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Buyukbayram ME, Hannarici Z, Turhan A, Caglar AA, Esdur PÇ, Bilici M, Tekin SB, Erdemci B. A novel prognostic biomarker in progression free survival for patients with cervical cancer, glucose to c-reactive protein ratio (GCR). BMC Cancer 2024; 24:626. [PMID: 38783223 PMCID: PMC11112963 DOI: 10.1186/s12885-024-12347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Cervical cancer is a tumor with high morbidity and mortality. The importance of inflammatory and metabolic parameters affecting progression-free survival (PFS) and overall survival (OS) has been investigated more intensively recently. We aimed to investigate the effect of glucose/c-reactive protein (CRP) ratio [GCR], which shows these two parameters together, on PFS in cervical cancer. METHODS We retrospectively included 90 patients with adenocarcinoma and squamous cell carcinoma of the cervix. The effects of clinical variables, inflammatory and glycemic parameters on PFS and OS were analyzed by Kaplan-Meier method. The data were compared with the healthy control group of 90 individuals using the independent t test. The effect of parameters on mortality was analyzed using ROC curves and cut off values were determined. RESULTS Glucose, CRP, CRP/lymphocyte ratio (CLR) and GCR were statistically significant in predicting mortality (p < 0.05). Disease stage, glucose, CRP, CLR and GCR were associated with overall survival. CRP, CLR and GCR were associated with progression-free survival (p < 0.05). In multivariate analysis, GCR was prognostic for PFS (p = 0.025). GCR was statistically significant while compared with the patient and healthy control group (p < 0.001). CONCLUSION In cervical cancer, GCR rate was found to be prognostic independent of stage. Higher GCR rate was associated with longer PFS duration.
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Affiliation(s)
| | - Zekeriya Hannarici
- Department of Medical Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Aykut Turhan
- Department of Medical Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | | | - Pınar Çoban Esdur
- Department of Medical Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Mehmet Bilici
- Department of Medical Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Salim Basol Tekin
- Department of Medical Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Burak Erdemci
- Department of Radiation Oncology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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2
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Hoffman M, Dunsmore V, Cliby W, Chi D, Wheeler S, Clarke-Pearson D. Surgical training of gynecologic oncology fellows: Long-term trends and implications for future education. Gynecol Oncol 2024; 184:254-258. [PMID: 38696840 DOI: 10.1016/j.ygyno.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/02/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES The surgical training of gynecologic oncology (GO) fellows is critical to providing excellent care to women with gynecologic cancers. We sought to evaluate changes in techniques and surgical volumes over an 18-year period among established GO fellowships across the US. METHODS We emailed surveys to 30 GO programs that had trained fellows for at least 18 years. Surveys requested the number of surgical cases performed by a fellow for seventeen surgical procedures over each of five-time intervals. A One-Way Analysis of Variance was conducted for each procedure, averaged across institutions, to examine whether each procedure significantly changed over the 18-year span. RESULTS 14 GO programs responded and were included in the analysis using SPSS. We observed a significant increase in the use of minimally invasive (MIS) procedures (robotic hysterectomy (p < .001), MIS pelvic (p = .001) and MIS paraaortic lymphadenectomy (p = .008). There was a concurrent significant decrease in corresponding "open" procedures. There was a significant decrease in all paraaortic lymphadenectomies. Complex procedures (such as bowel resection) remained stable. However, there was a wide variation in the number of cases reported with extremely small numbers for some critical procedures. CONCLUSIONS The experience of GO fellows has shifted toward increased use of MIS. While these trends in care are appropriate, they do not diminish the need in many patients for complex open procedures. These findings should help spur the development of innovative training to maintain the ability to provide these core, specialty-defining procedures safely.
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Affiliation(s)
- Mitchel Hoffman
- Moffitt Cancer Center, University of South Florida, Tampa, FL, United States of America
| | - Victoria Dunsmore
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, United States of America
| | - William Cliby
- Mayo Clinic, Rochester, MN, United States of America
| | - Dennis Chi
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Stephanie Wheeler
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, United States of America
| | - Daniel Clarke-Pearson
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
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3
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Daniels J, Asante K, Tackie JNO, Kyei KA. Survival rate of cervical cancer: a five year review at a Major Teaching Hospital in Ghana, West Africa. Ecancermedicalscience 2024; 18:1663. [PMID: 38439806 PMCID: PMC10911670 DOI: 10.3332/ecancer.2024.1663] [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: 08/18/2023] [Indexed: 03/06/2024] Open
Abstract
Cervical cancer (CC) is one of the leading causes of cancer-related deaths among females in Ghana. Despite the magnitude of the public health challenge posed by CC in Ghana, survival data as well as reported incidence and mortality rates are primarily based on studies conducted in the capital city of the country. Even though age at diagnosis is known to affect the overall survival of CC patients, the role of this factor in the prognosis of CC patients in Ghana has not been sufficiently explored. The aim of this study was to determine the 5-year survival rate of Ghanaian woman treated for CC at a large tertiary healthcare facility in Ghana. This research was a single-institution-based quantitative retrospective cohort study conducted among patients with histopathologically confirmed CC. Clinical and socio-demographic data were retrieved from patients' medical records. Data analysis was done using the Statistical Package for the Social Sciences software version 23. Kaplan Meier curves were used to present the survival rates and median survival time. The peak age at diagnosis was between 45 and 80 years with the modal age group of patients between 75 and 80 years. The mean age at diagnosis was 63.3 ± 15.7 years ranging from 27 to 104 years. The overall survival rates at 1, 3 and 5 years were 76.5%, 51.5% and 32.4%, respectively. The median survival time was 65.8 months. Age < 50 years was associated with higher survival estimates than age >50 years. The 5-year overall survival rate of CC patients reported in this study (32.4%) is relatively low compared with countries in the developed world but like previous reports at other healthcare facilities in Ghana as well as in other underdeveloped countries.
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Affiliation(s)
- Joseph Daniels
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
- https://orcid.org/0000-0002-1466-150X
| | - Kwesi Asante
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Judith Naa Odey Tackie
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Kofi Adesi Kyei
- National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Radiography, University of Ghana, Accra, Ghana
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Jones NC, Fusani AU, Cox KM, Martinez VP, Guerra L, Gonzalez E. Assessing Spanish Health Literacy and Cervical Cancer Knowledge, Attitudes, and Behaviors in a Student-Run Free Clinic. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023:10.1007/s13187-023-02278-9. [PMID: 36884133 DOI: 10.1007/s13187-023-02278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
While the incidence of cervical cancer continues to decrease, there is a significant discrepancy in incidence rates and screening behaviors among Hispanic and non-Hispanic white patients in the USA. This project examines the relationship between Spanish health literacy and cervical cancer screening knowledge, attitudes, and practices among native Spanish-speaking patients at risk for cervical cancer at the USF BRIDGE Healthcare Clinic, a student-run free clinic in Tampa, FL. Spanish-speaking patients ≥21 years (n = 34) participated in a quality improvement project that included an assessment of Spanish health literacy and a written survey on cervical cancer knowledge. Chi-squared tests were performed to assess potential relationships between health literacy and cervical cancer knowledge, attitudes, health behaviors, and demographics. Seven participants (20.6%) scored between 0 and 14 on the SAHL-S, indicating inadequate health literacy. A significant difference in cervical cancer health knowledge was found between patients with adequate health literacy compared to patients with inadequate health literacy (p = 0.002). There is a potential association between low Spanish health literacy and subsequent poorer understanding of cervical cancer in BRIDGE patients. This implies that patients of low health literacy may have poorer comprehension of other aspects of their care beyond cervical cancer screening. Strategies are discussed to improve communication with BRIDGE patients of low Spanish health literacy that may be applicable to other patient populations.
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Affiliation(s)
- Nat C Jones
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA.
| | - Anna Ulyanenkova Fusani
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Kaitlyn Maria Cox
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Valeria Pereira Martinez
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Lucy Guerra
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Eduardo Gonzalez
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
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5
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Silvera SAN, Kaplan AM, Laforet P. Knowledge of Human Papillomavirus and Cervical Cancer Among Low-Income Women in New Jersey. Public Health Rep 2023; 138:302-308. [PMID: 35301894 PMCID: PMC10031832 DOI: 10.1177/00333549221081821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Although much research has been conducted on knowledge and awareness of the connection between human papillomavirus (HPV) and cervical cancer risk among university students, few studies have examined these associations among low-income populations. We examined knowledge of HPV and cervical cancer risk among racially and ethnically diverse low-income women. METHODS We used a cross-sectional study design to recruit and interview 476 low-income women in New Jersey from November 1, 2013, through February 28, 2016. We used multivariate logistic regression to determine whether knowledge of HPV and its association with cervical cancer risk differed by race and ethnicity. RESULTS Compared with non-Hispanic White women, Hispanic (odds ratio [OR] = 0.37; 95% CI, 0.18-0.77) and non-Hispanic Black (OR = 0.38; 95% CI, 0.19-0.77) women were significantly less likely to report having heard of HPV. Of women who had ever heard of HPV (n = 323), non-Hispanic Black women were significantly less likely (OR = 0.44; 95% CI, 0.21-0.89) than non-Hispanic White women to report knowing that HPV can be associated with cervical cancer. CONCLUSIONS Given the higher rates of HPV infection among non-Hispanic Black and Hispanic women, these results suggest a need to improve education about risks of HPV among low-income populations. These messages need to include information on the connection between HPV and cervical cancer and must be provided in culturally and linguistically appropriate ways.
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Affiliation(s)
| | | | - Priscila Laforet
- Department of Epidemiology, Columbia
University Mailman School of Public Health, New York, NY, USA
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6
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Cervix-Online computer program: 27 years of hospital-based clinical registry for cervical cancer at the University Medical Centre Maribor. Radiol Oncol 2021; 56:198-207. [PMID: 34957730 PMCID: PMC9122286 DOI: 10.2478/raon-2021-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Clinical registries are designed to collect quality data about the care for cancer patients in order to improve it. They gather data that are generated during diagnosis and cancer treatment and also post-treatment follow-up. Analysis of collected data allows an improvement in the quality of patient care and a comparison with other health care providers. The aim of the present article is to describe the current version and practice of hospital-based cervical cancer registry in UKC Maribor. MATERIALS AND METHODS The first questionnaire for monitoring patients with cervical cancer was introduced at the Department of Gynecologic and Breast Oncology of the Maribor General Hospital in 1994. Since then, the principles for treating cervical cancer have been revised on several occasions. Therefore, based on our experience and new approaches to treatment, we have frequently amended the questionnaire content. It was redesigned into a form that is currently in use and transformed into a Cervix-Online computer program in 2014. RESULTS Over the last 27 years, we have collected data on cervical cancer patients treated at the University Medical Centre Maribor and former Maribor General Hospital. The Cervix-Online computer program that was developed for this purpose enabled a rapid and reliable collection, processing and analysis of 116 different data of patients with cervical cancer, including general data, history, diagnostic procedures, histopathological examination results, treatment methods, and post-treatment follow-ups. CONCLUSIONS The hospital-based cervical cancer registry with Cervix-Online computer program enables the collection of data to enhance diagnosis and the treatment of cervical cancer patients, the organization of day-to-day service, as well as the comparison of our treatment results with national and international standards. Incomplete or incorrect data entry, however, might pose a limitation of the clinical registry, which depends on several healthcare professionals involved in the diagnostic procedures, treatment, and follow-up of cervical cancer patients.
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Kirubarajan A, Leung S, Li X, Yau M, Sobel M. Barriers and facilitators for cervical cancer screening among adolescents and young people: a systematic review. BMC Womens Health 2021; 21:122. [PMID: 33757512 PMCID: PMC7989022 DOI: 10.1186/s12905-021-01264-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening as this population has historically been under-screened. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening (CCS) among adolescents and young people globally. METHODS We conducted a systematic review following PRISMA guidelines of three key databases: Medline-OVID, EMBASE, and CINAHL. Supplementary searches were done through ClinicialTrials.Gov and Scopus. Databases were examined from 1946 until the date of our literature searches on March 12th 2020. We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss CCS, were not specific to individuals under the age of 35, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. RESULTS Of the 2177 original database citations, we included 36 studies that met inclusion criteria. The 36 studies included a total of 14,362 participants, and around half (17/36, 47.2%) of studies specifically targeted students. The majority of studies (31/36, 86.1%) discussed barriers and facilitators to Pap testing specifically, while one study analyzed self-sampling (1/36, 2.8%), one study targeted HPV DNA testing (1/36, 2.8%), and the remainder (4/36, 11.1%) were not specified. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and systemic barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. CONCLUSION There are unique barriers and facilitators that affect CCS rates in adolescents and young people. Health systems and healthcare providers worldwide should address the challenges for this unique population.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Shannon Leung
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Xinglin Li
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Matthew Yau
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mara Sobel
- Department of Obstetrics and Gynecology, Sinai Health System, Toronto, ON, Canada
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8
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Ortiz AP, Soto-Salgado M, Calo WA, Hull P, Fernández ME, Colon-López V, Tortolero-Luna G. Elimination of cervical cancer in U.S. Hispanic populations: Puerto Rico as a case study. Prev Med 2021; 144:106336. [PMID: 33678233 DOI: 10.1016/j.ypmed.2020.106336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer remains a major burden for women around the world. In 2018, the World Health Organization called for the elimination of cervical cancer worldwide (<4 cases per 100,000 women-years), within the 21st century. In the U.S., despite great progress toward this goal, existing disparities among racial/ethnic groups in cervical cancer raise concerns about whether elimination can be achieved for all women. We describe: 1) disparities in cervical cancer among Hispanics in the U.S. and factors that contribute to their increased risk, 2) prevention and control efforts to increase equity in the elimination of cervical cancer in this population, and 3) cervical cancer control efforts in Puerto Rico (PR), a U.S. territory, as a case study for cervical cancer elimination among a minority and underserved Hispanic population. Hispanics have the highest incidence rates of cervical cancer among all racial/ethnic groups in the U.S. Despite being more likely to complete HPV vaccination series, lower cervical cancer screening and access to treatment may lead to a higher cervical cancer mortality in Hispanics compared to non-Hispanic White women. These disparities are influenced by multiple individual-, sociocultural-, and system-level factors. To achieve the goal of cervical cancer elimination in the U.S., systematic elimination plans that consider the needs of Hispanic populations should be included within the Comprehensive Cancer Control Plans of each state. Because PR has implemented coordinated efforts for the prevention and control of cervical cancer, it represents a notable case study for examining strategies that can lead to cervical cancer elimination among Hispanics.
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Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America.
| | - Marievelisse Soto-Salgado
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America; Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Pamela Hull
- University of Kentucky Markey Cancer Center, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
| | - María E Fernández
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, TX, United States of America
| | - Vivian Colon-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Guillermo Tortolero-Luna
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America
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Carrillo T, Montealegre JR, Bracamontes CG, Scheurer ME, Follen M, Mulla ZD. Predictors of timely diagnostic follow-up after an abnormal Pap test among Hispanic women seeking care in El Paso, Texas. BMC WOMENS HEALTH 2021; 21:11. [PMID: 33407351 PMCID: PMC7788782 DOI: 10.1186/s12905-020-01161-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 12/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. The purpose of this study is to describe patient characteristics associated with timely receipt of a diagnostic colposcopy after an abnormal Pap test among Hispanic women in El Paso, a Texas-Mexico border city. METHODS We conducted a retrospective chart review of Hispanic patients seen at an academic colposcopy clinic following an abnormal Pap test. An optimal diagnostic interval to colposcopy was based on a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) quality indicator and was defined as receipt of colposcopy within 90 days or less from the date of an abnormal Pap test. Risk ratios (RR) were calculated by building a generalized linear model fit using a Poisson distribution, log link, and robust variance. RESULTS Overall, 177 of the 270 women (65.6%) received follow-up within an optimal diagnostic interval. After adjusting for other variables in the model, women who were 30 years of age or older were 32% more likely to have an optimal interval than younger women (adjusted RR = 1.32, P < 0.01). High school graduates were less likely than more educated women to have an optimal interval (adjusted RR = 0.68, P < 0.01). Participation in the NBCCEDP was not associated with receipt of follow-up within an optimal diagnostic interval. CONCLUSIONS Compared with women with greater educational attainment, high school graduates were less likely to receive follow-up within an optimal diagnostic interval, as were younger (≤ 30 years) women compared with older women. Participation in the NBCCEDP was not associated with receipt of care within an optimal diagnostic interval.
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Affiliation(s)
- Thelma Carrillo
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Christina G Bracamontes
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Michael E Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Michele Follen
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.,NYC Health + Hospitals
- Kings County, Brooklyn, NY, USA
| | - Zuber D Mulla
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA. .,Office of Faculty Development (MSC 21007), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA.
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TILs and Anti-PD1 Therapy: An Alternative Combination Therapy for PDL1 Negative Metastatic Cervical Cancer. J Immunol Res 2020; 2020:8345235. [PMID: 32964058 PMCID: PMC7492938 DOI: 10.1155/2020/8345235] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 12/27/2022] Open
Abstract
Background We investigated the efficacy of TILs and anti-PD1 combination therapy in patients with metastatic cervical cancer with low MSI expression and PDL1-negative. Methods A total of 80 patients were put on TILs and anti-PD1 combination therapy, and the progression-free survival time (PFS) and overall survival time (OS) were assessed by Kaplan–Meier analysis. Univariate and multivariate analyses were performed to identify factors that could predict the prognosis of metastatic cervical cancer in the previously described patients. Results The objective response rate was 25%, whereas the mPFS and mOS were 6.1 and 11.3 months, respectively. The therapeutic efficacy was influenced by the characteristics of TILs, infection with HPV, and development of fever just after the therapy. Conclusion Overall, our results show that the combination therapy of TILs and anti-PD1 significantly improves the prognosis of metastatic cervical cancer.
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11
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Surgical training in gynecologic oncology: Past, present, future. Gynecol Oncol 2020; 158:188-193. [PMID: 32456991 DOI: 10.1016/j.ygyno.2020.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
The purpose of this paper is to review the surgical care related to training in gynecologic oncology, from past, present and future perspectives. A marked decline in the incidence of cervical cancer as well as improvements in radiation therapy have led to a reduction in the numbers of radical hysterectomies and exenterations being performed. Utilization of neoadjuvant chemotherapy is reducing the extent of cytoreductive operations, including intestinal surgery. The incorporation of sentinel lymphatic mapping has reduced the number of pelvic, paraaortic and inguinal lymphadenectomies being performed. Coupled with these changes are other factors limiting time for surgical training including an explosion in targeted anticancer therapies and more individualized options beyond simple cytotoxic therapy. With what is likely to be a sustained impact on training, gynecologic oncologists will still provide a broad range of care for women with gynecologic cancer but may be quite limited in surgical scope and rely on colleagues from other surgical disciplines. Enhancement of surgical training by off-service rotations, simulation, attending advanced surgical training courses and/or a longer duration of training are currently incorporated into some programs. Programs must ensure that fellows take full advantage of the clinical materials available, particularly those related to the potential deficiencies described. Changing required research training to an additional elective year could also be considered. Based on the perspectives noted, we believe it is time for our subspecialty to reevaluate its scope of surgical training and practice.
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Human Papillomavirus Vaccination Expected to Reduce Human Papillomavirus-Associated Cancers and May Lessen Racial/Ethnic Disparities of Cancer Incidence. J Adolesc Health 2019; 65:709-710. [PMID: 31753292 DOI: 10.1016/j.jadohealth.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022]
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13
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Persistent socioeconomic and racial and ethnic disparities in pathogen burden in the United States, 1999-2014. Epidemiol Infect 2019; 147:e301. [PMID: 31709963 PMCID: PMC6873154 DOI: 10.1017/s0950268819001894] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The disproportionate burden of prevalent, persistent pathogens among disadvantaged groups may contribute to socioeconomic and racial/ethnic disparities in long-term health. We assessed if the social patterning of pathogen burden changed over 16 years in a U.S.-representative sample. Data came from 17 660 National Health and Nutrition Examination Survey participants. Pathogen burden was quantified by summing the number of positive serologies for cytomegalovirus, herpes simplex virus-1, HSV-2, human papillomavirus and Toxoplasma gondii and dividing by the number of pathogens tested, giving a percent-seropositive for each participant. We examined sex- and age-adjusted mean pathogen burdens from 1999–2014, stratified by race/ethnicity and SES (poverty-to-income ratio (PIR); educational attainment). Those with a PIR < 1.3 had a mean pathogen burden 1.4–1.8 times those with a PIR > 3.5, with no change over time. Educational disparities were even greater and showed some evidence of increasing over time, with the mean pathogen burden among those with less than a high school education approximately twice that of those who completed more than high school. Non-Hispanic Black, Mexican American and other Hispanic participants had a mean pathogen burden 1.3–1.9 times non-Hispanic Whites. We demonstrate that socioeconomic and racial/ethnic disparities in pathogen burden have persisted across 16 years, with little evidence that the gap is closing.
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Zhu J, Wang H, Gao MJ, Li YF, Huang YQ, Shi JP, Wang WJ. Prognostic values of lymphocyte and eosinophil counts in resectable cervical squamous cell carcinoma. Future Oncol 2019; 15:3467-3481. [PMID: 31580723 DOI: 10.2217/fon-2018-0879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: Cervical cancer is one of the leading causes of cancer mortality in women. Peripheral white blood cell parameters such as neutrophil (NE), eosinophil (EO), basophil (BA), as well as lymphocyte (LY) and monocyte (MO), are correlated with tumor outcomes. Methods: In total, 110 cervical squamous cell carcinoma patients were recruited in this study. The potential prognostic factors were evaluated by univariate and multivariate survival analysis. Results: Cox regression analysis model indicated that higher pretreatment EO level and increased post-/preradiotherapy EO ratio were independently associated with worse progression-free survival. Lower pretreatment LY or higher EO levels and increased post-/preradiotherapy EO ratio were independently associated with worse overall survival. Conclusion: LY and EO are correlated with outcomes of cervical squamous cell cancer.
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Affiliation(s)
- Jie Zhu
- Department of Oncology, Changzhou Traditional Chinese Medical Hospital, Changzhou, Jiangsu 213003, PR China
| | - Han Wang
- Department of Oncology, Jining Cancer Hospital, Jining, Shandong 272000, PR China
| | - Min-Jie Gao
- Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, PR China
| | - Yi-Fan Li
- Department of Oncology, Binzhou People's Hospital, Binzhou, Shandong 256600, PR China
| | - Yue-Qing Huang
- Department of General Practice, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, PR China
| | - Jian-Ping Shi
- Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, PR China
| | - Wen-Jie Wang
- Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215001, PR China
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Montealegre JR, Varier I, Bracamontes CG, Dillon LM, Guillaud M, Sikora AG, Follen M, Adler-Storthz K, Scheurer ME. Racial/ethnic variation in the prevalence of vaccine-related human papillomavirus genotypes. ETHNICITY & HEALTH 2019; 24:804-815. [PMID: 28870103 PMCID: PMC6185800 DOI: 10.1080/13557858.2017.1373073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
Objective: There are currently three licensed human papillomavirus (HPV) vaccines that protect against cervical cancer. Here we compare the prevalence of bi-, quadri-, and nonavalent vaccine-related HPV genotypes in a multi-ethnic sample of non-Hispanic white, non-Hispanic black, Hispanic, and Asian women. Design: Patients in this analysis (n = 419) represent a subset of women with a previous abnormal Pap test participating in a clinical trial. HPV genotyping was conducted using the Roche Linear Array. Prevalent HPV genotypes were grouped according to their inclusion in each of the vaccines: bivalent (16, 18), quadrivalent (16, 18, 6, 11), and nonavalent (16, 18, 31, 33, 45, 52, 58, 6, 11). Results: The prevalence of HPV genotypes covered by the bi-/quadrivalent vaccines was lowest among non-Hispanic black (15%) and Hispanic women (20%), compared to non-Hispanic white (38%) and Asian women (38%). Across all racial/ethnic groups, a large proportion of infections (38%-49%) were with genotypes included in the nonavalent vaccine. However, the prevalence of HPV genotypes not covered by any vaccine was significantly higher among non-Hispanic black (36%) and Hispanic women (42%), compared to non-Hispanic white (24%) and Asian women (16%) (p < 0.001). Racial/ethnic differences in HPV genotype prevalence were observed when controlling for demographic and sexual behavior characteristics, as well as when restricting the analysis to women with CIN 2+. Conclusion: Our data suggest racial/ethnic differences in the prevalence of vaccine-related HPV genotypes. In particular, non-Hispanic black and Hispanic women had the lowest prevalence of HPV genotypes covered by the bi-/quadrivalent vaccines. While a large proportion of their infections were covered by the nonavalent vaccine, non-Hispanic black and Hispanic women also had the highest prevalence of HPV genotypes not covered by any vaccine.
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Affiliation(s)
- Jane R. Montealegre
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Indu Varier
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Laura M. Dillon
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry, Houston, Texas, USA
| | - Martial Guillaud
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Andrew G. Sikora
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
- Department of Otolaryngology, Baylor College of Medicine. Houston, Texas, USA
| | - Michele Follen
- Department of Obstetrics and Gynecology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Karen Adler-Storthz
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry, Houston, Texas, USA
| | - Michael E. Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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Wang WJ, Li Y, Zhu J, Gao MJ, Shi JP, Huang YQ. Prognostic Values of Systemic Inflammation Response (SIR) Parameters in Resectable Cervical Cancer. Dose Response 2019; 17:1559325819829543. [PMID: 30833874 PMCID: PMC6393952 DOI: 10.1177/1559325819829543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/09/2018] [Accepted: 12/11/2018] [Indexed: 01/16/2023] Open
Abstract
Background: Cervical carcinoma is the leading cause of cancer mortality in women. C-reactive protein (CRP), albumin (ALB), globulin (GLB), lactate dehydrogenase (LDH), and albumin-to-globulin ratio (AGR) are indicators of systemic inflammation response correlated with tumor outcomes. Methods: This study recruited 110 patients with cervical cancer. The patients were divided into 2 groups according to pretreatment median values of CRP, ALB, GLB, LDH, and AGR. The post/preradiotherapy or post/pretreatment ratios were defined as rates of pretreatment CRP, ALB, GLB, LDH, and AGR values and the corresponding ones obtained after radiotherapy or whole treatment. Results: Higher pretreatment CRP or LDH levels were correlated with worse progression-free survival (PFS) and overall survival (OS). Increased post/preradiotherapy CRP ratio was correlated with worse PFS and OS, increased post/preradiotherapy LDH ratio was correlated with worse PFS. Increased post/pretreatment CRP ratio was correlated with worse PFS and OS, not-increased post/pretreatment AGR ratio was correlated with worse OS. Cox regression analysis model indicated that, moderately or poorly of differentiation, higher pretreatment CRP or LDH levels were independently associated with worse PFS, higher pretreatment CRP or LDH levels and increased post/pretreatment CRP ratio were independently associated with worse OS. Conclusion: CRP, LDH, or AGR are correlated with outcomes of resectable cervical cancer.
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Affiliation(s)
- Wen-Jie Wang
- Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Ying Li
- Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Jie Zhu
- Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Min-Jie Gao
- Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Jian-Ping Shi
- Department of Radio-Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Yue-Qing Huang
- Department of General Practice, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
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Flores BE, Acton G, Arevalo-Flechas L, Gill S, Mackert M. Health Literacy and Cervical Cancer Screening Among Mexican-American Women. Health Lit Res Pract 2019; 3:e1-e8. [PMID: 31294299 PMCID: PMC6608916 DOI: 10.3928/24748307-20181127-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 06/12/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health literacy is a requisite skill for making personal health and health care decisions. Low health literacy may contribute to lower cervical cancer screening rates and cervical cancer health disparities among Mexican-American women in South Texas. OBJECTIVE To explore older Mexican-American women's health literacy related to cervical cancer from the perspective of Zarcadoolas, Pleaseant, and Greer's health literacy model. METHODS We conducted five focus groups and seven individual interviews with 30 Mexican and Mexican-American women in South Texas. We analyzed demographic data using descriptive statistics and conducted thematic analysis of focus group and individual interview data. KEY RESULTS Several themes reflected the domains of health literacy, including fundamental literacy ("speaking of language"), science literacy (cancer prevention), cultural literacy ("we are different"), civic literacy (the availability of "consejos" [advice]), and media literacy (e.g., "telenovelas" [soap-operas] teach a lot). In this article, we present findings related to culture and language under the domains of fundamental and cultural literacy. CONCLUSIONS Mexican-American women's cultural values and language use may serve as both deterrents and incentives to cervical cancer screening. The meaning of words can be lost in translations. Health care providers can use this information to provide cervical cancer screening education congruent with Mexican-American's culture, language, and code switching. [HLRP: Health Literacy Research and Practice. 2019;3(1):e1-e8.]. PLAIN LANGUAGE SUMMARY The understanding of culture and language can help health care providers improve cervical cancer screening practices among Mexican-American women. The results from this study can be used to individualize patient care and to develop education and communication strategies that are similar to the population we serve, including Mexican-American women.
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Affiliation(s)
- Bertha E. Flores
- Address correspondence to Bertha E. Flores, PhD, RN, WHNP-BC, John A. Hartford BAGNC Scholar (09-11), UT Health San Antonio, School of Nursing, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900;
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18
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Hu K, Wang W, Liu X, Meng Q, Zhang F. Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma of cervix after definitive radiotherapy or concurrent chemoradiotherapy. Radiat Oncol 2018; 13:249. [PMID: 30558636 PMCID: PMC6296025 DOI: 10.1186/s13014-018-1197-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023] Open
Abstract
Background Concurrent chemoradiotherapy (CCRT) is effective in the treatment of locally advanced cervical squamous cell carcinoma (SCC). However, whether treatment outcomes of cervical adenocarcinoma are equivalent to SCC after CCRT has been a topic of debate. Methods Medical records of cervical cancer patients treated with definitive radiotherapy or CCRT in our institute from January 2011 to December 2014 were reviewed. Patients were treated with intensity modulated radiation therapy combined with intracavitary brachytherapy. Weekly cisplatin was the first line regimen of concurrent chemotherapy. The treatment outcomes of patients with SCC and adenocarcinoma were compared with a multivariate Cox regression model, and log-rank method before and after propensity score matching (1:1). Results A total of 815 patients with stage IB-IVA cervical cancer were included, with 744 patients in the SCC group and 71 patients in adenocarcinoma group. The median follow-up period was 36.2 months (range, 1.0–76.2 months). The 3-year overall survival (OS), disease-free survival (DFS), pelvic control and distant control rates of patients in the SCC group and adenocarcinoma group were 85.2 and 75.4% (p = 0.005), 77.5 and 57.3% (p < 0.001), 89.0 and 74.0% (p = 0.001) and 86.0 and 74.4% (p = 0.011), respectively. After multivariate analysis, histology was an independent factor of OS (p = 0.003), DFS (p < 0.001), pelvic control (p = 0.002) and distant control (p = 0.003). With propensity score matching, 71 pairs of patients were selected. After matching, the OS (p = 0.017), DFS (p = 0.001), pelvic control (p = 0.015) and distant control (p = 0.009) of patients with adenocarcinoma were poorer than those of patients with SCC. In subgroup analysis, patients with adenocarcinoma had significantly worse OS and DFS compared with patients with SCC, regardless of treatment with radiotherapy alone or CCRT. Conclusion The present study demonstrated that patients with adenocarcinoma of the cervix had poorer OS and DFS than patients with SCC, regardless of treatment with radiotherapy alone or CCRT. New treatment approaches should be considered for cervical adenocarcinoma.
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Affiliation(s)
- Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Qingyu Meng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China.
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19
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Xue R, Cai X, Xu H, Wu S, Huang H. The efficacy of concurrent weekly carboplatin with radiotherapy in the treatment of cervical cancer: A meta-analysis. Gynecol Oncol 2018; 150:412-419. [PMID: 29996970 DOI: 10.1016/j.ygyno.2018.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We aimed to evaluate whether carboplatin has a comparable efficacy with cisplatin as part of weekly concurrent chemoradiotherapy for cervical cancer (Car-RT vs. Cis-RT). METHODS A literature search was conducted and both prospective and retrospective studies that evaluated the efficacy of Car-RT for cervical cancer were included. The primary endpoints were complete response (CR) rate, progression-free survival (PFS)/disease-free survival (DFS), overall survival (OS), reported as odds ratios (ORs) and 95% confidence intervals (CIs). The estimated CR rate and survival of patients treated with Car-RT were pooled. Acute toxicity was also summarized. RESULTS Twelve studies consisting of 1698 patients were eligible for meta-analysis. A lower CR rate (OR, 0.53; 95% CI, 0.34-0.82, I2 = 0%) and a trend toward poorer 3-year PFS/DFS (OR, 0.71; 95% CI, 0.49-1.02, I2 = 0%) and 3-year OS (OR, 0.70; 95% CI, 0.46-1.05, I2 = 36%) were found in Car-RT compared with Cis-RT. For the Car-RT groups, the pooled overall CR rate was 81% (95% CI 0.74-0.89). The pooled 3-year PFS/DFS rate was 64% (95% CI 0.52-0.78). The pooled 3-year OS rate was 73% (95% CI 0.62-0.87). Acute toxic events ≥ grade 3 were infrequent in the Car-RT groups. CONCLUSIONS Car-RT showed a poorer tumor response and a trend toward inferior survival compared with Cis-RT in the treatment of cervical cancer. However, this evidence was limited by the imbalance among studies. Due to the encouraging efficacy and low toxicity, carboplatin is a suitable concurrent agent for patients with contraindications to cisplatin.
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Affiliation(s)
- Renliang Xue
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China
| | - Xiumei Cai
- Department of Intensive Care Medicine, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Hongyao Xu
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China
| | - Shengxi Wu
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China
| | - Hecheng Huang
- Department of Radiation Oncology, Shantou Central Hospital, Shantou, China.
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Temkin SM, Rimel BJ, Bruegl AS, Gunderson CC, Beavis AL, Doll KM. A contemporary framework of health equity applied to gynecologic cancer care: A Society of Gynecologic Oncology evidenced-based review. Gynecol Oncol 2018; 149:70-77. [PMID: 29605053 DOI: 10.1016/j.ygyno.2017.11.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/19/2017] [Accepted: 11/07/2017] [Indexed: 01/21/2023]
Abstract
Health disparities are defined as the preventable difference in the burden of disease, injury, and violence, or opportunity to achieve optimal health that socially disadvantaged populations experience compared to the population as a whole. Disparities in incidence and cancer outcomes for women with gynecologic malignancies have been well described particularly for American women of Black race. The etiology of these disparities has been tied to socio-economics, cultural, educational and genetic factors. While access to high quality treatment has been primarily linked to survival from cervical and ovarian cancer, innate biologic distinctions have been principally cited as reasons for differences in incidence and mortality in cancers of the uterine corpus. This article will update the framework of disparities to incorporate a broader understanding of the social determinants of health and how they affect health equity by addressing the root causes of disparities within the health care system. Special populations are identified who are at risk for health inequities which include but are not limited to Black race, underserved racial and ethnic minorities (e.g. indigenous peoples, low English fluency), trans/gender nonconforming people and rural populations. Each of these populations at risk have unique structural barriers within the healthcare system impacting gynecologic cancer outcomes. The authors provide practical recommendations for practitioners aimed at eliminating cancer related outcome disparities.
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Affiliation(s)
- Sarah M Temkin
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
| | - B J Rimel
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Camille C Gunderson
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma city, OK, USA
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Skelton WP, Castagno J, Cardenas-Goicoechea J, Daily K, Yeung A, Markham MJ. Bevacizumab Eligibility in Patients with Metastatic and Recurrent Cervical Cancer: A Retrospective Review. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2018; 12:1179554918779587. [PMID: 29887734 PMCID: PMC5989046 DOI: 10.1177/1179554918779587] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/18/2018] [Indexed: 12/01/2022]
Abstract
Objective: Bevacizumab is approved for use in combination with chemotherapy for metastatic/recurrent cervical cancer (CC), with increased survival/response rates. However, use of bevacizumab is not always feasible or safe. The purpose of this study was to identify the percentage of metastatic/recurrent CC patients at our institution who would have been eligible to receive bevacizumab. Methods: A retrospective study was conducted to identify metastatic/recurrent CC patients treated at UFHealth between 2006 and 2016. Chart review was performed to determine if the patient met bevacizumab eligibility criteria. Results: In total, 79 patients with metastatic/recurrent CC were identified; 85.5% would have been ineligible to receive bevacizumab, and 14.5% would have been eligible. The most common reason for exclusion was active bleeding (68.4%); 94% of which was vaginal. In all, 27.6% would be excluded due to poor renal function, and 23.7% due to poor performance status (PS). Conclusions: Despite improved survival, only 14.5% of metastatic/recurrent CC patients treated over a 10-year period would have been eligible to receive bevacizumab. Most patients would have been excluded due to active bleeding, most commonly vaginal bleeding, a common complication from their disease. Identifying novel therapies for metastatic/recurrent CC patients with improved safety profiles that would allow for their use in this challenging population is critical.
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Affiliation(s)
- William Paul Skelton
- Division of General Internal Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jacqueline Castagno
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joel Cardenas-Goicoechea
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Karen Daily
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Anamaria Yeung
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Merry Jennifer Markham
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
- Merry Jennifer Markham, Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, PO Box 100278, Gainesville, FL 32610-0278, USA.
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Metastatic Sarcomatoid Squamous Cell Carcinoma of the Cervix Presenting with Chest Mass. Case Rep Oncol Med 2017; 2017:5264564. [PMID: 29062577 PMCID: PMC5618741 DOI: 10.1155/2017/5264564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/26/2017] [Accepted: 08/16/2017] [Indexed: 01/18/2023] Open
Abstract
Background Sarcomatoid squamous cell carcinoma is a rare and aggressive form of cervical cancer. We report a case of metastatic sarcomatoid squamous cell carcinoma (SSCC) of cervix that presented with an anterior chest wall mass. Case A 43-year-old Hispanic female presented with a two-month history of a central chest wall mass. The patient's only past medical history was SSCC of the cervix, stage IIB, diagnosed two years priorly. She underwent neoadjuvant chemoradiation therapy (CRT) with cisplatin followed by radical hysterectomy. Surgical margins were positive which led to adjuvant CRT with carboplatin and paclitaxel. PET scan 4 months after the postoperative treatment was negative for recurrence and metastatic disease. On current presentation, the CT chest revealed anterior mediastinal destructive soft tissue mass involving sternum, and the biopsy showed SSCC. The patient received palliative radiation therapy to her chest with improvement in pain and ability to swallow. After discussing the prognosis she refused further chemotherapy and decided on hospice care. Conclusion Despite good response to first-line therapy, SSCC tends to recur early and does not respond to second-line therapy. Radiation therapy seems to be the most effective modality for treatment, but randomized controlled trials of therapy are impractical.
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Deng H, Deng Y, Liu F, Chen J, Li Z, Zhao K, Guan X, Liang W. Stomatin-like protein 2 is overexpressed in cervical cancer and involved in tumor cell apoptosis. Oncol Lett 2017; 14:6355-6364. [PMID: 29181097 PMCID: PMC5696708 DOI: 10.3892/ol.2017.7054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/11/2017] [Indexed: 12/14/2022] Open
Abstract
Stomatin-like protein 2 (SLP-2) is overexpressed in numerous types of human cancer and previous studies revealed that SLP-2 may function in mitochondria. The purpose of the present study was to evaluate the expression of SLP-2 in cervical cancer and the association between SLP-2 expression and clinical features, in addition to investigating the role of SLP-2 in the apoptosis of cervical cancer cells. The expression profile of SLP-2 was determined by quantitative polymerase chain reaction, western blotting and immunohistochemical staining. The effect of SLP-2 on cell apoptosis induced by chemotherapeutics in cervical cancer cells was evaluated using Annexin V staining and terminal deoxynucleotidyl-transferase-mediated dUTP nick end labeling (TUNEL) assays. The results indicated that SLP-2 expression in cervical cancer was significantly upregulated at the mRNA and protein levels, compared with that in normal cervical tissues. Immunohistochemical analysis revealed significant correlation between SLP-2 protein expression and clinical characteristics, including the squamous cell carcinoma antigen (P=0.003), deep stromal invasion (P=0.021), lymphovascular space involvement (P=0.044) and pelvic lymph node metastasis (P<0.001), which served as independent prognostic factors for predicting the shortening of overall survival time in patients with early-stage cervical cancer. In addition, TUNEL and Annexin V binding assays revealed that silencing SLP-2 expression significantly enhanced the sensitivity of cervical cancer cells to apoptosis induced by chemotherapeutics. Taken together, the results of the present study suggest that SLP-2 may be a progressive gene in the development of cervical cancer. Overexpression of SLP-2 serves an important role in the apoptosis of human cervical cancer cells.
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Affiliation(s)
- Huan Deng
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Department of Oncology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, P.R. China
| | - Yongjian Deng
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Feiye Liu
- Cancer Center, Traditional Chinese Medicine-Integrated Hospital, Southern Medical University, Guangzhou, Guangdong 510315, P.R. China
| | - Jie Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Zheng Li
- Department of Obstetrics and Gynecology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Kelei Zhao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xiaoqian Guan
- Department of Oncology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, P.R. China
| | - Weijiang Liang
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Cadet TJ, Burke SL, Stewart K, Howard T, Schonberg M. Cultural and emotional determinants of cervical cancer screening among older Hispanic women. Health Care Women Int 2017; 38:1289-1312. [PMID: 28825525 DOI: 10.1080/07399332.2017.1364740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics' cervical cancer screening behaviors.
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Affiliation(s)
- Tamara J Cadet
- a Simmons College School of Social Work , Boston , Massachusetts , USA.,b Harvard School of Dental Medicine Department of Oral Health Policy and Epidemiology , Boston , Massachusetts , USA
| | - Shanna L Burke
- c Florida International University , Robert Stempel College of Public Health and Social Work , Miami , Florida, USA
| | | | - Tenial Howard
- a Simmons College School of Social Work , Boston , Massachusetts , USA
| | - Mara Schonberg
- e Harvard Medical School , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
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25
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Abstract
The incidence of cervical cancer in the United States has decreased more than 50% in the past 30 years because of widespread screening. In 1975, the rate was 14.8 per 100,000 women. By 2011, it decreased to 6.7 per 100,000 women. Mortality from the disease has undergone a similar decrease from 5.55 per 100,000 women in 1975 to 2.3 per 100,000 women in 2011 (1). The American Cancer Society (ACS) estimated that there would be 12,900 new cases of cervical cancer in the United States in 2015, with 4,100 deaths from the disease (2). Cervical cancer is much more common worldwide, particularly in countries without screening programs, with an estimated 527,624 new cases of the disease and 265,672 resultant deaths each year (3). When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed (4, 5).New technologies for cervical cancer screening continue to evolve, as do recommendations for managing the results. In addition, there are different risk-benefit considerations for women at different ages, as reflected in age-specific screening recommendations. In 2011, the ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) updated their joint guidelines for cervical cancer screening (6), as did the U.S. Preventive Services Task Force (USPSTF) (7). Subsequently, in 2015, ASCCP and the Society of Gynecologic Oncology (SGO) issued interim guidance for the use of a human papillomavirus (HPV) test for primary screening for cervical cancer that was approved in 2014 by the U.S. Food and Drug Administration (FDA) (8). The purpose of this document is to provide a review of the best available evidence regarding the prevention and early detection of cervical cancer.
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Chang HK, Kim DS, Chae JJ, Kim M, Myong JP, Lee KH, Lee MW, Park TC. Inhibition of ERK activity enhances the cytotoxic effect of peroxisome proliferator-activated receptor γ (PPARγ) agonists in HeLa cells. Biochem Biophys Res Commun 2016; 482:843-848. [PMID: 27888104 DOI: 10.1016/j.bbrc.2016.11.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 11/21/2016] [Indexed: 12/27/2022]
Abstract
In this study, we examined whether the peroxisome proliferator-activated receptor γ (PPARγ) agonists, ciglitazone (CGZ) and troglitazone (TGZ), induce cell death in human cervical cancer HeLa cells. The cells were treated with a range of CGZ or TGZ doses for 24 or 48 h. Low concentrations of CGZ (≤10 μM) or TGZ (≤20 μM) had no effect on cell viability whereas higher doses induced cell death in a time- and dose-dependent manner as evidenced by the detection of activated caspase-3 and PARP cleavage. Treatment with the PPARγ antagonist GW9662 followed by PPARγ agonists did not increase CGZ- or TGZ-induced cell death, indicating that PPARγ agonists induced HeLa cell death independently of PPARγ. Moreover, ERK1/2 activation was observed at a CGZ concentration of 25 μM and a TGZ concentration of 35 μM, both of which induced cell death. To elucidate the role of ERK1/2 activated by the two PPARγ agonists, the effect of U0126, an inhibitor of ERK1/2, on PPARγ-agonist-induced cell death was examined. Treatment with 10 or 20 μM U0126 followed by CGZ or TGZ induced the down-regulation of ERK1/2 activity and a decrease in Bcl-2 expression accompanied by the collapse of mitochondrial membrane potential, which in turn significantly enhanced CGZ- or TGZ-induced apoptotic cell death. Our results suggest that PPARγ agonists are capable of inducing apoptotic cell death in HeLa cells independently of PPARγ and that inhibition of ERK1/2 activity offers a strategy to enhance the cytotoxicity of PPARγ agonists in the treatment of cervical cancer.
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Affiliation(s)
- Ha Kyun Chang
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae Seong Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Jun Chae
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Minsun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun-Pyo Myong
- Department of Occupational & Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myoung Woo Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Tae Chul Park
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Wilson KL, Smith ML, Rosen BL, Pulczinski JC, Ory MG. HPV Vaccination Status and Mandate Support for School-Aged Adolescents Among College Females. J Sch Nurs 2016; 33:232-245. [PMID: 27470309 DOI: 10.1177/1059840516659764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to describe college-aged females' human papillomavirus (HPV) knowledge and beliefs, perceptions and perceived benefits of the HPV vaccine, and identify characteristics associated with vaccination status and support for HPV vaccine mandates. Data were collected from 1,105 females by an Internet-delivered questionnaire during February to March 2011. This descriptive study utilizes χ2 tests and t-tests to compare participant responses. HPV-related knowledge scores were 8.08 out of 11 points. Those who initiated HPV vaccination were significantly younger, single, engaged in sex, were sexually active, and had a Pap test. Participants who had more friends receiving the vaccine were significantly more likely to support mandates for 9-11 and 12-17 years and were more likely to complete the HPV vaccination cycle. Findings suggest the importance of educational programs adopted and delivered by school nurses, which aim to improve student knowledge and reduce misconceptions related to the HPV vaccine and vaccination mandates.
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Affiliation(s)
- Kelly L Wilson
- 1 Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Matthew Lee Smith
- 2 Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, USA.,3 Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, TX, USA
| | - Brittany L Rosen
- 4 School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Jairus C Pulczinski
- 3 Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, TX, USA
| | - Marcia G Ory
- 3 Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, TX, USA
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Abstract
To assess the understanding of the term 'Pap smear' among women across the entire adult lifespan after recent changes to the guidelines on cervical cancer screening. Women attending the Obstetrics and Gynecology clinic at a large safety net teaching hospital in a Midwestern city were provided one of two versions of a confidential and anonymous survey to complete. The difference between the two versions was the way the primary research question was worded. There were 174 participants ranging in age from 15 to 69 (mean = 33.9) years. Of the 73 women who completed version A of the survey, 74 % were able to identify at least one correct descriptor for the term 'Pap smear.' Women who could identify at least one correct descriptor for the term 'Pap smear' were on average older than those who could not (mean = 36.9 vs. 28.7 years; p = 0.012). Of the 94 patients completing survey version B, 67 % could not differentiate a pelvic exam from a Pap smear. There was no association between age and ability to differentiate a pelvic exam from a Pap smear. The majority of women cannot distinguish a Pap smear from a pelvic exam. The unexpected finding of less understanding among younger women prompts a need for further research and invites discussion of whether more cervical cancer prevention education, with more emphasis on HPV vaccines in recent years, has neglected the importance of Pap smears-which is beginning to show up in knowledge of younger women. Both these findings suggest a need for increased patient education during female preventive health clinic visits.
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Ingles DJ, Lin HY, Fulp WJ, Sudenga SL, Lu B, Schabath MB, Papenfuss MR, Abrahamsen ME, Salmeron J, Villa LL, Lazcano Ponce E, Giuliano AR. An analysis of HPV infection incidence and clearance by genotype and age in men: The HPV Infection in Men (HIM) Study. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2015; 1:126-135. [PMID: 27547836 PMCID: PMC4986989 DOI: 10.1016/j.pvr.2015.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/31/2015] [Accepted: 09/05/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Genital HPV infection in men causes benign and cancerous lesions, the incidence of which differs by age. The goal of this work was to comprehensively evaluate incidence and clearance of individual HPV genotypes among men by age group. METHODS HIV-negative men ages 18-70 with no history of anogenital cancer were recruited for the HPV Infection in Men (HIM) Study. Participants completed clinical exams and questionnaires every six months for up to ~4 years. Genital specimens underwent HPV genotyping, with associations between age and HPV assessed using Cox analyses. RESULTS 4085 men were followed for a median of 48.6 months (range: 0.3-94.0). Significantly lower HPV incidence rates were observed among the oldest age group (55-70 years) for grouped high-risk (incidence rate ratio [IRR]=0.71), HPV16 (IRR=0.54), grouped low-risk (IRR=0.74), and HPV6 (IRR=0.57) infections compared to men ages 18-24. However, incidence of the grouped 9-valent HPV vaccine types remained constant across the lifespan. Likelihood of HPV6 and HPV16 clearance remained constant until age 54, then increased significantly for men ages 55-70 (adjusted hazard ratio [AHR]=1.92 and 1.65, respectively). CONCLUSIONS Men remain susceptible to HPV infections throughout their lifespan, highlighting the need for prevention efforts with long-lasting duration.
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Affiliation(s)
- Donna J. Ingles
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hui-Yi Lin
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - William J. Fulp
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Staci L. Sudenga
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Beibei Lu
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | - Jorge Salmeron
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Instituto Mexicano del Seguro Social, Mexico
| | | | - Eduardo Lazcano Ponce
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Instituto Mexicano del Seguro Social, Mexico
| | - Anna R. Giuliano
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Majidi A, Ghiasvand R, Hadji M, Nahvijou A, Mousavi AS, Pakgohar M, Khodakarami N, Abedini M, Amouzegar Hashemi F, Rahnamaye Farzami M, Shahsiah R, Sajedinejhad S, Mohagheghi MA, Nadali F, Rashidian A, Weiderpass E, Mogensen O, Zendehdel K. Priority Setting for Improvement of Cervical Cancer Prevention in Iran. Int J Health Policy Manag 2015; 5:225-32. [PMID: 27239863 DOI: 10.15171/ijhpm.2015.201] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 11/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting. METHODS We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran. RESULTS From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry. CONCLUSION A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran.
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Affiliation(s)
- Azam Majidi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghiasvand
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam-Sadat Mousavi
- Department of Genecology Oncology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Pakgohar
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Khodakarami
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrandokht Abedini
- Deputy of Public Health, Maternal Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Farnaz Amouzegar Hashemi
- Radiotherapy Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Shahsiah
- Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Sajedinejhad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nadali
- Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.,Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - Ole Mogensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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Grueneisen J, Schaarschmidt BM, Heubner M, Suntharalingam S, Milk I, Kinner S, Heubner A, Forsting M, Lauenstein T, Ruhlmann V, Umutlu L. Implementation of FAST-PET/MRI for whole-body staging of female patients with recurrent pelvic malignancies: A comparison to PET/CT. Eur J Radiol 2015; 84:2097-102. [PMID: 26321491 DOI: 10.1016/j.ejrad.2015.08.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/02/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the diagnostic competence of FAST-PET/MRI and PET/CT for whole-body staging of female patients suspect for a recurrence of a pelvic malignancy. METHODS 24 female patients with a suspected tumor recurrence underwent a PET/CT and subsequent PET/MRI examination. For PET/MRI readings a whole-body FAST-protocol was implemented. Two readers separately evaluated the PET/CT and FAST PET/MRI datasets regarding identification of all tumor lesions and qualitative assessment of visual lesion-to-background contrast (4-point ordinal scale). RESULTS Tumor relapse was present in 21 of the 24 patients. Both, PET/CT and PET/MRI allowed for correct identification of tumor recurrence in 20 of 21 cases. Lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the detection of malignant lesions were 82%, 91%, 97%, 58% and 84% for PET/CT and 85%, 87%, 96%, 63% and 86% for PET/MRI, lacking significant differences. Furthermore, no significant difference for lesion-to-background contrast of malignant and benign lesions was found. CONCLUSION FAST-PET/MRI provides a comparably high diagnostic performance for restaging gynecological cancer patients compared to PET/CT with slightly prolonged scan duration, yet enabling a markedly reduced radiation exposure.
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Affiliation(s)
- Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany.
| | - Benedikt Michael Schaarschmidt
- Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, D-40225 Dusseldorf, Germany
| | - Martin Heubner
- Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Saravanabavaan Suntharalingam
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Ines Milk
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Antonia Heubner
- Department of Obstetrics and Gynecology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Thomas Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Verena Ruhlmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
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Burns RB, Potter JE, Ricciotti HA, Reynolds EE. Screening Pelvic Examinations in Adult Women: Grand Rounds Discussion From the Beth Israel Deaconess Medical Center. Ann Intern Med 2015; 163:537-47. [PMID: 26436618 DOI: 10.7326/m15-1220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pelvic examinations have historically been a part of regular preventive care. However, because women can now be screened for cervical cancer at intervals up to every 5 years, the question of whether women need to be seen annually for routine pelvic examinations has arisen. In July 2014, the American College of Physicians (ACP) issued a guideline presenting the available evidence on screening for pathologic conditions using pelvic examination in adult, asymptomatic women at average risk. The American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice had previously issued a committee opinion in August 2012 on the need for annual examinations and provided guidelines on important elements of this procedure, including when to examine asymptomatic women. ACOG reaffirmed its initial position after publication of the ACP guideline. The guidelines differ-the ACP guideline recommends against and the ACOG committee opinion recommends in favor of routine annual pelvic examination. This paper summarizes a discussion between an internist and a gynecologist on how they would balance these recommendations in general and what they would suggest for an individual patient.
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Morris VK, Rashid A, Rodriguez-Bigas M, Das P, Chang G, Ohinata A, Rogers J, Crane C, Wolff RA, Eng C. Clinicopathologic Features Associated With Human Papillomavirus/p16 in Patients With Metastatic Squamous Cell Carcinoma of the Anal Canal. Oncologist 2015; 20:1247-52. [PMID: 26382740 DOI: 10.1634/theoncologist.2015-0091] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/22/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The incidence of anal carcinoma in the U.S. continues to increase steadily, and infection with the human papillomavirus (HPV) is an established risk factor for the development of anal carcinoma. However, the clinicopathologic characteristics of patients with metastatic squamous cell carcinoma of the anal canal according to HPV status have not yet been defined. MATERIALS AND METHODS The records of patients treated for metastatic squamous cell carcinoma of the anal canal at the MD Anderson Cancer Center from June 2005 to August 2013 were reviewed. The patients were tested for the presence of HPV DNA by in situ hybridization and/or the p16 oncoprotein by immunohistochemistry. Associations between the presence of HPV and clinicopathologic attributes were measured. RESULTS Of the 72 patients reviewed, 68 tumors (94%) had detectable HPV. Patients with HPV-negative tumors were more likely to be of nonwhite ethnicity (odds ratio, 8.7) and have a strong (>30 pack-year) tobacco history (odds ratio, 8.7). A trend toward improved survival from the time of diagnosis of metastatic disease was noted among patients with HPV-positive tumors. CONCLUSION Most patients with metastatic anal cancer had detectable HPV, with differences in tobacco history and ethnicity detected according to HPV status. The high frequency of HPV positivity for patients with metastatic anal cancer has important implications for novel immunotherapy treatment approaches, including ongoing clinical trials with immune checkpoint blockade agents using antibodies targeting the programmed death-1 receptor. IMPLICATIONS FOR PRACTICE Previous studies investigating the clinical features of patients with anal cancer focused on those with early-stage disease. The present study characterizes, for the first time, clinical and pathological features according to human papillomavirus (HPV) status for patients with metastatic anal cancer. A high frequency of HPV-positive tumors and correlations between HPV status and both ethnicity and tobacco history was found. No standard-of-care therapy is available for patients with metastatic anal cancer, and most receive cytotoxic chemotherapy. The high prevalence of HPV in the current population generates optimism for ongoing clinical trials investigating the role of immune checkpoint blockade agents as a novel treatment approach for this disease.
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Affiliation(s)
- Van K Morris
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Asif Rashid
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Miguel Rodriguez-Bigas
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Prajnan Das
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George Chang
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aki Ohinata
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jane Rogers
- Department of Clinical Pharmacy Services, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher Crane
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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34
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Trends in the incidence of cervical cancer and severe precancerous lesions in Denmark, 1997–2012. Cancer Causes Control 2015; 26:1105-16. [DOI: 10.1007/s10552-015-0603-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/20/2015] [Indexed: 01/18/2023]
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35
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Meyerson BE, Zimet GD, Multani GS, Levell C, Lawrence CA, Smith JS. Increasing Efforts to Reduce Cervical Cancer through State-Level Comprehensive Cancer Control Planning. Cancer Prev Res (Phila) 2015; 8:636-41. [PMID: 25943743 DOI: 10.1158/1940-6207.capr-15-0004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
Reducing cervical cancer disparities in the United States requires intentional focus on structural barriers such as systems and policy that impact access to human papillomavirus (HPV) vaccination, cervical cancer screening, and treatment. Such changes are difficult and often politicized. State comprehensive cancer control (CCC) plans are vehicles that, if designed well, can help build collective focus on structural changes. Study objectives were to identify the prioritization of cervical cancer in state CCC plans, the conceptualization of HPV within these plans, and the focus of plans on structural changes to reduce cervical cancer disparities. Data were gathered by systematic content analysis of CCC plans from 50 states and the District of Columbia from February-June 2014 for evidence of cervical cancer prioritization, conceptualization of HPV, and focus on structural barriers to cervical cancer vaccination, screening or treatment. Findings indicate that prioritization of cervical cancer within state CCC plans may not be a strong indicator of state efforts to reduce screening and treatment disparities. While a majority of plans reflected scientific evidence that HPV causes cervical and other cancers, they did not focus on structural elements impacting access to evidence-based interventions. Opportunities exist to improve state CCC plans by increasing their focus on structural interventions that impact cervical cancer prevention, detection, and treatment, particularly for the 41% of plans ending in 2015 and the 31% ending between 2016 and 2020. Future studies should focus on the use of policy tools in state CCC plans and their application to cervical cancer prevention and treatment.
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Affiliation(s)
- Beth E Meyerson
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana. Indiana University-Purdue University Indianapolis (IUPUI) Center for HPV Research, Indianapolis, Indiana. Rural Center for AIDS/STD Prevention, Bloomington, Indiana.
| | - Gregory D Zimet
- Indiana University-Purdue University Indianapolis (IUPUI) Center for HPV Research, Indianapolis, Indiana. Indiana University School of Medicine, Indianapolis, Indiana
| | - Gurprit S Multani
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana. Rural Center for AIDS/STD Prevention, Bloomington, Indiana
| | - Caleb Levell
- Indiana Cancer Consortium, Indianapolis, Indiana
| | - Carrie A Lawrence
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana. Rural Center for AIDS/STD Prevention, Bloomington, Indiana
| | - Jennifer S Smith
- Indiana Cancer Consortium, Indianapolis, Indiana. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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36
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Watkins KL, Reitzel LR, Wetter DW, McNeill LH. HPV awareness, knowledge and attitudes among older African-American women. Am J Health Behav 2015; 39:205-11. [PMID: 25564833 PMCID: PMC5038912 DOI: 10.5993/ajhb.39.2.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess correlates of human papillomavirus (HPV) awareness, knowledge, and attitudes among older, church-going African-American women. METHODS Participants (N = 759), aged 40-80, answered survey questions about HPV awareness, knowledge, and attitudes toward vaccination of adolescent daughters. Associations between participant characteristics and HPV items were assessed using chi-square tests and logistic regression analyses. RESULTS Younger age, higher education, a family history of cancer, and less spirituality were each associated with HPV awareness individually, and when considered jointly in a single model (p values <.038). Higher education was related to HPV knowledge (p = .006). CONCLUSIONS African-American women of older age, less education, no family history of cancer, and/or higher spirituality might benefit from targeted church-based HPV educational campaigns.
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Affiliation(s)
- Kellie L Watkins
- The University of Texas School of Public Health, Department of Epidemiology, Houston, TX, USA
| | - Lorraine R Reitzel
- The University of Houston, College of Education, Department of Educational Psychology, Houston, TX, USA.
| | - David W Wetter
- Department of Psychology, Rice University, Houston, TX, USA
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Roncancio AM, Ward KK, Sanchez IA, Cano MA, Byrd TL, Vernon SW, Fernandez-Esquer ME, Fernandez ME. Using the Theory of Planned Behavior to Understand Cervical Cancer Screening Among Latinas. HEALTH EDUCATION & BEHAVIOR 2015; 42:621-6. [PMID: 25712240 DOI: 10.1177/1090198115571364] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To reduce the high incidence of cervical cancer among Latinas in the United States it is important to understand factors that predict screening behavior. The aim of this study was to test the utility of theory of planned behavior in predicting cervical cancer screening among a group of Latinas. A sample of Latinas (N = 614) completed a baseline survey about Pap test attitudes subjective norms, perceived behavioral control, and intention to be screened for cervical cancer. At 6 months postbaseline, cervical cancer screening behavior was assessed. Structural equation modeling was used to test the theory. Model fit statistics indicated good model fit: χ(2)(48) = 54.32, p = .246; comparative fit index = .992; root mean square error of approximation = .015; weighted root mean square residual = .687. Subjective norms (p = .005) and perceived behavioral control (p < .0001) were positively associated with intention to be screened for cervical cancer, and the intention to be screened predicted actual cervical cancer screening (p < .0001). The proportion of variance (R2) in intention accounted for by the predictors was .276 and the R2 in cervical cancer screening accounted for was .130. This study provides support for the use of the theory of planned behavior in predicting cervical cancer screening among Latinas. This knowledge can be used to inform the development of a theory of planned behavior-based intervention to increase cervical cancer screening among Latinas and reduce the high incidence of cervical cancer in this group of women.
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Affiliation(s)
| | | | - Ingrid A Sanchez
- The University of Texas School of Public Health, Houston, TX, USA
| | | | | | - Sally W Vernon
- The University of Texas School of Public Health, Houston, TX, USA
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Williams M, Moneyham L, Kempf MC, Chamot E, Scarinci I. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama. AIDS Patient Care STDS 2015; 29:13-9. [PMID: 25514125 DOI: 10.1089/apc.2014.0063] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
African American women have disproportionately high prevalence rates of HIV and cervical cancer. HIV-infected women are significantly less likely to obtain recommended cervical cancer screenings than HIV-uninfected women. The purpose of this study was to examine sociocultural and structural factors associated with cervical cancer screening among HIV-infected African American in Alabama. The PEN-3 Model and the Health Belief Model were used as theoretical frameworks. In-depth interviews were conducted with twenty HIV-infected African American women to identify perceptions, enablers, and nurturers, perceived susceptibility, perceived severity, and perceived benefits related to cervical cancer and screening. The most common positive perceptions, enablers, and nurturers that contributed to cervical cancer screening included internal motivation and awareness of the importance of HIV-infected women getting Pap tests due to their weakened immune system. Negative perceptions, enablers, and nurturers included lack of knowledge about cervical cancer and screening, and lack of perceived susceptibility to cervical cancer. The results of this study can be used to guide the development of culturally relevant cervical cancer and screening education interventions aimed at increasing cervical cancer screening adherence among HIV-infected African American women.
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Affiliation(s)
- Michelle Williams
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Linda Moneyham
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Eric Chamot
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Isabel Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Frank LB, Murphy ST, Chatterjee JS, Moran MB, Baezconde-Garbanati L. Telling stories, saving lives: creating narrative health messages. HEALTH COMMUNICATION 2015; 30:154-63. [PMID: 25470440 PMCID: PMC5608451 DOI: 10.1080/10410236.2014.974126] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Increasingly, health communication practitioners are exploring the use of narrative storytelling to convey health information. For this study, a narrative film was produced to provide information about the human papillomavirus (HPV) and cervical cancer prevention. The storyline centered on Lupita, a young woman recently diagnosed with HPV who informs her family about HPV and the availability of the HPV vaccine for her younger sister. The objective was to examine the roles of identification with characters and narrative involvement (made up of three dimensions: involvement, perceived relevance, and immersion) on perceived response efficacy, perceived severity, and perceived susceptibility to HPV and behavior (discussing the HPV vaccine with a health care provider). A random sample of 450 European American, Mexican American, and African American women between the ages of 25 and 45 years, living in the Los Angeles area, was surveyed by phone before, 2 weeks after, and 6 months after viewing the film. The more relevant women found the narrative to their own lives at 2 weeks, the higher they perceived the severity of the virus and the perceived response efficacy of the vaccine to be. Also at 2 weeks, identifying with characters was positively associated with perceived susceptibility to HPV but negatively associated with perceived severity. At 6 months, identification with specific characters was significantly associated with perceived threat and behavior. These findings suggest that different aspects of narrative health messages should be manipulated depending on the specific beliefs and behaviors being targeted. Implications for narrative message design are discussed.
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Affiliation(s)
- Lauren B Frank
- a Department of Communication , Portland State University
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40
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Abstract
Previous studies have shown an association between cervical cancer screening and racial/ethnic minority status, no usual source of care, and lower socioeconomic status. This study describes the demographics and health beliefs of women who report never being screened for cervical cancer by area of residence. Data from the 2010 Behavioral Risk Factor Surveillance System were used to study women aged 21-65 years who reported never being screened for cervical cancer. Multivariate logistic regression modeling was used to calculate predicted marginals to examine associations between never being screened and demographic characteristics and health belief model (HBM) constructs by metropolitan statistical area (MSA). After adjusting for all demographics and HBM constructs, prevalence of never being screened was higher for the following women: non-Hispanic Asians/Native Hawaiians/Pacific Islanders (16.5 %, 95 % CI = 13.7 %, 19.8 %) who live in MSAs; those with only a high school diploma who live in MSAs (5.5 %, 95 % CI = 4.7 %, 6.5 %); those living in non-MSAs who reported "fair or poor" general health (4.1 %, 95 % CI = 3.1 %, 5.4 %); and those living in either MSAs and non-MSAs unable to see a doctor within the past 12 months because of cost (MSA: 4.4 %, 95 % CI = 4.0 %, 4.8 %; non-MSA: 3.4 %, 95 % CI = 2.9 %, 3.9 %). The Affordable Care Act will expand access to insurance coverage for cervical cancer screening, without cost sharing for millions of women, essentially eliminating insurance costs as a barrier. Future interventions for women who have never been screened should focus on promoting the importance of screening and reaching non-Hispanic Asians/Native Hawaiians/Pacific Islanders who live in MSAs.
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Reimer RA, Schommer JA, Houlihan AE, Gerrard M. Ethnic and gender differences in HPV knowledge, awareness, and vaccine acceptability among White and Hispanic men and women. J Community Health 2014; 39:274-84. [PMID: 24150246 DOI: 10.1007/s10900-013-9773-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study was to examine factors associated with human papillomavirus (HPV) knowledge and awareness, and HPV vaccination among White and Hispanic males and females. Differences in HPV knowledge, sources of information, vaccine awareness, vaccination status, and interest in vaccination were examined. A community sample was recruited from local health care clinics in a medium sized Midwestern city between May 2010 and December 2011. Participants (N = 507) were White (n = 243) and Hispanic, males (n = 202) and females between the ages of 15-30. Results indicate that White and female participants were significantly more likely to have heard of HPV, have higher levels of HPV knowledge, have been diagnosed with HPV, and be aware of the HPV vaccine for women. White and female participants were also more likely to have heard of HPV from their physician and were significantly more interested in receiving the HPV vaccine in the future. There was no effect of ethnicity on interest in the vaccine per a doctor's recommendation, however. Findings suggest that Whites and females have greater levels of HPV awareness and knowledge and that, while Hispanic participants are less likely than White participants to be told about the HPV vaccine from their provider, they may be equally receptive to such a recommendation.
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Affiliation(s)
- Rachel A Reimer
- Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA,
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42
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[(18)F]FDG PET/MRI vs. PET/CT for whole-body staging in patients with recurrent malignancies of the female pelvis: initial results. Eur J Nucl Med Mol Imaging 2014; 42:56-65. [PMID: 25223420 DOI: 10.1007/s00259-014-2902-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/25/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the diagnostic potential of PET/MRI with [(18)F]FDG in recurrent ovarian and cervical cancer in comparison to PET/CT. METHODS A group of 19 patients with suspected recurrence of pelvic malignancies (ovarian cancer, 11 patients; cervical cancer, 8 patients) scheduled for an [(18)F]FDG PET/CT were subsequently enrolled for a PET/MRI. The scan protocol comprised: (1) a T1-W axial VIBE after contrast agent adminstration, (2) an axial T2-W HASTE, (3) a coronal TIRM, (4) an axial DWI, and dedicated MR sequences of the female pelvis including (5) a T1-W VIBE before contrast agent adminstration, (6) a sagittal T2-W TSE, and (7) a sagittal T1-W dynamic VIBE. The datasets (PET/CT, PET/MRI) were rated separately by two readers regarding lesion count, lesion localization, lesion conspicuity (four-point scale), lesion characterization (benign/malignant/indeterminate) and diagnostic confidence (three-point scale). All available data (histology, prior examinations, PET/CT, PET/MRI, follow-up examinations) served as standard of reference. Median values were compared using the Wilcoxon rank sum test. RESULTS Metastatic lesions were present in 16 of the 19 patients. A total of 78 lesions (malignant, 58; benign, 20) were described. Both PET/CT and PET/MRI allowed correct identification of all malignant lesions and provided equivalent conspicuity (3.86 ± 0.35 for PET/CT, 3.91 ± 0.28 for PET/MRI; p > 0.05). Diagnostic confidence was significantly higher for PET/MRI in malignant (p < 0.01) and benign lesions (p < 0.05). CONCLUSION Both PET/CT and PET/MRI offer an equivalently high diagnostic value for recurrent pelvic malignancies. PET/MRI offers higher diagnostic confidence in the discrimination of benign and malignant lesions. Considering the reduced radiation dose and superior lesion discrimination, PET/MRI may serve as a powerful alternative to PET/CT in the future.
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Vidal AC, Smith JS, Valea F, Bentley R, Gradison M, Yarnall KSH, Ford A, Overcash F, Grant K, Murphy SK, Hoyo C. HPV genotypes and cervical intraepithelial neoplasia in a multiethnic cohort in the southeastern USA. Cancer Causes Control 2014; 25:1055-62. [PMID: 24928693 PMCID: PMC4082644 DOI: 10.1007/s10552-014-0406-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/28/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE For poorly understood reasons, invasive cervical cancer (ICC) incidence and mortality rates are higher in women of African descent. Oncogenic human papillomavirus (HPV) genotypes distribution may vary between European American (EA) and African-American (AA) women and may contribute to differences in ICC incidence. The current study aimed at disentangling differences in HPV distribution among AA and EA women. METHODS Five-hundred and seventy-two women were enrolled at the time of colposcopic evaluation following an abnormal liquid-based cytology screen. HPV infections were detected using HPV linear array, and chi-squared tests and linear regression models were used to compare HPV genotypes across racial/ethnic groups by CIN status. RESULTS Of the 572 participants, 494 (86 %) had detectable HPV; 245 (43 %) had no CIN lesion, 239 (42 %) had CIN1, and 88 (15 %) had CIN2/3. Seventy-three percent of all women were infected with multiple HPV genotypes. After adjusting for race, age, parity, income, oral contraception use, and current smoking, AAs were two times less likely to harbor HPV 16/18 (OR 0.48, 95 % CI 0.21-0.94, p = 0.03) when all women were considered. This association remained unchanged when only women with CIN2/3 lesions were examined (OR 0.22, 95 % CI 0.05-0.95, p = 0.04). The most frequent high-risk HPV genotypes detected among EAs were 16, 18, 56, 39, and 66, while HPV genotypes 33, 35, 45, 58, and 68 were the most frequent ones detected in AAs. CONCLUSIONS Our data suggest that while HPV 16/18 are the most common genotypes among EA women with CIN, AAs may harbor different genotypes.
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Affiliation(s)
- Adriana C Vidal
- Program of Cancer Detection, Prevention and Control, Division of Clinical and Epidemiologic Research, Department of Obstetrics and Gynecology, Duke University School of Medicine, P.O. Box 104006, Durham, NC, 27710, USA,
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Baezconde-Garbanati LA, Chatterjee JS, Frank LB, Murphy ST, Moran MB, Werth LN, Zhao N, Amezola de Herrera P, Mayer D, Kagan J, O'Brien D. Tamale Lesson: A case study of a narrative health communication intervention. ACTA ACUST UNITED AC 2014. [DOI: 10.1179/1753807614y.0000000055] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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45
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Froment MA, Gomez SL, Roux A, DeRouen MC, Kidd EA. Impact of socioeconomic status and ethnic enclave on cervical cancer incidence among Hispanics and Asians in California. Gynecol Oncol 2014; 133:409-15. [PMID: 24674831 PMCID: PMC5746172 DOI: 10.1016/j.ygyno.2014.03.559] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study aimed to evaluate the incidence of cervical cancer by nativity [United States (US) versus non-US], neighborhood socioeconomic status and ethnic enclave among Hispanics and Asians in California. METHODS Using data from the California Cancer Registry, information on all primary invasive cervical cancer (Cca) patients diagnosed in California from January 1, 1990 through December 31, 2004 was obtained. We analyzed the influence of enclave, socioeconomic status and nativity on Cca incidence. RESULTS Among the 22,189 Cca cases diagnosed between 1990 and 2004, 50% were non-Hispanic white, 39% Hispanic and 11% Asian women, and 63% US-born. Seventy percent of the Cca cases were squamous cell carcinoma, 19% adenocarcinoma and 11% other histologies. Higher incidence of Cca was observed in high enclave (76%) and low socioeconomic status (70%) neighborhoods. By ethnic group, US-born women showed lower rates of squamous cell carcinoma compared to foreign-born women. Hispanics living in low socioeconomic and high enclave had 12.7 times higher rate of Cca than those living in high socioeconomic, low enclave neighborhoods. For Asian women incidence rates were 6 times higher in the low socioeconomic, high enclave neighborhoods compared to those living in high socioeconomic, low enclave neighborhoods. CONCLUSION More targeted outreach to increase Pap smear screening and human papilloma virus vaccination for women living in high enclave neighborhoods can help decrease the incidence of Cca in these groups of women.
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Affiliation(s)
- Marie-Anne Froment
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA.
| | - Scarlett L Gomez
- Cancer Prevention Institute of California, Fremont, CA, USA; Department of Health Research and Policy, School of Medicine, Stanford, CA, USA
| | - Audrey Roux
- Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | | | - Elizabeth A Kidd
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA
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Mother-Daughter Dyad Recruitment and Cancer Intervention Challenges in an African American Sample. J Racial Ethn Health Disparities 2014; 1:120-129. [PMID: 25489496 DOI: 10.1007/s40615-014-0019-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Developing an effective youth-based health messaging intervention for African American women, who remain disparately impacted by cancer, presents unique challenges. This paper reports on the challenges with recruiting familial dyads from predominantly low-income, African American neighborhoods, as well as the challenges associated with designing and implementing an upward-directed cancer screening intervention. We developed and pilot tested an educational workshop that provided adolescents with cancer screening information to share with their mother or female relative. Data from follow-up interviews and focus groups, as well as observation records regarding implementation obstacles highlight important lessons learned. The use of familial dyads as well as issues of access posed challenges for recruitment and follow-up. Workshop-related challenges stemmed from the approach, content and length. Finally, personal and environmental factors presented barriers to adolescent message delivery and adult follow-through. By identifying these challenges, we hope to influence and enable the future development of effective adolescent-initiated health messaging interventions.
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Effects of Electronic Health Record–Based Interventions on Cervical Cancer Screening in Adolescents. J Low Genit Tract Dis 2014; 18:169-73. [DOI: 10.1097/lgt.0b013e31829821e8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls. J Pediatr Health Care 2014; 28:155-64. [PMID: 23522561 DOI: 10.1016/j.pedhc.2013.01.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 01/07/2013] [Accepted: 01/17/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A quality improvement project was undertaken to determine if an evidence-based educational brochure and reminder system can increase human papillomavirus (HPV) vaccine uptake and dose completion rates. METHOD Development of a brochure to promote HPV vaccine uptake was based on predictors of parental acceptance and Health Belief Model concepts. Electronic alerts prompted telephone reminders for dose completion. This quality improvement project utilized a quasi-experimental design with 24 parents of preteen girls from a private pediatric practice and a historical control group of 29 parents. HPV vaccine rates were compared between the groups. RESULTS A significant difference in HPV vaccine uptake (χ(2) = 11.668, P = .001; odds ratio [OR] = 9.429, 95% confidence interval [CI] = 2.686-33.101) and dose completion (χ(2) = 16.171, P < .001; OR = 22.500, 95% CI = 4.291-117.990) rates were found between the historical control and intervention groups. Parents who received the clinical protocol were 9.4 times and 22.5 times more likely to have HPV vaccine uptake and dose completion, respectively. DISCUSSION Low national HPV vaccine rates demonstrate the need for theory-based vaccine delivery programs. These results show that an evidence-based educational brochure and reminder system appeared to improve HPV vaccine uptake and dose completion rates at this private pediatric practice.
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49
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Yang L, Jia X, Li N, Chen C, Liu Y, Wang H. Comprehensive clinic-pathological characteristics of cervical cancer in southwestern China and the clinical significance of histological type and lymph node metastases in young patients. PLoS One 2013; 8:e75849. [PMID: 24130747 PMCID: PMC3794011 DOI: 10.1371/journal.pone.0075849] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze the clinic-pathological characteristics of women with cervical cancers in southwestern China and discuss the features and prognosis of young patients. METHODS A retrospective study was performed, which consisted of 1,543 patients diagnosed with cervical cancer and underwent treatment at West China Second University Hospital between November 2005 and December 2010. Among them, 154 young patients with surgical procedures between November 2005 and December 2008 were selected for a 5-year follow-up and prognostic analysis. RESULTS The proportion of advanced FIGO stage in patients aged over 35 years was higher than in patients aged 35 years or younger (55.1% vs 38.8%, P<0.001), and strong correlation was found between FIGO stages and the postoperative pathological risk factors (P<0.05). 312 patients (20.2%) were under 35 years old in the last 5 years. The proportion of cervical adenocarcinoma remained high in young patients (13.6%), and young women with adenocarcinoma had a higher rate of LN metastases, comparing with those with squamous cell carcinoma (42.9% vs 15.8%, P = 0.004). Young patients with adenocarcinoma had shorter progression-free survival than those who had squamous cell carcinoma (P = 0.024). Patients aged 35 years or younger with positive postoperative pathological risk factors had shorter progression-free survival, comparing with those with negative factors (P<0.01). CONCLUSION Patients over 35 years were preliminarily diagnosed as advanced FIGO stage and they were more likely to have deep stromal invasion, LVSI, LN metastases, parametrial and surgical margin involvement. Regarding to young patients, cervical adenocarcinoma increased the risk of LN metastases and positive postoperative pathological risk factors could apparently worsen the prognosis. Histological type and LN metastases were independent prognostic factors for young patients in southwestern China. We re-emphasize the importance of health education and regular smear screening for elder women, and more attention should be paid to young patients with adenocarcinoma or LN metastases.
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Affiliation(s)
- LingYun Yang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Chengdu, Sichuan University, Sichuan, P.R.China
| | - XiBiao Jia
- Department of Gynecology and Obstetrics, West China Second University Hospital, Chengdu, Sichuan University, Sichuan, P.R.China
| | - NingWei Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Chengdu, Sichuan University, Sichuan, P.R.China
| | - Cen Chen
- Department of Gynecology and Obstetrics, West China Second University Hospital, Chengdu, Sichuan University, Sichuan, P.R.China
| | - Yi Liu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Chengdu, Sichuan University, Sichuan, P.R.China
| | - HongJing Wang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Chengdu, Sichuan University, Sichuan, P.R.China
- * E-mail:
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Roncancio AM, Ward KK, Fernandez ME. The influence of time perspective on cervical cancer screening among Latinas in the United States. J Health Psychol 2013; 19:1547-53. [PMID: 23928988 DOI: 10.1177/1359105313495073] [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: 11/16/2022] Open
Abstract
To develop effective interventions to increase cervical cancer screening among Latinas, we should understand the role of cultural factors, such as time perspective, in the decision to be screened. We examined the relation between present time orientation, future time orientation, and self-reported cervical cancer screening among Latinas. A group of 206 Latinas completed a survey measuring factors associated with screening. Logistic regression analyses revealed that future time orientation was significantly associated with self-reported screening. Understanding the influence of time orientation on cervical cancer screening will assist us in developing interventions that effectively target time perspective and screening.
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