NCI CANCERLIT^® Search: Screening and Prevention of Gynecologic Neoplasms - September 2001

Last Modified: November 1, 2001

Non-hormonal contraception and the risk of ovarian cancer.
Oral contraceptives, other methods of contraception, and risk reduction for ovarian cancer.
Cervical cancer vaccine trials started.
Ovarian and endometrial function during hormonal contraception.
The effect of the duration of progestin use on the occurrence of endometrial cancer in postmenopausal women.
Significant pelvic recurrence in high-risk pathologic stage I--IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy.
A population-based case-control study of carotenoid and vitamin A intake and ovarian cancer (United States).
Global challenges of cervical cancer prevention.
Molecular genetics and endometrial cancer.
Genital HPV: links to cervical cancer, treatment, and prevention.
Screening and early detection among racial and ethnic minority women.
Oral contraceptive use in perimenopause.
Opening the door to HPV testing.
Routine vaginal cuff smear testing in post-hysterectomy patients with benign uterine conditions: when is it indicated?
Low national breast and cervical cancer-screening rates in American Indian and Alaska Native women with diabetes.
Cancer screening rates.
The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge.
Direct-to-vial experience with AutoCyte PREP in a small New England regional cytology practice.
Educational review: role of the surgeon in hereditary breast cancer.
Information about screening - is it to achieve high uptake or to ensure informed choice?
Medicare expands preventive screening benefits.
Policy analysis of cervical cancer screening strategies in low-resource settings: clinical benefits and cost-effectiveness.
Regular use of analgesic drugs and ovarian cancer risk.
Role of population-based studies in assessing genetic cancer risk.
Women's attitudes toward preventive strategies for hereditary breast or ovarian carcinoma differ from one country to another: differences among English, French, and Canadian women.
Cancer screening among community health center women: eliminating the gaps.
Insurance policies for prophylactic mastectomy: to cover or not to cover?
How does menopause alter the primary care of women?
[Screening for cancer: from guidelines to practice]
[Recommendations on cancer screening in the European Union]
Physical activity and cancer prevention -- is 'no pain, no gain' passe?
Oral contraceptives, cancer and vascular disease.

CancerMail from the National Cancer Institute

1
UI - 21236976
AU - Weiss NS; Rossing MA
TI - Non-hormonal contraception and the risk of ovarian cancer.
SO - Epidemiology 2001 May;12(3):300
AD - Department of Epidemiology, School of Public Health and Community Medicine, Box 357236, University of Washington, Seattle, WA 98195-7236, USA.

2
UI - 21236978
AU - Ness RB; Grisso JA; Vergona R; Klapper J; Morgan M; Wheeler JE; Study of Health and Reproduction (SHARE) Study Group
TI - Oral contraceptives, other methods of contraception, and risk reduction for ovarian cancer.
SO - Epidemiology 2001 May;12(3):307-12
AD - Graduate School of Public Health and Pittsburgh Cancer Institute, University of Pittsburgh, USA.
Oral contraceptives reduce the risk of ovarian cancer, but the impact of other methods of contraception has not been fully explored. This population-based, case-control study involved women 20-69 years of age who had ever had intercourse. We compared cases with a recent diagnosis of ovarian cancer (N = 727) with community controls (N = 1,360). All methods of contraception evaluated were associated with a reduced risk for ovarian cancer. After adjustment for age, race, pregnancies, and family history of ovarian cancer, the odds ratios for ever-use of each method as compared with never-use were: oral contraceptives for contraception, 0.6 (95% confidence interval = 0.5-0.8); intrauterine device, 0.8 (95% confidence interval = 0.6-1.0); barrier methods, 0.8 (95% confidence interval = 0.6-0.9); tubal ligation, 0.5 (95% confidence interval 0.4-0.7); and vasectomy, 0.8 (95% confidence interval = 0.6-1.1). Nulligravid women were not protected by any of these contraceptive methods. Multigravid women, however, were protected by all methods. We conclude that various methods of contraception reduce ovarian cancer risk. This effect does not appear to result from contraceptive use being a nonspecific marker of fertility. The results imply mechanisms other than hormonal or ovulatory by which ovarian cancer risk is reduced.

3
UI - 21261307
AU - Anonymous
TI - Cervical cancer vaccine trials started.
SO - AIDS Patient Care STDS 2001 Apr;15(4):229-30

4
UI - 21319052
AU - The ESHRE Capri Workshop Group
TI - Ovarian and endometrial function during hormonal contraception.
SO - Hum Reprod 2001 Jul;16(7):1527-35
AD - Department of Obstetrics and Gynaecology, University of Milan, Via Della Commenda 12, 20122 Milan, Italy. piergorgio.crosignani@unimi.it
This report addresses the balance of benefits and risks from changes in ovarian and endometrial function from hormonal contraception. The main mode of action of hormonal contraception is inhibition of ovulation, due chiefly to the dose of oestrogen in combined oral contraceptives. With 20 microg dosages of ethinyl oestradiol follicular activity is more common so that contraception depends on suppression of the LH surge or disruption of the endometrial cycle. In polycystic ovary syndrome (PCOS) treated with oral contraceptives, cysts become smaller and in time the ovarian volume is reduced, ovarian testosterone secretion is reduced and there are potentially favourable effects on carbohydrate and lipid metabolism. Typical oral contraceptive users in the 1980s had a lower incidence of ovarian cysts, but modern oral contraceptives do not appear to affect the incidence of functional cysts or benign epithelial cysts. Moreover, randomized controlled trials indicate that oral contraception prescriptions are unlikely to prevent the development of functional cysts or to hasten their disappearance. Oral contraceptives, however, greatly reduce pelvic pain in women with symptomatic endometriosis and improve the health-related quality of life. Bleeding is a common response with all types of hormonal contraception, but current methodology is inadequate to make accurate comparisons of different products or of different phasic formulations. With continuing use, however, combined oral contraception is associated with endometrial atrophy, the biological plausibility for a reduced risk of endometrial carcinoma. With progestin-only contraception, a number of endometrial changes are considered as possible mechanisms of the associated bleeding but it remains largely unexplained. Oral contraceptives are frequently used for treatment of dysfunctional uterine bleeding, although only one trial has been reported. Oral contraceptive use confers protection from endometrial [relative risk (RR) 0.5] and ovarian (RR 0.4) cancers and in both cases, the protection lasts for up to 2 decades after stopping use.

5
UI - 21342262
AU - Archer DF
TI - The effect of the duration of progestin use on the occurrence of endometrial cancer in postmenopausal women.
SO - Menopause 2001 Jul-Aug;8(4):245-51
AD - Department of Obstetrics and Gynecology, and Clinical Research Center, Eastern Virginia Medical School, Norfolk, Virginia, USA. archerdf@evms.edu
OBJECTIVE: Women who have ever used estrogen replacement therapy (ERT), even at a low dose, have an increased incidence of endometrial cancer. The addition of a progestin to ERT reduces the incidence of endometrial cancer. The duration of progestin administration is more important than the dose. DESIGN: A MEDLINE review of the literature was performed using the search terms endometrial cancer, epidemiology, and hormone replacement therapy (HRT). RESULTS: Women who have ever used ERT have an increased incidence of endometrial cancer. The use of HRT for more than 5 years, with a progestin use of <10 days per cycle, has a relative risk = 1.8. Continuous combined HRT, or sequential or cyclic HRT with >10 days of progestin per cycle, appears to decrease the incidence of endometrial cancer to that found in nonusers of HRT. CONCLUSIONS: The use of HRT in postmenopausal women with a uterus reduces the incidence of endometrial cancer. The duration of progestin administration should be 14 days or more per cycle based on recent epidemiologic data.

6
UI - 21376167
AU - Mundt AJ; McBride R; Rotmensch J; Waggoner SE; Yamada SD; Connell PP
TI - Significant pelvic recurrence in high-risk pathologic stage I--IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy.
SO - Int J Radiat Oncol Biol Phys 2001 Aug 1;50(5):1145-53
AD - Department of Radiation and Cellular Oncology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL 60637, USA. mundt@rover.uchicago.edu
OBJECTIVE: To evaluate the risk of pelvic recurrence (PVR) in high-risk pathologic Stage I--IV endometrial carcinoma patients after adjuvant chemotherapy alone. METHODS: Between 1992 and 1998, 43 high-risk endometrial cancer patients received adjuvant chemotherapy. All patients underwent primary surgery consisting of total abdominal hysterectomy and bilateral salpingo-oophorectomy. No patients received preoperative radiation therapy (RT). Regional lymph nodes and peritoneal cytology were sampled in 62.8% and 83.7% of cases, respectively. Most patients had Stage III--IV disease (83.7%) or unfavorable histology tumors (74.4%). None had evidence of extra-abdominal disease. All patients received 4-6 cycles of chemotherapy as the sole adjuvant therapy, consisting primarily of cisplatin and doxorubicin. Recurrent disease sites were divided into pelvic (vaginal, nonvaginal) and extrapelvic (para-aortic, upper abdomen, liver, and extra-abdominal). Median follow-up was 27 months (range, 2--96 months). RESULTS: Twenty-nine women (67.4%) relapsed. Seventeen (39.5%) recurred in the pelvis and 23 (55.5%) in extrapelvic sites. The 3-year actuarial PVR rate was 46.5%. The most significant factors correlated with PVR were cervical involvement (CI) (p = 0.01) and adnexal (p = 0.05) involvement. Of the 17 women who developed a PVR, 8 relapsed in the vagina, 3 in the nonvaginal pelvis, and 6 in both. The 3-year vaginal and nonvaginal PVR rates were 37.8% and 26%, respectively. The most significant factor correlated with vaginal PVR was CI (p = 0.0007). Deep myometrial invasion (p = 0.02) and lymph nodal involvement (p = 0.03) were both correlated with nonvaginal PVR. Nine of the 29 relapsed patients (31%) developed PVR as their only (6) or first site (3) of recurrence. Factors associated with a higher rate of PVR (as the first or only site) were CI and Stage I--II disease. CONCLUSIONS: PVR is common in high-risk pathologic Stage I-IV endometrial cancer patients after adjuvant chemotherapy alone. These results support the continued use of locoregional RT in patients undergoing adjuvant chemotherapy. Further studies are needed to test the addition of chemotherapy to locoregional RT.

7
UI - 21118887
AU - Bertone ER; Hankinson SE; Newcomb PA; Rosner B; Willet WC; Stampfer MJ; Egan KM
TI - A population-based case-control study of carotenoid and vitamin A intake and ovarian cancer (United States).
SO - Cancer Causes Control 2001 Jan;12(1):83-90
AD - Department of Boistatistics and Epidemiology, University of Massachusetts, Amherst 01003-9304, USA. elizabeth.bertone@channing.harvard.edu
OBJECTIVE: To evaluate the association between dietary intake of carotenoids and vitamin A and the incidence of ovarian cancer. METHODS: We conducted a population-based case-control study of ovarian cancer in Massachusetts and Wisconsin. Incident cases diagnosed between 1991 and 1994 were identified through statewide tumor registries. We selected community controls at random from lists of licensed drivers and Medicare recipients; 327 cases and 3129 controls were included in the analysis. Data were collected by telephone interview, which included an abbreviated food and supplement list to quantify typical consumption of carotenoids (lutein/zeaxanthin, alpha-carotene, beta-carotene), retinol and total vitamin A at 5 years prior to diagnosis in cases, or to a comparable reference date in controls. Results were adjusted for age, state, and other risk factors. RESULTS: Participants with the highest dietary intake of lutein/zeaxanthin (> or =24,000 microg/week) experienced a 40% lower risk of ovarian cancer (95% CI = 0.36-0.99) compared to those with the lowest intake. Intake of alpha-carotene, beta-carotene, retinol and total vitamin A was unrelated to risk. Among foods, we observed non-significantly lower risks with high consumption of spinach, carrots, skim/lowfat milk and liver. CONCLUSION: These results support previous findings suggesting an inverse relationship between carotenoid intake and ovarian cancer risk.

8
UI - 21230099
AU - Monsonego J
TI - Global challenges of cervical cancer prevention.
SO - Clin Exp Obstet Gynecol 2001;28(1):5-13

9
UI - 21369414
AU - Lalloo F; Evans G
TI - Molecular genetics and endometrial cancer.
SO - Best Pract Res Clin Obstet Gynaecol 2001 Jun;15(3):355-63
AD - Department of Clinical Genetics, St Mary's Hospital, Hathersage Rd, Manchester, M13 0JH, UK.
Endometrial cancer is the ninth most common malignancy in females. Inherited forms of this malignancy exist. Mutations in mismatch repair genes result in hereditary non-polyposis colorectal cancer, which confers a lifetime risk of bowel cancer between 60-80% and an endometrial cancer risk of up to 60%. Current screening involves the use of transvaginal ultrasound and hysteroscopy. Genetic testing for mutations in the mismatch repair genes is available, and if a pathogenic change is found within a family, predictive testing becomes available for unaffected family members. If blood samples from family members are unavailable, tumour blocks may be studied to assess microsatellite instability, a feature of mismatch repair gene mutations.While mutations in the mismatch repair genes are found in inherited endometrial cancer they are rarely seen in sporadic cancers. However, there are a range of somatic gene mutations that are currently being studied in order to provide insight into the pathogenesis of endometrial cancer. Copyright 2001 Harcourt Publishers Ltd.

10
UI - 21409437
AU - Perez LA
TI - Genital HPV: links to cervical cancer, treatment, and prevention.
SO - Clin Lab Sci 2001 Summer;14(3):183-6; quiz 193
AD - Medical Technologist at Esoterix Infectious Disease Center, San Antonio, TX, USA. lperezwork@hotmail.com
Human papillomavirus is one of the most prevalent sexually transmitted viruses. It consists of over 230 different subtypes and infects the squamous epithelial cells in humans producing cutaneous, mucosal, and epidermodysplasia verruciformis type infections. There are several risk factors for human papillomavirus infections. These include a sexually active life-style beginning at a young age, having multiple lifetime sex partners, having sex with a partner with genital warts, and long term oral contraceptive use. Approximately 80% of sexually active individuals acquire the virus in their lifetime. Clinical and laboratory detection of the virus consists of macroscopic, serologic, and molecular techniques. Although removal of the lesions is preferable, treatment of human papillomavirus infections may include cryotherapy, loop electrosurgical excision procedure, laser surgery, and drug therapy. Certain human papillomavirus subtypes, particularly human papillomavirus 16, have been linked to cervical cancer, therefore, prophylactic and therapeutic vaccines are currently being developed to prevent or fight the virus.

11
UI - 21415206
AU - Smith ED; Phillips JM; Price MM
TI - Screening and early detection among racial and ethnic minority women.
SO - Semin Oncol Nurs 2001 Aug;17(3):159-70
AD - University of Illinois, Chicago College of Nursing, Chicago, IL, USA.
OBJECTIVES: To highlight sociocultural factors reported to influence and strategies to promote breast and cervical cancer screening and early detection behaviors of racial and ethnic minority women. DATA SOURCES: Published articles, book chapters, and reports. CONCLUSIONS: The most successful strategies for promoting screening and early detection among racial and ethnic minority women are collaborative and include approaches that are culturally sensitive and appropriate. NURSING IMPLICATIONS: Intercultural and intracultural differences in racial and ethnic minority women challenge nurses to explore strategies that focus on the health care provider, the health care delivery system, and the individual woman within the context of the woman's culture.

12
UI - 21411239
AU - Kaunitz AM
TI - Oral contraceptive use in perimenopause.
SO - Am J Obstet Gynecol 2001 Aug;185(2 Suppl):S32-7
AD - Gynecology, Menopause and Bone Density Services, Medicus Diagnostic Center, Department of Obstetric and Gynecology, University of Florida Health Science Center, Jacksonville, FL 32209, USA.
Perimenopause represents a transition period lasting about 5 years before the permanent cessation of spontaneous menses. During this transition, the emphasis of clinical care changes. Although women still need effective contraception during perimenopause, issues including loss of bone mineral density, menstrual cycle changes, and vasomotor instability also need to be addressed. Hormone replacement therapy is not the first-line treatment for women with symptomatic perimenopause because hormone replacement therapy neither suppresses ovulation nor provides contraception; also, it will not prevent and in fact may aggravate unpredictable perimenopausal bleeding. Oral contraceptives offer many benefits for healthy, nonsmoking, perimenopausal women. Oral contraceptive use by women in their 40s has been found to decrease the risk of postmenopausal hip fractures and regularize menses in women with dysfunctional uterine bleeding, reducing the need for surgical intervention for benign menstrual conditions. Use of oral contraceptives also can reduce long-term risk of endometrial and ovarian cancers. There is also good evidence that oral contraceptives relieve vasomotor symptoms in perimenopausal women. Oral contraceptives can be viewed as a strategy not only to improve perimenopausal symptoms, provide effective contraception, and reduce some long-term health risks, but also to enhance the quality of life for perimenopausal women.

13
UI - 20531235
AU - Check W
TI - Opening the door to HPV testing.
SO - CAP Today 2000 Oct;14(10):1, 58, 62-4, passim

14
UI - 20386417
AU - Videlefsky A; Grossl N; Denniston M; Sehgal R; Lane JM; Goodenough G
TI - Routine vaginal cuff smear testing in post-hysterectomy patients with benign uterine conditions: when is it indicated?
SO - J Am Board Fam Pract 2000 Jul-Aug;13(4):233-8
AD - Department of Family and Preventive Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA 30335, USA.
BACKGROUND: By the age of 60 years, an estimated 33% of women will have undergone a hysterectomy. Approximately 85% of these hysterectomies are performed for benign disease. The object of this study was to evaluate cytologic findings from vaginal cuff smears in patients who have undergone hysterectomy for benign uterine conditions. METHODS: We conducted a community-based retrospective study and follow-up of women with vaginal cuff cytologic smears who had had a hysterectomy for benign uterine conditions. A total of 220 women were randomly selected who had one or more vaginal cuff smears. The main outcomes measures were invasive carcinoma, dysplastic lesions, and infections detected by vaginal cuff smear testing. The setting was a large inner-city hospital. RESULTS: Ninety-seven percent of 220 women who underwent hysterectomy for benign uterine conditions and who were observed for an average of 89 months had no cytologic abnormalities on vaginal cuff smears. Cytologic evaluation found no invasive carcinomas. Dysplastic lesions were detected in 7 patients (3%). Seventy percent of patients (n = 154) had one or more infections; these infections included bacterial vaginosis (106), trichomoniasis (95), candidiasis (40), koilocytosis suggestive of human papilloma virus (HPV) infection (3), and cytopathic effect of herpes (4). The prevalence of koilocytosis was much higher in the patients with dysplasia (P = .0003). CONCLUSIONS: Most routine vaginal cuff cytology screening tests need not be performed in women who have had a hysterectomy for benign uterine conditions.

15
UI - 20386418
AU - Giroux J; Welty TK; Oliver FK; Kaur JS; Leonardson G; Cobb N
TI - Low national breast and cervical cancer-screening rates in American Indian and Alaska Native women with diabetes.
SO - J Am Board Fam Pract 2000 Jul-Aug;13(4):239-45
AD - Epidemiology Program, Aberdeen Indian Health Service Area, Rapid City, SD, USA.
BACKGROUND: The cervical cancer mortality rate for American Indian and Alaska Native women is twice that of all races in the United States. To date the only published national breast and cervical cancer-screening rates for American Indian and Alaska Native women are based on self-reported data. When the Indian Health Service (IHS) conducts an annual audit on patients with diabetes, it includes cancer screening. This observational study presents national breast and cervical cancer-screening rates for American Indian and Alaska Native women with diabetes. METHODS: Cancer-screening rates were extracted from the 1995 diabetic audit for the 12 IHS areas. These rates were compared with rates for women without diabetes of the same age, 50 to 69 years, by chart review, at four IHS hospitals in the Aberdeen IHS area. RESULTS: Screening rates for women with diabetes in the 12 areas varied: mammogram (ever) 35% to 78%; clinical breast examination (last year) 28% to 70%, and Papanicolaou smear (last year) 26% to 69%. The Aberdeen IHS area women with diabetes had 51% more clinic visits per year than women without diabetes, but the groups had similar screening rates. CONCLUSION: Cancer-screening rates for American Indian and Alaska Native women vary by region. In the Aberdeen IHS area, women with diabetes had more visits (missed opportunities) but similar screening rates as women without diabetes. The diabetic audit could be used to monitor national IHS cancer-screening trends for women with diabetes and in the Aberdeen IHS area for all women aged 50 to 69 years.

16
UI - 21003411
AU - Samuelson P
TI - Cancer screening rates.
SO - J Am Board Fam Pract 2000 Nov-Dec;13(6):468-9

17
UI - 21323102
AU - Twinn S
TI - The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge.
SO - J Adv Nurs 2001 Apr;34(2):230-7
AD - Department of Nursing, Chinese University of Hong Kong, Shatin, China. sftwinn@cuhk.edu.hk
AIM: This paper examines the methodological issues arising from an evaluation of the effectiveness of a health education project undertaken to increase Hong Kong Chinese women's knowledge of the prevention of cervical cancer and the uptake of screening. BACKGROUND: The significance of health promotion to the prevention of diseases currently affecting contemporary society has become increasingly recognized. Within the context of health promotion health education continues to provide an important preventive strategy. Indeed the leading causes of mortality such as coronary heart disease and cancer lend themselves well to health education interventions. However the evaluation of the effectiveness of health education remains complex and raises some important methodological issues. DESIGN: The project used a health education intervention as the major preventive strategy and employed multiple methods of evaluation to assess its effectiveness. Outcome evaluation consisted of a confidential questionnaire administered at two points in time to measure changes in health-related behaviour and knowledge. It also included the collection of data from service providers to assess changes in the uptake of cervical cancer screening. Process evaluation involved the use of focus groups with randomly selected groups of women who had participated in the health education intervention and a diary kept by the project nurse. FINDINGS: Methodological issues identified in the evaluation of the project included the extent to which changes in health-related knowledge and behaviour could be attributed to the intervention, the sensitivity of outcome measures and challenges in developing methods of process evaluation appropriate to the target population. CONCLUSIONS: The findings highlight the complexity of designing effective evaluation strategies for health education and the need to consider these issues in the development of both process and outcome evaluation.

18
UI - 21254125
AU - Marino JF; Fremont-Smith M
TI - Direct-to-vial experience with AutoCyte PREP in a small New England regional cytology practice.
SO - J Reprod Med 2001 Apr;46(4):353-8
AD - Seacoast Pathology P.A., 1 Hampton Road, Suite 108, Exeter, NH 03833, USA.
OBJECTIVE: To evaluate and assess the efficiency and efficacy of the AutoCyte PREP thin-layer Pap test method (TriPath Imaging, Inc., Burlington, North Carolina) in a privately owned cytology laboratory. STUDY DESIGN: Data from 35,496 conventional Pap smear preparations performed in 1999 were compared to 6,357 conventional Pap smears and 15,534 AutoCyte PREP cases that were collected, prepared and processed from January 1 to July 31, 2000. RESULTS: The AutoCyte PREP demonstrated a statistically significant increased detection of low grade squamous intraepithelial lesions (LSIL) (47%) (P = .0011) and high grade squamous intraepithelial lesions (HSIL) (116%) (P = .0002) when compared to conventional Pap smears processed during the same time period. When compared to the conventional Pap smears from 1999, the LSIL lesions increased by 57% (P < .00001), and the HSIL lesions increased by 55% (P = .0002). Both increases are statistically significant. The atypical squamous cells of undetermined significance (ASCUS)/LSIL ratio was reduced by 48% (P < .00001) using AutoCyte PREP when compared to the 1999 conventional Pap smear experience. The unsatisfactory rate was reduced by 70%. AutoCyte PREP demonstrated improved histologic correlation in HSIL cases. CONCLUSION: AutoCyte PREP was significantly more effective than the conventional Pap smear for the detection of both LSIL and HSIL. The ASCUS/LSIL ratio and unsatisfactory cases were also significantly reduced.

19
UI - 21249655
AU - Newman LA; Kuerer HM; Hunt KK; Vlastos G; Ames FC; Ross MI; Singletary SE
TI - Educational review: role of the surgeon in hereditary breast cancer.
SO - Ann Surg Oncol 2001 May;8(4):368-78
AD - Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Up to 10% of the breast cancers detected in the United States are related to an inherited germline mutation, usually in the BRCA1 or BRCA2 genes, and the majority of these patients will at some point require surgical evaluation and/or treatment. Women who harbor a genetic predisposition for breast cancer face an increased risk for early onset disease, bilateral tumors, and other non-breast malignancies, such as ovarian cancer. These issues raise questions regarding the appropriate surveillance regimen, and the potential efficacy of risk reduction strategies that should be considered. Once a breast cancer diagnosis has been established, the prognosis appears to be similar to stage-controlled sporadic breast cancer, despite an increased prevalence of adverse primary tumor features. However, the role of breast conservation therapy for these patients and the optimal means of addressing the substantially increased risk for contralateral tumors is not yet defined. The reported literature in this area, including a discussion of the value of genetic counseling and genetic testing, is reviewed.

20
UI - 21259769
AU - Raffle AE
TI - Information about screening - is it to achieve high uptake or to ensure informed choice?
SO - Health Expect 2001 Jun;4(2):92-8
AD - Consultant in Public Health Medicine, Avon Health Authority, King Square House, Bristol, UK.
For many years, public information about screening has been aimed at achieving high uptake but concerns are now being raised about this approach. There are several problems that have prompted these concerns. By giving information that emphasizes only the positive aspects of screening the autonomy of individuals is ignored, individuals feel angry when they perceive that they are let down by screening, symptoms may be disregarded because of the belief that screening gives full protection, health service staff carry the blame for problems that are in fact inherent in screening, and sound debate about policy and investment in screening is hampered by misunderstanding about the benefits and costs of screening. If we adopt instead an approach that makes explicit the limitations and adverse effects then a different set of problems will be encountered. We risk a reduction in uptake of screening and thus population benefits may reduce, those most likely to be deterred from accepting screening may be the most socially disadvantaged, there will be a cost in terms of staff time to explain screening more fully to participants, and cost-effectiveness could be reduced if uptake falls so low as to make services barely viable. In the UK current General Medical Council (GMC) advice to doctors about informed consent for screening makes it clear that full information should be given. The UK National Screening Committee has also signalled the need for a changed approach to information giving so that individuals are offered a choice based on appreciation of risks and benefits. It will take time for this approach to be fully reflected across the full range of UK screening programmes. New national information will be needed to assist staff in giving full information, and some aspects of policy, such as screening coverage targets for Health Authorities and General Practitioners, will need to be altered. There are many questions still to be answered about the kind of information needed to achieve informed participation, and about how it should be framed and communicated. These questions can begin to be addressed when there is clarity at national level about the purpose of information about screening.

21
UI - 21430216
AU - Moore KJ
TI - Medicare expands preventive screening benefits.
SO - Fam Pract Manag 2001 Jun;8(6):16

22
UI - 21320829
AU - Goldie SJ; Kuhn L; Denny L; Pollack A; Wright TC
TI - Policy analysis of cervical cancer screening strategies in low-resource settings: clinical benefits and cost-effectiveness.
SO - JAMA 2001 Jun 27;285(24):3107-15
AD - Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Ave, Suite 2, Boston, MA 02115-5924, USA. sgoldie@hsph.harvard.edu
CONTEXT: Cervical cancer is a leading cause of cancer-related death among women in developing countries. In such low-resource settings, cytology-based screening is difficult to implement, and less complex strategies may offer additional options. OBJECTIVE: To assess the cost-effectiveness of several cervical cancer screening strategies using population-specific data. DESIGN AND SETTING: Cost-effectiveness analysis using a mathematical model and a hypothetical cohort of previously unscreened 30-year-old black South African women. Screening tests included direct visual inspection (DVI) of the cervix, cytologic methods, and testing for high-risk types of human papillomavirus (HPV) DNA. Strategies differed by number of clinical visits, screening frequency, and response to a positive test result. Data sources included a South African screening study, national surveys and fee schedules, and published literature. MAIN OUTCOME MEASURES: Years of life saved (YLS), lifetime costs in US dollars, and incremental cost-effectiveness ratios (cost per YLS). RESULTS: When analyzing all strategies performed as a single lifetime screen at age 35 years compared with no screening, HPV testing followed by treatment of screen-positive women at a second visit, cost $39/YLS (27% cancer incidence reduction); DVI, coupled with immediate treatment of screen-positive women at the first visit was next most effective (26% cancer incidence reduction) and was cost saving; cytology, followed by treatment of screen-positive women at a second visit was least effective (19% cancer incidence reduction) at a cost of $81/YLS. For any given screening frequency, when strategies were compared incrementally, HPV DNA testing generally was more effective but also more costly than DVI, and always was more effective and less costly than cytology. When comparing all strategies simultaneously across screening frequencies, DVI was the nondominated strategy up to a frequency of every 3 years (incremental cost-effectiveness ratio, $460/YLS), and HPV testing every 3 years (incremental cost-effectiveness ratio, $11 500/YLS) was the most effective strategy. CONCLUSION: Cervical cancer screening strategies that incorporate DVI or HPV DNA testing and eliminate colposcopy may offer attractive alternatives to cytology-based screening programs in low-resource settings.

23
UI - 21381633
AU - Moysich KB; Mettlin C; Piver MS; Natarajan N; Menezes RJ; Swede H
TI - Regular use of analgesic drugs and ovarian cancer risk.
SO - Cancer Epidemiol Biomarkers Prev 2001 Aug;10(8):903-6
AD - Department of Cancer Prevention, Epidemiology and Biostatistics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA. kirsten.moysich@roswellpark.org
Analgesics have been shown to reduce risk for colorectal cancer. Results from three recent reports (D. W. Cramer et al., Lancet, 351: 104-107, 1998; C. Rodriguez et. al., Lancet, 352: 1354-1355, 1998; L. Rosenberg et al., Cancer Epidemiol. Biomark. Prev., 9: 933-937, 2000) suggest that these drugs might be associated with decreased risk for ovarian cancer. In this hospital-based case-control study, we compared 547 patients with ovarian cancer to 1094 age-matched patients with nonneoplastic conditions. All of the participants received treatment at the Roswell Park Cancer Institute between 1982 and 1998 and completed a comprehensive epidemiological questionnaire that included information on demographics, life-style factors, and reproductive characteristics as well as frequency and duration of aspirin and acetaminophen use. Women who reported that they had used one or more of these agents at least once a week for at least 6 months were classified as analgesic users. Logistic regression was used to compute crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Aspirin users were not at reduced risk of ovarian cancer compared with nonusers (adjusted OR, 1.00; CI, 0.73-1.39). There was also no evidence of a decrease in risk as a function of greater frequency of use or prolonged duration of use. Regular acetaminophen use was associated with a reduced risk (adjusted OR, 0.56; 95% CI, 0.34-0.86), and risk reductions were observed for women with the greatest frequency of use (adjusted OR, 0.32; 95% CI, 0.09-1.08) and longest duration of use (adjusted OR, 0.51; 95% CI, 0.27-0.97). These data suggest that regular use of acetaminophen, but not aspirin, may be associated with lower risk of ovarian cancer.

24
UI - 21396251
AU - Berry DA
TI - Role of population-based studies in assessing genetic cancer risk.
SO - J Natl Cancer Inst 2001 Aug 15;93(16):1188-9

25
UI - 21433659
AU - Julian-Reynier CM; Bouchard LJ; Evans DG; Eisinger FA; Foulkes WD; Kerr B; Blancquaert IR; Moatti JP; Sobol HH
TI - Women's attitudes toward preventive strategies for hereditary breast or ovarian carcinoma differ from one country to another: differences among English, French, and Canadian women.
SO - Cancer 2001 Aug 15;92(4):959-68
AD - INSERM U379, Epidemiology and Social Sciences Applied to Medical Innovation, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite, 13273 Marseilles cedex 9, France. julian@marseille.inserm.fr
BACKGROUND: The authors investigated the acceptability to women of the preventive strategies available for dealing with hereditary breast/ovarian carcinoma in France, the United Kingdom, and Canada, countries selected because of their cultural differences. The authors aimed to discover the existence of specific factors that may affect acceptability of these preventative measures. METHODS: A cross-sectional, multicenter survey was conducted in Marseilles, France (n = 141), in Manchester, England (n = 130), and in Montreal, Quebec (n = 84). All of the women attending cancer genetic clinics for the first time because of a family history of breast-ovarian carcinoma completed a self-administered questionnaire before their clinic consultation. RESULTS: Variations in responses to different preventative options presented on the questionnaire were seen within the sample of patients considered as a whole. The highest levels of acceptability were obtained for mammographic screening (87%) and chemoprevention (58%). In contrast, prophylactic oophorectomy and prophylactic mastectomy were thought to be acceptable at an early age (before 35 years), an age associated with the highest prophylactic efficacy, by only 19% and 16% of the respondents, respectively. After multivariate adjustment, the statistical data showed that the British respondents were more in favor of oophorectomy (P < 0.0001) and more in favor of chemoprevention than the French (P < 0.001) and the Canadian respondents (P < 0.001). The British (overall adjusted response [OR(adj)] = 3.9; P < 0.001) and Canadian respondents (OR(adj) = 3; P < 0.01) were more in favor of prophylactic mastectomy than the French. The cumulated acceptability of mammography before the age of 40 years was found to be greater in the French (OR(adj) = 2.8; P < 0.01) and Canadian (OR(adj) = 3.1; P < 0.05) samples than in the British sample. CONCLUSION: These results demonstrated the existence of international variations in the acceptability of the preventive strategies available for women at risk for hereditary breast/ovarian carcinoma. Therefore, these results suggested that when establishing medical recommendations or planning public health interventions, physicians must integrate the population's perception of advantages and drawbacks with the patient's individual decision making. Copyright 2001 American Cancer Society.

26
UI - 20518153
AU - Regan J; Lefkowitz B; Gaston MH
TI - Cancer screening among community health center women: eliminating the gaps.
SO - J Ambulatory Care Manage 1999 Oct;22(4):45-52
AD - Office of Data, Evaluation, Analysis and Research, Health Resources and Services Administration, U.S. Department of Health and Human Services, Bethesda, Maryland, USA.
OBJECTIVE: The elimination of health status gaps among minority and low income populations is part of the mission of community health centers (CHCs). Cervical and breast cancer incidence and mortality are related to both minority and socioeconomic status, and CHCs are in a unique position, by virtue of their target population, to effect positive outcomes through screening and early detection. METHODS: Completed in 1995, the survey described in this article included questions from the 1992 NHIS Cancer Supplement, which collected information on the utilization of cancer-screening services, including Pap smear testing, mammography, and clinical breast examination. RESULTS: CHCs are providing access to Pap smear testing, mammography, and clinical breast examination for women who are at an increased risk for morbidity and mortality associated with cancers of the cervix and breast. A higher proportion of CHC women of most racial and ethnic groups and women below poverty level are up to date on cancer screening than comparison groups. In most cases, CHC women meet or exceed the Healthy People 2000 objectives for the nation.

27
UI - 20487065
AU - Steven Piver M
TI - Insurance policies for prophylactic mastectomy: to cover or not to cover?
SO - Ann Surg Oncol 2000 Oct;7(9):714

28
UI - 21395428
AU - Onega T
TI - How does menopause alter the primary care of women?
SO - JAAPA 2000 Apr;13(4):42-4, 47-8, 51-4 passim
AD - Physician Assistant Program, University of Iowa, Iowa City, USA.

29
UI - 21387132
AU - Sasco AJ
TI - [Screening for cancer: from guidelines to practice]
SO - Bull Cancer 2001 Jul;88(7):643-4
AD - Unite d'epidemiologie pour la prevention du cancer, Centre international de recherche, Institut national de la sante et de la recherche medicale, 150, cours Albert-Thomas, 69372 Lyon Cedex 8, France.

30
UI - 21387140
AU - Micksche M; Lynge E; Diehl V; Estape J; Vertio H; Faivre J; Papamichail M; Daly PA; Veronesi U; Dicato M; Kroes R; Limbert E; Holm LE; Vandenbroucke A; Davies T; Groupe des Experts Cancerologues de l'Union Europeenne
TI - [Recommendations on cancer screening in the European Union]
SO - Bull Cancer 2001 Jul;88(7):687-92

31
UI - 21426769
AU - Vainio H; Bianchini F
TI - Physical activity and cancer prevention -- is 'no pain, no gain' passe?
SO - Eur J Cancer Prev 2001 Aug;10(4):301-2

32
UI - 21426770
AU - La Vecchia C
TI - Oral contraceptives, cancer and vascular disease.
SO - Eur J Cancer Prev 2001 Aug;10(4):303-5