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Balan L, Secosan C, Sorop VB, Pirtea M, Cimpean AM, Chiriac D, Balan C, Borsi E, Iorga A, Pirtea L. Impact of SARS-CoV-2 Pandemic on the Diagnosis of Cervical Cancer and Precursor Lesions-A Single-Center Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:909. [PMID: 38929526 PMCID: PMC11206154 DOI: 10.3390/medicina60060909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/19/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Our aim was to perform a retrospective analysis of the volume of cervical screening tests, the number of patients treated with an excision method, and the incidence of invasive and non-invasive cervical during a pandemic and pre-pandemic period of 24 months. Materials and Methods: The study compared 404 patients who underwent cervical cone biopsy for cervical cancer. The study examined patients' specimens based on histopathological characteristics and categorized cervical lesions based on pap smear. Results: There was a statistically significant age difference between the two study periods. The mean difference was 32 years before the pandemic and 35 years during the pandemic (p-value > 0.05). The biggest patient loss ratio identified by age group was in the 50-59-year group, with a 14.53% loss in the pre-pandemic period and a 9.1% loss in the pandemic period. In the pandemic period, patients from rural areas presented in the clinical trial with a lower rate of 39.52% (83 patients) vs. 60.47% (127 patients) in urban areas. A higher percentage of patients experiencing cervicorrhagia as a clinical manifestation in the pandemic period vs. the pre-pandemic period, with an increase in more severe lesions in the pandemic period, had a statistical significance of 8% more newly diagnosed compared to the pre-pandemic period. Conclusions: The addressability of the patients during the COVID period was not affected in a drastic way in our study. We encountered a decrease in appointments in the age group of 50-59 years and a decrease in patients with rural residence. In our study, we found an increase in cervical bleeding as a reason for consultation in the pandemic period with a higher lesion degree, both on a pap smear and on a cervical biopsy.
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Affiliation(s)
- Lavinia Balan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (V.-B.S.); (M.P.); (D.C.); (L.P.)
| | - Cristina Secosan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (V.-B.S.); (M.P.); (D.C.); (L.P.)
| | - Virgiliu-Bogdan Sorop
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (V.-B.S.); (M.P.); (D.C.); (L.P.)
| | - Marilena Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (V.-B.S.); (M.P.); (D.C.); (L.P.)
| | - Anca Maria Cimpean
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Daniela Chiriac
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (V.-B.S.); (M.P.); (D.C.); (L.P.)
| | - Catalin Balan
- Department of Cell and Molecular Biology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Ema Borsi
- Department of Internal Medicine, Discipline of Hematology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Ariana Iorga
- Clinical Hospital of Infectious Diseases and Pulmonology “Dr. Victor Babes”, 300310 Timisoara, Romania;
| | - Laurentiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.B.); (V.-B.S.); (M.P.); (D.C.); (L.P.)
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Sedeta E, Sung H, Laversanne M, Bray F, Jemal A. Recent Mortality Patterns and Time Trends for the Major Cancers in 47 Countries Worldwide. Cancer Epidemiol Biomarkers Prev 2023; 32:894-905. [PMID: 37195435 DOI: 10.1158/1055-9965.epi-22-1133] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/22/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Most prior studies have reported cancer mortality trends across countries for specific cancer types. Herein, we examine recent patterns and trends in cancer mortality rates for the eight common forms of cancer in 47 countries across five continents (except Africa) based on the World Health Organization mortality database. METHODS Rates were age-standardized to the 1966 Segi-Doll world population, and trends in the age-standardized rates for the most recent 10 years of data were examined using Joinpoint regression. RESULTS Cancer-specific mortality rates vary substantially across countries, with rates of infection-related (cervix and stomach) and tobacco-related cancers (lung and esophagus) varying by 10-fold. Recent mortality rates for all major cancers decreased in most of the studied countries except lung cancer in females and liver cancer in males, where increasing rates were observed in most countries. Rates decreased or stabilized in all countries for lung cancer in men and stomach cancer in both sexes. CONCLUSIONS The findings reinforce the importance of implementing and strengthening resource-stratified and targeted cancer prevention and control programs in all parts of the world to further reduce or halt the rising cancer burden. IMPACT The results may inform cancer prevention and treatment strategies and in so doing, reduce the marked global cancer disparities observed today.
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Affiliation(s)
- Ephrem Sedeta
- Brookdale University Hospital Medical Center, Brooklyn, New York
| | - Hyuna Sung
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
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Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, Arbyn M, Basu P, Bray F, Vaccarella S. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health 2023; 11:e197-e206. [PMID: 36528031 PMCID: PMC9848409 DOI: 10.1016/s2214-109x(22)00501-0] [Citation(s) in RCA: 337] [Impact Index Per Article: 337.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tracking progress and providing timely evidence is a fundamental step forward for countries to remain aligned with the targets set by WHO to eliminate cervical cancer as a public health problem (ie, to reduce the incidence of the disease below a threshold of 4 cases per 100 000 women-years). We aimed to assess the extent of global inequalities in cervical cancer incidence and mortality, based on The Global Cancer Observatory (GLOBOCAN) 2020 estimates, including geographical and socioeconomic development, and temporal aspects. METHODS For this analysis, we used the GLOBOCAN 2020 database to estimate the age-specific and age-standardised incidence and mortality rates of cervical cancer per 100 000 women-years for 185 countries or territories aggregated across the 20 UN-defined world regions, and by four-tier levels of the Human Development Index (HDI). Time trends (1988-2017) in incidence were extracted from the Cancer Incidence in Five Continents (CI5) plus database. Mortality estimates were obtained using the most recent national vital registration data from WHO. FINDINGS Globally in 2020, there were an estimated 604 127 cervical cancer cases and 341 831 deaths, with a corresponding age-standardised incidence of 13·3 cases per 100 000 women-years (95% CI 13·3-13·3) and mortality rate of 7·2 deaths per 100 000 women-years (95% CI 7·2-7·3). Cervical cancer incidence ranged from 2·2 (1·9-2·4) in Iraq to 84·6 (74·8-94·3) in Eswatini. Mortality rates ranged from 1·0 (0·8-1·2) in Switzerland to 55·7 (47·7-63·7) in Eswatini. Age-standardised incidence was highest in Malawi (67·9 [95% CI 65·7 -70·1]) and Zambia (65·5 [63·0-67·9]) in Africa, Bolivia (36·6 [35·0-38·2]) and Paraguay (34·1 [32·1-36·1]) in Latin America, Maldives (24·5 [17·0-32·0]) and Indonesia (24·4 [24·2-24·7]) in Asia, and Fiji (29·8 [24·7-35·0]) and Papua New Guinea (29·2 [27·3-31·0]) in Melanesia. A clear socioeconomic gradient exists in cervical cancer, with decreasing rates as HDI increased. Incidence was three times higher in countries with low HDI than countries with very high HDI, whereas mortality rates were six times higher in low HDI countries versus very high HDI countries. In 2020 estimates, a general decline in incidence was observed in most countries of the world with representative trend data, with incidence becoming stable at relatively low levels around 2005 in several high-income countries. By contrast, in the same period incidence increased in some countries in eastern Africa and eastern Europe. We observed different patterns of age-specific incidence between countries with well developed population-based screening and treatment services (eg, Sweden, Australia, and the UK) and countries with insufficient and opportunistic services (eg, Colombia, India, and Uganda). INTERPRETATION The burden of cervical cancer remains high in many parts of the world, and in most countries, the incidence and mortality of the disease remain much higher than the threshold set by the WHO initiative on cervical cancer elimination. We identified substantial geographical and socioeconomic inequalities in cervical cancer globally, with a clear gradient of increasing rates for countries with lower levels of human development. Our study provides timely evidence and impetus for future strategies that prioritise and accelerate progress towards the WHO elimination targets and, in so doing, address the marked variations in the global cervical cancer landscape today. FUNDING French Institut National du Cancer, Horizon 2020 Framework Programme for Research and Innovation of the European Commission; and EU4Health Programme.
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Affiliation(s)
- Deependra Singh
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Jerome Vignat
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | | | - Marzieh Eslahi
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Ophira Ginsburg
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France; Center for Global Health, US National Cancer Institute, Bethesda, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
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Ahmad A, Tiwari RK, Saeed M, Al-Amrah H, Han I, Choi EH, Yadav DK, Ansari IA. Carvacrol instigates intrinsic and extrinsic apoptosis with abrogation of cell cycle progression in cervical cancer cells: Inhibition of Hedgehog/GLI signaling cascade. Front Chem 2023; 10:1064191. [PMID: 36712982 PMCID: PMC9874127 DOI: 10.3389/fchem.2022.1064191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
Recent times have seen a strong surge in therapeutically targeting the hedgehog (HH)/GLI signaling pathway in cervical cancer. HH signaling pathway is reported to be a crucial modulator of carcinogenesis in cervical cancer and is also associated with recurrence and development of chemoresistance. Moreover, our previous reports have established that carvacrol (CAR) inhibited the proliferation of prostate cancer cells via inhibiting the Notch signaling pathway and thus, it was rational to explore its antiproliferative effects in cervical cancer cell lines. Herein, the present study aimed to investigate the anticancer and apoptotic potential of CAR on C33A cervical cancer cells and further explore the underlying mechanisms. We found that CAR significantly suppressed the growth of C33A cells, induced cell cycle arrest, and enhanced programmed cell death along with augmentation in the level of ROS, dissipated mitochondrial membrane potential, activation of caspase cascade, and eventually inhibited the HH signaling cascade. In addition, CAR treatment increased the expression of pro-apoptotic proteins (Bax, Bad, Fas-L, TRAIL, FADDR, cytochrome c) and concomitantly reduced the expression of anti-apoptotic proteins (Bcl-2 and Bcl-xL) in C33A cells. CAR mediates the activation of caspase-9 and -3 (intrinsic pathway) and caspase-8 (extrinsic pathway) accompanied by the cleavage of PARP in cervical cancer cells. Thus, CAR induced apoptosis by both the intrinsic and extrinsic apoptotic pathways. CAR efficiently inhibited the growth of cervical cancer cells via arresting the cell cycle at G0/G1 phase and modulated the gene expression of related proteins (p21, p27, cyclin D1 and CDK4). Moreover, CAR inhibited the HH/GLI signaling pathway by down regulating the expression of SMO, PTCH and GLI1 proteins in cervical carcinoma cells. With evidence of the above results, our data revealed that CAR treatment suppressed the growth of HPV-C33A cervical cancer cells and further elucidated the mechanistic insights into the functioning of CAR.
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Affiliation(s)
- Afza Ahmad
- Department of Biosciences, Integral University, Lucknow, India
| | | | - Mohd Saeed
- Department of Biology, College of Sciences, University of Hail, Hail, Saudi Arabia
| | - Hadba Al-Amrah
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ihn Han
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical & Biological Physics, Kwangwoon University, Seoul, South Korea
| | - Eun-Ha Choi
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical & Biological Physics, Kwangwoon University, Seoul, South Korea,*Correspondence: Eun-Ha Choi, ; Dharmendra K. Yadav,
| | - Dharmendra K. Yadav
- Department of Pharmacy and Gachon Institute of Pharmaceutical Science, College of Pharmacy, Gachon University, Incheon, South Korea,*Correspondence: Eun-Ha Choi, ; Dharmendra K. Yadav,
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5
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Muntyanu A, Nechaev V, Pastukhova E, Logan J, Rahme E, Netchiporouk E, Zubarev A, Litvinov IV. Risk factors and communities disproportionately affected by cervical cancer in the Russian Federation: A national population-based study. Lancet Reg Health Eur 2022; 20:100454. [PMID: 35813967 PMCID: PMC9256716 DOI: 10.1016/j.lanepe.2022.100454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Cervical cancer is one of the leading causes of cancer in women of childbearing age worldwide. A substantial fraction of cervical cancer is associated with Human Papilloma Virus (HPV) infection and is preventable through vaccination and screening. The aim of the study is to describe geographic and epidemiologic trends in incidence and mortality of cervical cancer in Russia during 2007–2018. Methods Publicly accessible data from the P.A. Herzen Moscow Oncology Research Institute and the Ministry of Health of Russian Federation for 2007–2018 was used for this study. Cervical cancer incidence and mortality rates were analyzed using descriptive statistics and results were mapped to determine the geographic distribution. Potential contributing risk factors in the population were studied using univariate and multivariate Poisson regression analyses. Findings A total of 187,013 patients were diagnosed with cervical cancer in Russia between 2007 and 2018. The average age-standardized incidence (ASIR) and mortality rates (ASMR) were 15.70/100,000 and 5.76/100,000 females, respectively, with a 27% increase in the incidence observed between 2007 and 2018. The highest ASIR was observed in the Far Eastern Federal District and the lowest in the Central Federal District. Multivariate model for cervical cancer ASIR showed that daily smoking (p = 0·0003) and syphilis (p = 0.003) were significantly associated with cervical cancer incidence. Interpretation The incidence of cervical cancer in Russia is rising at a significant pace. This trend can in part be attributed to a lack of nationwide cervical cancer screening . The presented results are valuable for informing public health policy on HPV vaccinations, smoking prevention and cervical cancer screening as urgent interventions are needed to combat a troubling trend. Funding This work was supported by the Cancer Research Society (CRS)-Canadian Institutes for Health Research (CIHR) Partnership Grant #25343 to Dr. Litvinov. Canadian Dermatology Foundation research grant to Dr. Litvinov, and by the Fonds de la recherche du Québec – Santé to Dr. Sasseville (#22648) and to Dr. Litvinov (#34753 and #36769). This research was further supported by the CIHR Catalyst Grant #428712 to Dr. Litvinov.
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Affiliation(s)
| | | | - Elena Pastukhova
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Elham Rahme
- Division of Clinical Epidemiology, McGill University, Montréal, Québec, Canada
| | | | - Andrei Zubarev
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ivan V. Litvinov
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Corresponding author.
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6
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Chargari C, Arbyn M, Leary A, Abu-Rustum NR, Basu P, Bray F, Chopra S, Nout R, Tanderup K, Viswanathan AN, Zacharopoulou C, Soria JC, Deutsch E, Gouy S, Morice P. Increasing global accessibility to high-level treatments for cervical cancers. Gynecol Oncol 2022; 164:231-241. [PMID: 34716024 PMCID: PMC9496636 DOI: 10.1016/j.ygyno.2021.10.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023]
Abstract
Human papillomaviruses (HPV)-related gynecological cancers are a major health care issue, and a leading cause of cancer death in low- and middle-income countries (LMIC). In 2020, the World Health Organization launched a program aimed at cervical cancer elimination, by screening and vaccination strategies. Offering the best possible care to women diagnosed with invasive cancer is a complementary objective. Treatment of cervical cancer as per modern standards is complex and multimodal, mainly relying on surgery, external-beam radiotherapy (+/-chemotherapy) and brachytherapy. In parallel with the pivotal role of multidisciplinary discussion, international societies provide guidance to define the most effective and least toxic anti-cancer strategy, homogenize treatment protocols and provide benchmark quality indicators as a basis for accreditation processes. The challenge is to offer the appropriate diagnostic workup and treatment upfront and to avoid non- evidence-based treatment that consumes resources, impairs quality of life (QoL), and compromises oncological outcome. Various strategies may be applied for improving treatment quality: development of surgical mentorship, companion-training programs and international cooperation. The lack of radiotherapy/brachytherapy facilities is a major concern in LMIC. Reinforcing international support in terms of education, training, research and development and technical cooperation with national projects is required to increase access to minimum requirements but also introduce modern techniques, upgrade radiotherapy/brachytherapy services, and expand access to modern systemic treatments. In countries with robust economies, compliance to standards should also be increased. Integrative cancer care and multidisciplinary approaches are needed to tackle the dual challenge of increasing cure rates while minimizing QoL impairment. Appropriate dimensioning of the resources to avoid harmful treatment delays and access to expert referral centers is also a priority.
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Affiliation(s)
- C Chargari
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | - M Arbyn
- Unit Cancer Epidemiology - Belgian Cancer Centre, Brussels, Belgium
| | - A Leary
- Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - N R Abu-Rustum
- Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, United States; European Society of Gynecological Oncology, Geneva, Switzerland
| | - P Basu
- Early Detection, Prevention & Infection Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - F Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, UK
| | - S Chopra
- Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Navi Mumbai, Homi Bhabha National Institute, Maharashtra, India
| | - R Nout
- Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - K Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD, United States
| | - C Zacharopoulou
- European Parliament, Committee on the Environment, Public Health and Food Safety, France
| | - J C Soria
- Governance, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - E Deutsch
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - S Gouy
- Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - P Morice
- Inserm U-1030, Université Paris-Saclay, Le Kremlin-Bicêtre, France; European Society of Gynecological Oncology, Geneva, Switzerland; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
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Psychological Variables Associated with HPV Vaccination Intent in Romanian Academic Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178938. [PMID: 34501527 PMCID: PMC8430846 DOI: 10.3390/ijerph18178938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 01/05/2023]
Abstract
The aim of this study was to evaluate (1) the female medical students’ knowledge about HPV infection; (2) the associations between the HPV vaccination intent and coping strategies, health locus of control (HLOC), and sense of coherence; and (3) the specific differences between preclinical and clinical students in terms of the vaccination intent. Participants included 1243 female medicine students (mean age = 21.526, SD = 2.007), who completed The Multidimensional Health Locus of Control (MHLC)—Form A, the Brief COPE Scale, the Sense of Coherence Scale (SOC-13), and two questionnaires measuring the knowledge about the HPV infection and the HPV vaccination intent. Results show a good knowledge about HPV, which progressively increased during the study cycles. Still, the main contributors to vaccination intent are represented by coping strategies and health locus of control. Refusal of vaccination is associated to behavioral disengagement and the use of religion, precontemplation and contemplation to denial, and preparation to planning, positive reframing, and the powerful others component of HLOC. Sense of coherence did not predict vaccination intent. In clinical years, active coping outweighs HLOC in making the decision to get vaccinated. These results could be helpful in designing personalized strategies for addressing vaccine hesitancy in academic communities.
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Salciccioli I, Zhou CD, Okonji EC, Shalhoub J, Salciccioli JD, Marshall D. European trends in cervical cancer mortality in relation to national screening programs, 1985-2014. Cancer Epidemiol 2021; 74:102002. [PMID: 34371420 DOI: 10.1016/j.canep.2021.102002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cervical cancer is the fourth leading oncological cause of death in women. Variable trends in cervical cancer mortality have been observed across Europe, despite the widespread adoption of screening programs. This variability has previously been attributed to heterogeneity in the quality of screening programs. METHODS Age-standardized cervical cancer death rates for European countries between 1985 and 2014 were analyzed using Joinpoint regression. Countries were dichotomized based on year of implementation and population invitational coverage of national population-based cervical cancer screening programs. National cervical cancer mortality trends during the study period were compared based on this classification. RESULTS Decreasing trends in mortality were observed in all European countries with the specific exceptions of Bulgaria, Greece and Latvia. The highest rates of cervical cancer mortality throughout the study period were in Romania (16.0-14.9/100,000) and the lowest rates in Italy (1.4-1.2/100,000). The greatest percentage decline in mortality was observed in the United Kingdom and the greatest absolute reduction in mortality was seen in Hungary. European countries which implemented a national population-based cervical cancer screening program prior to 2009 demonstrated greater improvements in cervical cancer mortality outcomes compared to those that did not (p = 0.016). CONCLUSION Cervical cancer mortality is improving in most European countries; however, substantial variation remains. Trends in mortality were associated with the time of implementation of national population-based cervical screening programs.
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Affiliation(s)
| | | | | | | | - Justin D Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Dominic Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
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Small W, Peltecu G, Puiu A, Corha A, Cocîrṭă E, Cigăran RG, Plante M, Jhingran A, Stang K, Gaffney D, Bacon M, McCormack M. Cervical cancer in Eastern Europe: review and proceedings from the Cervical Cancer Research Conference. Int J Gynecol Cancer 2021; 31:1061-1067. [PMID: 33122244 DOI: 10.1136/ijgc-2020-001652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023] Open
Abstract
Cervical cancer is the third most common cancer among women worldwide, with a disproportionately high burden of disease in less-developed regions of the world. The Cervix Cancer Research Network was founded by the Gynecologic Cancer InterGroup with a mission to improve outcomes in cervical cancer by enhancing international access to clinical trials, specifically in under-represented, underdeveloped areas. The Cervix Cancer Research Network held its third international educational symposium in Bucharest in 2018 and is the subject of this report. The purpose of this symposium was to advance the international understanding of cervical cancer treatment patterns, to foster recruitment to Cervix Cancer Research Network clinical trials, and identify key Cervix Cancer Research Network clinical trial concepts to improve cervical cancer care worldwide.
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Affiliation(s)
- William Small
- Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Anastasia Puiu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Andrei Corha
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Elena Cocîrṭă
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Ruxandra Gabriela Cigăran
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, Filantropia Hospital, Bucharest, Romania
| | - Marie Plante
- Department of Obstetrics, Gynecology and Reproduction, CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Kyle Stang
- Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Monica Bacon
- Cervical Cancer Research Network, Kingston, Ontario, Canada
| | - Mary McCormack
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
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10
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Application of Mixture Cure Models in Determining the Survival of Patients with Cervical Cancer. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.93966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Cervical cancer is the fourth most common cancer among women and the seventh most common worldwide. Objectives: The present study aimed at investigating the usability of cure models in analyzing patients' survival. Besides, the factors affecting the long-term and short-term survival of the patients were determined, using Weibull, log-logistic, and log-normal models. Methods: The sample population of the study included 109 female patients with cervical cancer referred to Motahhari Hospital of Urmia (West Azerbaijan province) from 2004 to 2015. The cure survival analysis was used to determine the patients' survival. Results: The mean and standard deviation age at diagnosis was 50.1 ± 11.7 years. The patients' age, age at marriage, and the disease relapse were significant in the single-variable model on the long-term survival function of the patients. Moreover, the findings showed that Cured Log Logistic Parametric Model was more suitable for analyzing survival data in West Azerbaijan Province, Iran. The relapse variable was significant for all the parametric models. Conclusions: Given the divided sample population into immune and susceptible groups, the mixture cure models can be used to analyze the long-term and short-term survival of the patients with cervical cancer. Moreover, these models can be used to recognize the factors affecting both groups simultaneously.
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11
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Stelzle D, Tanaka LF, Lee KK, Ibrahim Khalil A, Baussano I, Shah ASV, McAllister DA, Gottlieb SL, Klug SJ, Winkler AS, Bray F, Baggaley R, Clifford GM, Broutet N, Dalal S. Estimates of the global burden of cervical cancer associated with HIV. LANCET GLOBAL HEALTH 2020; 9:e161-e169. [PMID: 33212031 PMCID: PMC7815633 DOI: 10.1016/s2214-109x(20)30459-9] [Citation(s) in RCA: 301] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/27/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Background HIV enhances human papillomavirus (HPV)-induced carcinogenesis. However, the contribution of HIV to cervical cancer burden at a population level has not been quantified. We aimed to investigate cervical cancer risk among women living with HIV and to estimate the global cervical cancer burden associated with HIV. Methods We did a systematic literature search and meta-analysis of five databases (PubMed, Embase, Global Health [CABI.org], Web of Science, and Global Index Medicus) to identify studies analysing the association between HIV infection and cervical cancer. We estimated the pooled risk of cervical cancer among women living with HIV across four continents (Africa, Asia, Europe, and North America). The risk ratio (RR) was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer to calculate the proportion of women living with HIV among women with cervical cancer and population attributable fractions and age-standardised incidence rates (ASIRs) of HIV-attributable cervical cancer. Findings 24 studies met our inclusion criteria, which included 236 127 women living with HIV. The pooled risk of cervical cancer was increased in women living with HIV (RR 6·07, 95% CI 4·40–8·37). Globally, 5·8% (95% CI 4·6–7·3) of new cervical cancer cases in 2018 (33 000 new cases, 95% CI 26 000–42 000) were diagnosed in women living with HIV and 4·9% (95% CI 3·6–6·4) were attributable to HIV infection (28 000 new cases, 20 000–36 000). The most affected regions were southern Africa and eastern Africa. In southern Africa, 63·8% (95% CI 58·9–68·1) of women with cervical cancer (9200 new cases, 95% CI 8500–9800) were living with HIV, as were 27·4% (23·7–31·7) of women in eastern Africa (14 000 new cases, 12 000–17 000). ASIRs of HIV-attributable cervical cancer were more than 20 per 100 000 in six countries, all in southern Africa and eastern Africa. Interpretation Women living with HIV have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for women living with HIV are especially important for countries in southern Africa and eastern Africa, where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. Funding WHO, US Agency for International Development, and US President's Emergency Plan for AIDS Relief.
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Affiliation(s)
- Dominik Stelzle
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Munich, Germany; Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Luana F Tanaka
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | | | - Anoop S V Shah
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sami L Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Munich, Germany; Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Rachel Baggaley
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland.
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12
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Bray F, Laversanne M, Weiderpass E, Arbyn M. Geographic and temporal variations in the incidence of vulvar and vaginal cancers. Int J Cancer 2020; 147:2764-2771. [PMID: 32410226 DOI: 10.1002/ijc.33055] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 01/03/2023]
Abstract
Vulvar and vaginal cancers are relatively rare cancers, together responsible for less than 1% of the global cancer incidence among women in 2018. The majority of vaginal cancers and a lesser proportion of vulvar cancers are associated with HPV, with rising incidence rates of vulvar cancer observed in younger women, possibly due to an increased prevalence of high-risk HPV types. This report assesses recent international variations in the incidence rates of vulvar and vaginal cancer derived from high-quality data from population-based cancer registries in 68 countries, and further assesses time trends for selected longer-term series in eight countries (Australia, China, Colombia, India, Norway, Slovakia, the U.S., and the U.K.) over the period 1983 to 2012. We observed a 30-fold variation in the recorded incidence rates of vulvar cancer in contrast with the threefold variation for vaginal cancer. We also observed a rising incidence of vulvar cancer in Australia, Norway and the U.K., and Slovakia, with a more rapid rise in the rates seen in women aged < 60 years at diagnosis. The annual percentage change over the most recent decade varied from 1.7% in Norway to 4.1% in Slovakia. The increases are largely confined to younger women and are likely linked to generational changes in sexual behaviour (earlier age at sexual debut and increasing transmission of HPV among cohorts born 1940 to 1950 and thereafter. Vaginal cancer incidence rates, in contrast, were lower and more stable, despite the higher HPV-attributable fraction relative to vulvar cancer. Irrespective of the trends, an increasing number of women are predicted to be diagnosed worldwide with both cancer types in future decades as population ageing and growth continues. The promise of high-coverage HPV vaccination will likely counter this rising burden, but the impact may take a number of decades.
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Affiliation(s)
- Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Elisabete Weiderpass
- Office of the Director, International Agency for Research on Cancer, Lyon, France
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Brussels, Belgium
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13
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Arbyn M, Bruni L, Kelly D, Basu P, Poljak M, Gultekin M, Bergeron C, Ritchie D, Weiderpass E. Tackling cervical cancer in Europe amidst the COVID-19 pandemic. Lancet Public Health 2020; 5:e425. [PMID: 32673570 PMCID: PMC7357980 DOI: 10.1016/s2468-2667(20)30122-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels B1050, Belgium.
| | - Laia Bruni
- Consortium for Biomedical Research in Cancer Epidemiology Research Program, Catalan Institute of Oncology - IDIBELL, Barcelona, Spain
| | - Daniel Kelly
- Royal College of Nursing, School of Healthcare Sciences, University of Cardiff, Cardiff, UK
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Murat Gultekin
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Ankara, Turkey
| | | | - David Ritchie
- Association of European Cancer Leagues, Brussels, Belgium
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Cervical Cancer Mortality in East-Central European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134639. [PMID: 32605159 PMCID: PMC7369878 DOI: 10.3390/ijerph17134639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022]
Abstract
Changes that took place in Europe in the early 1990s had an impact on health-associated issues. They were an impulse for the changes in healthcare systems and, consequently, also for the changes in cancer control programmes. Those changes also had an effect on mortality rates due to cervical cancer (CC). Therefore, the aim of this study is to analyse CC mortality trends in east-central Europe after 1990. Data on deaths due to CC were retrieved from the WHO Mortality Database. Trends in east-central European countries between 1990 and 2017 were assessed using Joinpoint Regression Program software. CC mortality decreased in the majority of analysed countries. However, an increase was observed in Latvia and Bulgaria. Despite decreasing mortality in the majority of the analysed countries, significant differences were observed. In order to improve the epidemiological situation, effective early detection programmes for cervical cancer ought to be rearranged and based not only on pap smears but also on molecular methods, as well as on introducing widespread programmes of vaccination against HPV.
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15
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Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health 2020; 8:e191-e203. [PMID: 31812369 PMCID: PMC7025157 DOI: 10.1016/s2214-109x(19)30482-6] [Citation(s) in RCA: 1908] [Impact Index Per Article: 477.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of prophylactic vaccines to prevent HPV infection and HPV assays that detect nucleic acids of the virus. WHO has launched a Global Initiative to scale up preventive, screening, and treatment interventions to eliminate cervical cancer as a public health problem during the 21st century. Therefore, our study aimed to assess the existing burden of cervical cancer as a baseline from which to assess the effect of this initiative. METHODS For this worldwide analysis, we used data of cancer estimates from 185 countries from the Global Cancer Observatory 2018 database. We used a hierarchy of methods dependent on the availability and quality of the source information from population-based cancer registries to estimate incidence of cervical cancer. For estimation of cervical cancer mortality, we used the WHO mortality database. Countries were grouped in 21 subcontinents and were also categorised as high-resource or lower-resource countries, on the basis of their Human Development Index. We calculated the number of cervical cancer cases and deaths in a given country, directly age-standardised incidence and mortality rate of cervical cancer, indirectly standardised incidence ratio and mortality ratio, cumulative incidence and mortality rate, and average age at diagnosis. FINDINGS Approximately 570 000 cases of cervical cancer and 311 000 deaths from the disease occurred in 2018. Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2·1 million cases), colorectal cancer (0·8 million) and lung cancer (0·7 million). The estimated age-standardised incidence of cervical cancer was 13·1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100 000 women. Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa. The highest incidence was estimated in Eswatini, with approximately 6·5% of women developing cervical cancer before age 75 years. China and India together contributed more than a third of the global cervical burden, with 106 000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India. Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore). The global average age at death from cervical cancer was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed. INTERPRETATION Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. The global scale-up of HPV vaccination and HPV-based screening-including self-sampling-has potential to make cervical cancer a rare disease in the decades to come. Our study could help shape and monitor the initiative to eliminate cervical cancer as a major public health problem. FUNDING Belgian Foundation Against Cancer, DG Research and Innovation of the European Commission, and The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
| | | | - Laia Bruni
- Consortium for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain; Unit of Infections and Cancer, Catalonian Institute of Oncology, Barcelona, Spain
| | | | - Mona Saraiya
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Atlanta, GA, USA
| | - Jacques Ferlay
- International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
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16
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Wild CP, Espina C, Bauld L, Bonanni B, Brenner H, Brown K, Dillner J, Forman D, Kampman E, Nilbert M, Steindorf K, Storm H, Vineis P, Baumann M, Schüz J. Cancer Prevention Europe. Mol Oncol 2019; 13:528-534. [PMID: 30667152 PMCID: PMC6396376 DOI: 10.1002/1878-0261.12455] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/10/2019] [Indexed: 01/11/2023] Open
Abstract
The case for cancer prevention in Europe is the same as for all other parts of the world. The number of cancers is increasing, driven by demographic change and evolution in the exposure to risk factors, while the cost of treating patients is likewise spiralling. Estimations suggest that around 40% of cancers in Europe could be prevented if current understanding of risk and protective factors was translated into effective primary prevention, with further reductions in cancer incidence and mortality by screening, other approaches to early detection, and potentially medical prevention. However, the infrastructure for cancer prevention tends to be fragmented between and within different countries in Europe. This lack of a coordinated approach recently led to the foundation of Cancer Prevention Europe (Forman et al., 2018), a collaborative network with the main aims of strengthening cancer prevention in Europe by increasing awareness of the needs, the associated required resources and reducing inequalities in access to cancer prevention across Europe. This article showcases the need for strengthening cancer prevention and introduces the objectives of Cancer Prevention Europe and its foreseen future role in reducing the European cancer burden.
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Affiliation(s)
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Linda Bauld
- Usher InstituteCollege of Medicine and Veterinary MedicineUniversity of EdinburghUK
- Cancer Research UKLondonUK
| | | | | | - Karen Brown
- UK Therapeutic Cancer Prevention NetworkLeicester Cancer Research CentreUniversity of LeicesterUK
| | - Joakim Dillner
- Karolinska University LaboratoryKarolinska University HospitalStockholmSweden
| | - David Forman
- International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen UniversityThe Netherlands
| | | | | | | | - Paolo Vineis
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial CollegeLondonUK
| | | | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO)LyonFrance
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17
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Mendes D, Mesher D, Pista A, Baguelin M, Jit M. Understanding differences in cervical cancer incidence in Western Europe: comparing Portugal and England. Eur J Public Health 2019; 28:343-347. [PMID: 29059348 DOI: 10.1093/eurpub/ckx176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Cervical cancer incidence has decreased over time in England particularly after the introduction of organized screening. In Portugal, where opportunistic screening has been widely available with only slightly lower coverage than that of the organized programme in England, rates of cervical cancer have been higher than in England. We compared the burden of cervical cancer, risk factors and preventive interventions over time in both countries, to identify elements hindering the further decline in incidence and mortality in Portugal. Methods We used joinpoint regression to identify significant changes in rate time-trends. We also analyzed individual-level Portuguese data on sexual behaviour and human papillomavirus prevalence, and recent aggregate data on organized and opportunistic screening coverage. We compared published estimates of survival, risk factors and historical screening coverage for both countries. Results Despite stable incidence, cervical cancer mortality has declined in both countries in the last decade. The burden has been 4 cases and 1 death per 100 000 women annually higher in Portugal than in England. Differences in human papillomavirus prevalence and risk factors for infection and disease progression do not explain the difference found in cervical cancer incidence. Significant mortality declines in both countries followed the introduction of different screening policies, although England showed a greater decline than Portugal over nearly 2 decades after centralizing organized screening. Conclusion The higher rates of cervical cancer in Portugal compared to England can be explained by differences in screening quality and coverage.
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Affiliation(s)
- Diana Mendes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Modelling and Economics Unit, Public Health England, London, UK
| | - David Mesher
- HIV and STI Department, Public Health England, London, UK
| | - Angela Pista
- Department of Infectious Diseases, National Institute of Health, Lisbon, Portugal
| | - Marc Baguelin
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Modelling and Economics Unit, Public Health England, London, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Modelling and Economics Unit, Public Health England, London, UK
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18
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Ren CC, Yang L, Liu L, Chen YN, Cheng GM, Zhang XA, Liu H. Effects of shRNA-mediated silencing of PSMA7 on cell proliferation and vascular endothelial growth factor expression via the ubiquitin-proteasome pathway in cervical cancer. J Cell Physiol 2018; 234:5851-5862. [PMID: 29247526 DOI: 10.1002/jcp.26408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/11/2017] [Indexed: 12/20/2022]
Abstract
This study aims to evaluate the effects of PSMA7 silencing on cervical cancer (CC) cell proliferation and vascular endothelial growth factor (VEGF) expression through the ubiquitin-proteasome pathway. CC tissues (n = 43) and normal tissues (n = 27) were first collected from patients. Human CC cell line (SiHa) and human normal cervical epithelial cells (H8) were obtained and classified into the normal, blank, negative control (NC), PSMA7-shRNA1, and PSMA7-shRNA2 groups, respectively. In situ hybridization was used to detect the expressions of wild-type and mutant p53 proteins. Immunofluorescence assay was carried out to test the activity of 20S proteasomes. Reverse transcription quantitative polymerase chain reaction and Western blot analysis were both performed to determine the expressions of PSMA7, ubiquitin, P27, P53, and VEGF in sample tissues and cells. 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay was used to analyze cell proliferation rates, and flow cytometry was used to analyze the cell cycle and the apoptotic rate. Compared with normal tissues, CC tissues showed increased expression levels of PSMA7, ubiquitin, p53, VEGF as well as increased activity of 20S proteasomes but exhibited a decrease in p27 expression. Compared with the blank and NC groups, the PSMA7-shRNA1 and PSMA7-shRNA2 groups all had decreased expression levels of PSMA7, ubiquitin, p53, and VEGF as well as decreased cell proliferation, 20S proteasomes activity, and cell number in the S phase, increased p27 expression, cell apoptosis and cell number in the G0/G1 phase. Our study demonstrated that PSMA7 silencing can suppress CC cell proliferation and VEGF expression in addition to promoting cell apoptosis through inhibiting the UPP signaling pathway.
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Affiliation(s)
- Chen-Chen Ren
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Yang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling Liu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan-Nan Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guo-Mei Cheng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-An Zhang
- Department of Imaging, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Liu
- Department of Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Moga MA, Bălan A, Anastasiu CV, Dimienescu OG, Neculoiu CD, Gavriș C. An Overview on the Anticancer Activity of Azadirachta indica (Neem) in Gynecological Cancers. Int J Mol Sci 2018; 19:ijms19123898. [PMID: 30563141 PMCID: PMC6321405 DOI: 10.3390/ijms19123898] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022] Open
Abstract
In recent years, a wide range of studies have pointed out the importance of nutraceuticals as reservoirs of therapeutic compounds for several diseases, including cancer. This study is centered on the role of some nutraceuticals as anticancer agents and on their efficiency in the oncological gynecological field. Gynecological cancers include cervical, ovarian, and breast neoplasia and these are the major causes of morbidity and mortality in the female population. Cervical neoplasia affects sexually active women aged between 30 and 40 years and is considered the second leading cause of death for women worldwide. Epidemiological studies have shown a strong association of this cancer with human papilloma virus (HPV) infection, independent of any others risk factors. Ovarian cancer represents about 4% of all women’s cancers and breast neoplasia registers 52.8 new cases per 100,000 women annually. Since ancient times, herbal therapies have shown a wide range of beneficial effects and a high potential for safeguarding human health. Azadirachta indica (Neem) is a medicinal plant of Indian origin, a tree with more of 140 isolated compounds and at least 35 biologically active principles that have shown an important influence as tumor suppressors by interfering with the carcinogenesis process. Used for centuries in Asia as a natural remedy for cancer, neem compounds present in bark, leaves, flowers, and seed oil have been shown to possess properties such as chemopreventive capacity, apoptotic activities, immunomodulatory effects, and induction of p53-independent apoptosis. The current study is a systematic literature review based on the anticarcinogenic potential of neem compounds in gynecological cancers.
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Affiliation(s)
- Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Andreea Bălan
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Costin Vlad Anastasiu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Oana Gabriela Dimienescu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
| | - Carmen Daniela Neculoiu
- Department of Fundamental, Prophylactic and Clinical Sciences, Faculty of Medicine, University Transilvania Braşov, 500019 Brasov, Romania.
| | - Claudia Gavriș
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania.
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20
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Arbyn M, Smith SB, Temin S, Sultana F, Castle P. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ 2018; 363:k4823. [PMID: 30518635 PMCID: PMC6278587 DOI: 10.1136/bmj.k4823] [Citation(s) in RCA: 405] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of high-risk human papillomavirus (hrHPV) assays on self samples and the efficacy of self sampling strategies to reach underscreened women. DESIGN Updated meta-analysis. DATA SOURCES Medline (PubMed), Embase, and CENTRAL from 1 January 2013 to 15 April 2018 (accuracy review), and 1 January 2014 to 15 April 2018 (participation review). REVIEW METHODS Accuracy review: hrHPV assay on a vaginal self sample and a clinician sample; and verification of the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by colposcopy and biopsy in all enrolled women or in women with positive tests. Participation review: study population included women who were irregularly or never screened; women in the self sampling arm (intervention arm) were invited to collect a self sample for hrHPV testing; women in the control arm were invited or reminded to undergo a screening test on a clinician sample; participation in both arms was documented; and a population minimum of 400 women. RESULTS 56 accuracy studies and 25 participation trials were included. hrHPV assays based on polymerase chain reaction were as sensitive on self samples as on clinician samples to detect CIN2+ or CIN3+ (pooled ratio 0.99, 95% confidence interval 0.97 to 1.02). However, hrHPV assays based on signal amplification were less sensitive on self samples (pooled ratio 0.85, 95% confidence interval 0.80 to 0.89). The specificity to exclude CIN2+ was 2% or 4% lower on self samples than on clinician samples, for hrHPV assays based on polymerase chain reaction or signal amplification, respectively. Mailing self sample kits to the woman's home address generated higher response rates to have a sample taken by a clinician than invitation or reminder letters (pooled relative participation in intention-to-treat-analysis of 2.33, 95% confidence interval 1.86 to 2.91). Opt-in strategies where women had to request a self sampling kit were generally not more effective than invitation letters (relative participation of 1.22, 95% confidence interval 0.93 to 1.61). Direct offer of self sampling devices to women in communities that were underscreened generated high participation rates (>75%). Substantial interstudy heterogeneity was noted (I2>95%). CONCLUSIONS When used with hrHPV assays based on polymerase chain reaction, testing on self samples was similarly accurate as on clinician samples. Offering self sampling kits generally is more effective in reaching underscreened women than sending invitations. However, since response rates are highly variable among settings, pilots should be set up before regional or national roll out of self sampling strategies.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J Wytsmanstreet 14, B1050 Brussels, Belgium
| | - Sara B Smith
- Global Coalition Against Cervical Cancer, Durham, NC, USA
| | - Sarah Temin
- Department of Cancer Policy and Advocacy, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Farhana Sultana
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Registries and Research, Victorian Cytology Service Registries, Victorian Cytology Service Ltd, Carlton South, Australia
| | - Philip Castle
- Global Coalition Against Cervical Cancer, Durham, NC, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Trends in cervical cancer mortality rates in Lithuania, 1987–2016. Cancer Epidemiol 2018; 57:85-89. [DOI: 10.1016/j.canep.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/21/2018] [Accepted: 10/11/2018] [Indexed: 11/19/2022]
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Taghavi K, Banerjee D, Mandal R, Kallner HK, Thorsell M, Friis T, Kocoska-Maras L, Strander B, Singer A, Wikström E. Colposcopy telemedicine: live versus static swede score and accuracy in detecting CIN2+, a cross-sectional pilot study. BMC WOMENS HEALTH 2018; 18:89. [PMID: 29890991 PMCID: PMC6040214 DOI: 10.1186/s12905-018-0569-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/16/2018] [Indexed: 12/04/2022]
Abstract
Background This cross-sectional pilot study evaluates diagnostic accuracy of live colposcopy versus static image Swede-score evaluation for detecting significant precancerous cervical lesions greater than, or equal to grade 2 severity (CIN2+). Methods VIA or HrHPV positive women were examined using a mobile colposcope, in a rural clinic in Kolkata, India. Live versus static Swede-score colposcopy assessments were made independently. All assessments were by gynecologists, junior or expert. Static image assessors were blinded to live scoring, patient information and final histopathology result. Primary outcome was the ability to detect CIN2+ lesions verified by directed biopsies. Diagnostic accuracy was calculated for live versus static Swede-score in detecting CIN2+ lesions, as well as for interclass correlation. Results 495 images from 94 VIA positive women were evaluated in this study. Thirteen women (13.9%) had CIN2+ on biopsy. No significant difference was found in the detection of CIN2+ lesions between live and static assessors (area under curve = 0.69 versus 0.71, p = 0.63). A Swede-score of 4+, had a sensitivity of 76.9% (95% CI 46.2–95.0%) and 84.6% (95% CI 54.6–98.1%), for live- and static-image assessment respectively. The corresponding positive predictive values were found to be 90.9% (95% CI 75.7–98.1%) and 92.6% (95% CI 75.7–99.1%). The interclass correlation was good (kappa statistic = 0.60) for the senior static assessors. Conclusions Swede-score evaluation of static colposcopy images was found to reliably detect CIN2+ lesions in this study. Larger studies are needed to further develop the colposcopy telemedicine concept which may offer reliable guidance in management where direct specialist input is not available. Trial registration Ethical approval of the study was obtained by the Chittaranjan National Cancer Institute (CNCI) Human Research Ethics Committee (4.311/27/2014). The trial was retrospectively registered in the Clinical Trails Registry of India CTRI/2018/03/012470. Electronic supplementary material The online version of this article (10.1186/s12905-018-0569-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katayoun Taghavi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
| | - Dipanwita Banerjee
- Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Ranajit Mandal
- Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Malin Thorsell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Therese Friis
- Akademiska sjukhuset, Uppsala University Hospital, Uppsala, Sweden
| | | | - Björn Strander
- Department of Clinical Sciences, Sahlgrenska academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Elisabeth Wikström
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Păvăleanu I, Gafiţanu D, Ioanid N, Grigore M. Preliminary results of the first cervical cancer screening programme in the North Eastern region of Romania. J Med Screen 2018; 25:162-165. [PMID: 29764329 DOI: 10.1177/0969141317753462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cervical cancer represents a major health problem in Romania. A national population-based cervical cancer screening programme was launched in 2012. The aims of the study were to assess the participation rate and to estimate the prevalence of epithelial cell abnormalities in the first four years of the programme in North Eastern Romania. METHODS The participation rate, representing the proportion of eligible women screened in the programme, was evaluated for 2012-2016. The prevalence of cytological abnormalities was estimated by age group and calendar year. RESULTS Of 107,968 Pap smears taken, 312 were unsatisfactory (0.3%). The number of smears decreased by year. The participation rate over the four years was 16.9%. Of the 107,656 satisfactory smears, 6.5% were positive for squamous and/or glandular lesion, among which 0.5% contained high-grade squamous intraepithelial or worse lesions. CONCLUSION The participation rate in the first four years of the programme was low. The effectiveness of the screening programme should be improved by attendance monitoring of the target population, and follow-up of screen-positive women. Measures should be taken to raise coverage and assure quality at all steps of the screening chain. The data collected should include all screening tests from both opportunistic and organized settings.
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Affiliation(s)
- Ioana Păvăleanu
- 1 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iaşi, Romania
| | - Dumitru Gafiţanu
- 1 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iaşi, Romania
| | | | - Mihaela Grigore
- 1 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy 'Grigore T. Popa', Iaşi, Romania
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Dehler S, Tonev S, Korol D, Rohrmann S, Dimitrova N. Recent Trends in Cancer Incidence: Impact of Risk Factors, Diagnostic Activities and Data Quality of Registration. TUMORI JOURNAL 2018. [DOI: 10.1177/1636.17894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Sabine Rohrmann
- Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
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Vincerževskiene I, Jasilionis D, Austys D, Stukas R, Kaceniene A, Smailyte G. Education predicts cervical cancer survival: a Lithuanian cohort study. Eur J Public Health 2018; 27:421-424. [PMID: 28115421 DOI: 10.1093/eurpub/ckw261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background : We examined inequalities in cervical cancer survival in Lithuania by education and place of residence. : The study is based on the linked dataset that includes all records of the 2001 population Census, all records from Lithuanian Cancer Registry (cancer incidence) and all death and emigration records from Statistics Lithuania for the period between 6 April 2001 and 31 December 2009. The study group includes cervical cancers registered in the Cancer Registry from 1 January 2002 to 31 December 2006. Analysis was restricted to women who were 25-64 years old at the Census date (in total 1 866 cases). : During the study period there were 671 deaths corresponding to an overall 5-year survival proportion 64.13% (95% CI 61.86-66.31). Place of residence and education of cervical cancer patients had strong impact on survival; 5-year survival was higher in women living in urban areas than in rural (68.61 and 55.93%) and survival decreased with decreasing education: from 79.77% in highest education group to 64.85 and 50.48% in groups with secondary and lower than secondary education. The effect of place of residence declined when stage of disease was included in the model and became not significant in final model with education adjustment. The effect of education declined after inclusion of stage and other variables, however, remained significant. : We found that women with higher education experienced higher survival following a cervical cancer diagnosis, and stage of disease at the time of diagnosis explains only the part of observed differences.
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Affiliation(s)
- Ieva Vincerževskiene
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
| | - Domantas Jasilionis
- Laboratory for Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany.,Centre for Demographic Research, Vytautas Magnus University, Kaunas, Lithuania
| | - Donatas Austys
- Institute of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rimantas Stukas
- Institute of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Auguste Kaceniene
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania.,Institute of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Petkeviciene J, Ivanauskiene R, Klumbiene J. Sociodemographic and lifestyle determinants of non-attendance for cervical cancer screening in Lithuania, 2006–2014. Public Health 2018; 156:79-86. [DOI: 10.1016/j.puhe.2017.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/29/2017] [Accepted: 12/16/2017] [Indexed: 01/21/2023]
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Kurtinaitienė R, Rimienė J, Labanauskaitė I, Lipunova N, Smailytė G. Increasing attendance in a cervical cancer screening programme by personal invitation: experience of a Lithuanian primary health care centre. Acta Med Litu 2016; 23:180-184. [PMID: 28356807 PMCID: PMC5287991 DOI: 10.6001/actamedica.v23i3.3383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND High participation rates are an essential component of an effective screening programme and many approaches were introduced as being successful for enhancing compliance to screening guidelines. The aim of this study was to evaluate to which extent a personal invitation by mail increases the rate of attendance in a cervical cancer screening programme in a primary health care centre. MATERIALS AND METHODS The study was carried out as a pilot project to gain insight into feasibility of applying a well-known compliance increasing measure in Lithuanian population. The study included a sample of women registered at the primary health care centre in Panevėžys who had not participated in the cervical cancer screening programme for six and more years. Personal registered invitation letters to attend the primary health care centre for a Pap smear were sent out to 1789 women by mail. RESULTS In total, 2195 women were tested during 2011 at the primary health care centre. 487 (22.2%) of them attended the screening programme after receiving a personal invitation letter. Response rate for attending screening after receiving a personal invitation letter was 27.3%. CONCLUSIONS Our study demonstrated that personal invitation letters addressed to long-term non-attendees could markedly increase participation in cervical cancer screening in Lithuania.
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Affiliation(s)
- Rūta Kurtinaitienė
- Vilnius University Hospital Santariškių Klinikos, Centre of Obstetrics and Gynaecology, Vilnius, Lithuania
| | | | - Ingrida Labanauskaitė
- Vilnius City Clinical Hospital, Department of Obstetrics and Gynaecology, Vilnius, Lithuania
| | - Nadežda Lipunova
- National Cancer Institute, Cancer Control and Prevention Centre, Vilnius, Lithuania
| | - Giedrė Smailytė
- National Cancer Institute, Laboratory of Cancer Epidemiology, Vilnius, Lithuania
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Vaccarella S, Franceschi S, Zaridze D, Poljak M, Veerus P, Plummer M, Bray F. Preventable fractions of cervical cancer via effective screening in six Baltic, central, and eastern European countries 2017-40: a population-based study. Lancet Oncol 2016; 17:1445-1452. [PMID: 27567054 PMCID: PMC5052457 DOI: 10.1016/s1470-2045(16)30275-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cervical cancer incidence remains high in several Baltic, central, and eastern European (BCEE) countries, mainly as a result of a historical absence of effective screening programmes. As a catalyst for action, we aimed to estimate the number of women who could be spared from cervical cancer across six countries in the region during the next 25 years, if effective screening interventions were introduced. METHODS In this population-based study, we applied age-period-cohort models with spline functions within a Bayesian framework to incidence data from six BCEE countries (Estonia, Latvia, Lithuania, Belarus, Bulgaria, and Russia) to develop projections of the future number of new cases of cervical cancer from 2017 to 2040 based on two future scenarios: continued absence of screening (scenario A) versus the introduction of effective screening from 2017 onwards (scenario B). The timespan of available data varied from 16 years in Bulgaria to 40 years in Estonia. Projected rates up to 2040 were obtained in scenario A by extrapolating cohort-specific trends, a marker of changing risk of human papillomavirus (HPV) infection, assuming a continued absence of effective screening in future years. Scenario B added the effect of gradual introduction of screening in each country, under the assumption period effects would be equivalent to the decreasing trend by calendar year seen in Denmark (our comparator country) since the progressive regional introduction of screening from the late 1960s. FINDINGS According to scenario A, projected incidence rates will continue to increase substantially in many BCEE countries. Very high age-standardised rates of cervical cancer are predicted in Lithuania, Latvia, Belarus, and Estonia (up to 88 cases per 100 000). According to scenario B, the beneficial effects of effective screening will increase progressively over time, leading to a 50-60% reduction of the projected incidence rates by around 2040, resulting in the prevention of cervical cancer in 1500 women in Estonia and more than 150 000 women in Russia. The immediate launch of effective screening programmes could prevent almost 180 000 new cervical cancer diagnoses in a 25-year period in the six BCEE countries studied. INTERPRETATION Based on our findings, there is a clear need to begin cervical screening in these six countries as soon as possible to reduce the high and increasing incidence of cervical cancer over the next decades. FUNDING None.
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Affiliation(s)
| | | | - David Zaridze
- Russian NN Blokhin Cancer Research Centre, Moscow, Russia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Piret Veerus
- Estonian Cancer Screening Registry, National Institute for Health Development, Estonia
| | - Martyn Plummer
- International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
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Samson KK, Haynatzki G, Soliman AS, Valerianova Z. Temporal changes in the cervical cancer burden in Bulgaria: Implications for eastern european countries going through transition. Cancer Epidemiol 2016; 44:154-160. [PMID: 27597149 DOI: 10.1016/j.canep.2016.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/20/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In most developed countries, incidence of cervical cancer declined likely due to well-established cervical cancer screening programs. However, such decline has not been identified in Eastern Europe, where such programs are not well established. METHODS This study utilized data of the Bulgarian Cancer Registry for the period 1993-2013. Age-standardized incidence and mortality trends were analyzed using Joinpoint regression. Maps were created to illustrate spatial distributions of rates. RESULTS The northern region of Bulgaria showed a larger cervical cancer burden than the southern region and rural women tended to be diagnosed at older ages (p<0.0001) and later stages (p<0.0001) than urban women. The distribution of disease stages changed over the 21 years, with most common stages of diagnosis being stage II in 1993 (39.2%) to stage I in 2013 (44.7%; p<0.0001). While age-standardized mortality slightly increased over the 21 years (from 4.8 to 5.2 per 100,000; p=0.009), age-standardized incidence increased from 14.0 to 21.4 per 100,000 up until 2006 (p<0.001), after which it plateaued. CONCLUSIONS The lack of a similar plateau in mortality may be because the second most prevalent stage of diagnosis in recent years was stage III, indicating diagnosis at advanced symptomatic stages. Cervical cancer incidence is expected to continue to decrease if screening programs are strengthened and human papillomavirus vaccines are widely utilized. As Bulgaria has shared cervical cancer trends with other Eastern European countries in the past, it may be beneficial to develop future prevention interventions based on a regional, rather than a country-specific level.
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Affiliation(s)
- Kaeli K Samson
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gleb Haynatzki
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amr S Soliman
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zdravka Valerianova
- Bulgarian National Cancer Registry, National Oncological Hospital, Sofia, Bulgaria.
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Altobelli E. Improving cervical cancer screening in Baltic, central, and eastern European countries. Lancet Oncol 2016; 17:1349-1350. [PMID: 27567056 DOI: 10.1016/s1470-2045(16)30388-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 07/29/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Emma Altobelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 Coppito (L'Aquila), Italy.
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The Role of Natural Polyphenols in the Prevention and Treatment of Cervical Cancer-An Overview. Molecules 2016; 21:molecules21081055. [PMID: 27548122 PMCID: PMC6274328 DOI: 10.3390/molecules21081055] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 12/28/2022] Open
Abstract
Cervical cancer represents the second leading cause of death for women worldwide. The importance of the diet and its impact on specific types of neoplasia has been highlighted, focusing again interest in the analysis of dietary phytochemicals. Polyphenols have shown a wide range of cellular effects: they may prevent carcinogens from reaching the targeted sites, support detoxification of reactive molecules, improve the elimination of transformed cells, increase the immune surveillance and the most important factor is that they can influence tumor suppressors and inhibit cellular proliferation, interfering in this way with the steps of carcinogenesis. From the studies reviewed in this paper, it is clear that certain dietary polyphenols hold great potential in the prevention and therapy of cervical cancer, because they interfere in carcinogenesis (in the initiation, development and progression) by modulating the critical processes of cellular proliferation, differentiation, apoptosis, angiogenesis and metastasis. Specifically, polyphenols inhibit the proliferation of HPV cells, through induction of apoptosis, growth arrest, inhibition of DNA synthesis and modulation of signal transduction pathways. The effects of combinations of polyphenols with chemotherapy and radiotherapy used in the treatment of cervical cancer showed results in the resistance of cervical tumor cells to chemo- and radiotherapy, one of the main problems in the treatment of cervical neoplasia that can lead to failure of the treatment because of the decreased efficiency of the therapy.
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Ulinskas K, Janulionis E, Valuckas K, Samerdokiene V, Atkocius V, Rivard M. Long-term results for Stage IIIB cervical cancer patients receiving external beam radiotherapy combined with either HDR 252Cf or HDR 60Co intracavitary brachytherapy. Brachytherapy 2016; 15:353-360. [DOI: 10.1016/j.brachy.2016.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/29/2015] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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Ngo C, Samuels S, Bagrintseva K, Slocker A, Hupé P, Kenter G, Popovic M, Samet N, Tresca P, von der Leyen H, Deutsch E, Rouzier R, Belin L, Kamal M, Scholl S. From prospective biobanking to precision medicine: BIO-RAIDs - an EU study protocol in cervical cancer. BMC Cancer 2015; 15:842. [PMID: 26531748 PMCID: PMC4632364 DOI: 10.1186/s12885-015-1801-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/16/2015] [Indexed: 11/29/2022] Open
Abstract
Background Cervical cancer (CC) is -second to breast cancer- a dominant cause of gynecological cancer-related deaths worldwide. CC tumor biopsies and blood samples are of easy access and vital for the development of future precision medicine strategies. Design BIO-RAIDs is a prospective multicenter European study, presently recruiting patients in 6 EU countries. Tumor and liquid biopsies from patients with previously non-treated cervical cancer (stages IB2-IV) are collected at defined time points. Patients receive standard primary treatment according to the stage of their disease. 700 patients are planned to be enrolled. The main objectives are the discovery of -dominant molecular alterations, -signalling pathway activation, and -tumor micro-environment patterns that may predict response or resistance to treatment. An exhaustive molecular analysis is performed using 1° Next generation sequencing, 2° Reverse phase protein arrays and 3° Immuno-histochemistry. Discussion The clinical study BIO-RAIDs is activated in all planned countries, 170 patients have been recruited till now. This study will make an important contribution towards precision medicine treatments in cervical cancer. The results will support the development of clinical practice guidelines for cervical cancer patients to improve their prognosis and their quality of life. Trial registration Clinicaltrials.gov: NCT02428842, registered 10 February 2015.
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Affiliation(s)
- Charlotte Ngo
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France.,Present address: Department of gynecological and breast oncological surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Sanne Samuels
- Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Ksenia Bagrintseva
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Andrea Slocker
- Department of Radiation Oncology, Institut Gustave Roussy (IGR), 114 Rue Edouard-Vaillant, 94805, Villejuif Cedex, France
| | - Philippe Hupé
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France.,INSERM U900, Paris, France.,Mines ParisTech, Fontainebleau, France.,CNRS UMR 144, Paris, France
| | - Gemma Kenter
- Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Marina Popovic
- Department of Gynecology, Institut of Oncology of Vojvodina (IOV), Put Doktora Goldmana 4, 21204, Sremska Kamenica, Serbia
| | - Nina Samet
- Department of Radiology Gynecology, Institute of Oncology of Republic of Moldova, str. N. Testemiţanu 30, MD-2025, Chişinău, Republica Moldova
| | - Patricia Tresca
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Heiko von der Leyen
- Hannover Clinical Trial Center (HCTC) GmbH, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Eric Deutsch
- Department of Radiation Oncology, Institut Gustave Roussy (IGR), 114 Rue Edouard-Vaillant, 94805, Villejuif Cedex, France
| | - Roman Rouzier
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Lisa Belin
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Maud Kamal
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Suzy Scholl
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France. .,Institut Curie, 26 rue d'Ulm 75248, Paris, Cedex 05, France.
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Vansevičiūtė R, Venius J, Žukovskaja O, Kanopienė D, Letautienė S, Rotomskis R. 5-aminolevulinic-acid-based fluorescence spectroscopy and conventional colposcopy for in vivo detection of cervical pre-malignancy. BMC WOMENS HEALTH 2015; 15:35. [PMID: 25887444 PMCID: PMC4405835 DOI: 10.1186/s12905-015-0191-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/27/2015] [Indexed: 11/10/2022]
Abstract
Background Sensitized fluorescence diagnostics are based on selective accumulation of photosensitizer in the tissue where carcinogenesis has started. The present study compared topical 5-aminolevulinic acid (5-ALA)-based fluorescence spectroscopy (FS) in vivo with conventional colposcopy for cervical intraepithelial neoplasia (CIN) detection. Methods We enrolled 48 patients who were referred for colposcopy because of high-grade changes in cervical cytology. Every inspected cervix was divided in to quadrants, and there were 174 quadrants included in the study. Each patient had a cytological smear, colposcopy, FS and histopathological analysis. For FS, 3% 5-ALA cream was used topically and after an average 135 min incubation, fluorescence spectra were recorded from the cervix in vivo. FS and colposcopy results were correlated with histopathology. Results All spectra were evaluated by a ratio of the protoporphyrin IX fluorescence intensity at 634 nm and autofluorescence intensity at 510 nm. For proper grouping of low-risk and high-risk cases, a threshold of 3.87 was calculated. Data per quadrant showed that FS had higher sensitivity than colposcopy (71.7% vs 67.4%) but specificity was greater for colposcopy (86.6% vs 75.6%). Combination of the methods showed higher sensitivity (88.0% vs 67.4%) but reduced specificity (88.0% and 69.5%), but it had the highest number of correctly identified high-risk changes and the highest (79.3%) accuracy. Data for each patient showed FS sensitivity of 91.2%, which was greater than for colposcopy (88.2%). Higher overdiagnosis resulted in decreased specificity for fluorescence methodology—71.4% versus 78.6% for colposcopy. In both cases, accuracy was 85.4% and effectiveness was >80%, which means that both methods can be used to determine high-risk cervical intraepithelial neoplasia. The diagnostic sensitivity of 97.1% for this complementary diagnosis indicates that it could be the best choice for detection of high-risk changes. Conclusions 5-ALA-based FS is an objective method, requiring short-term administration for appropriate fluorescence measurements. FS is a promising diagnostic tool with similar accuracy as colposcopy but with the potential advantage of providing objective results.
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Affiliation(s)
| | - Jonas Venius
- National Cancer Institute, Vilnius, Lithuania. .,Laboratory of Biomedical Physics, National Cancer Institute, Vilnius, Lithuania.
| | - Olga Žukovskaja
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | | | - Simona Letautienė
- National Cancer Institute, Vilnius, Lithuania. .,Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Ričardas Rotomskis
- Laboratory of Biomedical Physics, National Cancer Institute, Vilnius, Lithuania. .,Biophotonics Group, Laser Research Center, Vilnius University, Vilnius, Lithuania.
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The end of the decline in cervical cancer mortality in Spain: trends across the period 1981-2012. BMC Cancer 2015; 15:287. [PMID: 25886170 PMCID: PMC4408572 DOI: 10.1186/s12885-015-1306-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/31/2015] [Indexed: 01/08/2023] Open
Abstract
Background In Spain, cervical cancer prevention is based on opportunistic screening, due to the disease’s traditionally low incidence and mortality rates. Changes in sexual behaviour, tourism and migration have, however, modified the probability of exposure to human papilloma virus among Spaniards. This study thus sought to evaluate recent cervical cancer mortality trends in Spain. Methods We used annual female population figures and individual records of deaths certified as cancer of cervix, reclassifying deaths recorded as unspecified uterine cancer to correct coding quality problems. Joinpoint models were fitted to estimate change points in trends, as well as the annual (APC) and average annual percentage change. Log-linear Poisson models were also used to study age-period-cohort effects on mortality trends and their change points. Results 1981 marked the beginning of a decline in cervical cancer mortality (APC1981–2003: −3.2; 95% CI:-3.4;-3.0) that ended in 2003, with rates reaching a plateau in the last decade (APC2003–2012: 0.1; 95% CI:-0.9; 1.2). This trend, which was observable among women aged 45–46 years (APC2003–2012: 1.4; 95% CI:-0.1;2.9) and over 65 years (APC2003–2012: −0.1; 95% CI:-1.9;1.7), was clearest in Spain’s Mediterranean and Southern regions. Conclusions The positive influence of opportunistic screening is not strong enough to further reduce cervical cancer mortality rates in the country. Our results suggest that the Spanish Health Authorities should reform current prevention programmes and surveillance strategies in order to confront the challenges posed by cervical cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1306-x) contains supplementary material, which is available to authorized users.
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Ding YX, Cheng Y, Sun QM, Zhang YY, You K, Guo YL, Han D, Geng L. Mechanical characterization of cervical squamous carcinoma cells by atomic force microscopy at nanoscale. Med Oncol 2015; 32:71. [DOI: 10.1007/s12032-015-0507-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/23/2015] [Indexed: 01/08/2023]
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The significance of reduced glutathione and glutathione S-transferase during chemoradiotherapy of locally advanced cervical cancer. MEDICINA-LITHUANIA 2014; 50:222-9. [PMID: 25458959 DOI: 10.1016/j.medici.2014.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/18/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine changes in reduced glutathione (GSH) and glutathione S-transferase (GST) during neoadjuvant chemotherapy followed by concurrent chemoradiation for patients with stage IIB-IIIB cervical cancer, and to evaluate their significance to the efficacy of the treatment. MATERIALS AND METHODS According to the prospective phase II study protocol, 36 patients with stage IIB-IIIB cervical cancer were enrolled. A short course of intensive weekly neoadjuvant cisplatin and gemcitabine chemotherapy followed by concurrent weekly cisplatin and gemcitabine-based chemoradiation was administered. Blood samples for GSH, GST analysis were collected and analyzed before the start of the treatment, after neoadjuvant chemotherapy, and after the end of the chemoradiation. RESULTS A statistically significant increase in the concentration of GSH after neoadjuvant chemotherapy was identified. After chemoradiation, values of this rate significantly decreased in contrast with GSH concentration after neoadjuvant chemotherapy in cases of stage IIB, regional metastases negative patients group, patients with a positive response to treatment, and patients who had no progression of the disease during the first 2 years after treatment. Statistically significant changes in GST during the treatment were not identified; the GST concentration after chemoradiation showed a statistically significant difference in GST concentrations in terms of the progression of the disease and disease without progression. CONCLUSIONS The results suggest that changes in the concentration of GSH during the treatment of locally advanced cervical cancer might be important for the prediction of the efficacy of the treatment. Statistically significant changes in GST concentration levels during the treatment were not observed.
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Pikala M, Maniecka-Bryla I. Years of life lost due to malignant neoplasms characterized by the highest mortality rate. Arch Med Sci 2014; 10:999-1006. [PMID: 25395953 PMCID: PMC4223125 DOI: 10.5114/aoms.2013.36237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/05/2013] [Accepted: 05/15/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The analysis of premature deaths measured with years of life lost between the studied and referential populations helps to emphasize the social and economic aspect of a loss caused by deaths due to malignant neoplasms. The aim of the study was to analyze years of life lost by inhabitants of the Lodz province due to malignant neoplasms. MATERIAL AND METHODS The study material included a database which contained information gathered from 313,144 death certificates (including 66,899 people who died of malignant neoplasms) of inhabitants of the Lodz province who died between 1999 and 2008. The SEYLLp (Standard Expected Years of Life Lost per living person) method was used to determine years of life lost. Jointpoint models were used to analyze time trends. RESULTS In males the diseases which mostly contributed to death were tracheal, bronchial and lung malignant neoplasms (SEYLLp = 170.7) and cancer of the large intestine, rectum and anus (SEYLLp = 47.5). In females the principal diseases were tracheal, bronchial and lung malignant neoplasms (SEYLLp = 61.6), breast cancer (SEYLLp = 60.4) and cancer of the large intestine, rectum and anus (SEYLLp = 42.3). The years of life lost were growing in the period under study. CONCLUSIONS The number of years lost due to malignant neoplasms in the Lodz province between 1999 and 2008 was growing. The main reasons for deaths in females were tracheal, bronchial and lung malignant neoplasms as well as breast cancer and in males - cancer of the large intestine, rectum and anus as well as prostate cancer.
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Affiliation(s)
- Malgorzata Pikala
- Department of Epidemiology and Biostatics, Medical University of Lodz, Poland
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Human papillomavirus genotype distribution in invasive cervical cancer in Bosnia and Herzegovina. Cancer Epidemiol 2014; 38:504-10. [DOI: 10.1016/j.canep.2014.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/10/2014] [Accepted: 06/20/2014] [Indexed: 11/24/2022]
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Vaccarella S, Franceschi S, Engholm G, Lönnberg S, Khan S, Bray F. 50 years of screening in the Nordic countries: quantifying the effects on cervical cancer incidence. Br J Cancer 2014; 111:965-9. [PMID: 24992581 PMCID: PMC4150271 DOI: 10.1038/bjc.2014.362] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 05/22/2014] [Accepted: 06/04/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nordic countries' data offer a unique possibility to evaluate the long-term benefit of cervical cancer screening in a context of increasing risk of human papillomavirus infection. METHODS Ad hoc-refined age-period-cohort models were applied to the last 50-year incidence data from Denmark, Finland, Norway and Sweden to project expected cervical cancer cases in a no-screening scenario. RESULTS In the absence of screening, projected incidence rates for 2006-2010 in Nordic countries would have been between 3 and 5 times higher than observed rates. Over 60,000 cases or between 41 and 49% of the expected cases of cervical cancer may have been prevented by the introduction of screening in the late 1960s and early 1970s. CONCLUSIONS Our study suggests that screening programmes might have prevented a HPV-driven epidemic of cervical cancer in Nordic countries. According to extrapolations from cohort effects, cervical cancer incidence rates in the Nordic countries would have been otherwise comparable to the highest incidence rates currently detected in low-income countries.
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Affiliation(s)
- S Vaccarella
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | - S Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | - G Engholm
- Department of Documentation & Quality, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - S Lönnberg
- Cancer Registry of Norway, P.O. box 5313 Majorstuen, Oslo N-0304, Norway
| | - S Khan
- Swedish Cancer Registry, National Board of Health and Welfare, S-106 30 Stockholm, Sweden
| | - F Bray
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
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5-Aminolevulinic acid-based fluorescence diagnostics of cervical preinvasive changes. Medicina (B Aires) 2014; 50:137-43. [DOI: 10.1016/j.medici.2014.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 12/29/2022] Open
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Bray F, Lortet-Tieulent J, Znaor A, Brotons M, Poljak M, Arbyn M. Patterns and Trends in Human Papillomavirus-Related Diseases in Central and Eastern Europe and Central Asia. Vaccine 2013; 31 Suppl 7:H32-45. [DOI: 10.1016/j.vaccine.2013.02.071] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 01/28/2013] [Accepted: 02/11/2013] [Indexed: 10/25/2022]
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Kesic V. Prevention of Cervical Cancer in Central and Eastern Europe and Central Asia: A Challenge for the Future. Vaccine 2013; 31 Suppl 7:vii-ix. [DOI: 10.1016/j.vaccine.2012.11.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 10/29/2012] [Accepted: 11/22/2012] [Indexed: 11/17/2022]
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Mosavi-Jarrahi A, Kliewer EV. Cervical cancer incidence trends in Canada: a 30-year population-based analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:620-626. [PMID: 23876639 DOI: 10.1016/s1701-2163(15)30877-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To use the most recent data to update the trend in cervical cancer incidence in Canada over the 30 year period from 1978 to 2009. METHODS Registered cases of cervical cancer and the corresponding person years for the Canadian population were retrieved from an online data repository of the International Agency on Research on Cancer and from Statistics Canada for the period 1978 to 2009. Annual age-standardized rates were estimated for all data combined and for each province separately. The ages of cases were aggregated into three groups: 25 to 39, 40 to 59, and 60 to 75 years. Joinpoint regression analysis was used to describe the trend across age groups and provinces. RESULTS Between 1978 and 2006, the age-adjusted cervical cancer rate in Canada decreased from 20.05 to 12.66 per 100 000 females; after 2006 the rate increased. Greater reductions were observed in the older age groups. The average annual percentage change (AAPC) was -1.1% (95% CI -1.1% to 0.09%), -1.8% (95% CI -2.5% to -1.2%), and -2.6% (95% CI -3.9% to -1.4%) for age groups 25 to 39, 40 to 60, and 60 to 75, respectively. The AAPC varied between provinces, ranging from -0.22% (95% CI -1.4% to 0.9%) in Saskatchewan to -3.02% (95% CI -4.5% to -1.5%) in Newfoundland and Labrador. In Ontario the incidence of cervical cancer increased annually between 2006 and 2009. The trend in British Columbia included a significant change of slope in 1984. CONCLUSION The incidence of cervical cancer decreased in Canada and across all provinces between 1978 and 2009. The decrease was greater in older women.
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Affiliation(s)
- Alireza Mosavi-Jarrahi
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC; Department of Social Medicine, Medical School, Shaheed Beheshti University of Medical Sciences and Health Services, Tehran, Iran; Cancer Control Research, British Columbia Cancer Agency, Vancouver BC
| | - Erich V Kliewer
- Cancer Control Research, British Columbia Cancer Agency, Vancouver BC; Community Health Sciences, University of Manitoba, Winnipeg MB; Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg MB
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Trends in the incidence of in situ and invasive cervical cancer by age group and histological type in Korea from 1993 to 2009. PLoS One 2013; 8:e72012. [PMID: 23977194 PMCID: PMC3745377 DOI: 10.1371/journal.pone.0072012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Our study aims to describe changes in carcinoma in situ (CIS) and invasive cervical carcinoma (ICC) in Korean women diagnosed between 1993 and 2009. METHODS All cases of CIS and invasive cervical carcinoma diagnosed from 1993 to 2009 in the Korean National Cancer Incidence database were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) in incidence rates were compared according to age and histological type. Additionally, we used Korea National Health and Nutrition Examination Survey (KNHANES) to know the association between screening rate for cervical cancer and incidence rate of cervical cancer. RESULTS Between 1993 and 2009, 72,240 cases of ICC were reported in Korea. Total incidence rate of ICC was 14.7 per 100,000 females. ASRs of ICC declined 3.8% per year, from 19.3 per 100,000 in 1993 to 10.5 per 100,000 in 2009. Although the overall incidence rate of adenocarcinoma remained stable, invasive squamous cell carcinoma showed a decreasing trend (APC -4.2%). For women aged 60-79 years, ASRs for squamous cell carcinoma increased from 1993 to 2001, and decreased from 2001 to 2009 (APC: -4.6%). Total 62,300 cases of CIS were diagnosed from 1993 to 2009. Total incidence rate of CIS was 12.2 per 100,000 females. ASRs of CIS increased 5.7% per year, from 7.5 per 100,000 in 1993 to 19.0 per 100,000 in 2009. Adenocarcinoma in situ increased 13.2% per year. There was a strong positive correlation between screening rate for cervical cancer and incidence rate for CIS (p-value = 0.03) whereas screening rate showed a strong negative correlation with incidence rate for squamous ICC (p-value = 0.04). CONCLUSIONS The increasing trend in CIS, coupled with a decreasing trend in ICC, suggests the important role of cervix cancer screening. The incidence of adenocarcinoma showed a plateau, but the incidence of adenocarcinoma in situ showed an increasing trend.
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Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors. Eur J Cancer 2013; 49:3262-73. [PMID: 23751569 DOI: 10.1016/j.ejca.2013.04.024] [Citation(s) in RCA: 322] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 04/22/2013] [Accepted: 04/26/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cervical cancer trends in a given country mainly depend on the existence of effective screening programmes and time changes in disease risk factors, notably exposure to human papillomavirus (HPV). Screening primarily influences variations by period of diagnosis, whereas changes in risk factors chiefly manifest themselves as variations in risk across successive birth cohorts of women. METHODS We assessed trends in cervical cancer across 38 countries in five continents, age group 30-74 years, using age-standardised incidence rates (ASRs) and age-period-cohort (APC) models. Non-identifiability in APC models was circumvented by making assumptions based on a consistent relationship between age and cervical cancer incidence (i.e. approximately constant rates after age 45 years). FINDINGS ASRs decreased in several countries, except in most of Eastern European populations, Thailand as well as Uganda, although the direction and magnitude of period and birth cohort effects varied substantially. Strong downward trends in cervical cancer risk by period were found in the highest-income countries, whereas no clear changes by period were found in lower-resourced settings. Successive generations of women born after 1940 or 1950 exhibited either an increase in risk of cervical cancer (in most European countries, Japan, China), no substantial changes (North America and Australia) or a decrease (Ecuador and India). INTERPRETATION In countries where effective screening has been in place for a long time the consequences of underlying increases in cohort-specific risk were largely avoided. In the absence of screening, cohort-led increases or, stable, cervical cancer ASRs were observed. Our study underscores the importance of strengthening screening efforts and augmenting existing cancer control efforts with HPV vaccination, notably in those countries where unfavourable cohort effects are continuing or emerging. FUNDING Bill and Melinda Gates Foundation (BMGF).
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Affiliation(s)
- Salvatore Vaccarella
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France.
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Vanagas G, Padaiga Z. Healthcare spending in the case of a HPV16/18 population-wide vaccination programme. Scand J Public Health 2012; 40:406-11. [PMID: 22821227 DOI: 10.1177/1403494812455467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The policy of population-wide human papillomavirus (HPV) vaccination has been debated as the introduction of such a programme in a low-resource country faces the risk of insufficient cost-effectiveness. OBJECTIVES To assess the potential healthcare spending changes after the introduction of a HPV16/18 population-wide vaccination programme in Lithuania. STUDY DESIGN For a cost-effectiveness analysis, we used mathematical simulation and epidemiological data modelling based on a Lithuanian female population. We performed comparative analysis of an annual 12-year-old girls population-wide vaccination programme combined with cervical cancer screening programme compared to the screening programme strategy only. RESULTS HPV vaccination would gain an average of 35.6 life years per death avoided or up to 284.8 thousand life years would be gained over 90 years in total. The programme costs would be 2932.58 EUR per life year gained. All costs associated with the introduction of the vaccination programme could be recovered in 48 years. The HPV vaccination programme in Lithuania has the potential to generate up to 40.07 million EUR of economic returns annually compared with the current practice of the cervical screening alone. CONCLUSIONS In Lithuania the HPV16/18 vaccination programme would be economically effective only in the long term. The investment costs of HPV16/18 vaccination have the potential to be recovered.
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Affiliation(s)
- Giedrius Vanagas
- Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJL, Naghavi M. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet 2011; 378:1461-84. [PMID: 21924486 DOI: 10.1016/s0140-6736(11)61351-2] [Citation(s) in RCA: 642] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Breast and cervical cancer are important causes of mortality in women aged ≥15 years. We undertook annual age-specific assessments of breast and cervical cancer in 187 countries. METHODS We systematically collected cancer registry data on mortality and incidence, vital registration, and verbal autopsy data for the period 1980-2010. We modelled the mortality-to-incidence (MI) ratio using a hierarchical model. Vital registration and verbal autopsy were supplemented with incidence multiplied by the MI ratio to yield a comprehensive database of mortality rates. We used Gaussian process regression to develop estimates of mortality with uncertainty by age, sex, country, and year. We used out-of-sample predictive validity to select the final model. Estimates of incidence with uncertainty were also generated with mortality and MI ratios. FINDINGS Global breast cancer incidence increased from 641,000 (95% uncertainty intervals 610,000-750,000) cases in 1980 to 1,643,000 (1,421,000-1,782,000) cases in 2010, an annual rate of increase of 3·1%. Global cervical cancer incidence increased from 378,000 (256,000-489,000) cases per year in 1980 to 454,000 (318,000-620,000) cases per year in 2010-a 0·6% annual rate of increase. Breast cancer killed 425,000 (359,000-453,000) women in 2010, of whom 68,000 (62,000-74,000) were aged 15-49 years in developing countries. Cervical cancer death rates have been decreasing but the disease still killed 200,000 (139,000-276,000) women in 2010, of whom 46,000 (33,000-64,000) were aged 15-49 years in developing countries. We recorded pronounced variation in the trend in breast cancer mortality across regions and countries. INTERPRETATION More policy attention is needed to strengthen established health-system responses to reduce breast and cervical cancer, especially in developing countries. FUNDING Susan G Komen for the Cure and the Bill & Melinda Gates Foundation.
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Scholl SME, Kenter G, Kurzeder C, Beuzeboc P. Pathway profiling and rational trial design for studies in advanced stage cervical carcinoma: a review and a perspective. ISRN ONCOLOGY 2011; 2011:403098. [PMID: 22091418 PMCID: PMC3195803 DOI: 10.5402/2011/403098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 04/30/2011] [Indexed: 12/21/2022]
Abstract
Multiple genetic abnormalities will have occurred in advanced cervical cancer and multiple targeting is likely to be needed to control tumor growth. To date, dominant therapeutic targets under scrutiny for cervical cancer treatment have been EGFR pathway and angiogenesis inhibition as well as anti-HPV vaccines. The potentially most effective targets to be blocked may be downstream from the membrane receptor or at the level of the nucleus. Alterations of the pathways involved in DNA repair and in checkpoint activations, as well as the specific site of HPV genome integration, appear worth assessing. For genetic mutational analysis, complete exon sequencing may become the norm in the future but at this stage frequent mutations (that matter) can be verified by PCR analysis. A precise documentation of relevant alterations of a large spectrum of protein biomarkers can be carried out by reverse phase protein array (RPPA) or by multiplex analysis. Clinical decision-making on the drug(s) of choice as a function of the biological alteration will need input from bio-informatics platforms as well as novel statistical designs. Endpoints are yet to be defined such as the loss (or reappearance) of a predictive biomarker. Single or dual targeting needs to be explored first in relevant preclinical animal and in xenograft models prior to clinical deployment.
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Affiliation(s)
- Susy M E Scholl
- Département d'Oncologie, Institut Curie, 75005 Paris, France
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Arbyn M, Castellsagué X, de Sanjosé S, Bruni L, Saraiya M, Bray F, Ferlay J. Worldwide burden of cervical cancer in 2008. Ann Oncol 2011; 22:2675-2686. [PMID: 21471563 DOI: 10.1093/annonc/mdr015] [Citation(s) in RCA: 705] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The knowledge that persistent human papillomavirus infection is the main cause of cervical cancer has resulted in the development of assays that detect nucleic acids of the virus and prophylactic vaccines. Up-to-date and reliable data are needed to assess impact of existing preventive measures and to define priorities for the future. MATERIALS AND METHODS Best estimates on cervical cancer incidence and mortality are presented using recently compiled data from cancer and mortality registries for the year 2008. RESULTS There were an estimated 530,000 cases of cervical cancer and 275,000 deaths from the disease in 2008. It is the third most common female cancer ranking after breast (1.38 million cases) and colorectal cancer (0.57 million cases). The incidence of cervical cancer varies widely among countries with world age-standardised rates ranging from <1 to >50 per 100,000. Cervical cancer is the leading cause of cancer-related death among women in Eastern, Western and Middle Africa; Central America; South-Central Asia and Melanesia. The highest incidence rate is observed in Guinea, with ∼6.5% of women developing cervical cancer before the age of 75 years. India is the country with the highest disease frequency with 134,000 cases and 73 000 deaths. Cervical cancer, more than the other major cancers, affects women <45 years. CONCLUSIONS In spite of effective screening methods, cervical cancer continues to be a major public health problem. New methodologies of cervical cancer prevention should be made available and accessible for women of all countries through well-organised programmes.
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Affiliation(s)
- M Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; European Cooperation on Development and Implementation of Cancer Screening and Prevention Guidelines, International Agency for Research on Cancer, Lyon, France; Health-Economic Modelling of Prevention Strategies for HPV-Related Diseases in European Countries, Free University of Amsterdam, Amsterdam, The Netherlands.
| | - X Castellsagué
- Health-Economic Modelling of Prevention Strategies for HPV-Related Diseases in European Countries, Free University of Amsterdam, Amsterdam, The Netherlands; Unit of Infections and Cancer, Catalonian Institute of Oncology, Barcelona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - S de Sanjosé
- Health-Economic Modelling of Prevention Strategies for HPV-Related Diseases in European Countries, Free University of Amsterdam, Amsterdam, The Netherlands; Unit of Infections and Cancer, Catalonian Institute of Oncology, Barcelona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - L Bruni
- Health-Economic Modelling of Prevention Strategies for HPV-Related Diseases in European Countries, Free University of Amsterdam, Amsterdam, The Netherlands; Unit of Infections and Cancer, Catalonian Institute of Oncology, Barcelona; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - M Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - F Bray
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
| | - J Ferlay
- Section of Cancer Information, International Agency for Research on Cancer, Lyon, France
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