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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Gynecologic Neoplasms - March 2002
National Cancer Institute®
Last Modified: March 1, 2002
Table of Contents
1
UI - 11817905
AU - Anonymous
TI -
Page for patients. Oral contraceptives.
SO - Prev Med 2002 Feb;34(2):125-6
2
UI - 11481905
AU - Szentirmay Z; Cseh J; Pulay T; Kasler M
TI -
[Human papillomavirus and cervical cancer: genetic background of the
neoplastic process]
SO - Orv Hetil 2001 Jul 8;142(27):1429-36
AD - Orszagos Onkologiai Intezet, Budapest.
In a 2-year period, 136 HPV positive cytological samples of the cervix
uteri were analyzed at the Department of Molecular Pathology, National
Institute of Oncology, Hungary. Comparison with the international data
obtained from the literature revealed that the Hungarian epidemiological
data bore closest resemblance to the European ones except some
differences. The HPV18 is rather seldom encountered in this country.
Similarly low occurrence was noted only in Japan. However, the 14.1%
occurrence rate of HPV58 in Hungary is by far higher than that in any
other country in this analysis except Japan where this virus is of
similarly high frequency. In Hungary, the incidence of HPV59 is
relatively high just like in Central and South America. HPV33 and HPV66
infections occur in a significantly higher number with Hungary than in
any of the countries studied. In our study The European type variant of
HPV16 (E-V-350G) occurred in 2/10 CIN II-III cases. The authors also
compared the various clinico-pathological grouping of HPV types
published, and identified several inconsistencies. Viruses considered to
have high risk occurred in intact epithelium, CIN I-II-III and carcinoma
alike. The general tendency was, however, that certain viruses
correlated with specific clinico-pathological entities. At present there
is no reason to include the PCR-based HPV typing in the mass screening
of cervical cancers. HPV typing and physical state of the virus can
reasonable be determined if the cervical cytology is suspect for HPV
infection or even control examination after "loop" conisation. Negative
cytology completed with negative HPV-DNA test means the lack of cancer
risk even in the case of a previously removed CIN or carcinoma. However,
a positive HPV test detected after conisation associated with negative
cytology finding indicates a risk of 70% of the development of CIN
within 2 years.
3
UI - 11843936
AU - Cruickshank ME
TI -
Is cervical screening necessary in older women?
SO - Cytopathology 2001 Dec;12(6):351-3
4
UI - 11843937
AU - McGahan CE; Blanks RG; Moss SM
TI -
Reasons for variation in coverage in the NHS cervical screening
programme.
SO - Cytopathology 2001 Dec;12(6):354-66
AD - Cancer Screening Evaluation Unit, Institute of Cancer Research, Section
of Epidemiology, Sutton, UK.
In order to investigate reasons for variation in coverage of cervical
screening, data from standard Department of Health returns were obtained
for all Health Authorities for 1998/1999. Approximately 80% of the
variation between health authorities is explained by differences in age
distribution and area classification. Considerable differences between
Health Authority and Office of National Statistics (ONS) population
figures in City and Urban (London) areas for the age group 25-29 years
and for City (London) for age group 30-34 years, suggest an effect of
list inflation in these groups. Coverage as a performance indicator may
be more accurately represented using the age range 35-64 years. Using
this narrower age range, the percentage of health authorities meeting
the 80% 5-year coverage target increases from 87% to 90%.
5
UI - 11843938
AU - Wordsworth S; Ryan M; Waugh N
TI -
Costs and benefits of cervical screening IV: valuation by women of the
cervical screening programme.
SO - Cytopathology 2001 Dec;12(6):367-76
AD - Health Economics Research Unit, University of Aberdeen, UK.
s.wordsworth@abdn.ac.uk
OBJECTIVES: To assess the value of the cervical smear test to women,
taking account of the positive and negative aspects of the cervical
screening service. DESIGN: A postal survey. SETTING: Tayside Health
Board region of Scotland. PARTICIPANTS: A sample of 2000 women aged
20-59. MAIN OUTCOME MEASURES: Maximum willingness to pay (WTP) for a
cervical smear test. RESULTS: Women were prepared to pay 50.20 British
pounds per smear on a 3-yearly basis. Willingness to pay was positively
related to income, but unrelated to age and whether or not the
respondent had previously had a smear. CONCLUSIONS: Previous studies
have estimated the cost per screen or cost per life year saved by
cervical screening. This study used the economic instrument of WTP to
take account of other potential (dis)benefits to women. The value women
place on having a smear was more than the cost to the National Health
Service (NHS) of providing the service. The output of a WTP study is
potentially useful at the policy level. Future work should explore both
the value of alternative approaches to cervical screening, and the value
of competing health care interventions.
6
UI - 11843939
AU - Migliore G; Rossi E; Aldovini A; Mudu P; Alderisio M; Giovagnoli MR;
TI -
Fabiano A; Morosini PL; Branca M
Variation in the assessment of adequacy in cervical smears.
SO - Cytopathology 2001 Dec;12(6):377-82
AD - Laboratory of Epidemiology and Biostatistics, Cytopathology Unit,
National Institute of Health, Rome, Italy.
OBJECTIVE: To assess the interobserver reproducibility of the diagnosis
of 'adequacy' of cervical smears according to the Bethesda System
criteria in cervical smears. STUDY DESIGN: 358 cervical smears were
obtained from three Italian cytopathological centres in 1998-99. All
centres provided consecutively collected smears. The cervical smears
were independently and blindly assessed by four cytologists.The
screening was performed using a 10x objective and an additional
evaluation of the percentage of cellularity was performed using a 4x
objective. RESULTS: The proportion of smears assessed by the four
cytologists as 'adequate' ranged from 60% to 70%, the proportion of
'satisfactory for evaluation but limited by' ranged from 27% to 38%, and
the proportion of 'inadequate smears' ranged from 2% to 4%. Full
agreement in the assessment of smear adequacy was observed in 311 slides
and disagreement was observed only in 47. The category 'inadequate
smear' was less reliable than the other two; however, the kappa value
observed was acceptable. CONCLUSION: The present study shows that it is
possible to achieve a high reproducibility in the assessment of smear
adequacy, at least among expert cytologists who follow the Bethesda
System criteria strictly.
7
UI - 11843940
AU - Herbert A; Johnson J
TI -
Personal view. Is it reality or an illusion that liquid-based cytology
is better than conventional cervical smears?
SO - Cytopathology 2001 Dec;12(6):383-9
AD - Histopathology Department, Guy's and St Thomas' Hospitals NHS Trust,
London, UK.
Liquid-based cytology (LBC) has been heralded as the way forward for
cervical screening, and as the answer to many of its problems. It is
already used as a sole method of cell preparation in many private
clinics in the UK. It is being used for colposcopy smears in many NHS
clinics and is now being piloted for primary screening in three
screening centres in England, as well as one in Scotland and one in
Wales. LBC has been welcomed as a new technology because it deals with
the problem of specimen adequacy at source, removing responsibility for
slide preparation and fixation from the clinician or nurse. It provides
uniformly well-fixed preparations that are free of inflammatory exudate
and blood, and seem easier to screen than conventional smears. There are
many articles in the world literature suggesting that LBC is more
accurate than conventional screening, and it is thought likely to reduce
the number of false negative tests. The main reasons for piloting LBC in
the NHS Cervical Screening Programme (NHSCSP) lie in its potential for
reducing screening times and for reducing the numbers of repeats for
inadequate tests. LBC is expensive in terms of equipment, capital costs,
maintenance, consumables, training, technical preparation time,
transportation and disposal of liquid media. Its costs could be
justified if they were offset by the money saved from reduced screening
time and repeat tests, but only if its accuracy in terms of sensitivity
and specificity were proven to be equal to or better than conventional
cytology. Although that is generally held to be true by the public and
medical profession alike, there is very little hard evidence to support
it.
8
UI - 11843944
AU - Mania E; Placidi A; Manca G
TI -
Procedures of rapid rescreening of Pap smears.
SO - Cytopathology 2001 Dec;12(6):410
9
UI - 11169969
AU - Bergstrom A; Pisani P; Tenet V; Wolk A; Adami HO
TI -
Overweight as an avoidable cause of cancer in Europe.
SO - Int J Cancer 2001 Feb 1;91(3):421-30
AD - Department of Medical Epidemiology, Karolinska Institute, Stockholm,
Sweden.
There is growing evidence that excess body weight increases the risk of
cancer at several sites, including kidney, endometrium, colon, prostate,
gallbladder and breast in post-menopausal women. The proportion of all
cancers attributable to overweight has, however, never been
systematically estimated. We reviewed the epidemiological literature and
quantitatively summarised, by meta-analysis, the relationship between
excess weight and the risk of developing cancer at the 6 sites listed
above. Estimates were then combined with sex-specific estimates of the
prevalence of overweight [body mass index (BMI) 25-29 kg/m(2)] and
obesity (BMI > or = 30 kg/m(2)) in each country in the European Union to
obtain the proportion of cancers attributable to excess weight. Overall,
excess body mass accounts for 5% of all cancers in the European Union,
3% in men and 6% in women, corresponding to 27,000 male and 45,000
female cancer cases yearly. The attributable proportion varied, in men,
between 2.1% for Greece and 4.9% for Germany and, in women, between 3.9%
for Denmark and 8.8% for Spain. The highest attributable proportions
were obtained for cancers of the endometrium (39%), kidney (25% in both
sexes) and gallbladder (25% in men and 24% in women). The largest number
of attributable cases was for colon cancer (21,500 annual cases),
followed by endometrium (14,000 cases) and breast (12,800 cases). Some
36,000 cases could be avoided by halving the prevalence of overweight
and obese people in Europe.
10
UI - 11783689
AU - Updegrove KK
TI -
An evidence-based approach to male circumcision: what do we know?
SO - J Midwifery Womens Health 2001 Nov-Dec;46(6):415-22
AD - University of Pennsylvania Midwifery Program, USA.
Midwives care for women throughout their childbearing years, guiding
them through decisions made about themselves and their newborn children.
The decision to circumcise a male infant depends on a number of factors,
including medical, social, cultural, and religious considerations. Data
surrounding medical benefits and risks of this surgery are inconsistent
and, therefore, confusing. However, substantial data exist to support
the conclusions that uncircumcised males have greater incidences of
urinary tract infections, especially in the first 6 months of life when
complications are greatest, greater incidences of ulcerative sexually
transmitted infections, and increased transmission of human
immunodeficiency virus. This article reviews available research on the
medical benefits and risks of infant circumcision. Informed consent is
essential for all parents who must make this decision.
11
UI - 11818345
AU - Marteau TM; Hankins M; Collins B
TI -
Perceptions of risk of cervical cancer and attitudes towards cervical
screening: a comparison of smokers and non-smokers.
SO - Fam Pract 2002 Feb;19(1):18-22
AD - Psychology and Genetics Research Group, Guy's King's and St Thomas's
School of Medicine, Thomas Guy House, Guy's Campus, London SE1 9RT, UK.
OBJECTIVES: The aim of this study was to compare smokers' and
non-smokers' perceptions of risks of cervical cancer and attitudes
towards cervical screening. METHODS: A cross-sectional descriptive study
was carried out in 722 women aged between 20 and 64 years. RESULTS:
While smokers perceived their relative risk of heart disease to be
greater than that of non-smokers, they did not perceive their risks of
cervical cancer to be greater. Smokers held less positive attitudes
towards cervical screening than did non-smokers. Smokers and non-smokers
did not differ in their intentions to attend for cervical screening: for
both groups, intentions were very high. Using logistic regression
analysis, both attitudes towards cervical screening [odds ratio (OR)
1.9; 95% confidence interval (CI) 1.7-2.2] and perceived relative risk
of developing cervical cancer (OR 1.5; 95% CI 1.0-2.1) were predictive
of intentions to attend for screening, as well as educational level (OR
3.8; 95% CI 1.2-11.3) and marital status (OR 0.6; 95% CI 0.3-0.9).
CONCLUSIONS: Smokers seem unaware of their increased risks of cervical
cancer and hence the increased value for them of regular smears.
Evaluations are needed to determine the effectiveness of interventions
delivered in the context of cervical screening aimed at (i) raising
smokers' awareness of their increased risk of cervical cancer and (ii)
stopping smoking.
12
UI - 11889288
AU - Pasick RJ; Stewart SL; Bird JA; D'Onofrio CN
TI -
Quality of data in multiethnic health surveys.
SO - Public Health Rep 2001;116 Suppl 1():223-43
AD - Northern California Cancer Center, Union City 94587-3106, USA.
Rpasick@nccc.org
OBJECTIVE: There has been insufficient research on the influence of
ethno-cultural and language differences in public health surveys. Using
data from three independent studies, the authors examine methods to
assess data quality and to identify causes of problematic survey
questions. METHODS: Qualitative and quantitative methods were used in
this exploratory study, including secondary analyses of data from three
baseline surveys (conducted in English, Spanish, Cantonese, Mandarin,
and Vietnamese). Collection of additional data included interviews with
investigators and interviewers; observations of item development; focus
groups; think-aloud interviews; a test-retest assessment survey; and a
pilot test of alternatively worded questions. RESULTS: The authors
identify underlying causes for the 12 most problematic variables in
three multiethnic surveys and describe them in terms of ethnic
differences in reliability, validity, and cognitive processes
(interpretation, memory retrieval, judgment formation, and response
editing), and differences with regard to cultural appropriateness and
translation problems. CONCLUSIONS: Multiple complex elements affect
measurement in a multiethnic survey, many of which are neither readily
observed nor understood through standard tests of data quality.
Multiethnic survey questions are best evaluated using a variety of
quantitative and qualitative methods that reveal different types and
causes of problems.
13
UI - 11727171
AU - Dayal M; Barnhart KT
TI -
Noncontraceptive benefits and therapeutic uses of the oral contraceptive
pill.
SO - Semin Reprod Med 2001 Dec;19(4):295-303
AD - Department of Obstetrics and Gynecology, University of Pennsylvania
Medical Center, Philadelphia, Pennsylvania 19104, USA.
The oral contraceptive pill is one of the most extensively studied
medications ever prescribed. The health benefits are numerous and
outweigh the risks of their use. Definitive evidence exists for
protection against ovarian and endometrial cancers, benign breast
disease, pelvic inflammatory disease requiring hospitalization, ectopic
pregnancy, and iron-deficiency anemia. It has also been suggested that
oral contraceptives may provide a benefit on bone mineral density,
uterine fibroids, toxic shock syndrome, and colorectal cancer. Minimal
supportive evidence exists for oral contraceptives protecting against
the development of functional ovarian cysts and rheumatoid arthritis.
Treatment of medical disorders with oral contraceptives is an
"off-label" practice. Dysmenorrhea, irregular or excessive bleeding,
acne, hirsutism, and endometriosis-associated pain are common targets
for oral contraceptive therapy. Most patients are unaware of these
health benefits and therapeutic uses of oral contraceptives, and they
tend to overestimate their risk. Counseling and education are necessary
to help women make well-informed health-care decisions and improve
compliance.
14
UI - 11694344
AU - Legro RS
TI -
Polycystic ovary syndrome: the new millenium.
SO - Mol Cell Endocrinol 2001 Nov 26;184(1-2):87-93
AD - Department of Obstetrics and Gynecology, Pennsylvania State University
College of Medicine, M.S. Hershey Medical Center, PO Box 850, Hershey,
PA 17033, USA. rsl1@psu.edu
Our understanding of Polycystic Ovary Syndrome (PCOS) has been hampered
by varying diagnostic criteria, and ignorance of the etiology of the
syndrome. PCOS women are uniquely insulin resistant and obesity
aggravates this underlying predisposition to insulin resistance.
Diagnostic criteria which focus on hyperandrogenism and/or menstrual
irregularity are more likely to identify insulin resistant women, than
such criteria as abnormal gonadotropin secretion or ovarian morphology.
The lack of a clear etiologic mechanism to the syndrome has led to a
multitude of symptom-oriented treatments with few therapies improving
all aspects of the endocrine syndrome of PCOS. Improving insulin
sensitivity has become established as a baseline treatment strategy in
PCOS. There are, however, few randomized controlled trials of adequate
power to provide an evidence based guide to treatment in PCOS.
15
UI - 11841530
AU - O'Malley AS; Forrest CB; Mandelblatt J
TI -
Adherence of low-income women to cancer screening recommendations.
SO - J Gen Intern Med 2002 Feb;17(2):144-54
AD - Department of Oncology, Georgetown University Medical Center, 2233
Wisconsin Ave. NW, Suite 440, Washington, D.C. 20007, USA.
omalleya@georgetown.edu
BACKGROUND: African-American and low-income women have lower rates of
cancer screening and higher rates of late-stage disease than do their
counterparts. OBJECTIVE: To examine the effects of primary care, health
insurance, and HMO participation on adherence to regular breast,
cervical, and colorectal cancer screening. DESIGN: Random-digit-dial and
targeted household telephone survey of a population-based sample.
SETTING: Washington, D.C. census tracts with > or =30% of households
below 200% of federal poverty threshold. PARTICIPANTS: Included in the
survey were 1,205 women over age 40, 82% of whom were African American.
MAIN OUTCOME MEASURES: Adherence was defined as reported receipt of the
last 2 screening tests within recommended intervals for age. RESULTS:
The survey completion rate was 85%. Overall, 75% of respondents were
adherent to regular Pap smears, 66% to clinical breast exams, 65% to
mammography, and 29% to fecal occult blood test recommendations.
Continuity with a single primary care practitioner, comprehensive
service delivery, and higher patient satisfaction with the relationships
with primary care practitioners were associated with higher adherence
across the 4 screening tests, after considering other factors.
Coordination of care also was associated with screening adherence for
women age 65 and over, but not for the younger women. Compared with
counterparts in non-HMO plans, women enrolled in health maintenance
organizations were also more likely to be adherent to regular screening
(e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to
3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR
1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01
to 2.83.) CONCLUSIONS: Organizing healthcare services to promote
continuity with a specific primary care clinician, a comprehensive array
of services available at the primary care delivery site, coordination
among providers, and better patient-practitioner relationships are
likely to improve inner-city, low-income women's adherence to cancer
screening recommendations.
16
UI - 11871796
AU - Sridhar N
TI -
New initiatives to combat cervical cancer in India.
SO - Lancet Infect Dis 2001 Dec;1(5):292
17
UI - 11867503
AU - McIntosh MW; Urban N; Karlan B
TI -
Generating longitudinal screening algorithms using novel biomarkers for
disease.
SO - Cancer Epidemiol Biomarkers Prev 2002 Feb;11(2):159-66
AD - Division of Public Health Sciences, Fred Hutchinson Cancer Research
Center, Seattle, Washington 98109-1024, USA. mmcintos@fhcrc.org
Recent advances in molecular technology are leading to the discovery of
new tumor biomarkers that may be useful for cancer screening and early
diagnosis. Translating a potential screening biomarker from the
laboratory to its use in patient care may require an algorithm or
screening rule for its application. An algorithm that can detect the
smallest deviation from a defined norm is likely to achieve the highest
sensitivity, but any practical screening algorithm must do so with
strict controls on test specificity to avoid false-positive results, and
unnecessary patient alarm and risk. Longitudinal algorithms that make
use of previous tumor marker values and trends are likely to obtain
improvements over single threshold rules. Thus far, a few longitudinal
screening algorithms have been proposed (e.g., using serial
prostate-specific antigen values for the detection of prostate cancer
and serial CA125 values for the detection of ovarian cancer), but these
algorithms are not appropriate for novel tumor marker discoveries,
because they rely on unverifiable assumptions that may not translate to
the behavior of the new marker. The algorithm presented here is
motivated by: (a) the need to develop an algorithm for early detection
using novel markers; (b) the practical demands on data and specimen
availability; and (c) the need to be robust enough to accommodate a wide
range of tumor growth behavior. We use Parametric Empirical Bayes
statistical theory to model the trajectory of markers over time in a
cohort of asymptomatic healthy subjects, and use the estimated
trajectory to produce person-specific thresholds that depend on the
screening history of each person. The thresholds are chosen to give the
person (or population) a specified false-positive rate. The resulting
algorithm is simple and can be represented in a simple graph or a chart.
The statistical analysis needed to generate the algorithm can be found
in nearly every basic statistical package. The algorithm is highly
robust and can detect a wide range of tumor behaviors. The Parametric
Empirical Bayes screening algorithm should take a central role when
evaluating marker discoveries for use in screening. The algorithm is
particularly useful when screening with a new marker of which the
behavior in the preclinical period is not well known.
18
UI - 11715007
AU - Kauff ND; Scheuer L; Robson ME; Glogowski E; Kelly B; Barakat R; Heerdt
TI -
A; Borgen PI; Davis JG; Offit K
Insurance reimbursement for risk-reducing mastectomy and oophorectomy in
women with BRCA1 or BRCA2 mutations.
SO - Genet Med 2001 Nov-Dec;3(6):422-5
AD - Clinical Genetics Service, Department of Medicine, Memorial
Sloan-Kettering Cancer Center, New York, NY 10021, USA.
PURPOSE: Risk-reducing surgery is an important option for women with
BRCA1 and BRCA2 mutations. There are reports in the literature that
insurance reimbursement for these procedures varies greatly. Because
health insurance coverage significantly affects medical decision-making,
current information regarding reimbursement practices of third-party
payers is needed. METHODS: Retrospective study of hospital billing
records of 38 women with documented BRCA1 or BRCA2 mutations who
underwent either a risk-reducing mastectomy or a risk-reducing
oophorectomy between March 1, 1997, and July 30, 2000. RESULTS: Complete
billing and reimbursement information was available for 35 women
undergoing a total of 39 risk-reducing surgeries. A total of 38 of 39
(97%) risk-reducing surgeries were covered in full, less applicable
coinsurance and deductibles. The rate of insurance reimbursement did not
vary with type of insurance, personal history of cancer, or type of
procedure. CONCLUSION: Insurance carriers reimbursed the vast majority
of BRCA mutation carriers undergoing risk-reducing surgery.
19
UI - 11876611
AU - Gavarasana S; Kalasapudi R S; Rao T D; Thirumala S
TI -
Prevention of carcinoma of cervix with human papillomavirus vaccine.
SO - Indian J Cancer 2000 Jun-Sep;37(2-3):57-66
AD - Department of Surgery, Brockton Hospital, MA 02402, USA.
BACKGROUND: Carcinoma of cervix is the most common cancer found among
the women of India. Though cervical cytology screening was effective in
preventing carcinoma of cervix in developed nations, it is considered
unsuitable in developing countries. Recent research has established an
etiological link between human papillomavirus infection and carcinoma of
cervix. In this review, an attempt is made to answer the question,
'whether carcinoma of cervix can be prevented with human papillomavirus
vaccine?' METHODS: Literature search using Pubmed and Medline was
carried out and relevant articles were reviewed. RESULTS: There is ample
experimental evidence to show that DNA of human papillomavirus
integrates with cervical cell genome. Viral genes E6 and E7 of HPV type
16 and 18 inactivate p53 function and Rb gene, thus immortalize the
cervical epithelial cells. Recombinant vaccines blocked the function of
E6 and E7 genes preventing development of papillomas in animals.
Vaccination with HPV-VLPs encoding for genes of E6 and E7 neutralizes
HPV integrated genome of malignant cells of uterine cervix. CONCLUSIONS:
Based on experimental evidence, it is possible to prevent carcinoma of
cervix with human papillomavirus vaccine, IMPLICATIONS: Further research
is necessary to identify a effective and safe HPV vaccine, routes of
administration and characteristics of potential beneficiaries.
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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