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Varon ML, Geng Y, Fellman BM, Troisi C, Fernandez ME, Li R, Reininger B, Schmeler KM, Allanson E. Interventions to increase follow-up of abnormal cervical cancer screening results: A systematic literature review and meta-analysis. PLoS One 2024; 19:e0291931. [PMID: 38381754 PMCID: PMC10880967 DOI: 10.1371/journal.pone.0291931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/10/2023] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Ensuring timely follow-up of abnormal screening results is essential for eliminating cervical cancer. OBJECTIVE The purpose of the study was to review single and multicomponent interventions designed to improve follow-up of women with abnormal cervical cancer screening results. We report on effectiveness across studies, and describe what aspects of these interventions might be more impactful. METHODS Publications were searched between January 2000 and December 2022. The search included observational, quasi-experimental (pre-post studies) and randomized controlled studies describing at least one intervention to increase follow-up of women with abnormal cervical cancer screening results. Outcomes of studies included completion of any follow-up (i.e., attending a follow-up appointment), timely diagnosis (i.e., colposcopy results within 90 days of screening) and time to diagnostic resolution (i.e., days between screening and final diagnosis). We assessed risk of bias for observational and quasi-experimental studies using the Newcastle-Ottawa Scale (NOS) tool and the Cochrane collaboration tool for randomized studies. We conducted a meta-analysis using studies where data were provided to estimate a summary average effect of the interventions on follow-up of patients and to identify characteristics of studies associated with an increased effectiveness of interventions. We extracted the comparison and intervention proportions of women with follow-up before and after the intervention (control and intervention) and plotted the odds ratios (ORs) of completing follow-up along with the 95% confidence intervals (CIs) using forest plots for the interventions vs. controls when data were available. FINDINGS From 7,457 identified studies, 28 met the inclusion criteria. Eleven (39%) of the included studies had used a randomized design. Most studies (63%) assessed completion of any follow-up visit as the primary outcome, whereas others measured time to definite diagnosis (15%) or diagnostic resolution (22%). Navigation was used as a type of intervention in 63% of the included studies. Most interventions utilized behavioral approaches to improve outcomes. The overall estimate of the OR for completion of follow-up for all interventions was 1.81 (1.36-2.42). The highest impact was for programs using more than one approach (multicomponent interventions) to improve outcomes with OR = 3.01 (2.03-4.46), compared with studies with single intervention approaches with OR = 1.56 (1.14-2.14). No statistical risks were noted from publication bias or small-study effects in the studies reviewed. CONCLUSION Our findings revealed large heterogeneity in how follow-up of abnormal cervical cancer screening results was defined. Our results suggest that multicomponent interventions were more effective than single component interventions and should be used to improve follow-up after abnormal cervical cancer screening results. Navigation appears to be an important tool for improving follow-up. We also provide recommendations for future studies and implications for policy in terms of better defining outcomes for these interventions.
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Affiliation(s)
- Melissa Lopez Varon
- Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Bryan M. Fellman
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Catherine Troisi
- Management, Policy & Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Maria E. Fernandez
- Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Ruosha Li
- Biostatistics, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Belinda Reininger
- Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Brownsville Regional Campus, Brownsville, Texas, United States of America
| | - Kathleen M. Schmeler
- Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Emma Allanson
- The Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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Varon M, Salcedo MP, Fellman B, Troisi C, Gowen R, Daheri M, Rodriguez AM, Toscano P, Guerra L, Gasca M, Cavazos B, Marin E, Fisher-Hoch S, Fernandez ME, Reininger B, Ruosha L, Baker E, Schmeler K. A Comprehensive Program to Improve Treatment of Precancerous Cervical Lesions in the Rio Grande Valley of Texas. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:89-98. [PMID: 37350621 DOI: 10.1097/phh.0000000000001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To assess the impact of a multicomponent intervention in women with cervical dysplasia who were treated with loop electrosurgical excision procedure (LEEP), as well as the time between colposcopy and treatment. DESIGN Retrospective cohort study. INTERVENTION Clinic participation in a multicomponent cervical cancer prevention program that included community outreach, patient in-reach, and navigation, as well as provider capacity building with in-person training and ongoing telementoring through Project ECHO. MAIN OUTCOME MEASURES Medical records were reviewed to evaluate women with cervical dysplasia undergoing treatment with LEEP within 90 days of colposcopy, as well as time between colposcopy and treatment. Baseline data from year 1 were compared with each subsequent year of implementation. Additional variables examined included patient's age, history of abnormal screening results, and percentage of families living below poverty line based on county of residence, parity, and clinic site. We performed logistic regression and multiple linear regression analyses to assess the programmatic impact in the outcomes of interest by year of program implementation. RESULTS A total of 290 women were included in the study. The proportion of women undergoing treatment within 90 days of colposcopy increased from 76.2% at baseline to 91.3% in year 3 and 92.9% in year 4 of program implementation. The odds of undergoing treatment within 90 days were 5.11 times higher in year 4 of program implementation than at baseline. The mean time between colposcopy and LEEP decreased from 62 days at baseline to 45 days by year 4 of program implementation. CONCLUSIONS Implementation of our multicomponent cervical cancer prevention program increased the proportion of women undergoing LEEP within 90 days of colposcopy and decreased the time between colposcopy and LEEP. This program has the potential to support cervical cancer prevention efforts and could be implemented in other low-resource settings.
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Affiliation(s)
- Melissa Varon
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Drs Varon, Salcedo, Baker, and Schmeler, and Mr Fellman); The University of Texas Health Science Center, School of Public Health, Houston, Texas (Drs Troisi, Fernandez, and Ruosha); The University of Texas Health Science Center, School of Public Health Brownsville Regional Campus, Brownsville, Texas (Ms Gasca, Drs Gowen, Fisher-Hoch, and Reininger); Harris Health, Houston, Texas (Ms Daheri); The University of Texas Medical Branch, Houston, Texas (Dr Rodriguez); McGovern Medical School, Houston, Texas (Mr Toscano) Su Clinica, Harlingen, Texas (Mss Guerra and Cavazos, and Dr Marin)
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Wang F, Song S, Guo B, Li Y, Wang H, Fu S, Wang L, Zhe X, Li H, Li D, Shao R, Pan Z. Increased TCP11 gene expression can inhibit the proliferation, migration and promote apoptosis of cervical cancer cells. BMC Cancer 2023; 23:853. [PMID: 37697257 PMCID: PMC10496356 DOI: 10.1186/s12885-023-11129-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/29/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Cervical cancer is a common gynecological malignancy. Gene microarray found that TCP11 gene was highly expressed in cervical cancer. However, the effect of TCP11 gene on the proliferation, apoptosis and migration of cervical cancer cells and its underlying molecular mechanisms are unclear. METHODS GEPIA database, tissue microarray, western blot and qRT-PCR were used to analyze the expression of TCP11 gene in cervical cancer tissues and cells and its relationship with patients' survival rate. The cell cycle and apoptosis were detected by flow cytometry, and the expressions of cell cycle and apoptosis related molecules and EMT-related molecules were detected by Western blot and qRT-PCR. RESULTS The results showed that TCP11 gene was highly expressed in cervical cancer tissues and cells compared with normal cervical tissues and cells, and its expression was positively correlated with patients' survival rate. The results of proliferation and migration assays showed that TCP11 overexpression inhibited the proliferation and migration of HeLa and SiHa cells. The results showed that TCP11 overexpression blocked the cell cycle of HeLa and SiHa cells, decreased the expression of CDK1 and Cyclin B1, and increased the apoptosis and the expression of caspase-3, cleaved-caspase-3 and cleaved-PARP. TCP11 overexpression increased the protein and mRNA expression of EMT-related molecules ZO-1 and E-cadherin. Conversely, TCP11 knockdown promoted the proliferation of HeLa and SiHa cells and the migration of HeLa cells. CONCLUSIONS TCP11 overexpression significantly inhibited the occurrence and development of cervical cancer cells, it may be a potentially beneficial biomarker for cervical cancer.
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Affiliation(s)
- Fang Wang
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
- Translational Medicine Center, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China
| | - Shuyan Song
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
| | - Bingxuan Guo
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
| | - Yangyang Li
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
| | - Huijuan Wang
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
- Department of Clinical Laboratory, the First Affiliated Hospital of School of Medicine, Shihezi University, Shihezi, Xinjiang, 832000, China
| | - Shaowei Fu
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
| | - Luyue Wang
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
| | - Xiangyi Zhe
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China.
| | - Hongtao Li
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
| | - Dongmei Li
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China
| | - Renfu Shao
- Centre for Bioinnovation, School of Science, Technology and Engineering, University of the Sunshine Coast, Maroochydore, 4556, Australia
| | - Zemin Pan
- Department of Biochemistry and Molecular Biology, School of Medicine, Xinjiang Endemic and Ethnic Disease and Education Ministry Key Laboratory, Shihezi University, Shihezi, Xinjiang, 832002, China.
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Islami F, Wiese D, Marlow EC, Kratzer TB, Massey J, Sung H, Jemal A. Progress in reducing cancer mortality in the United States by congressional district, 1996-2003 to 2012-2020. Cancer 2023; 129:2522-2531. [PMID: 37159301 DOI: 10.1002/cncr.34808] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND United States cancer death rates have been steadily declining since the early 1990s, but information on disparities in progress against cancer mortality across congressional districts is lacking. This study examined trends in cancer death rates, overall and for lung, colorectal, female breast, and prostate cancer by congressional district. METHODS County level cancer death counts and population data from the National Center for Health Statistics were used to estimate relative change in age-standardized cancer death rates from 1996-2003 to 2012-2020 by sex and congressional district. RESULTS From 1996-2003 to 2012-2020, overall cancer death rates declined in every congressional district, with most congressional districts showing a 20%-45% decline among males and a 10%-40% decline among females. In general, the smallest percent of relative declines were found in the Midwest and Appalachia, whereas the largest declines were found in the South along the East Coast and the southern border. As a result, the highest cancer death rates generally shifted from congressional districts across the South in 1996-2003 to districts in the Midwest and central divisions of the South (including Appalachia) in 2012-2020. Death rates for lung, colorectal, female breast, and prostate cancers also declined in almost all congressional districts, although with some variation in relative changes and geographical patterns. CONCLUSIONS Progress in reducing cancer death rates during the past 25 years considerably vary by congressional district, underscoring the need for strengthening existing and implementing new public health policies for broad and equitable application of proven interventions such as raising tax on tobacco and Medicaid expansion.
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Affiliation(s)
- Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Daniel Wiese
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Emily C Marlow
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Tyler B Kratzer
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Jason Massey
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Hyuna Sung
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Zhou Z, Zhou S, Zhang X, Zeng S, Xu Y, Nie W, Zhou Y, Xu T, Chen P. Quaternary Ammonium Salts: Insights into Synthesis and New Directions in Antibacterial Applications. Bioconjug Chem 2023; 34:302-325. [PMID: 36748912 DOI: 10.1021/acs.bioconjchem.2c00598] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The overuse of antibiotics has led to the emergence of a large number of antibiotic-resistant genes in bacteria, and increasing evidence indicates that a fungicide with an antibacterial mechanism different from that of antibiotics is needed. Quaternary ammonium salts (QASs) are a biparental substance with good antibacterial properties that kills bacteria through simple electrostatic adsorption and insertion into cell membranes/altering of cell membrane permeability. Therefore, the probability of bacteria developing drug resistance is greatly reduced. In this review, we focus on the synthesis and application of single-chain QASs, double-chain QASs, heterocyclic QASs, and gemini QASs (GQASs). Some possible structure-function relationships of QASs are also summarized. As such, we hope this review will provide insight for researchers to explore more applications of QASs in the field of antimicrobials with the aim of developing systems for clinical applications.
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Affiliation(s)
- Zhenyang Zhou
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry & Chemical Engineering, Anhui University, Hefei 230601, China
| | - Shuguang Zhou
- Department of Gynecology, Anhui Province Maternity and Child Healthcare Hospital, Hefei, Anhui 236000, China
| | - Xiran Zhang
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry & Chemical Engineering, Anhui University, Hefei 230601, China
| | - Shaohua Zeng
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry & Chemical Engineering, Anhui University, Hefei 230601, China
| | - Ying Xu
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry & Chemical Engineering, Anhui University, Hefei 230601, China
| | - Wangyan Nie
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry & Chemical Engineering, Anhui University, Hefei 230601, China
| | - Yifeng Zhou
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry & Chemical Engineering, Anhui University, Hefei 230601, China
| | - Tao Xu
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei 230032, China
| | - Pengpeng Chen
- Anhui Province Key Laboratory of Environment-Friendly Polymer Materials, School of Chemistry & Chemical Engineering, Anhui University, Hefei 230601, China
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Platt S, Montgomery GH, Schnur JH, Margolies L. BI-RADS 0 Screening Mammography: Risk Factors That Prevent or Delay Follow-Up Time to Diagnostic Evaluation. J Am Coll Radiol 2022; 19:1262-1268. [PMID: 35985631 DOI: 10.1016/j.jacr.2022.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE BI-RADS 0 screening mammograms require follow-up diagnostic imaging, optimally within 60 days. Our study aims to identify risk factors for delayed follow-up. METHODS We conducted a retrospective case-control study of individuals who had a nondiagnostic BI-RADS 0 screening mammogram between March 19, 2018, and March 19, 2020. Sociodemographic information was collected from self-reported questionnaire. We aimed to identify factors associated with <60-day follow-up, >60-day follow-up, or no follow-up outcomes. The χ2 test and univariate logistic regressions were performed. Significant variables were included in multinomial logistic regression. We also aimed to identify risk factors that lead to delayed follow-up times among individuals with follow-up. Spearman's correlation and Mann-Whitney Wilcoxon tests and Kruskal-Wallis tests were performed. RESULTS Review returned 5,034 screening mammograms. Of 4,552 individuals included, 904 (19.9%) had no follow-up. Of the 3,648 (80.1%) with follow-up, 2,797 (76.7%) had a follow-up <60 days (median 20 days) and 851 (23.3%) had follow-up >60 days (median 176 days). Multinomial regression found that Asian (P = .022), Black (P < .0001), and individuals who identified their race as other (P < .0001) were independently more likely to have no or >60-day follow-up. Individuals who did not report their race (P = .001) or completed the questionnaire in Spanish (P = .025) were more likely to have no or >60-day follow-up. Amongst individuals with follow-up, Black individuals (P < .0001), those who identified their race as other (P < .0001), Hispanic individuals (P = .04), and those who completed the questionnaire in Spanish (P < .0001) had follow-up delays. BRCA-positive individuals had shorter follow-up times (P = .021). DISCUSSION Follow-up time is affected by cancer risk factors such as BRCA status in addition to race, preferred language, and Hispanic ethnicity.
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Affiliation(s)
- Samantha Platt
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Guy H Montgomery
- Professor, Department of Population Health Science and Policy and Director, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie H Schnur
- Assistant Professor, Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurie Margolies
- Professor of Diagnostic, Molecular and Interventional Radiology and Professor and Director, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Dual-Signal-Encoded Barcodes with Low Background Signal for High-Sensitivity Analysis of Multiple Tumor Markers. CHEMOSENSORS 2022. [DOI: 10.3390/chemosensors10040142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The suspension array technology (SAT) is promising for high-sensitivity multiplexed analysis of tumor markers. Barcodes as the core elements of SAT, can generate encoding fluorescence signals (EFS) and detection fluorescence signals (DFS) in the corresponding flow cytometer channel. However, the bleed-through effect of EFS in the DFS channel and the reagent-driven non-specific binding (NSB) lead to background interference for ultrasensitive assay of multiple targets. Here, we report an ingenious method to eliminate background interference between barcode and reporter using low-background dual-signal-encoded barcodes (DSBs) based on microbeads (MBs) and quantum dots (QDs). The low-background DSBs were prepared via combination strategy of two signals containing scatter signals and fluorescence signals. Three types of MBs were distinguished by the scattering channel of flow cytometer (FSC vs. SSC) to obtain the scattered signals. Green quantum dots (GQDs) or red quantum dots (RQDs) were coupled to the surface of MBs by sandwich immune structure to obtain the distinguishable fluorescent signals. Furthermore, the amount of conjugated capture antibody on the MB’s surface was optimized by comparing the change of detection sensitivity with the addition of capture antibody. The combination measurements of specificity and NSB in SAT platform were performed by incubating the capture antibody-conjugated MBs (cAb-MBs) with individual QD-conjugated detection antibody (QDs-dAb). Finally, an SAT platform based on DSBs was successfully established for highly sensitive multiplexed analysis of six tumor markers in one test, which suggests the promising tool for highly sensitive multiplexed bioassay applications.
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Li F, Hu Y, Guo C, Lei L, Li F, Liu M, Liu Z, Pan Y, Liu F, Liu Y, Hu Z, Chen H, He Z, Ke Y. Economic Burden Conferred by Population-Level Cancer Screening on Resource-Limited Communities: Lessons From the ESECC Trial. Front Oncol 2022; 12:849368. [PMID: 35387122 PMCID: PMC8977508 DOI: 10.3389/fonc.2022.849368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Upper gastrointestinal (G.I.) cancer screening has been conducted in China for decades. However, the economic burden for treatment “intensively” occurred in advance due to screening in resource-limited communities remain unclear. Methods We compared the treatment costs for upper G.I. cancers from the screening and control arms of a population-based randomized trial in a high-risk area for esophageal cancer (EC) in China based on claims data from the health insurance system in the local area which included whole population coverage. Results The average out-of-pocket cost per treatment of EC in the screening arm was lower than that in the control arm ($5,972 vs. $7,557). This difference was a consequence of down-staging from screening which resulted in lower cost therapy for earlier stage cancers. Moreover, this result is similar for cardial and non-cardial gastric cancer in the two study arms ($7,933 vs. $10,605). However, three times as many (103 vs. 36) families in the screening arm suffered catastrophic health expenditure for all cancer types. The overall treatment cost for all EC patients in the screening arm ($1,045,119) was 2.44 times that in the control arm ($428,292), and the ratio for cardial and non-cardial gastric cancer was 1.12 ($393,261 vs. $351,557). Conclusion Cancer treatment secondary to screening may triple the likelihood of catastrophic patient medical expenditure, and sharply increase the economic pressure on the local community, particularly for cancer types which are of high prevalence. Financial support for patients and the health insurance system should be taken into consideration when planning budgets for cancer screening programs in communities which are resource-limited.
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Affiliation(s)
- Fuxiao Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China.,Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yanjun Hu
- Healthcare Security Administration of Hua County, Anyang, China
| | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Liang Lei
- Healthcare Security Administration of Hua County, Anyang, China
| | - Fenglei Li
- Hua County People's Hospital, Anyang, China
| | - Mengfei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhen Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yaqi Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fangfang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhe Hu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huanyu Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
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9
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Hu XL, Shang Y, Yan KC, Sedgwick AC, Gan HQ, Chen GR, He XP, James TD, Chen D. Low-dimensional nanomaterials for antibacterial applications. J Mater Chem B 2021; 9:3640-3661. [PMID: 33870985 DOI: 10.1039/d1tb00033k] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The excessive use of antibiotics has led to a rise in drug-resistant bacteria. These "superbugs" are continuously emerging and becoming increasingly harder to treat. As a result, new and effective treatment protocols that have minimal risks of generating drug-resistant bacteria are urgently required. Advanced nanomaterials are particularly promising due to their drug loading/releasing capabilities combined with their potential photodynamic/photothermal therapeutic properties. In this review, 0-dimensional, 1-dimensional, 2-dimensional, and 3-dimensional nanomaterial-based systems are comprehensively discussed for bacterial-based diagnostic and treatment applications. Since the use of these platforms as antibacterials is relatively new, this review will provide appropriate insight into their construction and applications. As such, we hope this review will inspire researchers to explore antibacterial-based nanomaterials with the aim of developing systems for clinical applications.
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Affiliation(s)
- Xi-Le Hu
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Feringa Nobel Prize Scientist Joint Research Center, School of Chemistry and Molecular Engineering, Frontiers Center for Materiobiology and Dynamic Chemistry, East China University of Science and Technology, 130 Meilong Rd, Shanghai 200237, China.
| | - Ying Shang
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Feringa Nobel Prize Scientist Joint Research Center, School of Chemistry and Molecular Engineering, Frontiers Center for Materiobiology and Dynamic Chemistry, East China University of Science and Technology, 130 Meilong Rd, Shanghai 200237, China.
| | - Kai-Cheng Yan
- Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Adam C Sedgwick
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78712-1224, USA
| | - Hui-Qi Gan
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Feringa Nobel Prize Scientist Joint Research Center, School of Chemistry and Molecular Engineering, Frontiers Center for Materiobiology and Dynamic Chemistry, East China University of Science and Technology, 130 Meilong Rd, Shanghai 200237, China.
| | - Guo-Rong Chen
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Feringa Nobel Prize Scientist Joint Research Center, School of Chemistry and Molecular Engineering, Frontiers Center for Materiobiology and Dynamic Chemistry, East China University of Science and Technology, 130 Meilong Rd, Shanghai 200237, China.
| | - Xiao-Peng He
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Feringa Nobel Prize Scientist Joint Research Center, School of Chemistry and Molecular Engineering, Frontiers Center for Materiobiology and Dynamic Chemistry, East China University of Science and Technology, 130 Meilong Rd, Shanghai 200237, China.
| | - Tony D James
- Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, UK. and School of Chemistry and Chemical Engineering, Henan Normal University, Xinxiang 453007, China
| | - Daijie Chen
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai 200240, China.
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10
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Benard VB, Jackson JE, Greek A, Senkomago V, Huh WK, Thomas CC, Richardson LC. A population study of screening history and diagnostic outcomes of women with invasive cervical cancer. Cancer Med 2021; 10:4127-4137. [PMID: 34018674 PMCID: PMC8209614 DOI: 10.1002/cam4.3951] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite advances to prevent and detect cervical cancer, national targets for screening have not been met in the United States. Previous studies suggested that approximately half of women who developed cervical cancer were not adequately screened. This study aimed to provide an updated examination of women's screening and diagnostic practices five years prior to an invasive cervical cancer diagnosis. METHODS The study included women age 21 years and older diagnosed with invasive cervical cancer in 2013-2016 from three population-based state cancer registries in the United States. Medical records abstraction identified screening history and diagnostic follow-up. A mailed survey provided sociodemographic data. Screening was a Pap or human papillomavirus (HPV) test between 6 months and 5 years before diagnosis. Adequate follow-up was defined per management guidelines. RESULTS Of the 376 women, 60% (n = 228) had not been screened. Among women who received an abnormal screening result (n = 122), 67% (n = 82) had adequate follow-up. Predictors of: (a) being screened were younger age, having a higher income, and having insurance; (b) adequate follow-up were having a higher income, and (c) stage 1 cervical cancer were being screened and younger age. CONCLUSION Unlike other cancer patterns of care studies, this study uses data obtained from medical records supplemented with self-report information to understand a woman's path to diagnosis, her follow-up care, and the stage of her cervical cancer diagnosis. This study provides findings that could be used to reach more unscreened or under screened women and to continue lowering cervical cancer incidence in the United States.
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Affiliation(s)
- Vicki B Benard
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cheryll C Thomas
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Lin CL, Ying TH, Yang SF, Chiou HL, Chen YS, Kao SH, Hsieh YH. MTA2 silencing attenuates the metastatic potential of cervical cancer cells by inhibiting AP1-mediated MMP12 expression via the ASK1/MEK3/p38/YB1 axis. Cell Death Dis 2021; 12:451. [PMID: 33958583 PMCID: PMC8102478 DOI: 10.1038/s41419-021-03729-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022]
Abstract
Metastasis-associated protein 2 (MTA2) is a transcription factor that is highly associated with matrix metalloproteinase 12 (MMP12). Thus, we hypothesized that MTA2 may regulate MMP12 expression and is involved in cervical cancer metastasis. Results showed that MTA2 and MMP12 were highly expressed in cervical cancer cells, and MTA2 knockdown reduced MMP12 expression and inhibited the metastasis of cervical cancer cells in xenograft mice. MMP12 knockdown did not influence the viability of cervical cancer cells but clearly inhibited cell migration and invasion both in vitro and in vivo. MMP12 was highly expressed in cervical tumor tissues and correlated with the poor survival rate of patients with cervical cancer. Further investigations revealed that p38 mitogen-activated protein kinase (p38), mitogen-activated protein kinase kinase 3 (MEK3), and apoptosis signal-regulating kinase 1 (ASK1) were involved in MMP12 downregulation in response to MTA2 knockdown. Results also demonstrated that p38-mediated Y-box binding protein1 (YB1) phosphorylation disrupted the binding of AP1 (c-Fos/c-Jun) to the MMP12 promoter, thereby inhibiting MMP12 expression and the metastatic potential of cervical cancer cells. Collectively, targeting both MTA2 and MMP12 may be a promising strategy for the treatment of cervical cancer.
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Affiliation(s)
- Chia-Liang Lin
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Tsung-Ho Ying
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hui-Ling Chiou
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Yong-Syuan Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shao-Hsuan Kao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Yi-Hsien Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
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12
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Liu Z, Liu J, Liu R, Xue M, Zhang W, Zhao X, Zhu J, Xia P. Downregulated ZNF132 predicts unfavorable outcomes in breast Cancer via Hypermethylation modification. BMC Cancer 2021; 21:367. [PMID: 33827486 PMCID: PMC8028803 DOI: 10.1186/s12885-021-08112-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/28/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND An important mechanism that promoter methylation-mediated gene silencing for gene inactivation is identified in human tumorigenesis. Methylated genes have been found in breast cancer (BC) and beneficial biomarkers for early diagnosis. Prognostic assessment of breast cancer remain little known. Zinc finger protein 132 (ZNF132) is downregulated by promoter methylation in prostate cancer and esophageal squamous cell carcinoma. However, no study provides information on the status of ZNF132, analyzes diagnosis and prognostic significance of ZNF132 in BC. METHODS In the present study, the expression of ZNF132 mRNA and protein level was determined based on the Cancer Genome Atlas (TCGA) RNA-Seq database and clinical samples analysis and multiple cancer cell lines verification. P rognostic significance of ZNF132 in BC was assessed using the Kaplan-Meier plotter. Molecular mechanisms exploration of ZNF132 in BC was performed using the multiple bioinformatic tools. Hypermethylated status of ZNF132 in BC cell lines was confirmed via Methylation specific polymerase chain reaction (MSP) analysis. RESULTS The expression of ZNF132 both the mRNA and protein levels was downregulated in BC tissues. These results were obtained based on TCGA database and clinical sample analysis. Survival analysis from the Kaplan-Meier plotter revealed that the lower level of ZNF132 was associated with a shorter Relapse Free Survival (RFS) time. Receiver operating characteristic curve (ROC) of 0.887 confirmed ZNF132 had powerful sensitivity and specificity to distinguish between BC and adjacent normal tissues. Bioinformatic analysis showed that 6% ((58/960)) alterations of ZNF132 were identified from cBioPortal. ZNF132 participated in multiple biological pathways based on the Gene Set Enrichment Analysis (GSEA) database including the regulation of cell cycle and glycolysis. Finally, MSP analysis demonstrated that ZNF132 was hypermethylated in a panel of breast cancer cell lines and 5-aza-2'-deoxycytidine (5-Aza-dC) treatment restored ZNF132 expression in partial cell lines. CONCLUSIONS Results revealed that hypermethylation of ZNF132 contributed to its downregulated expression and could be identified as a new diagnostic and prognostic marker in BC.
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Affiliation(s)
- Zhao Liu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China
| | - Jiaxin Liu
- Department of Gerontological Surgery, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China
| | - Ruimiao Liu
- Department of Clinical Laboratory, Peoples Hospital of Xi'an (Fourth Hospital of Xi'an), Xi'an, 710004, Shaanxi, China
| | - Man Xue
- Department of General Surgery, Tongchuan Mining Bureau Central Hospital, Tongchuan, 727000, Shaanxi, China
| | - Weifan Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China
| | - Xinhui Zhao
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China
| | - Jiang Zhu
- Department of Breast Disease, Shaanxi Provincial Cancer Hospital, Xi'an, 710061, Shaanxi, China
| | - Peng Xia
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China.
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13
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Zheng Z, Fedewa SA, Han X, Yabroff KR. Response to Letter to the Editor Regarding "Financial Hardship, Healthcare Utilization, and Health Among U.S. Cancer Survivors". Am J Prev Med 2021; 60:e109-e110. [PMID: 33482984 DOI: 10.1016/j.amepre.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
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14
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Ning YE, Liu Y, Xu XY, Zhang XY, Wang N, Zheng LQ. Knowledge of Cervical Cancer, Human Papilloma Virus (HPV) and HPV Vaccination Among Women in Northeast China. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1197-1205. [PMID: 31338812 PMCID: PMC7677602 DOI: 10.1007/s13187-019-01582-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This study aimed to research the understanding and knowledge of cervical cancer, human papilloma virus (HPV), and HPV vaccination, and the acceptance of HPV vaccination, among a population of women in northeastern China. A cross-sectional survey was carried out by questionnaire to investigate knowledge of cervical cancer, HPV, and HPV vaccination. The 230 female participants were native residents of northeastern China, and their ages ranged between 18 and 65 years. Questionnaires were randomly acquired by the respondents from online and paper questionnaire distribution. The questionnaire included questions on three major aspects to record people's perceptions of cervical cancer, HPV, and vaccines. Of the sample of 230 women surveyed, 80.9% had heard of cervical cancer, but understanding was only 15.7%; 38.3% knew about HPV; 20% knew about HPV vaccine; 39.6% agreed to receive HPV vaccination, and the remainder were mainly concerned about its safety and effectiveness. Data analysis showed that age, family income, and whether there was experience of screening all influenced knowledge of cervical cancer, but this was not statistically significant. The level of education had no obvious effect on the degree of knowledge about cervical cancer; however, with an improvement in education, women's awareness of HPV vaccine improved significantly (p < 0.05). Women who have received cervical cancer screening had significantly greater knowledge about cervical cancer and HPV than those with no screening (p < 0.05). Women in northeastern China have little knowledge of cervical cancer, HPV, and HPV vaccine, lack disease knowledge, and hold a skeptical attitude about HPV vaccination. Medical institutions are the main channel providing information to these women.
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Affiliation(s)
- Yu-e Ning
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110020 China
| | - Yao Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110020 China
| | - Xiao-yu Xu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110020 China
| | - Xin-yu Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110020 China
| | - Ning Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110020 China
| | - Li-qiang Zheng
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110020 China
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15
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The role and contribution of treatment and imaging modalities in global cervical cancer management: survival estimates from a simulation-based analysis. Lancet Oncol 2020; 21:1089-1098. [PMID: 32758463 DOI: 10.1016/s1470-2045(20)30316-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, causing more than 300 000 deaths globally each year. In addition to screening and prevention, effective cancer treatment is needed to reduce cervical cancer mortality. We discuss the role of imaging in cervical cancer management and estimate the potential survival effect of scaling up imaging in several different contexts. METHODS Using a previously developed microsimulation model of global cancer survival, we estimated stage-specific cervical cancer 5-year net survival in 200 countries and territories. We evaluated the potential survival effect of scaling up treatment (chemotherapy, surgery, radiotherapy, and targeted therapy), and imaging modalities (ultrasound, x-ray, CT, MRI, PET, and single photon emission CT [SPECT]) to the mean level of high-income countries, both individually and in combination. FINDINGS We estimate global cervical cancer 5-year net survival as 42·1% (95% uncertainty interval [UI] 33·8-48·5). Among individual imaging modalities, expanding MRI would yield the largest 5-year survival gains globally (data are absolute percentage point increase in survival 0·6, 95% UI 0·1-2·1), scaling up ultrasound would yield the largest gains in low-income countries (0·5, 0·0-3·7), expanding CT and x-ray would have the greatest effect in Latin America (0·8, 0·0-3·4) and Oceania (0·4, 0·0-3·2), and expanding PET would yield the largest gains in high-income countries (0·2, 0·0-0·8). Scaling up SPECT did not show major changes in any region. Among individual treatment modalities, scaling up radiotherapy would yield the largest absolute percentage point gains in low-income countries (5·2, 0·3-13·5), and expanding surgery would have the largest effect in lower-middle-income countries (7·4, 0·3-21·1) and upper-middle-income countries (0·8, 0·0-2·9). Estimated survival gains in high-income countries were very modest. However, the gains from expanding any single treatment or imaging modality individually were small across all income levels and geographical settings. Scaling up all treatment modalities could improve global 5-year net survival to 52·4% (95% UI 44·6-62·0). In addition to expanding treatment, improving quality of care could raise survival to 57·5% (51·2-63·5), and the cumulative effect of scaling up all imaging modalities together with expanded treatment and quality of care could improve 5-year net survival for cervical cancer to 62·5% (57·7-67·8). INTERPRETATION Comprehensive scale-up of treatment, imaging, and quality of care could substantially improve global cervical cancer 5-year net survival, with quality of care and imaging improvements each contributing about 25% of the total potential gains. These findings suggest that a narrow focus on the availability of treatment modalities could forgo substantial survival gains. Investments in imaging equipment, personnel, and quality of care efforts will also be needed to successfully scale up cervical cancer treatment worldwide. FUNDING Harvard T H Chan School of Public Health and National Cancer Institute.
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16
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Luft H, Perzan M, Mitchell R, Schmidt A. An integrative literature review of barriers and facilitators to cervical cancer screening among refugee women in the United States. Health Care Women Int 2020; 42:992-1012. [PMID: 32814006 DOI: 10.1080/07399332.2020.1803872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Refugee women experience disproportionally high cervical cancer-related mortality. In this integrative review, we identify and discuss factors related to cervical cancer screening among refugee women in the US according to the Social Ecological Model. Two qualitative and three quantitative studies met inclusion criteria. Individual-level factors include English-language ability, availability, and individual knowledge, attitudes, and beliefs. Interpersonal-level factors include interactions with family/friends, provider, and community health worker. Community-, organization-, and policy-level factors include sociocultural values, transportation, ability to navigate the healthcare system, and health insurance. We discuss findings in the context of related reviews and applicability to other global settings.
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Affiliation(s)
- Heidi Luft
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Mireille Perzan
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Rita Mitchell
- Advocate Aurora Library Network, Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Austin Schmidt
- Milwaukee Global Health Consortium, Milwaukee, Wisconsin, USA
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17
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Kumar AJ, Banco D, Steinberger EE, Chen J, Weidner R, Makim S, Parsons SK. Time to diagnostic resolution after an uncertain screening mammogram in an underserved population. Cancer Med 2020; 9:3252-3258. [PMID: 32160406 PMCID: PMC7196065 DOI: 10.1002/cam4.2970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Screening mammography has reduced breast cancer-associated mortality worldwide. Approximately 10% of patients require further diagnostic testing after an uncertain screening mammogram (Breast imaging reporting and data system [BI-RADS] = 0), and time to diagnostic resolution varies after BI-RADS = 0 screening mammogram. There is little data about factors associated with diagnostic resolution in patients of Chinese origin ("Chinese") receiving care in the US. METHODS We performed a retrospective analysis to identify patterns of diagnostic resolution in an urban US hospital with a large population of Chinese patients. We evaluated whether location of primary care provider (PCP) impacted time to resolution among Chinese patients, hypothesizing that patients with a PCP outside of the hospital would have longer time to diagnostic resolution than those patients with a PCP within the institution. RESULTS Between 2015 and 2016, 368 patients at Tufts Medical Center (Tufts MC) had resulting BI-RADS = 0 after screening mammogram. The majority of patients (341/368, 93%) achieved diagnostic resolution with median time to resolution 27 days (Q1: 14, Q3: 40). Seven percent (27/368) never achieved resolution. Among those with diagnostic resolution, 10% of patients required >60 days to achieve resolution. Chinese origin, no previous breast cancer, subsidized insurance, and outside referring physician were associated with longer time to resolution in univariable analysis. In multivariable regression, after adjusting for age, insurance, marital status, and prior breast cancer, Chinese patients with Tufts MC PCP experienced timelier diagnostic resolution vs Chinese patients without a Tufts MC PCP (hazard ratio [HR] = 1.85, P = .02). Location of PCP did not impact time to resolution among non-Chinese patients. CONCLUSION We identified patterns of diagnostic resolution in an urban hospital with a large historically underserved population. We found that Chinese patients without integrated primary care within the institution are at risk for delayed diagnostic resolution. Future interventions need to target at-risk patients to prevent loss of follow-up after uncertain screening mammogram.
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Affiliation(s)
- Anita J. Kumar
- Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMAUSA
- Department of MedicineTufts University School of MedicineBostonMAUSA
| | - Darcy Banco
- Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMAUSA
| | - Elise E. Steinberger
- Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMAUSA
| | - Joanna Chen
- Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMAUSA
| | - RuthAnn Weidner
- Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMAUSA
| | - Shital Makim
- Department of RadiologyTufts Medical CenterBostonMAUSA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMAUSA
- Department of MedicineTufts University School of MedicineBostonMAUSA
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Tsui J, Llanos AA, Doose M, Rotter D, Stroup A. Determinants of Abnormal Cervical Cancer Screening Follow-Up And Invasive Cervical Cancer Among Uninsured and Underinsured Women in New Jersey. J Health Care Poor Underserved 2020; 30:680-701. [PMID: 31130545 DOI: 10.1353/hpu.2019.0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To identify determinants of follow-up care and diagnosis of invasive cervical cancer among uninsured/underinsured women screened for cervical cancer. METHODS We examined the associations between health care facility, area-level, and individual-level factors on the outcomes of interest in retrospective cohort of women from the New Jersey Cancer Education and Early Detection Program (2000-2015). RESULTS Women screened at department of health clinics (aOR:3.11, 95% CI: 2.30-4.20) and health care system-affiliated clinics (aOR:1.71, 95% CI: 1.11-2.64) had higher odds of lacking follow-up care compared with women in private physician practices. Similarly, women residing in areas with the highest unemployment had higher odds of lacking follow-up (aOR:1.48, 95% CI: 1.07-2.06). Delays in follow-up care were higher for women born in Central/South American countries compared with U.S.-born women (aOR: 1.46, 95% CI: 1.12-1.92). CONCLUSIONS Improved outreach efforts and multilevel strategies are needed to address the persistent barriers to appropriate follow-up care for underserved women.
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19
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Rim SH, Allaire BT, Ekwueme DU, Miller JW, Subramanian S, Hall IJ, Hoerger TJ. Cost-effectiveness of breast cancer screening in the National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control 2019; 30:819-826. [PMID: 31098856 PMCID: PMC6613985 DOI: 10.1007/s10552-019-01178-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/03/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate the cost-effectiveness of breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS Using a modified CISNET breast cancer simulation model, we estimated outcomes for women aged 40-64 years associated with three scenarios: breast cancer screening within the NBCCEDP, screening in the absence of the NBCCEDP (no program), and no screening through any program. We report screening outcomes, cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and sensitivity analyses results. RESULTS Compared with no program and no screening, the NBCCEDP lowers breast cancer mortality and improves QALYs, but raises health care costs. Base-case ICER for the program was $51,754/QALY versus no program and $50,223/QALY versus no screening. Probabilistic sensitivity analysis ICER for the program was $56,615/QALY [95% CI $24,069, $134,230/QALY] versus no program and $51,096/QALY gained [95% CI $26,423, $97,315/QALY] versus no screening. CONCLUSIONS On average, breast cancer screening in the NBCCEDP was cost-effective compared with no program or no screening.
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Affiliation(s)
- Sun Hee Rim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-4, Atlanta, GA, 30341, USA.
| | | | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-4, Atlanta, GA, 30341, USA
| | - Jacqueline W Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-4, Atlanta, GA, 30341, USA
| | | | - Ingrid J Hall
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-4, Atlanta, GA, 30341, USA
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Allaire BT, Ekweme D, Hoerger TJ, DeGroff A, Rim SH, Subramanian S, Miller JW. Cost-effectiveness of patient navigation for breast cancer screening in the National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control 2019; 30:923-929. [PMID: 31297693 DOI: 10.1007/s10552-019-01200-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/20/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Patient navigation (PN) services have been shown to improve cancer screening in disparate populations. This study estimates the cost-effectiveness of implementing PN services within the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS We adapted a breast cancer simulation model to estimate a population cohort of women aged 40-64 years from the NBCCEDP through their lifetime. We incorporated their screening frequency and screening and diagnostic costs. RESULTS Within the NBCCEDP, Program with PN (vs. No PN) resulted in a greater number of mammograms per woman (4.23 vs. 4.14), lower lifetime mortality from breast cancer (3.53% vs. 3.61%), and fewer missed diagnostic resolution per woman (0.017 vs. 0.025). The estimated incremental cost-effectiveness ratios for a Program with PN was $32,531 per quality-adjusted life-years relative to Program with No PN. CONCLUSIONS Incorporating PN services within the NBCCEDP may be a cost-effective way of improving adherence to screening and diagnostic resolution for women who have abnormal results from screening mammography. Our study highlights the value of supportive services such as PN in improving the quality of care offered within the NBCCEDP.
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Affiliation(s)
- Benjamin T Allaire
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Donatus Ekweme
- Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Thomas J Hoerger
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Sun Hee Rim
- Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Sujha Subramanian
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
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Aras S, Maroun MC, Song Y, Bandyopadhyay S, Stark A, Yang ZQ, Long MP, Grossman LI, Fernández-Madrid F. Mitochondrial autoimmunity and MNRR1 in breast carcinogenesis. BMC Cancer 2019; 19:411. [PMID: 31046734 PMCID: PMC6498478 DOI: 10.1186/s12885-019-5575-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background Autoantibodies function as markers of tumorigenesis and have been proposed to enhance early detection of malignancies. We recently reported, using immunoscreening of a T7 complementary DNA (cDNA) library of breast cancer (BC) proteins with sera from patients with BC, the presence of autoantibodies targeting several mitochondrial DNA (mtDNA)-encoded subunits of the electron transport chain (ETC) in complexes I, IV, and V. Methods In this study, we have characterized the role of Mitochondrial-Nuclear Retrograde Regulator 1 (MNRR1, also known as CHCHD2), identified on immunoscreening, in breast carcinogenesis. We assessed the protein as well as transcript levels of MNRR1 in BC tissues and in derived cell lines representing tumors of graded aggressiveness. Mitochondrial function was also assayed and correlated with the levels of MNRR1. We studied the invasiveness of BC derived cells and the effect of MNRR1 levels on expression of genes associated with cell proliferation and migration such as Rictor and PGC-1α. Finally, we manipulated levels of MNRR1 to assess its effect on mitochondria and on some properties linked to a metastatic phenotype. Results We identified a nuclear DNA (nDNA)-encoded mitochondrial protein, MNRR1, that was significantly associated with the diagnosis of invasive ductal carcinoma (IDC) of the breast by autoantigen microarray analysis. In focusing on the mechanism of action of MNRR1 we found that its level was nearly twice as high in malignant versus benign breast tissue and up to 18 times as high in BC cell lines compared to MCF10A control cells, suggesting a relationship to aggressive potential. Furthermore, MNRR1 affected levels of multiple genes previously associated with cancer metastasis. Conclusions MNRR1 regulates multiple genes that function in cell migration and cancer metastasis and is higher in cell lines derived from aggressive tumors. Since MNRR1 was identified as an autoantigen in breast carcinogenesis, the present data support our proposal that both mitochondrial autoimmunity and MNRR1 activity in particular are involved in breast carcinogenesis. Virtually all other nuclear encoded genes identified on immunoscreening of invasive BC harbor an MNRR1 binding site in their promoters, thereby placing MNRR1 upstream and potentially making it a novel marker for BC metastasis.
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Affiliation(s)
- Siddhesh Aras
- Wayne State University School of Medicine, Center for Molecular Medicine and Genetics, 540 E. Canfield Ave, Detroit, MI, 48201, USA
| | - Marie-Claire Maroun
- Department of Internal Medicine, Wayne State University, Detroit, MI, 48201, USA.,Division of Rheumatology, Department of Internal Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Yeohan Song
- Department of Internal Medicine, Wayne State University, Detroit, MI, 48201, USA
| | | | - Azadeh Stark
- Department of Pathology, Henry Ford Health System, Detroit, MI, 48201, USA
| | - Zeng-Quan Yang
- Department of Oncology and Karmanos Cancer Institute, Wayne State University, Detroit, MI, 48201, USA
| | - Michael P Long
- Department of Pathology, Wayne State University, Detroit, MI, 48201, USA
| | - Lawrence I Grossman
- Wayne State University School of Medicine, Center for Molecular Medicine and Genetics, 540 E. Canfield Ave, Detroit, MI, 48201, USA.
| | - Félix Fernández-Madrid
- Department of Internal Medicine, Wayne State University, Detroit, MI, 48201, USA. .,Division of Rheumatology, Department of Internal Medicine, Wayne State University, Detroit, MI, 48201, USA. .,Wayne State University, University Health Center, 4H, 4201 St. Antoine, Detroit, MI, 48201, USA.
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Toledo-Guzmán ME, Hernández MI, Gómez-Gallegos ÁA, Ortiz-Sánchez E. ALDH as a Stem Cell Marker in Solid Tumors. Curr Stem Cell Res Ther 2019; 14:375-388. [PMID: 30095061 DOI: 10.2174/1574888x13666180810120012] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 02/07/2023]
Abstract
Aldehyde dehydrogenase (ALDH) is an enzyme that participates in important cellular mechanisms as aldehyde detoxification and retinoic acid synthesis; moreover, ALDH activity is involved in drug resistance, a characteristic of cancer stem cells (CSCs). Even though ALDH is found in stem cells, CSCs and progenitor cells, this enzyme has been successfully used to identify and isolate cell populations with CSC properties from several tumor origins. ALDH is allegedly involved in cell differentiation through its product, retinoic acid. However, direct or indirect ALDH inhibition, using specific inhibitors or retinoic acid, has shown a reduction in ALDH activity, along with the loss of stem cell traits, reduction of cell proliferation, invasion, and drug sensitization. For these reasons, ALDH and retinoic acid are promising therapeutic targets. This review summarizes the current evidence for ALDH as a CSCs marker in solid tumors, as well as current knowledge about the functional roles of ALDH in CSCs. We discuss the controversy of ALDH activity to maintain CSC stemness, or conversely, to promote cell differentiation. Finally, we review the advances in using ALDH inhibitors as anti-cancer drugs.
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Affiliation(s)
- Mariel E Toledo-Guzmán
- Departamento de Bioquimica, Laboratorio de Terapia Genica, Escuela Nacional de Ciencias Biologicas, Posgrado de Biomedicina y Biotecnologia Molecular, Instituto Politecnico Nacional, Mexico City, Mexico
- Subdireccion de Investigacion Basica, Instituto Nacional de Cancerologia, Av San Fernando 22, Colonia Seccion XVI, Tlalpan 14080, Mexico City, Mexico
| | - Miguel Ibañez Hernández
- Departamento de Bioquimica, Laboratorio de Terapia Genica, Escuela Nacional de Ciencias Biologicas, Posgrado de Biomedicina y Biotecnologia Molecular, Instituto Politecnico Nacional, Mexico City, Mexico
| | - Ángel A Gómez-Gallegos
- Subdireccion de Investigacion Basica, Instituto Nacional de Cancerologia, Av San Fernando 22, Colonia Seccion XVI, Tlalpan 14080, Mexico City, Mexico
- Posgrado de Ciencias Biológicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Elizabeth Ortiz-Sánchez
- Subdireccion de Investigacion Basica, Instituto Nacional de Cancerologia, Av San Fernando 22, Colonia Seccion XVI, Tlalpan 14080, Mexico City, Mexico
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Tsui J, DeLia D, Stroup AM, Nova J, Kulkarni A, Ferrante JM, Cantor JC. Association of Medicaid enrollee characteristics and primary care utilization with cancer outcomes for the period spanning Medicaid expansion in New Jersey. Cancer 2018; 125:1330-1340. [DOI: 10.1002/cncr.31824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/30/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jennifer Tsui
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- School of Public Health Rutgers, the State University of New Jersey Piscataway New Jersey
| | - Derek DeLia
- MedStar Health Research Institute Hyattsville Maryland
| | - Antoinette M. Stroup
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- School of Public Health Rutgers, the State University of New Jersey Piscataway New Jersey
- New Jersey State Cancer Registry New Jersey Department of Health Trenton New Jersey
| | - Jose Nova
- Center for State Health Policy Rutgers, the State University of New Jersey New Brunswick New Jersey
| | - Aishwarya Kulkarni
- Cancer Institute of New Jersey Rutgers, the State University of New Jersey New Brunswick New Jersey
- New Jersey State Cancer Registry New Jersey Department of Health Trenton New Jersey
| | - Jeanne M. Ferrante
- Department of Family Medicine, Robert Wood Johnson Medical School Rutgers, the State University of New Jersey New Brunswick New Jersey
| | - Joel C. Cantor
- Center for State Health Policy Rutgers, the State University of New Jersey New Brunswick New Jersey
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Breast Cancer Stage at Diagnosis in a New Jersey Cancer Education and Early Detection Site. Am J Clin Oncol 2018; 41:1043-1048. [DOI: 10.1097/coc.0000000000000425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cervical cancer screening among HIV-infected women in an urban, United States safety-net healthcare system. AIDS 2018; 32:1861-1870. [PMID: 29762164 DOI: 10.1097/qad.0000000000001881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Little is known about cervical cancer screening and results patterns among HIV-infected (HIV+) women in real-world healthcare settings. We characterized two periods of screening opportunity. DESIGN Retrospective cohort. SETTING US safety-net healthcare system in Dallas County, Texas. PARTICIPANTS We analyzed data from electronic medical records (EMR) of 1490 HIV+ women receiving care 2010-2014. MAIN OUTCOME MEASURES At baseline, we categorized a woman's Pap status 15 months prior to index date as under-screened (vs. screened), and cytology result (normal vs. abnormal). Then, we examined screening completion and results, and colposcopy uptake and results after an abnormal screen, in the subsequent 15-month period. RESULTS More than half of women (56%) had no evidence of a Pap test (i.e. under-screened) at baseline. Under-screened women were more likely to be older (50-64 years), have diabetes, and unknown viral load; they were less likely to be Black, Hispanic, have Medicaid, recently pregnant, have a HIV clinic visit, or a CD4 cell count at least 200 cells/μl. Nearly half of under-screened women (46%, n = 383) remained under-screened in the subsequent 15 months. Among women under-screened at baseline who later completed screening and follow-up during the study period, 21 high-grade dysplasia and three cancers were diagnosed. Overall, 40% of women did not receive colposcopy when needed, with most failures to follow-up occurring in women who were under-screened at baseline. CONCLUSION Most HIV+ women receiving care in a safety-net system did not receive sufficient screening for cervical cancer and remained at exceptionally high risk of developing high-grade dysplasia.
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Yao S, Liu T. Analysis of differential gene expression caused by cervical intraepithelial neoplasia based on GEO database. Oncol Lett 2018; 15:8319-8324. [PMID: 29805564 PMCID: PMC5950031 DOI: 10.3892/ol.2018.8403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 03/06/2018] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to identify the differentially expressed genes between cervical intraepithelial neoplasias (CIN) and adjacent normal tissue, and to construct a protein-protein interaction (PPI) network. A CIN dataset was obtained from Gene Expression Omnibus, and data of gene expression in CIN and adjacent normal tissue were extracted from GSE64217. The differentially expressed genes were selected using software package and heat map was drawn using the ‘pheatmap’ package. The selected differentially expressed genes were subjected to PPI, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis using Cytoscape, Database for Annotation, Visualization and Integrated Discovery, STRING and KOBAS. In the present study, 287 genes were differentially expressed between CIN and adjacent normal tissue, of which 170 were significantly upregulated and 118 genes were significantly downregulated (P<0.00001, fold-change >6). A differential gene expression network map was constructed to show the interactions of 30 protein products encoded by differentially expressed genes using STRING software. In particular, the key gene, EGR1, was identified using Cytoscape software. The KEGG pathway analysis revealed that the differential genes were mainly involved in several pathways, including ‘glutathione metabolism’, ‘arachidonic acid metabolism’, and ‘pentose phosphate pathway’. Results of the GO analysis showed that differential genes were enriched in different subsets. Specifically, small proline-rich protein 2E and 3, distal-less homeobox 5, epithelial membrane protein 1, cornifelin, periplakin, homeobox protein Hox-A13, estrogen receptor α, transglutaminase 1, small proline-rich protein 2A, Rh C glycoprotein, tumor protein p63, TGM3, homeobox B5 and small proline-rich protein 2D were enriched in ‘epithelial cell differentiation’, which affected the differentiation of epithelial cells. In conclusion, 287 differentially expressed genes were identified successfully. The key gene was identified based on the results of PPI, GO and KEGG analyses, and functional annotation and pathway analysis were also performed. Our study provides the basis for further studies on the interaction among differentially expressed genes.
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Affiliation(s)
- Shenghui Yao
- Department of Gynecology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221000, P.R. China
| | - Taifeng Liu
- Department of Medical Oncology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221000, P.R. China
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Using Evidence-Based Interventions to Improve Cancer Screening in the National Breast and Cervical Cancer Early Detection Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 22:442-9. [PMID: 26672405 DOI: 10.1097/phh.0000000000000369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening to low-income, un-, and underinsured women through more than 11 000 primary care clinics. The program is well-positioned to work with health systems to implement evidence-based interventions (EBIs) to increase screening among all women. OBJECTIVE To collect baseline data on EBI use, evaluation of EBIs, and related training needs among NBCCEDP grantees. DESIGN The Centers for Disease Control and Prevention conducted a Web-based survey in late 2013 among NBCCEDP grantees for the period July 2012 to June 2013. This was the first systematic assessment of EBIs among NBCCEDP grantees. SETTING The Centers for Disease Control and Prevention's NBCCEDP. PARTICIPANTS Primarily program directors/coordinators for all 67 NBCCEDP grantees. MAIN OUTCOME MEASURES Data captured were used to assess implementation of 5 EBIs, their evaluation, and related training needs. Frequencies and proportions were determined. Cluster analysis identified grantees with similar patterns of EBI use for NBCCEDP clients and providers. RESULTS On average, 4.1 of 5 EBIs were implemented per grantee for NBCCEDP clients and providers. Four clusters were identified including "high overall EBI users," "high provider EBI users," "high EBI users with no provider assessment and feedback," and "high client EBI users." Only 1.8 EBIs were implemented, on average, with non-NBCCEDP clients and providers. Fewer than half (n = 32, 47.8%) of grantees conducted process or outcome evaluation of 1 or more EBIs. Overall, 47.6% of grantees reported high or medium training needs for client-oriented EBIs and 54.3% for provider-oriented EBIs. CONCLUSIONS The NBCCEDP grantees are implementing EBIs extensively with clients and providers. Increased EBI use among non-NBCCEDP clients/providers is needed to extend the NBCCEDP's reach and impact. Grantee training and technical assistance is necessary across EBIs. In addition, grantees' use of process and outcome evaluation of EBI implementation must be increased to inform effective program implementation.
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Sivaram S, Majumdar G, Perin D, Nessa A, Broeders M, Lynge E, Saraiya M, Segnan N, Sankaranarayanan R, Rajaraman P, Trimble E, Taplin S, Rath GK, Mehrotra R. Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India. Lancet Oncol 2018; 19:e113-e122. [PMID: 29413465 PMCID: PMC5835355 DOI: 10.1016/s1470-2045(18)30003-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/17/2017] [Accepted: 11/16/2017] [Indexed: 12/16/2022]
Abstract
The reductions in cancer morbidity and mortality afforded by population-based cancer screening programmes have led many low-income and middle-income countries to consider the implementation of national screening programmes in the public sector. Screening at the population level, when planned and organised, can greatly benefit the population, whilst disorganised screening can increase costs and reduce benefits. The International Cancer Screening Network (ICSN) was created to share lessons, experience, and evidence regarding cancer screening in countries with organised screening programmes. Organised screening programmes provide screening to an identifiable target population and use multidisciplinary delivery teams, coordinated clinical oversight committees, and regular review by a multidisciplinary evaluation board to maximise benefit to the target population. In this Series paper, we report outcomes of the first regional consultation of the ICSN held in Agartala, India (Sept 5-7, 2016), which included discussions from cancer screening programmes from Denmark, the Netherlands, USA, and Bangladesh. We outline six essential elements of population-based cancer screening programmes, and share recommendations from the meeting that policy makers might want to consider before implementation.
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Affiliation(s)
- Sudha Sivaram
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | - Douglas Perin
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Ashrafun Nessa
- Department of Obstetrics and Gynecology, Bangabandhu Sheikh, Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Mireille Broeders
- Department for Health Evidence, Radboudumc, and Dutch Expert Centre for Screening, Nijmegen, Netherlands
| | - Elsebeth Lynge
- Center of Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Mona Saraiya
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nereo Segnan
- Center for Epidemiology and Prevention in Oncology, CPO Piemonte, WHO Collaborative Center for Cancer Early Diagnosis and Screening, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Rengaswamy Sankaranarayanan
- Screening Group, International Agency for Research on Cancer, Lyon, France; RTI International-India, New Delhi, India
| | - Preetha Rajaraman
- Office of Global Affairs, US Department of Health and Human Services, US Embassy, New Delhi, India
| | - Edward Trimble
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Stephen Taplin
- Public Health Research Branch, Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - G K Rath
- Rotary Cancer Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ravi Mehrotra
- National Institute of Cancer Prevention and Research, and WHO-Framework Convention on Tobacco Control Smokeless Tobacco Global Knowledge Hub, National Capital Region, India
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Hyeongsu KIM, Soon-Ae SHIN, Kunsei LEE, Jong-Heon PARK, Tae Hwa HAN, Minsu PARK, Eunyoung M, Hyoseon JEONG, Jung-Hyun LEE, Hyemi AHN, Vitna KIM. Effects of First Diagnosed Diabetes Mellitus on Medical Visits and Medication Adherence in Korea. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:209-218. [PMID: 29445630 PMCID: PMC5810383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The National Health Insurance Service (NHIS) conducted a screening test to detect chronic diseases such as hypertension and diabetes in Korea. This study evaluated the effects of health screening for DM on pharmacological treatment. METHODS The data from qualification and the General Health Screening in 2012, the insurance claims of medical institutions from Jan 2009 to Dec 2014, and the diabetic case management program extracted from the NHIS administrative system were used. Total 16068 subjects were included. Visiting rate to medical institution, medication possession ratio and the rate of medication adherence of study subjects were used as the indices. RESULTS The visiting rates to medical institutions were 39.7%. The percentage who received a prescription for a diabetes mellitus medication from a doctor was 80.9%, the medication possession ratio was 70.8%, and the rate of medication adherence was 57.8%. CONCLUSION The visiting rate, medication possession ratio and rate of medication adherence for DM medication were not high. In order to increase the visiting rate, medication possession ratio and rate of medication adherence, NHIS should support environment in which medical institutions and DM patients can do the role of each part.
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Affiliation(s)
- KIM Hyeongsu
- Dept. of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - SHIN Soon-Ae
- Big Data Steering Dept., National Health Insurance Service, Seoul, Korea,Correspondence:
| | - LEE Kunsei
- Dept. of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - PARK Jong-Heon
- Big Data Steering Dept., National Health Insurance Service, Seoul, Korea
| | - HAN Tae Hwa
- Dept. of Medical Engineering, College of Medicine, Yonsei University, Seoul, Korea
| | - PARK Minsu
- Granduate School of Public Health, Inje University, Seoul, Korea
| | - Minsu Eunyoung
- Dept. of Public Health Administration, Hanyang Women’s University, Seoul, Korea
| | - JEONG Hyoseon
- Dept. of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - LEE Jung-Hyun
- Dept. of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - AHN Hyemi
- Dept. of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - KIM Vitna
- Dept. of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
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Quang C, Hill S, Blair S, Dyess DL, Liles JS. Patient and Tumor Disparities in Breast Cancer Based on Insurance Status. Am Surg 2017. [DOI: 10.1177/000313481708300840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study seeks to determine whether uninsured breast cancer patients are more likely to present with advanced disease relative to insured patients. We retrospectively reviewed newly diagnosed breast cancer patients over a 27-month period. Patients were sorted based on insurance status at diagnosis. Demographic and tumor-specific data were collected and analyzed using non-parametric testing. We identified 276 breast tumors in 260 patients. Out of the 260 patients, 71 patients (27.3%) were uninsured and were more likely to be black (P < 0.05), present with a breast-specific complaint rather than an abnormal mammogram (P < 0.05), and present with more advanced disease (52% stage II or worse vs 26.6% in the insured population; P < 0.01). Percentage of invasive carcinoma and tumor biology were independent of insurance status. Insured patients were more likely to receive surgery as first therapy (76.5 vs 46.0%, P < 0.01), whereas uninsured patients were more likely to receive chemotherapy suggesting multimodality treatment. Uninsured patients had a longer time to therapy initiation (56.0 days vs 44.5 days, P < 0.05). Our study confirms that uninsured patients present with higher stage disease are more likely to have breast-specific complaints and are more likely to require chemotherapy as first-line treatment confirming the under-utility of screening mammography within our uninsured patients.
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Affiliation(s)
- Celia Quang
- Department of Surgery, University of South Alabama, Mobile, Alabama
| | - Seth Hill
- College of Medicine, University of South Alabama, Mobile, Alabama
| | - Scott Blair
- Department of Surgery, University of South Alabama, Mobile, Alabama
| | - Donna Lynn Dyess
- Department of Surgery, University of South Alabama, Mobile, Alabama
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Reeder-Hayes KE, Anderson BO. Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change. Clin Cancer Res 2017; 23:2655-2664. [PMID: 28572260 PMCID: PMC5499686 DOI: 10.1158/1078-0432.ccr-16-2630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/03/2017] [Accepted: 04/06/2017] [Indexed: 01/06/2023]
Abstract
Sizeable disparities exist in breast cancer outcomes, both between Black and White patients in the United States, and between patients in the United States and other high-income countries compared with low- and middle-income countries (LMIC). In both settings, health system factors are key drivers of disparities. In the United States, Black women are more likely to die of breast cancer than Whites and have poorer outcomes, even among patients with similar stage and tumor subtype. Over-representation of higher risk "triple-negative" breast cancers contributes to breast cancer mortality in Black women; however, the greatest survival disparities occur within the good-prognosis hormone receptor-positive (HR+) subtypes. Disparities in access to treatment within the complex U.S. health system may be responsible for a substantial portion of these differences in survival. In LMICs, breast cancer mortality rates are substantially higher than in the United States, whereas incidence continues to rise. This mortality burden is largely attributable to health system factors, including late-stage presentation at diagnosis and lack of availability of systemic therapy. This article will review the existing evidence for how health system factors in the United States contribute to breast cancer disparities, discuss methods for studying the relationship of health system factors to racial disparities, and provide examples of health system interventions that show promise for mitigating breast cancer disparities. We will then review evidence of global breast cancer disparities in LMICs, the treatment factors that contribute to these disparities, and actions being taken to combat breast cancer disparities around the world. Clin Cancer Res; 23(11); 2655-64. ©2017 AACRSee all articles in this CCR Focus section, "Breast Cancer Research: From Base Pairs to Populations."
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Affiliation(s)
- Katherine E Reeder-Hayes
- Division of Hematology and Oncology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
- The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, School of Medicine, University of Washington, Seattle, Washington
- Program in Epidemiology, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Koroukian SM, Bakaki PM, Htoo PT, Han X, Schluchter M, Owusu C, Cooper GS, Rose J, Flocke SA. The Breast and Cervical Cancer Early Detection Program, Medicaid, and breast cancer outcomes among Ohio's underserved women. Cancer 2017; 123:3097-3106. [PMID: 28542870 DOI: 10.1002/cncr.30720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/01/2017] [Accepted: 03/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND As an organized screening program, the national Breast and Cervical Cancer Early Detection Program (BCCEDP) was launched in the early 1990s to improve breast cancer outcomes among underserved women. To analyze the impact of the BCCEDP on breast cancer outcomes in Ohio, this study compared cancer stages and mortality across BCCEDP participants, Medicaid beneficiaries, and "all others." METHODS This study linked data across the Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, death certificates, and the US Census and identified 26,426 women aged 40 to 64 years who had been diagnosed with incident invasive breast cancer during the years 2002-2008 (deaths through 2010). The study groups were as follows: BCCEDP participants (1-time or repeat users), Medicaid beneficiaries (women enrolled in Medicaid before their cancer diagnosis [Medicaid/prediagnosis] or around the time of their cancer diagnosis [Medicaid/peridiagnosis]), and all others (women identified as neither BCCEDP participants nor Medicaid beneficiaries). The outcomes included advanced-stage cancer at diagnosis and mortality. A multivariable logistic and survival analysis was conducted to examine the independent association between the BCCEDP and Medicaid status and the outcomes. RESULTS The percentage of women presenting with advanced-stage disease was highest among women in the Medicaid/peridiagnosis group (63.4%) and lowest among BCCEDP repeat users (38.6%). With adjustments for potential confounders and even in comparison with Medicaid/prediagnosis beneficiaries, those in the Medicaid/peridiagnosis group were twice as likely to be diagnosed with advanced-stage disease (adjusted odds ratio, 2.20; 95% confidence interval, 1.83-2.66). CONCLUSIONS Medicaid/peridiagnosis women are at particularly high risk to be diagnosed with advanced-stage disease. Efforts to reduce breast cancer disparities must target this group of women before they present to Medicaid. Cancer 2017;123:3097-106. © 2017 American Cancer Society.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Paul M Bakaki
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Phyo Than Htoo
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Xiaozhen Han
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Mark Schluchter
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Medicine, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gregory S Cooper
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Medicine, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Johnie Rose
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Family and Community Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Susan A Flocke
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Family and Community Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Xu Y, Zhang X, Luan C, Wang H, Chen B, Zhao Y. Hybrid hydrogel photonic barcodes for multiplex detection of tumor markers. Biosens Bioelectron 2017; 87:264-270. [DOI: 10.1016/j.bios.2016.08.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/20/2022]
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Youl PH, Aitken JF, Turrell G, Chambers SK, Dunn J, Pyke C, Baade PD. The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1156. [PMID: 27869758 PMCID: PMC5129366 DOI: 10.3390/ijerph13111156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 01/07/2023]
Abstract
Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland, Australia. Interviews ascertained method of detection and dates of medical/procedural appointments, and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI)). The cohort included 1560 women with symptom-detected and 1642 with screen-detected BC. Symptom-detected women had higher odds of DI of >60 days if they were Indigenous (OR = 3.12, 95% CI = 1.40, 6.98); lived in outer regional (OR = 1.50, 95% CI = 1.09, 2.06) or remote locations (OR = 2.46, 95% CI = 1.39, 4.38); or presented with a "non-lump" symptom (OR = 1.84, 95% CI = 1.43, 2.36). For screen-detected BC, women who were Indigenous (OR = 2.36, 95% CI = 1.03, 5.80); lived in remote locations (OR = 2.35, 95% CI = 1.24, 4.44); or disadvantaged areas (OR = 1.69, 95% CI = 1.17, 2.43) and attended a public screening facility (OR = 2.10, 95% CI = 1.40, 3.17) had higher odds of DI > 30 days. Our study indicates a disadvantage in terms of DI for rural, disadvantaged and Indigenous women. Difficulties in accessing primary care and diagnostic services are evident. There is a need to identify and implement an efficient and effective model of care to minimize avoidable longer diagnostic intervals.
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Affiliation(s)
- Philippa H Youl
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
- School of Population Health, University of Queensland, Brisbane, QLD 4072, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
| | - Gavin Turrell
- Institute of Health and Ageing, Australian Catholic University, Fitzroy, VIC 3115, Australia.
| | - Suzanne K Chambers
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
| | - Jeffrey Dunn
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
- School of Social Science, University of Queensland, Brisbane, QLD4072, Australia.
| | - Christopher Pyke
- Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia.
| | - Peter D Baade
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia.
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Ortiz-Sánchez E, Santiago-López L, Cruz-Domínguez VB, Toledo-Guzmán ME, Hernández-Cueto D, Muñiz-Hernández S, Garrido E, De León DC, García-Carrancá A. Characterization of cervical cancer stem cell-like cells: phenotyping, stemness, and human papilloma virus co-receptor expression. Oncotarget 2016; 7:31943-54. [PMID: 27008711 PMCID: PMC5077987 DOI: 10.18632/oncotarget.8218] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/06/2016] [Indexed: 02/07/2023] Open
Abstract
Cancer stem cells (CSC) exhibit high tumorigenic capacity in several tumor models. We have now determined an extended phenotype for cervical cancer stem cells. Our results showed increased CK-17, p63+, AII+, CD49f+ expression in these cells, together with higher Aldehyde dehydrogenase (ALDHbright)activity in Cervical CSC (CCSC) enriched in cervospheres. An increase in stem cell markers, represented by OCT-4, Nanog, and β-catenin proteins, was also observed, indicating that under our culture conditions, CCSC are enriched in cervospheres, as compared to monolayer cultures. In addition, we were able to show that an increased ALDHbright activity correlated with higher tumorigenic activity. Flow cytometry and immunflorescence assays demonstrated that CCSC in cervosphere cultures contain a sub-population of cells that contain Annexin II, a Human papillomavirus (HPV) co-receptor. Taken together, under our conditions there is an increase in the number of CCSC in cervosphere cultures which exhibit the following phenotype: CK-17, p63+, AII+, CD49f+ and high ALDH activity, which in turn correlates with higher tumorigenicity. The presence of Annexin II and CD49f in CCSC opens the possibility that normal cervical stem cells could be the initial target of infection by high risk HPV.
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Affiliation(s)
- Elizabeth Ortiz-Sánchez
- 1 Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Secretaría de Salud (SS), México City, Mexico
| | - Luz Santiago-López
- 1 Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Secretaría de Salud (SS), México City, Mexico
| | - Verónica B. Cruz-Domínguez
- 1 Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Secretaría de Salud (SS), México City, Mexico
| | - Mariel E. Toledo-Guzmán
- 1 Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Secretaría de Salud (SS), México City, Mexico
| | - Daniel Hernández-Cueto
- 2 Laboratorio de Marcadores Moleculares, Hospital Infantil de México “Federico Gómez”, SA, Mexico City, Mexico
| | - Saé Muñiz-Hernández
- 1 Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Secretaría de Salud (SS), México City, Mexico
| | - Efraín Garrido
- 3 Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City, Mexico
| | - David Cantú De León
- 4 Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Secretaría de Salud (SS), México City, Mexico
| | - Alejandro García-Carrancá
- 5 Unidad de Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM) and Instituto Nacional de Cancerología, Secretaría de Salud (SS), Mexico City, Mexico
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Oppong BA, Dash C, Coleman T, Torres T, Adams-Campbell LL. Time to Diagnostic Evaluation After Mammographic Screening in an Urban Setting. J Womens Health (Larchmt) 2016; 25:1225-1230. [PMID: 27182625 DOI: 10.1089/jwh.2015.5661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Capital Breast Care Center (CBCC), a screening facility established to serve minority women, developed a culturally sensitive patient care paradigm that would address concerns of adherence to follow-up of abnormal results after initial mammogram. Women with abnormal mammograms are assigned a Black or Latina navigator who facilitates the additional workup needed by scheduling follow-up, arranging transportation, providing counsel/emotional support, and even accompanying them to diagnostic imaging or biopsy appointment. We present data on follow-up rates after breast cancer screening. METHODS All patients seen at CBCC are entered into a prospectively collected database. We calculated intervals (in days) between the screening and diagnostic visits. Descriptive statistics and median time to follow-up are reported. Differences between Black and Hispanic women on time interval were tested by t-test. RESULTS From January 2010 to December 2012, 4605 digital screening mammograms were performed. Fifty-two percent of the women self-identified as Black, 41% as Hispanic, 4% White, 2% Asian, and 1% as "other." Of the screening studies, 451 (9.8%) required additional workup, out of which 362 (80%) of the women returned for the recommended diagnostic imaging. The median interval between screening and diagnostic imaging was 39 days (range: 6-400). Of the 162 women recommended to have a core needle biopsy, 81.5% underwent biopsy within a median of 21 days (range: 0-221 days). CONCLUSION At the CBCC, time to patient follow-up after initial mammographic screening is within the CDC-recommended performance standard of less than 60 days. For a population that historically has low rates of clinical follow-up, we attribute this reduction in delays to breast cancer diagnostic resolution to a culturally sensitive patient navigation program. Additional studies are needed to assess how the existing navigation program can be individualized/tailored to target the remaining 20% of women who did not adhere to the recommended workup.
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Affiliation(s)
- Bridget A Oppong
- 1 Breast Division, Department of Surgery, MedStar Georgetown University Hospital , Washington, District of Columbia.,2 Georgetown University Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| | - Chiranjeev Dash
- 2 Georgetown University Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| | - Tesha Coleman
- 3 Capital Breast Care Center, Georgetown Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| | - Tanya Torres
- 3 Capital Breast Care Center, Georgetown Lombardi Comprehensive Cancer Center , Washington, District of Columbia
| | - Lucile L Adams-Campbell
- 2 Georgetown University Lombardi Comprehensive Cancer Center , Washington, District of Columbia
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Koroukian SM, Bakaki PM, Schluchter M, Owusu C, Cooper GS, Flocke SA. Comparing Breast Cancer Outcomes Between Medicaid and the Ohio Breast and Cervical Cancer Early Detection Program. J Oncol Pract 2015; 11:478-85. [PMID: 26374859 DOI: 10.1200/jop.2014.002634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare outcomes between women enrolling in Medicaid after being diagnosed with breast cancer and those referred to Medicaid through the Ohio Breast and Cervical Cancer Early Detection Program (BCCEDP). METHODS Using linked data from the 2002 to 2008 Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, and Ohio death certificates (through 2010), we identified women 40 to 64 years of age diagnosed with incident invasive breast cancer during the study years and enrolled in Medicaid 3 months before or after cancer diagnosis. We compared the following outcomes across BCCEDP one-time and repeat participants and nonparticipants: (1) cancer stage at diagnosis, (2) treatment delays, (3) receipt of standard treatment, and (4) survival. We conducted multivariable logistic regression and survival analysis to examine the association between BCCEDP participation and the outcomes of interest, controlling for potential confounders. RESULTS We identified 427 and 654 BCCEDP participants and nonparticipants, respectively; 28.5% of BCCEDP women were repeat participants. Compared with nonparticipants, BCCEDP one-time and repeat participants were significantly less likely to be diagnosed with advanced-stage cancer (one-time: adjusted odds ratio [AOR], 0.64; 95% CI, 0.49 to 0.85; repeat: AOR, 0.34; 95% CI, 0.23 to 0.52), or experience delays in treatment initiation (one-time: adjusted hazard ratio [AHR], 1.29; 95% CI, 1.09 to 1.51; repeat: AHR, 1.38; 95% CI, 1.11 to 1.72). In addition, although we observed no difference in receipt of standard cancer treatment, BCCEDP participants experienced cancer-specific and overall survival benefits. CONCLUSION Compared with nonparticipants, BCCEDP participants experienced earlier breast cancer stage at diagnosis, shorter time to treatment initiation, and survival benefits.
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Affiliation(s)
- Siran M Koroukian
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Paul M Bakaki
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Mark Schluchter
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Cynthia Owusu
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Gregory S Cooper
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
| | - Susan A Flocke
- Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH
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Shi YH, Wang BW, Tuokan T, Li QZ, Zhang YJ. Association between micronucleus frequency and cervical intraepithelial neoplasia grade in Thinprep cytological test and its significance. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:8426-8432. [PMID: 26339413 PMCID: PMC4555741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/28/2015] [Indexed: 06/05/2023]
Abstract
A micronucleus is an additional small nucleus formed due to chromosomes or chromosomal fragments fail to be incorporated into the nucleus during cell division. In this study, we assessed the utility of micronucleus counting as a screening tool in cervical precancerous lesions in Thinprep cytological test smears under oil immersion. High risk HPV was also detected by hybrid capture-2 in Thinprep cytological test smears. Our results showed that micronucleus counting was significantly higher in high-grade squamous intraepithelial lesion (HSIL) and invasive carcinoma cases compared to low-grade squamous intraepithelial lesion (LSIL) and non-neoplastic cases. Receiver operating characteristic (ROC) curve analysis revealed that micronucleus counting possessed a high degree of sensitivity and specificity for identifying HSIL and invasive carcinoma. Cut-off of 7.5 for MN counting gave a sensitivity of 89.6% and a specificity of 66.7% (P = 0.024 and AUC = 0.892) for detecting HSIL and invasive carcinoma lesions. Multiple linear regression analysis showed that only HSIL and invasive cancer lesions not age, duration of marital life and number of pregnancy are significantly associated with MN counting. The positive rate of high risk HPV was distinctly higher in LSIL, HSIL and invasive cancer than that in non-neoplstic categories. In conclusions, MN evaluation may be viewed as an effective biomarker for cervical cancer screening. The combination of MN count with HPV DNA detection and TCT may serve as an effective means to screen precancerous cervical lesions in most developing nations.
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Affiliation(s)
- Yong-Hua Shi
- Department of Pathology, Basic Medicine College of Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Bo-Wei Wang
- Department of Pathology, First Affiliated Hospital of Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Talaf Tuokan
- Department of Pathology, Basic Medicine College of Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Qiao-Zhi Li
- Department of Pathology, Basic Medicine College of Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Ya-Jing Zhang
- Department of Pathology, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical UniversityUrumqi, Xinjiang, China
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Miller JW, Royalty J, Henley J, White A, Richardson LC. Breast and cervical cancers diagnosed and stage at diagnosis among women served through the National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control 2015; 26:741-7. [PMID: 25724415 PMCID: PMC4797940 DOI: 10.1007/s10552-015-0543-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/20/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess cancers diagnosed and the stage of cancer at the time of diagnosis among low-income, under-insured, or uninsured women who received services through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS Using the NBCCEDP database, we examined the number and percent of women diagnosed during 2009-2011 with in situ breast cancer, invasive breast cancer, and invasive cervical cancer by demographic and clinical characteristics, including age, race and ethnicity, test indication (screening or diagnostic), symptoms (for breast cancer), and screening history (for cervical cancer). We examined these characteristics by stage at diagnosis, a new variable included in the database obtained by linking with state-based central cancer registries. RESULTS There were 11,569 women diagnosed with invasive breast cancer, 1,988 with in situ breast cancer, and 583 with invasive cervical cancer through the NBCCEDP. Women who reported breast symptoms or who had diagnostic mammography were more likely to be diagnosed with breast cancer, and at a later stage, than those who did not have symptoms or who had screening mammography. Women who had been rarely or never screened for cervical cancer were more likely to be diagnosed with cervical cancer, and at a later stage, than women who received regular screenings. CONCLUSIONS Women served through the NBCCEDP who have not had prior screening or who have symptoms were more often diagnosed with late-stage disease.
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Affiliation(s)
- Jacqueline W Miller
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-76, Atlanta, GA, 30341, USA,
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The National Breast and Cervical Cancer Early Detection Program: 25 Years of public health service to low-income women. Cancer Causes Control 2015; 26:653-6. [PMID: 25837262 DOI: 10.1007/s10552-015-0565-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/17/2015] [Indexed: 01/30/2023]
Abstract
This article presents an overview of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a valuable and successful national public health program in the USA that will soon celebrate its 25th anniversary. Simulation modeling and other analyses have demonstrated that the NBCCEDP has significantly reduced breast and cervical cancer mortality among low-income uninsured and underinsured women in the USA, a major goal of the original legislation. The NBCCEDP has also served to build cancer prevention and control capacity in state and local health agencies and created strong and unique public-private partnerships aimed at improving women's health. As such, the impact of NBCCEDP extends beyond the millions of women served by the program to include increased public health system capacity and effectiveness regarding cancer early detection and control for all women.
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Forward. The reach and health impacts of the national breast and cervical cancer early detection program. Cancer Causes Control 2015; 26:649-50. [PMID: 25794898 DOI: 10.1007/s10552-015-0561-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 01/30/2023]
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Preventing premature deaths from breast and cervical cancer among underserved women in the United States: insights gained from a national cancer screening program. Cancer Causes Control 2015; 26:805-9. [PMID: 25783456 DOI: 10.1007/s10552-015-0541-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/20/2015] [Indexed: 02/05/2023]
Abstract
This commentary highlights some of the valuable insights gained from a special collection of papers that utilized data from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and appear in this special issue. The data and experiences of the NBCCEDP can inform the identification of new opportunities and directions for meeting the cancer screening needs of underserved women in a complex and changing health care environment.
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Ryerson AB, Miller J, Eheman CR. Reported breast symptoms in the National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control 2015; 26:733-40. [PMID: 25754109 DOI: 10.1007/s10552-015-0544-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 02/24/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE The frequency and types of breast symptoms reported by women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) have never been characterized. This study aims to establish the frequency of reported symptoms and the diagnostic outcomes associated with reported symptoms. METHODS We examined the frequency of symptoms reported prior to mammography using medical record abstraction data from women in the NBCCEDP. We also calculated adjusted odds ratios (aOR) of having an abnormal mammogram, an abnormal clinical breast examination, or a final diagnosis of breast cancer by symptoms, compared to asymptomatic women. RESULTS In our sample of women, 10.3 % reported at least one symptom. Women with symptoms were younger and more likely to be non-Hispanic white. Among those reporting symptoms, breast lump (31.7 %) and pain or tenderness (49.3 %) was most common. A relatively low proportion of women with symptoms were diagnosed with in situ (0.9 %) or invasive breast cancer (4.3 %). However, a self-reported breast lump [aOR 13.7; 95 % confidence interval (CI) 7.8-24.1], inflammation or changes to the skin/nipple (aOR 27.8; 95 % CI 8.7-88.8), and other or unspecified symptoms (aOR 3.4; 95 % CI 2.1-7.5) were associated with an increased risk of invasive breast cancer. CONCLUSIONS Although the prevalence of breast cancer among women reporting symptoms is relatively low, knowing which symptoms carry the highest breast cancer risk is important to assist in appropriate diagnostic workup.
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Affiliation(s)
- A Blythe Ryerson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, F-76, Atlanta, GA, 30341, USA,
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