and gynecologic cancer screening practices (except clinical breast examination), body awareness, trait anxiety, and perceived risk. Hispanic and American Indian women reported greater breast self-examination frequency than Caucasian and African American women. Caucasian and African American women reported more mammogram use than Hispanic and American Indian women. Increased body awareness was related to fewer gynecologic exams for American Indian women. CONCLUSIONS: Women of different ethnic backgrounds respond differently to breast and gynecologic cancer screening practices. The influence of psychosocial variables on these practices varied with different groups. IMPLICATIONS FOR NURSING PRACTICE: Nursing interventions to increase breast and gynecologic cancer screening should be ethnic-specific, with particular attention to the meaning of body awareness to American Indian women and trait anxiety and perceived risk to African American women.
UI - 21354745
AU - Bauer G
TI - Lactobacilli-mediated control of vaginal cancer through specific reactive oxygen species interaction.
SO - Med Hypotheses 2001 Aug;57(2):252-7
AD - Abteilung Virologie, Institut fur Medizinische Mikrobiologie und Hygiene, Universitat Freiburg, Germany. email@example.com
Klebanoff et al. proposed that hydrogen peroxide-producing lactobacilli and peroxidase in the vagina of healthy women might be responsible for the prevention of vaginosis and also might exert an antitumor effect (1). Based on recent evidence on superoxide anion generation by transformed cells (2,3) and on the potential of myeloperoxidase for selective apoptosis induction in transformed cells (4), a model for specific reactive oxygen species interaction during lactobacilli-mediated tumor control in the vagina is presented here.We propose that peroxidase, which converts hydrogen peroxide into hypochlorous acid, is responsible for creating a microbicidal vaginal milieu by maintaining a balanced, non-toxic, steady state level of the microbicides H(2)O(2)and HOCI. In case individual superoxide anion-producing transformed cells eventually appear in the mucosa they will be driven into apoptosis by interaction of HOCI with superoxide anions which leads to the generation of hydroxyl radicals. Hence selective apoptosis induction in transformed cells represents the key element of lactobacilli-mediated antitumor defense. Since papilloma virus infected cells are resistant to this pathway of apoptosis induction, they are plausible candidates for circumvention of lactobacilli-mediated control of oncogenesis. Copyright 2001 Harcourt Publishers Ltd.
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. firstname.lastname@example.org
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.
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.
UI - 21419600
AU - Hale GE; Hughes CL; Robboy SJ; Agarwal SK; Bievre M
TI - A double-blind randomized study on the effects of red clover isoflavones on the endometrium.
SO - Menopause 2001 Sep-Oct;8(5):338-46
AD - Center for Women's Health, Los Angeles, California, USA.
OBJECTIVE: To assess the effects of a red clover-derived isoflavone extract on the Ki-67 proliferative marker of endometrial biopsies in 45-to 50-year-old perimenopausal women. We hypothesized that we would be able to detect a decrease in the Ki-67 proliferative index during the late follicular phase after a 3-month course of approximately 50 mg red clover isoflavones. Isoflavones have been found to have some antiestrogenic effects, and an antiproliferative effect during the perimenopausal period may be especially useful owing to the excessive endometrial proliferation often characteristic of this period. DESIGN: In a double-blind, randomized, controlled study, 30 women between the ages of 45 and 50 years consented to an endometrial biopsy before and after a 3-month course of either placebo or active isoflavone extract. The biopsies were timed as close as possible to days 7-11 of the menstrual cycle, and simultaneous measurements of transvaginal endometrial thickness, uterine artery Doppler, hormone profiles, lipids, and bone markers were performed. RESULTS: Of 30 women, 2 did not return for a second biopsy, and a third had an unsuccessful second biopsy. Four subjects were excluded from the Intention to Treat analysis because they did not have a menstrual bleed within the time frame of the study (3 subjects) or were tested on day 13 instead of between days 7 and 11 of the cycle (1 subject). There was no change in the Ki-67 proliferation index after treatment in either group. Eight subjects in the placebo group and eight in the P-07 group had proliferative endometrial biopsies that were synchronized with estradiol levels at baseline and post-treatment, and analysis of these subjects revealed no detectable change in the relationship between estradiol levels and Ki-67 with treatment in either group. There was no change in fasting lipids, bone markers, uterine Doppler resistance, or pulsatility index. CONCLUSION: In this small pilot study, we did not find, using immunohistochemical quantification of the Ki-67 antigen, that red clover isoflavones had an antiproliferative effect in the endometrium. Small sample size, examination of a relatively short interval in the menstrual cycle, and isoflavone formulation may have contributed to our lack of findings; however, we believe that the issue of isoflavones and their possible antiproliferative effect is deserving of further study. A simpler physiological model with less hormonal variability, such as healthy, recently menopausal women on predetermined doses of estrogen, may prove to be more informative.
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. email@example.com
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.
UI - 21103802
AU - Solomon D; Schiffman M; Tarone R; ALTS Study group
TI - Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial.
SO - J Natl Cancer Inst 2001 Feb 21;93(4):293-9
AD - Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. firstname.lastname@example.org
BACKGROUND: More than 2 million U.S. women receive an equivocal cervical cytologic diagnosis (atypical squamous cells of undetermined significance [ASCUS]) each year. Effective colposcopy triage strategies are needed to identify the minority of women who have clinically significant disease while avoiding excessive follow-up evaluation for others. METHODS: The ASCUS/LSIL (i.e., low-grade squamous intraepithelial lesion) Triage Study (ALTS) is a multicenter, randomized trial comparing the sensitivity and specificity of the following three management strategies to detect cervical intraepithelial neoplasia grade 3 (CIN3): 1) immediate colposcopy (considered to be the reference standard), 2) triage to colposcopy based on human papillomavirus (HPV) results from Hybrid Capture 2(TM) (HC 2) and thin-layer cytology results, or 3) triage based on cytology results alone. This article summarizes the cross-sectional enrollment results for 3488 women with a referral diagnosis of ASCUS. All statistical tests are two-sided. RESULTS: Among participants with ASCUS, the underlying prevalence of histologically confirmed CIN3 was 5.1%. Sensitivity to detect CIN3 or above by testing for cancer-associated HPV DNA was 96.3% (95% confidence interval [CI] = 91.6% to 98.8%), with 56.1% of women referred to colposcopy. Sensitivity of a single repeat cytology specimen with a triage threshold of HSIL or above was 44.1% (95% CI = 35.6% to 52.9%), with 6.9% referred. Sensitivity of a lower cytology triage threshold of ASCUS or above was 85.3% (95% CI = 78.2% to 90.8%), with 58.6% referred. CONCLUSIONS: HC 2 testing for cancer-associated HPV DNA is a viable option in the management of women with ASCUS. It has greater sensitivity to detect CIN3 or above and specificity comparable to a single additional cytologic test indicating ASCUS or above.
UI - 21310738
AU - Cuzick J
TI - HPV testing in cervical screening.
SO - Pharmacoepidemiol Drug Saf 2001 Jan-Feb;10(1):33-6
AD - Department of Mathematics, Statistics and Epidemiology, ICRF Laboratories, 61 Lincoln's Inn Fields, London WC2A 3PX, UK.
UI - 21310743
AU - Gray JA
TI - The evolution of screening.
SO - Pharmacoepidemiol Drug Saf 2001 Jan-Feb;10(1):49-54
AD - UK National Screening Committee, UK.
Botany is usually considered to be the gentlest of sciences with botanists being regarded as people who study relatively safe specimens, compared with, for example, anthropologists or microbiologists. However, botanists have their moments, particularly when collecting new species. The great botanists of the eighteenth and nineteenth centuries risked their lives in collecting and bringing back species, which we now take for granted, and Robert Brown was one of these adventurers, a young Scot who accompanied Sir Joseph Banks to New Holland. It was not, however, for his adventurous lifestyle that Brown is remembered but for his startling observation of the movements of pollen grains on a microscope slide. He noted that the pollen grains were in perpetual agitated motion, without purpose or direction but full of energy. This motion, called Brownian motion, arises from the movement of molecules, and Brownian motion is the term that has been applied to much of healthcare, including many screening programmes, which have in the past been marked more by the amount of energy and activity than by a clear sense of direction or positive achievement.
UI - 21439162
AU - Mahavni V; Sood AK
TI - Hormone replacement therapy and cancer risk.
SO - Curr Opin Oncol 2001 Sep;13(5):384-9
AD - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
The advantages and disadvantages of hormone replacement therapy (HRT) have been debated nearly as long as the treatment has been in use, especially the relationship between HRT and risk of cancer development. It is hoped that recently published studies will shed more light on this complex issue. Several large population studies suggest that there may be a small but increased risk of developing breast cancer in HRT users, especially in estrogen and progesterone users. This risk appears most pronounced after 5 years of HRT use. Endometrial cancer, which has long been associated with unopposed estrogen use, can be successfully prevented with the addition of progestins to the HRT regimen, provided it is given for at least 10 days each month. Estrogen replacement therapy has also been shown to significantly reduce the risk for colon cancer but not rectal cancers. Finally, a large prospective study has linked HRT with an increase in ovarian cancer mortality.
UI - 96256342
AU - Lerman C; Narod S; Schulman K; Hughes C; Gomez-Caminero A; Bonney G;
TI - Gold K; Trock B; Main D; Lynch J; Fulmore C; Snyder C; Lemon SJ; Conway T; Tonin P; Lenoir G; Lynch H BRCA1 testing in families with hereditary breast-ovarian cancer. A prospective study of patient decision making and outcomes.
SO - JAMA 1996 Jun 26;275(24):1885-92
AD - Department of Medicine, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA.
OBJECTIVES: To identify predictors of utilization of breast-ovarian cancer susceptibility (BRCA1 gene) testing and to evaluate outcomes of participation in a testing program. DESIGN: Prospective cohort study with baseline interview assessment of predictor variables (eg, sociodemographic factors, knowledge about hereditary cancer and genetic testing, perceptions of testing benefits, limitations, and risks). BRCA1 test results were offered after an education and counseling session in a research setting. Outcome variables (including depression, functional health status, and prophylactic surgery plans [follow-up only]) were assessed at baseline and 1-month follow-up interviews. PARTICIPANTS: Adult male and female members (n=279) of families with BRCA1-linked hereditary breast-ovarian cancer (HBOC). RESULTS: Of subjects who completed a baseline interview (n=192), 60% requested BRCA1 test results (43% of all study subjects requested results). Requests for results were more frequent for persons with health insurance (odds ration [OR], 3.74; 95% confidence interval [CI], 2.06-6.80); more first-degree relatives affected with breast cancer (OR, 1.59; 95% CI, 1.16-2.16); more knowledge about BRCA1 testing (OR, 1.85; 95% CI, 1.36-2.50); and indicating that test benefits are important (OR, 1.45; 95% CI, 1.13-1.86). At follow-up, noncarriers of BRCA1 mutations showed statistically significant reductions in depressive symptoms and functional impairment compared with carriers and nontested individuals. Individuals identified as mutation carriers did not exhibit increases in depression and functional impairment. Among unaffected women with no prior prophylactic surgery, 17% of carriers (2/12) intended to have mastectomies and 33% (4/12) to have oophorectomies. CONCLUSIONS: Only a subset of HBOC family members are likely to request BRCA1 testing when available. Rates of test use may be higher in persons of a higher socioeconomic status and those with more relatives affected with breast cancer. For some high-risk individuals who receive test results in a research setting that includes counseling, there may be psychological benefits. More research is needed to assess the generalizability of these results and evaluate the long-term consequences of BRCA1 testing.
UI - 97179322
AU - Nayfield SG
TI - Ethical and scientific considerations for chemoprevention research in cohorts at genetic risk for breast cancer.
SO - J Cell Biochem Suppl 1996;25():123-30
AD - Chemoprevention Branch, National Cancer Institute, Bethesda, Maryland 20892, USA.
Identification of cohorts at genetic risk for cancer offers unique research opportunities to explore the steps in carcinogenesis, from the inheritance of a predisposing mutation to the development of preinvasive lesions or overt malignancy, and to evaluate interventions to modulate the carcinogenic process. However, cancer prevention strategies for most inherited cancer predisposition syndromes are of unproven benefit, and the potential for adverse psychosocial effects and employment or insurance discrimination associated with genetic testing is substantial. Thus testing for genetic cancer risk remains highly controversial, and the National Center for Human Genome Research and the American Society of Human Genetics advise DNA testing for presymptomatic identification of cancer risk only in the setting of a carefully monitored research environment. The commercial availability of predictive genetic testing, particularly for inherited susceptibility to cancer, has focused attention not only on the urgent need for research in cancer prevention for cohorts at genetic cancer risk but also on ethical considerations surrounding clinical prevention research in genetic risk groups. This paper addresses the interrelationship of ethical and scientific issues in conducting chemoprevention research in these cohorts, especially for those studies which require presymptomatic testing for specific gene mutations as a study entry criterion or as a criterion for stratification. Practical approaches to study design and implementation issues for chemoprevention research in genetic risk cohorts are discussed, emphasizing the interactions of ethical and scientific considerations at all levels of the research process.
UI - 97174834
AU - Hallowell N; Murton F; Statham H; Green JM; Richards MP
TI - Women's need for information before attending genetic counselling for familial breast or ovarian cancer: a questionnaire, interview, and observational study.
SO - BMJ 1997 Jan 25;314(7076):281-3
AD - Centre for Family Research, Faculty of Social and Political Sciences, University of Cambridge.
OBJECTIVES: To describe women's information needs prior to genetic counselling for familial breast or ovarian cancer. DESIGN: Prospective study including semistructured telephone interviews before genetic counselling, observations of consultations, completion of postal questionnaires, and face-to face interviews within two months of counselling. SUBJECTS: 46 women attending genetic counselling for familial breast or ovarian cancer. MAIN OUTCOME MEASURES: Subjects' understanding of process and content of genetic counselling before attending and attitudes about their preparation for the counselling session. RESULTS: Although all women interviewed before the clinic expected to discuss their risk of developing cancer and risk management options, there was evidence of a lack of knowledge about the process and content of genetic counselling, 17 (37%) women said they did not know what else would happen. Most women interviewed after counselling viewed it positively, but 26 (65%) felt they had been inadequately prepared and 11 (28%) felt that their lack of preparation meant that they could not be given an accurate estimation of their risk of cancer. CONCLUSIONS: Some women felt that they did not obtain optimum benefit from genetic counselling because they were inadequately prepared for it. We suggest that cancer family history clinics should provide women with written information about the process and content of genetic counselling before their clinic attendance.
UI - 98279722
AU - Goelen G; Rigo A; Neyns B; Betz W; De Greve J
TI - Ethical aspects of genetic counseling in familial breast and ovarian cancer. Combining applied theory and reflective practice.
SO - Ann N Y Acad Sci 1997 Dec 29;833():170-2
AD - Cancer Prevention Center, Vrije Universiteit Brussel, Belgium. email@example.com
UI - 98313794
AU - Foster P; Anderson CM
TI - Reaching targets in the national cervical screening programme: are current practices unethical?
SO - J Med Ethics 1998 Jun;24(3):151-7
AD - Manchester University.
The principle of informed consent is now well established within the National Health Service (NHS) in relation to any type of medical treatment. However, this ethical principle appears to be far less well established in relation to medical screening programmes such as Britain's national cervical screening programme. This article will critically examine the case for health care providers vigorously pursuing women to accept an invitation to be screened. It will discuss the type of information which women would need in order to make an informed decision about whether or not to be screened. The lack of such information in current patient leaflets on the "smear test" will then be documented. Finally, the article will explore possible ways of maximising women's autonomy in relation to the cervical screening programme without sacrificing any of its main benefits.
UI - 98313840
AU - Koenig BA; Greely HT; McConnell LM; Silverberg HL; Raffin TA
TI - Genetic testing for BRCA1 and BRCA2: recommendations of the Stanford Program in Genomics, Ethics, and Society. Breast Cancer Working Group.
SO - J Womens Health 1998 Jun;7(5):531-45
AD - Program in Genomics, Ethics, and Society, Stanford University Center for Biomedical Ethics, Palo Alto, California, USA.
UI - 99172847
AU - Coughlin SS
TI - Implementing breast and cervical cancer prevention programs among the Houma Indians of southern Louisiana: cultural and ethical considerations.
SO - J Health Care Poor Underserved 1998 Feb;9(1):30-41
AD - Tulane University, USA.
This paper provides an overview of the ethical and cultural issues that were taken into account in planning a cross-cultural study of barriers to breast and cervical cancer screening among Houma Indian women who reside in Terrebonne Parish, Louisiana. In such cross-cultural studies, the investigators and members of the target population are from different cultural backgrounds. In planning the study, ethical principles and cultural norms were carefully specified to ensure that the welfare of the participants would be protected and potential benefits maximized. This experience with the Houma Indian Nation illustrates the need for greater participation of research subjects in the planning and implementation of studies on their behalf. An ethical, culturally sensitive approach to cancer control research is needed to address the health concerns of Native American populations.
UI - 99191788
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.
UI - 21523832
AU - Cramer DW; Kuper H; Harlow BL; Titus-Ernstoff L
TI - Carotenoids, antioxidants and ovarian cancer risk in pre- and postmenopausal women.
SO - Int J Cancer 2001 Oct 1;94(1):128-34
AD - Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA. firstname.lastname@example.org
An inverse association between ovarian cancer risk, carotenoids and antioxidant vitamins has been suggested by several epidemiologic studies and 1 experimental trial of a vitamin A analogue. From a population-based study of 549 cases of ovarian cancer and 516 controls, we estimated the consumption of the antioxidant vitamins A, C, D and E and various carotenoids, including alpha- and beta-carotene and lycopene, using a validated dietary questionnaire. Multivariate logistic regression was used to calculate the exposure odds ratios adjusted for established ovarian cancer risk factors. Intakes of carotene, especially alpha-carotene, from food and supplements were significantly and inversely associated with risk for ovarian cancer, predominantly in postmenopausal women. Intake of lycopene was significantly and inversely associated with risk for ovarian cancer, predominantly in premenopausal women. Food items most strongly related to decreased risk for ovarian cancer were raw carrots and tomato sauce. Consumption of fruits, vegetables and food items high in carotene and lycopene may reduce the risk of ovarian cancer. Copyright 2001 Wiley-Liss, Inc.
UI - 21461404
AU - Sherris J; Herdman C; Elias C
TI - Cervical cancer in the developing world.
SO - West J Med 2001 Oct;175(4):231-3
AD - Program for Appropriate Technology in Health (PATH), 4 Nickerson St, Seattle, WA 98109, USA. email@example.com
UI - 21471862
AU - Sassi F; Le Grand J; Archard L
TI - Equity versus efficiency: a dilemma for the NHS. If the NHS is serious about equity it must offer guidance when principles conflict.
SO - BMJ 2001 Oct 6;323(7316):762-3
UI - 21487491
AU - Mathevet P
TI - [Viruses and cervical cancers]
SO - Rev Prat 2001 Sep 1;51(13):1413-6
AD - Service de Gynecologie-Obstetrique Hopital Edouard-Herriot 69437 Lyon. firstname.lastname@example.org
Currently it is evident that human papillomaviruses are involved in the development of cervical cancer. The mechanisms of cancer initiation are in relation with certain types of papillomavirus. But the discrepancy between the high prevalence of papillomavirus infection and the low frequency of cancer in infected women, gives evidence of the importance of healing process in relation with the host's immune response and the activation of other carcinogenic factors. The understanding of the role of papillomavirus in cervical cancer, gives prospects to prophylactic and therapeutic strategies in relation with antiviral treatments or papillomavirus-specific vaccines.
UI - 21487493
AU - Boulanger JC; Naepels P
TI - [Screening and diagnosis of cervical cancer]
SO - Rev Prat 2001 Sep 1;51(13):1426-31
AD - Centre de gynecologie-obstetrique CHU d'Amiens 80054 Amiens. email@example.com
The screening of cervical cancer is ideal. Performing its screening allows discovering early stage of invasive cancer but above all to diagnose numerous precursor lesions: their treatment carry out the prevention of invasive cancer. Without an organised screening in France, there is a spontaneous screening. Nevertheless the incidence of invasive cancer decreased twofold since twenty years. It remains unfortunately frequent. With a well organised mass screening its rate will probably decrease significantly.
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