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NCI CANCERLIT® Search: Screening and Prevention of Gynecologic Neoplasms - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 11440066
AU - Arillo-Santillan E; Nigenda G; Sanchez-Prado VM; de Ruiz PA;
TI -
Najera-Aguilar P; Lazcano-Ponce EC
Mexico City physicians' awareness about cervical cancer prevention:
implications for cancer screening.
SO - J Cancer Educ 2001 Summer;16(2):75-9
AD - Teaching Department, Academic Secretariat, National Public Health
Institute, Cuernavaca, Morelos, Mexico.
BACKGROUND: In spite of an early cancer detection program (CCSP), Mexico
has a mortality rate for cervical cancer of 16.5 per 100,000 women.
METHOD: A cross-sectional study of 330 physicians at the Mexico City
General Hospital evaluated their knowledge of the CCSP, etiology,
diagnostic alternatives, and treatment guidelines. Variance analysis was
the statistical procedure used. Replies to a questionnaire about
cervical cancer prevention awareness were scored on a scale from 1 to 9.
RESULTS: According to the awareness scale, the global average
classification was 4.4, with 50% of the physicians scoring 4 or less.
There was no difference in the CCSP knowledge scores of gynecologists
(mean 4.92, 95% CI 4.2-5.3), oncologists (mean 4.85, 95% CI 4.3-5.5),
pathologists (mean 5.23, 95% CI 4.9-5.6), and those in other specialties
(mean 4.29, 95% CI 4.2-5.0), p > 0.05. Many respondents attributed
CCSP's lack of effectiveness to public apathy (68.12%). CONCLUSIONS: The
effectiveness of the CCSP can be improved by educating health
professionals if this education is combined with elimination of
obstacles to its use. More information is needed to justify revising how
doctors are educated in terms of not only quality of the training but
also the contents of pre- and postgraduate training programs.
2
UI - 11446489
AU - Patnick J; Monsonego J; de Wolf C; Verbeek A; Bonte J; Agnantis N; De
TI -
Oliveira CF; Dexeus S; Maggino T; Onnis A; Zielinski J
ESGO consensus document on cervical cancer screening. European Society
of Gynaecological Oncology.
SO - Eur J Gynaecol Oncol 2001;22(2):99-101
3
UI - 11475387
AU - Hagen MD; Garber AM; Goldie SJ; Lafata JE; Mandelblatt J; Meltzer D;
TI -
Neumann P; Siegel JE; Sox HC Jr; Tsevat J
Does cost-effectiveness analysis make a difference? Lessons from Pap
smears. Symposium.
SO - Med Decis Making 2001 Jul-Aug;21(4):307-23
4
UI - 11499690
AU - Srivastava A; McKinnon W; Wood ME
TI -
Risk of breast and ovarian cancer in women with strong family histories.
SO - Oncology (Huntingt) 2001 Jul;15(7):889-902; discussion 902, 905-7,
911-13
AD - Division of Hematology and Oncology, University of Vermont College of
Medicine, Burlington 05401, USA.
Assessing the risk of breast and ovarian cancer starts with obtaining a
complete and accurate family history. This can reveal evidence of
inherited cancer risk. The highest risk of cancer is associated with
germ-line abnormalities in several genes, including BRCA1, BRCA2, and
TP53. Moderate-risk genes associated with syndromes that are inherited
in an autosomal dominant pattern (such as Cowden's disease, hereditary
non-polyposis colorectal cancer, Muir-Torre syndrome, and Peutz-Jeghers
syndrome) exhibit lower penetrance and thus less risk of breast and/or
ovarian cancer. Low-risk genes likely require significant environmental
exposure, and although they are associated with the lowest risk of
cancer, they account for more cancer than high- and moderate-risk genes.
Lifetime risks for breast or ovarian cancer can be estimated. The Gail
and Claus models, the more widely utilized models for calculation of
lifetime breast cancer risk, are discussed. Models are also available
for determining the likelihood of finding a BRCA1/2 mutation (the
BRCAPRO and Myriad models). Appropriate candidates for testing include
affected individuals who are most likely to have a hereditary form of
cancer. Testing should proceed only after a thorough discussion of the
risks, benefits, and limitations of testing. Risk-reducing options are
available to women with a strong family history of breast and ovarian
cancer. These options include high-risk screening, chemoprevention, and
prophylactic surgery.
5
UI - 11499181
AU - Memarzadeh S; Berek JS
TI -
Advances in the management of epithelial ovarian cancer.
SO - J Reprod Med 2001 Jul;46(7):621-9; discussion 629-30
AD - Division of Gynecologic Oncology, University of California-Los Angeles
School of Medicine, 27-136 CNS, 10833 Le Conte Avenue, Los Angeles, CA
90095-1740, USA.
More than 23,400 new cases of ovarian cancer and 13,900 deaths are
expected in the United States this year. Epithelial ovarian cancer is
the most common histologic type of ovarian malignancy. Although there
have been advances in the chemotherapeutic treatment of ovarian cancer,
the five year survival of women with advanced-stage disease is 25-30%.
Because the disease is typically asymptomatic until the disease has
metastasized and because effective screening strategies are not
unavailable, 70-75% of women present with advanced-stage disease. Of
ovarian cancer cases, 90-95% are sporadic and 5-10% associated with
germ-line mutations, including BRCA1 and BRCA2. Known risk factors for
ovarian cancer include nulliparity and a strong family history of
ovarian cancer. The use of oral contraceptives is known to decrease the
risk of ovarian cancer: five years of use will decrease the risk by 50%.
The staging of ovarian cancer (according to the International Federation
of Obstetrics and Gynecology) requires surgical exploration. Determining
the extent of disease is essential to appropriate management. Survival
in patients with metastatic disease is improved in those who undergo
optimal primary cytoreductive surgery. Adjuvant chemotherapy is
recommended in patients with high-risk, early-stage disease and all
patients with advanced-stage disease. Standard chemotherapy is a
combination of paclitaxel and carboplatin. Selected patients with
recurrent disease can undergo secondary cytoreductive surgery.
Second-line chemotherapy for patients who initially respond to
paclitaxel and carboplatin and who have a prolonged disease
progression-free intervals (longer than 12 months) can be re-treated
with either drug or both. Those whose responses to initial therapy were
less successful can be treated with other chemotherapeutic agents--e.g.,
liposomal doxorubicin, topotecan, etoposide, gemcitabine or taxotere.
6
UI - 11544692
AU - Anttila A; Pukkala E; Nieminen P; Hakama M
TI -
[Incidence of cervical cancer is clearly increasing in Finland]
SO - Duodecim 1998;114(11):1117-24
AD - Suomen Syoparekisteri, joukkotarkastusrekisteri Liisankatu 21 B, 00170
Helsinki. ahti.anttila@cancer.fi
7
UI - 11544696
AU - Nieminen P
TI -
[How to read a PAP report?]
SO - Duodecim 1998;114(11):1138-43
AD - HYKS:n naistenklinikka PL 140, 00029 HYKS. pekka.nieminen@huch.fi
8
UI - 11527105
AU - Bottorff JL; Balneaves LG; Sent L; Grewal S; Browne AJ
TI -
Cervical cancer screening in ethnocultural groups: case studies in
women-centered care.
SO - Women Health 2001;33(3-4):29-46
AD - School of Nursing, University of British Columbia, Vancouver, Canada.
Bottorff@nursing.ubc.ca
INTRODUCTION: The purpose of this study was to identify and describe
critical elements of women-centered care within the context of providing
cervical screening to three ethnocultural groups in Canada: Asian, South
Asian and First Nations. METHODS: Data for this collective case study
included open-ended interviews with purposive samples of women and key
informants from each target group. Following thematic analysis,
cross-case analysis was completed by comparing and contrasting issues
and contextual factors influencing women's and providers' experiences.
RESULTS: Cervical screening services for each group were shaped by
attention to ethnocultural values, women's desire for thorough
explanations, and the importance of a comfortable setting. While
participation rates varied across clinics, women were positive about
their experiences in obtaining cervical screening. Some women's
expectations that they could address a range of health concerns with
female health providers at the clinics were stymied by structural
barriers that prevented staff from addressing issues beyond those
directly related to cervical screening. Cross-case analysis revealed
three key elements of women-centered care: respectful and culturally
appropriate interactions between women and health providers, the
importance of providing acceptable alternatives for women, and the need
for comprehensive health services. CONCLUSION: While the establishment
of Pap test clinics for ethnocultural groups has the potential to
enhance participation in cervical screening, changes in health policy
and the structure of health services are required for existing programs
to fully implement the elements of women-centered health care identified
in this study. Other models of providing health care to women in
ethnocultural groups, including the use of clinics staffed by nurse
practitioners, should be evaluated.
9
UI - 11563564
AU - Apgar BS
TI -
New tests for cervical cancer screening.
SO - Am Fam Physician 2001 Sep 1;64(5):729-30, 732
10
UI - 11563569
AU - Nuovo J; Melnikow J; Howell LP
TI -
New tests for cervical cancer screening.
SO - Am Fam Physician 2001 Sep 1;64(5):780-6
AD - Department of Family and Community Medicine, University of California,
Davis, School of Medicine, Sacramento 95817, USA.
jim.nuovo@ucdmc.ucdavis.edu
The Papanicolaou (Pap) smear has been used to screen women for cervical
cancer since 1940. Recently, a number of new technologies have been
developed to improve the detection of cervical cancer and its
precursors. However, there is substantial controversy about whether the
new tests offer meaningful advantages over the conventional Pap smear.
Ideally, these new tests will increase the early detection of meaningful
Pap smear abnormalities, reduce the number of unsatisfactory smears and
provide fewer ambiguous results. It is also hoped that these new
screening methods will not increase the number of false-positive
results, but will improve the productivity of cytology laboratories
without substantially increasing costs. The new tests include
liquid-based/thin-layer preparations to improve the quality and adequacy
of the Pap smear; computer-assisted screening methods to improve Pap
smear interpretation; and new-generation human papillomavirus testing
methods that may be useful in triaging patients with atypical squamous
cells of undetermined significance or low-grade squamous intraepithelial
lesions. Evidence on these new tests is reviewed and the advantages and
disadvantages of their use are discussed.
11
UI - 11563870
AU - Dillner J
TI -
Primary screening for human papillomavirus infection.
SO - Best Pract Res Clin Obstet Gynaecol 2001 Oct;15(5):743-57
AD - Department of Medical Microbiology, Lund University, MAS University
Hospital, Malmo, Sweden.
As human papillomavirus infection is now known to be a necessary risk
factor for at least 95% of cervical cancers, the medical community has a
responsibility to assess and evaluate how this knowledge should best be
used for the prevention of cervical cancer. Organized screening
strategies combining cytological screening with human papillomavirus
testing in older age groups could theoretically be more sensitive than
current screening programmes in reducing the incidence of cervical
cancer. If it is possible safely to extend the screening interval in
human papillomavirus-negative women, such programmes could also both be
more effective and more cost-efficient. Although some modelling studies
have indicated that this could indeed be the case, evidence from
clinical trials evaluating the long-term protective effect of primary
human papillomavirus screening is still lacking. The key issues on the
research agenda for primary human papillomavirus screening are reviewed.
Copyright 2001 Harcourt Publishers Ltd.
12
UI - 11580729
AU - Ylikorkala O
TI -
Tubal ligation reduces the risk of ovarian cancer.
SO - Acta Obstet Gynecol Scand 2001 Oct;80(10):875-7
13
UI - 11598563
AU - Benchimol M; Gagneur O; Beddock R; Mention JE; Gondry J; Boulanger JC
TI -
[Removal or conservation of ovaries during hysterectomy for benign
lesions]
SO - J Gynecol Obstet Biol Reprod (Paris) 2001 Sep;30(5):476-83
AD - CHU d'Amiens, 124, rue Camille-Desmoulins, 80000 Amiens.
At the time of hysterectomy, the aging ovary presents a dilemma. We
conducted a prospective study to assess the feasibility of systematic
oophorectomy in women 50 years or older and a retrospective study of
hysterectomy history in patients who developed cancer of the ovary. Our
finding and data in the literature point out the requirement for careful
assessment of two aspects of the problem, one technical (feasibility of
adnexectomy) and the other functional (ovary function and risk of cancer
on the retained ovary).
14
UI - 11604430
AU - Barratt A
TI -
Making the most of Pap tests.
SO - J Epidemiol Community Health 2001 Nov;55(11):774-5
15
UI - 11604432
AU - Taylor RJ; Morrell SL; Mamoon HA; Wain GV
TI -
Effects of screening on cervical cancer incidence and mortality in New
South Wales implied by influences of period of diagnosis and birth
cohort.
SO - J Epidemiol Community Health 2001 Nov;55(11):782-8
AD - NSW Cervical Screening Program, Westmead Hospital, Sydney, NSW 2145,
Australia.
STUDY OBJECTIVES: Cervical cancer incidence and mortality in NSW during
1972-1996 is examined under counterfactual assumptions to estimate the
number of new cervical cancer cases averted and deaths avoided, with
projections to 2006. SETTING: Cervical cancer incident cases and deaths
in NSW for 1972-96 were obtained from the NSW Central Cancer Registry,
Sydney, Australia. DESIGN: Data were analysed by age-period-cohort (APC)
modelling, using Poisson regression. Projection of incidence to 2006 was
based on a linear trend for period effects. A counterfactual scenario
was constructed assuming stable period effects (1972-74), but modelled
cohort effects. Modelled rates were converted to cases and deaths (using
mortality:incidence ratios for cervical cancer), and compared with
actual data to estimate cancers prevented and deaths averted due to
screening. RESULTS: Rising cohort effects with recency of birth were
found after controlling for age and period of diagnosis, and declining
period effects were identified after controlling for age and birth
cohort. The estimated cumulated number of new cases of cervical cancer
prevented during 1972-1996 was 3440. The cumulated number of averted
deaths over 1972-1996, derived from incident cases, was estimated to be
1610 (including actual declines in the M/I ratio). With no change in the
M/I ratio from 1972, estimated cumulated mortality averted due to
cervical cancer for 1972-1996 was 1210 deaths. CONCLUSIONS: Cervical
screening has prevented a substantial number of new cases of cervical
cancer and deaths. In addition, secondary prevention and improved
treatment has contributed further to cervical cancer deaths averted.
16
UI - 11606071
AU - Kupets R; Covens A
TI -
Strategies for the implementation of cervical and breast cancer
screening of women by primary care physicians.
SO - Gynecol Oncol 2001 Nov;83(2):186-97
AD - Toronto-Sunnybrook Regional Cancer Center, University of Toronto,
Toronto, Ontario, M4N 3M5, Canada. rachel.kupets@tsrcc.on.ca
OBJECTIVE: While effective screening tests for the prevention and early
detection of cervical and breast cancers exist, poor screening rates are
evident. The aim of this paper was to determine the most effective
strategies for the implementation of breast and cervical cancer
screening delivered to women. METHODS: An in-depth search of the
literature using Medline and the Cochrane Library was carried out
between the years 1966 and 2000. Randomized controlled studies
addressing the delivery of both breast and cervical screening were
retained for the purposes of this review. Absolute difference (AD) in
screening was defined as screening rates in the intervention
arm--screening rates in the control arm. Number needed to intervene
(NNI) is a new term developed for the purpose of this paper and refers
to the number of physicians or physician-patient pairs that must be
exposed to the intervention before one screening test is performed. NNI
is defined as 1/AD. RESULTS: Strategies for the implementation of
screening tests are divided into three categories: physician-only based,
physician and patient based, and patient-only based. CONCLUSIONS:
Physician-based strategies, especially manual and computer-generated
reminders, appear to be the most effective approach in the
implementation of breast and cervical cancer delivery to women. Absolute
gains in screening rates were as high as 40% with an NNI of 2.5
physicians; therefore, approximately 3 physicians need to be exposed to
a reminder notice before 1 physician actually orders the screening
tests. Copyright 2001 Academic Press.
17
UI - 11606116
AU - Morice P; Pautier P; Delaloge S
TI -
Prophylactic surgery in patients with inherited risk of ovarian cancer.
SO - Gynecol Oncol 2001 Nov;83(2):445-7
18
UI - 11668519
AU - Royar J; Becher H; Chang-Claude J
TI -
Low-dose oral contraceptives: protective effect on ovarian cancer risk.
SO - Int J Cancer 2001 Nov 20;95(6):370-4
AD - Deutsches Krebsforschungszentrum, Division of Clinical Epidemiology,
Heidelberg, Germany.
Low-dose oral contraceptive (OC) formulations containing 35 microg or
less ethinyl estradiol have preferably been prescribed in the last
decade, however, few data exist on its relation to ovarian cancer risk.
We determined the effects of low-dose OC on the risk of ovarian cancer
in a population-based case-control study, including 282 patients ages
20-75 years at diagnosis of incident primary invasive ovarian cancer or
borderline tumour between 1993-1996 and 533 control subjects
individually matched by age and study area to each case. Analysis
excluded women who had undergone a bilateral ovariectomy or had a
previous diagnosis of either ovarian cancer or borderline tumour. The
association of OC use by ethinyl estradiol dose and ovarian cancer risk
was assessed by odds ratios (OR), adjusting simultaneously for the other
OC types and determinants of ovarian cancer risk. Ovarian cancer risk
was significantly reduced by 52% for ever use of any type of OC. The
reduction in risk was 7% per year of use (OR = 0.93, 95% confidence
interval [CI] = 0.90-0.96) and was more evident in first-use subjects
younger than 25 years. Risk reduction for ovarian cancer was substantial
for use of low-dose OC, the odds ratios being 0.86 (95% CI = 0.77-0.94),
0.91 (95% CI = 0.83-1.00), and 0.95 (95% CI = 0.91-0.99) per year of
using OC containing <35 microg, 35-<50 microg, and >or=50 microg ethinyl
estradiol, respectively. Our study provides evidence that low-dose oral
contraceptives confer substantial protection against the development of
ovarian cancer. Copyright 2001 Wiley-Liss, Inc.
19
UI - 11677113
AU - Pelucchi C; La Vecchia C; Chatenoud L; Negri E; Conti E; Montella M;
TI -
Calza S; Dal Maso L; Franceschi S
Dietary fibres and ovarian cancer risk.
SO - Eur J Cancer 2001 Nov;37(17):2235-9
AD - Istituto di Ricerche Farmacologiche Mario Negri, 20157 Milan, Italy.
pelucchi@marionegri.it
Data from an Italian multicentre case-control study on ovarian cancer
were used to analyse the relationship between various types of fibres
and ovarian cancer risk. The study, conducted between 1992 and 1999,
included 1031 cases of incident, histologically-confirmed epithelial
ovarian cancer. Controls were 2411 women admitted to the same network of
hospitals for acute, non-malignant, non-hormonal-related diseases. Cases
and controls were interviewed using a validated food frequency
questionnaire (FFQ). Odds ratios (ORs), and the corresponding 95%
confidence intervals (CI), were estimated using unconditional multiple
logistic regression models. For total (Englyst) fibre, the OR for the
highest versus the lowest quintile of intake was 0.68, and the
continuous OR for the difference between the 80th and the 20th
percentile of intake was 0.87. For most types of fibre, the continuous
OR was significantly below 1. The OR was 0.83 for cellulose, 0.89 for
soluble non-cellulose polysaccharides (NCPs), 0.86 for total insoluble
fibre, 0.92 for insoluble NCP, and 0.95 (non-significant) for lignin.
The inverse association was consistent across strata of age, family
history and menopausal status, even if the association was apparently
stronger in postmenopausal women. When fibre was classified according to
the source, vegetable (but not grain) fibres, showed a significant
protective effect, with an OR of 0.78.
20
UI - 11682944
AU - Rogo KO
TI -
Cervical cancer can be controlled.
SO - East Afr Med J 2001 Feb;78(2):53-4
21
UI - 11693978
AU - Sankaranarayanan R; Budukh AM; Rajkumar R
TI -
Effective screening programmes for cervical cancer in low- and
middle-income developing countries.
SO - Bull World Health Organ 2001;79(10):954-62
AD - International Agency for Research on Cancer, Lyon, France.
sankar@iarc.fr
Cervical cancer is an important public health problem among adult women
in developing countries in South and Central America, sub-Saharan
Africa, and south and south-east Asia. Frequently repeated cytology
screening programmes--either organized or opportunistic--have led to a
large decline in cervical cancer incidence and mortality in developed
countries. In contrast, cervical cancer remains largely uncontrolled in
high-risk developing countries because of ineffective or no screening.
This article briefly reviews the experience from existing screening and
research initiatives in developing countries. Substantial costs are
involved in providing the infrastructure, manpower, consumables,
follow-up and surveillance for both organized and opportunistic
screening programmes for cervical cancer. Owing to their limited health
care resources, developing countries cannot afford the models of
frequently repeated screening of women over a wide age range that are
used in developed countries. Many low-income developing countries,
including most in sub-Saharan Africa, have neither the resources nor the
capacity for their health services to organize and sustain any kind of
screening programme. Middle-income developing countries, which currently
provide inefficient screening, should reorganize their programmes in the
light of experiences from other countries and lessons from their past
failures. Middle-income countries intending to organize a new screening
programme should start first in a limited geographical area, before
considering any expansion. It is also more realistic and effective to
target the screening on high-risk women once or twice in their lifetime
using a highly sensitive test, with an emphasis on high coverage (>80%)
of the targeted population. Efforts to organize an effective screening
programme in these developing countries will have to find adequate
financial resources, develop the infrastructure, train the needed
manpower, and elaborate surveillance mechanisms for screening,
investigating, treating, and following up the targeted women. The
findings from the large body of research on various screening approaches
carried out in developing countries and from the available managerial
guidelines should be taken into account when reorganizing existing
programmes and when considering new screening initiatives.
22
UI - 11693811
AU - Morice P; Pautier P; Delaloge S; Camatte S; Spatz A; Chompret A; Lhomme
TI -
C; Duvillard P; Castaigne D
Surgical management for prophylactic oophorectomy in women with an
inherited risk of ovarian cancer.
SO - Tumori 2001 Jul-Aug;87(4):S16-7
AD - Department of Gynecologic Surgery, Oncology Pathology and Genetics,
Institut Gustave Roussy, Villejuif, France. morice@igr.fr
23
UI - 11702832
AU - Flannelly G; Bolger B; Fawzi H; De Lopes AB; Monaghan JM
TI -
Follow up after LLETZ: could schedules be modified according to risk of
recurrence?
SO - BJOG 2001 Oct;108(10):1025-30
AD - Northern Gynaecological Oncology Centre, Elizabeth Hospital, Gateshead,
UK.
OBJECTIVES: To document the pattern of recurrence of disease following
large loop excision of the transformation zone (LLETZ) to identify a low
risk group of women who might benefit from less intensive cytological
surveillance. DESIGN: Analysis of prospectively collected information
with retrospective review of follow up smears. POPULATION: Three
thousand, five hundred and sixty women who underwent LLETZ (median age
31 years; IQR 12 years). SETTING: Colposcopy clinic at Northern
Gynaecological Oncology Centre, Gateshead. METHODS: Women treated with
LLETZ from 1988 to 1995 were reviewed. Information on the pathology from
LLETZ was collected prospectively and information on the subsequent
smears was obtained from the family health authorities. RESULTS:
Invasive cancer was detected on the original LLETZ in 134 women who were
excluded from the study. Of the remaining 3,426 women, histology of
LLETZ showed high grade CIN (II and III) in 2,371 (69%). At least one
follow up smear was undertaken in 3,385 women (99%). This constituted
9,765 women years of follow up with a mean duration of 35 months. Four
hundred and seventeen women (12.2%) had a dyskaryotic follow up smear.
Incomplete excision of the lesion and an age of > or = 50 years at the
time of the LLETZ were associated with an increased risk of recurrent
CIN. Based on these risk factors the study group was divided into three
risk groups: 1. women aged < 50 with no disease at the margins (n =
1680); 2. women aged > or = 50 with disease at the margins (n = 93); and
3. women aged < 50 with positive margins, or aged > or = 50 with
negative margins (n = 1653). The cumulative survival without recurrent
CIN at five years for these groups were 92%, 57% and 86%, respectively.
CONCLUSION: Women aged > or = 50 with CIN at the margins of excision
constituted a small minority high risk group (3%). Consideration should
be given to repeat treatment of these women rather than surveillance.
Women aged < 50 with complete excision of low grade CIN comprised 51% of
the study group. These women were at low risk of recurrent CIN and might
benefit from less intensive cytological surveillance following LLETZ.
24
UI - 11700260
AU - Giuliano AR; Papenfuss M; Abrahamsen M; Denman C; de Zapien JG; Henze
TI -
JL; Ortega L; Brown de Galaz EM; Stephan J; Feng J; Baldwin S; Garcia F;
Hatch K
Human papillomavirus infection at the United States-Mexico border:
implications for cervical cancer prevention and control.
SO - Cancer Epidemiol Biomarkers Prev 2001 Nov;10(11):1129-36
AD - Arizona Cancer Center, University of Arizona, Tucson, Arizona
85724-5024, USA. agiuliano@azcc.arizona.edu
The United States-Mexico border is a region comprised of a country with
one of the highest rates of invasive cervical cancer (Mexico) and a
country with one of the lowest rates (United States). Recent evidence
clearly indicates that human papillomavirus (HPV) infection is the cause
of cervical cancer. The distribution of specific types of HPV is known
to vary in different regions of the world, as do the cofactors that may
inhibit or promote HPV carcinogenesis. Estimating the prevalence of
oncogenic HPV is needed for guiding vaccine development. The purpose of
this study was to determine the prevalence of oncogenic and nononcogenic
HPV types and risk factors for HPV among women residing along the United
States-Mexico border. A cross-sectional study of 2319 women, ages 15-79
years, self-referring for gynecological care was conducted between 1997
and 1998. HPV was detected by PCR using the PYGMY 09/11 L1 consensus
primer, and HPV genotyping was conducted using the reverse line blot
method. Overall, the HPV prevalence was 14.4% with no significant
differences observed by country after adjustment for age. HPV 16 was the
most commonly detected HPV type in both the United States and Mexico.
Among women with high-grade squamous intraepithelial lesions, HPV types
58, 45, 51, 31, 35, 55, and 73 were most common in Mexico, and HPV types
18, 31, 35, 51, 52, and 58 were most common in the United States. In
both countries, HPV prevalence declined linearly with age from 25% among
women ages 15-19 years to 5.3% among women 56-65 years. Factors
significantly independently associated with HPV infection were older age
[adjusted odds ratio (AOR) = 0.15 for ages 56-65 years compared with
those 15-19 years], a marital status other than married (AOR =
1.58-3.29), increased numbers of lifetime male partners (AOR = 3.8 for >
or =10 partners compared with 1 partner), concurrent infection with
Chlamydia trachomatis (AOR = 1.79), ever use of Norplant (AOR = 2.69),
and current use of injectable contraceptives (AOR = 2.29). Risk factors
for HPV infection did not differ by country. Results from this study
suggest that in addition to HPV 16 and 18, HPV types 31, 45, 51, and 58
should be considered for inclusion in an HPV prevention vaccine for
distribution in Mexico.
25
UI - 11700272
AU - Schiff MA; Patterson RE; Baumgartner RN; Masuk M; van Asselt-King L;
TI -
Wheeler CM; Becker TM
Serum carotenoids and risk of cervical intraepithelial neoplasia in
Southwestern American Indian women.
SO - Cancer Epidemiol Biomarkers Prev 2001 Nov;10(11):1219-22
AD - University of Washington, Department of Epidemiology, Seattle,
Washington 98115, USA.
The objective of this research was to evaluate the association between
serum carotenoids and cervical intraepithelial neoplasia (CIN) among
Southwestern American Indian women. Cases were American Indian women
with biopsy-proven CIN II/III cervical lesions (n = 81) diagnosed
women from the same clinics with normal cervical epithelium (n = 160).
All of the subjects underwent interviews and laboratory evaluations.
Interviews evaluated demographic information, sexual history, and
cigarette smoking. Serum concentrations of alpha-carotene,
beta-carotene, beta-cryptoxanthin, lycopene, and lutein/zeaxanthin were
measured by high performance liquid chromatography. Cervical human
papillomavirus infection was detected using a PCR-based test. Increasing
levels of alpha-carotene, beta-cryptoxanthin, and lutein/zeaxanthin were
associated with decreasing risk of CIN II/III. In addition, the highest
tertiles of beta-cryptoxanthin (odds ratio = 0.39, 95% confidence
interval = 0.17-0.91) and lutein/zeaxanthin (odds ratio = 0.40, 95%
confidence interval = 0.17-0.95) were associated with the lowest risk of
CIN. In conclusion, specially targeted intervention efforts to increase
consumption of fruits and vegetables may protect Southwestern American
Indian women from developing CIN.
26
UI - 11717553
AU - Kahn JA
TI -
An update on human papillomavirus infection and Papanicolaou smears in
adolescents.
SO - Curr Opin Pediatr 2001 Aug;13(4):303-9
AD - Department of Pediatrics, Division of Adolescent Medicine, Children's
Hospital Medical Center, Cincinnati, Ohio 45229, USA. kahnj1@chmcc.org
Human papillomavirus infection is one of the most common sexually
transmitted infections in young women, and may lead to clinical sequelae
such as anogenital condylomata and cervical squamous cell carcinoma.
Recent data on the biology and natural history of HPV infection in
adolescents will have important implications for the development of
adolescent-specific protocols for cervical cancer screening and for
follow-up of abnormal cytology.
27
UI - 11715778
AU - Lie AK; Bjorge T; Helland A; Hagen B; Skjeldestad FE; Hagmar B; Thoresen
TI -
S
[Can human papillomavirus testing and vaccination prevent cervical
cancer?]
SO - Tidsskr Nor Laegeforen 2001 Oct 20;121(25):2947-51
AD - Seksjon for biopsi og autopsi Avdeling for patologi, Det Norske
Radiumhospital 0310 Oslo. agnes-kathrine.lie@labmed.uio.no
BACKGROUND: Cervical cancer is the third most frequent cancer among
women worldwide. Human papillomavirus (HPV) infection is a necessary
risk factor and the first step in cervical carcinogenesis. MATERIAL AND
METHODS: This article reviews the current literature concerning the
possibility of preventing cervical cancer by HPV testing and
vaccination. RESULTS: HPV testing cannot replace cytology, but will
reduce false negative cytology and may improve the screening programme
for cervical neoplasia. It has not yet been incorporated in any national
cervical cancer screening program, but trials are ongoing in Scandinavia
and in the Netherlands. The cost-effectiveness of HPV testing in
screening has to be proven and whether it can affect the recommended
screening-intervals. Therapeutic and prophylactic vaccines for HPV
associated disease are in progress. Evaluating the clinical trials that
are ongoing will take several years. Several anti-HPV vaccines are now
in clinical trials; Norway will also participate. Therapeutic vaccines
against cervical cancer have so far not been successful, but anogenital
dysplasias and condylomas may be more susceptible. Prophylactic vaccines
against HPV 6, 11, 16 and 18 have been evaluated in clinical phase I and
II trials, and phase III trials are in progress. INTERPRETATION: HPV
testing improves the specificity and sensitivity of cervical cytology
and it can be used to clarify cases with atypical cells of undetermined
significance (ASCUS) and low-grade intraepithelial neoplasia. In the
near future it may also be included in the cervical cancer screening
programme for women above the age of 30. The first results in clinical
vaccine trials are encouraging, and final conclusions about the
effectiveness of these vaccines may be achieved in five years' time.
28
UI - 9682246
AU - Kanetsky PA; Gammon MD; Mandelblatt J; Zhang ZF; Ramsey E; Dnistrian A;
TI -
Norkus EP; Wright TC Jr
Dietary intake and blood levels of lycopene: association with cervical
dysplasia among non-Hispanic, black women.
SO - Nutr Cancer 1998;31(1):31-40
AD - Department of Biostatistics and Epidemiology, University of Pennsylvania
School of Medicine, Philadelphia 19104, USA. pkanetsk@cceb.med.upenn.edu
We examined whether elevated levels of retinoids, carotenoids, folate,
and vitamin E protected against cervical dysplasia among non-Hispanic,
black women. We enrolled 32 women with incident cervical dysplasia,
including cervical intraepithelial neoplasia (CIN) I, CIN II, and CIN
III/carcinoma in situ, and 113 control women with normal cervical
cytology in case-control study. Micronutrient levels were estimated from
a food-frequency questionnaire (FFQ) and measured from blood samples.
Information on risk factors for cervical neoplasia was elicited by
interview. Hybrid capture was used to determine infection with human
papillomavirus. After adjustment for potential confounders, analysis of
micronutrient levels estimated from the FFQ suggested that women in the
upper tertile of lycopene and vitamin A intake were one-third (odds
ratio = 0.32, 95% confidence interval = 0.8-1.3) and one-fourth (odds
ratio = 0.24, 95% confidence interval = 0.05-1.2) as likely,
respectively, to have dysplasia as women in the lower tertile.
Borderline protective trends (p < or = 0.10) were apparent. Elevated
levels of serum lycopene also suggested some protection against
dysplasia. Results were not significant at alpha = 0.05 because of the
small number of case women enrolled. Overall, correlations between
estimates from the FFQ and serum levels were poor. This study indicates
that, among black women, lycopene and perhaps vitamin A may play a
protective role in the early stages of cervical carcinogenesis.
29
UI - 11759652
AU - Narod SA; Sun P; Risch HA; Hereditary Ovarian Cancer Clinical Study
TI -
Group
Ovarian cancer, oral contraceptives, and BRCA mutations.
SO - N Engl J Med 2001 Dec 6;345(23):1706-7
30
UI - 11759653
AU - Friedenson B
TI -
Ovarian cancer, oral contraceptives, and BRCA mutations.
SO - N Engl J Med 2001 Dec 6;345(23):1707
31
UI - 11519760
AU - Eaker S; Adami HO; Sparen P
TI -
Attitudes to screening for cervical cancer: a population-based study in
Sweden.
SO - Cancer Causes Control 2001 Aug;12(6):519-28
AD - Department of Medical Epidemiology, Karolinska Institutet, Stockholm,
Sweden. Sonja.Eaker@mep.ki.se
OBJECTIVES: To investigate how attitudes and beliefs about Pap smear
screening affect women's choice to participate in organized or
opportunistic screening. METHODS: Telephone interviews were conducted
with 430 (69.0%) non-attenders and 514 (80.7%) attenders to Pap smear
screening, sampled from a population-based database. The interviews were
conducted during 1998 in Uppsala County, Sweden. Main outcome measure:
odds ratios (OR) and 95% confidence intervals (CI). RESULTS:
Non-attendance was negatively associated with perceived severity of
cervical cancer compared to other malignancies (OR = 1.9, 95% CI
1.1-3.4) as well as with satisfactory benefits (OR = 0.7, 95% CI
0.6-0.8), but positively associated with time-consuming and economical
barriers (OR = 1.2, 95% CI 1.1-1.5 and OR = 1.7, 95% CI 1.2-2.5,
respectively). Non-attendance was also negatively associated with
anxiety, but was of borderline significance (OR = 0.9, 95% CI 0.8-1.0).
The results were strengthened with increasing time since last smear or
if self-reported attendance status was used instead of true attendance.
Non-attenders kept holding harder to their preferences than did
attenders, stating they would not participate if their preferences were
not met. CONCLUSIONS: Important differences in attitudes and beliefs
exist between non-attenders and attenders in Pap smear screening. Rather
than being emotional, the main barriers are either practical or rooted
in misunderstandings and lack of relevant information. These insights
offer opportunities to increase attendance rates considerably.
32
UI - 11548824
AU - Paschopoulos M; Kontostolis E; Lolis ED; Koliopoulos G; Alamanos Y;
TI -
Paraskevaidis E
The use of transvaginal sonography and vaginoscopic hysteroscopy in
women on tamoxifen.
SO - JSLS 2001 Jul-Sep;5(3):211-4
AD - Department of Obstetrics & Gynecology, Ioannina University Hospital,
Greece. paschomi@acropolis.net
BACKGROUND AND OBJECTIVES: Long-term administration of tamoxifen causes
endometrial changes. The aim of this study was to evaluate the role of
transvaginal sonography and vaginoscopic hysteroscopy in the screening
of patients on tamoxifen. METHODS: Seventy patients with breast cancer
treated with tamoxifen 20 mg daily underwent transvaginal sonography and
vaginoscopic hysteroscopy, a modified relatively painless approach, at
the beginning of the treatment and at a follow-up visit approximately 9
months after its initiation. RESULTS: At the follow-up visit, the mean
uterine dimensions and mean endometrial thickness as measured by
ultrasound were significantly larger, and pulsatility and resistance
indices of the uterine arteries as measured by Doppler were
significantly lower. Sonography revealed abnormal endometrial thickness
in 73% (51 of 70) of the patients, and 83% (58 of 70) had
hysteroscopical changes. Sonography missed 1 case of endometrial
adenocarcinoma. CONCLUSIONS: Vaginoscopic hysteroscopy, an approach that
causes reduced pain, can add significantly to the sensitivity of
transvaginal sonography for the detection of endometrial changes in
patients with breast cancer receiving tamoxifen. It is recommended for
every patient prior to the initiation of treatment and at the follow-up
visits.
33
UI - 11799954
AU - Hilmy N
TI -
Postmenopausal hormone-replacement therapy.
SO - N Engl J Med 2002 Jan 3;346(1):63-5
34
UI - 11725224
AU - Healey SM; Aronson KJ; Mao Y; Schlecht NF; Mery LS; Ferenczy A; Franco
TI -
EL
Oncogenic human papillomavirus infection and cervical lesions in
aboriginal women of Nunavut, Canada.
SO - Sex Transm Dis 2001 Dec;28(12):694-700
AD - Health Protection Unit, Department of Health, Government of Nunavut,
Iqaluit, Nunavut, Canada.
BACKGROUND: The high rate of cervical cancer among aboriginal women of
northern Canada has prompted the search for more aggressive methods to
augment Papanicolaou (Pap) screening in this population. Nearly all
cervical cancers result from oncogenic human papillomavirus (HPV)
infections. This has generated interest for incorporating HPV testing
into the current screening program. GOALS: To determine the prevalence
of oncogenic HPVs in Nunavut, and to assess the association between HPV
and squamous intraepithelial lesions (SIL). STUDY DESIGN: A
cross-sectional study was conducted on the Pap-screened populations in
19 communities of Nunavut, Canada. Liquid-based cytology was used to
screen for SIL. HPV testing was performed using the Hybrid Capture II
assay. Correlates of HPV infection and SIL were assessed by logistic
regression with control for potential confounders. RESULTS: In 1290
women ages 13 to 79 years, the prevalence rate was 26% for oncogenic HPV
and 6.9% for SIL. The odds ratio for the association between HPV and SIL
was 37.9 (95% CI, 17.7-80.8) after multivariate adjustment. This
association increased markedly with increasing viral load. More than 90%
of the women with squamous intraepithelial lesions had positive test
results for HPV. More than 75% of the women who had positive test
results for HPV but negative test results for SIL were younger than 30
years. CONCLUSION: The results of this study form the basis for further
evaluation of the role that liquid-based cytology and HPV testing plays
and will contribute to the strategy for cervical cancer prevention in
Nunavut.
35
UI - 11765199
AU - Sismondi P; Biglia N; Ujcic E; Ponzone R; Roagna R
TI -
Raloxifene and endometrial cancer.
SO - Tumori 2001 Sep-Oct;87(5):S18-9
AD - Department of Gynecological Oncology, Mauriziano Umberto I Hospital,
University of Turin.
36
UI - 11765212
AU - Tirelli U; Bernardi D; Vaccher E
TI -
Cervical cancer in HIV.
SO - Tumori 2001 Sep-Oct;87(5):S9-11
AD - Divisione di Oncologia Medica A, Istituto Nazionale Tumori, Aviano (PN).
37
UI - 11745286
AU - Fairfield KM; Hankinson SE; Rosner BA; Hunter DJ; Colditz GA; Willett WC
TI -
Risk of ovarian carcinoma and consumption of vitamins A, C, and E and
specific carotenoids: a prospective analysis.
SO - Cancer 2001 Nov 1;92(9):2318-26
AD - Channing Laboratory, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115,
USA. kathleen.fairfield@channing.harvard.edu
BACKGROUND: Antioxidant vitamins may decrease risk of cancer by limiting
oxidative DNA damage leading to cancer initiation. Few prospective
studies have assessed relations between antioxidant vitamins and ovarian
carcinoma. METHODS: The authors prospectively assessed consumption of
vitamins A, C, and E and specific carotenoids, as well as fruit and
vegetable intake, in relation to ovarian carcinoma risk among 80,326
participants in the Nurses' Health Study who had no history of cancer
other than nonmelanoma skin carcinoma. Women reported on known and
suspected ovarian carcinoma risk factors including reproductive factors,
smoking, and use of vitamin supplements on biennial mailed
questionnaires from 1976 to 1996. Food frequency questionnaires were
included in 1980, 1984, 1986, and 1990. The authors confirmed 301
incident cases of invasive epithelial ovarian carcinoma during 16 years
of dietary follow-up (1980-1996). Pooled logistic regression was used to
control for age, oral contraceptive use, body mass index, smoking
history, parity, and tubal ligation. RESULTS: The authors observed no
association between ovarian carcinoma risk and antioxidant vitamin
consumption from foods, or foods and supplements together. The
multivariate relative risks (95% confidence intervals [CIs]) for ovarian
carcinoma among women in the highest versus lowest quintile of intake
were 1.04 (95% CI, 0.72-1.51) for vitamin A from foods and supplements;
1.01 (95% CI, 0.69-1.47) for vitamin C; 0.88 (95% CI, 0.61-1.27) for
vitamin E; and 1.10 (95% CI, 0.76-1.59) for beta
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