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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Gynecologic Neoplasms - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
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.
2
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.
3
UI - 21454124
AU - Gjorgov AN
TI -
Tubal ligation and risk of ovarian cancer.
SO - Lancet 2001 Sep 8;358(9284):843-4; discussion 844
4
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.
5
UI - 21270631
AU - Sasieni P; Cuzick J
TI -
Routine audit is an ethical requirement of screening.
SO - BMJ 2001 May 12;322(7295):1179
6
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.
7
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
8
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
9
UI - 20487065
AU - Piver MS
TI -
Insurance policies for prophylactic mastectomy: to cover or not to
cover?
SO - Ann Surg Oncol 2000 Oct;7(9):714
10
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.
11
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. mfoxall@unmc.edu
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.
12
UI - 21433044
AU - Solomon R
TI -
New procedure under study may replace Pap smear.
SO - Posit Living 2001 Apr;10(3):34
13
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. tgfb@ukl.uni-freiburg.de
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.
14
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.
15
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.
16
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.
17
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.
18
UI - 21454918
AU - Anonymous
TI -
Cervical cancer and the Pap test.
SO - N C Med J 2001 Sep-Oct;62(5):277-8
19
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. ds87v@nih.gov
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.
20
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.
21
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.
22
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.
23
UI - 21469910
AU - Quillin JM; Boardman CH; Bodurtha J; Smith T
TI -
Preventive gynecologic surgery for BRCA1/2 carriers--information for
decision-making.
SO - Gynecol Oncol 2001 Oct;83(1):168-70
24
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.
25
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.
26
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.
27
UI - 97274036
AU - Healy B
TI -
BRCA genes--bookmaking, fortunetelling, and medical care.
SO - N Engl J Med 1997 May 15;336(20):1448-9
28
UI - 97346100
AU - Raffle AE
TI -
Informed participation in screening is essential.
SO - BMJ 1997 Jun 14;314(7096):1762-3
29
UI - 98141534
AU - Anonymous
TI -
The screening muddle.
SO - Lancet 1998 Feb 14;351(9101):459
30
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.
ongdge@ar.vub.ac.be
31
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.
32
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.
33
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.
34
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.
35
UI - 20539581
AU - Julian-Reynier C; Eisinger F; Evans G; Foulkes W; Sobol H
TI -
Variation in prophylactic surgery decisions.
SO - Lancet 2000 Nov 11;356(9242):1687
36
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.
dcramer@partners.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.
37
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. otp@path.org
38
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
39
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.
patrice.mathevet@chu-lyon.fr
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.
40
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.
cgo@chu-amiens.fr
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.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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