1
|
Portocarrero-Bonifaz A, Syed S, Kassel M, McKenzie GW, Shah VM, Forry BM, Gaskins JT, Sowards KT, Avula TB, Masters A, Silva SR. Dosimetric and toxicity comparison between Syed-Neblett and Fletcher-Suit-Delclos Tandem and Ovoid applicators in high dose rate cervix cancer brachytherapy. Brachytherapy 2024; 23:397-406. [PMID: 38643046 DOI: 10.1016/j.brachy.2024.03.003] [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: 12/20/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To compare patient and tumor characteristics, dosimetry, and toxicities between interstitial Syed-Neblett and intracavitary Fletcher-Suit-Delclos Tandem and Ovoid (T&O) applicators in high dose rate (HDR) cervical cancer brachytherapy. METHODS A retrospective analysis was performed for cervical cancer patients treated with 3D-based HDR brachytherapy from 2011 to 2023 at a single institution. Dosimetric parameters for high-risk clinical target volume and organs at risk were obtained. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 5.0. RESULTS A total of 115 and 58 patients underwent Syed and T&O brachytherapy, respectively. Patients treated with Syed brachytherapy were more likely to have larger tumors and FIGO stage III or IV disease. The median D2cc values to the bladder, small bowel, and sigmoid colon were significantly lower for Syed brachytherapy. Patients treated with Syed brachytherapy were significantly more likely to be free of acute gastrointestinal (44% vs. 21%, p = 0.003), genitourinary (58% vs. 36%, p = 0.01), and vaginal toxicities (60% vs. 33%, p = 0.001) within 6 months following treatment compared to patients treated with T&O applicators. In contrast, Syed brachytherapy patients were more likely to experience late gastrointestinal (68% vs. 49%, p = 0.082), genitourinary (51% vs. 35%, p = 0.196), and vaginal toxicities (70% vs. 57%, p = 0.264). CONCLUSIONS Syed-Neblett and T&O applicators are suitable for HDR brachytherapy for cervical cancer in distinct patient populations. Acute toxicities are more prevalent with T&O applicators, while patients treated with Syed-Neblett applicators are more likely to develop late toxicities.
Collapse
Affiliation(s)
- Andres Portocarrero-Bonifaz
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY; Physics Department, Pontificia Universidad Catolica del Peru, Lima, Peru.
| | - Salman Syed
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Maxwell Kassel
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Grant W McKenzie
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Vishwa M Shah
- Department of Gynecologic Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Bryce M Forry
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Jeremy T Gaskins
- Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, KY
| | - Keith T Sowards
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Thulasi Babitha Avula
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Adrianna Masters
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Scott R Silva
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| |
Collapse
|
2
|
Sundqvist A, Moberg L, Dickman PW, Högberg T, Borgfeldt C. Time Trends for Incidence and Net Survival of Cervical Cancer in Sweden 1960-2014-A Nationwide Population-Based Study. Cancer Epidemiol Biomarkers Prev 2022; 31:1572-1581. [PMID: 35654420 PMCID: PMC9344906 DOI: 10.1158/1055-9965.epi-21-1323] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim was to investigate time trends for incidence and long-term net survival in the morphologic subtypes and stages of cervical cancer in Sweden during the period 1960 to 2014. METHODS Women with invasive cervical cancer were identified through the Swedish Cancer Registry. Incidence and net survival were calculated according to morphology, age at diagnosis, and FIGO stage at diagnosis. RESULTS In total, 29,579 cases of invasive cervical cancer between 1960 and 2014 were included. The age-standardized incidence for squamous cell carcinoma (SCC) decreased until 2000; thereafter, the incidence rate stagnated, and a small increase was found in 2014. The incidence of adenocarcinoma continuously increased. The age-standardized 5-year net survival increased. However, decreasing net survival with increasing age was found. A higher stage at diagnosis showed a worse net survival. SCC and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. CONCLUSIONS Age-standardized 5-year net survival improved between 1960 and 2014. A positive trend for short- and long-term net survival was seen for women ages 18 to 64 years but long-term net survival for women ≥75 years decreased. In this study, age and FIGO stage at diagnosis were found to be important prognostic factors in determining net survival. The morphologies, SCC, and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. IMPACT This study demonstrates longitudinal data on cervical cancer in Sweden for over 50 years with sub analyses on morphology, age, and stage at diagnosis.
Collapse
Affiliation(s)
- Avalon Sundqvist
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden
| | - Louise Moberg
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Thomas Högberg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund University, Sweden
| |
Collapse
|
3
|
Luo RZ, Chen SL, Li M, Li Y, Yang X, Liu LL. HPV E6/E7 mRNA in situ hybridization in endocervical adenocarcinoma: implications for prognosis and diagnosis. Cancer Cell Int 2021; 21:643. [PMID: 34861873 PMCID: PMC8641184 DOI: 10.1186/s12935-021-02349-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background Human papillomavirus (HPV) E6/E7 mRNA in situ hybridization (HPV E6/E7 RNAscope) appears to be a sensitive and specific technique in detecting transcriptionally active HPV. We aimed to examine the diagnostic utility of this technique in endocervical adenocarcinoma (ECA), to explore the prognostic factors for ECA patients and develop a clinically useful nomogram based on clinicopathological parameters to predict it. Methods We retrospectively analyzed 200 patients with ECA who had undergone surgery at Sun Yat-sen University Cancer Center from 2010 and 2014. The diagnostic performance of HPV E6/E7 RNAscope were evaluated by receiver operating characteristic (ROC) curve. A prognostic nomogram model including HPV E6/E7 RNAscope was generated based on multivariate Cox regression analysis, then we compared the predictive accuracy of the prognostic model with FIGO staging and treatment using concordance index (C-index), time-dependent ROC (tdROC), and decision curve analysis (DCA). Results The sensitivity and specificity of HPV E6/E7 RNAscope for distinguishing HPV-associated adenocarcinoma (HPVA) from non-HPV-associated adenocarcinoma (NHPVA) in the whole cohort were 75.8% and 80%, respectively. According the univariate analysis and multivariate logistic regression analysis, age, lymphovascular invasion (LVI), lymph node involvement (LNI), and HPV E6/E7 RNAscope were valuable predictive factors for OS. These parameters were incorporated into the nomogram model (nomogram A) compared with FIGO stage and treatment. The C-index of nomogram A for predicting OS was 0.825, which was significantly higher than FIGO stage (C-index = 0.653, p = 0.002) and treatment (C-index = 0.578, p < 0.001). Conclusions HPV E6/E7 RNAscope is highly specific for ECA, and the 4-variable nomogram showed more accurate prognostic outcomes in patients with ECA. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02349-1.
Collapse
Affiliation(s)
- Rong-Zhen Luo
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Shu-Lin Chen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.,Research Center for Translational Medicine, the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Mei Li
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Yue Li
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xia Yang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Li-Li Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China.
| |
Collapse
|
4
|
Wen YL, Yan SM, Wei W, Yang X, Zhang SW, Yun JP, Liu LL, Luo RZ. Transforming acidic coiled-coil protein-3: a novel marker for differential diagnosis and prognosis prediction in endocervical adenocarcinoma. Mol Med 2021; 27:60. [PMID: 34134633 PMCID: PMC8210387 DOI: 10.1186/s10020-021-00298-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/29/2021] [Indexed: 12/25/2022] Open
Abstract
Background Endocervical adenocarcinoma (ECA) is further classified as human papillomavirus (HPV)-associated (HPVA) or non-HPVA (NHPVA), per the International Endocervical Adenocarcinoma Criteria and Classification (IECC). HPVA is a glandular tumor with stromal invasion and/or exophytic expansile-type invasion, associated with the typical molecular characteristics of high-risk HPV (HR-HPV) infection. Transforming acidic coiled-coil protein-3 (TACC3),an oncogene that is frequently abnormally expressed,represents a vital biomarker for multiple human malignancies. This study aimed to examine the role of TACC3 in the diagnosis and prognosis of ECA. Methods We analyzed 264 patients with ECA who underwent surgical resection, classifying their tumors into HPVA and NHPVA subtypes. The expression levels of TACC3, P16, MLH1, PMS2, MSH2, MSH6 and Ki-67 in tumors were evaluated by tissue microarray using immunohistochemistry (IHC). HPV subtypes were identified in formalin-fixed paraffin-embedded (FFPE) ECA tissues by the polymerase chain reaction (PCR). Results ECA samples showed increased TACC3 expression relative to adjacent non-carcinoma samples. TACC3 expression was higher in HPVA than in NHPA. In the HPVA subtype, high TACC3 expression was significantly correlated with P16-positive, Ki-67-high expression. Furthermore, TACC3 levels were significantly related to tumor histological type (P = 0.006), nerve invasion (P = 0.003), differentiation (P = 0.004), surgical margin (P = 0.012), parametrium invasion (P = 0.040), P16 expression (P < 0.001), and Ki-67 (P = 0.004). Additionally, Kaplan–Meier analysis showed that TACC3 upregulation was associated with poor overall survival (OS, P = 0.001), disease-free survival (DFS, P < 0.001), and recurrence survival (P < 0.001). Multivariate analysis indicated that elevated TACC3 expression served as a marker to independently predict ECA prognosis. ROC curve analyses indicated that TACC3, P16, and HPV subtypes showed similar utility for distinguishing HPVA from NHPVA, with areas under the ROC curves of 0.640, 0.649, and 0.675, respectively. The combination of TACC3 and HPV subtypes improved the diagnostic performance of ECA compared with TACC3, P16, and HPV subtypes alone. Conclusions Taken together, our findings identify that TACC3 is a promising complementary biomarker for diagnosis and prognosis for patients with ECA. Supplementary Information The online version contains supplementary material available at 10.1186/s10020-021-00298-z.
Collapse
Affiliation(s)
- Yan-Lin Wen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Shu-Mei Yan
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Wei Wei
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Gynecological Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xia Yang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Shi-Wen Zhang
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Jing-Ping Yun
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Li-Li Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China.
| | - Rong-Zhen Luo
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, 651# Dong Feng Road East, Guangzhou, 510060, Guangdong, China.
| |
Collapse
|
5
|
Perceptions of care after end-of-treatment among younger women with different gynecologic cancer diagnoses - a qualitative analysis of written responses submitted via a survey. BMC WOMENS HEALTH 2020; 20:276. [PMID: 33353541 PMCID: PMC7754585 DOI: 10.1186/s12905-020-01133-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/22/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Less attention has been given to younger adults' psycho-oncology care needs than to children and older adults with cancer. The aim was to explore how care following end-of-treatment was perceived by women treated for different gynecologic cancer diagnoses during younger adulthood. METHODS A sample of 207 women diagnosed with gynecologic cancer 2008 to 2016, aged 19-39 at time of diagnosis answered one open-ended question regarding important aspects of care after end-of-treatment. The written responses were analyzed with manifest content analysis and presented in relation to the women's diagnoses, i.e., cervical (n = 130), ovarian (n = 57), and other gynecologic cancer diagnoses (n = 20). RESULTS The analysis resulted in three categories: Unmet long-term supportive care needs, Satisfying long-term supportive care, and Health care organizational difficulties. Over half of the women (66.7%) described unmet care needs. The corresponding figures were 80.7, 63.1 and 50% for women diagnosed with ovarian, cervical and other gynecologic cancer diagnoses, respectively. Satisfying supportive care were described by approximately one quarter of the women (26.1%). Among women diagnosed with ovarian cancer 14% described satisfying supportive care. The corresponding figures were 26.9 and 30% for women diagnosed with cervical cancer and other gynecological diagnoses, respectively. Approximately one quarter of the women, irrespectively of diagnosis, described aspects related to health care organizational difficulties (28%). CONCLUSIONS The results highlight the importance of good quality care linked to the diagnosis and based on an understanding of the woman's need, desire and expectation of support after end-of-treatment.
Collapse
|
6
|
Silva SR, Gaskins JT, Nichols MR, Metzinger DS, Todd SL, Eldredge-Hindy HB. Cervical cancer incidence and mortality rates in Kentucky. Gynecol Oncol 2020; 158:446-451. [PMID: 32456989 DOI: 10.1016/j.ygyno.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The goal of this study was to assess how the incidence and mortality of cervical cancer in Kentucky has changed from 1995 through 2017. Additionally, trends in incidence and mortality across different geographic areas and between different races were evaluated. METHODS Age-adjusted annual incidence and mortality rates for cervical cancer were collected from the Kentucky Cancer Registry (KCR). A quadratic fit model was used to evaluate changes in the incidence and mortality over time and to compare differences in cervical cancer incidence and mortality by: 1) rural versus urban counties, 2) Appalachian versus non-Appalachian counties, and 3) black versus white women. RESULTS Overall, the incidence of cervical cancer has significantly decreased throughout Kentucky since 1995. When comparing different geographic regions, the incidence was 14% and 23% higher in rural and Appalachian counties, respectively, compared to urban and non-Appalachian counties (p < 0.0001) throughout the study period. The incidence of cervical cancer was significantly higher in black women compared to white women from 1995 through 2007, but since 2008 there has been no significant difference in cervical cancer incidence based on race. Similar to incidence rates, mortality from cervical cancer was 29% higher in Appalachia (p = 0.0004) throughout the studied time period. Black women had higher age-adjusted mortality than white women until 2012, but since that time there has not been a significant difference in cervical cancer mortality based on race. CONCLUSIONS Women residing in rural and Appalachian Kentucky have higher cervical cancer incidence and mortality rates.
Collapse
Affiliation(s)
- Scott R Silva
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, 529 S. Jackson St., Louisville, KY 40202, United States of America.
| | - Jeremy T Gaskins
- Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, 485 E. Gray St., Louisville, KY 40202, United States of America
| | - Matthew R Nichols
- Department of Gynecologic Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, 529 S. Jackson St., Louisville, KY 40202, United States of America
| | - Daniel S Metzinger
- Department of Gynecologic Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, 529 S. Jackson St., Louisville, KY 40202, United States of America
| | - Sarah L Todd
- Department of Gynecologic Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, 529 S. Jackson St., Louisville, KY 40202, United States of America
| | - Harriet B Eldredge-Hindy
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, 529 S. Jackson St., Louisville, KY 40202, United States of America
| |
Collapse
|
7
|
Xiao Y, Cheng H, Wang L, Yu X. Clinical response and safety of apatinib monotherapy in recurrent, metastatic cervical cancer after failure of chemotherapy: a retrospective study. J Gynecol Oncol 2019; 31:e2. [PMID: 31788992 PMCID: PMC6918889 DOI: 10.3802/jgo.2020.31.e2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 04/29/2019] [Accepted: 05/27/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To observe the safety and short-term efficacy of apatinib in the treatment of
recurrent, metastatic cervical cancer in patients who have already received more than
two kinds of comprehensive treatment. Methods Forty-eight patients with recurrent or metastatic cervical cancer after radiotherapy or
surgery who received apatinib between June 2016 and June 2017 were involved in this
study. These patients experienced progression after first-line or second-line
chemotherapy. There were 38 patients with cervical squamous cell carcinoma, 8 with
adenocarcinoma, and 2 with adenosquamous carcinoma. Progression-free survival (PFS),
overall survival (OS), and treatment-related adverse events (AEs) were reviewed and
evaluated. Results All patients had complete follow-up records, and the median follow-up time was 14.5
months (5.5–20.5 months). Among the 48 patients, 14.58% achieved a partial
response and 52.08% achieved stable disease. The overall response rate and disease
control rate were 14.58% and 66.67%, respectively. The median time that the 48 patients
received oral apatinib was 8.2 months. The median PFS was 4.6 months (95% confidence
interval [CI]=3.31–5.26) and OS was 13.9 months (95% CI=8.37–17.96). The
main apatinib-related adverse reactions were leukopenia (37.5%), neutropenia (41.67%),
hemorrhage (37.5%), hypertension (33.33%), proteinuria (12.5%), fatigue (37.5%), and
hand-foot syndrome (27.08%). Most of them were grade 1–2, and no drug-related
death occurred. Conclusions Apatinib can improve the disease control rate of recurrent and metastatic cervical
cancer when chemotherapy has failed, and the treatment is well tolerated. This
represents that apatinib may be a new treatment option for metastatic cervical cancer
patients.
Collapse
Affiliation(s)
- Yan Xiao
- Department of Gynecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Huijun Cheng
- Department of Gynecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China.
| | - Li Wang
- Department of Gynecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Xiao Yu
- Department of Gynecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| |
Collapse
|
8
|
Kim M, Lee H, Kiang P, Aronowitz T, Sheldon LK, Shi L, Kim S, Allison J. HPV Vaccination and Korean American College Women: Cultural Factors, Knowledge, and Attitudes in Cervical Cancer Prevention. J Community Health 2019; 44:646-655. [PMID: 30863974 DOI: 10.1007/s10900-019-00634-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Human papillomavirus (HPV) is the most prevalent sexually transmitted infection that leads to nearly all cervical cancers in the United States (U.S.), which could be prevented with the HPV vaccine. Korean American women experience a high burden of cervical cancer, but little is known about their awareness, knowledge, attitudes, sociocultural factors and social network/support related to intention to obtain the HPV vaccine. This study reports baseline characteristics of 104 Korean American college women aged 18-26 and who have not been previously vaccinated against HPV, as part of a pilot randomized controlled trial testing feasibility, acceptability, and preliminary effectiveness of an HPV storytelling intervention. Data were analyzed including descriptive statistics, bivariate analysis, and multivariate logistic regression. Multivariate logistic regression was performed to understand the relationship between independent predictors of intention to receive HPV vaccination. Overall, 34.6% of participants intended to obtain the vaccine. Positive predictors of intention to receive HPV vaccine were: years in the U.S., academic major, awareness of HPV and HPV vaccine, knowledge, and HPV recommendation by healthcare provider and parents. The multivariate logistic model showed that intention to receive the HPV vaccine was significantly associated with HPV vaccine recommendation by parents (OR 4.58, 95% CI 1.37-15.36) and knowledge (OR 1.11, 95% CI 1.11-1.22). These findings suggest a need for development of interventions that are not only culturally tailored but also acculturation-sensitive to promote HPV vaccination among Korean American college women. This may play a significant role in cervical cancer prevention among Korean American college women.
Collapse
Affiliation(s)
- Minjin Kim
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Haeok Lee
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125-3393, USA
| | - Peter Kiang
- School for Global Inclusion and Social Development, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125-3393, USA
| | - Teri Aronowitz
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125-3393, USA
| | | | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125-3393, USA
| | - Sun Kim
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125-3393, USA
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| |
Collapse
|
9
|
Bonin L, Devouassoux-Shisheboran M, Golfier F. Clinicopathological characteristics of patients with mucinous adenocarcinoma of the uterine cervix: A retrospective study of 21 cases. J Gynecol Obstet Hum Reprod 2019; 48:319-327. [PMID: 30807852 DOI: 10.1016/j.jogoh.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/28/2019] [Accepted: 02/19/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Few studies in the literature take into account the WHO's 2014 redefinition of the characteristics of mucinous adenocarcinoma of the uterine cervix. Our objective was to describe the characteristics of a group of these patients. MATERIAL AND METHODS This was a retrospective descriptive study of patients diagnosed between 1 January 2005 and 31 May 2016 in three hospitals in Lyon, France. All the cases of cervical adenocarcinoma were reanalysed by an expert in gynaecological pathology to retain the mucinous subtypes as defined in the 2014 WHO classification. We analysed their clinical and pathological characteristics. RESULTS Among the 82 cases of cervical adenocarcinoma, 21 (26%) were diagnosed as mucinous. Ten were gastric type, of which four were in the extremely well differentiated form of minimal deviation adenocarcinomas, six were intestinal type, two were signet-ring cell type, and three were not otherwise specified. The patients' mean age was 42 years and 18 patients were premenopausal. The revealing symptom was metrorrhagia in eight cases (38%) and mucinous vaginal discharge in four (19%). Fifteen (72%) of the cervical smear were abnormal. Five (31%) of the 16 patients with gastric or intestinal type adenocarcinoma had a specific radiological presentation: multiple cysts of the uterine isthmus, visible on ultrasound and with T2 hyperintensity on MRI. CONCLUSION Mucinous adenocarcinoma is a rare form of cervical cancer that can be confused with other pathological types. It can be detected using cervical smears and should be suspected in cases of mucinous discharge and characteristic MRI features.
Collapse
Affiliation(s)
- Lucie Bonin
- Department of Gynaecological Surgery and Oncology, Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France.
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - François Golfier
- Department of Gynaecological Surgery and Oncology, Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 165 chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| |
Collapse
|
10
|
Sheu J, Palileo A, Chen MY, Hoepner L, Abulafia O, Kanis MJ, Lee YC. Hospice utilization in advanced cervical malignancies: An analysis of the National Inpatient Sample. Gynecol Oncol 2018; 152:594-598. [PMID: 30587442 DOI: 10.1016/j.ygyno.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/27/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hospice services improve quality of life and outcomes for patients and caretakers, compared to inpatient mortality. This study identifies factors that exert the strongest influence on end-of-life care modalities in patients with cervical cancer. METHODS Admissions with a diagnosis of cervical cancer that were discharged to hospice or died in-hospital were identified in the National Inpatient Sample years 2007-2011, excluding admissions coded for hysterectomy. Logistic regression models were used to examine differences in age, race, length of stay, primary payer, hospital region, admission type, hospital bedsize, hospital teaching status, income quartile, and Elixhauser comorbidity index score between the groups. RESULTS 2073 admissions with a diagnosis of cervical cancer resulting in hospice discharge (n = 1290) or inpatient death (n = 783) were identified. Age (P = 0.01), hospital region (P = 0.01), length of hospitalization (P < 0.01), Elixhauser comorbidity index score (P = 0.03), and urban vs. rural location (P = 0.01) had a significant impact on disposition in univariate analysis. Admissions of patients categorized as Asian/Pacific Islander (OR = 2.24, 95% CI 1.11-4.49), hospitalizations lasting 0-3 days (OR = 1.57, 95% CI 1.21-2.03), and admissions in rural areas (OR = 1.62, 95% CI 1.12-2.36) had higher rates of in-hospital death compared to the reference groups. Patients aged 18-45 years (OR = 0.69, 95% CI 0.52-0.90) and those treated in the South (OR 0.59, 95% CI 0.45-0.77) and West (OR = 0.50, 95% CI 0.30-0.81) had lower odds ratios of inpatient mortality. CONCLUSION Modalities of care in terminal cervical cancer vary among sociodemographic and clinical factors. This data underscores the continued push for improved end-of-life care among cervical cancer patients and can guide clinicians in appropriate targeted counseling to increase utilization of hospice resources.
Collapse
Affiliation(s)
- Joanne Sheu
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States of America.
| | - Albert Palileo
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States of America
| | - Michael Y Chen
- College of Medicine, SUNY Downstate Medical Center, United States of America
| | - Lori Hoepner
- School of Public Health, SUNY Downstate Medical Center, United States of America
| | - Ovadia Abulafia
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States of America
| | - Margaux J Kanis
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States of America
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States of America
| |
Collapse
|
11
|
Wang J. Analysis of the application values of different combination schemes of liquid-based cytology and high-risk human papilloma virus test in the screening of high-grade cervical lesions. ACTA ACUST UNITED AC 2018; 52:e7517. [PMID: 30484489 PMCID: PMC6262752 DOI: 10.1590/1414-431x20187517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/23/2018] [Indexed: 11/22/2022]
Abstract
The aim of this study was to explore the value of different combination schemes of liquid-based cytology (LBC) and high-risk human papilloma virus (HPV) test in the screening of high-grade (≥CIN 2) cervical lesions. From 5727 women who had undergone examinations with LBC and high-risk HPV test, 1884 patients with positive results of either or both LBC and HPV test were included in this study and underwent cervical biopsy. Based on the pathological examination results, comparisons of the assessment indicators of all diagnostic tests were made, and the application values of LBC and high-risk HPV test and different combination schemes of the two in the screening of high-grade (≥CIN II) cervical lesions were estimated. Compared with the single test method, the sensitivity and negative predictive value of the combination scheme of LBC+HPV (with one positive result) were increased significantly (98.7% and 99.7%), but the specificity (60.8%) and accuracy rate (65.4%) dropped significantly (P<0.05). The sensitivity of LBC+HPV (with two positive results) was the lowest (80.7%), but the specificity and accuracy rate were the highest (83.5% and 83.1%, P<0.05). Z test showed that differences in the screening efficiency of four schemes were not statistically significant (P>0.05). Both LBC and HPV test were effective methods in the screening of high-grade cervical lesions; combination of the two tests did not improve the screening efficiency, but the scheme of LBC+HPV (with two positive results) significantly increased the sensitivity and negative predictive value, which was of better cost-benefit value.
Collapse
Affiliation(s)
- Jian Wang
- Department of Obstetrics and Gynecology, Institution Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
| |
Collapse
|
12
|
Shin JY, Choi KS, Suh M, Park B, Jun JK. Comparison of cervical cancer screening among women with and without hysterectomies: a nationwide population-based study in Korea. BMC Cancer 2018; 18:810. [PMID: 30098592 PMCID: PMC6087535 DOI: 10.1186/s12885-018-4723-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer screening is not recommended for women who underwent hysterectomy with no history of cervical intraepithelial neoplasia (CIN) of grade 2 or higher. We aimed to determine the cervical cancer screening rate in Korean women who underwent hysterectomies and compare it to that in women with intact uteri. METHODS We used data from the 2014-2016 Korean National Cancer Screening Survey; 6807 women aged 30-74 years were included in the study. Participants were asked about their experiences with cervical cancer screening, hysterectomy status, and other variables associated with cancer screening. RESULTS The screening rates among women who have undergone a hysterectomy vs. those who have not during the past 2 years were 61.8% (95% confidence interval [CI], 58.8-64.9) and 64.7% (95% CI, 64.1-65.3), respectively. Among younger women (30-44 years) and women with a family history of cancer, those with hysterectomies showed a higher cervical cancer screening rate than those without (77.8% vs. 57.1% and 75.0% vs. 67.1%, respectively). CONCLUSIONS Despite available evidence and clinical recommendations, a considerable number of Korean women who no longer have a cervix continue to undergo unnecessary cervical cancer screening. It is necessary to identify the exact underlying causes for this phenomenon, and systematic efforts are required to prevent unnecessary screening for women who have undergone a hysterectomy.
Collapse
Affiliation(s)
- Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, 41944 Republic of Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
- Department of Medicine, College of Medicine, Hanyang University, Seoul, 04763 Republic of Korea
| | - Jae Kwan Jun
- Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
| |
Collapse
|
13
|
Pattern of Care, Health Care Disparities, and Their Impact on Survival Outcomes in Stage IVB Cervical Cancer: A Nationwide Retrospective Cohort Study. Int J Gynecol Cancer 2018; 28:1003-1012. [PMID: 29757872 DOI: 10.1097/igc.0000000000001264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although locally advanced cervical cancer can be cured, patients with stage IVB disease have poor prognosis with limited treatment options. Our aim was to describe the pattern of care and analyze health disparity variables that may account for differences in treatment modalities and survival in this population. METHODS The National Cancer Database was queried for patients diagnosed between 2004 and 2013 with metastatic squamous cell carcinoma or adenocarcinoma of the cervix. Codes representing parenchymal and lymphatic metastasis (beyond the para-aortic radiation fields) were used to identify the cohort. Variables included age, race, insurance status, comorbidity, treatment modality, and outcomes. We used Kaplan-Meier methods to compare survival curves and Cox proportional hazards to estimate the association between variables and overall survival (OS). Log-rank method was used to compare Kaplan-Meier curves. RESULTS There were 4576 patients identified. The majority was white (59.7%); 19.5% were Hispanic, and 9.6% were black. Fifty-one percent had Medicare/Medicaid; 33.7% had private, and 12.5% had no insurance. The majority (56.3%) received chemotherapy (CMT) alone or in combination with radiation therapy (RT) and/or surgery. Median follow-up was 7.3 months (0-124.8 months). Median OS was 11.5 months (10.5-12.5 months). Higher probability of receiving CMT and RT was associated with having private insurance (P < 0.001). Significant prognostic values positively affecting survival on multivariate analysis included black and Asian race, private insurance, comorbidity index of 0, metastatic site at initial presentation (lung), and treatment modality. Patients treated with CMT + RT with or without surgery had significantly better median OS (12 months) compared with those treated with CMT alone (8.3 months), RT alone (4.8 months), or those untreated (2.3 months) (P < 0.001). CONCLUSIONS Insurance status influences treatment options in patients with distant metastatic cervical cancer. Race, comorbidity index, metastatic site, and suboptimal treatment appear to affect survival outcomes. Regardless of treatment, survival was extremely limited.
Collapse
|
14
|
Yang DX, Soulos PR, Davis B, Gross CP, Yu JB. Impact of Widespread Cervical Cancer Screening: Number of Cancers Prevented and Changes in Race-specific Incidence. Am J Clin Oncol 2018; 41:289-294. [PMID: 26808257 PMCID: PMC4958036 DOI: 10.1097/coc.0000000000000264] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES With recent approval of standalone HPV testing and increasing uptake of HPV vaccination, some have postulated that we are moving toward a "post-Pap" era of cervical cancer prevention. However, the total number cases that have been prevented by Pap smear screening as well as its impact on racial disparities are unknown. METHODS We estimated national cervical cancer incidence from 1976 to 2009 using the Surveillance, Epidemiology, and End Result database. Screening data were obtained from the literature and National Cancer Institute Progress Reports. We examined early, late, and race-specific trends in cancer incidence, and calculated the estimated number of cancers prevented over the past 3 decades. RESULTS From 1976 to 2009, there was a significant decrease in the incidence of early-stage cervical cancer, from 9.8 to 4.9 cases per 100,000 women (P<0.001). Late-stage disease incidence also decreased, from 5.3 to 3.7 cases per 100,000 women (P<0.001). The incidence among black women decreased from 26.9 to 9.7 cases per 100,000 women (P<0.001), a greater decline compared with that of white women and women of other races. After adjusting for "prescreening era" rates of cervical cancer, we estimate that Pap smears were associated with a reduction of between 105,000 and 492,000 cases of cervical cancer over the past 3 decades in the United States. CONCLUSIONS A large number of early-stage and late-stage cervical cancers were prevented and racial disparity in cancer rates were reduced during an era of widespread Pap smear screening.
Collapse
Affiliation(s)
- Daniel X. Yang
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Pamela R. Soulos
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Brigette Davis
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Cary P. Gross
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - James B. Yu
- Yale University School of Medicine, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| |
Collapse
|
15
|
Abstract
ObjectiveThe aim of this study was to evaluate nationwide gynecological cancer trends in Turkey.MethodsNational cancer registry data (2009–2013) of Turkish Ministry of Health were evaluated. Ovarian, cervical, endometrial, vulvar, vaginal, and tubal cancers are evaluated with respect to age of diagnosis, incidence rates within years, stage, histological distributions, and mortality rates. Data were collected from active cancer registry centers, which increased from 23% in 2009 to 47.5% coverage of the whole population by 2012, and mortality data (2010–2015) were obtained from the Turkish Statistical Institute.ResultsA total of 16,023 gynecological cancers were evaluated among 116,940 female patients with cancer (13.7%). Average incidence for gynecological cancers was 22.7 of 100,000, representing 8437 total new cases annually. Incidence changes within time were not statistically significant, when evaluated for each tumor type. Estimated risk of gynecological cancer development before the age of 80 years was 3.08% (95% confidence interval, 3.07–3.09). The most common gynecological cancers were uterine corpus cancers, which were followed by ovarian and cervical carcinomas. Ovarian and uterine cancer incidences were closer to European levels rather than Asian countries, whereas cervical cancer incidence was extremely low. Gynecological cancers constituted an important fraction of cancer-related mortality in women by comprising approximately 10.35% of cancer-related deaths. Mortality rates due to gynecological cancers did not show a statistically significant increase within years.ConclusionsThis is the first national cancer registry report to be published for gynecological cancers by the Turkish Governmental Department. As a result, Turkish gynecological cancer epidemiological data were consistent with the data obtained from European and developed countries rather than Asian countries, except for cervical cancer incidence, which is extremely low.
Collapse
|
16
|
HPV Vaccination: Are We Meeting Our Targets in Cervical Cancer Prevention? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0216-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
17
|
Wang J, Bai Z, Wang Z, Yu C. Comparison of Secular Trends in Cervical Cancer Mortality in China and the United States: An Age-Period-Cohort Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111148. [PMID: 27869688 PMCID: PMC5129358 DOI: 10.3390/ijerph13111148] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/09/2016] [Accepted: 11/14/2016] [Indexed: 11/16/2022]
Abstract
Background: As one of the most common cancers in the female population, cervical cancer has ranked as the second most incident gynecological cancer in recent years, trailing only breast cancer. We aimed to assess and compare the secular trends in cervical cancer mortality in China and the United States and analyze the independent effects of chronological age, time period and birth cohort using age-period-cohort (APC) analysis. Methods: We performed an age-period-cohort analysis using the intrinsic estimator method to estimate the independent effects of age, time period, and birth cohort on cervical cancer mortality. We collected mortality data for China and the United States from the WHO Mortality Database and China Health Statistical Yearbook database. Results: We examined the general trends in cervical mortality rates in China and the United States during the periods 1988-2012 and 1953-2012, respectively. The age-standardized mortality rates (ASMRs) for cervical cancer in urban China, rural China and the U.S. showed a general decreasing trend during the observation period, except for urban China, which experienced a significant increase beginning in 2002. The mortality rates for cervical cancer in the three areas showed a general increasing trend with age, regardless of the period effect. Period effects declined steadily in both rural China (from 0.19 to -0.26) and the U.S. (from -0.20 to -0.43); however, a slight increasing trend was identified (from -0.25 to 0.33) in urban China, which indicated that the risk of mortality increased with time. Cohort effects peaked in the cohort born in 1911-1915 in both rural China and urban China, declined consistently in the cohort born before 1950, and then decreased again in the cohort born after 1976-1980. The cohort effect in the U.S. peaked in the birth cohort born in 1876-1880, then leveled off and slightly decreased in younger generations. Conclusions: Our study showed that in general, cervical cancer mortality rates increased with age and decreased with birth cohort in the U.S., while the risk of mortality was highest in the cohort born during 1946-1975 in urban China. Additionally, the risk of mortality consistently increased with age in women younger than 64 years old in urban and rural China and began to decline in older groups. Although the age and cohort effects were relatively strong, the period effect may be the key factor affecting cervical cancer mortality trends, mainly reflecting the immediate effects of effective treatment and the implementation of screening.
Collapse
Affiliation(s)
- Jinyao Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Zhiqiang Bai
- College of Life Science and Technology, Huazhong Agriculture University, Wuhan 430070, China.
| | - Zhenkun Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
- Global Health Institute, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
| |
Collapse
|
18
|
Pattern classification of endocervical adenocarcinoma: reproducibility and review of criteria. Mod Pathol 2016; 29:1083-94. [PMID: 27255163 PMCID: PMC5506840 DOI: 10.1038/modpathol.2016.94] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/07/2016] [Accepted: 04/14/2016] [Indexed: 11/09/2022]
Abstract
Previously, our international team proposed a three-tiered pattern classification (Pattern Classification) system for endocervical adenocarcinoma of the usual type that correlates with nodal disease and recurrence. Pattern Classification-A tumors have well-demarcated glands lacking destructive stromal invasion or lymphovascular invasion, Pattern Classification-B tumors show localized, limited destructive invasion arising from A-type glands, and Pattern Classification-C tumors have diffuse destructive stromal invasion, significant (filling a 4 × field) confluence, or solid architecture. Twenty-four cases of Pattern Classification-A, 22 Pattern Classification-B, and 38 Pattern Classification-C from the tumor set used in the original description were chosen using the reference diagnosis originally established. One H&E slide per case was reviewed by seven gynecologic pathologists, four from the original study. Kappa statistics were prepared, and cases with discrepancies reviewed. We found a majority agreement with reference diagnosis in 81% of cases, with complete or near-complete (six of seven) agreement in 50%. Overall concordance was 74%. Overall kappa (agreement among pathologists) was 0.488 (moderate agreement). Pattern Classification-B has lowest kappa, and agreement was not improved by combining B+C. Six of seven reviewers had substantial agreement by weighted kappas (>0.6), with one reviewer accounting for the majority of cases under or overcalled by two tiers. Confluence filling a 4 × field, labyrinthine glands, or solid architecture accounted for undercalling other reference diagnosis-C cases. Missing a few individually infiltrative cells was the most common cause of undercalling reference diagnosis-B. Small foci of inflamed, loose or desmoplastic stroma lacking infiltrative tumor cells in reference diagnosis-A appeared to account for those cases up-graded to Pattern Classification-B. In summary, an overall concordance of 74% indicates that the criteria can be reproducibly applied by gynecologic pathologists. Further refinement of criteria should allow use of this powerful classification system to delineate which cervical adenocarcinomas can be safely treated conservatively.
Collapse
|
19
|
Beavis AL, Levinson KL. Preventing Cervical Cancer in the United States: Barriers and Resolutions for HPV Vaccination. Front Oncol 2016; 6:19. [PMID: 26870696 PMCID: PMC4733925 DOI: 10.3389/fonc.2016.00019] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
Human papillomavirus (HPV) vaccination rates for preadolescent and adolescent girls in the United States are far behind those of other developed nations. These rates differ substantially by region and state, socioeconomic status, and insurance status. In parents and young women, a lack of awareness and a misperception of the risk of this vaccine drive low vaccination rates. In physicians, lack of comfort with discussion of sexuality and the perception that the vaccine should be delayed to a later age contribute to low vaccination rates. Patient- and physician-targeted educational campaigns, systems-based interventions, and school-based vaccine clinics offer a variety of ways to address the barriers to HPV vaccination. A diverse and culturally appropriate approach to promoting vaccine uptake has the potential to significantly improve vaccination rates in order to reach the Healthy People 2020 goal of over 80% vaccination in adolescent girls. This article reviews the disparities in HPV vaccination rates in girls in the United States, the influences of patients’, physicians’, and parents’ attitudes on vaccine uptake, and the proposed interventions that may help the United States reach its goal for vaccine coverage.
Collapse
Affiliation(s)
- Anna Louise Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Kimberly L Levinson
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
| |
Collapse
|
20
|
Wilbur DC. Practical issues related to uterine pathology: in situ and invasive cervical glandular lesions and their benign mimics: emphasis on cytology-histology correlation and interpretive pitfalls. Mod Pathol 2016; 29 Suppl 1:S1-11. [PMID: 26715169 DOI: 10.1038/modpathol.2015.138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/16/2015] [Accepted: 11/05/2015] [Indexed: 11/09/2022]
Abstract
In situ and invasive neoplastic glandular lesions of the uterine have cytologic correlates that must be distinguished from a variety of benign and reactive conditions. Careful study of the cytologic features allows discrimination in the majority of cases; however, the designation of 'atypical glandular cells' is reserved for equivocal cases that cannot be readily resolved. In this article, the cytologic features of endocervical adenocarcinoma in situ and invasive endocervical adenocarcinoma will be presented, highlighting their correlation to the well-known histologic features. Variants of the usual type of endocervical neoplasms that have important clinical and differential diagnostic features, including mucinous adenocarcinoma and clear-cell carcinoma, will be discussed. There are a number of common cytologic mimics of endocervical neoplasms, including tubal metaplasia, directly sampled (abraded) endometrium, and high-grade squamous intraepithelial lesion involving endocervical glands. The cytologic features of these entities and their differentiation from endocervical neoplasia will be explored. Finally, the role of ancillary studies such as human papillomavirus testing in the management of glandular lesions of the cervix will be integrated into the discussion.
Collapse
Affiliation(s)
- David C Wilbur
- James Homer Wright Laboratory of Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Taras HL, Kalichman MW, Schulteis G, Dumbauld J, Bell Y, Seligman FF, West KD. Soliciting views of various communities on health research: a prelude to engagement in specific research projects. Health Expect 2015; 18:2753-63. [PMID: 25103450 PMCID: PMC4320671 DOI: 10.1111/hex.12249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Members of the public are increasingly engaged in health-service and biomedical research and provide input into the content of research, design and data sharing. As there is variation among different communities on how research is perceived, to engage all sectors of the general public research institutions need to customize their approach. OBJECTIVE This paper explores how research institutions and community leaders can partner to determine the best ways to engage different sectors of the public in research. DESIGN Following a literature review, a research institution engaged with four different sectors of the public through their respective representative community-based organizations (CBOs) by interviews with leaders, community member focus groups and a joint project. SETTING San Diego and Imperial Counties, California, United States of America (USA). CONCLUSION Before embarking on more specific research projects, investigators can gain valuable insights about different communities' attitudes to, and understanding of, health services and biomedical research by interacting directly with members of the community, collaborating with community leaders, and jointly identifying steps of engagement tailored to the community.
Collapse
Affiliation(s)
- Howard L. Taras
- Clinical & Translational Research InstituteUniversity of California‐San DiegoLa JollaCAUSA
| | | | - Gery Schulteis
- Research & DevelopmentVA San Diego Healthcare SystemDepartment of AnesthesiologyUniversity of California‐San DiegoLa JollaCAUSA
| | - Jill Dumbauld
- Clinical & Translational Research InstituteUniversity of California‐San DiegoLa JollaCAUSA
| | - Yvonne Bell
- Clinicas de Salud del Pueblo, Inc.BrawleyCAUSA
| | | | - Kathy D. West
- Epilepsy Foundation of San Diego CountySan DiegoCAUSA
| |
Collapse
|
22
|
The importance of social support for women with elevated anxiety undergoing care for gynecologic malignancies. Int J Gynecol Cancer 2015; 24:1700-8. [PMID: 25340295 DOI: 10.1097/igc.0000000000000285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to screen for depression and anxiety and to assess well-being among women diagnosed with gynecologic malignancies, identify factors associated with elevated depressive or anxiety symptoms, and further characterize the needs of those with elevated anxiety or depressive symptoms. METHODS/MATERIALS Women presenting for gynecologic cancer at an academic center during the course of 10 months were offered screening for depressive and anxiety symptoms. Patients were screened with the Primary Care Evaluation of Mental Disorders' Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7. The Functional Assessment of Cancer Therapy-General assessed well-being. Demographics, psychiatric history, and components about the cancer and treatment were collected. Those who screened positive with scores of 10 or higher on the Patient Health Questionnaire-9 or the Generalized Anxiety Disorder-7 were offered a meeting with the study psychiatrist for further evaluation both with the Structured Clinical Interview for Diagnosis as well as with an interview to discuss their experiences and to assess their desired needs. RESULTS When family and social well-being was added to the logistic regression model, higher family and social well-being was the strongest factor associated with lower amounts of anxiety (odds ratio, 0.10; P = 0.001 for a cutoff of 10; odds ratio, 0.21; P = 0.012 for a cutoff of 8). Less than 30% who screened positive met with the study psychiatrist and were not receiving optimal treatment. CONCLUSIONS Given that low family and social well-being and elevated anxiety symptoms were so highly correlated, those with anxiety symptoms would most benefit from social interventions. However, this study also found that patients with elevated depressive or anxiety symptoms were difficult to engage with a psychiatric provider. We need partnership between psychiatry and gynecology oncology to identify those with elevated depressive and anxiety symptoms and develop better ways to provide psychosocial supports.
Collapse
|
23
|
Winer I, Alvarado-Cabrero I, Hassan O, Ahmed QF, Alosh B, Bandyopadhyay S, Thomas S, Albayrak S, Talukdar S, Al-Wahab Z, Elshaikh MA, Munkarah A, Morris R, Ali-Fehmi R. The prognostic significance of histologic type in early stage cervical cancer – A multi-institutional study. Gynecol Oncol 2015; 137:474-8. [DOI: 10.1016/j.ygyno.2015.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
|
24
|
Historical trends of radiotherapy use in prevalent malignancies over 38 years in SEER. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13566-015-0182-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
25
|
RhoC mediates invasion and migration of CaSki cells through the Rho-associated serine-threonine protein kinase 1 signaling pathway. Int J Gynecol Cancer 2014; 24:184-91. [PMID: 24457551 DOI: 10.1097/igc.0000000000000053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The small GTPase RhoC in human cancers is up-regulated and correlated with tumor metastasis. However, the role of Rho/Rho-associated serine-threonine protein kinase 1 (ROCK1) signaling pathway in human cervical cancer is still unclear. In this study, we examine the effects of RhoC and its major downstream target, ROCK1, on the invasion and migration of CaSki cells to investigate the role of RhoC/ROCK1 signaling pathway in the progression of cervical squamous cell carcinoma. METHODS RhoC and ROCK1 protein expression in CaSki cells was detected by Western blotting. Scratch and transwell assays were carried out to assess the effects of RhoC on invasion and migration of CaSki cells. Cell viability was assayed by MTT test after adding the ROCK1 inhibitor Y-27632 to CaSki cells. RESULTS Overexpression of RhoC protein in CaSki cells significantly increases ROCK1 expression and promotes cell invasion and migration compared with the control group (P < 0.05). However, in the inhibition of ROCK1 with Y-27632 in CaSki cells when RhoC was overexpressed, the rate of invasiveness and migration was reduced remarkably (P < 0.05), dropping to comparable levels as the control. CONCLUSIONS This study suggested that the activation of RhoC/ROCK1 signaling pathways is likely involved in the progression of cervical squamous cell carcinoma.
Collapse
|
26
|
Tang J, Li J, Wang S, Zhang D, Wu X. On what scale does it benefit the patients if uterine arteries were preserved during ART? Gynecol Oncol 2014; 134:154-9. [DOI: 10.1016/j.ygyno.2014.04.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/18/2014] [Accepted: 04/19/2014] [Indexed: 11/15/2022]
|
27
|
Robison K, Clark L, Eng W, Wu L, Raker C, Clark M, Tejada-Berges T, Dizon DS. Cervical cancer prevention: Asian-American women's knowledge and participation in screening practices. Womens Health Issues 2014; 24:e231-6. [PMID: 24533982 DOI: 10.1016/j.whi.2013.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 11/20/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to compare cervical cancer knowledge and prevention strategy participation among Chinese-American women compared with Southeast-Asian-American women. METHODS We performed a cross-sectional survey of Chinese and Southeast Asian women in Rhode Island. Anonymous surveys were administered following informed consent. The survey included demographics and questions related to health care practices, cervical cancer, and the human papilloma virus (HPV). Categorical variables were compared by Fisher's exact test. Mean scores of correct answers on the knowledge questions were compared by Student's t-test and analysis of variance. RESULTS Ninety-six Chinese women and 132 Southeast Asian women were included in the analysis. Sixty-seven percent of Chinese women had at least a college education compared with 37% of Southeast Asian women (p < .0001). Nineteen percent of Chinese women reported annual household incomes of greater than $100,000 compared with 3% of Southeast Asian women (p = .0003). Twenty percent of Southeast Asian women did not have health insurance compared with 10% of Chinese women (p = .06). Among both groups, 25% of participants either never had a pap test or did not know if they ever had a pap test. There was a greater lack of knowledge about the relationship between HPV and cervical cancer among Chinese (mean 2.9 out of 8 questions) compared with Southeast Asian (mean 3.6 out of 8 questions; p = .02). CONCLUSIONS Regardless of ethnic subgroup, education, or income, all participants had a poor knowledge of cervical cancer and HPV. This study supports the need for improvement in cervical cancer prevention education among all Asian women.
Collapse
Affiliation(s)
- Katina Robison
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Lindsay Clark
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Whitney Eng
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lily Wu
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christina Raker
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melissa Clark
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Trevor Tejada-Berges
- Women & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Don S Dizon
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| |
Collapse
|
28
|
Treatment Patterns and Outcomes in Pregnancy-Associated Adenocarcinoma of the Cervix. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Trends in the incidence of in situ and invasive cervical cancer by age group and histological type in Korea from 1993 to 2009. PLoS One 2013; 8:e72012. [PMID: 23977194 PMCID: PMC3745377 DOI: 10.1371/journal.pone.0072012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Our study aims to describe changes in carcinoma in situ (CIS) and invasive cervical carcinoma (ICC) in Korean women diagnosed between 1993 and 2009. METHODS All cases of CIS and invasive cervical carcinoma diagnosed from 1993 to 2009 in the Korean National Cancer Incidence database were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) in incidence rates were compared according to age and histological type. Additionally, we used Korea National Health and Nutrition Examination Survey (KNHANES) to know the association between screening rate for cervical cancer and incidence rate of cervical cancer. RESULTS Between 1993 and 2009, 72,240 cases of ICC were reported in Korea. Total incidence rate of ICC was 14.7 per 100,000 females. ASRs of ICC declined 3.8% per year, from 19.3 per 100,000 in 1993 to 10.5 per 100,000 in 2009. Although the overall incidence rate of adenocarcinoma remained stable, invasive squamous cell carcinoma showed a decreasing trend (APC -4.2%). For women aged 60-79 years, ASRs for squamous cell carcinoma increased from 1993 to 2001, and decreased from 2001 to 2009 (APC: -4.6%). Total 62,300 cases of CIS were diagnosed from 1993 to 2009. Total incidence rate of CIS was 12.2 per 100,000 females. ASRs of CIS increased 5.7% per year, from 7.5 per 100,000 in 1993 to 19.0 per 100,000 in 2009. Adenocarcinoma in situ increased 13.2% per year. There was a strong positive correlation between screening rate for cervical cancer and incidence rate for CIS (p-value = 0.03) whereas screening rate showed a strong negative correlation with incidence rate for squamous ICC (p-value = 0.04). CONCLUSIONS The increasing trend in CIS, coupled with a decreasing trend in ICC, suggests the important role of cervix cancer screening. The incidence of adenocarcinoma showed a plateau, but the incidence of adenocarcinoma in situ showed an increasing trend.
Collapse
|
30
|
Tinker AV, Ellard S, Welch S, Moens F, Allo G, Tsao MS, Squire J, Tu D, Eisenhauer EA, MacKay H. Phase II study of temsirolimus (CCI-779) in women with recurrent, unresectable, locally advanced or metastatic carcinoma of the cervix. A trial of the NCIC Clinical Trials Group (NCIC CTG IND 199). Gynecol Oncol 2013; 130:269-74. [PMID: 23672928 DOI: 10.1016/j.ygyno.2013.05.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/03/2013] [Accepted: 05/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE HPV infection has been associated with deregulation of the PI3K-Akt-mTOR pathway in invasive cervical carcinomas. This 2-stage phase II study assessed the activity of the mTOR inhibitor, temsirolimus, in patients with measurable metastatic and/or locally advanced, recurrent carcinoma of the cervix. METHODS Temsirolimus 25mg i.v. was administered weekly in 4 week cycles. One response among the first 18 patients was required to proceed to the second stage of accrual. Correlative molecular studies were performed on archival tumor tissue. RESULTS Thirty-eight patients were enrolled. Thirty-seven patients were evaluable for toxicity and 33 for response. One patient experienced a partial response (3.0%). Nineteen patients had stable disease (57.6%) [median duration 6.5 months (range 2.4-12.0mo)]. The 6-month progression free survival rate was 28% (95% CI: 14-43%). The median progression free survival was 3.52 months [95% CI (1.81-4.70)]. Adverse effects were mild-moderate in most cases and similar to other temsirolimus studies. No toxicity>grade 3 was observed. Assessment of PTEN and PIK3CA by IHC, copy number analyses and PTEN promoter methylation status did not reveal subsets associated with disease stability. CONCLUSION Single agent temsirolimus has modest activity in cervical carcinoma with about two-thirds of patients exhibiting stable disease. Molecular markers for treatment benefit remain to be identified.
Collapse
Affiliation(s)
- A V Tinker
- BC Cancer Agency, Vancouver Clinic, Vancouver, BC, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Roncancio AM, Ward KK, Fernandez ME. Understanding cervical cancer screening intentions among Latinas using an expanded theory of planned behavior model. Behav Med 2013; 39:66-72. [PMID: 23930898 PMCID: PMC4895917 DOI: 10.1080/08964289.2013.799452] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We examined the utility of an expanded theory of planned behavior (TPB) model in predicting cervical cancer screening intentions among Latinas. The model included acculturation and past cervical cancer screening behavior along with attitude, subjective norms, and perceived behavioral control. This cross-sectional study included a sample of 206 Latinas who responded to a self-administered survey. Structural equation modeling was employed to test the expanded TPB model. Acculturation (p = .025) and past screening behavior (p = .001) along with attitude (p = .019), subjective norms (p = .028), and perceived behavioral control (p = .014) predicted the intention to be screened for cervical cancer. Our findings suggest that the TPB is a useful model for understanding cervical cancer screening intentions among Latinas when both past behavior and culture are included. This research highlights the importance of culture on behavior and indicates a need to develop culturally sensitive, theory-based interventions to encourage screening and reduce cervical cancer-related health disparities in Latinas.
Collapse
Affiliation(s)
- Angelica M. Roncancio
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX
| | - Kristy K. Ward
- University of California at San Diego, Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, CA
| | - Maria E. Fernandez
- The University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Houston, TX
| |
Collapse
|