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NCI CANCERLIT^® Search: Screening and Prevention of Gynecologic Neoplasms - September 2002

National Cancer Institute^®
Last Modified: September 1, 2002

U.S. Centers for Disease Control and Prevention guidelines for the treatment of sexually transmitted diseases: an opportunity to unify
Breast and ovarian cancer screening practices in healthy women with a strong family history of breast or ovarian cancer.
Lessons from the audit of invasive cervical cancer.
Is it reality or an illusion that liquid-based cytology is better than conventional cervical smears?
Is it reality or an illusion that liquid-based cytology is better than conventional cervical smears?
Paradigms for primary prevention of ovarian carcinoma.
Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.
Strategies for the modification of risk factors in gynecological cancers.
Tea consumption and ovarian cancer risk: a case-control study in China.
Ovarian cancer screening and prevention.
Human papillomavirus. To screen or not to screen.
Cervical screening.
Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention.
Association between acetaminophen or nonsteroidal antiinflammatory drugs and risk of developing ovarian, breast, or colon cancer.
State trends in health risk factors and receipt of clinical preventive services among US adults during the 1990s.
Endometrial safety of hormone replacement therapy: review of literature.
Effectiveness of an intervention to increase Pap test screening among Chinese women in Taiwan.
A review of the literature: interventions to maximize capacity to consent and reduce anxiety of women with learning disabilities preparing
Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection.
Management of women with smears showing mild dyskaryosis.
[Human papillomavirus: a vaccine against cervical carcinoma uterine]
2001 Consensus Guidelines for the management of women with cervical cytological abnormalities.
Views of Irish general practitioners on screening for cervical cancer.
Knowledge of cervical cancer screening and use of cervical screening facilities among women from various socioeconomic backgrounds in Durban,
Breast cancer risk assessment in patients seen in a gynecologic oncology clinic.
Location-guided screening of liquid-based cervical cytology specimens: a potential improvement in accuracy and productivity is demonstrated in a
Only one quarter of women with learning disability in Exeter have cervical screening.
Cervical screening for women with learning disability. Numbers screened can be optimised by using a focused initiative.
Cervical screening for women with learning disability. Concerted effort is needed to ensure these women use preventive services.
Cervical screening for women with learning disability. Sefton has multidisciplinary group to promote sexual health care for these women.
Physicians urged to recommend Pap tests to women ages 65 and older--new educational materials now available from NCI.
Diet and the prevention of cancer.
[Efficacy of organized screening in comparison to spontaneous Pap samples in the prevention of invasive cervical cancer]
[Advantages of female sterilization--is there disadvantages?]
Polycystic ovary syndrome. Long term sequelae and management.
Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation.
Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations.
Oophorectomy in carriers of BRCA mutations.
Oophorectomy in carriers of BRCA mutations.
Oophorectomy in carriers of BRCA mutations.
Oophorectomy in carriers of BRCA mutations.
Early cervical cancer rescreening.
The Pap smear: a victim of its own success?

1
UI - 12186516
AU - Workowski KA; Levine WC; Wasserheit JN; Centers for Disease Control and
TI - Prevention, Atlanta, Georgia U.S. Centers for Disease Control and Prevention guidelines for the treatment of sexually transmitted diseases: an opportunity to unify clinical and public health practice.
SO - Ann Intern Med 2002 Aug 20;137(4):255-62
AD - Centers for Disease Control and Prevention, Atlanta, GA 30333. kgw2@cdc.gov
Sexually transmitted diseases (STDs) constitute an epidemic of tremendous magnitude, with an estimated 15 million persons in the United States acquiring a new STD each year. Effective clinical management of STDs is a strategic common element in efforts to prevent HIV infection and to improve reproductive and sexual health. Sexually transmitted diseases may result in severe, long-term, costly complications, including facilitation of HIV infection, tubal infertility, adverse outcomes of pregnancy, and cervical and other types of anogenital cancer. The publication of national guidelines for the management of STDs, by the U.S. Centers for Disease Control and Prevention (CDC), has been a key component of federal initiatives to improve the health of the U.S. population by preventing and controlling STDs and their sequelae. This paper presents new recommendations from the 2002 CDC Guidelines for the Treatment of Sexually Transmitted Diseases in the context of current disease trends and public health.

2
UI - 11881908
AU - Isaacs C; Peshkin BN; Schwartz M; Demarco TA; Main D; Lerman C
TI - Breast and ovarian cancer screening practices in healthy women with a strong family history of breast or ovarian cancer.
SO - Breast Cancer Res Treat 2002 Jan;71(2):103-12
AD - Department of Medical Oncology, Lombardi Cancer Center, Georgetown University, Washington, DC 20007-2197, USA. isaacsc@georgetown.edu
Studies in women with a family history of cancer demonstrate a wide variability in the uptake of cancer screening measures. Little data exist regarding the breast and ovarian cancer screening practices of women who are members of hereditary breast cancer families. In order to address this issue, we examined the screening behaviors and the determinants of screening in a clinic based group of 216 women with a strong family history of breast or ovarian cancer who were participating in a free genetic counseling and testing research program. At baseline, prior to obtaining genetic counseling or testing, 50% of women ages 30-39, 83% of those age 40-49, 69% of those 50-64, and 53% of those >65 reported having a mammogram in the prior year. Adherence to mammography recommendations was correlated with age, number of relatives with breast cancer, and income. Twenty percent of participants had at least one CA- 125 performed and 31 % had ever obtained a screening ultrasound. Having at least one relative with ovarian cancer was very strongly associated with ovarian cancer screening [OR = 12.3, 95% CI = 4.6-33 for CA-125; OR=4.9, 95% CI=2.4, 10.1 for ultrasound]. No association between cancer worries/distress and either breast or ovarian cancer screening was found. In conclusion, the breast and ovarian screening uptake in healthy women from hereditary breast cancer families is suboptimal, even for women over age 50, for whom annual mammography is clearly indicated. These findings indicate a need for better education about screening guidelines for high-risk women.

3
UI - 11985562
AU - Shaw PA
TI - Lessons from the audit of invasive cervical cancer.
SO - Cytopathology 2002 Feb;13(1):1-3

4
UI - 11985571
AU - Kitchener HC
TI - Is it reality or an illusion that liquid-based cytology is better than conventional cervical smears?
SO - Cytopathology 2002 Feb;13(1):64-5

5
UI - 11985572
AU - Linder J
TI - Is it reality or an illusion that liquid-based cytology is better than conventional cervical smears?
SO - Cytopathology 2002 Feb;13(1):66

6
UI - 12139233
AU - Barnes MN; Grizzle WE; Grubbs CJ; Partridge EE
TI - Paradigms for primary prevention of ovarian carcinoma.
SO - CA Cancer J Clin 2002 Jul-Aug;52(4):216-25
AD - Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
OBJECTIVE: To provide the clinician with current concepts regarding prevention of ovarian cancer. Specifically, in this review, we provide a rationale for chemoprevention of ovarian cancer, a description of promising chemopreventive agents, and an overview of surgical strategies used in the prevention of ovarian cancer. DATA SOURCES: A computerized the MEDLINE database from the period of 1966 to present. Search terms utilized included ovarian neoplasms, primary prevention, chemoprevention, oral contraceptives, NSAIDs, retinoids, ovariectomy, and tubal sterilization. Additional sources were identified through cross-referencing. METHODS OF STUDY SELECTION: All identified references relevant to prevention of ovarian carcinoma were reviewed. TABULATION, INTEGRATION, AND RESULTS: Each reference was reviewed to determine the relevant contribution to the fundamental science of ovarian cancer prevention. Particular attention was paid to those studies that offered insight into the development of translational trials in ovarian cancer chemoprevention. CONCLUSIONS: Investigation into chemoprevention for ovarian cancer represents a vastly underdeveloped area of research. Continued research efforts toward identification of novel compounds will accelerate the progress of clinical trials in this neglected area of investigation.

7
UI - 12174401
AU - Wismer BA; Moskowitz JM; Min K; Chen AM; Ahn Y; Cho S; Jun S; Lew A; Pak
TI - YM; Wong JM; Tager IB Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.
SO - J Public Health Manag Pract 2001 Mar;7(2):61-70
AD - Center for Family and Community Health, School of Public Health, University of California, Berkeley, California, USA.
Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.

8
UI - 11876392
AU - Benedet JL; Cabero-Roura L
TI - Strategies for the modification of risk factors in gynecological cancers.
SO - Eur J Gynaecol Oncol 2002;23(1):5-10
AD - Department of Obstetrics & Gynecology, University of British Columbia, BC Cancer Agency, Vancouver, Canada.
Strategies to modify risk for female or gynecological cancers will vary with our knowledge of the epidemiology, etiology, and specific molecular mechanisms for each individual cancer. In general, cancer preventive strategies have been divided into primary and secondary prevention with primary prevention directed toward the causative factors for a disease. Secondary prevention is classically used in cervical cancer cytology screening programs and is essentially an attempt to identify individuals in a population with preclinical phases of the disease where intervention will impact mortality the most. A vast literature has evolved regarding the epidemiology of most of the common cancers in women. While the specific molecular mechanisms are not completely understood at this time knowledge of contributing factors for many of these tumors is well known. The association of cigarette smoking with lung cancer has been well established and the increasing rates of lung cancer, particularly in women, are directly linked to the increasing number of female smokers in the population. Indeed in many western countries lung cancer deaths have overtaken breast cancer as the most common cause of death from malignant disease in women. Excessive sun exposure without adequate skin protection is another lifestyle activity that is related to the high incidence of skin cancer in certain areas. Epidemiologically, cervical cancer has been studied extensively with the current data indicating a causal role of exposure to human papillomavirus (HPV), particularly at an early age in this disease. Hereditary breast and ovarian cancer syndromes are well understood and as more information on human genomics becomes available a clear understanding of the underlying molecular mechanisms of these diseases will be possible and hopefully will result in effective strategies for their control. Unfortunately, in spite of the vast knowledge that is available regarding risk factors for many of these malignancies we have been unable to influence effective lifestyle changes that could substantially reduce the risk of these malignancies in our population. Increased efforts in education, research, and commitment--both financial and educational--are required by governments and other social organizations.

9
UI - 12163323
AU - Zhang M; Binns CW; Lee AH
TI - Tea consumption and ovarian cancer risk: a case-control study in China.
SO - Cancer Epidemiol Biomarkers Prev 2002 Aug;11(8):713-8
AD - School of Public Health, Curtin University of Technology, Perth, WA 6845, Australia.
To investigate whether tea consumption has an etiological association with ovarian cancer, a case-control study was conducted in China during 1999-2000. The cases were 254 patients with histologically confirmed epithelial ovarian cancer. The 652 controls comprised 340 hospital visitors, 261 non-neoplasm hospital outpatients, and 51 women recruited from the community. Information on the frequency, type, and duration of tea consumption was collected by personal interview using a validated questionnaire. The risk of ovarian cancer for tea consumption was assessed using adjusted odds ratios based on multivariate logistic regression analysis, accounting for confounding demographic, lifestyle, and familial factors including hormonal status and family ovarian cancer. The ovarian cancer risk declined with increasing frequency and duration of overall tea consumption. The adjusted odds ratio was 0.39 for those drinking tea daily and 0.23 for those drinking tea for >30 years, compared with nontea drinkers. The dose response relationships were significant, and the inverse association with ovarian cancer was observed for green tea consumption. We concluded that increasing frequency and duration of tea drinking, especially green tea, can reduce the risk of ovarian cancer. However, the protective effects of black tea and Oolong tea need to be additionally investigated.

10
UI - 12184039
AU - Cherry C; Vacchiano SA
TI - Ovarian cancer screening and prevention.
SO - Semin Oncol Nurs 2002 Aug;18(3):167-73
AD - Family Risk Assessment Program, Fox Chase Cancer Center, 7701 Burholme Ave, Philadelphia, PA 19111, USA.
OBJECTIVES: To review current ovarian cancer prevention and detection recommendations using a risk assessment framework, and discuss the genes related to hereditary ovarian cancer syndromes. DATA SOURCES: Published articles, consensus opinions, and reports. CONCLUSIONS: Women at highest risk are those with a family history and/or genetic predisposition. Management guidelines include pelvic exam, CA125, and transvaginal ultrasound, although their efficacy is limited. Individualized risk assessment can be useful in assisting women who face decisions regarding prevention options. IMPLICATIONS FOR NURSING PRACTICE: Nurses are challenged to identify women at increased risk for ovarian cancer, and to recognize the complex issues faced when these women pursue screening and prevention strategies.

11
UI - 8130902
AU - Newkirk GR
TI - Human papillomavirus. To screen or not to screen.
SO - Arch Fam Med 1993 Dec;2(12):1227-8

12
UI - 12171231
AU - Ford S
TI - Cervical screening.
SO - Br J Gen Pract 2002 Aug;52(481):674

13
UI - 12184549
AU - Anonymous
TI - Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention.
SO - MMWR Recomm Rep 2002 May 10;51(RR-6):1-78
These guidelines for the treatment of patients who have sexually transmitted diseases (STDs) were developed by the Centers for Disease Control and Prevention (CDC) after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on September 26-28, 2000. The information in this report updates the 1998 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 1998;47 [No. RR-1]). Included in these updated guidelines are new alternative regimens for scabies, bacterial vaginosis, early syphilis, and granuloma inguinale; an expanded section on the diagnosis of genital herpes (including type-specific serologic tests); new recommendations for treatment of recurrent genital herpes among persons infected with human immunodeficiency virus (HIV); a revised approach to the management of victims of sexual assault; expanded regimens for the treatment of urethral meatal warts; and inclusion of hepatitis C as a sexually transmitted infection. In addition, these guidelines emphasize education and counseling for persons infected with human papillomavirus, clarify the diagnostic evaluation of congenital syphilis, and present information regarding the emergence of quinolone-resistant Neisseria gonorrhoeae and implications for treatment. Recommendations also are provided for vaccine-preventable STDs, including hepatitis A and hepatitis B.

14
UI - 11898889
AU - Meier CR; Schmitz S; Jick H
TI - Association between acetaminophen or nonsteroidal antiinflammatory drugs and risk of developing ovarian, breast, or colon cancer.
SO - Pharmacotherapy 2002 Mar;22(3):303-9
AD - Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Switzerland. Christoph.Meier@unibas.ch
STUDY OBJECTIVE: To explore the association between exposure to acetaminophen (paracetamol) or nonsteroidal antiinflammatory drugs (NSAIDs) and risk of developing ovarian, breast, or colon cancer. DESIGN: Retrospective case-control study SETTING: General practice offices. SUBJECTS: Four hundred eighty-three women with ovarian cancer and 1877 women matched for age, years of medical history in computer record, general practice attended, and calendar time; 3706 women with breast cancer and 14,155 matched control subjects; and 635 women with colon cancer and 2434 matched control subjects. INTERVENTION: United Kingdom-based General Practice Research Database was searched for women aged 50-89 years with a first-time diagnosis of ovarian, breast, or colon cancer and for matched controls to assess prescription analgesic exposure. MEASUREMENTS AND MAIN RESULTS: Regular acetaminophen exposure (> or = 30 prescriptions) was associated with a slightly decreased risk of developing breast (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.7-1.0) but not ovarian (OR 1.0, 95% CI 0.6-1.5) or colon (OR 1.0, 95% Cl 0.7-1.4) cancer. Regular NSAID exposure was associated with a reduced risk of colon (OR 0.5, 95% CI 0.3-0.9) but not ovarian or breast cancer. CONCLUSION: We found no evidence for a decreased ovarian cancer risk for women with regular acetaminophen or NSAID exposure.

15
UI - 12020301
AU - Nelson DE; Bland S; Powell-Griner E; Klein R; Wells HE; Hogelin G; Marks
TI - JS State trends in health risk factors and receipt of clinical preventive services among US adults during the 1990s.
SO - JAMA 2002 May 22-29;287(20):2659-67
AD - National Cancer Institute, Division of Cancer Control and Population Sciences, 6130 Executive Blvd, MSC 7365, EPN 4068, Bethesda, MD 20892-7365, USA. nelsond@mail.nih.gov
CONTEXT: Monitoring trends is essential for evaluating past activities and guiding current preventive health program and policy efforts. Although tracking progress toward national health goals is helpful, use of national estimates is limited because most preventive health care activities, policies, and other efforts occur at the state or community level. There may be important state trends that are obscured by national data. OBJECTIVE: To estimate state-specific trends for 5 health risk factors and 6 clinical preventive services. DESIGN: Telephone surveys were conducted from 1991 through 2000 as part of the Behavioral Risk Factor Surveillance System. SETTING AND PARTICIPANTS: Randomly selected adults aged 18 years or older from 49 US states. Annual state sample sizes ranged from 1188 to 7543. MAIN OUTCOME MEASURES: Statistically significant changes (P<.01) in state prevalences of cigarette smoking, binge alcohol use, physical inactivity, obesity, safety belt use, and mammography; screening for cervical cancer, colorectal cancer, and cholesterol levels; and receipt of influenza and pneumococcal disease vaccination. RESULTS: There were statistically significant increases in safety belt use for 39 of 47 states and receipt of mammography in the past 2 years for women aged 40 years or older for 43 of 47 states. For persons aged 65 years or older, there were increases in receipt of influenza vaccination for 44 of 49 states and ever receiving pneumococcal vaccination for 48 of 49 states. State trends were mixed for binge alcohol use (increasing in 19 of 47 states and declining in 3), physical inactivity (increasing in 3 of 48 states and declining in 11), and cholesterol screening (increasing in 13 of 47 states and decreasing in 5). Obesity increased in all states and smoking increased in 14 of 47 states (declining only in Minnesota). Cervical cancer screening increased in 8 of 48 states and colorectal cancer screening increased in 13 of 49 states. New York experienced improvements for 8 of 11 measures, while 7 of 11 measures improved in Delaware, Kentucky, and Maryland; in contrast, Alaska experienced improvements for no measures and at least 4 of 11 measures worsened in Iowa, North Dakota, and South Dakota. CONCLUSIONS: Most states experienced increases in safety belt use, mammography, and adult vaccinations. Trends for smoking and binge alcohol use are disturbing, and obesity data support previous findings. Trend data are useful for targeting state preventive health efforts.

16
UI - 12065168
AU - Van Gorp T; Neven P
TI - Endometrial safety of hormone replacement therapy: review of literature.
SO - Maturitas 2002 Jun 25;42(2):93-104
AD - Department of Obstetrics and Gynaecology, Algemene Kliniek St.-Jan, Broekstraat 104, 1000, Brussels, Belgium.
Unopposed estrogens for treating menopausal symptoms were extensively used when epidemiological findings associated them with an increased endometrial cancer risk. Adding progestogens reverse this side effect efficiently but patient, dose, type and especially time during which the progestogen is administered are important. Long-term uterine safety of the long cycle HRT with administration of the progestogen every 3 months remains unclear. Because regular bleeding lowers compliance, continuous combined estrogen-progestogen treatment has become popular. Many different regimens are now available using oral, transdermal, subcutaneous, intravaginal or intra-uterine application of the estrogen and/or progestogen. Available but inadequate studies seem to point towards a slightly decreased endometrial cancer risk with continuous combined preparations compared with non-HRT-users and an increased risk with long-term oral but not vaginal treatment with low-potency estrogen formulations such as estriol. Newer compounds for menopausal health such as tibolone and raloxifene seem to be safe. As for any women with abnormal vaginal bleeding, those on HRT must have an intra-uterine evaluation. Transvaginal ultrasound (TVU) is very accurate in predicting a normal uterine cavity but inaccurate in predicting endometrial pathology because of a low specificity and positive predictive value of a thick echogenic endometrium. In all such cases a three-dimensional visualisation of intra-uterine lesions is more accurate. Periodic examination with TVU and/or endometrial biopsy of HRT exposed endometrium in asymptomatic women is not cost-effective. The available limited data on the use of HRT in hysterectomised women for early stage endometrial cancer show little evidence in terms of recurrence.

17
UI - 12190056
AU - Hou SI; Fernandez ME; Baumler E; Parcel GS
TI - Effectiveness of an intervention to increase Pap test screening among Chinese women in Taiwan.
SO - J Community Health 2002 Aug;27(4):277-90
AD - Department of Health Promotion and Behavior, School of Health and Human Performance, College of Education at the University of Georgia, Athens 30602-6522, USA. shou@coe.uga.edu
This study assessed the effectiveness of a theory-based direct mail campaign in encouraging non-compliant women, aged 30 and older or younger if married, to obtain a Pap test. Participants were female family members of inpatients admitted to one of the major teaching were recruited in the randomized intervention trial. Three months following implementation of the intervention, women in the intervention group reported a higher rate of Pap test screening than women in the comparison group (50% versus 32%) (p = 0.002). Women in the intervention group also showed higher perceived pros of a Pap test at follow-up (p = 0.031). Although women in both groups showed an increased knowledge and intention to obtain a Pap, only the intervention group had significantly higher follow-up scores on perceived pros and susceptibility. The results shows that the intervention was effective in increasing Pap test screening among Chinese women within three months. The results also support the use of Intervention Mapping, a systematic program development framework for planning effective interventions.

18
UI - 12184837
AU - Broughton S
TI - A review of the literature: interventions to maximize capacity to consent and reduce anxiety of women with learning disabilities preparing for a cervical smear test.
SO - Health Serv Manage Res 2002 Aug;15(3):173-85
AD - Community Team for Adults with Learning Difficulties, SALD Office, Princess of Wales Hospital, Lynn Rd, Ely, Cambridgeshire, CB6 1DN, UK.
Due to the complex nature of the cervical screening for women with learning disabilities, this literature review has several different strands. The aim of which is to give a general overview of the literature available about women with learning disabilities and cervical screening. Discussing key issues in relation to uptake, access and risk factors associated with cervical screening. The role of the learning disability nurse in supporting access to cervical screening services within primary care will be explored. The notion that anxiety and a woman's capacity to consent impacts on her accessing cervical screening services and ultimately undergoing a cervical smear test, will be examined. Relaxation techniques with regard to ascertaining which techniques are more effective when used with individuals with a learning disability will also be discussed.

19
UI - 11314432
AU - Franco EL; Duarte-Franco E; Ferenczy A
TI - Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection.
SO - CMAJ 2001 Apr 3;164(7):1017-25
AD - Department of Oncology, McGill University, Montreal, Que.
Organized screening has contributed to a decline in cervical cancer incidence and mortality over the past 50 years. However, women in developing countries are yet to profit extensively from the benefits of screening programs, and recent trends show a resurgence of the disease in developed countries. The past 2 decades have witnessed substantial progress in our understanding of the natural history of cervical cancer and in major treatment advances. Human papillomavirus (HPV) infection is now recognized as the main cause of cervical cancer, the role of coexisting factors is better understood, a new cytology reporting terminology has improved diagnosis and management of precursor lesions, and specific treatment protocols have increased survival among patients with early or advanced disease. Current research has focused on the determinants of infection with oncogenic HPV types, the assessment of prophylactic and therapeutic vaccines and the development of screening strategies incorporating HPV testing and other methods as adjunct to cytology. These are fundamental stepping stones for the implementation of effective public health programs aimed at the control of cervical cancer.

20
UI - 8019244
AU - Hammond R
TI - Management of women with smears showing mild dyskaryosis.
SO - BMJ 1994 May 28;308(6941):1383-4

21
UI - 12197051
AU - Franceschi S
TI - [Human papillomavirus: a vaccine against cervical carcinoma uterine]
SO - Epidemiol Prev 2002 May-Jun;26(3):140-4
AD - Field and Intervention Study Unit, International Agency for Research on Cancer, Lyon, France.
Human papillomavirus (HPV) has been identified in fewer than 20 years as the central cause of cervical carcinoma and one of the most powerful known human carcinogens. At least 20 different types of HPV have been associated with relative risks of approximately 100 for both squamous-cell carcinoma and the rarer adenocarcinoma of the cervix uteri. Cytologic screening programs have contributed to the decline of cervical cancer mortality in Europe and the United States. Long-term screening programs remain, however, outside the reach of the poorest countries, where 80% of deaths for cervical carcinoma occurs. More than 20 different types of prophylactic and/or therapeutic vaccines against HPV are being evaluated in clinical or preclinical studies. One such type, a prophylactic vaccine based on the marked immunogenicity and safety of the empty viral capsid, will start being evaluated in 2002 in 3 phase-III randomized studies, mostly in the United States and Latin America. The International Agency for Research on Cancer and World Health Organization are planning, in parallel with the studies above, a double blind randomized phase IV study of approximately 40,000 adolescent and young women in Asia. Such study, which should include a cluster randomization (by village of birth); a comparison with another vaccine (rather than with placebo); and, possibly, the inclusion of adolescents and young adults of male sex. Such trial may accelerate by many years the availability of an anti-HPV vaccine among populations at highest risk for cervical carcinoma.

22
UI - 11966387
AU - Wright TC Jr; Cox JT; Massad LS; Twiggs LB; Wilkinson EJ;
TI - ASCCP-Sponsored Consensus Conference 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities.
SO - JAMA 2002 Apr 24;287(16):2120-9
AD - Department of Pathology, College of Physicians and Surgeons of Columbia University, Room 16-404, P&S Bldg, 630 W 168th St, New York, NY 10032, USA. tcw1@columbia.edu
OBJECTIVE: To provide evidence-based consensus guidelines for the management of women with cervical cytological abnormalities and cervical cancer precursors. PARTICIPANTS: A panel of 121 experts in the diagnosis and management of cervical cancer precursors, including representatives from 29 professional organizations, federal agencies, and national and international health organizations, were invited to participate in a consensus conference sponsored by the American Society for Colposcopy and Cervical Pathology (ASCCP). EVIDENCE AND CONSENSUS PROCESS: Guidelines for the management of women with cervical cytological abnormalities were developed through a multistep process. Starting 6 months before the conference, working groups developed draft management guidelines based on formal literature reviews of English-language articles published in 1988-2001, as well as input from the professional community at large, obtained using interactive Internet-based bulletin boards. On September 6-8, 2001, the ASCCP Consensus Conference was held in Bethesda, Md. Guidelines with supporting evidence were presented and underwent discussion, revision, and voting. CONCLUSIONS: Management of women with atypical squamous cells (ASC) depends on whether the Papanicolaou test is subcategorized as of undetermined significance (ASC-US) or as cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H). Women with ASC-US should be managed using a program of 2 repeat cytology tests, immediate colposcopy, or DNA testing for high-risk types of human papillomavirus (HPV). Testing for HPV DNA is the preferred approach when liquid-based cytology is used for screening. In most instances, women with ASC-H, low-grade squamous intraepithelial lesion, HSIL, and atypical glandular cells should be referred for immediate colposcopic evaluation.

23
UI - 12120972
AU - McDonald P; Herity B; Johnson Z; O'Kelly F
TI - Views of Irish general practitioners on screening for cervical cancer.
SO - Ir J Med Sci 2001 Jul-Sep;170(3):186-8
AD - Department of Public Health, Eastern Regional Health Authority, Dublin, Ireland.
BACKGROUND: A national cervical screening programme is being established in Ireland and there is little information on the level of resources required. AIMS: To obtain information on attitudes of Irish general practitioners (GPs) and on the resources needed by them in relation to participation in the programme. METHODS: An anonymous postal questionnaire was sent to a random sample of 600 GPs, approximately 25% of the total population of GPs in Ireland. RESULTS: A response rate of 87.5% was obtained. The majority (88%) would participate in a national programme. Those who would not were more likely to be in single-handed practice, aged over 44 years, have no ancillary staff, no computer and be in rural practice. GPs were in favour of a special fee for smear taking, a training programme and management guidelines on the test report. They did not want bonus payments for achieving targets or the report to be sent to the client as well as the doctor. CONCLUSION: GPs will support a national cervical screening programme but a number of organisational issues must be discussed with them to ensure a successful programme.

24
UI - 12144686
AU - Wellensiek N; Moodley M; Moodley J; Nkwanyana N
TI - Knowledge of cervical cancer screening and use of cervical screening facilities among women from various socioeconomic backgrounds in Durban, Kwazulu Natal, South Africa.
SO - Int J Gynecol Cancer 2002 Jul-Aug;12(4):376-82
AD - Department of Obstetrics and Gynaecology and MRC/UN Pregnancy Hypertension Research Unit, Nelson R Mandela School of Medicine, University of Natal, Congella 4013, South Africa. gynae@nu.ac.za
The value of screening for cervical cancer has been proven. Such screening in developed countries has achieved a decrease in incidence and mortality by about 80%. Although screening facilities are available in certain parts of developing countries, the incidence of cervical cancer remains very high and many patients present with late stage disease. The study was performed among women from different socioeconomic circumstances (low, middle, and upper social/financial backgrounds). The assessment was performed by means of a questionnaire. The majority of patients from lower socio-economic circumstances with multiple risk factors were not aware of cervical screening or facilities available for this purpose. However, in spite of knowledge of cervical screening and the availability of such services, the majority of women (87%) from higher social and educational backgrounds did not undergo cervical screening. Most patients resided within a 12-kilometer radius of a facility that either provided or could potentially provide screening. Although some patients (36.7%) had had a screening test performed at some time in the past, only 27.3% of patients reported having had a Pap test. This was due to failure on the part of the healthcare giver to disseminate information to the patient regarding the reason and value of cervical screening. Among women from higher socioeconomic groups, the level of education was better and knowledge of the Pap test was not age-dependent. We conclude that the mere provision of a cervical cancer screening service is not sufficient to ensure successful uptake since screening is a multifaceted entity. Improvement of socioeconomic and educational circumstances should improve the uptake of a screening program only if the healthcare giver provides appropriate information to the patient and the patient takes the initiative to avail themselves of such screening.

25
UI - 12144688
AU - Miller BE
TI - Breast cancer risk assessment in patients seen in a gynecologic oncology clinic.
SO - Int J Gynecol Cancer 2002 Jul-Aug;12(4):389-93
AD - Section on Gynecologic Oncology, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. bemiller@wfubmc.edu
The objective of this study was to determine if breast cancer risk assessment following the Gail model should be incorporated into a gynecologic oncology clinic. The Gail model was used to assess the risk of breast cancer in 329 patients with preinvasive lower genital tract disease (Pre, n = 86), invasive vulvar and cervical (Cx, n = 102), uterine (Ut, n = 87), and ovarian cancer (Ov, n = 54) seen in an inner city gynecologic oncology office. T-test, chi square test, and Pearson and Spearman correlation coefficients were used for statistical evaluation. A P-value of less than 0.05 was regarded significant. An estimated 5-year risk of breast cancer of 1.67 or more was noted in 9% of the Pre patients, 5% of Cx patients, 21% of the Ut patients, and 9% of the Ov patients. The difference between Cx and Ut patients was significant. The average 5-year risk was calculated at 0.77 for Pre patients, 0.77 for Cx patients, 1.18 for Ut patients, and 1.11 for Ov patients. These differences were significant, but mirror the age distribution. The average age was 43.6 for Pre patients, 52.2 years for Cx, 61.5 years for Ut, and 58.5 years for Ov patients; these differences were significant. When calculations were corrected for the mean age (53 years), there were no significant differences between groups regarding the average risk: Pre: 1.04, Cx: 0.81, Ut: 0.96, Ov: 0.97. Only eight patients (2.4%), six of them in the Pre and Cx group, would be expected to derive significant benefit from tamoxifen therapy. We conclude that elevated 5-year breast cancer risk to 1.67% or higher is noted in about 11% of patients seen in a gynecologic oncology office, mainly related to age and family history. Risk assessment and regular screening should be part of any follow-up exam.

26
UI - 12219782
AU - Wilbur DC; Parker EM; Foti JA
TI - Location-guided screening of liquid-based cervical cytology specimens: a potential improvement in accuracy and productivity is demonstrated in a preclinical feasibility trial.
SO - Am J Clin Pathol 2002 Sep;118(3):399-407
AD - Cytopathology Unit, ViaHealth, Rochester, NY, USA.
A 2-armed, masked study was performed on 1,275 AutoCyte PREP (TriPath, Burlington, NC) slides. Manual screening (current practice [CP]) was compared with automated screening with location-guided screening (LGS) using the AutoPap system with the SlideWizard 2 automated review microscopy station (TriPath). Cytologic adjudication determined "truth" for each slide. LGS identified more abnormal cases at all interpretive levels and classified abnormalities more specifically. For high-grade squamous intraepithelial lesions and above, the overall sensitivity of appropriate triage to pathologist review was 98.4% for LGS and 91.1% for CP. The appropriate triage for all abnormal cases was 92.1% for LGS and 87.9% for CP. The potential exists for more accurate and productive cytologic interpretation using this system, which requires no manual screening of a portion of slides and only limited review of another portion of "predotted" slides.

27
UI - 9641948
AU - Pearson V; Davis C; Ruoff C; Dyer J
TI - Only one quarter of women with learning disability in Exeter have cervical screening.
SO - BMJ 1998 Jun 27;316(7149):1979

28
UI - 10024277
AU - Hall P; Ward E
TI - Cervical screening for women with learning disability. Numbers screened can be optimised by using a focused initiative.
SO - BMJ 1999 Feb 20;318(7182):536-7

29
UI - 10094542
AU - Djuretic T; Laing-Morton T; Guy M; Gill M
TI - Cervical screening for women with learning disability. Concerted effort is needed to ensure these women use preventive services.
SO - BMJ 1999 Feb 20;318(7182):537

30
UI - 10094543
AU - Whitmore J
TI - Cervical screening for women with learning disability. Sefton has multidisciplinary group to promote sexual health care for these women.
SO - BMJ 1999 Feb 20;318(7182):537

31
UI - 11963351
AU - NCI
TI - Physicians urged to recommend Pap tests to women ages 65 and older--new educational materials now available from NCI.
SO - Del Med J 2002 Mar;74(3):143-4

32
UI - 9848907
AU - Cummings JH; Bingham SA
TI - Diet and the prevention of cancer.
SO - BMJ 1998 Dec 12;317(7173):1636-40
AD - MRC Dunn Clinical Nutrition Centre, Cambridge CB2 2DH. john.cummings@nrc-dunn.cam.au.uk

33
UI - 12181953
AU - Kallio M; Nieminen P; Anttila A; Hakama M
TI - [Efficacy of organized screening in comparison to spontaneous Pap samples in the prevention of invasive cervical cancer]
SO - Duodecim 2001;117(14):1442-6
AD - Suomen Syoparekisteri Liisankatu 21 B, 00170 Helsinki.

34
UI - 12181932
AU - Lindstrom K; Ylikorkala O
TI - [Advantages of female sterilization--is there disadvantages?]
SO - Duodecim 2001;117(17):1697-9

35
UI - 12032449
AU - Legro RS
TI - Polycystic ovary syndrome. Long term sequelae and management.
SO - Minerva Ginecol 2002 Apr;54(2):97-114
AD - Department of Obstetrics and Gynaecology, M.S. Hershey Medical Center Pennsylvania State, University College of Medicine, Hershey, PA, USA. RSL1@psu.edu
Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women and is defined by hyperandrogenic chronic anovulation with the exclusion of secondary causes, such as congenital adrenal hyperplasia or an androgen secreting tumor. PCOS women are uniquely insulin resistant. It is estimated that 5% of the female population is affected. The underlying genetic defect in insulin action is unknown. Obesity aggravates the underlying predisposition to insulin resistance. Diagnostic criteria which focus on menstrual irregularity are more likely to identify insulin resistant women. About 40% of PCOS women display glucose intolerance (either impaired glucose tolerance or type 2 diabetes) in response to an oral glucose challenge. Additionally women display multiple other risk factors for cardiovascular disease including dyslipidemia and elevated circulating inflammatory markers. The lack of a clear etiologic mechanism to the syndrome has led in the past to a multitude of symptom-oriented treatments with few therapies improving all aspects of the endocrine syndrome of PCOS. Recently treatments resulting in improved insulin sensitivity, either through weight loss/exercise programs or pharmaceutical, have been shown to improve both the endocrine and metabolic abnormalities in the syndrome. Anti-diabetic agents in PCOS have been examined in a number of randomized studies which have shown a treatment benefit. Further indications for these agents such as the prevention of pregnancy loss or the conversion to type 2 diabetes still need to be investigated in properly designed studies.

36
UI - 12023992
AU - Kauff ND; Satagopan JM; Robson ME; Scheuer L; Hensley M; Hudis CA; Ellis
TI - NA; Boyd J; Borgen PI; Barakat RR; Norton L; Castiel M; Nafa K; Offit K Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation.
SO - N Engl J Med 2002 May 23;346(21):1609-15
AD - Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New York 10021, USA.
BACKGROUND: Risk-reducing salpingo-oophorectomy is often considered by carriers of BRCA mutations who have completed childbearing. However, there are limited data supporting the efficacy of this approach. We prospectively compared the effect of risk-reducing salpingo-oophorectomy with that of surveillance for ovarian cancer on the incidence of subsequent breast cancer and BRCA-related gynecologic cancers in women with BRCA mutations. METHODS: All women with BRCA1 or BRCA2 mutations identified during a six-year period were offered enrollment in a prospective follow-up study. A total of 170 women 35 years of age or older who had not undergone bilateral oophorectomy chose to undergo either surveillance for ovarian cancer or risk-reducing salpingo-oophorectomy. Follow-up involved an annual questionnaire, telephone contact, and reviews of medical records. The time to cancer in the two groups was compared by Kaplan-Meier analysis and a Cox proportional-hazards model. RESULTS: During a mean follow-up of 24.2 months, breast cancer was diagnosed in 3 of the 98 women who chose risk-reducing salpingo-oophorectomy and peritoneal cancer was diagnosed in 1 woman in this group. Among the 72 women who chose surveillance, breast cancer was diagnosed in 8, ovarian cancer in 4, and peritoneal cancer in 1. The time to breast cancer or BRCA-related gynecologic cancer was longer in the salpingo-oophorectomy group, with a hazard ratio for subsequent breast cancer or BRCA-related gynecologic cancer of 0.25 (95 percent confidence interval, 0.08 to 0.74). CONCLUSIONS: Salpingo-oophorectomy in carriers of BRCA mutations can decrease the risk of breast cancer and BRCA-related gynecologic cancer.

38
UI - 12324566
AU - Zhuang SH; Leonard GD; Swain SM
TI - Oophorectomy in carriers of BRCA mutations.
SO - N Engl J Med 2002 Sep 26;347(13):1037-40; discussion 1037-40

39
UI - 12353511
AU - Peshkin BN; DeMarco TA; Schwartz MD
TI - Oophorectomy in carriers of BRCA mutations.
SO - N Engl J Med 2002 Sep 26;347(13):1037-40; discussion 1037-40

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