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Winkler SS, Tian C, Casablanca Y, Bateman NW, Jokajtys S, Kucera CW, Tarney CM, Chan JK, Richardson MT, Kapp DS, Liao CI, Hamilton CA, Leath CA, Reddy M, Cote ML, O'Connor TD, Jones NL, Rocconi RP, Powell MA, Farley J, Shriver CD, Conrads TP, Phippen NT, Maxwell GL, Darcy KM. Racial, ethnic and country of origin disparities in aggressive endometrial cancer histologic subtypes. Gynecol Oncol 2024; 184:31-42. [PMID: 38277919 DOI: 10.1016/j.ygyno.2024.01.009] [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: 10/23/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE This study investigated the risk of an aggressive endometrial cancer (EC) diagnosis by race, ethnicity, and country of origin to further elucidate histologic disparities in non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander (API), American Indian/Alaskan Native (AIAN) vs. non-Hispanic White (NHW) patients, particularly in Hispanic or API subgroups. METHODS Patient diagnosed between 2004 and 2020 with low grade (LG)-endometrioid endometrial cancer (ECC) or an aggressive EC including grade 3 EEC, serous carcinoma, clear cell carcinoma, mixed epithelial carcinoma, or carcinosarcoma in the National Cancer Database were studied. The odds ratio (OR) and 95% confidence interval (CI) for diagnosis of an aggressive EC histology was estimated using logistic modeling. RESULTS There were 343,868 NHW, 48,897 NHB, 30,013 Hispanic, 15,015 API and 1646 AIAN patients. The OR (95% CI) for an aggressive EC diagnosis was 3.07 (3.01-3.13) for NHB, 1.08 (1.06-1.11) for Hispanic, 1.17 (1.13-1.21) for API and 1.07 (0.96-1.19) for AIAN, relative to NHW patients. Subset analyses by country of origin illustrated the diversity in the OR for an aggressive EC diagnosis among Hispanic (1.18 for Mexican to 1.87 for Dominican), Asian (1.14 Asian Indian-Pakistani to 1.48 Korean) and Pacific Islander (1.00 for Hawaiian to 1.33 for Samoan) descendants. Hispanic, API and AIAN patients were diagnosed 5-years younger that NHW patients, and the risk for an aggressive EC histology were all significantly higher than NHW patients after correcting for age. Insurance status was another independent risk factor for aggressive histology. CONCLUSIONS Risk of an aggressive EC diagnosis varied by race, ethnicity, and country of origin. NHB patients had the highest risk, followed by Dominican, South/Central American, Cuban, Korean, Thai, Vietnamese, and Filipino descendants.
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Affiliation(s)
- Stuart S Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Yovanni Casablanca
- Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Suzanne Jokajtys
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA. USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Cheng-I Liao
- Division of Obstetrics and Gynecology, Pingtung Veterans General Hospital, Pingtung, Taiwan
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Megan Reddy
- California Pacific Medical Center, San Francisco, CA, USA
| | - Michele L Cote
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Timothy D O'Connor
- Institute for Genome Sciences, Department of Medicine, Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA
| | - John Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA.
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Richardson MT, Barry D, Steinberg JR, Thirunavu V, Strom DE, Holder K, Zhang N, Turner BE, Magnani CJ, Weeks BT, Young AMP, Lu CF, Wolgemuth TR, Laasiri N, Squires NA, Anderson JN, Karlan BY, Chan JK, Kapp DS, Roque DR, Salani R. Underrepresentation of racial and ethnic minority groups in gynecologic oncology: An analysis of over 250 trials. Gynecol Oncol 2024; 181:1-7. [PMID: 38096673 DOI: 10.1016/j.ygyno.2023.12.001] [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: 10/16/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials. METHODS Gynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data. RESULTS 2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013-2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years - REMGs made up 19.6% of trial participants in 2007-2009 compared to 38.1% in 2016-2018 (p < 0.0001). CONCLUSION Less than half of trials that published results reported race/ethnicity data. Available data reveals that enrollment of REMGs is significantly below expected rates based on national census data. These disparities persisted even after additionally adjusting for population size. Despite improvement in recent years, additional recruitment of REMGs is needed to achieve more representative and equitable participation in gynecologic cancer clinical trials.
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Affiliation(s)
- Michael T Richardson
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Danika Barry
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Jecca R Steinberg
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Vineeth Thirunavu
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Danielle E Strom
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Kai Holder
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Naixin Zhang
- Division of Gynecologic Oncology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Brandon E Turner
- Harvard Radiation Oncology Program, Boston, MA, United States of America
| | - Christopher J Magnani
- Division of Urological Surgery, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Brannon T Weeks
- Brigham and Women's Hospital/Massachusetts General Hospital Integrated Residency Program in Obstetrics and Gynecology, Boston, MA, United States of America
| | - Anna Marie P Young
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Connie F Lu
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Tierney R Wolgemuth
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Nora Laasiri
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Natalie A Squires
- Department of Obstetrics and Gynecology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, United States of America
| | - Jill N Anderson
- Department of Obstetrics and Gynecology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, United States of America
| | - Beth Y Karlan
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - John K Chan
- California Pacific / Palo Alto Medical Foundation / Sutter Research Institute, San Francisco, CA, United States of America
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Dario R Roque
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ritu Salani
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America.
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Fitch KC, Nguyen CGT, Vasquez Guzman CE, Holmes RS, Bruegl AS. Persistent cervical cancer disparities among American Indian/Alaska Native women: a systematic scoping review exploring the state of the science in this population. Cancer Causes Control 2024; 35:193-201. [PMID: 37783893 DOI: 10.1007/s10552-023-01799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE American Indian/Alaska Native (AI/AN) populations experience significantly higher incidence and mortality rates of cervical cancer. The objective of this systematic scoping review is to characterize the volume and nature of research being conducted specific to the AI/AN population regarding cervical cancer and related clinical themes. METHODS This scoping review was conducted in collaboration with the Pacific Northwest Evidence-based Practice Center. Search strategies identified eligible publications from 1990 through 4 February 2022. Two reviewers independently abstracted study data, including clinical area, number of participants and percent inclusion of AI/AN, intervention or risk factor, outcomes reported, Indian Health Service (IHS) Region, and funding source. We used published algorithms to assess study design. RESULTS Database searches identified 300 unique citations. After full-text evaluation of 129 articles, 78 studies and 9 secondary publications were included (total of 87). Approximately 74% of studies were observational in design, with cross-sectional methodology accounting for 42.7% of all included studies. The most common clinical theme was cervical cancer screening. The most common intervention/exposure was risk factor, typically race (AI/AN compared with other groups) (69%). For studies with documented funding sources, 67% were funded by the US Government. CONCLUSION Of the small number of publications identified, the majority are funded through government agencies, are descriptive and/or cross-sectional studies that are hypothesis generating in nature, and fail to represent the diversity of the AI/AN populations in the US. This systematic scoping review highlights the paucity of rigorous research being conducted in a population suffering from a greater burden of disease.
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Affiliation(s)
- Katherine C Fitch
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd, L466, Portland, OR, 97239, USA.
| | - Christine G T Nguyen
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd, L466, Portland, OR, 97239, USA
| | | | - Rebecca S Holmes
- Department of Family Medicine, Oregon Health & Sciences University, Portland, OR, USA
| | - Amanda S Bruegl
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd, L466, Portland, OR, 97239, USA
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Gartner DR, Maples C, Nash M, Howard-Bobiwash H. Misracialization of Indigenous people in population health and mortality studies: a scoping review to establish promising practices. Epidemiol Rev 2023; 45:63-81. [PMID: 37022309 DOI: 10.1093/epirev/mxad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Indigenous people are often misracialized as other racial or ethnic identities in population health research. This misclassification leads to underestimation of Indigenous-specific mortality and health metrics, and subsequently, inadequate resource allocation. In recognition of this problem, investigators around the world have devised analytic methods to address racial misclassification of Indigenous people. We carried out a scoping review based on searches in PubMed, Web of Science, and the Native Health Database for empirical studies published after 2000 that include Indigenous-specific estimates of health or mortality and that take analytic steps to rectify racial misclassification of Indigenous people. We then considered the weaknesses and strengths of implemented analytic approaches, with a focus on methods used in the US context. To do this, we extracted information from 97 articles and compared the analytic approaches used. The most common approach to address Indigenous misclassification is to use data linkage; other methods include geographic restriction to areas where misclassification is less common, exclusion of some subgroups, imputation, aggregation, and electronic health record abstraction. We identified 4 primary limitations of these approaches: (1) combining data sources that use inconsistent processes and/or sources of race and ethnicity information; (2) conflating race, ethnicity, and nationality; (3) applying insufficient algorithms to bridge, impute, or link race and ethnicity information; and (4) assuming the hyperlocality of Indigenous people. Although there is no perfect solution to the issue of Indigenous misclassification in population-based studies, a review of this literature provided information on promising practices to consider.
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Affiliation(s)
- Danielle R Gartner
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Ceco Maples
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Madeline Nash
- Department of Sociology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Heather Howard-Bobiwash
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
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Sherman BM, Islam JY, Gartner DR. Regional Variation in HPV Knowledge and Awareness among American Indians and Alaska Natives: An Analysis of the Health Information National Trends Survey, 2011-2020. Cancer Epidemiol Biomarkers Prev 2023; 32:1625-1634. [PMID: 37606643 DOI: 10.1158/1055-9965.epi-23-0547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/24/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND American Indian and Alaskan Native (AIAN) people experience a disproportionately high incidence of human papillomavirus (HPV)-related cancers and mortality, and these rates vary across geographic regions. To address the unexplained regional differences among AIAN people, we describe regional variations and sociodemographic correlates of HPV-related knowledge and HPV vaccination awareness indicators. METHODS A cross-sectional study was implemented with data for 866 AIAN respondents pooled from eight cycles of the Health Information National Trends Survey. We used χ2 tests to determine whether there were regional differences in the indicators and then used multivariable, modified Poisson regression to explore associations between sociodemographic characteristics and HPV-related knowledge and vaccination awareness measures. RESULTS Of the 13 indicators, just one demonstrated regional variation. However, we observed a high level of uncertainty regarding HPV and HPV vaccine-related knowledge and experience. We also observed that women were more likely than men to have heard of HPV [adjusted prevalence ratio (aPR), 1.29; 95% confidence interval (CI):1.03-1.63], the HPV vaccine (aPR, 1.59; 95% CI: 1.15-2.22), and to have discussed it with their providers (aPR, 3.69; 95% CI: 1.47-9.28). There were also differences by age, education, and insurance status. CONCLUSIONS High levels of uncertainty and lack of regional variation in indicators suggest that there may be missed opportunities across Indian Country for engagement between health care providers and AIAN in HPV-related conversations. IMPACT Efforts toward improving HPV knowledge and vaccination should target all at-risk sexes (and genders), age groups, and education levels. Moreover, AIAN-serving health care providers should be empowered with sufficient understanding, so they are prepared for discussions with at-risk patients.
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Affiliation(s)
- Bendu M Sherman
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Jessica Y Islam
- Center for Immunization and Infection Research in Cancer, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Danielle R Gartner
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
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Gartner DR, Islam JY, Margerison CE. Medicaid expansions and differences in guideline-adherent cervical cancer screening between American Indian and White women. Cancer Med 2023; 12:8700-8709. [PMID: 36629351 PMCID: PMC10134301 DOI: 10.1002/cam4.5593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although preventable through screening, cervical cancer incidence and mortality are higher among American Indian and Alaska Native women (AIAN) than White women. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansions may uniquely impact access and use of cervical cancer screening among AIAN women and ultimately alleviate this disparity. METHODS Using Medicaid eligible AIAN (N = 4681) and White (N = 57,661) women aged 18-64 years from the 2010-2020 Behavioral Risk Factor Surveillance System, we implemented difference-in-differences regression to estimate the association between the Medicaid expansions and guideline-adherent cervical cancer screening and health care coverage. RESULTS The Medicaid expansions were not associated with guideline-adherent cervical cancer screening (AIAN: -1 percentage point [ppt] [95% confidence interval, CI: -4, 2 ppts]; White: 3 ppts [95% CI: -0, 6 ppts]), but were associated with a 2 ppt increase (95% CI: 0, 4 ppt) in having had a pap test in the last 5 years among White women. The Medicaid expansions were also associated with increases in having a health plan (AIAN: 5 ppts [95% CI: 1, 9]; White: 11 ppts [95% CI: 7, 15]) and decreases in avoiding medical care due to costs (AIAN: -8 ppts [95% CI: -13, -2]; White: -6 ppts [95% CI: -9, -4]). CONCLUSIONS While we observed improvements in health care coverage, we did not observe changes to guideline-adherent cervical cancer screening following the ACA's Medicaid expansions. Given the disproportionate burden of cervical cancer among AIAN women, identifying ways to improve cervical cancer screening uptake and delivery should be prioritized to reduce preventable deaths.
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Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Jessica Y. Islam
- Cancer Epidemiology ProgramH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Oncologic SciencesUniversity of South FloridaTampaFloridaUSA
| | - Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
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Bruegl AS, Emerson J, Tirumala K. Persistent disparities of cervical cancer among American Indians/Alaska natives: Are we maximizing prevention tools? Gynecol Oncol 2023; 168:56-61. [PMID: 36399813 PMCID: PMC9797436 DOI: 10.1016/j.ygyno.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cervical cancer incidence and mortality disparities experienced by American Indian/Alaska Native (AI/AN) women have persisted for decades. Pap smear screening and HPV vaccination are powerful tools to prevent cervical cancer. We evaluated the utilization of these tools among AI/ANs living in the Pacific Northwest (PNW). METHODS The Indian Health Service (IHS) National Data Warehouse's Epi Data Mart was analyzed using all healthcare visits from 2010 to 2020 from IHS, Tribal, and Urban Indian clinics in the PNW. Women ages 21-64 were included and considered up-to-date on pap smears if they had either cytology within 3 years or cytology with HPV testing within 5 years of the most recent clinical encounter. HPV vaccination rates for both sexes were calculated for individuals ages 9-26. HPV vaccination was considered complete if: two vaccines were received prior to age 15 or after three vaccinations if initiated after age 15. FINDINGS Cervical cancer screening rates are below the national average of 73.5% ranging between 57.1% - 65.0%. Sub-analysis of age groups shows substantially lower rates of up-to-date pap smear screening in the 50-64 age group. HPV vaccination rates have increased over time for both sexes across all age groups. However, the current vaccination rate of 58.6% is well below the Healthy People 2030 goal of 84.3%. INTERPRETATION Cervical cancer screening and HPV vaccination are the cornerstones of cervical cancer prevention and early detection. These tools are underutilized and public health efforts can be strengthened to improve cervical cancer disparities in AI/AN women. FUNDING Author ASB: Funding for this project has been provided through the Robert Wood Johnson Foundation Harold Amos Minority Faculty Development Grant and the National Cancer Institute K08 Mentored Clinical Scientist Development Award.
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Affiliation(s)
- A S Bruegl
- Division of Gynecologic Oncology, Department of OB/Gyn, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - J Emerson
- Division of Gynecologic Oncology, Department of OB/Gyn, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - K Tirumala
- Northwest Portland Area Indian Health Board, Tribal Epidemiology Center, 2121 SW Broadway Street, Suite 300, Portland, OR 97201, United States of America
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Monk BJ, Tan DSP, Hernández Chagüi JD, Takyar J, Paskow MJ, Nunes AT, Pujade-Lauraine E. Proportions and incidence of locally advanced cervical cancer: a global systematic literature review. Int J Gynecol Cancer 2022; 32:1531-1539. [PMID: 36241221 PMCID: PMC9763192 DOI: 10.1136/ijgc-2022-003801] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Optimal treatment of cervical cancer is based on disease stage; therefore, an understanding of the global epidemiology of specific stages of locally advanced disease is needed. OBJECTIVE This systematic literature review was conducted to understand the global and region-specific proportions of patients with cervical cancer with locally advanced disease and to determine the incidence of the locally advanced disease. METHODS Systematic searches identified observational studies published in English between 2010 and June 10, 2020, reporting the proportion of patients with, and/or incidence of, locally advanced stages of cervical cancer (considered International Federation of Gynecology and Obstetrics (FIGO) IB2-IVA). Any staging criteria were considered as long as the proportion with locally advanced disease was distinguishable. For each study, the proportion of locally advanced disease among the cervical cancer population was estimated. RESULTS The 40 included studies represented 28 countries in North or South America, Asia, Europe, and Africa. Thirty-eight studies reported the proportion of locally advanced disease among populations with cervical cancer. The estimated median proportion of locally advanced disease among all cervical cancer was 37.0% (range 5.6-97.5%; IQR 25.8-52.1%); estimates were generally lowest in North America and highest in Asia. Estimated proportions of ≥50% were reported in nine studies from Asia, Europe, Brazil, and Morocco; estimates ≤25% were reported in six studies from Asia, United States, Brazil, and South Africa. Locally advanced disease was reported for 44% and 49% of women aged >70 and ≥60 years, and 5-100% of younger women with cervical cancer. A greater proportion of locally advanced disease was reported for Asian American (19%) versus White women (8%) in one United States study. Two of five studies describing the incidence of locally advanced disease reported rates of 2-4/100 000 women among different time frames. CONCLUSION This review highlights global differences in proportions of locally advanced cervical cancer, including regional variance and disparities according to patient race and age.
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Affiliation(s)
- Bradley J Monk
- Virginia G Piper Cancer Center at HonorHealth, Phoenix, Arizona, USA,Division of Gynecologic Oncology, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, Arizona, USA
| | - David S P Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore,Department of Medicine, Yong Loo Lin School of Medicine, Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | | | - Jitender Takyar
- Evidence Evaluation HEOR, Parexel International, Chandigarh, India
| | - Michael J Paskow
- Global Medical Affairs, AstraZeneca, Gaithersburg, Maryland, USA
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Enrollment of Individuals From Racial and Ethnic Minority Groups in Gynecologic Cancer Precision Oncology Trials. Obstet Gynecol 2022; 140:654-661. [PMID: 36075065 DOI: 10.1097/aog.0000000000004917] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/01/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To characterize whether enrollment patterns in precision oncology clinical trials for gynecologic cancers reflect the racial and ethnic diversity of patients with gynecologic cancers in the United States. METHODS ClinicalTrials.gov was queried to perform this cross-sectional review. We included precision oncology trials -defined as trials using molecular profiling of a tumor or the patient genome to identify targetable alterations to guide treatment-of ovarian, uterine, cervical, and vulvar cancers in the United States. National Cancer Institute Surveillance, Epidemiology, and End Results and United States Census Bureau data were used to estimate cancer burden and the expected number of trial participants by race and ethnicity for each gynecologic cancer. The ratio of actual-to-expected participants was calculated. A ratio greater than 1 signified overenrollment. A random effects meta-analysis was performed to assess the relative weights of individual trials. RESULTS We identified 493 trials, 61 of which met inclusion criteria. There were 2,573 patients enrolled in ovarian cancer trials, 1,197 in uterine cancer trials and 162 in cervical cancer trials. Non-Hispanic White women were overrepresented overall (enrollment ratio 1.26, 95% CI 1.20-1.32) and across all cancer types on subgroup analysis. Asian women, non-Hispanic Black women, and Hispanic women were underrepresented overall (enrollment ratios 0.63, 95% CI 0.41-0.86; 0.51, 95% CI 0.36-0.66 and 0.30, 95% CI 0.23-0.36, respectively). In subgroup analyses, Asian women and non-Hispanic Black women were underrepresented in ovarian and uterine cancer trials and Hispanic women were underrepresented across all cancer types. CONCLUSION Non-Hispanic Black women, Asian women, and Hispanic women with gynecologic cancers are underrepresented in precision oncology trials. Few U.S.-based precision oncology trials exist for uterine and cervical cancers, which have a high burden of morbidity and mortality among racial and ethnic minority groups. Failure to equitably enroll patients who belong to racial and ethnic minority groups may perpetuate existing disparities in gynecologic cancer outcomes.
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Kills First CC, Sutton TL, Shannon J, Brody JR, Sheppard BC. Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs. Cancer 2022; 128:1560-1567. [PMID: 35132620 PMCID: PMC10257521 DOI: 10.1002/cncr.34118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/22/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
Disparities in pancreatic cancer incidence and outcomes exist in Native American populations. These disparities are multifactorial, difficult to quantify, and are influenced by historical, socioeconomic, and health care structural factors. The objective of this article was to assess these factors and offer a call to action to overcome them. The authors reviewed published data on pancreatic cancer in Native American populations with a focus on disparities in incidence, outcomes, and research efforts. The historical context of the interactions between Native Americans and the United States health care system was also analyzed to form actionable items to build trust and collaboration. The incidence of pancreatic cancer in Native Americans is higher than that in the general US population and has the worst survival of any major racial or ethnic group. These outcomes are influenced by a patient population with often poor access to high-quality cancer care, historical trauma potentially leading to reduced care utilization, and a lack of research focused on etiologies and comorbid conditions that contribute to these disparities. A collaborative effort between nontribal and tribal leaders and cancer centers is key to addressing disparities in pancreatic cancer outcomes and research. More population-level studies are needed to better understand the incidence, etiologies, and comorbid conditions of pancreatic cancer in Native Americans. Finally, a concerted, focused effort should be undertaken between nontribal and tribal entities to increase the access of Native Americans to high-quality care for pancreatic cancer and other lethal malignancies.
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Affiliation(s)
| | | | | | - Jonathan R. Brody
- OHSU, Department of Surgery, Portland, OR, 97239
- OHSU Brenden-Colson Center for Pancreatic Care, Portland, OR, 97239
| | - Brett C. Sheppard
- OHSU, Department of Surgery, Portland, OR, 97239
- OHSU Brenden-Colson Center for Pancreatic Care, Portland, OR, 97239
- OHSU, Department of Cell, Developmental and Cancer Biology, Knight Cancer Institute, Portland, OR, 97239
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Implicit biases in healthcare: implications and future directions for gynecologic oncology. Am J Obstet Gynecol 2022; 227:1-9. [PMID: 35026128 DOI: 10.1016/j.ajog.2021.12.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/09/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022]
Abstract
Health disparities have been found among patients with gynecologic cancers, with the greatest differences arising among groups based on racial, ethnic, and socioeconomic factors. Although there may be multiple social barriers that can influence health disparities, another potential influence may stem from healthcare system factors that unconsciously perpetuate bias toward patients who are racially and socioeconomically disadvantaged. More recent research suggested that providers hold these implicit biases (automatic and unconscious attitudes) for stigmatized populations with cancer, with emerging evidence for patients with gynecologic cancer. These implicit biases may guide providers' communication and medical judgments, which, in turn, may influence the patient's satisfaction with and trust in the provider. This narrative review consolidated the current research on implicit bias in healthcare, with a specific emphasis on oncology professionals, and identified future areas of research for examining and changing implicit biases in the field of gynecologic oncology.
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12
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Song YY, Liu H, Wang S, Jiang XL. Correlates of posttraumatic growth among spouses of newly diagnosed gynecological cancer survivors: A cross-sectional study. Eur J Oncol Nurs 2021; 54:102039. [PMID: 34537537 DOI: 10.1016/j.ejon.2021.102039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Despite increasing research on posttraumatic growth (PTG) of spouses of cancer patients, and the positive effects of spouses' PTG on both spouses and patients, there is little information on PTG and its correlates among husbands of gynecological cancer survivors, especially those of newly diagnosed survivors. We aimed to assess PTG among spouses of newly diagnosed gynecological cancer survivors and to examine its correlates. METHODS In a cross-sectional study, a total of 400 spouses of newly diagnosed gynecological cancer survivors were recruited and completed questionnaires with information on general characteristics, rumination, self-disclosure, locus of control, and PTG. Univariate analysis and multiple linear regression analysis were performed. RESULTS The mean score of PTG among the spouses was 57.77 (SD = 12.03). There were significant differences in PTG among spouses with different education levels, marriage duration, number of children, per capita monthly income, other traumatic events within 6 months, and time since diagnosis groups. Pearson's correlation analysis revealed that deliberate rumination, self-disclosure, and locus of control were significantly associated with PTG. The multiple regression model revealed that 53.6% of the variance in PTG was explained by marriage duration, time since diagnosis, self-disclosure, deliberate rumination, and internality locus of control. CONCLUSIONS This study was one of the early attempts in evaluating PTG among spouses of newly diagnosed gynecological cancer survivors and identified several significant, potentially modifiable factors (self-disclosure, deliberate rumination, and internality locus of control) associated with PTG, providing an important guide for the development of effective psychosocial interventions for this population.
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Affiliation(s)
- Yuan-Yuan Song
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Song Wang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiao-Lian Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Abtahi M, Gholami S, Nashi HHJ. High dose rate 192Ir versus high dose rate 60Co brachytherapy: an overview of systematic reviews of clinical responses of gynecological cancers from 1984 to 2020. Biomed Phys Eng Express 2021; 7:055022. [DOI: https:/doi.org/10.1088/2057-1976/ac1c52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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Abtahi M, Gholami S, Jassim HH. High dose rate 192Ir versus high dose rate 60Co brachytherapy: an overview of systematic reviews of clinical responses of gynecological cancers from 1984 to 2020. Biomed Phys Eng Express 2021; 7:055022. [PMID: 34375964 DOI: 10.1088/2057-1976/ac1c52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
The Purpose. Radioisotope of192Iradium (192Ir) has a half-life (74 days) and is not easily accessible in developing countries. As a result, by the time source shipment clearance and the customs paperwork are completed, a large proportion of useful activity had already been decayed away. In fact,60Cobalt (60Co) remote afterloading systems are commercially available by many venders. As a result, it may well become an alternative source to192Ir and conform many of these challenges. The aim of this study is that to report clinical responses of different types of gynaecological cancers treated with high dose rate (HDR)192Ir and HDR60Co brachytherapy in order to check whether HDR60Co could be used as an alternative brachytherapy, source to HDR192Ir.Materials and Methods. A retrospective study of clinical responses of different types of gynaecological cancers, staged from I to IV according to recommendations of International Federation of Gynaecology and Obstetrics (FIGO), treated by brachytherapy alone, radiotherapy alone (combined brachytherapy and radiotherapy) and combined radiotherapy and chemotherapy (brachytherapy, radiotherapy and chemotherapy) between 1984 and December 2020 was conducted. The patients were treated with external beam radiotherapy 45-51 Gy boosted with HDR192Ir and HDR60Co afterloading brachytherapy of 18-30 Gy to point A.The results. The study scrutinized the data of 11086 patients with different types of gynaecological cancers. Most of the patients, 70 percent of them, were diagnosed with gynaecological cancers in stages II and III. For patients treated with192Ir brachytherapy source 5-years overall survival rate (OS), local control, 2-years, 5-years and 10-years disease free survival (DFS), complications of gastro-intestine (GI) and complications of genito-urinary (GU) were 63.5%, 92%, 72.6%, 64.07%, 43.75%, 3.9% and 5.92%, but for those treated with60Co they were 57.7%, 86.63%, 82.5%, 53.35%, 43.75%, 4.8% and 3.7%, respectively.Conclusions.The use of HDR60Co brachytherapy has the capacity to produce overall survival rate and disease control in patients with carcinoma of the gynaecology comparable to that reported for HDR192Ir brachytherapy. Currently, the toxicity and damage of the normal tissues and radiation-related second cancers are of a similar incidence to that of standard HDR192Ir brachytherapy. Source exchange frequency is not a serious concern because it requires less frequency of replacement, and commissioning can be accomplished within years; hence, replacing HDR192Ir with HDR60Co brachytherapy achieves significant cost saving. Therefore, we recommend that60Co source ought to be the first choice for low resource radiotherapy setting as it offers economic advantages over192Ir and have comparable clinical outcomes to that of192Ir source.
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Affiliation(s)
- M Abtahi
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - S Gholami
- Radiation Oncology department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - H H Jassim
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
- Najaf Health Directorate, Ministry of Health, Najaf, Iraq
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Racial-Ethnic and Socioeconomic Disparities in Guideline-Adherent Treatment for Endometrial Cancer. Obstet Gynecol 2021; 138:21-31. [PMID: 34259460 PMCID: PMC10403994 DOI: 10.1097/aog.0000000000004424] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/04/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the association of race-ethnicity and neighborhood socioeconomic status with adherence to National Comprehensive Cancer Network guidelines for endometrial carcinoma. METHODS Data are from the SEER (Surveillance, Epidemiology, and End Results) cancer registry of women diagnosed with endometrial carcinoma for the years 2006-2015. The sample included 83,883 women after inclusion and exclusion criteria were applied. Descriptive statistics, bivariate analyses, univariate, and multivariate logistic regression models were performed to evaluate the association between race-ethnicity and neighborhood socioeconomic status with adherence to treatment guidelines. RESULTS After controlling for demographic and clinical covariates, Black (odds ratio [OR] 0.89, P<.001), Latina (OR .92, P<.001), and American Indian or Alaska Native (OR 0.82, P=.034) women had lower odds of receiving adherent treatment and Asian (OR 1.14, P<.001) and Native Hawaiian or Pacific Islander (OR 1.19 P=.012) women had higher odds of receiving adherent treatment compared with White women. After controlling for covariates, there was a gradient by neighborhood socioeconomic status: women in the high-middle (OR 0.89, P<.001), middle (OR 0.84, P<.001), low-middle (OR 0.80, P<.001), and lowest (OR 0.73, P<.001) neighborhood socioeconomic status categories had lower odds of receiving adherent treatment than the those in the highest neighborhood socioeconomic status group. CONCLUSIONS Findings from this study suggest there are racial-ethnic and neighborhood socioeconomic disparities in National Comprehensive Cancer Network treatment adherence for endometrial cancer. Standard treatment therapies should not differ based on sociodemographics. Interventions are needed to ensure that equitable cancer treatment practices are available for all individuals, regardless of racial-ethnic or socioeconomic background.
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Dang JHT, Stewart SL, Blumberg DA, Rodriguez HP, Chen MS. Patient and clinician factors associated with uptake of the human papillomavirus (HPV) vaccine among adolescent patients of a primary care network. Vaccine 2021; 39:3528-3535. [PMID: 34023133 DOI: 10.1016/j.vaccine.2021.04.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination rates for adolescents remain relatively low. The purpose of this study is to examine patient and clinician factors associated with HPV vaccination among patients, ages 11-17, of a large community-based primary care network. METHODS Electronic health records and administrative data from a large primary care network from January 2017 - June 2018 for patients ages 11-17 (n = 10,682) and the 198 primary care clinicians that saw them were analyzed. Mixed effects logistic regression models examined the association of patient and clinician factors with HPV vaccine uptake. RESULTS Most patients (63.0%) had at least one dose of the HPV vaccine, and 37.7% were up to date. In adjusted analyses, patients who received the tetanus, diphtheria, and pertussis (Tdap) vaccine (OR = 2.8, 95% CI: 2.1-3.9) compared to those who did not receive the vaccine and patients with five or more medical visits (OR = 1.9, 95% CI: 1.6-2.2) had the greatest odds of being up to date with the HPV vaccine series. Compared to White patients, African American/Black (OR = 0.8, 95% CI: 0.6 - 1.0) and Alaskan Native/American Indian (OR = 0.5, 95% CI: 0.3-0.9) patients were less likely to be up to date. Boys were also less likely to be up to date with the HPV vaccine series compared to girls (OR = 0.7, 95% CI: 0.7-0.8). Additionally, patients with family/general practice primary care clinicians were less likely to have their patients up to date than those with pediatricians (OR = 0.8, 95% CI: 0.6 - 1.0). CONCLUSION HPV vaccine uptake varied by patient characteristics, heath care utilization and primary care clinician specialty. These findings may inform future evidence-based interventions aimed at increasing HPV vaccine uptake among adolescents by targeting patient sub-groups and reducing missed opportunities for vaccination.
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Affiliation(s)
- Julie H T Dang
- University of California, Davis School of Medicine, Division of Health Policy and Management, Department of Public Health Sciences, 4501 X Street, Suite 3003, Sacramento, CA 95817, USA.
| | - Susan L Stewart
- University of California, Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, 2450 48th Street, Suite 1600, Sacramento, CA 95817, USA
| | - Dean A Blumberg
- University of California, Davis Health, Department of Pediatrics, 2561 Stockton Blvd, Sacramento, CA 95817, USA
| | - Hector P Rodriguez
- University of California, Berkeley, School of Public Health, Division of Health Policy and Management, 2121 Berkeley Way #5427, Berkeley, CA 94704, USA
| | - Moon S Chen
- University of California, Davis School of Medicine, Division of Hematology and Oncology, 2540 48th Street, Suite 1600, Sacramento, CA 95817, USA
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Haozous EA, Lee J, Soto C. Urban American Indian and Alaska Native Data Sovereignty: Ethical Issues. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2021; 28:77-97. [PMID: 34586627 PMCID: PMC8877071 DOI: 10.5820/aian.2802.2021.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper examines the ethical issues underlying research with urban American Indians and Alaska Natives (AI/ANs) through the lens of tribal sovereignty. There are 574 federally recognized tribes within the United States. Each of those tribes is recognized by the federal government as having sovereign status, an important political designation that ensures that decisions impacting tribal peoples must be made after consultation with those nations. Most AI/AN people live away from their designated tribal lands, yet their sovereign rights are frequently only recognized when living on tribal lands. These urban AI/ANs are still considered citizens of their sovereign nations, yet they lack the protections afforded to those who live on tribal lands, including protections surrounding research with their tribal communities. We explore the Belmont Report and related documents and demonstrate their inadequacy in considering the cultural and ethical concerns specific to protecting urban AI/ANs. We also provide several solutions to help guide future institutional policies regarding research with urban AI/ANs that honors Indigenous data sovereignty, including consultation, partnership with community advisory boards, employment of data use agreements, and ensuring informed consent.
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Franciszek Dłuski D, Mierzyński R, Poniedziałek-Czajkowska E, Leszczyńska-Gorzelak B. Ovarian Cancer and Pregnancy-A Current Problem in Perinatal Medicine: A Comprehensive Review. Cancers (Basel) 2020; 12:E3795. [PMID: 33339178 PMCID: PMC7765590 DOI: 10.3390/cancers12123795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15-5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords "ovarian cancer", "ovarian malignancy", "adnexal masses", "ovarian tumor" and "pregnancy" was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother's decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes.
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Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Lubelskie Region, Poland; (R.M.); (E.P.-C.); (B.L.-G.)
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